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Initial Report

Korean War Unit Histories

HEADQUARTERS

MOBILE ARMY SURGICAL HOSPITAL

8076TH ARMY UNIT

14 January l95l

SUBJECT: Annual Report of Medical Department Activities, Mobile
Army Surgical Hospital, 8076th Army Unit.

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 ACTIVITIES OF THE COMMAND

The principal medical activities of this command have been; to furnish surgical and medical support to the combat division, principally in the care of non--transportable casualties so seriously wounded that further evacuation to the rear would jeopardize their recovery; to co-ordinate evacuation of all casualties, from division areas to installations in the rear, and treat slightly wounded cases who can 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 per General Orders No. 161, Hq 8th US Army, APO 343, dated 19 July 1950, under T/O&E 8-571, dated 28 October 1948, and expanded per General Orders No. 180, Hq 8th US Army Korea, APO 301, dated 24 November 1950. Due to the wide variation in the tactical situation encountered in this theatre, the missions of this unit have varied widely. This unit has been operational 152 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 one occasion and 192 on another were admitted during a 24 hour period. The greatest number of dispositions in one 24 hour period was 608. It was fortunate that the unit during its busiest time at Miryang had selected a woolen mill to set up in, for its expansion was unlimited. Storage warehouses were used as wards and as the patient load increased, new wards were opened up 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 Headquarters Section, a Professional Service and Administrative Service. The Professional Service 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 dental technician, enlisted man, was attached to the command.


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On this date a Dental Section was added to Professional Service.

This arrangement while caring for but surgical cases worked well; but as the situation changed and the mission of the hospital, in addition to being primarily surgical, become one of an evacuation hospital, minor changes were made which it is believed helped the unit to function more smoothly. The Headquarters Section and the Detachment Headquarters were consolidated thereby pooling the resources of three clerks. Four Enlisted Men were originally in the Registrar Section; two more were assigned because of the heavy patient load. An Evacuation Section consisting of one Medical Corps officer, one Medical Service Corps officer and one NCO was established as a subdivision of the Registrar Section. This provided for a smooth co-ordination of patients designated for evacuation from the Holding wards to the evacuating medium (i.e. ambulance, train and/or air).

The need for local security, which because of the tactical situation and locations in some areas rendered it impossible for other units nearby to supply local security made it necessary to add a Guard Section consisting of ten Enlisted Men. By making this a permanent section disruption of night and day personnel shifts was avoided making for a smoother functioning unit.

From 28 October 1950 through 3l December 1950, the unit moved six times. Local buildings were utilized in all instances and supplemented with tents as necessary. Because of the problem of weatherproofing, heating, and lighting these buildings, a separate Utilities Section of seven Enlisted Men was set up, which greatly facilitated housekeeping. It is believed a trained electrician and carpenter would be a definite addition and facilitate greatly the lighting and housekeeping problem encountered.

B. Equipment -- Equipment as basically supplied this unit was entirely adequate for function of the operating section and ward sections, however, when casualties were exceptionally heavy there was a shortage of oxygen flow meters, suction apparati and anesthesia machines, but as the need for this additional equipment arose it was promptly supplied through 8th Army Medical Supply channels.

The following recommendations are submitted 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 injuries in hyperextension while the patient is under general anesthesia. Two modifications of the table could be made very easily - one the addition of the Goldthwaite irons and their end pieces to the present table for the application of jackets in the hyperextended supine position and the use of a canvas strap with 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 the Goldthwaite irons. There is too much equipment available in the orthopedic line of some types and too little of other types in the field. The use of plates, screws, Lohman clamps, twist drills, etc. is of questionable value at the field levels and under field conditions but these and others are included in the field fracture and amputation sets. Coversely [sic] there is very little Kirschner wire and Steinman equipment available and in the Korean Theater up to this time there has been almost none of this available. It is felt that these should be heavily 


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stocked in the Mobile Army Surgical Hospitals. These are unquestionably emergency treatment items and are of more 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 known that wire suture material is inert in the presence of sepsis and the use of 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 repair presents itself in cases incurred under clean circumstances and recently enough to be repaired, such as one finds in mess and utility personnel of nearby units.

The 250,000 BTU gasoline space heaters as supplied to this organization have been invaluable, however much difficulty has been experienced in keeping them operational. The chief difficulty with the blower type unit heater being the frailness and lack of stability of the gasoline engines which require almost constant maintenance to keep them in adjustment and in functioning condition. These blower motors can be only regarded as gadgets rather than as functional pieces of equipment. At present this organization has converted one of these units which became so unserviceable that it is powered by an electric motor. This modification has proved much more dependable and satisfactory than the units supplied.

C. Attached Units -- This unit has always been supplied with at least one ambulance platoon and sometimes with two depending on the tactical situation.

Too much cannot be said in praise of the helicopters stationed at the hospital who brought seriously wounded patients from inaccessible areas and evacuated seriously wounded casualties from forward medical installations, thereby providing a quick, smooth comfortable evacuation from forward areas to the hospital with a minimum of shock and delay.

3. PHYSICAL AND MENTAL HEALTH OF THE COMMAND

In general, the physical and mental health of this command has been excellent, of all disease encountered in the past six months, those of infectious origin have predominated. Included below are diseases and incidence of such in this command during the past six months.

a. Infectious

Poliomyelitis -- a rapidly fatal case of bulbar polio was observed. That patient was evacuated to a hospital ship where, despite treatment in a respirator, he died six hours later.

Hepatitis -- There have been five cases at sporadic intervals. All were evacuated to Japan. Two have returned to duty.

Dysentery - Dysentery, presumably bacterial, was of moderate incidence during the summer months. All cases responded quickly to the newer antibiotic agents (aureomycin and chloramphenicol). The source of infection could not be localized, but mess, water and latrine sanitation in hospital area were definitely excluded. 


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Upper Respiratory Infections -- There have been two mild outbreaks of nasal pharyngitis, acute catarrahal, in this command. There has been no pneumonia, either viral or bacterial.

Tuberculosis -- One case of suspected TB of kidney, manifested by persistent hematuria, dysuria, and irregularity of one calyx on retrograde urography was studied and evacuated. No instance of pulmonary TB has been seen.

Venereal Disease - Gonorrhea five cases and chancroid two cases have been noted. No suspected luetic lesions have been observed.

Malaria -- There has been no malaria observed in this command. All have received by roster weekly prophylactic doses of chloroquin during the malaria season.

No Cholorea, Tetanus, protozoan, or metazoan diseases have been observed.

b. Organic Disease

One case of hypertensive cardio--vascular disease in a forty-five year old Enlisted member of the command was observed and evacuated.

c. Accidents and Injuries

Burns -- There have been three cases of burns, all due to gasoline explosions. One case of 1st and 2nd degree burns involving 10% of body surface required evacuation, others were treated on duty status.

Injuries -- Four fractures due to injuries have occurred, two of sufficient severity to require evacuation. Others were treated on duty status. There was one case of severance of radial artery with concurrent dislocation of radio-carpal joint, treated here and evacuated for physio-therapy. He has subsequently returned to duty. One nurse developed torticollis and was evacuated.

There has been no heat exhaustion or frost--bite. There have been no casualties as a result of enemy action.

d. Psychiatric Disease

Two psychiatric casualties have been evacuated from the theater with diagnoses of paranoid schizo--phrenia, and severe anxiety state, in general the mental health of this command has been excellent, and morale has remained high.

4. SANITATION

The officers, nurses and enlisted personnel have been housed in local buildings within the hospital compound when these were available. Sectional and squad tents have been used at other times. Ventilation and heating have always been good to excellent. General cleanliness of the quarters has been well maintained. During the summer months mosquito and fly control was good. DDT spraying was carried out effectively throughout the hospital area with the occasional assistance of a sanitation team from a nearby unit. The usual "fly attractive" areas such 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 with disinfectant solutions, and mess cleanliness. Rodents presented no problem. Frequent aerosol bomb spraying of the operating room was carried out during the summer months, and mosquito netting was placed so as to cover the entrance to the operating room, as well as to the patients wards. Insect repellent as well as DDT powder was available to all patients. Tissues removed at surgery, as well as old dressings were burned and buried. Water supply has at all times been within easy reach of the hospitals water truck. The hospital utilities section has made shower baths available to the unit whenever possible. Occasionally the shower points of nearby larger unite have been available. Hospital laundry has been handled very efficiently by the Quartermaster laundries of nearby divisional units. While at Miryang, their facilities were not available and local labor was hired to do the hospital laundry. The hospital supplies and equipment for necessary sanitary measures have been quite adequate.

5. INCIDENCE OF INFECTIOUS DISEASES OBSERVED IN HOSPITALIZED CASES

a. Venereal Diseases -- chancroid, gonorrhea, luetic chancre, and lympho-granuloma venereum were the most frequently observed infectious illnesses. All diagnoses were clinical, save for smears in suspected gonorrhea and chancroid, as this installation has no facilities for serological diagnosis. Whenever possible, persons with venereal disease were returned to duty, but often they had to be evacuated because their unit had left the area. Gonorrhea was treated with either 300,000 or 600,000 units of procaine penicillin with good effect. Patients with suspected primary syphillis were started on a course of procaine penicillin, 600,000 units daily x 10, and then returned to duty with instruction to report to their unit dispensary to complete the treatment. Chancroid was treated with streptomycin 0.7 gms twice a day for five days, initially, but later in the year, good results were obtained with aureomycin 2 to 4 gms daily for five to ten days. The same treatment was used in lymphogranuloma venereum.

b. Dysentery - dysentery was the next most frequent type of infectious disease. No laboratory confirmation as to type was obtained. The majority were presumed to be bacillary, and most of these responded to aureomycin or chloroimycetin therapy, usually being ready for duty in two to five days.

c. Malaria -- malaria was observed frequently in August and September. A few cases were found in December, but these occurred among members of the Philippine 10th BCT, and were thought to be acute recurrense of chronic malaria acquired before arrival in Korea. All cases beceme clinically well with chloroquin, the most frequent dosage schedule used being 1.0 gm stat, with 0.5 gms three times daily for three days thereafter.

d. Encephalitis -- Encephalitis of unknown type, but thought to be Japanese B was seen often in August and September. All had positive spinal fluid findings, usually showing 100 to 1200 cells per cu. mm., with lymphocytes and neutrophils varying in predominance from case to case. All cases were acutely and severely ill at the time of evacuation, but no patients died before leaving the unit. Only three eases of poliomyslitis were observed, two of whom expired because of respiratory failure.

e. Hepatitis - hepatitis as evidenced by icterus was seen infrequently, and all such cases were quickly evacuated for definitive therapy.

f. Respiratory Infections of various types were seen with increasing frequency during late November and December. The most serious of these were 


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pnuemonitis, of unknown type, seen most commonly among Philippine troops and Thailanders. These patients were evacuated due to the tactical situation before the results of aureomycin therapy could be evaluated. For incidence and control of infectious diseases in the command, see paragraphs three and tour.

6. OUTSTANDING CLINICAL EXPERIENCES, IMPROVEMENTS IN MEDICAL PRACTICE

This unit was located in an area where casualties were extremely heavy, and for a time we received all surgical casualties from the 2nd Infantry Division, 24th Infantry Division, 1st Cavalry Division, 5th Regiment--1st Marine Brigade, and ROK forces. In less than a two months period, three hundred (300) laporatomies were performed in this institution. About fifteen (15) ruptured uretheras, numerous injuries to extremities, chest and head were encountered. TBM [Technical Bulletin Medical, 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 points can be emphasized which can be of future help to the trained surgeon uninitiated in war surgery. For all wounds or injury other than enumerated below TBM 147 very adequately covers the basic procedures.

Intra-Abdominal Wounds

A bold, ample para median incision provides better exposure and is much less time consuming than a transverse incision and is in nearly all cases the incision of choice. The surgeon then quickly assays the amount of work to be performed. The first step should be gentle but rapid exploration of the small bowel from Treitz to cecum, with complete evisceration of the small bowel. This maneuver affords thorough inspection of the small bowel for perforations; inspection of the mesentery for bleeders, which if present are promptly secured; direct vision of all colic gutters, and easy and thorough inspection of the posterior abdomen. Intestinal perforations are marked and clamped to prevent further contamination of the abdomen, and the remainder of the abdomen surveyed. The viscera are now replaced and the survey completed and the necessary operative procedures are now performed. While it is realized that evisceration is a shocking procedure the operating time and the more thorough exploration afforded, well overweighs the disadvantages.

Severely lacerated livers were encountered accompanied in several cases by marked hemorrhage. Fibrinfoam has been the only one of the foams available at this installation. Its use in these cases has in general been disappointing. Best results have been obtained using deep mattress sutures with generous fat grafts beneath the loops to prevent the sutures from lacerating the liver substance. In several cases rather large hepatic ducts were torn by the missiles, and rather than trust entirely a Penrose drain, a latex tube of 26 F with side perforations was placed along the damaged area or actually incorporated into the bed of the furrow before securing the mattress sutures. The tube, along with the Penrose drain, was then delivered to the outside through a stab wound in the right flank. Over 350 cc of bile drainage has been obtained from these tubes in a 24 hour period.

Chest Wounds

Combined thoraco-abdominal wounds were handled in the main by aspirating the blood from the cheat by catheter and suction prior to closure of the defect in the diaphragm. The case was then handled primarily as a chest case. We were very much impressed by the very small number of wounds of the chest which 


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required open thoracotomy. The majority responded well to repeated aspirations of blood, maintenance of normal chest physiology in so far as possible, blood transfusions, oxygen and general supportive measures. When catheter drainage of the thorax with underwater seal was indicated, the use of large catheters cannot be stressed too strongly, as smaller ones tend to become blocked and require too much attention to keep them functioning properly.

Wounds of the G U Tract

Perforated urinary bladders and vesico--rectal fistulas were treated in accordance with TBM 147. There is nothing outlined in this bulletin as to the care of uretheral wounds. Approximately 15 completely ruptured urethras were observed. These were almost always associated with perineal and pelvic injuries. While it is realized that the procedure as suggested here cannot be properly evaluated until the final end results are appraised, it is believed. that difficult secondary reconstructive surgery has been minimized, in that a patent splinted channel has been maintained from the bladder through the urethral meatus in all cases. If a 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 and no further treatment was believed indicated. If, however, a catheter could not be passed the defect was explored, and a primary reconstruction was accomplished over a splinting catheter. Urinary flow was diverted from the anastomosed area by one of two methods, depending on the location of the detect. If the rupture was in the bulb or anterior, an external perineal urethrostomy was done with bladder drainage accomplished by a 26 F 5cc Foley catheter, and a No. 20 F or 22 F splint extending through the urethrostomy and out through the urethral meatus. If the lesion was proximal to the bulb, a splinting catheter was passed to the bladder, a suprapubic cystostomy accomplished, the defect repaired, and the pelvic diaphragm and perineal muscles repaired as well as possible.

Traumatic lesions of the upper G U tract included many contused kidneys lacerated kidneys, and one case in which the ureter was severed in the upper third. As with lesions of the lower tract, there was almost always coexistent pathology. In general, where possible, operative procedure was delayed and serial urinalyses were done to determine the progression or regression of the hematuria. If the hematuria decreased, and the patient was adequately supported, as one could be certain the kidney was the only organ involved, no operative intervention was attempted. Cases not responding to the treatment as outlined above, were explored, usually transperitoneally, as there was usually associated abdominal pathology. Resection of a badly shattered lower pole of one kidney was carried out in one case. Two lacerated parenchymal lesions of renal tissue 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 been preferable, but the procedure was further complicated because the subject had an intrarenal pelvis. At the same procedure three perforations of the small intestine were also repaired. Only three nephrectomies were performed during the entire period of this report.

It is regrettable that due to the rush and pressure upon this unit more detailed studies could not be carried out on these casualties. It is also unfortunate that the results of the work done here cannot be further observed. The salient points learned from this experience can only restate that which has so often been stated. Before any 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 gentleness throughout all procedures must be strictly observed.

7. PERSONNEL

This organization as any other has encountered personnel

problems. The personnel strength has been increased by General Orders 180, HQ EUSAK, and it is felt that the proper number of personnel, including medical officers, nurses and enlisted men, is now sufficient to carry out the assigned tasks of this hospital. Under T/O&E 8--571, the following breakdown of personnel is supplied: 14 Medical Corps Officers, 2 Medical Service Corps Officers, 1 Warrant Officer, l2 Army Nurse Corps Officers and 97 Enlisted Men. By issuance of General Orders 180, Hq EUSAK, the following revision was made: 15 Medical Corps Officers, 5 Medical Service Corps Officers, 17 Army Nurse Corps Officers and 121 Enlisted Men. Attached for administration, duty, rations and quarters was always an ambulance platoon from either the 567th Medical Ambulance Company (Sep) or 584th Medical Ambulance Company (Sep). This was always provided by Medical Section, EUSAK, in order that proper evacuation be accomplished.

With the constant moving up and down the peninsula, administration at times has been hindered, but on the whole, taking into consideration the difficulties of distribution and mail, breakage and occasional loss of equipment, and the shortage of AR's, SR's and other governing materials, the organization has been able to keep up its administration in a very satisfactory manner.

8. TRAINING

During the majority of the time, the personnel of the hospital have been working. Because of the steady influx of work, "on the job training" has been the source of knowledge acquired by personnel. It is believed that "doing" plus an occasional helping suggestion is the best way of learning under field conditions.

During the periods of time when the hospital was not abnormally busy, inventories, policing and improvements of all kinds were and still are generally in order.

9. SUPPLY

Supply problems experienced during the period of this report have been relatively small. During the period of time this unit was located at Miryang, Korea, all medical supplies were procured from the 6th Medical Depot in Pusan. Usually a representative of the supply section was dispatched to Pusan with a requisition to be filled and returned either by hospital or by vehicle, however, from time to time when emergencies occurred medical items were flown in by liaison plane and helicopter.

On moving North a constant flew of supplies was provided by the advance platoons of the 6th Medical Depot. The use of helicopter transport proved invaluable during periods of action resulting in large numbers of seriously wounded casualties, when as many as 100 units of whole blood were used in an 8 hour period and reserve blood supplies were depleted.

Blanket and litter exchange proved to 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 caused some concern, since no exchange has 


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been provided. The exchange of blankets at Kunu-ri during the latter part of November proved quite a problem due to the extreme cold weather requiring up to six blankets per patient, the exceptionally high census, and fact that all patients were evacuated by air. Since the supply run to Pyongyang required at least a full day, the shortage was alleviated by airlifts arranged through the 8th Army Surgeon's office.

Quartermaster, Signal, Ordnance, Engineer logistical support has been adequately provided by the 2nd Infantry Division and 24th Infantry Division, as well as the various Army technical supply units.
 

K. E. VAN BUSKIRK
Lt Colonel, MC
Commanding