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Chapter 1, Part 3

Medical Science Publication No. 4, Volume II

USE OF MEDICAL CONSULTANTS IN THE FAR EAST COMMAND*

COLONEL CHARLES L. LEEDHAM, MC

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

Colonel Hagman and I were closely associated toward the end of his tour as Surgical Consultant to the Far East Command, and the beginning of mine as Medical Consultant. He was very helpful and most cooperative. Were it not 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 into two parts, that of the functions of consultants who were an integral part of the medical service of the command, and that of the functions of consultants who visited the Far East from the United States. The activities of each of these groups overlapped considerably, since it was normally an obligation on the part of the command consultant to accompany the visiting consultant on 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 serving in his own specialty: namely, medicine, surgery, neuropsychiatry and orthopedics. The Eighth Army in Korea and the Korea Communications Zone had similar consultants.

Responsibilities of the command consultant were varied, but basically his position was that of maintaining proper staffing of hospitals and assuring the adequacy of medical care in the Far East. To do this job properly he had to cope with personnel assignment problems, particularly those concerned with a proper balance in hospital staffing and the utilization of outstanding talent.

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.


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morale. Many of the younger medical officers, who had heretofore known only the comforts of living in the United States, found themselves suddenly transplanted to a strange, alien land, facing the rigors and realities of war. The consultant found himself in the most unenviable role of father confessor to these officers, listening to all their tales of woe sympathetically, reassuring them, and frequently representing them and serving as an intermediary for them in their grievance with higher headquarters. It was my conviction that 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 always gave talks to the unit's personnel, made ward rounds and participated in the teaching clinics. In addition, one of my principal responsibilities was to organize medical meetings and clinics in the Far East. I was fortunate in being able to arrange at least one meeting a month for internists at one or another locale in the command. Many of these meetings proved highly successful and all were very well attended.

Before I continue further, I would like to interject at this point the fact that in addition to those responsibilities noted, I was required to and did function in my primary mission-consultation work. I visited many hospitals for the purpose of coping with troublesome cases. Eventually, consultations were made on each routine visit. I remember on one occasion having to fly to Korea to consult on the illness of The Prime Minister of the Republic of South Korea. On another occasion I made a quick night flight to a remote area in Japan to see a patient and decide whether or not this soldier with lower nephron nephrosis and severe uremia should be flown back to Korea, in a sort of reverse medical evacuation, to receive the benefits of the artificial kidney.

Accompanying visiting consultants from the United States on prearranged itineraries of the Far East occupied much of the busy schedule of the command consultant. These visiting consultants were men of high caliber, well known in medicine and usually teachers of some note. Many of them were university professors of international repute. The command consultant planned the itinerary for the visitor, effected the required administrative work, and literally served as an aide to the visiting medical dignitary. The command consultant considered these visits successful if the visitor were able to 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 to plan the visits so that the consultant from the United States could visit the more distant installations in the command and speak to the young, eager medical officers. Such visits were always successful from the


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

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

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

I would like, now, to discuss some of the background pertaining to the utilization of consultants. The concept of noted medical practitioners from the United States serving as short-term consultants in overseas commands was 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 purpose of improving training, morale, medical care, and also to provide valuable consultation services. During the Korean conflict, the Far East Command used consultants for the purposes I have just described and, in addition, made use of research consultants sent by the Army Medical Service Graduate School for specific purposes, usually the investigation of a particular clinical problem. Rather than describe the formal functions and utilization procedures of research consultants, I should like to portray their activities by an outline of the visits of several groups during the period of the Korean operation and my assignment as consultant in medicine.


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The Far East was visited during my tenure therein by approximately 12 clinical consultants each year, usually one a month. These consultants were generally apportioned on a fairly equal basis among the major specialties of medicine, surgery, neuropsychiatry and orthopedics. Occasionally a specialty of lesser importance to the Korean problem was included. These individuals toured the Far East on a schedule that did not permit much deviation, and kept 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 the theater, 30 days in which to visit 30 hospitals located in the principal Japanese islands and throughout Korea and Okinawa. Moreover, the medical services of the Air Force and the Navy in the Far East desired them to visit their installations. Whenever possible the Navy and Air Force hospitals were similarly visited, with at least one or two days spent making ward rounds, giving talks and conducting teaching clinics. The principal objective of the command consultant was to stimulate interest in the visit of the consultants from the United States, and get as many doctors as possible from surrounding hospitals to attend those meetings at the hospital being visited.

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

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

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


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

A number of the consultants were excellent teachers and demonstrated interest in the medical officers, their work and their problems. Others came as sight-seers and on shopping tours, indicating very soon that they were there for purely personal reasons. Through the efforts of the local consultants, however, this latter group was guided, prodded and pushed into situations where they had to perform at their assigned mission. In general, the work of these consultants was effective.

The best consultants were those who had prior Army experience and who were teachers. It is my recommendation that any plan for the future to utilize consultants overseas should include men who possess both these qualifications. The accomplishments of this program were great. The morale of our younger medical officers was markedly raised. They realized they were not forgotten. The visitors always brought back the most recent information from the United States concerning medical problems and advances in therapy and diagnosis. They proved an inspiration to our men. Those consultants who had famous names were particularly good teachers. The entire program was well worth the effort expended on it. I recommend very strongly that it be continued, not only during peacetime but also during those periods when the United States may be involved in a war. Making available to our medical officers late technics and fresh concepts that originate from civilian sources not only creates broader horizons for our officers but helps make for better morale. Conversely, the leaders in civilian medical circles gain a great deal by becoming aware of the problems and accomplishments of medico-military men. They were given an indication of the difficulties concurrent with the practice of field medicine in some of the most backward areas of the world. A rapport and understanding were created between Army medical officers and notables representing civilian medical institutions that provided, in my opinion, a most fruitful relationship. Since my return from the Far East I can add that in my own case, because of this rapport and understanding, problems that were not immediately resolvable were resolved. As a result of their Far East tours of our medical facilities, these consultants have a greater knowledge of the Army and its problems, and are thus helping us immeasurably to maintain the highest standards of medical care.

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


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to make use of the experience and the talent of the research consultant by having him talk with clinicians. We were particularly fortunate in this regard in getting all such consultants to talk with our men at Tokyo Army Hospital. Since there were four other Army hospitals and one Army convalescent hospital in the Tokyo area, and inasmuch as all consultants were required to clear through Tokyo before further travel through the command, I was frequently successful in getting the research consultant to visit one or more of these hospitals, and occasionally overnight to one of our lesser known facilities. The command consultant soon learned to use ingenuity that he did not believe he possessed to accomplish his ends. He was able to 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 primarily surgical in nature, there was little for the medical consultant to do concerning them. There was usually one, never more than two, internists assigned to a MASH. These medical officers were usually C-3139's, and were used principally for preoperative and postoperative care. In this type of work they proved highly effective. During a lull in the fighting, the MASH units frequently did station-hospital-type work. It was then that the internist came into his 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 these hospitals. At each hospital I would normally make a clinical talk and show a film. Rarely did I stay longer than a half-day. Nevertheless I always left with a great lift, with a feeling that here the Medical Service was accomplishing 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 field installations of the Army. The number of lives and limbs saved because of the MASH's special location and function cannot be comprehended unless one could see such a unit during a military operation when the flow of wounded was heavy. Many a veteran now living owes his life or one or more of his limbs to these units. Really emergency life-saving surgery was done here. The job they did was a truly outstanding one, while their accomplishments were rarely paralleled. It is no wonder that I, like so many others, always came away with a vicarious feeling of accomplishment, after a visit to these 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 not decisive. The story of the Army Medical Service during this


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operation, an operation fought in the most disease-ridden area and under the worst possible conditions of weather and terrain ever encountered by an American soldier, is a story of success. I was particularly fortunate in serving as the Far East's Consultant in Medicine at this time. I was grateful that I could learn first-hand the problems faced by our units in every echelon of medical service, and that I could witness the exploits of 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 of my Service career.