In God We Trust
"VA does have significant information regarding Agent Orange use in Korea along the DMZ. DoD has confirmed that Agent Orange was used from April 1968 up through July 1969 along the DMZ. DoD defoliated the fields of fire between the front line defensive positions and the south barrier fence. The size of the treated area was a strip of land 151 miles long and up to 350 yards wide from the fence to north of the "civilian control line." There is no indication that herbicide was sprayed in the DMZ itself.
Herbicides were applied through hand spraying and by hand distribution of pelletized herbicides. Although restrictions were put in place to limit potential for spray drift, run-off, and damage to food crops, records indicate that effects of spraying were sometimes observed as far as 200 meters down wind. Units in the area during the period of use of herbicide were as follows:
The four combat brigades of the 2nd Infantry Division, including the following units:
a) 1-38 Infantry
b) 2-38 Infantry
c) 1-23 Infantry
d) 2-23 Infantry
e) 3-23 Infantry
f) 3-32 Infantry
g) 109th Infantry
h) 209th Infantry
i) 1-72 Armor
j) 2-72 Armor
k) 4-7th Cavalry
Also, the 3rd Brigade of the 7th Infantry Division, including the following units:
a) 1-17th Infantry
b) 2-17th Infantry
c) 1-73 Armor
d) 2-10th Cavalry
Field Artillery, Signal, and Engineer troops were supplied as support personnel as required. The estimated number of exposed personnel is 12,056.
Unlike Viet Nam, exposure to Agent Orange is not presumed for veterans who served in Korea. Claims for compensation for disabilities resulting from Agent Orange exposure from veterans who served in Korea during this period will be developed for evidence of exposure. If the veteran was exposed the presumptive conditions found for Agent Orange exposure apply."
[KWE Note: Gary D. Moore, 5161 Howard Road, Smiths Creek, MI 48074-2023, USA.]
According to an article in the October 2014 VFW Magazine, DMZ veteran Ron Reigstad of Minneapolis, Minnesota, received a ruling from the VA for a service-connected disability. It was the first time a post 1971 Korea veteran had received such a ruling. Reigstad served in Korea as a combat engineer from 1975 to 1977.
Stressing the need for a properly developed claim with a strong medical opinion. VFW National Veterans Service Deputy Director Derald T. Manar said that Reigstad, "served in an area previously sprayed with herbicides, and his job required him to not only walk upon the earth but to dig it up." With the help of Tom Hanson of Post 7639 in Willmar, Minnesota, the VA granted a service-connected disability rating for diabetes mellitus, Type II, and peripheral neuropathy.
Letter to VFW - 20 April 2014
To: Commander, National Headquarters, Veterans of Foreign Wars
Thru: Commander, Department of Illinois, Veterans of Foreign Wars
Commander, District 12, Department of Illinois, Veterans of Foreign Wars
Subject: Dioxin (Agent Orange) Long Term Residual Effects Korean DMZ
Two months ago, I found out that I have Adult Diabetes Type 2, which is one of the many side effects of Dioxin exposure. I already knew many veterans who have served in Vietnam and Korea suffer from not just this side effect but many others. I have discussed with other veterans who have also served in Korea, in particular those who have also served up on the DMZ north of Freedom Bridge/Imjin-gak (River). Many of these veterans also suffer not only from Diabetes, but many of the other side effects of Dioxin exposure.
Agent Orange was used in Korea from approximately 1968 to 1971. Those that served in Korea at that time are the only ones who are acknowledged to have had exposure to Dioxin. It does not cover those that were exposed afterward, where it resides in the dirt for many years to come.
From 1971 to 1991 we still had Troops running patrols, manning Guard Posts, and Observation Posts in the American Sector (11 Mile Stretch) after the use of AO. Our final troops exited Vietnam by 1975 and they are covered in the Zone for Agent Orange. But, in Vietnam we did not naturally get a chance to see the effects of Dioxin exposure in the ground to those Veterans. In Korea, many of us believe we were exposed to it through the 70s and 80s due to aliments we now suffer from.
The US Government/VA needs to look at supporting and caring for these Veterans who are suffering from the side effects caused by exposure to Agent Orange. The Government needs to determine and accept that Dioxins remained in the area/ground well after its use and not just during. We exposed these Troops to an unsafe environment and now they suffer from it in sickness/illnesses, and in some cases death. I believe you will find in most cases, it has taken several years for the illnesses to appear, quite similar to those who were exposed to Agent Orange when it was used in Vietnam.
The Veterans of Foreign Wars membership rules changed several years ago, to allow those who have served in Korea since 1953 to become members of the VFW. Now as the VFW it is our mission to support these Troops that are affected, make it known that they are just as important as Veterans, as our other Veterans are that have served in combat zones! They too served a mission that was difficult on the DMZ, that was real, and sometimes was deadly. Serving on the Korean DMZ and running missions, were not training but a real world situation. These Troops lives were on the line constantly, under the threat of the north. Whether it was being shot at randomly, ambushed by roaming NK soldiers, avoiding minefields that were and are still in place! These Troops were and still are our fellow brothers who deserve to be given equal treatment for their service. A service that many never knew that really existed and/or accepted. Now we as members of the VFW need to see them given the recognition for a duty that was unforgiving, and make the rest of our members and all US Citizens aware of it. They are our brothers and should not be forgotten!
From 1972 to 1991, approximately 50,000 troops have served in the American Sector of the DMZ, and that is a conservative number! For the VA to see an issue/trend here is very limited due to relatively small number of veterans who have served there. With DMZ veterans spread in 50 states, territories, working, living, and retired overseas, and in some cases have passed on, it is hard to see that there is a trend/issue. That is why I ask the Veterans of Foreign Wars to stand up and help these veterans who need it now and never have been recognized for their efforts and their sickness from exposure to Agent Orange.
Last, just for the record. Not only am I currently active with my VFW Post here, but I am a Past Commander of Freedom Bridge Memorial Post 9985, Tongduchon, Republic of Korea. My info is: 831 W Jefferson, Vandalia, IL 62471; phone: [Please enable JavaScript.]; email: [Please enable JavaScript.].
(signed) Thomas J. Lucken, Senior Vice Commander, VFW Post 9770, Brownstown, IL
Letter to VFW - 1 May 2014
To: Commander, National Headquarters, Veterans of Foreign Wars
Thru: Commander, Department of Illinois, Veterans of Foreign Wars
Commander, District 12, Department of Illinois, Veterans of Foreign War
Subject: Dioxin (Agent Orange) Long Term Residual Effects Korean DMZ (Continuation Letter)
This is to add to my previous letter I sent on April 20, 2014. My son John H. Lucken, who is a member of VFW Post 9770, suffers from Spinal Bifida, a birth defect from those who were exposed to Agent Orange and its Dioxins. A birth defect that is define by the VA.
John was born on July 17, 1989 at 121st Evac Hospital, Yongsan, Korea. John's mother is Korean from the north part of the ROK. Her name is Mun, Yong-Cha! John's spinal bifida is on record with the VA besides dealing with PTSD from Afghanistan 2009.
Would I know that my service would come back to haunt him even more, then me! My info is: 831 W Jefferson, Vandalia, IL 62471; phone: [Please enable JavaScript.]; email: [Please enable JavaScript.].
(signed) Thomas J. Lucken, Senior Vice Commander, VFW Post 9770, Brownstown, IL
The Center's website reveals the fact that more than 300 products, particularly those used by the Navy from the 1930s through the 1970s, contained asbestos. That website states: "Clearly, virtually no portion of a naval ship was asbestos-free between the '30s and mid-70s, making Navy veterans and shipyard workers one of the most at-risk groups for developing asbestos-related diseases." Thousands of veterans developed mesothelioma, particularly those who served in the U.S. Navy. To learn more about veterans' exposure to asbestos, visit www.asbestos.com.
Mesothelioma & Asbestos Cancer Resource Center
This resource provides information about mesothelioma lawyers and litigation, the latest news about mesothelioma and asbestos cancer, treatment options and mesothelioma and veterans. It can be viewed on the Internet at www.asbestos.net.
Mesothelioma Cancer and Veterans - Asbestosnews.com is a site dedicated to providing news and information on mesothelioma, asbestosis, and other respiratory conditions caused by asbestos exposure. Veterans who served between the 1930s and 1970s faced a high-risk of asbestos exposure, particularly Navy veterans.
Mesothelioma Treatment - As I recently searched for resources regarding naval vessels, I came across your site, Korean War Educator. My name is Christian and as the communications coordinator for http://www.MesotheliomaTreatment.net, I feel that my site represents a valuable resource to the visitors of Korean War Educator. As our military veterans age, it becomes increasingly important to ensure their continued health, especially after they sacrificed so much for their nation. Unfortunately, the dangers our veterans face do not end with the close of their military service. As a result of the materials used in many military applications, veterans of all military branches almost certainly encountered the toxin, asbestos, during their service. However, veterans of the navy and those who served on naval vessels face the highest risk because asbestos was such a prevalent insulator on-board. Of all individuals diagnosed with mesothelioma today, 30% served in the armed forces. I encourage you to share our site, http://www.MesotheliomaTreatment.net, on that page as a text link.
Mesothelioma Lawyers - The Korean War Educator does not endorse any particular lawyer with regards to mesothelioma claims. However, information about attorneys who deal with this deadly disease is welcome for posting in case it might be of use to Korean War veterans.
The Mesothelioma Lawyer Center offers comprehensive asbestos and mesothelioma information, but with an emphasis on the legal options available to asbestos victims and their families. The legal options available to asbestos victims are of the utmost importance, so that victims and their families can pay for medical expenses and receive compensation for the pain and suffering they endure. The Center's website is: www.MesotheliomaLawyerCenter.org. The KWE requested information about the fees that the Center charges veterans and found out the following from company representative Susan Kolb: "The standard fee is 40%, keeping in mind the client pays nothing up front, the attorney covers expenses, and the client pays nothing if the case is unsuccessful.."
See also the story of Allen Johnson on the Korean War Educator.
by Ashley Rowland & Yoo Kyong Chang
Stars & Stripes
Published May 25, 2011
SEOUL — Sparked by a posting made seven years ago on a veterans’ website, South Korea on Wednesday began investigating the possible burial of chemicals at a former U.S. base nearly five decades ago, according to an official from the prime minister’s office.
A former soldier stationed at Camp Mercer posted a comment in May 2004 on the Korean War Project website that said the U.S. buried hundreds of gallons of chemicals at Camp Mercer — a small installation in Bucheon that was turned over to South Korea in the 1990s — while he was stationed there in 1963 and 1964. “We dug a pit with a bulldozer, donned rubber suits and gas masks and dump every imaginable chemical — hundreds of gallons if not more — into the ground on a knoll behind the second storage warehouse on the right,” retired Master Sgt. Ray Bows wrote.
Bows’ comments attracted widespread attention in South Korean media this week following recent allegations that the U.S. buried the defoliant Agent Orange at another base, Camp Carroll, in 1978. Three U.S. veterans told a Phoenix television station that they helped bury large amounts of the chemical in a ditch there and continue to suffer health problems from their exposure to it.
The 8th Army said this week that a large number of drums containing pesticides, herbicides and solvents were buried at Carroll in 1978 but were removed the following two years, along with 40 to 60 tons of soil. Officials say they do not know if Agent Orange was among those chemicals. The military found trace amounts of dioxin, a component of Agent Orange, in 2004 in one of 13 test holes bored at the site, but determined that the amount was too small to be a health threat. Officials had not answered a query from Stars and Stripes as of Wednesday night asking what had prompted that testing.
Issues Regions Publications About Donate Foreign Policy In Focus
Agent Orange in Korea
by Gwyn Kirk and Christine Ahn
July 7, 2011
Christine AhnIn May, three former U.S. soldiers admitted to dumping hundreds of barrels of chemical substances, including Agent Orange, at Camp Carroll in South Korea in 1978. This explosive news was a harsh reminder to South Koreans of the high costs and lethal trail left behind by the ongoing U.S. military presence.
“We basically buried our garbage in their backyards,” U.S. veteran Steve House told a local news station in Phoenix, Arizona. A heavy equipment operator in the Army, House said he was ordered to dig a ditch the length of a city block to bury 55-gallon drums marked with bright yellow and orange labels: “Province of Vietnam, Compound Orange.” House said that the military buried 250 drums of defoliants stored on the base, which served then as the U.S. Army Material Support Center in Korea. Later they buried chemicals transported from other places on as many as 20 occasions, totaling up to 600 barrels.
“This stuff was just seeping through the barrels,” said Robert Travis, another veteran now living in West Virginia. “There was a smell, I couldn’t describe it, just sickly sweet.” Immediately after wheeling the barrels from a warehouse at Camp Carroll, Travis developed a severe rash; other health problems emerged later. He said there were “approximately 250 drums, all OD (olive drab) green… with a stripe around the barrel dated 1967 for the Republic of Vietnam.”
A third soldier, Richard Cramer of Illinois, said that his feet went numb as he buried barrels of Agent Orange at Camp Carroll. He spent two months in a military hospital and now has swollen ankles and toes, chronic arthritis, eye infections, and impaired hearing. “If we prove what they did was wrong,’ says Cramer, “they should ‘fess up and clean it up and take care of the people involved.”
The three veterans are now seriously ill. Steve House suffers from diabetes and neuropathy, two out of 15 diseases officially linked to Agent Orange. “This is a burden I’ve carried around for 35 years,” House, aged 54, told Associated Press reporters. “I just recently found out that I have to have some major surgery… If I’m going to check out, I want to do it with a clean slate.”
A deadly herbicide, Agent Orange is widely known for its use during the Vietnam War when the U.S. military sprayed an estimated 10 million gallons on forests and rice fields. In Korea, the U.S. military used Agent Orange along the de-militarized zone to defoliate the forests and prevent North Koreans from crossing the border.
“The United States Army has acknowledged that pesticides, herbicides and other toxic compounds were buried at Camp Carroll,” writes New York Times reporter Mark MacDonald. Although the chemicals and about 60 tons of contaminated soil were purportedly dug up and removed, “the Army is still searching its records to discover what became of the excavated chemicals and soil.”
According to a February 25, 2011 report by the U.S. Army Corps of Engineers Far East Command, the U.S. military has discovered evidence of a burial site within Camp Carroll measuring 83 feet long, 46 feet wide, and 20 feet deep. It confirmed contamination on the base with high concentrations of highly carcinogenic perchloroethylene (PCE), pesticides, heavy metals, and components of dioxin. According to Hankyoreh, the report also cites testimony from a Korean employee, Gu Ja-yeong, who worked at Camp Carroll and participated in burying drums, cans, and bottles containing chemicals in 1974 and 1975. The report recommends monitoring once or twice a year and removing the soil from the burial site because ground-water chloroform levels were 24 times the South Korean standard for drinkable water. Chloroform is a carcinogen that can cause liver, kidney, and nervous system problems.
Two earlier environmental studies of Camp Carroll, commissioned by U.S. Forces in Korea (USFK), were not shared with the South Korean government until the recent whistle-blowing by the U.S. vets. In 1992, a Woodward-Clyde report confirmed the burial of toxic chemicals. “Many potential sources of soil and groundwater contamination still exist at the base and the presence of contaminated groundwater has been documented,” the report stated. “From 1979 to 1980, approximately 6,100 cubic feet (40 to 60 tons) of soil were reportedly excavated from this area and disposed offsite.”
Samsung C&T reported on a second survey in 2004. This also found soil samples from the base contained pesticides and dioxins: “Hazardous materials and waste, including solvents, petroleum oils and lubricants, pesticides, herbicides and other industrial chemicals have been used and stored onsite for over 40 years.” The Korea Herald reported, “more than 100 kinds of harmful chemicals including pesticides and herbicides were buried.” Hankyoreh reported that the Samsung survey found “quantities of highly carcinogenic trichloroethylene (TCE) and perchloroethylene (PCE) at 31 and 33 times the standard levels of potable water, respectively.” The 2004 report estimated that it would cost $98.3 million to remove all the contaminated soil from Camp Carroll. Both the 1992 and 2004 reports state that a significant amount of soil had been excavated, but they differ as to when this actually happened. According to the Korea Times, the 2004 report concluded, “The fate of the excavated drums is unknown”.
So what happened to the buried chemicals? Camp Carroll is located in Waegwan, about 20 miles north of Daegu. “If Agent Orange was dumped in 1978, the drums may have already eroded. And the toxic substance could have contaminated the soil and underground water near the area,” said Chung In-cheol of Green Korea United. “The U.S. camp is situated just 630 meters away from the Nakdong River,” says Chung, “which is the water source for major cities like Daegu and Busan.”
Cancer rates in the Chilgok area near Camp Carroll were up to 18.3 percent higher than the national average between 2005 and 2009, according to Statistics Korea’s website, and mortality rates for nervous system diseases were above the national average.
Environmental contamination on U.S. bases in South Korea has been a source of contention between Washington and Seoul. Since 2001, South Korea has spent $3.4 million to clean up 2,000 tons of oil-contaminated ground water near Yongsan Army Garrison and Camp Kim. The South Korean military is now conducting environmental tests at 85 former U.S. bases that were returned to South Korean control between 1990 and 2003.
With the latest revelations, the South Korean public is calling for a full-scale assessment of the environmental damage of all U.S. military facilities in Korea. Under the Status of Forces Agreement (SOFA) between the two nations, the United States has no responsibility to clean up the land it uses for bases. Some advocates are seeking a revision of the SOFA to hold Washington responsible for the contamination it causes.
After House spoke out, the USFK and the South Korean government assured the public that they would research his claims, though they disagreed about the method of investigation. The USFK preferred to use ground-penetrating radar (GPR) while the South Korean government insisted on sampling the soil and underground water. According to Hankyoreh, GPR can test for foreign matter such as canisters containing harmful materials, but it cannot verify soil or water contamination. “The South Korean government has repeatedly stated that this kind of investigation is incapable of resolving the questions harbored by the population,” said a Ministry of the Environment official.
The joint ROK-U.S. team is using ground-penetrating radar and electrical resistivity devices at 41 sites since the news broke in late May. According to a team official, the USFK is not just worried about dioxin, but other toxic and carcinogenic materials, which soil and water tests can detect. Indeed, investigation of an underground stream and groundwater near Camp Carroll has shown traces of PCE, a known carcinogen that attacks the nervous system and can cause reproduction problems. The Chilgok regional government sealed the well upon learning from the joint Korea-U.S. team that the amount of PCE exceeded the level for acceptable drinking water.
Agent Orange contains the deadly chemical dioxin, a byproduct of industrial processes involving chlorine or bromine. Decades after its use in Vietnam, there is still great controversy about its effects on human and environmental health, despite the fact grandchildren of Vietnamese soldiers and civilians have been born with abnormalities attributable to their ancestors’ exposure.
In 1995, Arnold Schecter and Le Cao Dai of the Vietnam Red Cross published research findings showing “that high levels of dioxin contamination persist in the blood, tissue, and breast milk of Vietnamese living in sprayed areas.” Schecter tested soil and human tissue samples from people living near the former Bien Hoa U.S. military base where 7,500 gallons of Agent Orange were spilled in 1970.
In 1998, Hatfield Consultants published the results of a four-year study of soil and water samples in the A Luoi valley near the Ho Chi Minh trail and the site of three former U.S. Special Forces bases where Agent Orange was stored and sprayed. Working with Vietnamese scientists, Hatfield found “a consistent pattern of food chain contamination by Agent Orange dioxin… which included soil, fishpond sediment, cultured fish, ducks and humans.” They found dioxin levels in some breast milk samples to be dozens of times higher than maximum levels recommended by the World Health Organization.
Although Vietnamese officials and scientists believe that many thousands of people are victims of Agent Orange, “remarkably little has been proved with scientific certainty,” Robert Dreyfuss wrote in 2000. The Institute of Medicine reports “strong evidence that exposures to herbicides is associated with five serious diseases, including Hodgkin’s disease and a form of leukemia… and ‘suggestive’ evidence that herbicides might cause birth defects and cancer.” A major factor limiting serious research into dioxin contamination is the high costs. According to Dreyfuss, it cost $600 to $1000 to test one single soil or tissue sample for tiny traces of Agent Orange dioxin.
Since 1981, U.S. veterans of the Vietnam War who were exposed to dioxin have been entitled to register with the Veteran Administration’s Agent Orange Registry. Of the nearly 3 million U.S. soldiers who served in Vietnam, approximately 300,000 veterans are on the list and entitled to free annual health exams. In a 2003 article in the San Francisco Chronicle, David Perlman wrote that more than 22,000 vets have successfully claimed disability and are entitled to “free long-term treatment for a variety of disorders that are ‘presumptively’ caused by exposure to dioxin.” Compensation has ranged from $104 to $2,193 a month.
U.S. veterans have attempted to sue the manufacturers of Agent Orange for compensation. In 1984, seven U.S. chemical companies agreed to settle a suit brought by U.S. veterans in 1979. In making this settlement, the companies refused to accept liability, claiming that the scientific evidence did not prove Agent Orange was responsible for the medical conditions alleged. By 1997, 291,000 U.S. veterans had received a total of $180 million dollars over a period of 12 years. “My brother was given $362, and me, I was given $60,” recalls U.S. veteran George Johnson. “My brother has never been able to have kids.”
South Korean veterans who served in the Vietnam War also attempted to sue Agent Orange manufacturers. In 2006, the Korea Times reported that the “Seoul High Court ruled that Dow Chemical and Monsanto should pay $63 billion won ($62 million) to a group of 6,700 Korean veterans… who first filed lawsuits against the company in 1999.” However, this ruling is largely symbolic since the Korean authorities cannot force the companies to comply.
When asked why he came forward now, Steve House said, “I’ve wanted the government to take care of this nightmare I’ve had to live with for the last 30 years. I don’t want to poison kids or anything, and I don’t want to hurt GIs.”
For House and other vets, also at issue is the question of medical compensation. According to the U.S. Veterans Affairs website, “Veterans who served … in or near the Korean Demilitarized Zone (DMZ) anytime between April 1, 1968 and August 31, 1971 and who have a disease VA recognizes as associated with Agent Orange exposure are presumed to have been exposed to herbicides. These Veterans do not have to show they were exposed to Agent Orange to get disability compensation for these diseases.” Veterans like House, however, who were exposed to Agent Orange after this time period, or in other parts of Korea outside of the DMZ, are not considered eligible for disability compensation.
Although more information is likely to emerge from the joint U.S.-R.O.K. investigation in the coming weeks, both the U.S. and Korean public must ask and demand answers to many urgent questions. What happened to the barrels of Agent Orange and contaminated soil at Camp Carroll? How much dioxin and other contaminants have leached into the soils surrounding Camp Carroll and other U.S. military bases? Will the U.S. government provide medical assistance and financial compensation to the veterans who handled a substance that was known to be toxic in 1978? Who will compensate the Korean people who may have been exposed to these contaminants – that the U.S. military knew of as far back as 1992, but never told the South Korean government.
Based on the experience of thousands of U.S. vets and civilians who live around U.S. bases — in this country and overseas — even routine military operations can have serious long-term costs to human health and the environment. Without adequately addressing its toxic legacy in South Korea, the U.S. military continues to take fertile land to expand and create new bases, as it did in seizing rice paddies from farmers in Pyongtaek. The ROK-U.S. naval base now under construction on Jeju Island will have a devastating impact on the island’s marine ecology, affecting fishermen and women sea divers who depend on the clean sea for their livelihood, and the Korean people who rely on the ocean for seafood. The blind rhetoric of national security must no longer trump human security, certainly not when the U.S. military isn’t even willing to provide adequate medical care to its own veterans and protection to the Korean people they are purportedly in Korea to defend.
Christine Ahn is the executive director of the Korea Policy Institute and a columnist for Foreign Policy In Focus, and Gwyn Kirk is a member of Women for Genuine Security and a contributor to FPIF.
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by Jamie Reno
International Business Times
April 09, 2014
For the past decade, U.S. Army veteran Steve House has been on a mission. Riding the highways of America from Oregon to Virginia on his Harley, he has visited dozens of fellow vets and medical and military experts to hear their stories and collect information to bolster his claim that he is entitled to disability payments after being exposed to toxic chemicals during his service in the late 1970s.
House, 56, a burly, deep-voiced man with a long beard and ponytail who was stationed at Camp Carroll in South Korea, suffers from diabetes, liver disease, glaucoma, neuropathy and other illnesses. He has been locked in a bitter, protracted battle with the Department of Veterans Affairs over his claim that his illnesses are linked to his work burying 250 barrels of Agent Orange, the toxic defoliant, in 1978 -- three years after the last Marines left Vietnam.
House has doggedly pursued any information that might help get his claim approved and prove to VA that he’s not fabricating his exposure. His claim was repeatedly denied by the VA until last week, when a judge with VA’s Board of Veterans’ Appeals (BVA) acknowledged that House’s suffering resulted from chemical exposure at Camp Carroll, though it stopped short of naming Agent Orange.
“I was determined to show that I was telling the truth about why I’m so sick,” House said. “I gave up countless hours of my life, including years of my vacation time that I should have spent with my family, digging for facts. I have a very understanding wife. I had to do what I had to do.”
The VA portrayed the ruling as a single administrative finding that applies to this one man. But House and others who have long alleged a government cover-up regarding Agent Orange and other toxic chemicals say it is an acknowledgement of the malevolent consequences of veterans’ exposure to those chemicals, even if, at this stage, it is unclear how the ruling will affect cases that are specifically about Agent Orange.
Rick Weidman, executive director of government affairs for Vietnam Veterans of America (VVA), called the judge’s decision on House’s claim historic. “It’s a precedent, a real turning point that we haven’t had before,” Weidman said. “Despite the fact that VA is still not saying that Agent Orange was buried there, virtually no one to date has gotten recognition for exposure to toxic chemicals, Agent Orange or otherwise, outside of the war zone. VA finally admits they sprayed Agent Orange along the DMZ [in Korea], but as far as toxins harming veterans at any other location, they very rarely admit it.”
“I won,” House said flatly. “It’s good news and I’m grateful. But I have mixed emotions about it. I feel kind of numb. My fight isn’t over. There are a lot of my buddies out there who were also at Camp Carroll who are sick now and that I hope to help.”
In a bluntly worded, 18-page court document, BVA Judge K.J. Alibrando acknowledged that Camp Carroll was contaminated with pesticides, PCBs, TCEs and heavy metals, and that these chemicals harmed House. The ruling did not cover Agent Orange, but Alibrando granted House “service connection” for most of his variety of serious health issues, pending some routine physical exams.
“They granted me pretty much everything down the line. It’s very rare,” said House, who can’t work but currently has only a 30 percent disability rating. “Of course I wish VA would acknowledge that we buried that Agent Orange. We know what we were ordered to do on that base. But at least VA now admits there were toxic chemicals there that harmed me. This is a victory.”
Weidman said House had “the best-documented case of toxic chemical exposure outside of Vietnam of anyone I have ever seen, by far. He’s an extremely bright guy. He just had too much documentation; the facts were on his side. His case shows that the Department of Defense and VA’s story about toxic exposures to troops on U.S. military bases is starting to unravel.”
By contrast, a VA spokesperson told IBTimes that House’s disability case will have no influence on other cases.
“Pursuant to regulation, decisions issued by the Board of Veterans’ Appeals [Board] are nonprecedential in nature,” said the spokesperson, Meagan Lutz. “This means that decisions by the board are considered binding only with regard to the specific case decided. Each case presented to the board is decided on the basis of the individual facts of the case, with consideration given to all evidence of record, in light of applicable procedure and substantive law.” Lutz added that the percentage House receives for his disability rating “will be determined based on the nature and severity of his service."
Agent Orange, which was used by the DOD during the Vietnam War, had devastating effects on U.S. troops as well as Vietnamese civilians. The herbicide has been scientifically linked to several types of cancer as well as Parkinson’s disease, diabetes, skin problems and other diseases and conditions, many of which House now suffers with.
To date, disability claims from veterans like House who said they were exposed to Agent Orange and other chemicals have mostly been limited to those who served in Vietnam and in a few select places, including the Korean DMZ – not other military bases.
While the judge's ruling does not directly affect Agent Orange cases, House and Weidman believe that it sets a precedent, and will help focus renewed attention on veterans’ exposure to toxic chemicals, including Agent Orange.
The Marine Corps Times reported last week that Maine Gov. Paul LePage is expected to sign into law a bill calling on the federal government to recognize disabilities suffered by Maine soldiers who were exposed to Agent Orange at a military base in Canada. The bill, sponsored by Democratic Sen. John Tuttle, focuses on potential exposure by Maine Army National Guard members at Canadian Forces Base Gagetown in New Brunswick. Fields at the base were sprayed with chemical herbicides, including a small amount of Agent Orange, according the the Marine Corps Times.
There is growing evidence that Agent Orange was used before, during and after the war on U.S. military bases across the globe, and that it contaminated troops after the war in Air Force planes that had been used in Vietnam to spray the defoliant.
House, whose father served in the Korean War, said he hopes his case will lead to more awareness of toxic dumps on U.S. military bases, and in particular, that Camp Carroll is “just another Camp Lejeune," referring to the North Carolina Marine base where service members and their families were exposed to solvent-contaminated drinking water from 1953 to 1987. "It’s toxic and people who were stationed there have been harmed, as have the civilians who live near the base. Our bases are toxic and are hurting veterans, and the public needs to know this. I hope this decision by the judge will lead to more decisions for other veterans who were stationed there and are now suffering.”
Thousands of American veterans were exposed to nuclear radiation during atmospheric nuclear testing that took place during the 1950s through 1963. To learn about the importance of obtaining a Film Badge Radiation Exposure History and how to get it, visit the Atomic Veterans website. You or your loved one may be eligible to receive compensation under the Radiation Exposure Compensation Act.
See Atomic Veterans Project on the Korean War Educator.
See Korean War Veterans Memoirs on the KWE:
Paul Mason
Cancer issues are being brought to the forefront by the Blue Water Navy Vietnam Veterans Association at www.bluewaternavy.org. Blue Water Navy provides Agent Orange information to veterans. There is a special section on their website seeking information from Korean War veterans who might have been exposed to cancer-causing agents in Korea. View the Blue Water Navy website here.
View the entire study of cancer incidences as they relate to Australia's Korean War veterans. The study was funded by the Australian government in 2003. The significance of this study to American Korean War veterans is that Americans served in the same areas in Korea as the Australians. The conditions were the same for both nationalities.
Were you stationed at the US Marine Corps base at Camp Lejeune, North Carolina from 1957 to 1987? If so you were likely exposed to contaminated water. Water wells at the base were closed in 1984 and 1985, but not before an estimated half a million Marines and members of their families drank water that was contaminated with 40 times the current EPA limit of trichloroethylene and perchloroethylene--both cancer causing agents. These chemicals were dumped into ground water by an off-base dry cleaning business, as well as chemicals leaking from underground storage tanks and unsafe disposal practices at the base.
The Agency for Toxic Substances and Disease Registry is currently conducting a study of the water contamination at Camp Lejeune. A representative of the agency notes that women who were in their first trimester of pregnancy when exposed seem to have been affected more than others. Miscarriages occurred in many cases. So did skin cancer, boils, rashes, and cysts.
In 2008 President George W. Bush signed a law requiring the Marine Corps to notify those who may have been exposed to contaminated water at Camp Lejeune. Victims can now file a claim relating to their exposure to the contaminated water.
DDT was used during the Korean War to delouse American troops, foreign troops, and native Koreans. Details about this use are referenced on many Internet websites. The following information can be found within World Wide Web resources.
See Robert Balie Cox Jr. Memoir - Korean War Educator
See Doyle Rowell Memoir - Korean War Educator
See Wayne Pickett Memoir - Minnesota American Legion Legionnaire, March 2008
Personal diary of Carl H. Hulsman (2nd Chemical Mortar Battalion, Korea 1950-51) - See 13 March 1951 - "I picked two lice off the back of my head and then dosed myself well with a DDT spray can. I slept with my trousers off, first time since Pusan in December."
War and American Women: Heroism, Deeds, & Controversy by William B. Breuer. See reference to Cpt. Anna McGoff Robie, Army nurse at the 14th Field Hospital Korea 1951. She notes that the nurses were sprayed twice weekly with DDT.
[KWE Note: All credit for this information goes to it author, Sgt. Jim White. Found on www.koreanveterans.org.]
Making an argument to the VA for Tactical Herbicide Exposure.
I believe that an awful lot of 51st Signal Battalion veterans are missing an "EXTREMELY IMPORTANT SECTION" of this report and not explaining it properly or correctly in how it pertains to their service in South Korea.
On Page 19, (swiping the pages listed), you come to Paragraph (a). It begins, "To counter NK Infiltrators use of heavily vegetated areas along the DMZ." At the bottom of that paragraph it states the following, VERY CLEARLY!
"On 28 April the application of "Monuron" was completed in the I-Corps area. A total of 145,000 pounds of Monuron (2,900 drums) was sprayed by hand for a total coverage of 580 acres in the I-Corps area. A total of 1,500 drums of Monuron had been spread over 341 acres in the FROKA area during April."
First, the I-Corps Area, WAS AND INCLUDES CAMP RED CLOUD. CRC was I-Corps Command Headquarters for years! Second, coverage of 580 acres in the I-Corps area. CRC was only approximately 160 acres in size, according to military documents. That leaves 420 additional acres of coverage to account for. Since Camp Pililaau was within walking distance of CRC, and basically right up the road, one can easily make the argument (I did in my VA Statement of Claim), that spraying CRC and NOT Pililaau, which was I-Corps'only signal communications unit and controlled the entire communications network for ALL I-Corps units, (which included the 2nd Infantry Division, the 7th Infantry Division, the 1st and 6th ROK Army, the 5th ROK Marines, and the 25th ROK Army, as well as ALL REMOTE RADIO SITES, in the western section of the DMZ, it is completely illogical to say or even assume that Camp Pililaau was not afforded vegetation control/protection from infiltrators by the use of Agent Orange or Monuron. It is simply not possible. The Army at times can be stupid, BUT NOT THAT STUPID.
If you served or worked at Pililaau, CRC, a remote radio site, or on tactical field maneuvers, be sure to include and reference this fact, listed in this government document, that we provided the communications ability for I-Corps (GP), and all units attached or assigned to the First Corps. Let the VA just try to "PROVE" that that is not the way it was!
After citing this document, you then find and cite Army Field Manual FM 11-92, which will back up, show, document, prove, that is the way Corps Signal Operations did, in fact, work. This manual is titled "CORPS SIGNAL BATTALION OPERATIONS". One will compliment/prove the other. The Army Field Manual is ARMY LAW, and is INDISPUTABLE in how it is carried out. Even the VA cannot dispute Army Law and procedures. Only the Secretary of Defense and the Joint Chiefs of Staff can change or modify Army Laws and regulations. You and I lived by those Army Regulations in the performance of our duties EACH AND EVERY DAY WHILE IN THE US ARMY.
GOOD LUCK.
SGT. JIM WHITE
Third Brigade, 2nd Division Area, Korea - Chemicals used:
Hyvar XWS
tandex
Yrox B
Yrox oil
concentrate (liquids)
bromacil
tandex
Urox 22 (solids)
In 1968, chemicals were sent from the Plant Sciences Lab, Ft. Detrick, Maryland, to the Republic of Korea for the purpose of testing their effectiveness in the control of vegetation.
Source: Gary D. Moore, 5161 Howard Road, Smiths Creek, MI 48074-2023
Thousands of American veterans (in fact, more than 5,300 in just the first winter of the Korean War) suffered frostbite during the extreme cold temperatures in Korea during the war years. Many of them were evacuated and received treatment in a timely fashion. Unfortunately, however, too many others did not have that chance due to the battle conditions they were in at the time. The latter lost fingers and/or hands, toes and/or feet, and had to endure the anguish of frostbitten noses and ears. Decades later, these Korean War casualties are still experiencing the after effects of frostbite. Some receive medical assistance and compensation from the Department of Veterans Affairs. But there are still thousands of Korean War veterans who either don’t know they are eligible for disability benefits based on their cold weather injuries, or they can’t get anyone in the VA to believe that their current health problems are service-related. To learn more about cold weather injuries in the Korean War, visit the Weather - Topics page of the Korean War Educator.
Col. John Zitzelberger has spent 25 years lobbying the Veterans Administration and Congress on behalf of veterans with cold injury. He has had great success helping veterans of the Chosin and the Bulge substantiate their claims with the VA. In the course of doing this, his son Joe Zitzelberger tells us that Colonel Zitzelberger has amassed a large amount of information to help veterans deal with the VA and their claim. This information is compiled, in PDF form, and usually distributed via CD-ROM at Chosin Few meetings and Regimental reunions. Son Joe has built a website that offers the same documentation, again in PDF form. Viewers who think they might benefit from this information can find it at http://www.chosin-few.org.
Ray Walker was an A/1/5 Marine in Korea from August to December 1950. He suffered cold weather injuries from the Chosin Reservoir and offers this advice to veterans seeking cold weather injury benefits from the V.A.:
"The V.A. accepts that you probably have cold injury if you were at Chosin in the winter of '50. First, take your DD214 and go to either the VFW or DAV and hook up with a counselor. If you have a personal doctor, ask him to arrange for you to get a EMG exam on your legs by a neurologist. If you have nerve damage, neuropathy, it will show up on the EMG or "electromylogram." They stick a pin in at the top of the thigh and another on the foot and run a small current that follows the nerve.
Take the doctor's report to the DAV or whomever you're using and file a claim for service connected disability. You ought to get 40% on the feet. It will take the better part of a year to get it all processed. Also, file for your hands. They'll probably accept the hands if the feet are cold injured."
[KWE Note: The following document is an unclassified document from the Defense Technical Information Center. It is part of the report of the Proceedings of the DOD Symposium on Evolution of Military Medical Entomology.]
W. J. Sames 1, H. C. Kim 2, T. A. Klein3, 1 LTC, Medical Service Corps, U.S. Army; 2 Entomologist, Yongsan, Korea: 3 COL, Medical Service Corps, U.S. Army (Retired)
To understand entomological issues during the Korean War, one must first know something about Korea and the cultural and political situation during that period. Korea is a peninsular country that over the centuries has periodically been occupied by China or Japan. These occupations had a detrimental effect on the country because human and material resources were routinely stripped from the peninsula. The occupations and subsequent national freedom led to a strong sense of national pride in the Korean people and a not inconsequential xenophobia.
The Japanese occupation from 1910-1945 differed only in its magnitude. Koreans were enslaved and forced to work in war factories or other menial positions. The country experienced widespread deforestation at the hands of the occupiers, and the little wood that remained was gathered for cooking and heating. The widespread loss of forest cover led to landslides and flooding during the summer monsoons.
On September 2, 1945, the Japanese surrendered to the Allied Forces onboard the USS Missouri in Tokyo Bay. This signified the end of World War II and the beginning of the Allied occupation of northeast Asia. By prior agreement with the Union of Soviet Socialist Republics (USSR), Korea was split into two halves along the 38th parallel; the northern half became the Democratic People’s Republic of Korea (North Korea) with USSR oversight, and the southern half became the Republic of Korea (South Korea) with United States (US) oversight. North Korea and South Korea are about the size of the states of Pennsylvania and Illinois, respectively, are 70-80% mountainous, and have less than 20% arable land; in 1950, their respective populations were estimated to be 23 and 48 million people.
In 1949, the US considered South Korea an independent country that no longer needed the presence of US occupation forces, so US forces withdrew from Korea to established bases in Japan. North Korea, still backed by the USSR, took the US withdrawal as indifference to the region and decided it was time to forcibly reunite the country.
On June 25, 1950, North Korean artillery began firing south and North Korean troops began their invasion of South Korea. President Truman protested this action and ordered US military intervention; the United Nations (UN) considered North Korea’s action an act of aggression, and sixteen nations under the auspices of the UN joined the ROK in expelling the aggressors. US troops stationed in Japan sprung into action but were too few to stop the North Korean military surge. Within months, the North Koreans occupied almost all of South Korea except for an area in the southeast around the city of Pusan, with the outer boundary referred to as the Pusan perimeter. The stalling action by UN forces allowed sufficient troops and equipment to enter the Pusan perimeter, and a UN offensive action was
imminent.
North Korea - Area: 120,540 km; 14% arable land; 80% mountains; 23 million people
South Korea - Area: 98,477 km; 19% arable land; 73% mountains; 48 million peopleHighest peak in North Korea: Mt. Paektu (2744m)
After breaking out of the Pusan perimeter, General Douglas MacArthur implemented a surprise attack on
September 15, 1950 at Inchon, a port city to the west of Seoul, effectively entrapping the North Korean Army and cutting off their supplies. Many North Koreans surrendered; the rest began an immediate and rapid retreat. By December 1950, UN forces had pushed the North Korean Army to within a few miles of the Chinese border. China then entered the war on the side of North Korea, and millions of Chinese soldiers marched into North Korea, pushing the UN forces south. Eventually, the war settled around the 38th parallel, and on July 27, 1953, an armistice was signed and a demilitarized zone established to create a buffer between the opposing forces. Numerous hostile actions have since been documented, underscoring the reality that South Korea and its allies are still not at peace with North Korea.
Korea was an agrarian society and infrastructure throughout the country was minimal in 1950. There were no highways until 1966, and much of the population still lived in traditional Korean housing. The aftereffects of WWII left the people impoverished and struggling to reestablish their lives with few resources and threats of catastrophic disease. The Korean War severely aggravated the problems for Koreans, many of whom were rendered homeless or displaced by combat actions. Disease was rampant during this period, with high morbidity and mortality due to smallpox, typhoid, typhus, other diseases, and harsh environmental conditions.
Living conditions for military personnel were generally open and makeshift. Soldiers were exposed to environmental extremes, and arthropod and rodent interactions were common. For example, during the winter of 1950-1951, intense cold led to over 5,000 frostbite injuries in US forces (Shaver 1962). Arthropod-borne diseases (louse-borne relapsing fever and typhus, Japanese encephalitis, vivax malaria, and epidemic hemorrhagic fever) threatened all civilian and military populations.
Louse-borne diseases were holdovers from WWII and rapidly expanded as displaced Koreans relocated to crowded areas with inadequate hygiene and sanitation opportunities. Louse-borne typhus is estimated to have caused 32,000 cases and 6,000 deaths in South Korean soldiers and civilians. No US cases were reported in Korea; one occurred in Japan (Long 1954, Pruitt 1954).
Lice also affected prisoner of war (POW) camps and were of great concern at the Koje Island POW camp along the southern coast of South Korea. North Korean POWs were kept at this location, and a 10% DDT dust was used as the louse control agent. Over time, the DDT treatments did not appear to have an effect on the lice, and an investigation of the problem was initiated (Military Entomology Information Service 1965). Military entomologists suggested that the lice had become resistant to DDT and requested a new insecticide (Hurlbut I960). However, authorities in the US felt that DDT was adequate and that the problem lay in its application or in a bad batch of the chemical (Dews 1960).
Fleet Epidemic Disease Control Unit No. 1 planned and conducted tests to evaluate DDT efficacy and louse Army and Navy entomologists from the 37th Preventive Medicine (PM) Company, the 297th PM Survey Detachment, and the resistance. DDT was tested for its efficacy against Cal ex pipiens larvae (mosquito species), killing them at one part per 2 million. The DDT met expectations of efficacy, and a mass delousing ensued (Curtin 1953, Dews 1960).
For the resistance test, South Korean soldiers were employed and an arm band was placed on each arm of the shirtless volunteers (Lt. Nibley, USA, and CDR Hurlbut, USN, were among those that checked Korean subject’s DDT armband as part of the test for louse resistance to DDT.) One arm band was treated with 10% DDT while the other was left untreated. Lice were placed under each arm band and counted at 24 and 48 hours. No difference was observed between the treated and untreated arm bands, which strongly suggested louse resistance to DDT. The US authorities approved the use of a new insecticide, lindane, which provided effective louse control.
Implementing the use of lindane at the Koje Island POW camp was a challenge. POWs, who were accustomed to standing in long lines to be treated with ineffective DDT, had no faith that the new product would be any better and many refused to go for treatment. On the first day, some POWs submitted to treatment; once they saw how well lindane worked, word quickly spread, and the rest of the camp complied (Dews 1960). In a short time, the louse infestation on Koje was brought under control.
Japanese encephalitis, a viral mosquito-borne disease, was also of concern because 300 cases had occurred in US military personnel between August and October 1950. Little was known about this disease, so blood sera from 2 1 0 of these cases were sent to the 406th Medical Laboratory at Camp Zama, Japan, to determine its etiology.
Vivax malaria, a parasitic mosquito-borne disease, was of great concern, with infection rates of 8.3, 3.2, and 1.9/1 000/year for 1951, 1952, and 1953, respectively (Cowdrey 1990). Acute and latent forms of the disease were expressed. Soldiers affected with the acute form showed disease symptoms within two weeks of exposure and became medical liabilities in Korea. Those affected with the latent form showed disease symptoms months to a year later. Because deployments to Korea were 19 months or less, many soldiers returned home with inactive latent malaria parasites in their liver. Later, when the disease appeared in these soldiers, health authorities became concerned that malaria would reestablish itself in the US. Chloroquine was the chemoprophylaxis of choice, but it only suppressed blood parasites and did not affect the parasitic liver stage. Primaquine, which killed the liver parasite, was approved for use during this period, thus reducing latent cases and relieving concerns about reintroducing malaria into the US (Coatney et al. 1953, Hunter 1953, Archambeault 1954, Marshall 1954, Pruitt 1954, Brundage 2003).
Epidemiological studies were conducted in South Korea to determine the malaria infection rate of Korean civilians (Murdoch and Lueders 1953, Marshall 1954), and military entomologists (Army, Air Force, Navy) were instrumental in preventing the disease through the application of pesticides by ground and air, and through advocating the use of uniforms treated with repellents (M-1960 contained 30% 2-butyl-2-ethyl-l,3-propanediol for protection against mosquitoes and biting flies, 30% N- butylacetanilide for ticks, 30% benzyl benzoate for chiggers and fleas, and 10% of an emulsifier, Tween 80 [polyoxyethylene ether of sorbitan monooleate]) (Gupta et al. 2003).
Epidemic hemorrhagic fever (now known as hantavirus) was a viral disease of great importance. Over 3,000 UN soldiers were affected, with an initial mortality rate of 14.6% that was reduced to 2.7% as medical providers learned more about the management of this infection (Pruitt 1954). However, very little was known about this disease, so studies began in earnest to understand its etiology and how to control and/or prevent it. Studies of Japanese literature suggested this was the same disease encountered by Japanese military forces in Manchuria during their 1938-1940 campaign, and notes from the Japanese experience were useful (Katz 1954, Traub et al. 1954). Studies of the agent were confounded because it had been observed that applica vector was involved in the transmission cycle (Traub 1954).
Initially thought to be a vector-bome disease with a rodent reservoir, all potential vectors (mites, mosquitoes, black flies, and fleas) were studied (Traub et al. 1954). In 1976, the virus was isolated from the black-striped mouse, Apodemns agrarius (Lee et al. 1978), and named Hantaan virus after the Hantaan River where it was first isolated.
During the war, many rodents were live-captured to study hantaviral and other diseases, but live traps were in short supply and those that were available were quickly acquired by others for personal use (Applewhite 1953). Therefore, soldiers of the preventive medicine detachments improvised and built traps from beer cans and mouse snap-traps, both of which were abundant (Bevier 1953). These “Beer Can Traps” were made by cutting off the top of the can and affixing the mouse trap to the open end, with the trigger extending into the can. A flat piece of metal was placed over the wire “snap” loop so that once the trap was triggered, the loop covered the open end of the can and trapped the rodent. Application of the repellent M-1960 appeared to reduce epidemic hemorrhagic fever rates, suggesting that because the supposed vectors were not known to transmit disease to humans, and research on how to prevent, treat, and control a disease is not the same as biological warfare studies. The Communists also claimed that the US protection given to Japanese scientists (who practiced biological warfare during WWII) in exchange for their secrets was further evidence that the US was engaged in biowarfare. A team of “experts” sympathetic to the Communist cause was sent to investigate. Their report condemned the US, but upon questioning, the team admitted that they never saw the evidence; their report was based exclusively on what they had been told or shown by the North Koreans and Chinese. The report caused more controversy but was considered biased.
During WWII, scrub typhus was feared more than malaria in parts of Southeast Asia, but only 8 UN soldiers acquired the disease during the Korean War even though thousands of cases were diagnosed in the civilian population (Ley and Markelz 1961). Similarly, tick-borne disease was not a factor, as ticks were uncommon and very few soldiers complained of tick attachment (Traub 1954). The lack of trees and leaf litter may have limited the habitats capable of supporting ticks that parasitize humans.
A history of entomology during the Korean War would not be complete without discussing the contributions of the 406 th Medical Laboratory, Camp Zama, Japan. The 406th served as the primary laboratory supporting entomological studies throughout the war, and entomologists in Japan worked closely with entomologists stationed in Korea. The laboratory conducted epidemiological, virological and entomological studies on arthropod- and rodent-borne diseases, and provided mounted specimens to US and regional museums (US Army 1953). Arthropods studied and mounted included mosquitoes, black flies, filth flies, mites, lice, and fleas. In addition, birds and small mammals were studied and mounted. The laboratory expanded to meet its research demands, and many Japanese joined the staff. Some of the new employees were sympathetic to Communism, a situation that caused friction subsequently (Lockwood 2009).
During the winter of 1950-1951, reports of massive disease outbreaks in the North Korean military and among civilian and Chinese military populations were received. These reports also stated that the North Korean authorities were doing nothing to mitigate the problem. Several reports claimed that the “Black Death” was spreading throughout North Korea. Black Death to US medical personnel meant flea-borne plague, Yersinia pestis. If UN forces were to move north in the spring, they would encounter this disease and needed to be prepared. To validate the reports, the US sent Col. Crawford F. Sams into North Korea to investigate. Colonel Sams infiltrated North Korea near Wonsan and determined the disease to be hemorrhagic smallpox, not plague. US military personnel were vaccinated against smallpox, with the result that only 4 soldiers developed the disease during the war (Waldo 1955). However, the North Korean civilian population suffered tremendously and its population dropped from 1 1 to 3 million people (Sams 1998).
In the spring of 1951, North Korea and China accused the US of engaging in biological warfare and cited multiple examples of attacks with a variety of arthropods (Collembola, crickets, Plecopterans, etc.) and small rodents (moles) harboring disease (Lockwood 2009). The Communist sympathizers within the 406 th Medical Laboratory claimed that the US was conducting biological warfare studies using arthropods and rodents. To most people, these accusations seemed ludicrous The US denied all allegations concerning the use of biological weapons, pointing out that disease was already rampant in both Koreas and without medical intervention many people would fall ill and die. Two recent books (Lockwood 2009, Endicott and Hagerman 1998) provide insights on this issue, as well as references to other books, literature, and documentation.
Entomologists from the Army, Air Force, and Navy served during the Korean War. Army entomologists served on the 8 th Army Surgeon’s Staff and in the Preventive Medicine Company and Survey Detachments.
LTC Samuel O. Hill of the 8th Army Surgeon’s Staff, was the first entomologist to enter the combat zone (Bunn and Webb 1961). He was later replaced by LTC Samuel C. Dews who served in this position for the remainder of the war. In a 1953 report, LTC Dews reported that 38 entomologists served in Korea during the war, but Bunn and Webb (1961) reported 65 entomologists; the difference may lie in the numbers who served in units only (38) versus those who served in units plus those who were conducting research (65). Traub et al. (1954) is an example of those involved in research. Further studies are needed to determine exact numbers. Lieutenant Carlyle Nibley Jr. and Captain Robert Altman served in Korea, and many of authors listed in the reference section of this paper also served. In 1954, Col/ (ret.) Harold D. Newson and LTC (ret.) Alexander A. Hubert served in Korea (Newson and Hubert, personal communication).
The 37th Preventive Medicine (PM) Company and 10 different PM Detachments saw service during the Korean War. In 1950, two types of detachments existed and were in the middle of a name change. Malaria Control Detachments were redesignated as PM Control Detachments and Malaria Survey Detachments were redesignated as PM Survey Detachments. Two sanitary engineers typically served in the PM Control Detachments, whereas an entomologist and a parasitologist served in the PM Survey Detachments. Nine enlisted personnel were assigned to each of these detachments (Curtin and Spitzer 1953).
In September 1950, the 38th and 207th PM Survey Detachments were moved from Japan to Korea and were the first two detachments deployed to the war zone. Seven PM Control Detachments served in Korea and one served in Japan for the duration of the war. Similarly, three PM Survey detachments served in Korea and one served for the duration in Japan. Table 2 provides a summary of the entomological work performed by the PM Survey Detachments.
Members of the Preventive Medicine Division, Medical Section, HQs, Eighth
US Army Korea (January 1952):
[KWE Note: The following are listed by Unit, Date Served in War, Country, and Activation/inactivation.]
*Data derived from US Army Directory and Station Lists for the Korean War period. Except for the 37th PM Company and 406* General Laboratory, all units are detachments with the 17th Malaria Survey Detachment being inactivated before the name was changed to PM Survey Detachments.
Travel Miles Logged - 36,718
Total Identifications Made - 73,152
*Data from Curtin and Spitzer (1953)
The Army used L-13 and OH1/L-19 aircraft for aerial spraying, because these smaller aircraft could go into small valleys where the larger USAF aircraft could not go.
While most Army vector control missions were ground based, it became necessary for the Army to engage in aerial spray missions in the narrow, small valleys where the larger US Air Force aircraft could not go. The Army modified the L-13 and 0H1/L-19 aircraft for aerial spraying and sprayed DDT for the control of mosquitoes and filth flies (Harder 1953 a, b).
Navy entomologists primarily served in the port cities that were feeding Korea with essential supplies, equipment, and troops. They were also essential to vector control at the Koje Island POW camp and during malaria epidemiological studies around port cities. At present, we believe six Navy entomologists served during the Korean War, with CDR H. S. Hurlbut confirmed as being present because he wrote about his experiences and appears in photographs. Many of Hurlbut’s photos include CWO R. S. MacDonough, but we have not determined the latter’s association with entomology.
The Korean War was the Air Force’s first war as a separate service. To meet the needs for aerial spray missions, the Air Force activated the 1st Epidemiological Flight in May 1951. The mission was flown on 17 June (Muchmore and Read 1953) and the first season was completed on October 8, 1951 (Nowell 1954, Lumpkin and
Konopnicki 1960). The Air Force used a variety of aircraft for the aerial spray mission: C-40, C-46, C-47, L-20, L-5, and the T-6. Aerial spray missions commonly targeted mosquitoes and filth flies to reduce disease affecting military and civilian populations. A DDT oil solution of 20% was commonly sprayed.
At the time of this writing, we are unable to determine which Air Force entomologists served in Korea, even though we have an extensive list of those who served in that capacity.
During the Korean War, the word “Mosquito” with a capital “M” referred not to an insect but to an airplane (Futrell 1983). The T-6 “Texan” was used as a Forward Air Controller, and it was commonly called the “Mosquito” by its pilots and ground crew.. Two theories have been advanced for this moniker. The first postulates the use of the call sign “Mosquito” as in “Mosquito 1, this is “Mosquito 2, over.” Pilots and ground crews apparently liked this call sign and began calling the T-6 the “Mosquito” (Futrell 1983). An alternative explanation is that North Korean and Chinese prisoners called this aircraft a mosquito (Mogi in Korean) because they associated its buzzing around with the “bites” (bombs) that followed shortly thereafter (Morris 1997). Much work remains to be done before we have a clear picture of military entomology during the Korean War.
References for this presentation came from the US Army Center of Military History, Fort McNair, DC; the US Army Institute of Military History, Carlyle, PA; entomological, scientific and tropical medicine journals of the period (e.g.. Mosquito News, Am J Hyg); collections of unpublished documents on file at the Armed Forces Pest Management Board; books written about the Korean War; and Internet searches on subjects or people who may have served during that era.
Applewhite R. 1953. Rodent surveys. Proceedings of The Military Preventive Medicine Association in Korea, Insect and rodent control in Korea, Chosun Hotel, Seoul, April 8, 1953.
Archambeault CP. 1954. Mass antimalarial therapy in veterans returning from Korea. J Am Med Assoc 154:1411-1415.
Bevier G. 1953. Rodent control in a division area. Proceedings of The Military Preventive Medicine Association in Korea, Insect and rodent control in Korea, Chosun Hotel, Seoul, April 8, 1953.
Brundage JF. 2003. Conserving the fighting strength: milestones of operational military preventive medicine research. Chapter 5, Military Preventive Medicine: Mobilization and Deployment, Volume 1. Department of Defense, Office of The Surgeon General, US Army, Borden Institute. 704p; ill.
Bunn RW, Webb JE, Jr. 1961. History of the US Army Medical Service Corps, chapter VIII, laboratory specialties, section 7, entomology.
Coatney GR et al. 1953. Korean vivax malaria. V. Cure of infection by primaquine administered during the long-term latency. Am J Trop Med Hyg 2:985-988.
Cowdrey AE. The medics’ war. (Washington, DC: US Army Center of Military History, 1987).
Curtin T. 1953. History of the 37th Preventive Medicine Company. Proceedings of The Military Preventive Medicine Association in Korea, Insect and rodent control in Korea, Chosun Hotel, Seoul, April 8, 1953.
Curtin T, Spitzer CH. 1953. Preventive medicine survey unit activity in KComZ. Proceedings of The Military Preventive Medicine Association in Korea, Insect and rodent control in Korea, Chosun Hotel, Seoul, April 8, 1953.
Dews SC. 1953. Mass Delousing Operation. Proceedings of The Military Preventive Medicine Association in Korea, Insect and rodent control in Korea, Chosun Hotel, Seoul, April 8, 1953.
Dews SC. 1960. Military entomology in Korea. In Dews SC, Knight KL, Blakeslee TE, Hurlbut HS. 1960. Military entomology history. Armed Forces Pest Management Board, report.
Endicott S, Hagerman E. 1998. The United States and biological warfare: secrets from the early cold war and Korea. (Bloomington, Indiana University Press, 1998).
Futrell RF. 1983. The United States Air Force in Korea, 1950-1953. Office of Air Force History, Washington, DC.
Gupta RK, Gambel JM, Schiefer BA. 2003. Personal protective measures against arthropods. Chapter 22, Military Preventive Medicine: Mobilization and Deployment, Volume 1. Department of Defense, Office of The Surgeon General, US Army, Borden Institute. 704p; ill.
Harder FK. 1953a. Use of detachable air spray tanks on the L-19 aircraft. Proceedings of The Military Preventive Medicine Association in Korea, Insect and rodent control in Korea, Chosun Hotel, Seoul, April 8, 1953.
Harder FK. 1953b. Use of F- 19 insecticide spray kit in division areas. Proceedings of The Military Preventive Medicine Association in Korea, Insect and rodent control in Korea, Chosun Hotel, Seoul, April 8, 1953
Hunter GW. 1953. Focal health hazards among US Army troops returning from Korea. Am .J Pub Health 43:1408-1417.
Hurlbut HS. 1960. Military entomology history: the Korean War. In Dews SC, Knight KF, Blakeslee TE,
Hurlbut HS. 1960. Military entomology history. Armed Forces Pest Management Board, report.
Katz S. 1954. Hemorrhagic fever of the Far Eastern type. Presented 29 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.
Fee, H.W., Lee, P.W., & Johnson, K.M. 1978. Isolation of the etiologic agent of Korean Hemorrhagic Fever. J Infect Dis 137:3.
Ley HL, Markelz RA. 1961. Scrub typhus: occurrence in United Nations personnel in Korea. Mil Med 126:834-837.
Lockwood JA. 2009. Six-legged soldiers: using insects as weapons of war. (New York, Oxford University Press, 2009).
Long AP. 1954. General aspects of preventive medicine in the Far East Command. Presented 29 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.
Lumpkin JI, Konopnicki MJ. 1960 Military aerial spray operations, 1946-1960. Tactical Air Command US Air Force.
Marshall IH: Malaria in Korea. 1954. In: Recent advances in medicine and surgery based on professional medical experiences in Japan and Korea 1950-1953. Presented 29 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.
Military Entomology Information Service. 1965. DDT and lindane resistance in the body louse. Armed Forces Pest Control Board, Walter Reed Army Medical Center, Washington DC.
Morris C. 1997. Mosquito control in Korea. Wing Beats Spring 1997 : 15-17.
Muchmore HG, Read RE. 1953. Air spray program in Korea. Proceedings of The Military Preventive Medicine Association in Korea, Insect and rodent control in Korea, Chosun Flotel, Seoul, April 8, 1953.
Murdoch W, Lueders HW. 1953. Wonju malaria survey. Proceedings of The Military Preventive Medicine Association in Korea, Insect and rodent control in Korea, Chosun Hotel, Seoul, April 8, 1953.
Nowell WR. 1954. The entomological program in the United States Air Force. Proceedings of the 1954 New Jersey Mosquito Extermination Association Annual Meeting, Atlantic City, NJ.
Pruitt, FW. 1954. General aspects of medicine in Korea and Japan 1950- 53.
Sams, CF. 1998. Medic: the mission of an American military doctor in occupied Japan and wartorn Korea. Zakarian Z (ed.), M. E. Sharpe Inc., Armonk, New York.
Shaver WD. 1962. The impact of disease on military operations: selected incidences from World War II, Korea, and Lebanon. General Reference and Research Branch Historical Unit, USAMEDS, Forest Glen Section, Walter Reed Army Medical Center, Washington 12, DC.
Traub R. 1954. Advances in our knowledge of military medical importance of mites and fleas due to postwar experiences in the Pacific area. Presented 29 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.
Traub R, Hertig M, Lawrence WH, Harriss TT. 1954. Potential vectors and reservoirs of hemorrhagic fever in Korea. Am J Hyg 59:291-305.
US Army. 1953. Clinical laboratory and research report, 1953. US Anny 406 th Medical General Laboratory and Far East Medical Research Unit, Camp Zama, Japan.
Waldo HH. 1955. Smallpox among “vaccinated” troops. US Armed Forces Med J 6: 799-806.
"TOKYO, (AP)—A strange illness for which no sure cure has been found has broken out among United Nations forces in Korea, Gen. Ridgway's headquarters said today. Brig. Gen. William E. Shambora, surgeon of the Far East Command, said the mysterious malady strikes suddenly and is characterized by fever and a headache. These symptoms are common in the early stages of several known infectious diseases. Sulfa and antibiotics have failed to stem the disease, Shambora said. The malady is strikingly similar to that reported by the Japanese among their Manchurian troops in 1939. The Japanese called the disease "epidemic hemorrhagic fever." They believe it is caused by a tiny virus carried by field mice and transmitted to man by mites. Shambora said some patients recover quickly while others develop further symptoms. These include hemorrhages under the skin, around the eyes and the internal organs". - Lock Haven Express (newspaper), Lock Haven, PA, Thursday, November 8, 1951, pg. 1
On this page of the Korean War Educator our readers can find the names of many of the fatalities caused by hemorrhagic fever. We have found no government compilation of hemorrhagic fever fatalities by name. To add information, comments, corrections, fatality names and bio information to this page, contact Lynnita. We would love to hear from Korean War hemorrhagic fever survivors and any medical personnel and staff that cared for the hemorrhagic fever patients.
Over the course of the Korean War, more than 3,000 UN troops became ill with hemorrhagic fever, and the mortality rate was ten percent and higher. (There was no known cure and it was not widely known what it was or what caused it.) American servicemen experienced a range of symptoms ranging from fever, headache, chills, loss of appetite, vomiting, internal bleeding, and renal failure. Fatalities could occur within one to two weeks of contracting the illness.
Shortly after the Battle of Chipyong-ni, Capt. Claude A. Scott, battalion surgeon of the 1st Battalion, 23rd Infantry Regiment, was the first man evacuated from the battalion because he was critically ill with hemorrhagic fever. In 1951, the pick-up of soldiers affected by hemorrhagic fever became so overwhelming that helicopters in the 8193rd Helicopter Detachment needed supplemental aircraft to retrieve the sick. An L-19 with an improvised litter built of one-inch padded plywood was attached to the helicopter unit. According to a 1951 After Action Report, this L-19 greatly reduced the time that a stricken serviceman was picked up and taken to the hemorrhagic fever MASH, no doubt saving lives. The report recommended that another L-19 be sent to complement the first one.
The number of men stricken with this mysterious illness continued to grow as 1951-52 progressed. In 1952, the 8228th MASH, 48th Surgical Unit was mentioned in the Annual Report of Medical Services Activities, 7th Infantry Division. The 8228th MASH was a hospital in Seoul that was reserved for personnel with hemorrhagic fever and cold injuries (Eighth U.S. Army Cold Injury Treatment Center). Established in April of 1952, that year the hospital had 2,237 admissions (Army = 1,625; Navy = 9; USMC - 183; Air Force = 6; allied and neutral military personnel = 223) and other = 191). The illness continued to strike military personnel, so much so that the 382nd General Hospital, a rehab hospital for hemorrhagic fever patients, upgraded its bed capacity to 1,000. Nurses at the 11th Evacuation hospital were among the first to use an artificial kidney machine to treat patients with hemorrhagic fever.
Some of the United States' most learned virologists and epidemiologists were involved in the study of the strange fever outbreak. Dr. Joseph Edward Smadel (1909-1963), a virologist and civilian researcher for the Army, led a team of Army scientists in a study of the hemorrhagic fever breakout in Korea. Their mission was to study the cause, transmission, prevention, and treatment of the strange disease. Smadel found out that from April to December of 1952, 46 out of 828 patients diagnosed with the fever died (fatality rate of 5.6 percent).
Among Smadel's colleagues was Capt. Robert Wayne McCollum Jr. (1925-2010). After serving in the US Army Medical Corps from 1952 to 1954, he went on to pioneer studies into the nature and spread of polio, hepatitis and mononucleosis at Yale School of Medicine. For nearly a decade he was Dean of Dartmouth School Medical Center. In 1951-52, noted endocrinologist and physiologist Dr. William Francis "Fran" Ganong Jr. (1924-2007) served as Lieutenant, then Captain in the Army Medical Corps in Japan and Korea, and helped to set up the mobile army surgical hospital (MASH) to treat patients with hemorrhagic fever. He later published several scientific papers about the Korean hemorrhagic fever.
Dr. Sheldon Edward Greisman, a New York University College of Medicine graduate, volunteered for Army service while serving as chief resident at New York's Bellevue Hospital. Dr. Greisman was assigned to the 48th MASH unit in Korea during the Korean War. He investigated Korean epidemic hemorrhagic fever in combat troops. He also served as a MASH unit psychiatrist.
Dr. George Schreiner, a 1946 graduate of Georgetown University Medical School, was a renowned nephrologist. When the Korean War broke out, he volunteered for the Army and was posted to the Washington Veterans Administration where he worked on the artificial kidney. A year followed at Walter Reed Army Hospital to begin research into the causes of kidney failure in Korean and US soldiers in the field. Briefly posted to the hospital ships in Pusan, Korea, he observed soldiers returning from the Han valley with skin and hemorrhagic fever associated with acute kidney failure. In 1951, he was invited to become Chief of a new Division of Nephrology at Georgetown University Hospital by Laurence H. Kyle (Endocrinology and Metabolism) and Harold Jeghers (Chief of Medicine) in a largely Boston-trained Department of Medicine, as the first Georgetown graduate to hold a leadership position in the medical school. He remained there for the next 35 years.
It was not until 1978, long after the cease fire, that the virus that caused hemorrhagic fever was identified. It was discovered in a field mouse found near the Hantan River and was from then on known as the "Hantavirus". This virus transferred to humans via mouse droppings, mouse urine, and mouse saliva--primarily droppings. The virus could remain on dry droppings for long periods of time. During the Korean War, United Nations troops came in contact with mice that were searching for food and trying to keep out of the weather. Mice crawled into bunkers, tents, food supplies, clothing, and sleeping bags.
Dr. Ho-Wang Lee of South Korea discovered the Hantaan and Seoul viruses, which cause hemorrhagic fever with renal syndrome. He also identified which rodents harbor the viruses, the way the viruses are transmitted from rodents to humans, and developed an effective vaccine that has significantly reduced the incidence of this disease. Some of his research is posted on this page of the KWE.
Unfortunately, as late as 1986 American Marines stationed in Korea contracted hemorrhagic fever, with fourteen Marines suffering from the virus. The Marines were among 3,754 Marines who participated in a joint US/ROK training exercise from September 7 through November 15, 1986. Two of the fourteen died of severe renal failure and shock. One 19-year old Marine developed hemorrhagic fever on November 5. For the next five days the illness continued, and then 24 hours after that he died in Seoul. The second Marine died on Okinawa in November of 1986. All Marines that suffered from the fever had been quartered in the Unchon area. This outbreak was the largest cluster of fever victims among US personnel in Korea since the Korean War. [Source: "Outbreak of Hemorrhagic Fever with Renal Syndrome Among U.S. Marines in Korea" (AD-A228 197)]
In 1994 the U.S. Army reported eight cases of hemorrhagic fever, with one fatality. In 1995 three American soldiers contracted the fever. In 2002 the Korea National Institute of Health reported 336 cases, including one death. Victims were mostly area farmers and soldiers. From January to August 2003 there were 82 cases of hemorrhagic fever. A U.S. soldier stationed at Camp Hovey, Dongducheon, was diagnosed with hemorrhagic fever on October 27, 2005. On November 8-9, 2005, two soldiers from Camp Casey, Dongducheon, were also diagnosed with hemorrhagic fever. On November 13, 2005, another soldier from the same unit at Camp Casey was confirmed to have the fever. [Source: CDC Dispatch, Vol. 15, No. 11, November 2009]
While severe symptoms of hemorrhagic fever could kill someone in a matter of days, health complications from those recovering from hemorrhagic fever could last for months.
After contracting the illness, Korean War veteran Bobby Ray Breeden of Texas (1929-2020) was in and out of hospitals in Korea, Japan, Hawaii, California and Texas for 135 days. Prior to being drafted in the Army and contracting hemorrhagic fever, Bobby was a healthy high school graduate who had been drafted to play professional baseball by Kansas City.
John F. "Jack" Goedeke Sr. of Easton, Maryland, was a BAR-man in the 24th Infantry Division when the entire division was sent to Korea on July 1, 1953. He told the Star-Democrat newspaper staff (June 25, 2000, pg. 26): "My most threatening time turned out to be my stint in Yangu Valley. In mid-September 1954, I contracted what was first thought to be malaria. I was flown by helicopter to the 11th Evac hospital near Seoul where I was diagnosed as having hemorrhagic fever, a potentially fatal fever. I normally weighed 175 pounds and I had lost 40 pounds in just over a week. After about six weeks of treatment in the hospital, I was discharged and very thankful to the good Lord for having my health back. I recently read that hemorrhagic fever is related in some obscure way to the Eboli virus. I was very lucky. I was discharged from the army on December 8, 1954 — exactly two years and one day from the day I was inducted. I was two years older and considerably wiser from the experiences of the past 24 months."
8th MASH Hospital, November 1953
[KWE Note: All credit to this article goes to Harold Jack Elbon, who has also published the book, My Journey-West Virginia to Korea and Back to W.V.u. Contact information provided: Harold Jack Elbon, 326 Florida Ave., Saint Cloud, Florida 34769.]
"Barely awake, and completely drenched in cold perspiration. I knew I was running a high fever and clumsily struggled to unzip my sleeping bag before losing consciousness.
Later, someone was shaking me and saying “If you want breakfast you’d better get your a** outta’ bed”. My reply was “Where am I”? “Man, you’re a soldier in the US Army and we are in Munson, Korea“. Struggling to get dressed, and staggering toward the Mess Hall. I smelled greasy frying bacon and it made me stop and vomit.
I went on sick call and told the doctor it felt like the Flu. He took my temperature and blood pressure and carefully examined the roof of my mouth. His eyes got big, and he asked me to raise my arms and his eyes widened again. I looked under my arm and saw that my side torso was covered with red spots. He told me to go in the next room and lie down on the bed. I heard him on the telephone requesting a helicopter. He was sending me to the 48th Mash Hospital for evaluation. “May I return to my area to get my personal belongings?” Absolutely not, you are now under quarantine until the hospital finds out what’s wrong with you.”
I was carried out to the helicopter on a stretcher and strapped on the exterior of the helicopter. It was one of those one man jobs with a plastic bubble like the one in the show MASH. I remember looking back at the rear rotor and thinking…if that thing comes off it will be like a buzz saw and bisect me. Looking over the side at the rice paddies surrounded by mountains, I thought how beautiful and peaceful it looks from up here.
We landed at the 48th MASH Hospital. They carried me inside and the Army nurse had me get on the scales. Then she took me by wheelchair to my assigned bed. I suggested I wasn’t sick enough to be in a hospital that it felt like I was getting the Flu. “The doctors will be in tomorrow morning and will determine if you are sick enough to be kept a few days for observation” she politely but sternly replied.
About an hour later, they brought a Korean (ROK) soldier in and put him in the bed beside mine. He knew some English words and I knew a little Korean. He put his hand at the back of his neck and said Opo? I replied Opo which means hurts. Then he put his right hand under his rib cage and asked Opo? I put my under my rib cage and pressed and it hurt. Later I learned that our livers were enlarged. The Korean patient said “American doctors are sissy doctors, and am not sick enough to be in a hospital, I should be back on the front lines”. I told him I felt the same way. The nurse returned to take my temperature. She had me drink water, and changed my cold damp sheets.
The next morning, lying there with my eyes half closed, I watched the Medics take the ROK soldier’s vital signs Suddenly he stiffened, turned a purplish red color and DIED!!! As they rushed him out of the room, I thought about our short conversation comparing symptoms the night before, and thought “Maybe I am sick”.
When the medics returned, they took my vitals and a doctor prescribed Quinine and a shot of penicillin. Meanwhile more soldiers were brought in with the same symptoms. My meals consisted of ½ slice of toast, 1 cup of pear juice, and I cup of tea, 7 days a week because that’s all I could keep down.
Each day was the same. My temperature went up at night and the nurses kept waking me to drink water. They explained I might go into convulsions if I didn’t replace the water I was losing. God bless them, they worked hard and really cared. The number of patients grew in alarming numbers to about 100. Somebody died every few days. After several days of treatments of Quinine and penicillin, they concluded it wasn’t Malaria.
Finally, the Army medical staff thought this fever and rash may be an Oriental disease, and they brought in a consulting Japanese doctor. He asked if I had seen any rats in Munsan. He suspected the North Koreans and/or the Chinese had infected rats and they had come over to the American side. We had mess halls and the rats likely had invaded us and transmitted Hemorrhagic Fever via fleas, or mosquitos. I told him, I haven’t seen any rats, but I have been bitten by mosquitos”. He explained, “It is similar to the Bubonic Plague that killed hundreds of thousands of people in Europe during the Middle Ages”.
Each day began with 4 shots in my buttocks and removal of blood from my arms and fingers. After 3 weeks, my arms looked like a junkie’s. My hips were so caked that the nurses could no longer give me 4 injections. They would push very hard to get one in and then unscrew the syringe and screw on another one.
Surprisingly, my diet of ½ slice of toast, 1 cup of tea, and 1 cup of pear juice did not get boring. Thankfully, I could keep it down. Thanksgiving Day arrived and they brought a large tray of Turkey and all the trimmings and put it on my bedside table. I looked at it and began to cry like a baby. They knew I couldn’t eat it but they prepared it anyway, so I could witness the American tradition. I felt the hospital staff truly cared for me. Sobs were heard from all over the hospital. I wondered if some patients thought it was their last supper, and it was. I still cry when I think about that 1953 Thanksgiving.
It seemed as though someone in that ward would die almost every night. Before I went to sleep, I prayed that God would give me one more day, and wondered if I would wake up the next morning. My weight had plummeted and I looked like a thin prisoner of war.
I spent the long days reliving my life from early childhood, from life during the depression, to being a teenager during World War II. I even replayed football and basketball games in my mind.
Both my mother and sister had similar dreams on the same night that I was in an Army Hospital in Korea. The next day my mother called someone in the US Government and they called the Red Cross. They were able to track me down to the 48th MASH Hospital. A few days later, a Chaplain came to my bedside and sat down. He brought some stationary and would not leave until I wrote a letter to my mother and sister. I asked, “How do you write a letter to your mother and sister and tell them you are dying?” The Chaplain said, “Tell them the truth and that you love them and ask them to pray for you.
My mother and sister had the church that I had grown up in, the First Baptist Church of Webster Springs, WV, and many of the citizens of that small town praying for me.
One night shortly afterward I did not have a fever. The nurses were overjoyed and told me I was one of the lucky ones because about 85% of their patients died. “It wasn’t luck, I replied, God answered the prayers of my mother, and sister, and the First Baptist Church, and the good people of Webster Springs, WV”. If any of the nurses and doctors that were at the 48th MASH Hospital in Nov, of 1953, recognize this period, I would like to thank them for the outstanding care they extended to me and the other patients.
The next morning on December 4th I was carried on a stretcher to a plane that took me to a hospital in Japan for a month. Rest, recuperation and gaining weight were on the agenda. When I was taken off the plane in Japan, the Salvation Army Ladies were there to ask if there was anything they could get for me. I humbly asked “Do you have any milk?” They laughed and said sure. They said almost every request from soldiers returning from Korea was for milk because all we had in Korea was powdered milk.
I spent about a month at the hospital at Tachikawa, Japan and was given a wheelchair. The doctor told me not to walk until I gained weight. I had 3 meals per day and snacks between meals. My appetite vigorously returned.
Since my 3 year Army enlistment was due to expire on January 17th, the military flew me to Ft. Meade, Md. for discharge. A few days past the 17th, I went to the office and complained. I told the Commanding Officer that the 2nd semester at West Virginia University would start in less than 2 weeks. I wanted out in time to enroll. He explained my records had not caught up with me and he could not discharge me without them. When I expressed my dissatisfaction with his reply, he said “The Army can extend your tour of duty indefinitely at the convenience of the Army”.
I telephoned my mother and she called Senator Mathew M. Neely. A few days later, I was ordered to the Commanding Office’s quarters and was asked, “Do you have friends in high places?” “No I replied, but my mother has”. He said he would give me an Honorable Discharge but I had to sign an affidavit that my discharge date was supposed to be January 17th. I abruptly responded “Fine”.
I was sent to the doctor who said “If you stay until your papers arrive from Korea, you may be able to get disability benefits”. I said “No, I feel okay and I don’t want to take the government’s money unless I have to, besides, I want to get back in college”. The doctor said he would give me a 0% Disability. He said “That’s better than No Disability because it indicates that something happened and I could submit a claim later if I needed to”. I was discharged January 22, 1954. That turned out to be a mistake. I was not as well as I thought and later needed assistance, but the VA declined my request for help because they couldn’t find my Medical Records. After 50 years of trying to obtain my records, I wrote to Senator Robert Bird and he was able to get them for me.
I was shocked to learn that the final diagnosis was” Infectious Mononucleosis with Hepatitis and Jaundices”. My symptoms were the same as the other patients who died, and when the fever finally broke, the nurses said, “You are one of the lucky ones you are going to live.” I am thankful that GOD healed me. But I wonder about the diagnoses.
Was it given because they felt the doctors back home would not know how to treat someone who had suffered with Hemorrhagic Fever and the symptoms of Infectious Mononucleosis, Hepatitis and Jaundice are similar? Was it because I survived? Was it because they would not say “He was healed by God as a result of all the prayers said by hundreds of people”? It is well known that the 48th MASH handled Hemorrhagic Fever cases.
Headquarters, 7th Infantry Division
Office of the Division Surgeon
Annual Report Medical Service Activities, 1953
(1) Control and Prevention of Hemorrhagic Fever
In January of 1953 a program for hemorrhagic fever control was already in effect. This program included dipping of clothes in miticide (51-R-300), spraying of quarters with lindane, and rodent control.
During April, as part of this same program, a better degree of control over the miticiding of clothing was obtained by instituting the dipping of outer garments prior to issuance to regimental clothing exchanges. This practice was continued throughout the rest of the year.
Beginning with July further attempts were made to insure that all US troops in this division wore miticided clothes. Since a great deal of clothing was found to be laundered by indigenous personnel rather than by the Quartermaster laundry, miticide dips were made available for their use. The personnel were given instructions as to the proper method of impregnation.
(2)Incidence of Hemorrhagic Fever
The division was in the Hemorrhagic Fever belt for the whole of the year - both while on line and after being moved into reserve to a less endemic area for the latter part of the year. The incidence of the disease remained rather low throughout the year. Cases of Hemorrhagic Fever began to occur in May when five cases were recorded. In June eight cases occurred with the peak being reached in July when nineteen cases were confirmed. The disease dropped to three cases in August after which the disease almost disappeared for the rest of the year.
In 1974, Ho Wang Lee of the Korea University completed a study of Korean hemorrhagic fever. His research was prepared for the Army Research and Development Group (Far East). He noted that the first cases of the fever were reported in 1951 among U.S. forces stationed in the Yunchun and Chulwon area. He said that there were 2,804 total hospitalized cases of U.S. troops from 1951 to 1972. He provided the following figures in this order: Year of Hospitalization, Number of Cases, Year of Hospitalization, Number of Cases.
The government divided fatalities as "battle" or "non-battle". The causes of non-battle deaths are sometimes findable, but when a death is listed as "died of other causes", it is difficult to determine which ones of those were caused by hemorrhagic fever. This agonizing fever caused as much as 10-15% mortality among the total cases diagnosed.
1951 -
Ankrom, 1Lt. Okay Maurice - died November 9, 1951
Basquin, Pfc. Gerald Donald - died October 26, 1951
Beres, Pfc. Alfred M. - died November 18, 1951
Collier, Pfc. Toland James - died November 29, 1951
Flinn, 1Lt. Robert Francis "Bob" - died October 9, 1951
Hooper, Pfc. Robert Mullen - died August 22, 1951
Johnson, Cpl. Donald Richard - died November 5, 1951
Locklin, Cpl. John Hildred - died December 15, 1951
Markitello, Pvt2 Louis - died December 16, 1951
McNeil, Pfc. Francis Leonard - died December 7, 1951
McPherson, MSgt. Ralph Arlin - died November 22, 1951
Messer, Pfc. Harold Richard - died October 22, 1951
Miller, Maj. Eugene Preston - died July 17, 1951
Norris, Cpl George - died September 4, 1951
Wiseman, Pfc. Donald Gilbert - died August 28, 1951
1952 -
Canavan, Pfc. John Patrick - died May 29, 1952
Caughey, Pfc. William John - died June 12, 1952
Enderson, Pfc. Raymond Arthur - died June 29, 1952
Engelhardt, Pfc. James Nelson - died July 2, 1952
Escabar, Cpl. Erasmo - died July 22, 1952
Hill, 1Lt. George Edwin - died June 11, 1952
Horne, Cpl. Arvel Cook - died June 27, 1952
Johnson, Pfc. Walter Fair - died June 15, 1952
Kiedrowski, Pfc. Edward - died June 15, 1952
Martineau, Pfc. George Percy - died July 10, 1952
Neufeld, Pfc. Donald Milton - died July 27, 1952
Simon, Cpl. George Albert - died July 9, 1952 (also listed as Siman)
Stevens, Cpl. J.E. - died August 24, 1952
Torres-Ramirex, Pfc. Emilio - died November 19, 1952
1953 -
Benoit, Pfc. Lionel V. - died October 27, 1953
Bullens, Pfc. Hearl E. - died December 16, 1953
Culmer, Pfc. Freddie Leon - died July 05, 1953
Ellis, Cpl. David - died November 16, 1953
Fair, Pfc. Robert Carl - died November 08, 1953
Figel, Pfc. Ronald Andrew - died October 23, 1953
Gusek, Pvt. Richard J. - died November 11, 1953
Hampton, Pfc. Alfred - died October 30, 1953
Johnson, Pfc. James Grant - died November 10, 1953
Linton, Capt. Paul Melvin - died December 11, 1953
Lloyd, Sfc. Harold Alvin - died November 9, 1953
McReynolds, Sgt. Cornelius - died February 17, 1953
Pendegrass, Pvt. William Jr. - died November 01, 1953
Smith, Pfc. Harold Walter - died November 30, 1953
Sommer, Pfc. Kenneth Charles - died December 5, 1953
Stiles, Pvt. Frank Eugene - died October 30, 1953
Thomas, Pvt. Edwin - died December 14, 1953
Tillou, Cpl. Everitt James - died October 12, 1953
Winters, Pvt. Donald Edwin - died June 18, 1953
1954 -
Eagan, A2C John Joseph - died December 28, 1954
Schafer, Pfc. Stanton Mayer - died January 09, 1954
Ankrom, 1Lt. Okey Maurice Jr. - Oke was born January 20, 1918, son of Okey Maurice Ankrom Sr. (1885-1921) and Emma Ethelda Dulaney Ankrom (1891-1971). His children were Oke, James and Mary Ankrom. His siblings were Mrs. Robert C. (Alma Mae Ankrom) Buffam (1911-1982); Louie Edward Ankrom (1912-1948) and Glenn A. Ankrom (1915-1964). Okey Jr. was a member of Company B, 79th Engineer Construction Battalion when he died in the 121st Evac. He is buried in Odd Fellows Cemetery, Parkersburg, West Virginia.
Basquin, Pfc. Gerald Donald - Gerald was born on April 02, 1932, in Norfolk, Virginia, son of Samuel Basquin and Alice Conner Basquin. He was serving with the 1st Field Artillery Observation Battalion, Artillery, when he died in the 121st Evacuation Hospital. He is buried in Rowley Cemetery, Rowley, Iowa.
Benoit, Pfc. Lionel Victor - Lionel was born May 29, 1931, and was from Connecticut. He was serving with the 461 Ordnance Ammunition Company, 67th Ordnance Battalion. He was taken to the 11th Evacuation Hospital when he developed hemorrhagic fever. He is buried in All Hallows Cemetery, Moosup, Windham County, Connecticut.
Beres, Pfc. Alfred M. - Alfred was born April 29, 1928, in Cheektowaga, New York. He was a member of Battery D, 15th Anti-Aircraft Artillery Automatic Weapons Battalion, 7th Infantry Division. He was a son of Joseph J. and Elizabeth Garus Beres. His siblings (according to Findagrave) were: Chester F. Beres (1932-2015), Edward J. Beres (1921-1994), Aloise J. Beres (1922-2005), Henry V. Beres (1927-2007), Frank D. Beres (1934-2002), Joseph Beres (died 1930), Joan Beres, Mrs. Edward J. (Stella M. Beres) Majchrzak (1925-?) Irene M. Beres Gawron (1924-2011), and Frances Beres Tidd. Alfred died in the 11th Evac Hospital in Korea and is buried in Saint Stanislaus Roman Catholic School, Cheektowaga.
Bullens, Pfc. Hearl E. - Hearl was born May 1, 1931, in Harriman, Roane County, Tennessee. He was serving in the Quartermaster Division when he was evacuated to 48th Mobile Army Surgical Hospital. He had just received his shipping orders to return to the United States. He was a son of Oliver Lee Bullens (1885-1975) and Sarah Catherine "Cassie" Bullens (1899-1980). His siblings were Reba Bullens Dickey Walker (1925-2004), Geneva Bullens Trout (1922-2003), Edith Bullens Hickey, Clifford Bullens, Ben Bullens, Ruby Bullens Whitaker, Lee Bullens Jr., Otho James Bullens, Andy "Jack" Bullens (1940-2019) and Mrs. Homer (Wanda) Harmon. Hearl is buried in Harriman Cemetery.
Canavan, Pfc. John Patrick - John Patrick was born June 04, 1929, son of Michael Canavan (1896-1987) and Mary Kilger Canavan (1904-1973). John was a member of Company A, 13th Engineering Combat Battalion, 7th Infantry Division when he died at the 8228th MASH. He is buried in All Saints Catholic Cemetery and Mausoleum, Des Plaines, Illinois.
Caughey, Pfc. William John "Bill" - Bill was born February 1, 1930, and was from the Muskegon, Michigan area. He fought at the PuKau River in Korea, contracted hemorrhagic fever at the front line, and died before he could be evacuated. He was serving with B Company, 1st Battalion, 180th Infantry Regiment, 45th Infantry Division. Bill is buried in Saint Marys Cemetery, Muskegon, Michigan.
Collier, Pfc. Toland James - Toland was born May 4, 1929, a son of Dr. Henry H. Collier Sr. and Annie B. Gilliard Collier (died 1992). He was a member of Company E, 2nd Battalion, 5th Cavalry Regiment, 1st Cavalry Division. His siblings were Lucius "Lou" Edward Collier Sr. (1924-2010), Dr. Henry H. Collier Jr., John Collier Sr., Dr. Charles Nathan Collier (died 1989), Pastor Merrick Collier, Ruby Collier Bryant, and Dr. Harold Roland Collier (died 1975). Toland died in the 121st Evac Hospital in Korea and is buried in Laurel Grove Cemetery South, Savannah, Chatham County, Georgia.
Culmer, Pfc. Freddie Leon - Freddie was born September 2, 1929 in Florida. He was serving in Battery D, l48th Field Artillery Battalion (105mm) and died at the 48th MASH. He is buried in Miami City Cemetery, Miami, Florida.
Eagan, A2C John Joseph Jr. - John Jr. was born December 24, 1929 in Pottsville, Pennsylvania, son of John Joseph Eagan Sr. (1908-1991) and Florence A. Mooney Eagan (1908-1982). His siblings were Mrs. Evan (Rita Eagan) Kranzley (1931-2015) and Mrs. William Joseph (Florence Catherine Eagan) Brehony (1936-2017). John was serving with the 1993rd ASCS Mobile Communications Squadron at Kimpo Air Base when he died at the 11th Evac Hospital. He is buried in Calvary Cemetery, Mount Carbon, Pennsylvania.
Ellis, Cpl. David Francis - David was born January 26, 1934, in Cambridge, Middlesex County, Massachusetts. He was serving with the 329th Signal Reconnaissance Company, IX Corps when he was taken to 48th Surgical Hospital, where he died. David's mother was Florence May Bushee Foss (later Faria) and William E. Gorse. The surname Ellis is on David's birth certificate. His siblings were Herbert Wilson Ellis, Marion Louise (Hattie Ellis) Hawes, Robert Field Ellis, Raymond Lewis Ellis, Edward Ellis, Richard James Ellis (Gorse) (later James Richard Curran). Edward Joseph Ellis (Gorse) and Paul Arthur Ellis (Gorse). David is buried in Fort Rosecrans National Cemetery, San Diego, California.
Enderson, Pfc. Raymond Arthur - Raymond was born July 1, 1928, son of Mattias Enderson (1892-1956) and Alice Johnson Enderson (1891-1982). His siblings were Herman Emil Enderson (1921-2013), Merle Enderson (1923-1997), Ivan Artist Enderson (1925-2018), Alice Marie (1932-1933) and Ivan Enderson. Raymond was serving with C Battery, 21st AAA AW Battaltion, 25th Infantry Division. He is buried in Mountain View Cemetery, Longmont, Colorado.
Engelhardt, Pfc. James Nelson - James was born June 09, 1932. He graduated from Port Neches Groves High School, Port Neches, Texas. He was a member of the 17th Ordnance Med. Maintenance Company when he became ill with hemorrhagic fever and died in 8228 MASH. He is buried in Glenwood Cemetery, Flint, Michigan.
Escabar, Cpl. Erasmo - Erasmo was born March 26, 1931. He was a member of C Battery, 12th Field Artillery Battalion (155mm), 2nd Infantry Division, when he died at the 11th Evacuation Hospital. He is buried in Escobares Cemetery, Escobares, Texas.
Fair, Pfc. Robert Carl - Robert was born in Cleveland, Ohio. He was a member of B Company, 5th RCT, when he died at the 48th MASH. No further information has been found about him.
Figel, Pfc. Ronald Andrew - Ronald was born on May 16, 1934. He was serving with the 303 Communications Recon Battalion when he contracted hemorrhagic fever and died in the 48th Surgical Hospital, Seoul, Korea. He is buried in Mountain View Cemetery, Auburn, King County, Washington.
Flinn, 1Lt. Robert Francis "Bob" - Bob was born January 25, 1925 in New York, the son of World War I veteran Francis Joseph Flinn (1897-1956), of Stony Brook, New York. After finishing grade and high school, Bob served in World War II, joining on January 22, 1943 in New York City. He was appointed to the United States Military Academy at West Point, graduating in 1950. In September of 1950 he was assigned as platoon leader of C Company, 65th Engineer Combat Battalion. He contracted hemorrhagic fever and was evacuated to a hospital near Seoul. He was transferred to Tokyo Army Hospital, Japan, where he died at the age of 26. He is buried in West Point Cemetery in New York.
Gusek, Pvt. Richard J. - No information on this veteran has been found to date.
Hampton, Pfc. Alfred - Alfred was born in Long Island City, New York. He was serving with L Company, 15th Infantry Regiment, 3rd Infantry Division when he died at the 48th MASH.
Hill, 1Lt. George Edwin - George was born November 13, 1925, a son of Carl Hill Sr. (1891-1980) and Edna Witt Hill (1894-1980). His siblings were Carl Hill Jr. (1918-1978) and Mrs. Francis Clarkson (Margaret Hill) Durkin. He was a World War II veteran. In Korea he was a member of Headquarters and Service Company, 65th Infantry Regiment, 3rd Infantry Division. He contracted Hemorrhagic Fever and was taken to the 25th Evacuation Hospital where he died on June 11, 1952. George is buried in Llano Cemetery, Amarillo, Texas.
Hooper, Pfc. Robert Mullen Jr. - Robert was born on January 18, 1925, son of World War I veteran Robert M. Hooper Sr. (1894-1963) and Mary Lou Williams Hooper (1897-1990). Robert Jr. was a member of the 3rd Antiaircraft Artillery AW Battalion, 3rd Infantry Division. He died in the 121 Evac Hospital in Korea and is buried in Ashley Heights Cemetery, Ashley Heights, North Carolina.
Horne, Cpl. Arvel Cook Jr. - Arvel was born October 12, 1927, son of Arvel Cook Horne Sr. (1901-1968) and Una Belle Reed Horne (1904-1954). His sister was Margaret Lee Horne Perkins (1923-1990). He was serving with Battery B, Aircraft Artillery (Automatic Weapons) Battalion, 7th Infantry Division, when he died at the 8228 MASH. This World War II veteran is buried in Resthaven Memorial Park, Princeton, West Virginia.
Johnson, Cpl. Donald Richard - Donald was born on April 8, 1929. He was from Ohio. The KWE believes (but has not confirmed) that he was the son of Robert B. Johnson (1883-1954) and Myrtle D. Hopkins Johnson, and his siblings were (possibly) Lida May Heath (1920-2006) and Herbert Johnson. Donald was serving with Company M, 3rd Battalion, 14th Infantry Regiment, 25th Infantry Division when he died at the 121st Evac Hospital. He is buried in Mentor Municipal Cemetery, Mentor, Ohio.
Johnson, Pfc. James Grant - James was born July 18, 1933. He contracted hemorrhagic fever while serving in Company A, 2nd Battalion, 38th Infantry Regiment, 2nd Infantry Division. He is buried in Mount Tabor Baptist Church Cemetery, Shumansville, Virginia.
Johnson, Pfc. Walter Fair - Walter was born November 22, 1930 and was from the Grand Cane, Louisiana area. He was serving with the 14th Infantry Regiment, G Company, 2nd Battalion, 25th Infantry Division when he died at the 11th Evacuation Hospital. He is buried in Friendship Cemetery, Grand Cane, Louisiana.
Kiedrowski, Pfc. Edward - Edward was born on July 8, 1927, a son of Joseph V. Kiedrowski (1869-1953) and Magdalena Garski Kiedrowski (1890-1965). His siblings were Florian Thomas (1911-1962), Chester V. (1914-1975), twin infants Alexander and Dominic (1915-1915), Regina (LeGros) (1916-1998), Alexander Valentine (1918-1992), Emil Ambrose (1919-2011), Elizabeth M. (Szczesniak) (1921-2019), Magdalen Celia (Conrad) (1023-2011), Rose Maryann (Zink) 1924-2002) and Geraldine Laverne (Krolikowski) (1931-2020) and seven half siblings. Edward was serving with the 7th Marine Regiment, Company C, 1st Battalion, 1st Marine Division, when he was wounded on May 28, 1952. He then contracted hemorrhagic fever, was evacuated to the USS Haven (AH-12) hospital ship, where he died. He is buried in Saint Florian Catholic Cemetery, Hatley, Wisconsin.
Linton, Capt. Paul Melvin - Paul was from Essex County, Massachusetts. He was serving in the 21st Ordnance Direct Support Company when he died of acute hemorrhagic fever and died at the 44th MASH. The 35 year old was a World War II and Korean War veteran who received the Distinguished Service Cross. He is buried in Pine Grove Cemetery, Lynn, Massachusetts
Lloyd, Sfc. Harold Alvin - Harold was born September 23, 1926 in Dayton, Ohio, a son of Arthur Lloyd and Clara Reinhart Lloyd. His siblings were Thomas "Tommy" Lloyd (survivor of the Bataan Death March in World War II), Robert Lloyd, Glenn Lloyd, Jack Lloyd, Helen Lloyd and Betty Lloyd Perry. He was married to Jessie Orr in New York, and they had one child, Theodore H. "Teddy" Lloyd, who was only 14-months old when his father died in Korea, They lived on Governor's Island, New York before he went to Korea. Theodore now lives with his wife Sonja in Mechanicsburg, Pennsylvania. During the Vietnam War Theodore served with the 595th Maintenance Company, 8th Army, and the 227th Maintenance Company in South Korea from April 1973 to May 1974. Harold Lloyd was a platoon sergeant, motorman and military policeman in Korea. He was also the recipient of a Bronze Star for meritorious service. He served in Company H, 2nd Battalion, 38th Infantry Regiment, 2nd Infantry Division. He died of hemorrhagic fever and is buried in Long Island National Cemetery, East Farmingdale, New York. Jessie Orr Lloyd later remarried and died on March 13, 2013.
Bronze Star Citation (awarded posthumously): Sergeant First Class Harold A. Lloyd, RA39733005, Infantry, United States Army, Company "H", 38th Infantry Regiment, 2nd Infantry Division, distinguished himself by meritorious service from 20 November 1952 to 9 November 1953. During that period Sergeant Lloyd served as Patrol and Desk Sergeant, 2nd Military Police Company and Platoon Leader, 81mm mortar section, Company "H", 38th Infantry Regiment. As Desk Sergeant he displayed a complete knowledge of administrative matters and worked long and arduous hours to insure a high standard of operational efficiency. His enthusiasm for his job and devotion to duty contributed greatly to the effective operation of the section. Sergeant Lloyd continuously displayed unusual coolness when fire missions were required, setting an example that was directly responsible for the high morale of the men under his command. He continually displayed a high degree of initiative and sound judgment which resulted in increased tactical proficiency. The services rendered by Sergeant Lloyd reflect great credit upon himself and the military service.
Locklin, Cpl. John Hildred - John was born October 10, 1927, a son of Hildred Locklin (1903-1992) and Corine Jospehine Crayton Locklin (1908-2006). John was a member of the 7th Cavalry Regiment, F Company, 2nd Battalion. His siblings were Mrs. Robert Louis (Lillian Marie Locklin) Prince (1926-2007), Cornelius Locklin (1929-1935), Howard Lee Locklin, and Mrs. James Reginald (Ruby Ray Locklin) Wheeler (1932-2006). John died in the Osaka Army Hospital, Honshu, Japan, and is buried in Journeys End Cemetery, Burkburnett, Wichita County, Texas.
Markitello, Pvt2 Louis - Louis was born on April 05, 1928, in Oakland, Alameda County, California. He was a member of A Company, 1st Battalion, 35th Infantry Regiment, 25th Infantry Division. He died in the 21st Evac Hospital, Pusan, Korea, and is buried in Golden Gate National Cemetery, San Bruno, California.
Martineau, Pfc. George Percy - George was born January 28, 1926, a son of World War I veteran Lorenzo A. Martineau (1894-1985) and Margaret M. Wills Martineau (1903-1985). His siblings were World War II veteran Arthur (1924-2012), Elmere Kramer, Faye Quam, William, Doris Margaret Markel (1936-2018), Frances Sather, Judy Hove, Joyce Wosick, Wanda DuRain, Connie Bushaw (his youngest sister who was five at the time of his death), Richmond E. l(1932-1939) and Mary Louise Keney. In 1940, George and his family were living in Eastman, North Dakota. During the Korean War George was a wireman with H Company, 3rd Battalion, 7th Marines. While on patrol from Hill 229 near the "Yoke", he contracted hemorrhagic fever. He was admitted to Company E, 1st Medical Battalion on July 05, 1952. The next day George was evacuated to the 8228th MASH and died there on July 10, 1952. His body was accompanied home by James F. Frye and he was buried in Pembina Cemetery, Pembina, North Dakota.
McNeil, Pfc. Francis Leonard - Francis was born December 30, 1927, in Santa Barbara, California, a son of Francis Jesse "Frank" McNeil (1896-1970) and Louise Emily Stickney McNeil (1895-1979). His sibling was Robert Stickney McNeil. Francis Leonard was a member of Company M, 3rd Battalion, 65th Infantry Regiment, 3rd Infantry Division when he died at the 121st Evac Hospital of hemorrhagic fever. He is buried in the San Luis IOOF Cemetery, San Luis Obispo, California.
McPherson, MSgt. Ralph Arlin - Ralph was born May 7, 1924. He was a World War II veteran. During the Korean War he was a member of Battery C, 99th Field Artillery Battalion, 1st Cavalry Division. He died in the 121st Evac Hospital and is buried in Knoxville National Cemetery, Knoxville, Tennessee.
McReynolds, Sgt. Cornelius - Cornelius was born November 28, 1929, son of Cornelius McReynolds. He was serving with A Battery, 82nd Anti-Aircraft Artillery AW Battalion when he contracted hemorrhagic fever and died in the 48th MASH. He is buried in Lincoln Cemetery, Chicago, Illinois.
Messer, Pfc. Harold Richard - Harold was born on December 9, 1928, in Lockridge, Iowa. He was a son of William H. Messer (1879-1943) and Mary Viola Jeffrey Messer (1903-1999) of Iowa. He attended Lockridge schools, was a member of the Baptist Church, and was formerly empoyed by the Burlington Railroad. Harold was indicted in the Army in November 6, 1950 in the third draft from Jefferson County, Iowa. His siblings were Kenneth "Kenny" Wilbert Messer (1937-2015), Carrie Messer Holloway, Elgie Holloway, Guy Gilbert Messer (1924-2012), Archie T. Messer (1926-1993) and Walter Messer. Harold is buried in Lockridge Cemetery, Lockridge, Iowa. He was a member of A Battery, 61st Field Artillery Battalion (105mm) when he contracted hemorrhagic fever. He was evacuated to a Norwegian Mobile Army Surgical Hospital, where he died. He is buried in Lockridge Cemetery, Lockridge, Iowa.
Miller, Maj. Eugene Preston - Eugene was born April 19, 1913, in Bristol, Tennessee, son of Eugene Wade Miller and Mary Kunhert Miller. A World War II and Korean War veteran, Major Miller was married to Helen House Miller of Ogden, Utah. He was a member of the 8202 KMAG when he died at the 121st Evac Hospital. He is buried in Ogden City Cemetery, Ogden, Utah.
Neufeld, Pfc. Donald Milton - Donald was born August 8, 1929, son of John "Jack" Benjamin Neufeld (1897-1966) and Frances Alice Haseman Neufeld. He had a sister, Mrs. William (Esther Frances Neufeld) Morgens (1931-2017). Donald was serving with the 17th Ordnance Medium Maintenance Company. He died of hemorrhagic fever near Kumwha, Korea. Donald was from Cottonwood County, Minnesota.
Norris, Cpl George - George was born March 01, 1929. He was serving with the 64th Heavy Tank Battalion, 3rd Infantry Division when he died in the 121st Evac Hospital. He is buried in Old Mississippi City Cemetery, Gulfport, Harrison County, Mississippi.
Pendegrass, Pvt. William Jr. - William was born April 18, 1928. The KWE believes (but has not proven) that he was related to Flora Pendegrass who died in 1934, and siblings Irene and Willie Mae from St. Clair County, Illinois. William was a member of Heavy Tank Company, 7th Infantry Regiment, 3rd Infantry Division when he contracted hemorrhagic fever and died at the 48th MASH in Korea. He is buried in Jefferson Barracks National Cemetery, Lemay, Missouri.
Schafer, Pfc. Stanton Mayer - Stanton was from Philadelphia County, Pennsylvania. He was serving with the 40th Military Police Company, 40th Infantry Division when he contracted hemorrhagic fever in the 48th MASH.
Simon, Cpl. George Albert - George was born April 12, 1915 in Wolf Run, Ohio, a son of Joseph Simon (died 1926) and Mary Urick Simon (1887-1972). Mary later married Mike Valko. Joseph and Mary were parents of seven children: George Simon, Ann M. Simon Roskos (1917-1996), Michael Joseph Simon (1923-2000), and four other sons. George was serving with Battery A, 37th Field Artillery Battalion, 2nd Infantry Division when he died of hemorrhagic fever at the 8228th MASH. He is buried in Newton Township Cemetery West Side, Newton Falls, Trumbull County, Ohio.
Smith, Pfc. Harold Walter - Harold was born October 1, 1929. He was serving with HQ Company, 65th Infantry, 3rd Infantry Division, when he developed hemorrhagic fever and was evacuated to the 48th Army Surgical Hospital. He died there. Harold is buried in Woodlawn Cemetery, Newfield, Tompkins County, New York.
Sommer, Pfc. Kenneth Charles - Kenneth was a member of Battery A, 64th Field Artillery Battalion, 25th Infantry Division. He developed hemorrhagic fever and was evacuated to the 48 Mobile Army Surgical Hospital where he died on December 5, 1953. He was born in 1931, the son of Carl J. Sommer (1905-1987) and Emma Lockman Sommer. (The KWE has not confirmed the name of his mother.) Kenneth is buried in Beaver Cemetery and Mausoleum, Beaver, Pennsylvania.
Stevens, Cpl. J.E. - J.E. was born November 6, 1929, a son of Thomas S. Stevens (1900-1964) and Mabel Ethel Williams Stevens (1891-1956). His siblings were Doyle Harvey Stevens (1922-1987), Harry Stevens, Clyde Stevens, and Olive Louise Stevens. J.E. enlisted in the Army on April 25, 1951. He was serving in the 702nd Ordnance Maintenance Battalion, 2nd Infantry Division when he contracted hemorrhagic fever and died at the 8228th MASH. This Choctaw American Indian is buried in Green Hills Memorial Park, Rancho Palos Verdes, California.
Stiles, Pvt. Frank Eugene - Frank was born September 12, 1932. He was serving with Headquarters Company, 27th Infantry Regiment, 25th Infantry Division when he contracted hemorrhagic fever and died at the 48th MASH. He is buried in Red Bank Cemetery, Haywood County, North Carolina.
Thomas, Pvt. Edwin - Edwin was born May 25, 1927. He was serving in Company L, 3rd Battalion, 27th Infantry Regiment, 25th Infantry Division when he died of hemorrhagic fever at the 48th MASH. He is buried in Provo City Cemetery, Provo, Utah.
Tillou, Cpl. Everitt James "Jim" - Everitt was born January 29, 1932 in Hackettstown, New Jersey, a son of Frederick B. Tillou Jr. (1895-1951) and Elizabeth Morrison Tillou (1894-1982). His siblings were Donald "Donnie" (1929-1987), Grant (1927-1996), Charles S. "Charlie" (1926-2016), Ruth Tillou Barlow, Howard, Mrs. Robert T. (Julia Tillou) Hackett (died 2014), Mary and John. Everitt was a member of Headquarters Company, 2nd Battalion, 7th Infantry Regiment, 3rd Infantry Division. He contracted hemorrhagic fever and was evacuated to the 48th Mobile Army Surgical Hospital where he died. He is buried in Mount Bethel Methodist Church Cemetery, Port Murray, New Jersey.
Torres-Ramirez, Pfc. Emilio - Emilio was born April 5, 1929 and was from San Sebastian, Puerto Rico. He was serving with Company A, 1st Battalion, 65th Infantry Regiment, 3rd Infantry Division, when he contracted hemorrhagic fever and died in the 8228th MASH. He is buried in the Municipal Cemetery, San Sebastian.
Winters, Pvt. Donald Edwin - Donald was born November 17, 1931, son of Douglass William Winters and Dorothy Mary Winters. He was from the Washington, DC area. He was the company clerk and records keeper for Headquarters, Headquarters Company, 36th Engineer Combat Group. He contracted hemorrhagic fever and died at the 121st MASH. He is buried in Arlington National Cemetery.
Wiseman, Pfc. Donald Gilbert - Donald was born September 01, 1927. He was serving in Company M, 3rd Battalion, 8th Cavalry, 1st Cavalry Division when he contracted hemorrhagic fever and died in the 121st Evac Hospital. He is buried in Golden Gate National Cemetery, San Bruno, California.
© Constance J. Moore
Colonel, ANC (Retired), ANCA Historian
[KWE Note: All credit for the following article goes to Col. Constance J. Moore.]
In the fall of 1951, along the 38th parallel in Korea there was an outbreak of an unknown febrile disease that caused illness-ravaged soldiers to be taken to aid stations and hospitals. The acute, self-limited infectious disease, called hemorrhagic fever, was characterized by a tortuous multitude of acute symptoms, including headache, nausea, blood seepage from weakened vascular walls, delirium, and kidney failure. [Reference #1] Army nurses were challenged to learn quickly how to care for these violently ill patients in order to help save their lives.
24-Hour Urine Collection Hemorrhagic Fever Centers were set up at hospitals such as the 45th Evacuation Hospital [Reference 2] in Seoul or 48th Mobile Army Surgical Hospital (MASH) [Reference 3] just northwest of Seoul. To monitor patients carefully, units were staffed to give one-to-one nursing care. Nurses ensured that patients maintained bed rest, since it slowed the nausea and pain. They discovered the keystone of the therapy was fluid management (hydration and electrolyte levels), and vital sign levels. Weights, intakes and outputs were scrupulously monitored throughout the course of the illness. To regulate body temperatures, patients were sponged and given antipyretics. Trendelenberg bed positioning was used to decrease the blood flow to the extremities. [Reference 4]
Since every patient developed some degree of kidney failure, fluid restriction was required. Cases became critical when patients went into kidney failure from septic shock. Patients deemed good candidates for dialysis were quickly transferred to the 11th Evacuation Hospital’s Renal Insufficiency Center where dialysis was used to hopefully correct severe fluid overload, minimize the effects of shock, and reverse the kidney failure. There were two nurses assigned to the dialysis unit, monitoring three 8-hour dialysis procedures round the clock. [Reference 5] They also sterilized equipment and tubing, and trained newly assigned corpsmen who were served with them. The dramatic changes in the conditions of these patients was chronicled by Lieutenant Mary T. Burley: "The first patient I saw who went on the artificial kidney was near death. The next morning he sat up in bed and read a magazine!" [Reference 6]
Once patients began to recover, Army nurses carefully managed the 8- to 12-week process. Usually patients had lost 30-50 pounds so they were given 5-7 meals each day as well as nutritional supplements and progressive exercises to regain their weight and strength. During this critical period, Nurses did their best to maintain patients’ morale and keep them occupied with entertainment, games and other activities.
Army nurses took the initiative, making quick decisions, and adopting innovative solutions to a broad range of medical-related problems associated with the disease. Because of the care they provided, many soldiers returning home with no ill effects of the disease.
1.George Hoffman, “The Korean War’s Silent Killer Strikes Again,” USA Today (Society for the Advancement of Education): 56.
2.Robert Markelz, “Hemorrhagic Fever 1. Medical Care,” American Journal of Nursing, 56(1): 39.
3.______, “48th Portable Surgical Hospital,” CBI Order of Battle Lineage and History, http://www.cbi-history.com/part_vi_48th_surgical_hosp.html, (accessed April 29, 2011).
4.Katrina Johnson, Hemorrhagic Fever 2. Nursing Care, American Journal of Nursing, 56(1): 41.
5.Duggan Maddux, “Dr. Paul Maddux,” Nephrology Oral History Project, (2007): 5, http://www.voiceexpeditions.com/assets/media/noh/pet/paul-teschan.pdf
6.______, “48th Portable Surgical Hospital,” CBI Order of Battle Lineage and History, http://www.cbi-history.com/part_vi_48th_surgical_hosp.html, (accessed April 29, 2011).
7.Katrina Johnson, Hemorrhagic Fever 2. Nursing Care, American Journal of Nursing, 56(1): 41.
"The Army nurses assigned to unique units also served with heroism in difficult circumstances. Members of the 11th Evacuation Hospital pioneered the art and science of renal dialysis nursing. They were among the first nurses to support patients with hemorrhagic fever on a first generation artificial kidney machine."
Quote from the US Government 60th Anniversary publication, "The Army Nurse Corps in the Korean War"
"As a result of improved resuscitation and treatment practices, .5 percent of patients suffering from shock stayed alive long enough only to end up with acute renal failure because of myocardial potassium intoxication, fluid volume overload, or both. Ninety percent of these patients died until doctors started using dialysis in 1951—and the death rate decreased to 53 percent. Nurses at the 11th Evacuation hospital were among the first to use an artificial kidney machine to treat patients with hemorrhagic fever." - Quote from "War History Online"
[KWE Note: All credit for the following biography of Marjorie J. Bennett is given to the author of: "Me. Here. Right Now: Genealogy for the Cooper, Smith, Smull, Munson, Ripley, Owens, Holler, Leroy, Linsey, Miller, Lisk, and other associated families"] Sideroad: Munson/Woodington Family.
Marjorie Bennett was the daughter of Arthur Bennett (1891-1934) and Emma L Otto Bennett Cohoe (1894-1988) born 15 Jan 1919 in Cassville, Grant County, Wisconsin. When she was 15, her father died and her mother moved the family to Lancaster in Grant County. Marjorie had two brothers who both served during World War II: Robert Henry Bennett, who served in the US Army Air Corps and Arthur Richard Bennett who served in the US Navy.
Marjorie completed her undergrad degree at Plattsburgh State Teacher's College in Wisconsin, then attended Finley School of Nursing in Dubuque, Iowa. She then attended the University of Wisconsin for public health training. In 1945, she began her work as the Assistant then Public Health Nurse for Grant County. While attending school in 1944, she had joined the cadet corps for the Women's Army Corps Reserves and asked to be activated in 1950. She left soon after for Ft Sam Houston, where the Army nursing course was held and was commissioned as a 1st Lieutenant. She graduated in July 1951.
After her training, she was sent to the Percy Jones Army Hospital in Battle Creek, Michigan where she served briefly before being assigned to the 8167th Tokyo Army Hospital during the middle of the Korean Conflict, supporting soldiers whose injuries were severe enough to have them transferred from the Korean theatre. She then did war duty in Korea, assigned to the 11th Evac Hospital. This was fast-moving, tactical medicine, but they were also among the first nurses to help patients with hemorrhagic fever on a first generation artificial kidney machine. The work of the doctors and nurses of the 11th would influence future improvements in renal failure treatment for the world. Only between 500-1,500 nurses served during the Korean conflict (funny how they didn't really keep track), but the women who served suffered the same hardships and trauma as their male counterparts, without the resources to identify at treat conditions like PTSD, especially in women. I'm sure all those who served saw too much.
After her tours overseas, she returned to the States and was assigned to Fort Benning Georgia's Army Hospital. She spent 3-1/2 years there before heading overseas again, this time to Tripler Army Hospital in Honolulu. That had to be a sweet assignment.
Her last assignment was in Georgia, once again and she moved her mother to her home after her stepfather's death. Marjorie retired as a Lt Colonel in about 1970 but stayed in Augusta, Georgia. Brother Robert lived nearby in Columbus, Georgia. Her brother died in 1976. Marjorie remained in Augusta until after her mother's 1988 death, residing in Marshall, Wisconsin until her death in 1995.
Marjorie was an active member in the Retired Officers Association, Retired Army Nurse Corps Association, Veterans of Foreign Wars, and Disabled American Veterans. She picked a career path completely apart from other women of her day and served with distinction in peace and war.
[KWE Note: All credit for the following article goes to the Appalachia State University (North Carolina Nursing History)}
Mattie Donnell Hicks: Korean War Nurse After World War II ended in August 1945, the nation returned to peaceful pursuits. On July 26, 1948, President Truman signed Executive Order 9981, abolishing racial segregation in the armed forces. In June 1950, North Korea, a small Asian nation of little concern to most Americans, launched a surprise invasion of its neighbor to the south. The United States was once again at war, fighting with its ally South Korea. Many active duty nurses were unexpectedly called to scene of battle. One of the North Carolina nurses responding to this call was Mattie Hicks.
Mattie Donnell Hicks was born in Greensboro, North Carolina on September 2, 1914, to John and Josephine Donnell. She was one of ten children. Pursuing her childhood dream, after graduating from the all African American Dudley High School, she enrolled at the Grady Hospital School of Nursing in Atlanta, Georgia. Three years later she earned her diploma and began her career at a segregated, rural hospital in Gainesville, Georgia. Hicks “wanted to do something different in going into the military to try to help the soldiers with their wounds and all that”. She joined the Army Nurse Corps on July 2, 1945 but served only a few weeks until World War II ended in August 1945. However, Hicks realized she enjoyed Army nursing so she re-enlisted in March 1946 and stayed for twenty one years.
When the Korean War broke out, Hicks was assigned to the 11th Evacuation Hospital in Wonju, Korea on the eastern battlefront. During the war, approximately 540 Army Nurses served on the ground in Korea. Seriously wounded and ailing troops were air lifted to awaiting Navy hospital ships or evacuated to Army Hospitals in Japan and the United States for more intense treatment than was available in Korean MASH units or evacuation hospitals. Many Army nurses served in the newly created Mobile Army Surgical Hospitals (MASH) units close to the front. Hicks and other nurses in Evacuation Hospitals took wounded soldiers from the MASH units and provided longer term care. She recalled in an oral history interview in 1999
We enjoyed our work very much. One thing, we were kept busy because patients would be coming right off the battlefield because they had the helicopters to pick them up, bring them right to the hospital which saved a lot of their lives … whenever a shipment would come in, you’d work … if they were in real bad shape, they would ship them on right away. But if they were not in too bad shape, they would stay right there and we’d take care of them.
Each Evacuation Hospital had a specialty area. The 11th Evacuation Hospital had a renal insufficiency unit and pioneered the use of renal dialysis. Hicks and her colleagues at the 11th Evacuation Hospital were among the first nurses to support patients with hemorrhagic fever on the first generation of artificial kidney machines. In addition to patients with renal disease and battlefield wounds, Hicks and her colleagues provided general car for soldiers and their family members with a variety of ailments. She recalled civilians coming to the hospitals with tuberculosis and gastro-intestinal distress.
“We had to run a tube down their throat and clean – and get all the fluid and stuff out of their stomach. And you know, through that tube live worms would come through, Live!”
When asked about her social situation in Korea, including homesickness, cold temperatures, Spartan accommodations and serving in one of the first integrated units in US armed forces history, Hicks remembered, “when you’re afraid, as most of us were, being in a theater where they were fighting and all that, you kind of act like a family”.
After her tour in Korea, Hicks served wherever the Army Nurse Corps needed her. Her postings included hospitals in Japan, Ohio, Pennsylvania, Virginia, Germany and North Carolina. She worked in medical surgical nursing and obstetrical nursing. She earned many medals for her courage and service including the World War II Victory Medal, the Korean Service Medal, the National Defense Service Medal, and Army Commendation Medal, the Armed Service Reserve Medal, a Meritorious Unit Citation and a United Nations Service Medal.
In March, 1966 Hicks retired from the Army having earned the rank of major. She returned home to Greensboro and built a home. After her years of travel she was ready to spend time with her extended family and childhood friends. She was dedicated to her church spending many hours serving on committees, in the choir and helping fellow congregants in need. Hicks passed away on March 14, 2004.
[KWE Note: Barbara Regan, native of Pensacola, Florida, served in the Army Nurse's Corps at the 43rd Surgical Hospital Mobile Army for two years. All credit for the following reference to hemorrhagic fever in Korea is given to Marketta Davis, Pensacola News Journal, "MASH Nurse's Past, Present Mission"]
"Regan said her unit was always busy, especially during the seasonal outbreak of hemorrhagic fever, a life-threatening virus that was passed to humans from mice, rats and fleas. Treatment involved fluids being injected into both arms and legs as well as plasma transfusions.
But what sticks out in Regan's mind the most from the outbreak is her unit's unintentional contribution resulting from a cat. When she first got the hospital where the fever patients were being treated, the nurse she relieved had two cats and wanted Regan to take them for a short time. The nurse said the cats were neutered but one unknowingly wasn't and ended up having four kittens who inevitably became the community rat killers.
Word reached the hospital that an orphanage in Seoul, the neighboring town to the hospital, was in need of cats to help control the rats passing the hemorrhagic fever virus and the hospital staff happily obliged. 'I was able to donate the cats so they were useful,' Regan said."
There is an excellent case study on the Internet about a Korean War veteran's struggle with Post Traumatic Stress. It is entitled, "Korean War Flashbacks: Treating PTSD," published in Mental Health Nursing, July 2003 by Alan Pringle and Dass Musruck. Referring to the veteran only as "John," the editors of Mental Health Nursing state: "Perhaps one of the most striking features of this case is that it concerns a very ordinary man living in a very ordinary street in a very ordinary catchment area. This does beg the question how many other veterans of armed conflict suffer in silence from PTSD symptoms."
How many "very ordinary men (and women) living on very ordinary streets" suffer in silence from PTSD symptoms? Lots and lots of our veterans. Too many. In an article published in PTSD Research Quarterly 7 (1) 1-8, researchers J. Wolfe and S.P. Proctor listed the main features of PTSD as follows:
[KWE Note: The following article is the online version of a published article written by Jim Goodwin, Psy.D. that originally appeared on pages 1-18 of Post-Traumatic Stress Disorders: a handbook for clinicians (Tom Williams, Ed.) in 1987. The Disabled American Veterans organization published the following online version on its website, and graciously granted permission to the Korean War Educator to post it on the KWE.
The article refers to veterans of the Vietnam War, but the content is equally apropos to veterans of the Korean War who suffer from the devastating effects of post-traumatic stress disorder, thus its posting on the KWE. All wars are different and unique in their own point in time and places of battle. But all wars also have similarities. So, too, are the PTSD symptoms experienced by all combat veterans.
Note Dr. Goodwin's list of symptoms of PTSD in Vietnam War veterans: chronic and/or delayed depression, isolation, rage, avoidance of feelings, alienation, survival guilt, anxiety reactions, sleep disturbance and nightmares, intrusive thoughts. While the Korean War and the Vietnam War greatly differed in many respects, the symptoms enumerated by Dr. Goodwin are the exact symptoms now being experienced by Korean War veterans who suffer from PTSD.]
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Most Vietnam veterans have adjusted well to life back in the United States, following their wartime experiences. That's a tribute to these veterans who faced a difficult homecoming to say the least.
However, a very large number of veterans haven't made it all the way home from the war in Southeast Asia. By conservative estimates, at least half a million Vietnam veterans still lead lives plagued by serious, war-related readjustment problems. Such problems crop up in a number of ways, varying from veteran to veteran. Flashbacks to combat... feelings of alienation or anger... depression, loneliness and an inability to get close to others... sometimes drug or alcohol problems... perhaps even suicidal feelings. The litany goes on.
In its efforts to help these veterans, the 700,000-member Disabled American Veterans (DAV) funded the Forgotten Warrior Project research on Vietnam veterans by John P. Wilson, Ph.D. at Cleveland State University. That research resulted in formation of the DAV Vietnam Veterans Outreach Program to provide counseling to these veterans in 1978. With 70 outreach offices across the United States, this DAV program served as a model for the Veterans Administration (VA) Operation Outreach program for Vietnam era veterans, which was established approximately a year later.
Clinically, the readjustment problems these veterans suffer were designated as Post Traumatic Stress Disorders in the American Psychiatric Association's Diagnostic & Statistical Manual III (DSM III). Counseling psychologists working with Vietnam veterans in the DAV and VA outreach programs emphasize that these disorders are not mental illnesses. Rather, they are delayed reactions to the stress these veterans--particularly combat veterans--underwent during the war in Southeast Asia.
The nature of post-traumatic stress disorders among Vietnam veterans is described in this paper by Jim Goodwin, Psy.D. Himself a Marine Corps veteran of Vietnam combat, Dr. Goodwin worked as a volunteer counselor in the DAV Vietnam Veterans Outreach Program while doing graduate work at the University of Denver's School of Professional Psychology. Following these studies, Dr. Goodwin rejoined the Armed Forces and is now a captain on active duty with the U.S. Army.
The material presented here is a condensation of Dr. Goodwin's chapter in Post-Traumatic Stress Disorders: a handbook for clinicians. Edited by Tom Williams, Psy.D., this 1987 book was published by the nonprofit Disabled American Veterans as a guide to counseling professionals who are working with or interested in the problems of Vietnam veterans. Due to limited quantities, the complete book has been made available chiefly to psychiatrists, psychologists and other mental health counseling professionals. It is hoped that Dr. Goodwin's paper will provide all of the information on post-traumatic stress disorders needed by veterans, their families, and the general public.
A final note: Gerald R. Ford, when he was President of our country, asked the American public to put Vietnam behind them and forget it. I can think of no Presidential injunction that has been more effective. As a Vietnam War veteran, myself, I believe it's both healthful and necessary to put the bitterness and dissension of the war years behind us. But to forget the Vietnam War, its troubled veterans, and their families would be unforgivable.
What price must the heart pay to live and love? Say you long hot days ahead without a kind word--days when fear will tear your insides apart - but one must go for duty calls... so very far away. My heart is numb, my brain reels--yet no tears. Another friend is laid to rest. God rest his soul this brave man. Keep him safe for we'll meet again--at another time, in another place. Hot sun, endless hours grant me some respite from loneliness. Sharp rattle, orange streaks across the black sky--a sensation of torn steel, woven with hot flesh and blood beside me. God! God whatever God you be, speed my soul on its way but not in endless eternity. Thoughts of home come to me--don't let me go; please no--I'm afraid!
A cold refreshing wind penetrates my bones--what a strange place this be. I hear familiar voices that have long passed from existence--I see faces--faces of friends long since dead. I realize now what has happened and where I am, yet I am happy with those whose names are carved in stone amidst the grass of a place called Arlington.
Please don't weep for me for I no longer worry about what tomorrow brings... for me it brings a much needed rest... a rest forever.
Below is a description of one Vietnam veteran's life more than ten years after the end of the war in Southeast Asia:
"My marriage is falling apart. We just don't talk any more. Hell, I guess we've never really talked about anything, ever. I spend most of my time at home alone in the basement. She's upstairs and I'm downstairs. Sure we'll talk about the groceries and who will get gas for the car, but that's about it. She's tried to tell me she cares for me, but I get real uncomfortable talking about things like that, and I get up and leave. Sometimes I get real angry over the smallest thing. I used to hit her when this would happen, but lately I just punch out a hole in the wall, or leave and go for a long drive. Sometimes I spend more time on the road just driving aimlessly than I do at home.
"I really don't have any friends and I'm pretty particular about who I want as a friend. The world is pretty much dog eat dog, and no one seems to care much for anyone else. As far as I'm concerned, I'm really not a part of this messed up society. What I'd really like to do is have a home in the mountains, somewhere far away from everyone. Sometimes I get so angry with the way things are being run. I think about placing a few blocks of C-4 (military explosive) under some of the sons-of-bitches. A couple of times a year, I get into fights at bars. I usually pick the biggest guy. I don't know why. I usually get creamed. There are times when I drive real crazily, screaming and yelling at other drivers.
"I usually feel depressed. I've felt this way for years. There have been times I've been so depressed that I won't even leave the basement. I'll usually start drinking pretty heavily around these times. I've also thought about committing suicide when I've been depressed. I've got an old .38 that I snuck back from Nam. A couple of times I've sat with it loaded, once I even had the barrel in my mouth and the hammer pulled back. I couldn't do it. I see Smitty back in Nam with his brains smeared all over the bunker. Hell, I fought too hard then to make it back to the World (U.S.): I can't waste it now. How come I survived and he didn't? There has to be some reason.
"Sometimes, my head starts to replay some of my experiences in Nam. Regardless of what I'd like to think about, it comes creeping in. It's so hard to push back out again. It's old friends, their faces, the ambush, the screams, their faces (tears)... You know, every time I hear a chopper (helicopter) or see a clear unobstructed green tree-line, a chill goes down my back; I remember. When I go hiking now, I avoid green areas. I usually stay above timber line. When I walk down the street, I get real uncomfortable with people behind me that I can't see. When I sit, I always try to find a chair with something big and solid directly behind me. I feel most comfortable in the corner of a room, with walls on both sides of me. Loud noises irritate me and sudden movement or noise will make me jump.
"Night is hardest for me. I go to sleep long after my wife has gone to bed. It seems like hours before I finally drop off. I think of so many of my Nam experiences at night. Sometimes my wife awakens me with a wild look in her eye. I'm all sweaty and tense. Sometimes I grab for her neck before I realize where I am. Sometimes I remember the dream; sometimes it's Nam, other times it's just people after me, and I can't run anymore.
"I don't know, this has been going on for so long; it seems to be getting gradually worse. My wife is talking about leaving. I guess it's no big deal. But I'm lonely. I really don't have anyone else. Why am I the only one like this? What the hell is wrong with me?"
The above description of one Vietnam veteran's problematic lifestyle, more than ten years after the war in Southeast Asia, is unfortunately not an unusual phenomenon.
It was not until World War I that specific clinical syndromes came to be associated with combat duty. In prior wars, it was assumed that such casualties were merely manifestations of poor discipline and cowardice. However, with the protracted artillery barrages commonplace during "The Great War," the concept evolved that the high air pressure of the exploding shells caused actual physiological damage, precipitating the numerous symptoms that were subsequently labeled "shell shock." By the end of the war, further evolution accounted for the syndrome being labeled a "war neurosis" (Glass, 1969).
During the early years of World War II, psychiatric casualties had increased some 300 percent when compared with World War I, even though the pre-induction psychiatric rejection rate was three to four times higher than World War I (Figley, 1978a). At one point in the war, the number of men being discharged from the service for psychiatric reasons exceeded the total number of men being newly drafted (Tiffany and Allerton, 1967).
During the Korean War, the approach to combat stress became even more pragmatic. Due to the work of Albert Glass (1945), individual breakdowns in combat effectiveness were dealt with in a very situational manner. Clinicians provided immediate onsite treatment to affected individuals, always with the expectation that the combatant would return to duty as soon as possible. The results were gratifying. During World War II, 23 percent of the evacuations were for psychiatric reasons. But in Korea, psychiatric evacuations dropped to only six percent (Bourne, 1970). It finally became clear that the situational stresses of the combatant were the primary factors leading to psychological casualty.
Surprisingly, with American involvement in the Vietnam War, psychological battlefield casualties evolved in a new direction. What was expected from past war experiences -- and what was prepared for -- did not materialize. Battlefield psychological breakdown was at an all-time low, 12 per one thousand (Bourne, 1970). It was decided that use of preventative measures learned in Korea and some added situational manipulation which will be discussed later had solved the age-old problem of psychological breakdown in combat.
As the war continued for a number of years, some interesting additional trends were noted. Although the behavior of some combatants in Vietnam undermined fighting efficiency, the symptoms presented rare but very well documented phenomenon of World War II began to be re-observed. After the end of World War II, some men suffering from acute combat reaction, as well as some of their peers with no such symptoms at war's end, began to complain of common symptoms. These included intense anxiety, battle dreams, depression, explosive aggressive behavior and problems with interpersonal relationships, to name a few. These were found in a five-year follow-up (Futterman and Pumpian- Mindlin, 1951) and in a 20-year follow-up (Archibald and Tuddenham, 1965).
A similar trend was once more observed in Vietnam veterans as the war wore on. Both those who experienced acute combat reaction and many who did not began to complain of the above symptoms long after their combatant role had ceased. What was so unusual was the large numbers of veterans being affected after Vietnam. The pattern of neuropsychiatric disorder for combatants of World War II and Korea was quite different than for Vietnam. For both World War II and the Korean War, the incidence of neuropsychiatric disorder among combatants increased as the intensity of the wars increased. As these wars wore down, there was a corresponding decrease in these disorders until the incidence closely resembled the particular prewar periods. The prolonged or delayed symptoms noticed during the postwar periods were noted to be somewhat obscure and few in numbers; therefore, no great significance was attached to them. However, the Vietnam experience proved different. As the war in Vietnam progressed in intensity, there was no corresponding increase in neuropsychiatric casualties among combatants. It was not until the early 1970s, when the war was winding down, that neuropsychiatric disorders began to increase. With the end of direct American troop involvement in Vietnam in 1973, the number of veterans presenting neuropsychiatric disorders began to increase tremendously (President's Commission on Mental Health 1978).
During the same period in the 1970s, many other people were experiencing varying traumatic episodes other than combat. There were large numbers of plane crashes, natural disasters, fires, acts of terrorism on civilian populations and other catastrophic events. The picture presented to many mental health professionals working with victims of these events, helping them adjust after traumatic experiences, was quite similar to the phenomenon of the troubled Vietnam veteran. The symptoms were almost identical. Finally, after much research (Figley, 1978a) by various veterans' task forces and recommendations by those involved in treatment of civilian post-trauma clients, the DSM III (1980) was published with a new category: post-traumatic stress disorder, acute, chronic and/or delayed.
When direct American troop involvement in Vietnam became a reality, military planners looked to previous war experiences to help alleviate the problem of psychological disorder in combat. By then it was an understood fact that those combatants with the most combat exposure suffered the highest incidence of breakdown. In Korea this knowledge resulted in use, to some extent, of a "point system." After accumulating so many points, an individual was rotated home, regardless of the progress of the war. This was further refined in Vietnam, the outcome being the DEROS (date of expected return from overseas) system. Every individual serving in Vietnam, except general officers, knew before leaving the United States when he or she was scheduled to return. The tour lasted 12 months for everyone except the Marines who, known for their one-upmanship, did a 13-month tour. DEROS promised the combatant a way out of the war other than as a physical or psychological casualty (Kormos, 1978).
The advantages were clear: there would not be an endless period of protracted combat with the prospect of becoming a psychological casualty as the only hope for return to the United States without wounds. Rather, if a combatant could just hold together for the 12 or 13 months, he would be rotated to the United States; and, once home, he would leave the war far behind.
The disadvantages to DEROS were not as clear, and some time elapsed before they were noticed. DEROS was a very personal thing; each individual was rotated on his own with his own specific date. This meant that tours in Vietnam were solitary, individual episodes. It was rare, after the first few years of the war, that whole units were sent to the war zone simultaneously. Bourne said it best: "The war becomes a highly individualized and encapsulated event for each man. His war begins the day he arrives in the country, and ends the day he leaves" (p. 12, 1970). Bourne further states, "He feels no continuity with those who precede or follow him: He even feels apart from those who are with him but rotating on a different schedule" (p. 42, 1970).
Because of this very individual aspect of the war, unit morale, unit cohesion and unit identification suffered tremendously (Kormos, 1978). Many studies from past wars (Grinker and Spiegel, 1945) point to the concept of how unit integrity acts as a buffer for the individual against the overwhelming stresses of combat. Many of the veterans of World War II spent weeks or months with their units returning on ships from all over the world. During the long trip home, these men had the closeness and emotional support of one another to rework the especially traumatic episodes they had experienced together. The epitaph for the Vietnam veteran, however, was a solitary plane ride home with complete strangers and a head full of grief, conflict, confusion and joy.
For every Vietnam combatant, the DEROS date became a fantasy that on a specific day all problems would cease as he flew swiftly back to the United States. The combatants believed that neither they as individuals nor the United States as a society had changed in their absence. Hundreds of thousands of men lived this fantasy from day to day. The universal popularity of short- timer calendars is evidence of this. A short-timer was a GI who was finishing his tour overseas. The calendars intricately marked off the days remaining of his overseas tour in all manner of designs with 365 spaces to fill in to complete the final design and mark that final day. The GIs overtly displayed these calendars to one another. Those with the shortest time left in the country were praised by others and would lead their peers on a fantasy excursion of how wonderful and carefree life would be as soon as they returned home. For many, this became an almost daily ritual. For those who may have been struggling with a psychological breakdown due to the stresses of combat, the DEROS fantasy served as a major prophylactic to actual overt symptoms of acute combat reaction. For these veterans, it was a hard- fought struggle to hold on until their time came due.
The vast majority of veterans did hold on as evidenced by the low neuropsychiatric casualty rates during the war (The President's Commission on Mental Health, 1978). Rates of acute combat reaction or acute post-traumatic stress disorder were significantly lowered relative to the two previous wars. As a result, many combatants, who in previous wars might have become psychological statistics, held on somewhat tenuously until the end of their tours in Vietnam.
The struggle for most was an uphill battle. Those motivators that keep the combatant fighting -- unit esprit de corps, small group solidarity and an ideological belief that this was the good fight (Moskos, 1975) -- were not present in Vietnam. Unit esprit was effectively slashed by the DEROS system. Complete strangers, often GIs who were strangers even to a specific unit's specialty, were transferred into units whenever individual rotations were completed. Veterans who had finally reached a level of proficiency had also reached their DEROS date and were rotated. Green troops or "fucking new guys" with almost no experience in combat were thrown into their places. These FNGs were essentially avoided by the unit, at least until after a few months of experience; "short timers" did not want to get themselves killed by relying on inexperienced replacements. Needles to say, the unit culture or esprit was often lost in the lack of communication with the endless leavings and arrivals.
There were other unique aspects of group dynamics in Vietnam. Seasoned troops would stick together, often forming very close small groups for short periods, a normal combat experience noted in previous wars (Grinker and Spiegel, 1945). Some groups formed along racial lines due to lack of unit cohesion within combat outfits. As a seasoned veteran got down to his last two months in Vietnam, he was struck by a strange malady known as the "short timer's syndrome." He would be withdrawn from the field and, if logistically possible, would be settled into a comparatively safe setting for the rest of his tour. His buddies would be left behind in the field without his skills, and he would be left with mixed feelings of joy and guilt. Interestingly, it was rare that a veteran ever wrote to his buddies still in Vietnam once he returned home (Howard, 1975). It has been an even rarer experience for two or more to get together following the war. This is a strong contrast to the endless reunions of World War II veterans. Feelings of guilt about leaving one's buddies to whatever unknown fate in Vietnam apparently proved so strong that many veterans were often too frightened to attempt to find out what happened to those left behind.
Another factor unique to the Vietnam War was that the ideological basis for the war was very difficult to grasp. In World War II, the United States was very clearly threatened by a uniformed and easily recognizable foe. In Vietnam, it was quite the opposite. It appeared that the whole country was hostile to American forces. The enemy was rarely uniformed, and American troops were often forced to kill women and children combatants. There were no real lines of demarcation, and just about any area was subject to attack. Most American forces had been trained to fight in conventional warfare, in which other human beings are confronted and a block of land is either acquired or lost in the fray. However, in Vietnam, surprise firing devices such as booby traps accounted for a large number of casualties with the human foe rarely sighted. A block of land might be secured but not held. A unit would pull out to another conflict in the vicinity; and, if it wished to return to the same block of land, it would once again have to fight to take that land. It was an endless war with rarely seen foes and no ground gains, just a constant flow of troops in and out of the country. The only observable outcome was an interminable production of maimed, crippled bodies and countless corpses. Some were so disfigured it was hard to tell if they were Vietnamese or American, but they were all dead. The rage that such conditions generated was widespread among American troops. It manifested itself in violence and mistrust toward the Vietnamese (DeFazio, 1978), toward the authorities, and toward the society that sent these men to Vietnam and then would not support them. Rather than a war with a just ideological basis, Vietnam became a private war of survival for every American individual involved.
What was especially problematic was that this was America's first teenage war (Williams, 1979). The age of the average combatant was close to 20 (Wilson, 1979). According to Wilson (1978), this period for most adolescents involves a psychosocial moratorium (Erickson, 1968), during which the individual takes some time to establish a more stable and enduring personality structure and sense of self. Unfortunately for the adolescents who fought the war, the role of combatant versus survivor, as well as the many ambiguous and conflicting values associated with these roles, let to a clear disruption of this moratorium and to the many subsequent problems that followed for the young veterans.
Many men, who had either used drugs to deal with the overwhelming stresses of combat or developed other behavioral symptoms of similar stress-related etiology, were not recognized as struggling with acute combat reaction or post-traumatic stress disorder, acute subtype. Rather, their immediate behavior had proven to be problematic to the military, and they were offered an immediate resolution in the form of administrative discharges, often with diagnoses of character disorders (Kormos, 1978).
The administrative discharge proved to be another method to temporarily repress any further overt symptoms. It provided yet another means of ending the stress without becoming an actual physical or psychological casualty. It, therefore, served to lower the actual incidence of psychological breakdown, as did the DEROS. Eventually, this widely used practice came to be questioned, and it was recognized that it had been used as a convenient way to eliminate many individuals who had major psychological problems dating from their combat service (Kormos, 1978).
When the veteran finally returned home, his fantasy about his DEROS date was replaced by a rather harsh reality. As previously stated, World War II vets took weeks, sometimes months, to return home with their buddies. Vietnam vets returned home alone. Many made the transition from rice paddy to Southern California in less than 36 hours. The civilian population of the World War II era had been treated to movies about the struggles of readjustment for veterans (i.e. The Man In The Grey Flannel Suit, The Best Years of Our Lives, Pride of The Marines) to prepare them to help the veteran (DeFazio, 1978). The civilian population of the Vietnam era was treated to the horrors of the war on the six o'clock news. They were tired and numb to the whole experience. Some were even fighting mad, and many veterans came home to witness this fact. Some World War II veterans came home to victory parades. Vietnam veterans returned in defeat and witnessed antiwar marches and protests. For World War II veterans, resort hotels were taken over and made into redistribution stations to which veterans could bring their wives and devote two weeks to the initial homecoming (Boros, 1973). For Vietnam veterans, there were screaming antiwar crowds and locked military bases where they were processed back into civilian life in two or three days.
Those veterans who were struggling to make it back home finally did. However, they had drastically changed, and their world would never seem the same. Their fantasies were just that: fantasy. What they had experienced in Vietnam and on their return to their homes in the United States would leave an indelible mark that many may never erase.
More than 8.5 million individuals served in the U.S. Armed Forces during the Vietnam era, 1964-1973. Approximately 2.8 million served in Southeast Asia. Of the latter number, almost one million saw active combat or were exposed to hostile, life- threatening situations (President's Commission on Mental Health, 1978). It is this writer's opinion that the vast majority of Vietnam era veterans have had a much more problematic readjustment to civilian life than did their World War II and Korean War counterparts. This was due to the issues already discussed in this chapter, as well as to the state of the economy and the inadequacy of the GI Bill in the early 1970s. In addition, the combat veterans of Vietnam, many of whom immediately tried to become assimilated back into the peacetime culture, discovered that their outlook and feelings about their relationships and future life experiences had changed immensely. According to the fantasy, all was to be well again when they returned from Vietnam. The reality for many was quite different.
A number of studies point out that those veterans subjected to more extensive combat show more problematic symptoms during the period of readjustment (Wilson, 1978; Strayer & Ellenhorn, 1975; Kormos, 1978; Shatan, 1978; Figley, 1978b). The usual pattern has been that of a combat veteran in Vietnam who held on until his DEROS date. He was largely asymptomatic at the point of his rotation back to the U.S. for the reasons previously discussed; on his return home, the joy of surviving continued to suppress any problematic symptoms. However, after a year or more, the veteran would begin to notice some changes in his outlook (Shatan, 1978). But, because there was a time limit of one year after which the Veterans Administration would not recognize neuropsychiatric problems as service-connected, the veteran was unable to get service-connected disability compensation. Treatment from the VA was very difficult to obtain. The veteran began to feel depressed, mistrustful, cynical and restless. He experienced problems with sleep and with his temper. Strangely, he became somewhat obsessed with his combat experiences in Vietnam. He would also begin to question why he survived when others did not.
For approximately 500,000 veterans (Wilson, 1978) of the combat in Southeast Asia, this problematic outlook has become a chronic lifestyle affecting not only the veterans but countless millions of persons who are in contact with these veterans. The symptoms described below are experienced by all Vietnam combat veterans to varying degrees. However, for some with the most extensive combat histories and other variables which have yet to be enumerated, Vietnam-related problems have persisted in disrupting all areas of life experience. According to Wilson (1978), the number of veterans experiencing these symptoms will climb until 1985, based on his belief of Erickson's psychosocial developmental stages and how far along in these stages most combat veterans will be by 1985. Furthermore, without any intervention, what was once a reaction to a traumatic episode may for many become an almost unchangeable personality characteristic.
The vast majority of the Vietnam combat veterans I have interviewed are depressed. Many have been continually depressed since their experiences in Vietnam. They have the classic symptoms (DSM III, 1980) of sleep disturbance, psychomotor retardation, feelings of worthlessness, difficulty in concentrating, etc. Many of these veterans have weapons in their possession, and they are no strangers to death. In treatment, it is especially important to find out if the veteran keeps a weapon in close proximity, because the possibility of suicide is always present.
When recalling various combat episodes during an interview, the veteran with a post-traumatic stress disorder almost invariably cries. He usually has had one or more episodes in which one of his buddies was killed. When asked how he handled these death when in Vietnam, he will often answer, "in the shortest amount of time possible" (Howard, 1975). Due to circumstances of war, extended grieving on the battlefield is very unproductive and could become a liability. Hence, grief was handled as quickly as possible, allowing little or no time for the grieving process. Many men reported feeling numb when this happened. When asked how they are now dealing with the deaths of their buddies in Vietnam, they invariable answer that they are not. They feel depressed; "How can I tell my wife, she'd never understand?" they ask. "How can anyone who hasn't been there understand?" (Howard, 1975).
Accompanying the depression is a very well developed sense of helplessness about one's condition. Vietnam-style combat held no final resolution of conflict for anyone. Regardless of how one might respond, the overall outcome seemed to be just an endless production of casualties with no perceivable goals attained. Regardless of how well one worked, sweated, bled and even died, the outcome was the same. Our GIs gained no ground; they were constantly rocketed or mortared. They found little support from their "friends and neighbors" back home, the people in whose name so many were drafted into military service. They felt helpless. They returned to the United States, trying to put together some positive resolution of this episode in their lives, but the atmosphere at home was hopeless. They were still helpless. Why even bother anymore?
Many veterans report becoming extremely isolated when they are especially depressed. Substance abuse is often exaggerated during depressive periods. Self medication was an easily learned coping response in Vietnam; alcohol appears to be the drug of choice.
Combat veterans have few friends. Many veterans who witnessed traumatic experiences complain of feeling like old men in young men's bodies. They feel isolated and distant from their peers. The veterans feel that most of their non-veteran peers would rather not hear what the combat experience was like; therefore, they feel rejected. Much of what many of these veterans had done during the war would seem like horrible crimes to their civilian peers. But, in the reality faced by Vietnam combatants, such actions were frequently the only means of survival.
Many veterans find it difficult to forget the lack of positive support they received from the American public during the war. This was especially brought home to them on the return from the combat zone to the United States. Many were met by screaming crowds and the media calling them "depraved fiends" and "psychopathic killers" (DeFazio, 1978). Many personally confronted hostility from friends and family, as well as strangers. After their return home, some veterans found that the only defense was to search for a safe place. These veterans found themselves crisscrossing the continent, always searching for that place where they might feel accepted. Many veterans cling to the hope that they can move away from their problems. It is not unusual to interview a veteran who, either alone or with his family, has effectively isolated himself from others by repeatedly moving from one geographical location to another. The stress on his family is immense.
The fantasy of living the life of a hermit plays a central role in many veterans' daydreams. Many admit to extended periods of isolation in the mountains, on the road, or just behind a closed door in the city. Some veterans have actually taken a weapon and attempted to live off the land.
It is not rare to find a combat veteran who has not had a social contact with a woman for years -- other than with a prostitute, which is an accepted military procedure in the combat setting. If the veteran does marry, his wife will often complain about the isolation he imposes on the marital situation. The veteran will often stay in the house and avoid any interactions with others. He also resents any interactions that his spouse may initiate. Many times, the wife is the source of financial stability.
The veterans' rage is frightening to them and to others around them. For no apparent reason, many will strike out at whomever is near. Frequently, this includes their wives and children. Some of these veterans can be quite violent. This behavior generally frightens the veterans, apparently leading many to question their sanity; they are horrified at their behavior. However, regardless of their afterthoughts, the rage reactions occur with frightening frequency.
Often veterans will recount episodes in which they became inebriated and had fantasies that they were surrounded or confronted by enemy Vietnamese. This can prove to be an especially frightening situation when others confront the veteran forcibly. For many combat veterans, it is once again a life-and- death struggle, a fight for survival.
Some veterans have been able to sublimate their rage, breaking inanimate objects or putting fists through walls. Many of them display bruises and cuts on their hands. Often, when these veterans feel the rage emerging, they will immediately leave the scene before somebody or something gets hurt; subsequently, they drive about aimlessly. Quite often, their behavior behind the wheel reflects their mood. A number of veterans have described to me the verbal catharsis they've achieved in explosions of expletives directed at any other drivers who may wrong them.
There are many reasons for the rage. Military training equated rage with masculine identity in the performance of military duty (Eisenhart, 1975). Whether one was in combat or not, the military experience stirred up more resentment and rage than most had ever felt (Egendorf, 1975). Finally, when combat in Vietnam was experienced, the combatants were often left with wild, violent impulses and no one upon whom to level them. The nature of guerrilla warfare -- with its use of such tactics as booby trap land mines and surprise ambushes with the enemy's quick retreat -- left the combatants feeling like time bombs; the veterans wanted to fight back, but their antagonists had long since disappeared. Often they unleashed their rage at indiscriminate targets for want of more suitable targets (Shatan, 1978).
On return from Vietnam, the rage that had been tapped in combat was displaced against those in authority. It was directed against those the veterans felt were responsible for getting them involved in the war in the first place -- and against those who would not support the veterans while they were in Vietnam or when they returned home (Howard, 1975). Fantasies of retaliation against political leaders, the military services, the Veterans Administration and antiwar protesters were present in the minds of many of these Vietnam combat veterans. These fantasies are still alive and generalized to many in the present era.
Along with the rage at authority figures from the Vietnam era, these veterans today often feel a generalized mistrust of anyone in authority and the "system" in the present era. Many combat veterans with stress disorders have a long history of constantly changing their jobs. It is not unusual to interview a veteran who has had 30 to 40 jobs during the past 10 years. One veteran I interview had nearly 80 jobs in a 10-year span. The rationale quite often given by the veterans is that they became bored or the work was beneath them. However, after I made some extended searched into their work backgrounds, it became apparent that they felt deep mistrust for their employers and coworkers; they felt used and exploited; at times, such was the case. Many have had some uncomfortable confrontations with their employers and job peers, and many have been fired or have resigned on their own.
The spouses of many of the veterans I have interviewed complain that the men are cold, uncaring individuals. Indeed the veterans themselves will recount episodes in which they did not feel anything when they witnessed the death of a buddy in combat or the more recent death of a close family relative. They are often somewhat troubled by these responses to tragedy; but, on the whole, they would rather deal with tragedy in their own detached way. What becomes especially problematic for these veterans, however, is an inability to experience the joys of life. They often describe themselves as being emotionally dead (Shatan, 1973).
The evolution of this emotional deadness began for Vietnam veterans when they first entered military boot camp (Shatan, 1973). There they learned that the Vietnamese were not to be labeled as people but as "gooks, dinks, slopes, zipperheads and slants." When the veterans finally arrived in the battle zone, it was much easier to kill a "gook" or "dink" than another human being. This dehumanization gradually generalized to the whole Vietnam experience. The American combatants themselves became "grunts," the Viet Cong became "Victor Charlie," and both groups were either "KIA" (killed in action) or "WIA" (wounded in action). Often, many "slopes" would get "zapped" (killed) by a "Cobra" (gunship), and the "grunts" would retreat by "Shithook" (evacuation by a Chinook helicopter); the jungle would be sown by "Puff the Magic Dragon" (a C-47 gunship with rapid-firing mini-gattling guns).
The pseudonyms served to blunt the anguish and the horror of the reality of combat (DeFazio, 1978). In conjunction with this almost surreal aspect of the fighting, psychic numbing furthered the coping and survival ability of the combatants by effectively knocking the aspect of feelings out of their cognitive abilities (Lifton, 1976). This defense mechanism of survivors of traumatic experiences dulls an individual's awareness of the death and destruction about him. It is a dynamic survival mechanism, helping one to pass through a period of trauma without becoming caught up in its tendrils. Psychic numbing only becomes nonproductive when the period of trauma is passed, and the individual is still numb to the affect around him.
Many veterans find it extremely uncomfortable to feel love and compassion for others. To do this, they would have to thaw their numb reactions to the death and horror that surrounded them in Vietnam. Some veterans I've interview actually believe that if they once again allow themselves to feel, they may never stop crying or may completely lose control of themselves; what they mean by this is unknown to them. Therefore, many of these veterans go through life with an impaired capacity to love and care for others. they have no feeling of direction or purpose in life. They are not sure why they even exist.
When others have died and some have not, the survivors often ask, "How is it that I survived when others more worthy than I did not?" (Lifton, 1973). Survival guilt is an especially guilt- invoking symptom. It is not based on anything hypothetical. Rather, it is based on the harshest of realities, the actual death of comrades and the struggle of the survivor to live. Often the survivor has had to compromise himself or the life of someone else in order to live. The guilt that such an act invokes or guilt over simply surviving may eventually end in self-destructive behavior by the survivor.
Many veterans, who have survived when comrades were lost in surprise ambushes, protracted battles or even normal battlefield attrition, exhibit self-destructive behavior. It is common for them to recount the combat death of someone they held in esteem; and, invariably, the questions comes up, "Why wasn't it me?" It is not unusual for these men to set themselves up for hopeless physical fights with insurmountable odds. "I don't know why, but I always pick the biggest guy," said the veteran in the transcript at the beginning of this chapter. Shatan (1973) notes that some of these men become involved in repeated single-car accidents. This writer interviewed one surviving veteran, whose company suffered over 80% casualties in one ambush. The veteran had had three single-car accidents during the previous week, two the day before he came in for the interview. He was wondering if he were trying to kill himself.
I have also found that those veterans who suffer the most painful survival guilt are primarily those who served as corpsmen or medics. These unfortunate veterans were trained for a few months to render first aid on the actual field of battle. The services they individually performed were heroic. With a bare amount of medical knowledge and large amounts of courage and determination, they saved countless lives. However, many of the men they tried to save died. Many of these casualties were beyond all medical help, yet many corpsmen and medics suffer extremely painful memories to this day, blaming their "incompetence" for these deaths. Listening to these veterans describe their anguish and torment... seeing the heroin tracks up and down their arms or the bones that have been broken in numerous barroom fights... is, in itself, a very painful experience.
Another less destructive trend that I have noticed exists among a small number of Vietnam combat veterans who have become compulsive blood donors. One very isolated and alienated individual I interviewed actually drives some 80 miles round-trip once every other month to make his donation. His military history reveals that he was one of 13 men out of a 60-man platoon who survived the battle of Hue. He was the only survivor who was not wounded. this veteran and similar vets talk openly about their guilt, and they find some relief today in giving their blood that others may live.
Many Vietnam veterans describe themselves as very vigilant human beings; their autonomic senses are tuned to anything out of the ordinary. A loud discharge will cause many of them to start. A few will actually take such evasive action as falling to their knees or to the ground. Many veterans become very uncomfortable when people walk closely behind them. One veteran described his discomfort when people drive directly behind him. He would pull off the road, letting others pass, when they got within a few car lengths of him.
Some veterans are uncomfortable when standing out in the open. Many are uneasy when sitting with others behind them, often opting to sit up against something solid, such as a wall. The bigger the object is, the better. Many combat veterans are most comfortable when sitting in the corner in a room, where they can see everyone about them. Needless to say, all of these behaviors are learned survival techniques. If a veteran feels continuously threatened, it is difficult for him to give such behavior up.
A large number of veterans possess weapons. This also is a learned survival technique. Many still sleep with weapons in easy reach. The uneasy feeling of being caught asleep is apparently very difficult to master once having left the combat zone.
Few veterans struggling with post-traumatic stress disorders find the hours immediately before sleep very comfortable. In fact, many will stay awake as long as possible. They will often have a drink or smoke some cannabis to dull any uncomfortable cognition that may enter during this vulnerable time period. Many report that they have nothing to occupy their minds at the end of the day's activities, and their thoughts wander. For many of them, it is a trip back to the battle zone. Very often they will watch TV late into the mornings.
Finally, with sleep, many veterans report having dreams about being shot at or being pursued and left with an empty weapon,, unable to run anymore. Recurrent dreams of specific traumatic episodes are frequently reported. It is not unusual for a veteran to reexperience, night after night, the death of a close friend or a death that he caused as a combatant. Dreams of everyday, common experiences in Vietnam are also frequently reported. For many, just the fear that they might actually be back in Vietnam is very disquieting.
Some veterans report being unable to remember their specific dreams, yet they feel dread about them. Wives and partners report that the men sleep fitfully, and some call out in agitation. A very few actually grab their partners and attempt to do them harm before they have fully awakened. Finally, maintaining sleep has proven to be a problem for many of these veterans. They report waking up often during the night for no apparent reason. Many rise quite early in the morning, still feeling very tired.
Traumatic memories of the battlefield and other less affect- laden combat experiences often play a role in the daytime cognitions of combat veterans. Frequently, these veterans report replaying especially problematic combat experiences over and over again. Many search for possible alternative outcomes to what actually happened in Vietnam. Many castigate themselves for what they might have done to change the situation, suffering subsequent guilt feelings today because they were unable to do so in combat. The vast majority report that these thoughts are very uncomfortable, yet they are unable to put them to rest.
Many of the obsessive episodes are triggered by common, everyday experiences that remind the veteran of the war zone: helicopters flying overhead, the smell of urine (corpses have no muscle tone, and the bladder evacuates at the moment of death), the smell of diesel fuel (the commodes and latrines contained diesel fuel and were burned when filled with human excrement), green tree lines (these were searched for any irregularity which often meant the presence of enemy movement), the sound of popcorn popping (the sound is very close to that of small arms gunfire in the distance), any loud discharge, a rainy day (it rains for months during the monsoons in Vietnam) and finally the sight of Vietnamese refugees.
A few combat veterans find the memories invoked by some of these and other stimuli so uncomfortable that they will actually go out of their way to avoid them. When exposed to one of the above or similar stimuli, a very small number of combat veterans undergo a short period of time in a dissociative-like state in which they actually re-experience past events in Vietnam. These flashbacks can last anywhere from a few seconds to a few hours. One veteran described an episode to me in which he had seen some armed men and felt he was back in Vietnam. The armed men were police officers. Not having a weapon to protect himself and others, he grabbed a passerby and forcefully sheltered this person in his home to protect him from what he felt were the "gooks." He was medicated and hospitalized for a week.
Such experiences among Vietnam veterans are rare, but not as uncommon as many may believe. Many veterans report flashback episodes that last only a few seconds. For many, the sound of a helicopter flying overhead is a cue to forget reality for a few seconds and remember Vietnam, re-experiencing feelings they had there. It is especially troublesome for those veterans who are still "numb" and specifically attempting to avoid these feelings. For others, it is just a constant reminder of their time in Vietnam, something they will never forget.
As already discussed, post-traumatic stress disorders result in widely varying degrees of impairment. When a single veteran (whether bachelor or divorced) with the disorder requests help, I refer him to a group of other combat veterans. The reasons are twofold. First, the veteran is usually quite isolated and has lost many of his social skills. He has few contacts with other human beings. The group provides a microcosm in which he can again learn how to interact with other people. It also helps remove the fear, prevalent among these veterans, that each individual veteran is the only individual with these symptoms. In addition, many of the veterans form close support groups of their own outside the therapy sessions; they telephone each other and help each other through particularly problematic episodes.
Second, the most basic rationale for group treatment of these veterans is that it finally provides the veteran with that "long boat ride home" with other veterans who have had similar experiences. It provides a forum in which veterans troubled by their combat experiences can work their feelings through with other veterans who have had similar conflicts. In addition, the present symptoms of the disorder are all quite similar, and there is more reinforcement in working through these symptoms with one's peers than in doing it alone.
The group situation is appropriate for most degrees of the symptoms presented. The especially isolated individuals will often be quite frightened of the initial group session. When challenged by questioning the strength that brought them to the initial interview, however, they will usually respond by following through with the group. Those with severely homicidal or suicidal symptoms are best handled in a more crisis-oriented, one-to-one setting until the crisis is resolved. I refer these veterans to an appropriate emergency team, with the expectation directly shared with the veteran that he will join the group as soon as the crisis has abated.
Veterans who are presently married or living with a partner present a somewhat different picture. Their relationships with their partners are almost invariable problematic. Frequently, a violent, explosive episode at home created the crisis that brought the veteran in for counseling in the first place. When such is the case or there is a history of battering of the partner, it is extremely important to refer the veteran and his partner to a family disturbance counseling center. The consequences of this continued behavior are obvious. In addition, a referral for the veteran to a group with other combat veterans is appropriate. The partner of the veteran may find some understanding of her plight and additional support from a woman's group created specifically for partners of Vietnam combat veterans.
Other veterans who are married or living with a partner may not be experiencing so serious a problem. However, the partners are often detached from one another; they just seem to live under the same roof, period. Referral of the veteran to a combat veterans group and referral of the partner to a partners of Vietnam veterans group is important.
Some veterans and their partners will jointly attend the screening session. Both are troubled by what has been happening and often want to enter marital therapy together immediately. In my experience, the veteran finds it extremely difficult in the beginning of therapy to deal with interactional aspects with his partner when other past interactions with traumatic overtones overshadow the present. When these traumatic experiences do surface, the partner is often unable to relate. Therefore, it is much more beneficial, in my opinion, to allow the veteran time with other combat veterans in a group. In the meantime, suggest a woman's support group for partners of Vietnam veterans for the spouse. Here she would receive additional support as well as an understanding of post-traumatic stress disorders. Sometime thereafter, marital therapy, couples group therapy or family therapy may be appropriate.
Many veterans with post-traumatic stress disorders, in addition to the symptoms already described, also have significant problems due to multiple substance abuse. In my experience, those veterans who have habitually medicated themselves have compounded the problem. Not only do they experience many of the symptoms already described, but the additional symptoms of chronic multiple substance abuse and alcoholism may mask the underlying reasons for self-medication as well. Therefore, these chronic syndromes, which perpetuate themselves through addictive behavior, must be dealt with first. Then a more accurate picture of the underlying problem will result, and an appropriate referral can be made.
Except for some help with an immediate crisis upon being first interviewed during the screening session, the combat veteran struggling with the symptoms of post-traumatic stress disorder, chronic and/or delayed, benefits most from group interaction with his combat peers. Throughout this paper I have emphasized the individual, solitary aspect of the war for each veteran. The aftermath of the war has followed in kind. Now, with the help from the DAV Vietnam Veterans Outreach Program and the VA's Operation Outreach (Vet Center) program, models have been established for reintegrating troubled Vietnam veterans with themselves and their society. Helping the community to recognize the problem and directing the veteran to the specialized services of the community have given the veteran struggling with this disorder a means of "coming home."
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Peter Griffin has a website that expands on the subject of Post Combat Stress Disorder. Peter's website includes poems he has written to honor veterans, but it is also a highly informative website about Post Combat Stress Disorder. To learn about the complexities of PCSD and to gain some understanding about those who suffer from it, visit the "Griffin's Lair" website.
Albert Julius Glass and Franklin D. Jones wrote extensively about psychiatry in the Korean War in Chapters 5 through 12 of the government-generated volume, Psychiatry in the U.S. Army: Lessons for Community Psychiatry.
The Soviet-sponsored government of North Korea, having failed to conquer its southern neighbor by less violent means, invaded South Korea (the Republic of Korea) on 25 June 1950. When the United States with other members of the United Nations came to the aid of the South Koreans, a war of over three years resulted that cost the Americans more than 110,000 battle casualties (19,353 KIA and 92,363 WIA) and over 365,000 non-battle admissions for disease and injury, including 13,565 psychiatric disorders. [Footnotes 1,2]
The campaigns set in motion by the invasion of South Korea came to be considered a “limited war.” The fighting was deliberately confined in geographic terms, political decisions placed restrictions upon military strategy and none of the belligerents with the exception of the two Korean governments used its full military potential. [Footnote 2, pp. 1-6] Thus, actual combat between Communist and South Korean-United Nations forces was contained within the Korean peninsula proper, including coastal waters. The United States and its allies did not extend hostilities across the borders of North Korea to attack bases from which came the Chinese Communist offensive or to interfere with the Soviet bases in the maritime provinces of Russia which sent armaments and other military supplies to the North Korean Army.
In June 1950 the active U.S. Army was about 591,000 and included 10 combat divisions. About 360,000 were within the Zone of the Interior. Another 231,000 were overseas, many performing occupation duties. The largest group, 108,500, was in the Far East. In Europe 80,000 were in Germany, 9,500 in Austria, and 4,800 in Trieste. Over 7,000 were assigned to the Pacific area, and about 7,500 to Alaska. In the Caribbean were about 12,200 troops. Several thousand troops were assigned to other military missions throughout the world.
The forces designated to carry out the U.S. Army’s emergency assignment were called the General Reserve. Except for one regimental combat team (RCT) in Hawaii, this force consisted of five combat divisions and small support units in the Zone of the Interior (ZI). The major General Reserve Units on 25 June 1950 were the 2nd Armored Division, 11th Airborne Division (minus one RCT), 3rd Armored Cavalry Regiment, 5th RCT (Hawaii), and the 14th RCT. [Footnote 2 – pp. 433-60]
In June 1950 U.S. Army forces in the Far East Command comprised four under-strength infantry divisions and seven anti-aircraft artillery battalions in Japan and one infantry regiment and two anti-aircraft artillery battalions in Okinawa. Major combat units were the 1st Cavalry Division (actually infantry) in Central Honshu, Japan, the 7th Infantry Division in Northern Honshu and Hokkaido, Japan, the 24th Infantry Division in Kyushu, Southern Japan, the 25th Infantry Division in South Central Honshu, Japan, and the 9th anti-aircraft artillery group in Okinawa.
Eighth Army, the main combat force of the Far East Command, had 93 percent of its authorized strength on 25 June 1950. Each division had an authorized strength of 12,500 men as compared to its authorized war strength of 18,900. Each division was short of its war strength by nearly 7,000 men, 1,500 rifles and 100 90-mm antitank guns, three rifle battalions, six heavy tank companies, three 105-mm field artillery batteries, and three anti-aircraft artillery batteries.
Until 1949, the primary responsibility of military units in the Far East Command was to carry out occupation duties. No serious effort was made in these years to maintain combat efficiency at battalion or higher level. This changed markedly beginning in April 1949, when General MacArthur issued a policy directive in which combat divisions of the Eighth Army were progressively relieved of the majority of their purely occupational missions and directed to undertake, along with Far East Air Force (FEAF) and US Navy, Far East (NAVFE), an intensified program for the establishment of a cohesive and integrated naval, air, and ground fighting team. However, there still remained many administrative features of the occupation which constituted a barrier to the full development of the planned training program.
The readiness of combat units within the Far East Command (FEC) was not enhanced by the quality of enlisted personnel received from the ZI. Replacements arriving from the United States during 1949 had a high percentage of lower intelligence ratings. In April 1949, 43 percent of Army enlisted personnel in FEC, rated in class IV and class V (the two lowest classes) on the Army General Classification Test.
All units of Eighth Army had completed the battalion phase of their training by the target date of 15 May 1950. Reports on Eighth Army’s divisions in May 1950 showed estimates ranging from 84 percent to 65 percent of full combat efficiency for the four divisions in Japan.
Equipment for FEC troops was mostly of World War II vintage. Much of it had been through combat. Vehicles, particularly, had been serviced and maintained with difficulty during the years of occupation. There was unusual dependence upon Japanese workmen, in the absence of U.S. Army service units, to duties ranging from menial hall tasks to highly technical functions.
By mid-1950, the American forces in the Far East had begun a gradual shift away from occupational duties to acquiring combat skills. However, these forces were under-strength, inadequately armed, and sketchily trained as commanders sought to overcome the inertia of years of occupation and the prevailing uneasy peace. [Footnote 2 – pp. 43-60]
Three separate, often different, but linked psychiatric programs of evaluation and treatment were simultaneously being operated in the several geographic areas of the Far East Command (FEC). In Korea, psychiatry at the division level (1st echelon, which included mainly the combat zone) would affect the numbers moved rearward and types of psychiatric cases evacuated to the army communication zone level (2nd echelon) psychiatric services which determined the numbers and types of mental disorders sent to neuropsychiatric services in Japan (3rd echelon). Psychiatric units in Japan or at the army level in Korea could return unfit individuals to combat duty and complicate the problems of division psychiatry. During the initial months of the Korean War, psychiatric facilities in Japan inappropriately evacuated many psychiatric cases to the ZI because “Limited Service” of World War II had been abolished in 1947. Also the neuropsychiatry (NP) staff during this early period were meager and lacked sophistication in combat psychiatry.
At the beginning of the Korean War on 25 June 1950, there were only nine psychiatrists and neurologists in the Far East Command (FEC). Eight of nine were residents with one or more years of training at Letterman, Fitzsimons, or Walter Reed General Hospitals who had been sent to the FEC with residents in other medical specialties in May 1950, for three months temporary duty to provide care for the occupation troops and their dependents. As American forces entered Korea in early July 1950, this small group of psychiatrists and neurologists were deployed in Korea, Japan, and Okinawa.
In response to urgent needs of the FEC for medical officer personnel, psychiatrists, neurologists, and other medical specialists began to arrive in Tokyo by airlift beginning in mid-July 1950. As additional increments of psychiatrists and neurologists arrived in succeeding months, it became necessary to indoctrinate the new arrivals with information relevant to combat psychiatry.
The orientation was conducted at the 361st Station Hospital in Tokyo, the “NP Center” of the FEC to which most incoming psychiatrists and neurologists were initially assigned. This preliminary assignment also made possible a coordination of the qualifications and desires of new arrivals with the needs of the Theater.
During this era, there was not the plethora of medical specialists available to the Army that existed in World War II. Even recall to active duty of many reserve medical officers and later the “doctor’s draft” brought into service mainly young medical officers with partial training and experience in the various medical specialties. Army Medical Service was therefore compelled to utilize its few career medical specialists as supervisors. In this regard, the author, a senior Regular Army specialist board-certified in psychiatry and neurology with extensive experience in World War II combat psychiatry, arrived in Tokyo during late September 1950 to assume the position of Theater Consultant in Neuropsychiatry. Soon he participated in the orientation and assignment of psychiatrists and neurologists new to the theatre. Fortunately, the Neuropsychiatric Consultant to the U.S. Army Surgeon General, Col. John Caldwell MC, had caused to be published a supplemental issue of the Bulletin of the U.S. Army Medical Department in November, 1949 entitled, “Combat Psychiatry.” The Supplemental Issue was entirely devoted to describing in some detail the establishment and operation of an echeloned system of combat psychiatry as developed in the Mediterranean Theater of World War II. “Combat Psychiatry” became the textbook for the orientation of neurosychiatric personnel in the Far East Command.
Beginning during World War I (1914-1918), the manifestations and frequency of most psychiatric disorders in participants of modern warfare were found to be related to the battle casualty rate, i.e., killed-in-action (KIA), wounded-in-action (WIA), and various aspects of the prevailing tactical situation. These relationships were again demonstrated in World War II and noted early in the Korean War.
Such combat related psychiatric disorders became differentiated in World War I, and in World War II from the less frequent traditional peacetime mental illnesses in which causation apparently originated within the person rather than from stressful battle situations. [Footnote 3]
As previously stated in Chapter 1, the term “exhaustion” was created during the Tunisian campaign of the Mediterranean Theater in World War II to designate combat-induced psychiatric disorders. (FDJ: It may have been selected from review of World War I literature since the term was occasionally used then and Hanson may have been familiar with the Salmon lectures.) After World War II, this wartime designation was made permanent as “Combat Exhaustion” on 19 October 1950, by the U.S. Army, which terminology was adopted by the Veterans Administration and later by the American Psychiatric Association. [Footnote 4 – pp. 1-2, Footnote 5 – p. 756]
The treatment of “Combat Exhaustion” was understood during the Korean War; however, some difficulties were encountered in its implementation. Commonly such cases were regarded as psychiatric casualties. Because of the background circumstances described above, combat-inducted psychiatric disorders and their management including prevention and treatment during the Korean War will be described in successive time phases as related to battle casualties, existing tactical situations and associated combat conditions.
Initially, during this period, medical and psychiatric support for 24th Division troops was necessarily limited to emergency care and evacuation which in itself posed difficult problems because of frequent retrograde movement of divisional medical facilities. This tactical situation made impossible the holding of any type patients for intra-divisional treatment. [Footnote 1, pp. 3-20]
Cpt. James Hammill MC (1 ½ years Army neurology residency at Fitzsimons General Hospital) was assigned to the 24th Division. Because of need and the tactical situation, he was utilized as commander of a clearing platoon, a component of the divisional medical battalion. Captain Hammill demonstrated coolness and leadership under fire. His clearing platoon was the last medical facility to leave Taejon as enemy tanks entered the city. His behavior under combat conditions achieved the respect of both line and medical officers which facilitated his later function as 24th Infantry Division Psychiatrist.
Neither the 1st Cavalry Division that arrived in Korea on 18 July nor the 25th Infantry Division whose first elements reached Korea on 15 July had met the enemy until the 24th Division was relieved on 22 July. These fresh elements and ROK forces fought off the North Korean Army with stubborn determination, strengthened the weak United Nations position, and allowed for some semblance of a battle line. But more enemy troops were hurled into the attack, forcing a continuation of United Nations’ withdrawal and delaying tactics. It was still impossible to hold patients for any type of intra-divisional treatment because of enemy infiltration and the realistic fear of medical facilities being overrun. Therefore it was not a serious deficiency that neither the 1st Cavalry Division nor the 25th Infantry Division had an assigned psychiatrist at this time. [Footnote 1 – pp. 3-4, Footnote 2 – pp. 115-125]
Admissions for psychiatric disorders during July 1950 occurred at a rate of 209/1,000/year, the highest in the Koran War to which was associated the highest KIA rate (769.04), the second highest WIA rate (950.97), and a high incidence of MIA (some 2,400) from the 24th Division, many of whom were later declared dead or died of wounds or disease. [Footnote 3, pp. 108, 116] The large majority of American troops in Korea during July 1950 were divisional with only a minority less exposed to combat (28,817 divisional versus 3,793 non-divisional). [Footnote 3, pp. 15-18]
This was in keeping with the accumulated experiences of World War II which indicated that the highest rates of psychiatric casualties occur during the initial severe battle experiences of combat units new to battle before the acquisition of combat skills, the development of group cohesiveness, and the removal of less effective immediate combat leaders. Thus, in July 1950 the most favorable circumstances existed for the causation of psychiatric casualties, namely high battle casualties in units new to intense combat. [Footnote 4]\
The almost continuous intense defensive fighting of August was responsible for the third highest battle casualties (KIA and WIA) of the Korean War and the third highest rate of psychiatric admissions. As the battle lines stabilized, it became possible for division clearing stations to hold and treat mild non-battle casualties. This action was also dictated by a desperate need to rapidly conserve and rehabilitate all available manpower in order to hold the thinly-manned perimeter defense lines. Under these circumstances divisional psychiatric treatment (1st echelon) began in latter August 1950.
Cpt. James Hammill assumed full-time function as the 24th Division psychiatrist. Cpt. Paul Stimson (1 ½ years civilian psychiatry residency) arrived in the 1st Cavalry Division to initiate division psychiatry. Lieutenant Colonel (LTC) Philip Smith (completed three years Army psychiatry residency and Board eligible) was assigned to the 25th Infantry Division in early August and soon thereafter began intra-divisional psychiatric treatment. Cpt. Martin John Schumacher (completed almost three years Army psychiatry residence) arrived with the 2nd Infantry Division in mid-August and began division psychiatry at the end of the month.
In early September, the enemy hurled their strongest assaults at various points of the Pusan Perimeter. As the fighting proceeded at this intensity, heavy casualties of all types were produced in United Nations troops. Intra-divisional psychiatric casualties were in full operation as 100 to 200 psychiatric casualties were receiving care in each of the division treatment centers. Three of the divisions utilized facilities and resources of holding platoons of division clearing companies as psychiatric centers. Additional cots, litters and other needed items, also personnel were somehow obtained by the respective division surgeons who quickly became aware of the project’s value; and, driven by the same need to salvage manpower, instituted similar programs for the intra-divisional treatment of patients wit mild organic illness or injury. Captain Schumacher of the 2nd Infantry Division improvised a separate unit for intra-divisional psychiatric treatment. The necessary equipment and personnel were obtained with the aid of the division chaplain.
Many psychiatric casualties were noted to have a large element of physical exhaustion, which was readily relieved by the two- to four-day period of sleep and rest provided in the treatment regimen. Other cases, less numerous, were more severe, exhibiting dissociative states and marked startle reaction. Gross hysteria such as blindness and extremity paralysis were stated by two division psychiatrists (Schumacher and Smith) to comprise ten percent of the case load. Individuals with somatic complaints were quite frequent, but showed relatively little overt anxiety.
All division psychiatrists explored the use of amytal or pentothal interviews in therapeutic endeavors. Schumacher claimed his results were quite successful, particularly with hysterical reactions, in restoring complete function. He returned such recovered patients promptly to combat duty and insisted that there were few recurrences.
The other division psychiatrists were not as impressed with the value of barbiturate interviews. All agreed that employment of the simple therapeutic technique of reassurance, explanation, and ventilation, when combined with a regimen of rest, sleep, food, and a short respite from battle stress accomplished miraculous improvement in haggard, apathetic, tremulous, weary, patients. Division psychiatrists learned that it was necessary to use a firm matter-of-fact approach to patients that indicated in the initial interview that they were not disabled, but temporarily worn out, that such a reaction was understandable and common, that recovery will occur after several days of rest and relief from battle following which return to the combat unit would be expected. In general, the principles of forward psychiatric treatment set forth in “Combat Psychiatry” as previously described were well-known to division psychiatrists and utilized in treatment programs.
The results of intra-divisional psychiatric treatment were uniformly 50 percent to 70 percent return to combat duty with relatively few recurrences. This success in salvaging needed combat personnel convinced division commanders, the Eighth Army Surgeon, and various division surgeons that division psychiatry was of practical value. The efforts of the four division psychiatrists, LTC Philip Smith, Captains James Hammill and Martin J. Schumacher, and 1LT (later Captain) Paul Stimson, firmly established division psychiatry in the Korean War. Thus it can be stated, that as a result of lessons learned in World War II, the reiteration of these principles in training memoranda and other Army publications, and the invaluable inclusion of psychiatrists in the Tables of Organization and Equipment (TOE) of combat divisions that in the Korean War, division psychiatry become operational within six to eight weeks after an unprepared onset of battle in contrast to the two-year delay in instituting a similar program in World War II. It is this achievement that spurs planning and efforts to further progress because it disproves that old adage that “men learn from history only that men learn nothing from history.” [Footnote 1, pp. 5-8, Footnote 2, pp. 125-137]
In sharp contrast to the prompt application of psychiatry at the division level, psychiatric efforts at the Army level were meager and ineffective. It was evident that a need to support division psychiatry by a second echelon of psychiatry at the Army level was not recognized, although such a need was first demonstrated in World War I and in World War II. This lack of recognition was unfortunate since two qualified psychiatrists were available in Eighth Army to provide the professional nucleus for a second echelon army level psychiatric facility.
Captain (later Major) W. Krause (one year civilian psychiatry residency and one year Army psychiatry experience) arrived in Korea on 7 July 1950 as the assigned psychiatrist with the 8054th Evacuation Hospital. This unit soon became operational in Pusan as the major medical facility serving Eighth Army, receiving thousands of sick and wounded during July, August, and September 1950. Captain Krause, while in charge of the psychiatric section, had other duties because of medical officer shortage. It was impossible to establish a psychiatric treatment program as bed space was scarce. Only non-transportable sick and wounded were held for emergency treatment. Evacuation was considered the only means of providing beds to receive the daily flow of patients from the combat zone. Captain Krause stated that he returned about ten percent of psychiatric patients to duty during August and September 1950, and evacuated about 1800 others in Japan. Captain Krause was not even able to obtain a separate room or small wall tent for privacy in psychiatric evaluation or treatment.
Captain (later Major) F. Gentry Harris (two years Army psychiatry residency at Letterman General Hospital, San Francisco, California) was one of the residents sent to the Far East Command in May 1950 for three months temporary duty. When American troops entered Korea in early July 1590, Captain Harris was assigned to Eighth Army Headquarters, then at Taegu, where he operated a general dispensary.
Captain Harris had received considerable indoctrination in combat psychiatry during residency training, and he made repeated requests to serve as a psychiatrist. After some time he was placed in charge of a convalescent unit of the 8054th Evacuation Hospital. It is unclear as to the purpose or expectations of function for this convalescent facility. In mid-August 1950, Captain Harris found a suitable building and proposed that he and Captain Krause be permitted to function as a psychiatric unit; however, he was unable to obtain necessary support or supplies and personnel from the Commanding Officer of the 8054th Evacuation Hospital, the senior medical officer in Pusan, who did not believe the project to be practical. At this time, because of the tenuous tactical situation, senior medical officers in Pusan were not sympathetic to holding psychiatric patients for treatment who could be readily evacuated. Captain Harris stated that during this time there was never any explicit or formal recognition of need for a psychiatric facility at the Army level.
In latter September 1950, Captain Harris was transferred to the 64th Field Hospital, then temporarily providing care for North Korean prisoners of war near Pusan. Captain Harris did give psychiatric treatment to a small number of mainly psychotic patients despite a major language barrier. At this time, the author saw Captain Harris and planned for his utilization at the Army level.
Thus it was that the plans and efforts of Captains Harris and Krause were largely ineffective, although they clearly saw the need, understood their role, and desired to function, but were unable to obtain the necessary logistical support. It should be appreciated that this was a time of confusion and tension. Medical support was difficult to obtain with supplies and personnel in great shortage. The evacuation and care of wounded assumed first priority and a need to maintain open beds for this purpose was a major concern of responsible senior medical officers. Last but not least was the overall anxiety that defenses would be overrun and patients lost to the enemy.
Thus, it seemed reasonable to move every patient out of Korea as soon as possible to keep the medical resources free to handle the daily load of new casualties. It was not uncommon for adverse news of battle to create more apprehension in the rear than in forward areas where the situation was better known at first hand as witness the fact that in mid-August 1950 with the establishment of the Pusan Perimeter, combat divisions began the treatment of psychiatric casualties.
Information relative to the above situations during July, August, and September 1950 was obtained by the author in early October 1950, from the two psychiatrists, Captains Krause and Harris, the commanding officer and other medical officers of the 8054th Evacuation Hospital, the Eighth Army Surgeon, and other line and medical officers. It would be presumptuous to be critical of their efforts when everyone was so sorely pressed. The following comments are made in a constructive spirit in the hope that this early experience of the Korean War may provide a worthwhile lesson for the future.
The major problem in dealing adequately with psychiatric casualties has been failure to appreciate the effectiveness of combat psychiatry in the field. It has been a source of amazement to senior line and medical officer, even those with considerable experience and training in the field, that one or several psychiatrists with a minimum of equipment and personnel can return to effective combat duty so many of their patients. In practice more than one-half of acute psychiatric casualties can be rehabilitated for combat duty within two to four days. This technique has been demonstrated in World War I, World War II, and the Korean War where it was shown that a single psychiatrist can handle 50 to 100 patients at any one occasion. For the time, effort and logistics required, it is perhaps the most economical type of medical care.
It would have been only necessary in the Pusan area during this early period to have established a minimum field or fixed facility which included cots, a simple mess, a water source, some sedative drugs, shelter, and a small number of personnel. Patients wore their uniforms and did not require frequent changes of bed linen, but towels were needed. The two available psychiatrists would have been sufficient. At least 50 percent of acute psychiatric casualties who were evacuated from Korea in July and August 1950 could have been restored to combat duty. This is precisely what occurred when division psychiatry became operational in latter August 1950. For those cases evacuated from division psychiatry to psychiatry at the Army level, experience indicated that about 30 percent were returned to combat units with most of the remainder utilized for combat support and non-combat duties. This pertinent usage of field combat psychiatry should receive emphasis in the training of career army medical officers who should become thoroughly aware that acute psychiatric casualties can be readily salvaged with a small expenditure of equipment and personnel.
Even the admission and evacuation of psychiatric casualties as was performed at the 8054th Evacuation Hospital required one to two days with Captain Krause working without privacy sitting on cots of patients in crowded wards. Yet he managed to return ten percent of mainly directly received psychiatric casualties to combat duty. By doubling the time of one to two days to two to four days in an organized treatment program, it is likely that 50 percent of directly received psychiatric casualties could have been removed from the evacuation flow to Japan.
There are other benefits of psychiatry at the Army level. A unit of this type removes psychiatric patients from the stream of sick and wounded, thus decreasing the overload of evacuation channels and admissions to base hospitals in Japan. Also, psychiatry at the Army level (2nd echelon) supports combat forces in battle when withdrawal or other tactical circumstances makes it impossible to treat patients at the division level. As already indicated, an Army level psychiatric service could have salvaged psychiatric casualties in July and August 1950 when division psychiatry was “impractical.”
Army level psychiatric service should be included in medical planning of any battle campaign since commonly in its early phases problems in deployment and other tactical circumstances tend to nullify division psychiatry. Following World War II, it was proposed to include a platoon of a separate clearing company with the addition of psychiatrists and other professional personnel as needed to constitute an Army level psychiatric service. After much discussion, it was deleted on the basis that such a unit could be readily created when needed, and its inclusion would only increase the complexity of already large Army medical facilities. In 1946, the author was present at a War Department Medical Board meeting held at Brooke Army Medical Center, San Antonio, Texas, during a discussion of the subject. All psychiatrists at the meeting agreed that there would be inevitable delay and much time lost before some future Army Surgeon could be convinced that Army level psychiatric units were needed. The psychiatrists argued that it should be part of a finite organized plan, but others rebutted that this knowledge was well-known and mollified the objections of the psychiatrists by a decision that the use of Army level psychiatric centers would be made a part of teaching doctrine. Time has proved the accuracy of the psychiatrists’ predictions. Failure to provide Army level psychiatric services in the initial phase of the Korean conflict again points to the necessity of formally establishing psychiatric function as an integral component of medical services of a combat army. It should not be forgotten that the relatively rapid establishment of division psychiatry in the Korean War was largely due to the inclusion of psychiatrists and ancillary personnel in the Tables of Organization or every combat division. [Footnote 5, pp. 9-13]
The sudden impact of war found medical facilities in Japan unprepared to receive the casualties that were evacuated from Korea in increasing numbers. Prior to hostilities, medical support barely met minimum requirements for the occupation troops and their dependents. These resources were now further reduced by the loss of medical personnel and provisional hospitals that were sent to Korea.
Psychiatric facilities and personnel shared in the professional shortage. As the psychiatric casualties entered Japan 3-5 July, the following facilities and personnel were present.
The Neuropsychiatry Service of the 361st Station Hospital, previously the Neuropsychiatry Center of the Far East Command (FEC). Personnel were a psychiatrist, a neurologist and two psychologists as follows:
Psychiatrist:
Col. Eaton Bennett Mc USA (two years Army psychiatry residency)
Neurologist:
Maj. (later LTC) Roy Clausen (one year neurology residency plus five years experience)
Psychologists:
1Lt. (later CPT) James Hoc
1Lt Ann Laue
Also present were several enlisted psychological and social work assistants. Facilities included closed and open wards with a capacity of 200 inpatients, EEG machine and electroconvulsive (ECT) apparatus.
Psychiatric Section of the Osaka Army Hospital. Personnel were a psychiatrist, a psychologist and a social worker as follows:
Psychiatric:
LTC Weldon Ruth (one and a half years Army psychiatry residency)
Psychologist:
Master Sergeant (M/Sgt) David Kupfer (excellent training)
Social Worker:
CPT. Topfer MSC (some experience, no formal training)
Facilities included open and closed wards with a capacity of 80 patients. The psychiatrist became ill in early August 1950 and required medical evacuation to the ZI. He was replaced by a general medical officer with the 7th Infantry Division in Northern Japan. The new psychiatrist and the neuropsychiatry team developed an effective treatment program.
Psychiatric Section of the 118th Station Hospital. Personnel was a psychiatrist:
Psychiatrist:
Maj. James Bailey (two years Army psychiatry residency)
Facilities included an open ward with a capacity of 60 patients. Closed facilities were available for transient care.
A large majority of all patients evacuated from Korea in July 1950 arrived first at the 118th Station Hospital in southern Japan, a short distance from the Korean Strait, southeast from Pusan. This hospital rapidly expanded as it assumed the functions of major triage for the transfer of patients to other hospitals in Japan.
Major Bailey at the 118th Station Hospital was caught up in the increasing flow of incoming patients, as was his counterpart with the 8054th Evacuation Hospital in Pusan, Captain Krause. Also, he could do little in establishing a treatment program since beds were available only for non-transportable patients. Further, he was needed in the sorting and triage of evacuees from Korea as the small medical staff often worked around the clock to keep patients moving north so that incoming casualties could be processed. Major Bailey stated that he managed to return ten percent of psychiatric evacuees to combat duty but triaged the remainder to the 361st Station Hospital in Tokyo.
On 15 July 1950, LTC Arthur Hessin MC (completed psychiatric residency and board eligible) arrived to join the 361st Hospital as Chief of the Neuropsychiatry Service. He was followed soon thereafter by a second: LTC Oswald Weaver (completed three years of Army psychiatry residency, also board eligible). An internist, Captain Fancy, and a general medical officer, Cpt. Dermott Smith, who desired psychiatric training were added to the neuropsychiatry staff which also included two other psychiatrists, Col. Eaton Bennett and LTC Ray Clausen. Physical facilities were expanded to include the adjoining detachment barracks which became an annex mainly for the Neuropsychiatry Service whose census averaged between 500 and 600 for August and September 1950. Somewhat over 50 percent of psychiatric admissions to the 361st Station Hospital during this period were evacuated to the ZI as the lack of available bed space and other problems apparently forced this means of disposition. [Footnote 6, pp. 14-16]
An administrative problem soon arose when it became apparent that many psychiatric admissions could function on a non-combat status, but not in combat. However, such a designation was not permitted since the term “Limited Service” utilized for this purpose during World War I had been deleted from Army Regulations. G-1 (personnel), GHQ Far East Command (FEC) finally resolved the problem temporarily at least by the designation of “general service with waiver for duty in Japan” to be accompanied by an appropriate change of the physical profile (PULHES) under the S category (Stability). PULHES, borrowed from the Canadian Military, had been also introduced after World War II. The geographic limitation was not a medical recommendation but a G-1 stipulation to insure filling depleted service units in Japan. At the end of 30-60-90 days as so stipulated, they were reexamined by a psychiatrist. A surprising proportion of up to 50 percent were found fit for combat, often with approval of involved persons, and returned to the original combat unit, thus preventing accumulation of the category “For duty only in Japan.” When the examination indicated unfitness for combat the individual remained in Japan to be reexamined usually in 90 days.
Return to combat duty had advantages for the individual other than increased self-esteem, as those in combat units became more quickly eligible for rotation to the United States than persons in non-combat assignments in Japan. But difficulties arose later when replacements for service units in Japan were not needed in large numbers. By this time fewer psychiatric casualties were evacuated to Japan as the first and second echelons of psychiatric services became fully operational in Korea. [Footnote 6 – p. 16]
The clinical picture of psychiatric casualties observed at the 361st Station Hospital was described as severe with florid manifestations of “free floating anxiety” including startle reactions, gross tremors, battle dreams, dissociative reactions, hysteria and outbursts of irritability or aggressive behavior. Observers were impressed by the incidence of severe reactions; however, it is common for the early psychiatric casualties of a war to be regarded as more severe and more frequent than later reactions when combat units have acquired battle skills, developed group cohesiveness, and removed less effective leaders.
A further explanation lies in the time and place where psychiatric casualties are observed. In the Tunisian campaign after the North African invasion of World War II, early psychiatric casualties were evacuated hundreds of miles to Algiers, Constantine, Casablanca and Oran over several days where they were observed by psychiatrists in rear Army hospitals to exhibit severe clinical symptoms much like that described in psychiatric casualties evacuated from Korea to the 361st Hospital. [Footnote 7]
At the 361st Hospital, patients were described as more severe than noted in Korea. When observed early, many showed marked improvement. Thus Captain Krause at Pusan, Korea was able to return ten percent to duty after only an evaluation; similarly Major Bailey did so in southern Japan. After repeated evacuation over many days, psychiatric casualties exhibit increased severity of symptoms as if to justify their evacuation from combat. Another explanation for increased severity of symptoms at the 361st Hospital was the fact that large numbers of psychiatric patients were being evacuated to the Zone of the Interior (United States). Logically, they were selected on the basis of severity of symptoms. All of the above noted reasons may have played a role in producing the severe reactions observed at the 361st Hospital in the early phase of the Korean War; but, as the conflict continued these severe type cases became increasingly rare.
Observers at the 361st Hospital were impressed by the seemingly large number of psychiatric casualties who claimed to have experienced combat in World War II. As explained by many of these individuals, they were more vulnerable to combat stress in Korea because dormant trauma in World War II had been revived. Most troops initially engaged in the Korean fighting were career army personnel with many World War II veterans.
In discussions of this issue by line officers during early October 1950, it was their consensus that men with previous combat experience were more effective than newcomers to battle. These officers placed emphasis upon the psychological and physiological un-preparedness of occupation troops for return to the rigors and hazards of war. This viewpoint was also expressed by many psychiatric casualties in discussing their inability to adapt to sudden change from the standpoint of training and state of mind.
A small but troublesome subcategory of psychiatric patients at the 361st Hospital during this period were career-commissioned and non-commissioned officers who had been classified as “Limited Service” during World War II because of partial mental or physical disability. After World War II some continued in the Army, while others reentered after a brief time in civil life. When “Limited Service” was abolished after World War II, they were placed on general service with their knowledge and consent.
These individuals functioned quite well in peacetime assignments and were promoted one or more times. The outbreak of hostilities found them in the occupation forces in Japan or assignments elsewhere, mainly the ZI. When ordered to Korea, many became prompt psychiatric casualties with anticipatory anxiety which caused hospitalization in Korea or in Japan en route to Korea. These individuals became part of the caseload of the NP Service at the 361st Hospital. They exhibited dependency intermixed with resentment, as they complained that an implied promise to them had been broken by the Army who should have known of their limitations and insured a continuation on non-combat duty. It would be paradoxical, however, to foster career non-combat personnel in an Army whose primary mission is combat.
Perhaps such personnel should seek positions in a civil governmental agency if the objective is security of employment. These patients were usually included in the group evacuated to the ZI for disability discharge, which could not readily be accomplished overseas. [Footnote 6, pp. 17-19]
The Far East Command was visited in mid-July 1950 by Dr. Karl Bowman, Psychiatric Consultant to the U.S. Army Surgeon General. He stayed in Japan for several weeks visiting US military psychiatric facilities. Dr. Bowman saw many incoming psychiatric casualties. He was impressed by the severity and frequency of psychiatric patients and recommended that a special psychiatric hospital be established in southern Japan with a capacity of 1,000 beds, although initially 200 beds would suffice. It was a logical suggestion because he saw so many patients with so few facilities. He also suggested instituting forward psychiatric treatment and that a Theater Consultant in Psychiatry be added to the Medical Section of GHQ (General Headquarters) Far East Command (FEC). The recommendation of Dr. Bowman to initiate forward psychiatric treatment was of great value. It provided the impetus toward implementing the assignment of psychiatrists to combat divisions in August 1950. [Footnote 6, pp. 19-20]
After an initial retreat and surrender of territory to gain time for replacements, American forces created a firm perimeter around the southern part of Pusan by the end of July. The division psychiatrists after having a stable front were able to implement principles of forward treatment. The second echelon of evacuation at army level was still in disarray mainly due to the failure of commanders to recognize psychiatric casualties as replacement resources. Third echelon treatment in Japan was scarcely any better with continued evacuation of casualties to ZI.
General MacArthur, foreseeing the enemy's vulnerable disposition early in the war even before the first clash between American and North Korean troops, had decided that a seaborne strike against the North Korean rear was a logical solution. A chance to strike deep behind the enemy's mass to cut lines of supply, then attack front-line divisions from two directions was enticing to the general, who in World War II had proved so well the value of amphibious envelopment against the Japanese. Before such a blow could be struck, General Walker had to halt the North Korean Army short of Pusan and General MacArthur had to build an amphibious force almost from the ground up. By the opening of September 1950, both generals had progressed considerably in meeting these essentials. [Footnote 1, pp. 139-154]
General MacArthur planned his bold amphibious venture at Inchon sustained only by hope and promises. At no time during planning did he have the men and guns he would need. The Joint Chiefs of Staff (JCS) frequently told MacArthur that with military resources of the United States at rock-bottom and with the short-fused target date (15 September 1950) on which General MacArthur adamantly insisted, the needed men and guns might not arrive on time.
Disagreements over time, place, and method of landing occurred. MacArthur knew that even with fullest support by Washington, he might not have by his chosen D-day enough men and equipment to breach the enemy’s defenses and exploit a penetration by X Corps. The nature and location of the planned landing dictated its direction by a tactical headquarters which was separate from Eighth Army. General Walker had his hands full with the Pusan Perimeter and could not easily divide his attention, effort, or staff. The size of the landing force, initially set at about two divisions, indicated a need for a corps command.
On 21 August 1950 General MacArthur requested permission to activate from sources available in the Theatre, a Headquarters X Corps. Department of the Army readily agreed and X Corps was formally established 26 August 1950. The Special Planning Staff, General Headquarters became Headquarters X Corps and Lieutenant General Edward M. Almond became its Commanding General in addition to duties as Chief of Staff and Deputy Commander, Far East command of United Nations Command. On 1 September 1950 MacArthur assigned the code name, Operation Chromite, to the planned landing at Inchon.
X Corps at embarkation numbered less than 70,000 men. Included as its major units were the First Marine Division, the 7th Infantry Division, the 92nd and 96th Field Artillery Battalions, the 56th Amphibious Tank and Tractor Battalion, the 19th Engineer Combat Group, and the 2nd Engineer Special Brigade. The 1st Marine Division had 25,040 men, including 2,760 Army troops and 2,786 Korean Marines; the 7th Marines, which arrived on 21 September 1950 added 4,000 men to the division strength. [Footnote 1, pp. 155-172]
Events dramatically justified General MacArthur’s firm confidence. American Marines, backed by devastating naval and air bombardment, assaulted Inchon on 15 September 1950 and readily defeated the weak, stunned, North Korean defenders. By mid-day Marines had seized Wolmi-do, the fortress island dominating Inchon harbor. By nightfall more than a third of Inchon had fallen.
Operation Chromite stayed on schedule. In the wake of the Marines, the 7th Division landed and struck south toward Suwon. Kimpo Airfield fell to the Marines on 19 September 1950 and on 20 September General MacArthur could tell the Joint Chiefs of Staff that his forces were pounding at the gates of Seoul. So far American forces had suffered only light casualties, while the North Koreans had lost heavily. At Inchon, supplies were being unloaded at a rate of 4,000 tons daily. Kimpo Airfield had swung into round-the-clock operation. When General Almond took command at 1800 on 21 September, he had almost 6,000 vehicles, 25,000 tons of equipment and 50,000 troops. [Footnote 1, pp. 173-174]
On 16 September 1950, Eighth Army and ROK troops, the Pusan Perimeter defenders, reinforced by the 27th British Brigade, began an all-out offensive to coordinate with the Inchon invasion. Fortunately, the success of MacArthur’s plan did not depend upon a prompt juncture of Eighth Army and X Corps. The North Korean Army fought as fiercely on 16 September as on 14 September, and for nearly a week stood off all attempts by Eighth Army to punch through their defenses.
By 22 September, signs of enemy weakness had appeared; the next day the North Korean Army, at last feeling the effects of severed lines of communication and a formidable force in its rear, began a general withdrawal from the Pusan Perimeter. The withdrawal turned into a rout. During the next week Eighth Army pursued the fleeing enemy. On the morning of 26 September 1950, a task force from the 1st Cavalry Division of Eighth Army met elements of the 7th Infantry Division of X Corps near Osan to mark the juncture of the two forces.
Psychiatric admissions were elevated for several days with high battle casualties at the beginning of the Eighth Army offensive, then dropped precipitously, as to be expected when victorious troops are rapidly advancing with few battle casualties. The combat troops were far ahead of their clearing company facilities as they outran the slower support troops. In this happy tactical situation, division psychiatric centers could not operate effectively because they were dislocated from the combat troops and too far in the rear. It is fortunate that such occasions do not require psychiatric support as mental patients who may be produced are too few to be of practical importance.
Meanwhile, X Corps had enlarged its holdings in the Inchon-Seoul area. The reinforced enemy gave stubborn battle for Seoul which forced street-by-street and house-to-house fighting. Seoul was finally secured on 28 September with the aid of 7th Division elements who attacked from the south; however, Marines bore the brunt of the fighting and suffered heavy battle casualties.
Psychiatric casualties from the Marine division were also numerous, but neither a division psychiatrist or intra-divisional psychiatric treatment was present. Together with battle casualties, Marine psychiatric casualties were initially evacuated to the Navy hospital ship Consolation at Inchon harbor and later to army hospitals that became operational in the X Corps area. Lieutenant Commander (LCDR) Wade Boswell MC, psychiatrist with the hospital ship, reported to the author in early October 1950 that he had little success in returning Marine psychiatric casualties to combat duty. Apparently the superior living conditions of the hospital ship were not conducive to improvement and return to combat hardships despite proximity of the hospital to the battle action and prompt placement of psychiatric casualties under treatment. This was in sharp contrast to the somewhat later results obtained at the relatively primitive setting of an army field hospital, where it was possible to return about 50 percent of Marine psychiatric patients to combat duty within a one- to three-day period of rest and brief psychotherapy. [Footnote 1, pp. 74-177, Footnote 2, pp. 21-23]
The 7th Infantry Division had relatively light battle casualties, and consequently had few psychiatric casualties. A psychiatric treatment section was included in the division clearing company facilities. It was headed by Captain David Markelz, who had a one-year Army residency in internal medicine and who was assigned as the assistant division psychiatrist because a psychiatrist was not available. Captain Markelz briefed himself on his new position by various readings, including Combat Psychiatry, a supplemental issue of the U.S. Army Medical Bulletin published November 1949. He saw about ten psychiatric patients from the relatively brief combat action of the 7th Infantry Division. These cases did not impress him as being severe and six were returned to duty after a short period of rest and sedation. [Footnote 2, p. 22]
For the month of September 1950, which included intense combat in both defense and offense mainly by Eighth army, there occurred the highest U.S. Army rate for WIA and the second highest for KIA. The rate of psychiatric admissions (includes cases only excused from duty) from U.S. Army personnel in September was also the second highest for the Korean War and the effect of tactical situations. [Footnote 3]
The psychiatric admission rate for October of 34.21/1,000/year, the lowest during the first 18 months of the Korean War, reflects the optimism that pervaded all ranks as well as light battle casualties for the month. [Footnote 3] It was not surprising that morale was high. The fortunes of war had been quickly and almost miraculously reversed and there was widespread expectations that soon the fighting would be over and return to comfortable Japan would be accomplished. [Footnote 2, p. 23]
Early in October 1950, LTC Philip Smith, 25th Infantry Division Psychiatrist, was medically evacuated to Japan. He was replaced in late October by Captain W. Krause of the 8054th Evacuation Hospital who volunteered for a divisional assignment. Fortunately few psychiatric or battle casualties occurred in the division during October, as the division remained near Taejon to combat guerrillas and mop up bypassed enemy remnants.
X Corps forces were increased by the addition of the 3rd Infantry Division, the first elements of which disembarked at Wonsan in early November. This division was unique in arriving with two psychiatrists, Captain (later Major) Clarence Miller (three years Army psychiatry residency) assigned as the division psychiatrist and 1st Lieutenant (later Captain) Clay Barritt (one year civilian psychiatry residency under Army auspices) assigned as the assistant division psychiatrist.
In November 1950, further gains of Eighth army and X Corps became increasingly limited due to stiffening enemy resistance, difficulties of maintaining adequate logistical support to forward troops, and onset of the severe North Korean winter with its numbing effect. This month, with its increasing enemy activity, saw a moderate rise of battle casualties (KIA and WIA) with a corresponding rise in the psychiatric admission rate as optimism of the previous month began to wane. In addition, there were significant increased rates for disease and non-battle injury—frostbite. Eighth Army continued to advance above Pyongyang and X Corps expanded its control over much of northeast Korea including the Chosin Reservoir district. By 25 November 1950, the United Nations’ forces were ready for a final offensive to the Yalu River with Eighth Army 75 to 80 miles above Pyongyang and X Corps anchored at the Manchurian border on the east by elements of the 7th Infantry Division in readiness to wheel westward and coordinate with the northward push of Eighth Army. [Footnote 2, pp. 23-24]
Surveys of divisional psychiatric programs by the author during October and November 1950 revealed some common problems. While all division surgeons appreciated the value and need for intra-divisional psychiatric treatment, they were unaware of or resistant to the function of the division psychiatrist in prevention. For this reason and because most division psychiatrists were unfamiliar with this aspect of their duties, they confined their efforts mainly to treatment and evaluation of referred or evaluated cases. This use of division psychiatrists was necessary during the Pusan Perimeter period when large numbers of psychiatric casualties focused attention upon treatment. This early role presumed that treatment was the major function which could be performed by a psychiatrist.
As a consequence, and consistent with the knowledge of division surgeons at this time, two divisions in Korea assigned their only psychiatrist as the assistant division psychiatrist. This designation insured restriction of preventive aspects in division psychiatric programs as assistant division psychiatrists were subordinate to division clearing and medical battalion commanders. Thus, the mission of the only psychiatrist could and was curtailed by the whims and ideas of clearing company commanders. These psychiatrists could not visit and make recommendations to combat units or in one instance obtain permission to discuss problems with the division surgeon, including policies and methods for treatment of psychiatric casualties. Also, the assistant division psychiatrist was subject to performing routine duties of the clearing company which in one division interfered with psychiatric treatment. [Footnote 2, pp. 24-25] Experiences with abuses which occur when the Table of Organization for a combat division permits two psychiatrists, when seldom can more than one be made available, leads the author to seriously question the value of this change from the Table of Organization in World War II combat divisions which contained a single psychiatrist specifically designated as the division psychiatrist and assigned to the office of the division surgeon. Even in the future, there will be too few psychiatrists available to assign two per division. In actual practice a general medical officer of the division clearing company can be readily trained to serve as assistant to the division psychiatrist when such help is needed. [Footnote 2, p. 25] After the Korean War a change was made replacing the assistant division psychiatrist with an officer psychiatric social worker or clinical psychologist as available. These officers became division social worker or division psychologist with the single division psychiatrist assigned to the office of the division surgeon.
In the course of the survey, an effort was made to orient psychiatrists assigned to divisions in assuming a role in preventive psychiatry to coordinate with efforts to remove obstacles to such a program. The young psychiatrists were receptive to such a function. It was agreed that division psychiatrists should regularly visit battalion and other divisional units when conditions permitted. In general a program of prevention was to be established as set forth in the November 1949 Supplemental Issue of the Bulletin U.S. Army Medical Department entitled Combat Psychiatry.
The administrative problems associated with division psychiatry were resolved in October 1950. The first concerned the Emergency Medical Tag (EMT) diagnoses of combat psychiatric casualties. All types of designations were used from “shell shock” to “psychosis,” including the ubiquitous “Psychoneurosis-anxiety state.” This practice caused a similar iatrogenic trauma to patients and semantic confusion to medical officers that occurred early in World War II. The Eighth Army Surgeon agreed to corrective action. An Eighth Army directive was issued implementing the use of “Combat Exhaustion” to designate all psychiatric casualties in combat troops, equivalently prescribed in current army regulations as “Combat Fatigue.”
The second problem was also resolved when the Eighth Army Surgeon agreed to issue a directive that all combat divisions submit periodic biweekly (semimonthly) reports giving data on battle casualties and psychiatric admissions, focused at the battalion level. The form used was identical with that utilized in World War II. From data in these reports division charts were constructed. The division psychiatric reports became a pertinent part of efforts to expand preventive aspects of psychiatric programs at this time, as they pinpoint differences of the various divisional elements and raise questions by command. As in World War II, during the Korean War, they became powerful levers for interest and research in preventive psychiatry. [Footnote 2, pp. 28-29]
A prompt result of efforts to establish preventive psychiatry programs within combat divisions occurred in the 24th Infantry Division. Here, Major Hammill enjoyed the full confidence of senior medical officers. He was properly assigned to the office of the division surgeon and had access to all divisional units. As a staff officer, he began the orientation of line and medical officers on pertinent psychiatric problems. Prior to leaving the division in November 1950 to complete residency training, he worked jointly with his replacement, Captain (later Major) William Hausman (two years civilian psychiatry residency under Army auspices) for a ten-day period. During this time there were visits to the various divisional elements where Captain Hausman was personally introduced to key line and medical officers. By this transition process, Major Hammill transferred his prestige, status, and gains for psychiatry in the division to Captain Hausman, who further developed the divisional program. This orientation of new incoming psychiatrists became a preferred procedure in the many changes of division psychiatrists that occurred in the Korean War. [Footnote 2, pp. 25-26]
The improper assignment of Cpt. Paul Stimson to the 1st Cavalry Division as the assistant division psychiatrist instead of division psychiatrist was corrected after discussion with the division surgeon. Captain Stimson assumed an increasing staff function as he developed a superior psychiatric program. Efforts to remedy a similar situation in the 2nd Infantry Division initially met failure after two attempts but was resolved several months later after the division surgeon and Captain Schumacher, the assigned only psychiatrist in the division, left Korea.
There was no problem in the assignment or function of Cpt. William Krause the assigned psychiatrist to the 25th Infantry Division. The only requirement was for a psychiatrist to implement an intra-divisional psychiatric program. The division surgeon recognized the necessity of both treatment and prevention in divisional psychiatry. He was happy to receive Captain Krause and gave him whole-hearted support.
The lack of a trained psychiatrist in the 7th Infantry Division was remedied in early November 1950. Captain (later Major) Wilmer Betts (one and a half years civilian psychiatry residency under Army auspices) was assigned to the 7th Infantry Division after prior discussion with the division surgeon on the comprehensive utilization of the division psychiatrist and a promise that Captain Betts would be correctly assigned and be permitted full function. The division surgeon not only kept the agreement, but his strong encouragement and support of Captain Betts facilitated the development of a superior divisional psychiatric program.
Efforts to persuade the 1st Marine Division to establish intra-divisional psychiatric treatment initially failed, but was later implemented. In November 1950, while at Hamhung, an important northeastern coastal port in North Korea, it became evident that a considerable number of Marine psychiatric casualties were being admitted to the 121st Evacuation Hospital at Hamhung, who provided medical support to the 1st Marine Division. It was suggested to the Marine Division Surgeon that he request a division psychiatrist who would conserve manpower by treatment and prevention. The Marine Division Surgeon was quite surprised to learn that so many psychiatric casualties were being produced in his division. After confirmation by his subordinates that Marine psychiatric casualties were indeed being sent to the 121st Evacuation Hospital, he agreed that the author could transmit to Navy Headquarters in Tokyo his willingness for the 1st Marine Division to receive a division psychiatrist. This was accomplished on the author’s next return to Tokyo, but a further delay occurred. In March 1951, a Navy psychiatrist was assigned to the 1st Marine Division. From all reports, a superior 1st Marine Division psychiatric program was developed. [Footnote 2, pp. 6-29]
This period saw a marked improvement in Army level psychiatric facilities, the second echelon of psychiatric treatment, which took place in late October 1950. In the second half of September 1950, Captains Krause and Harris continued their efforts at Pusan, but the rapid forward movement of United Nations combat troops in late September and October 1950 negated the value of the Pusan area, which became too rear for useful function. Medical facilities that were tactically situated to better support the combat troops were the 121st Evacuation Hospital and the 4th Field Hospital, units of X Corps medical services which became operational in the Inchon-Seoul sector during latter September and early October 1950, respectively. Both hospitals were receiving psychiatric patients, mainly from the 1st Marine Division at the time of the author’s visit to this area in early October. The 121st Evacuation Hospital was preparing to cease operations in order to move with other X Corps elements south to Pusan to participate in the next amphibious invasion. The 4th Field Hospital was transferred to the control of Eighth Army and remained at the site of Ascom City between Inchon and Seoul. Currently the 121st Evacuation Hospital is at this location.
The 4th Field Hospital had no trained psychiatrist, but Cpt. James Gibbs who had been accepted for Army psychiatry residency training, was assigned to this duty at his request. The author saw about 20 psychiatric patients in treatment-evaluation interviews with Captain Gibbs during a most concentrated course of psychiatric training, as in 24 hours an attempt was made to indoctrinate him in both the socio-dynamic concepts and treatment methods pertinent to combat psychiatric casualties. Captain Gibbs was an apt student, but further supervision was required at least for a time.
The 121st Evacuation Hospital had admitted about 40 patients to the psychiatric section during the brief period of its operation at Yongdongpo near Seoul. The assigned psychiatrist, Cpt. Thomas Glasscock (one year psychiatry residency under Army auspices) also required instruction in combat psychiatry and was introduced to the techniques of hypnosis and barbiturate interviews. As noted with Captain Krause of the 8054th Evacuation Hospital, Captain Glasscock had not been given such facilities as a small wall tent to permit privacy in work with patients. This difficulty was not uncommon at this time as two division psychiatrists were similarly handicapped. The necessity for such privacy was repeatedly stated by various psychiatrists as essential for proper functioning; but, their contentions were not seriously considered. On the surface it would appear to be a minor matter; nevertheless, it required personal guarantees to respective hospital commanders and division surgeons that psychiatrists obtained their best results by listening and talking to patients in an atmosphere which was conducive to privacy. Later, however, these same senior medical officers came to regard their psychiatric services as effective and valuable and freely gave their support.
In early October 1950, a conference was held with the Eighth Army Surgeon and the author on improving psychiatric services at the Army level (2nd echelon). The author accepted his decision that a separate psychiatric unit to support divisional psychiatry patients was not feasible at this time for reasons of difficulties in maintaining security in unstable rear areas and because supplies and personnel for such a facility were scarce. We agreed that a psychiatric team could be made operational in an already functioning hospital. Not acceptable was his suggestion that a Pusan area military hospital was the logical site for the psychiatric team. It was over 300 miles to the rear of the combat zone and literally miles out of the “war.” The author suggested the 4th Field Hospital near Seoul, only 30 to 40 miles back of the forward troops. Here also there was assurance of support from Col. L.B. Hanson, the Commanding Officer of the 4th Field Hospital. Initially this proposal was rejected by the Eighth Army Surgeon, who insisted on Pusan. The author argued that Captain Harris should be moved from Pusan to join with Captain Gibbs in forming the nucleus of a psychiatric team at the 4th Field Hospital. The matter was left at this stage but, to the author’s pleasant surprise, the Eighth Army Surgeon moved Cpt. F. Gentry Harris three weeks later to the 4th Field Hospital where he and Captain Gibbs formed a harmonious team, trained the needed medical corpsmen, established a treatment program, and by the end of October 1950, demonstrated that 80 percent of psychiatric admissions were returned to combat or non-combat duty. In late November Captain Harris was returned to the ZI to complete psychiatry residency training. He was replaced by 1Lt (later Captain) Harold Kolansky (one and a half years civilian psychiatry residency).
The 171st Evacuation Hospital that arrived in Korea in mid-September 1950 became operational for the first time at Pyongyang about 1 November 1950. As the most forward large medical facility soon the hospital was receiving all types of casualties. The assigned psychiatrist, Cpt. Richard Cole (one year civilian psychiatry residency under Army auspices) lacked experience with military psychiatric patients. The author spent several days of supervision with Captain Cole which focused upon brief evaluation and treatment of combat psychiatric casualties. Cases were seen together with later discussion.
The 121st Evacuation Hospital was visited again in early November 1950 at a new location in the X Corps sector near Hamhung. Captain Glasscock had excellent facilities for privacy of patient interviews at this time. He had improved in confidence and competence as he developed an efficient treatment program. This psychiatric section became the Army level psychiatric center for X Corps.
The 8054th Evacuation Hospital was mainly utilized for support of non-combat troops based in Pusan and Taegu. Captain Hausman replaced Captain Krause in late October and remained for several weeks prior to assignment with the 24th Infantry Division. Latter November 1950 found psychiatric facilities at Army level expanded and functioning effectively. The 171st Evacuation Hospital and the 4th Field Hospital gave adequate support to Eighth Army combat forces. The 121st Evacuation Hospital supported X Corps troops.
At this time another conference was held with the Eighth Army Surgeon to decide on the best location for an Army level psychiatric center to support the forthcoming United Nations offensive. This attack was publicized as a drive to the Yalu River with the goal of ending the war by Christmas. It was agreed that the Pyongyang area offered the best location. For this reason it was planned to establish a psychiatric team at the 64th Field Hospital, then about to move to Pyongyang. The author agreed to personally supervise the project. Initially Captain Cole, to be detached from the 171st Evacuation Hospital and the author, would constitute the psychiatric team. If all went well, Captain Kolansky, at the 4th Field Hospital would be moved to the psychiatric center at Pyongyang.
From the author’s visits to hospitals at Eighth Army and X Corps, it became evident that large numbers of military personnel were evacuated from combat units for subjective somatic complaints or mild non-disabling physical defects. Many such patients were observed in the various Army level psychiatric services where the underlying problems were defects in motivation and group cohesiveness. Efforts to correct these problems were directed at line and medical officers in the Far East Command. The concepts utilized and general orientation to these problems were described by the author in the Surgeon’s Circular, Far East Command, entitled Medical Evacuation and the Gain in Illness, January 1951, which was reproduced in the Symposium on Military Medicine in the Far East Command Bulletin of the U.S. Army Medical Department, September 1951. Cases were more frequent as combat and the winter became more severe. As in the Mediterranean Theatre of World War II, a subgroup of this category were manifested in persons whose spectacles were lost or broken. It was necessary to evacuate such individuals to hospitals at Army level for refraction and the furnishing of glasses. While in the hospital, other complaints were common. An average of ten days per person was lost from duty. Later during the winter of 1951, optical units were established in each division which finally resolved the problem. [Footnote 5, pp. 30-34]
During this period, a reorganization of psychiatric facilities in Japan was initiated. The current practice of concentrating most psychiatric evacuees from Korea at the 361st Station Hospital in Japan had serious disadvantages in treatment and disposition. Many psychiatric patients were seemingly adversely affected by the hospital setting, allowing them either to maintain a persistence of symptoms or to develop more severe manifestations than were previously noted. This resistance toward improvement and return to duty cannot be considered surprising when the comfortable atmosphere of a fixed hospital situated in the midst of peaceful urban Tokyo, where pleasures abound, is contrasted with the monotonous, primitive, and hazardous existence of Korea. In addition, patients at the 361st Hospital could readily observe and envy the evacuation to the United States of other psychiatric patients who were apparently being rewarded for persistent or severe manifestations of mental illness by being sent home.
It should not be assumed that reasons for continuing the gain in illness were in any large degree unconscious to individuals concerned since such matters were openly brought forward by them in treatment interviews and not infrequently were discussed among patients. In this connection, the concentration of patients at the 361st Hospital who had similar battle experiences, symptoms, conflicts, and desires fostered a negative group attitude toward return to duty even of a non-combat type. Patients reinforced each other in justifying complaints and contaminated new admissions with stories of “nothing being done for them” as they indoctrinated the newcomer on what the “score” was in this institution.
The psychiatric casualty when evacuated to Japan was especially vulnerable to group suggestion. Separated from the positive motivating forces of his combat unit, often troubled by guilt for leaving them, he was figuratively alone with his conflict and readily seized upon any support which would aid his symptom defense, the only excuse he had for patient status. The hospital patient group offered him such support by persons who had similar problems and needs. Their presence and numbers gave him justification for symptoms and facilitated the projection of painful self-directed criticism outward to hospital personnel and others who had not endured the hardships and hazards of combat and therefore could not appreciate or understand his problems.
A person rarely acts entirely upon his own wishes or needs. It is more usual to be part of some group since being alone is to be defenseless. Within the group the individual can solidify neurotic defenses or antisocial behavior. When the psychiatric patient was part of the 361st hospital group that sanctioned the use of symptoms for tangible benefits, he was encouraged to obtain further gain of illness. For this reason, many patients at the 361st Station Hospital had a recurrence or persistence of symptoms which related to combat stress, such as startle reaction, insomnia battle nightmares, and the like. In the hospital it seemed that psychiatric patients were fighting another battle, the battle to go home.
The adverse influence of large psychiatric patient groups in rear hospitals was a well known problem of base section psychiatry in World War II. Efforts were made to oppose this negative attitude including group therapy, a more rapid evaluation and disposition of less severe cases, a full program of physical activity, and finally successful program in forward zones (division and army levels) which limited the number evacuated to base sections. At this time therapeutic efforts of psychiatrists at the 361st Hospital were almost wholly occupied in contending with gain in illness. The 361st Hospital, located in a densely populated area of Tokyo, Japan, had little space for a physical reconditioning program. Instead, reliance was placed on indoor activities, mainly of a recreational nature including motion pictures, Red Cross and special services entertainment, occupational therapy, and evening passes to Tokyo. All of these activities made the thought of return even to non-combat duty an unpleasant prospect of resuming daily obligations and irksome tasks. In truth, it was difficult to establish positive rapport, for the therapist had little to offer the patient compared with the tangible benefits of remaining disabled.
Any efforts to minimize or correct the errors of current psychiatric treatment in Japan involved decreasing the admission of non-psychotic mental patients to fixed medical installations such as the 361st Station Hospital. Steps in this direction had already been taken by improvement of the psychiatric program in Korea at division and army levels which prevented evacuation of cases to Japan. The next phase was to limit the transfer of patients to the 361st Hospital from other areas in Japan, particularly the 118th Station Hospital in southern Japan which received most of the psychiatric evacuees from Korea. Finally, it was planned to establish psychiatric consultation and treatment at various locations in Japan to circumvent transfers to the 361st Station Hospital of any patient who showed no evidence of organic disease or psychosis. Thus, the total effort involved the decentralization of psychiatric facilities so that mental patients could be dealt with early and near the origin of situational difficulties. By this plan psychiatric evacuees from Korea would be evaluated and treated at whatever psychiatric center was first reached in Japan. Similarly psychiatric problems that arose from patients in Japanese hospitals or originated from nearby military units could also be treated locally, preferably on an outpatient basis. In effect the psychiatric program in Japan duplicated that of Korea where psychiatry at division and army levels represented a decentralized approach to evaluation and treatment near the origin of situational conflict. The 361st Station Hospital continued as a neuropsychiatric center but was utilized mainly for psychoses, severe neuroses, neurological disorders, or other problem cases who required full time inpatient services for care or diagnosis. [Footnote 6, pp. 35-39]
Additional psychiatry, neurology, psychology, and social work personnel needed to implement such a decentralized program began to arrive in early October 1950, when a neuropsychiatric team was assigned to the Far East Command. Several of its members have been previously mentioned as replacements for various positions in Korea. The team included the following:
The new arrivals were temporarily assigned to the 361st Station Hospital in Tokyo for a seven- to ten-day period of orientation to the neuropsychiatric problems of the Far East Command (FEC) which gave the author an opportunity to evaluate the aptitude and competence of the recent arrivals. Patients were seen together in individual case conferences and also lectures were given. This pre-assignment orientation became a standard procedure for all incoming neuropsychiatric officer personnel to the FEC. It made possible a more appropriate assignment from the standpoint of individual preference and needs of the theatre. Such a policy made for uniformity in methods of treatment and criteria for disposition which facilitated transition from civil to military psychiatry. Because most of the new neuropsychiatric personnel were relatively young in age and experience, eager to learn, and willing to consider other viewpoints and methods of therapy, this made the task of indoctrination far easier than perhaps if older and more experienced neuropsychiatric personnel with fixed opinions and methodology had been involved. [Footnote 6, pp. 39-40]
As part of the decentralization of psychiatric facilities in Japan, a treatment section at the 118th Station Hospital in southern Japan was established in early November 1950. Previously this hospital served as the receiving facility for most casualties evacuated from Korea and also as a triage center for psychiatric evacuees. An arrangement was made with the Commanding Officer of this hospital to permit the psychiatric section to have a minimum of 30 beds for short term treatment. Major Bailey, the assigned psychiatrist, was returned to the ZI to complete psychiatric training in November 1950. He was replaced by Captain (later Major) William Allerton. The decreased psychiatric casualties in October and November 1950 enabled the psychiatric section to begin functioning with the understanding that Allerton would transfer all severe cases to the 361st Station Hospital and hold mild cases for treatment.
Further progress toward decentralization in Japan included the increase of psychiatric facilities in the Osaka area. LTC Philip Smith, previously medically evacuated to Japan from Korea replaced Cpt. John Black, psychiatrist of Osaka Army Hospital in early November 1950, who was returned to the ZI for completion of residency training. An additional psychiatrist, a neurologist, and a clinical psychologist were to be assigned with LTC Smith when available, with the ultimate goal of establishing a psychiatric service of 80 beds with closed and open wards, instead of the extant psychiatric section. An ECT machine already on order along with an existing EEG apparatus would enable the expanded neuropsychiatric service to render a similar level of treatment as at the 361st Hospital. The transfer of patients from the Osaka area to the 361st Hospital in Tokyo would be unnecessary, especially since evacuation to the ZI could be accomplished directly from Osaka. The lack of psychiatric facilities in the Yokohama area was remedied in early November 1950 by arrival of the 141st General Hospital and the utilization of its neuropsychiatric service as an outpatient consultation and treatment center. Adequate space and facilities were found in the outpatient building of the 155th Station Hospital in Yokohama. The professional staff of the Neuropsychiatry Service included the following:
Subsequent operations of the Neuropsychiatry Service demonstrated that both consultation and treatment was provided for a large number of patients from local units and dependent families. Here, decentralization prevented a flow of both inpatients and consultations to the 361st Hospital in Tokyo. Prior services by the 361st Station Hospital was unsatisfactory because distance between Yokohama and Tokyo was sufficiently far as to make communication difficult with an inevitable delay in forwarding reports. The Yokohama center was able to render more meaningful advice and reports because unit commanders and other pertinent persons could be directly contacted either to elicit further information or give suggestions for assignment or disposition. Outpatient treatment was readily available for military persons or dependents with minimum time lost for work.
A visit to the 395th Station Hospital at Nagoya, Japan in mid-November 1950 by the author found that the hospital served as a medical facility for both nearby Air Force units and casualties evacuated from Korea. A trained psychiatrist was not present. It was decided to assign a trained psychiatrist to the hospital when available in order for the decentralized program to function, particularly with respect to frequently referred flying personnel. Cpt. Robert Yoder, MC (three years civilian psychiatry residency) was assigned to the 395th Station Hospital in December 1950. [Footnote 6, pp. 40-43]
Dr. Howard Fabing, M.D., Civilian Consultant to the U.S. Army Surgeon General in Neuropsychiatry, arrived in the FEC in early November 1950 for a 30-day tour. He was interested in determining if non-convulsive (also termed sub-convulsive) shock therapy was beneficial in the treatment of combat neuroses. He brought with him a new Reiter apparatus to instruct various Neuropsychiatry Service staff members of the 361st Station Hospital in the technique of non-convulsive treatment. Dr. Fabing’s preliminary results were encouraging. After completing his tour of psychiatric facilities in Japan and Korea, he obtained permission for an additional two-week stay at the 361st Hospital in order to personally supervise the treatment of acute combat neuroses by sub-convulsive shock therapy. The group selected for treatment consisted of twenty recently evacuated combat psychiatric casualties from Korea. They were given daily non-convulsive therapy for seven to ten days.
The results can be summarized as follows: approximately 50 percent of treated cases showed varying degrees of improvement. Neuropsychiatry staff members of the 361st Hospital were of the opinion that this type of therapy was only of limited value because similar or better results could be obtained with less inconvenience to both patients and hospital personnel. It should be noted, however, that cases available for selection by Dr. Fabing at this time were relatively fixed character disorders upon which battle stress had found fertile soil.
Such individuals were made even more refractory to treatment by the gain in illness incident to evacuation and hospitalization in Japan. Perhaps it was expecting too much for any rapid somatic therapy to alter basic personality particularly in an adverse therapeutic environment. More suitable cases were not available because of the lessened incidence of acute psychiatric casualties during October and November 1950 and that effective forward psychiatric treatment had been established in Korea beginning in latter August 1950. Psychiatric casualties who possessed relatively good motivation and a stable personality were returned to duty from treatment in Korea at division or army level. Persons with more disturbed personality substrate were evacuated to Japan. Because of current effective forward psychiatric treatment, it is doubtful whether non-convulsive shock therapy would be of benefit in the early phase of combat psychiatric breakdown. Moreover, time required for such treatment, namely seven to ten days, militates against its success since two or four days was the optimum period for best results of treatment at the division level. Even the more severe cases returned to Japan were later found to demonstrate more consistent improvement in a convalescent setting than the formal treatment of any type given in a comfortable fixed hospital atmosphere. Since time and place or setting has been demonstrated to be of major importance in the treatment of acute combat psychiatric casualties, perhaps Dr. Fabing should have determined the results of non-convulsive shock therapy in Korea at the Army level. [Footnote 6, pp. 44-45]
In early November 1950, a study of residual cerebral dysfunction from Japanese B encephalitis was initiated at the 361st Station Hospital. This was occasioned by an epidemic of some 300 cases from combat troops in Korea that occurred in the late summer and early fall of 1950. Clinically the victims ran the gamut from mild to severe with death in 100 of these cases. The more severely ill had an acute onset with headache, stiff neck, and fever, followed rapidly by an altered sensorium, confusion, delirium, and coma. The febrile phase was present for seven to ten days during which time constant nursing care, attention to nutrition, and adequate air passageways were crucial in sustaining life. In favorable cases the temperature returned to normal by lysis leaving the patient in a more or less vegetative mental state from which there was gradual but striking improvement in most cases.
Two hundred patients who had recently recovered from the febrile stage were gathered and studied at the 361st Station Hospital. Thirty of the group with the most severe loss of mentation were evacuated to the ZI. The remainder were thoroughly studied for residual train damage by neurological examination, serial EEG’s psychological test batteries, and psychiatric evaluation including a complete background history. The fast majority of the examined group were returned to limited duty status in the Tokyo area. The subjects were re-evaluated at three-month intervals over a period of six months. The common symptoms were headache, irritability, and tension feelings similar to the posttraumatic concussion syndrome. Very little organic residuals were demonstrated. After discharge to limited duty the persistence of symptoms largely depended upon adjustment to their assignments.
The clinical severity of the disease bore no relationship to the symptoms of headache or tension. Pre-illness personality and motivation for duty were apparently pertinent in determining the persistence of complaints. Outpatient psychotherapy and support was of value in facilitating adjustment to the resumption of duty. As with other organic disease, secondary gain in illness was strongly evident in complicating the rehabilitation of these patients. Pertinent in this respect was the semantic disadvantage inherent in the word “encephalitis.” A complete report of this project was prepared by LTC Oswald Weaver of the 361st Station Hospital. [Footnote 6, pp. 44-46]
1. Schnable, J. United States Army in the Korean War: Policy and Direction: The First Year. Washington, DC: Office of the Chief of Military History, United States Army; 1972.
2. Glass, A.J. Psychiatry at the division level. In: Notes of the Theater Consultant, Section VI. Unpublished manuscript held by The Medical Division, Office of the Chief of Military History, US Army, Washington, DC. [Compilation of data obtained from Medical Corps, Medical Service Corps and line officer participants who were present in Korea during the period 25 June 1950 to 30 September 1951.]
3. Reister, F.A. Battle Casualties and Medical Statistics: US Army Experience in the Korean War [Appendix B]. Washington, DC: The Surgeon General, Department of the Army; 1973.
4. Appleman, R.E. United States Army in the Korean War: South to the Naktong, North to the Yalu (June-November 1950). Washington, DC: Office of the Chief of Military History, Department of the Army; 1961.
5. Glass, A.J. Psychiatry at the Army level. In: Notes of the Theater Consultant, Section VI. Unpublished manuscript held by The Medical Division, Office of the Chief of Military History, US Army, Washington, DC.
6. Glass, A.J. Base section psychiatry. In: Notes of the Theater Consultant, Section VI. Unpublished manuscript held by The Medical Division, Office of the Chief of Military History, US Army, Washington, DC.
Chapter 8
The Chinese Communist Offensive
(26 November 1950 - 15 January 1951)
By Albert J. Glass, MD, FAPA
Chinese Communist Intervention
On 25 November 1950, Eighth Army began an all-out offensive in the western sector of the North Korean front to coordinate with the attack of X Corps on the east to reach the Yalu River (boundary between North Korea and Manchuria) and quickly end the Korean War. The Eighth Army attack proceeded unopposed for almost two days. On the night of 26-27 November, several fresh Chinese Communist armies counterattacked with a major thrust at the right flank, then held by ROK II Corps. The ROK troops collapsed exposing the 2nd Infantry Division, the Turkish Brigade and the 27th British Brigade to enemy onslaughts in the flank and rear. The position of other Eighth Army units was also untenable and they disengaged in an orderly withdrawal to the Pyongyang area to avoid entrapment. The 2nd Infantry Division and the Turkish Brigade were forced to fight their way out of entrapment during which enemy roadblocks and flank attacks caused heavy casualties. The Chinese broadened their offensive on 27 November 1950 with attacks against X Corps. On 28 November Chinese units slipped southeastward past the Marines and cut their supply route.
This wide display of Chinese strength swept away General MacArthur’s doubts. Instead of fighting fragments of the North Korean Army reinforced by token Chinese forces, Eighth Army and X corps now faced Chinese armies of about 300,000. MacArthur stated, “We face an entirely new war…which broadens the potentialities…beyond the sphere of decision by the Theater Commander.” MacArthur announced that for the time being he intended to pass from the offensive to the defensive making adjustments as the ground situation required. [Footnote 1, pp. 274-293; Footnote 2, p. 48]
Psychiatry at the Division Level
As initially in the Korean conflict, divisional medical support was limited to emergency care and evacuation because holding any type patient for treatment was impossible or hazardous. Even meager medical support was difficult to accomplish in the 2nd Infantry Division, which lost five medical officers (MIA) in the desperate retreat. Despite appreciable battle casualties (KIA and WIA) psychiatric admissions were not high in November (74.5/1,000/year) and December 1950 (59.8/1,000/year although definitely higher than October 1950 (34.51/1,000/year) when American forces were proceeding almost unopposed in pursuit and mopping up operations north of the 38th Parallel. As stated previously, this relatively low incidence of psychiatric casualties to battle casualties during rapid withdrawal was characteristic in World War II and the Korean War indicating lessened contact with the enemy, moving away from danger, and inability of division medical services during such times to detect or diagnose psychiatric problems. [Footnote 2, pp. 48-49)
Psychiatric admissions during this period were evacuated to medical facilities at the Army level since divisional psychiatric centers were dislocated and on the move. Intra-divisional psychiatric treatment did not become operative until December 1950 when the evacuation of Pyongyang was completed and stabilized defensive positions were established along the 38th Parallel. For several weeks enemy contact was slight and serious fighting not resumed until December 1950.
The battered 2nd Infantry Division was placed in Eighth Army reserve for rest, retraining, and absorption of replacements. The division personnel had been through a harrowing experience and were disheartened. Captain Schumacher, the division psychiatrist, was also adversely affected by his recent combat experience. However, his psychiatric unit with the 2nd Medical Battalion had suffered no battle casualties as, along with the 38th Infantry Regiment of the 2nd Infantry Division, they were enabled to withdraw along an alternate route, thereby avoiding enemy roadblocks and flank attacks that traumatized the other divisional units. Yet the experience contained elements of sustained anticipatory anxiety and tension from nearby combat. During this period when the 2nd Infantry Division was placed in army reserve, Brigadier General S.L.A. Marshall, using his debriefing techniques of combat units as utilized in World War II, again demonstrated that only 15-25 percent of riflemen fired their individual weapons in combat. Crew-served weapons such as machine guns, mortars, or artillery, however, were fired without such inhibition. [Footnote 3]
In early January 1951, Captain (later Major) Hyam Bolocan (three years civilian psychiatry residency and board eligible) replaced Captain Schumacher, 2nd Infantry Division Psychiatrist, who was returned to the ZI to complete professional training.
Similar massive Chinese Communist assaults in northeast Korea forced the withdrawal of X Corps. This was readily accomplished except in the mountainous Chosin Reservoir area where the 1st Marine Division and 7th Infantry Division elements were forced to fight their way out of encirclement. The story of their almost ten-day battle to reach safety, including air evacuating thousands of wounded and injured (also frostbite) from rapidly constructed improvised airfields, severe physical deprivations, intense cold, and the overwhelming numerical superiority of an enemy who attacked from all sides, was an epic in American military history. Despite the large number of wounds, injuries, and frostbite casualties, relatively few psychiatric casualties were diagnosed during this time. Here again was a situation with little or no gain in illness. Air evacuation was uncertain and mainly utilized for the obviously physically disabled; all others had to fight their way out.
Case 8-1. Intermittent Hysterical Paralysis
An illustration of the impact of reality upon mental mechanisms in such an environment was exemplified by a patient with hysterical paralysis of both lower extremities. His paralysis occurred during combat in early December 1950. During the fighting retreat he was transported in a 2 1/2–ton truck with other disabled patients as a litter case. When the convoy encountered enemy fire, the patient promptly recovered sufficient function to leave the defenseless vehicle and take cover. He repeated this temporary recovery several times until the convoy reached safety in the large airfield at Hungnam when the paralysis promptly recurred. By this time the patient’s repeated temporary recovery was apparent to others. Initially the patient had complete amnesia for these events, but they were vividly recalled as he relived battle experiences during a pentothal interview. In this session he portrayed dramatically how impossible it was for him to remain paralyzed in the vehicle and how he moved rapidly and instinctively to seek safety. [Footnote 2, pp. 49-51]
On 9 December 1950, relief troops mainly composed of 3rd Infantry Division and Marine elements reached the retreating column. By 11 December all United Nations troops had withdrawn to the coastal plain at Hungnam with the perimeter defenses of X Corps. Then followed a gradual evacuation by sea as the defensive perimeter, mainly manned by the 3rd Infantry Division strongly supported by the guns and planes of naval vessels standing off shore, was progressively narrowed. Total evacuation was completed on 24 December. X Corps troops were brought into southern Korea to become an integral component of Eighth Army. For the first time since September 1950 all United Nations troops in Korea had a single field commander, Lt. Gen. Matthew B. Ridgeway, who took command of Eighth Army on 27 December following the accidental death of Lt. Gen. Walton Walker.
The end of December saw a renewal of the communist offensive against the insecure defense lines of Eighth Army along the 38th Parallel. United Nations troops resumed an orderly withdrawal and by 4 January 1951 the enemy recaptured Seoul. By 7 January Eighth Army had withdrawn to a line along the general level of P’yongt’aek in the west, Wonju in the center, and Samshok on the east coast. Here stubborn resistance was offered to further enemy advances. At Wonju in early January, the 2nd Infantry Division with attached French and Dutch Battalions made a historic stand against severe enemy onslaughts. This successful defense marked the end of retreat for Eighth Army who consolidated a defense line across the waist of South Korea.
The period of December 1950 and early January 1951 found morale of United Nations troops at a low ebb. The expectations of an early victory in late November had turned to bitter defeat in December. There seemed to be no way of stopping the mass infantry tactics of the Chinese Communists who seemingly came on like hordes of locusts climbing over their own dead to move forward. The discouraging loss of hard-won territory, the bitter cold and uncomfortable field existence, and continued withdrawals produced a defeatist attitude with many rumors that Korea was to be evacuated. Indeed, for a time the decision as to continuance of the Korean War was uncertain. [Footnote 2, pp. 51-52]
The lowered morale of American troops was not reflected in psychiatric admissions, but rather in the rise of disease and non-combat injury, including self-inflicted wounds. It was true that inclement weather did cause increased respiratory and other infectious diseases including pneumonia, and no doubt the numbing cold and icy roads were responsible for such frostbite and accidental injury. Yet to the observer at this time, it was plainly evident that many psychiatric casualties were concealed among the numerous evacuees for subjective complaints and non-disabling conditions. In particular were cases of so-called frostbite who had no objective findings of cold injury, even after several days of observation. This ‘syndrome of the cold feet’ was compounded out of the usual numbing sensations of feet in intense cold weather, a conscious or unconscious wish for gain in illness and poor motivation. One can only speculate as to the greater vulnerability of psychiatric casualties to frostbite. It may well be that increased sympathetic stimulation, in such fear ridden persons, causes excessive vasoconstriction of the extremities and might account for lessened psychiatric cases noted at this time when frostbite casualties were so high. [Footnote 4] (FDJ: The complex interaction of physiological and psychological forces in frostbite is addressed elsewhere. – Footnote 5)
Self-Inflicted Wounds, Accidental Injury, and AWOL From Battle
The increase of self-inflicted wounds among American combat troops in North Korea during this winter period represented another source of manpower loss for psychological reasons. Almost invariably, it was explained by the involved person as a combination of numbed fingers and carelessness. Environmental conditions made it seem reasonable to expect many such unavoidable errors. Yet the relative innocuous nature of most current self-inflicted wounds and their occurrence in safe rear positions where there was no cause for haste, pointed to the purposeful nature of the accident. The increase of other accidental injuries tended to the belief that a dispirited, unhappy individual may become apathetic to an injury which could remove him from a traumatic environment. In this vein when rotation had been established in May 1951, serial signposts noted on a highway in North Korea were appropriate as follows: “Never fear….Rotation is here….Accidents unnecessary….Drive carefully.”
In further considering manpower loss from psychological causes it should be recognized that there were relatively few United Nations troops who were “AWOL” (absent without leave) from battle. This was in sharp contrast to numerous instances of such overt reactions to fear that occurred in the European and Mediterranean Theaters of Operations in World War II. In Korea, there was simply no safe place to which such an inclined person could go. It was dangerous to leave one’s unit and wander in rear areas from the standpoint of both guerrilla activity and the weather. The only escape from the hazards and discomforts was evacuation through medical channels. For this reason, in December 1950 and January 1951 a more accurate indication of manpower loss for psychological causes can be found in the increased incidence of disease and injury rather than the relatively low psychiatric rate that reflected lessened enemy contact during the period (See Table 9). [Footnote 2, pp. 53-54]
Psychiatry at the Army Level
Psychiatric facilities at the Army level were prepared at this time to support divisional psychiatric programs. The previously mentioned plan of establishing a psychiatric center at the 64th Field Hospital near the airfield in Pyongyang was implemented on 27 November 1950. Sufficient accommodations for 100 patients were made available in a building adjacent to the main hospital. Cpt. Richard Cole, detached from the 171st Evacuation Hospital and the author constituted the psychiatric team along with several corpsmen from the 64th Field Hospital. The psychiatric center at the 4th Field Hospital remained in operation headed by Captains Kolansky and Gibbs. The 8054th Evacuation Hospital in Pusan, the most rear hospitalization point in Eighth Army, had a small psychiatric unit headed by Captain (later Major) Stephen May who had replaced Captain Hausman in early December 1950. X Corps sector in northeast Korea was served by the psychiatric section of the 121st Evacuation Hospital at Hamhung headed by Cpt. Thomas Glasscock and supported by the psychiatric service of the Naval Hospital Ship Consolation under Lieutenant Commander (LCDR) Wade Boswell.
Neuropsychiatric personnel at the Army level were deliberately dispersed rather than concentrated in any area or unit by assigning one or two psychiatrists to various hospitals strategically located to receive the majority of psychiatric patients. This arrangement served a dual purpose; first, it provided alternative treatment services when divisional medical facilities were forced to dislocate due to battle reverses, thereby insuring continued psychiatric services at the Army level particularly needed in any large withdrawal action when intra-divisional psychiatric care was not feasible. Second, such dispersion made it possible for psychiatric facilities to adapt to air evacuation. At this time in Korea the majority of battle and other casualties from forward areas were evacuated by air. This rendered difficult if not impossible the triage of psychiatric cases to any one area or hospital. Whether patients were brought to this or that hospital depended upon weather, the condition of landing strips, the number of vacant beds, and even the needs of the flight crew. For this reason it was necessary that psychiatric services be situated wherever large numbers of all types of patients were brought for treatment.
As a result of the Communist offensive of late November 1950, thousands of sick and wounded poured into Pyongyang by plane, train, ambulance, and truck. All available medical facilities were soon overtaxed, forcing prompt re-evacuation to medical units in the Ascom City-Seoul area and Pusan.
All psychiatric cases were brought to the 64th Field Hospital as planned. Admissions did not exceed 20 per day, relatively few compared to the large number of wounded even though there was little prior screening by division psychiatrists who were on the move rearward with their divisions. Most psychiatric casualties were of the mild to moderate type, readily treated by physical restorative measures and brief psychotherapy. Patients who could not be returned to combat duty were evacuated to the 4th Field Hospital at Ascom City for prompt disposition to non-combat duty. The adverse tactical situation at Pyongyang made limited duty to this area impractical except for some patients placed on duty temporarily with the medical detachment of the 64th Field Hospital that was under-strength and needed all possible help. After five days of operation it became evident that Pyongyang was untenable and withdrawal of our forces from the city inevitable. When the 64th Field Hospital prepared to close, Captain Cole and the author moved to the 4th Field Hospital where they joined Captains Kolansky and Gibbs to become the major psychiatric service of Eighth Army. The 4th Field Hospital also became the principal hospitalization center in Korea as most other medical units were dislocated. The Commanding Officer, Col. L.B. Hanson, demonstrated characteristic energy and resourcefulness as he rapidly improvised added facilities to receive the large influx of casualties. In early December the 4th Field Hospital had about 2,000 beds in operation besides providing temporary quarters and meals for personnel of the 64th Field Hospital, 171st Evacuation Hospital, 10th Station Hospital, and nurses from three Mobile Army Surgical Hospitals (MASH). Many personnel of these hospitals participated in treatment of the large inpatient population. Colonel Hanson produced large stocks of food and reserve supplies; and, with his hospital warmed by steam heat and serving ice cream daily, it was a veritable oasis in the cold, dreary, and discouraging period that was the Korean War in December 1950.
The psychiatric service of the 4th Field Hospital had sufficient facilities and personnel to adequately deal with 20 to 40 daily psychiatric admissions. The effectiveness of treatment steadily improved. An account of this experience was reported. [Footnote 6] The rapid effective methods of the psychiatrists influenced their medical and surgical colleagues to adopt a similar management of mild illness and those persons with only subjective complaints. This emphasis upon prompt evaluation and treatment for return to duty rather than medical evacuation was also fostered by Colonel Hanson. As a result, 150 to 200 patients were daily returned to duty from the 4th Field Hospital during this time. [Footnote 7, pp. 55-58]
Base Section Psychiatry
The large influx of casualties caused by the Chinese counteroffensive again overflowed medical facilities in Japan. As before, most evacuees were flown to southern Japan where the 118th Station Hospital at Fukuoka functioned as an evacuation hospital, retaining non-transportable cases for treatment and transferring the remainder by plane and train to hospitals in the Tokyo and Osaka areas. For a brief period in late November and early December 1950, the 118th Station Hospital received over 1,000 patients daily. The Commanding Officer, Col. Lyman Duryea, enlarged the hospital to 1,600 beds and perfected a smoothly functioning medical and administrative team which received, fed, and triaged thousands of patients during this hectic period.
In early December 1950, the 141st General Hospital that was recently established in the Yokohama area was ordered to Camp Hakata (18 miles from Fukuoka) to increase medical facilities in southern Japan and lessen the burden of the 118th Station Hospital. The neuropsychiatric patients were made available in an area separated from the main hospital which had sufficient space for an outdoor recreational program. Arrangements were made for Cpt. William Allerton, psychiatrist of the 118th Station Hospital, to continue receiving all psychiatric evacuees from Korea who arrived in southern Japan. He was to maintain a census of 20 to 30 less-severe cases for treatment and return to duty, transferring the remainder to the 141st General Hospital; however, more severe except for psychiatric, neurological, and other problem patients would be sent to the 361st Hospital in Tokyo. The plan became operational in latter December 1950. By early January 1951 the psychiatric service of the 141st Hospital had over 100 patients. It became apparent that ECT apparatus, an EEG machine, and substantial closed ward facilities were needed for more complete coverage of psychiatry and neurology in this region. Steps were initiated to achieve this objective.
The 361st Station Hospital in Tokyo received most of the psychiatric casualties that arrived in Japan during late November and early December 1950. Many of these cases were prematurely evacuated to the ZI on the erroneous assumption that the large incoming patient load would continue and there would be insufficient beds at the 361st Station Hospital to receive them.
At this time a number of professional mental health personnel, recently arrived to the Far East Command, were receiving orientation at the 361st Station Hospital in Tokyo. They included six young naval medical officers with civilian residency training in psychiatry or neurology who were on loan to the Army for six to nine months. A list of the new arrivals in late November, December 1950 and early January 1951 follows:
Maj. Henry Segal – completed three years Army psychiatry residency
Cpt. Richard Turrell – one and a half years civilian neurology residency under Army auspices
1Lt. (later Captain) Richard Conde – one year civilian psychiatry residency
Cpt. (later Major) Robert Yoder – three years civilian psychiatry residency
1Lt. (later Captain) Herbert Levy – one year civilian psychiatry residency
1Lt. Stonewall Stickney – one year civilian psychiatry residency
1Lt. (later Captain) James Corbett – two and a half years civilian psychiatry residency
1Lt. Francis Hoffman – one and a half years civilian psychiatry residency
LTjg. Shane Mariner – one year civilian psychiatry residency
LTjg. Richard Blacher – one and a half years civilian psychiatry residency
LTjg. Haskell Shell – one and a half years civilian psychiatry residency
LTjg. Simon Harris – one and a half years civilian psychiatry residency
LTjg. James Allen – a half year civilian neurology residency
LTjg. Norman Austin – one year civilian neurology residency
1Lt. (later Captain) Frank Hammer – MSC PhD. Experimental Psychology
Captain Turrell had a primary medical specialty (MOS) of Internal Medicine due to two years of residency in that specialty; however, he was mainly interested in Neurology and was assigned to this specialty at his request. Captain Turrell was sent to the 361st Station Hospital where he replaced Maj. Roy Clausen who was returned to the ZI for completion of neurology residency. Captain Turrell displayed superior professional competence in Neurology.
1Lieutenant Hammer was assigned to the 361st Station Hospital for on-the-job training (OJT) in clinical psychology under 1LT James Hoch and made rapid progress. The period of instruction given at the 361st Station Hospital for mental health specialists newly assigned to the Far East Command included the following orientation.
Psychiatric casualties or cases of “combat exhaustion” were not fixed neuroses but amorphous, transient, emotional breakdowns due to situational battle stress with lowering of resistance for fear stimuli, either because of continued intense combat or inability of involved individuals to obtain emotional support from their combat units (group cohesiveness) or combinations of both conditions. The newly-arrived specialists also received orientation in administrative procedures involved in military settings, medical-legal issues relative to courts-martial, manifestations and prevalence of gain in illness, brief directive methods of psychotherapy, and the use of hypnosis and barbiturate interviews as uncovering therapeutic techniques. In treatment, emphasis was placed on factors of time and distance from the traumatic episode, the environmental circumstances under which therapy was given, and the attitude of the therapist and the treatment team toward return to duty.
The availability of new psychiatrists, neurologists, and other professional mental health personnel made possible the implementation of decentralizing neuropsychiatric programs. By such a system psychiatric patients would receive evaluation and care near the source of situational disorders and prevent the evacuation of such cases to the 361st Hospital which would then continue to be utilized for more severely ill and diagnostic problems. To accomplish this objective the following assignments and change were made in December 1950 and January 1951.
LTjg. James Allen and LTjg. Simon Harris were assigned to Osaka Army Hospital as part of a team headed by LTC Philip Smith (board eligible psychiatrist), to operate a neuropsychiatric service for the Osaka area. A Reiter ECT apparatus was given to this center to provide more comprehensive services and negate the need for transfer of patients to the 361st Hospital in Tokyo. LTjg. Haskell Shell was assigned to the 141st General Hospital at Camp Hakata in southern Japan to bolster the neuropsychiatric service as only Lieutenant Col. H. Wilkinson (board certified psychiatrist) Chief of the Neuropsychiatry Service was trained in psychiatry. A new Reiter ECT apparatus was also sent to this unit.
Cpt. Robert Yoder moved to the 395th Station Hospital in Nagoya to insure the availability of psychiatric consultation in the special problems of flight personnel. For similar reasons 1LT. Stonewall Stickney was sent to the 376th Station Hospital at Tachikawa that served the Air Force in the Tokyo area.
Maj. Henry Segal was assigned as psychiatric consultant to Tokyo Army Hospital, where he was in position to render prompt psychiatric consultation and treatment to large numbers of medical and surgical inpatients. The assignment of psychiatrists and neurologists as set forth was soon reflected by lower admission rates to the 361st Station Hospital, which were further decremented by the utilization of convalescent hospitals.
Use of Convalescent Hospitals
Two convalescent hospitals were established in Japan during this period. These facilities at Omiya (25 miles from Tokyo), the other at Nara (25 miles from Osaka), began receiving patients 9 December 1950. The convalescent hospitals were designed to relieve congestion in major hospital centers by receiving organic illness, wounds, or injuries that required several weeks of convalescent care prior to return to duty. Thus, the use of convalescent hospitals made available hundreds of hospital beds in fixed hospitals that were vitally needed at this time to provide for the influx of new casualties who mainly required active surgical or medical treatment. From the psychiatric standpoint, the opening of convalescent hospitals was an event of the first magnitude. It made available a realistic environment for psychiatric treatment which offset the vexing gain in illness unwittingly fostered by the atmosphere of the usual fixed hospital. In contrast, the convalescent hospital put all patients in fatigue uniforms and had a full daily program of calisthenics, marches, training, and athletic activities. Psychiatric patients under this regimen found little benefit in clinging to symptoms and were not adversely affected by suggestive evidence that evacuation to the ZI was possible. Indeed, everyone was going to duty. Psychiatric patients were deliberately dispersed among individuals recovering from organic disease or injury who gave little support to somatic symptoms or complaints of nervousness. The single assigned psychiatrist found less resistance to treatment as psychiatric patients turned to the therapist for assistance. An account of psychiatric treatment in the convalescent hospital setting can be found in the Symposium of Military Medicine – Supplemental Issue of the Surgeon’s Circular Far East Command, September, 1951. 1LT. Francis Hoffman was assigned to the Nara Convalescent Hospital in early January 1951. LTjg. Shane Mariner was sent to the Omiya Convalescent Hospital in latter December 1950 but was replaced by LTjg. Richard Blacher in mid-January 1951. LTjg. Mariner moved back to the 155th Station Hospital and reopened the psychiatric outpatient and Consultation Service which had been dormant since the 141st General Hospital was transferred to southern Japan.
The end of this period found neuropsychiatric facilities in Japan staffed and distributed to implement a decentralized program aimed at the outpatient and convalescent treatment for largely non-psychotic patients and the inpatient care of psychotic and neurological patients in three neuropsychiatric centers strategically located in major hospitalization areas. [Footnote 8, pp. 59-65]
References - Chapter 8
1. Schnabel, J. United States Army in the Korean War: Policy and Direction: The First Year. Washington, DC: Office of the Chief of Military History, United States Army; 1972.
2. Glass, A.J. Psychiatry at the division level. In: Notes of the Theater Consultant, Section VI. Unpublished manuscript held by The Medical Division, Office of the Chief of Military History, US Army, Washington, DC. [Compilation of data obtained from Medical Corps, Medical Service Corps and line officer participants who were present in Korea during the period 25 June 1950 to 30 September 1951.]
3. Marshall, S.L.A. Men Against Fire. New York: William Morrow & Co.; 1947.
4. Ransom, S.W. The normal battle reaction. Combat psychiatry. Bulletin US Army Medical Department, Supplemental Issue. November 1949:3-11.
5. Sampson, J.B. Anxiety as a factor in the incidence of combat cold injury: A review. Military Medicine. 1984:149 (2)89-91.
6. Kolansky, A.H., Cole, R.K. Field hospital neuropsychiatric service. US Armed Forces Medical Journal. 1951; 2:1539-1545.
7. Glass, A.J. Psychiatry at the Army level. In: Notes of the Theater Consultant, Section VI. Unpublished manuscript held by The Medical Division, Office of the Chief of Military History, US Army, Washington, DC.
8. Glass, A.J. Base section psychiatry. In: Notes of the Theater Consultant, Section VI. Unpublished manuscript held by The Medical Division, Office of the Chief of Military History, US Army, Washington, DC.
Chapter 9
The United Nations Winter Offensive
(15 January - 22 April 1951)
by Albert J. Glass, MD, FAPA
Cease-Fire Negotiations
By late January 1951, local successes of United Nations' forces and a renewed offensive spirit within General Ridgeway's command had altered the combat scene and improved the outlook. No longer was there a real threat of further evacuation.
Psychiatry at the Division Level
As indicated, by 15 January 1951 momentum of the Communist attack had reduced considerably and United Nations forces turned to aggressive patrolling. On 21 January began the United Nations tactics (Operation Killer) of employing armored counterattacks supported by infantry air, and artillery, designed to inflict a maximum of enemy casualties with minimum self losses. By the end of January our limited offensive reached north of Suwon and Inchon. In February 1951 the United Nations offensive continued scoring gains against stubborn resistance and by 14 February United Nations troops had seized Inchon, Kimpo Air Field, and secured a line along the south bank of the Han River. Then followed vicious enemy delaying actions. The Communist used road mines and dug-in positions, destroyed bridges, and demonstrated their ability to hold hill masses by repeated counterattacks. By mid-March 1951 resistance diminished. The enemy withdrew, fighting only rear guard actions as United Nations troops recaptured Seoul and pushed north toward the 38th Parallel. It was known that the Communists were building up a powerful reserve striking force. Yet they offered only sporadic resistance and by 8 April 1951 all enemy east of the Imjin River withdrew from South Korea. Bitter opposition occurred thereafter, particularly against United Nations offensive moves in the central and eastern sectors.
The winter offensive caused increased battle casualties and a consequent rise of the psychiatric casualty rate which remained at higher levels through February, March, and April 1951 paralleling aggressive United Nations tactics. However, the psychiatric incidence never reached levels that could be expected from uphill combat in such a bleak, desolate environment with living and fighting in sub-zero weather. There were many reasons for relatively low neuropsychiatric rates during this period. The battle line was more secure as United Nations combat units were placed tightly across the waist of the Korean Peninsula with none of the rear infiltration and confusion that plagued United Nations forces in previous periods of the Korean War. Enemy positions and territory were methodically and carefully taken with an obvious regard for sparing the lives of infantrymen. Operation Killer was well named and publicized as a procedure calculated to destroy the enemy with less emphasis upon capturing ground.
The resurgence of morale under this leadership and by this method of fighting was a remarkable phenomenon as defeatism was turned to grim determination and finally aggressive confidence when it became apparent that concentrated firepower and carefully planned assaults could overcome the previously feared human wave tactics of the Chinese Communist Armies. An added factor that maintained psychiatric admissions at reasonable levels was improved medical discipline. The now experienced divisional medical officers had learned to realistically appraise subjective complaints and firmly close the door of medical evacuation except for those disabled from mental or physical causes. Last but not least was the promise of rotation in March 1951. This most pertinent morale stimulus gave hope that relief was possible. Indeed, the first rotates left Korea on 18 April 1951.
During this period psychiatrists consolidated and organized functioning within divisions. Aid stations were visited regularly and battalion surgeons indoctrinated in techniques of psychiatric evaluation and treatment. Division psychiatrists were consulted by medical and line officers on morale, mental health, and personnel problems as they gradually became emancipated from a restricted role of mainly treatment and evaluation of referred cases.
In early January 1951, Cpt. Hyam Bolocan (three years civilian psychiatry residency and board eligible) was assigned as the 2nd Infantry Division Psychiatrist replacing Cpt. M.J. Schumacher, who was returned to the ZI to complete professional training. In April 1951, Captain Bolocan received a well-deserved promotion to major. As soon as Major Bolocan became a staff officer, he began to visit all divisional units and was thus available for consultations and discussions with line and medical officers. [Footnote 2, pp. 67-69]
It was commonly observed that when the division psychiatrist visits forward areas, he becomes highly regarded by combat personnel. His presence demonstrates that he shares their interest and viewpoint. By such visits the psychiatrist gains firsthand knowledge of combat problems. His recommendations display understanding of battle situations. Basically, visits by division psychiatrists evoke mechanisms of identification that on the one hand includes sharing by psychiatrists, even briefly, in the trials and tribulations of combat troops while on the other hand there was participation of combat line and medical officers with efforts of psychiatrists at prevention and treatment. The division psychiatrist who remains in the rear becomes resented as one who fears to share hardships and danger, even for a short period, and therefore does not belong in their world of anxiety and deprivation. This viewpoint of combat personnel was valid though based on an emotional bias for the psychiatrist can best understand mental processes by having had similar actual experiences, thus being enabled to objectively evaluate the symptoms and feelings of referred patients. [Footnote 2, pp. 60-70]
As in World War II, semimonthly division psychiatric reports were important instruments by which combat commanders became acquainted with the principles of preventive psychiatry. The comparison of psychiatric rates with the incidence of battle casualties (KIA, WIA, MIA), diseases and non-battle injury including frostbite and self-inflicted wounds aroused interest as to reasons for difference among various large divisional components. The Commanding General, 24th Infantry Division, instructed Maj. W. Hausman (division psychiatrist) to visit the three regimental commanders to discuss conditions which could explain variations of psychiatric rates in the three regiments. Major Hausman was impressed by the regimental commander with the lowest neuropsychiatric rate who personally screened and observed the functioning of assigned offices. [Footnote 2, pp. 70-71]
Major Clarence Miller, 3rd Infantry Division Psychiatrist, was returned to the ZI in February 1951. He was replaced by Cpt. Clay Barritt, the assistant division psychiatrist (one year civilian psychiatry residency under Army auspices). Captain Barritt demonstrated an ability to motivate and work with line and medical officers which made him a popular figure in his division.
Major Wilmer Betts, 7th Infantry Division Psychiatrist, studied self-inflicted wounds (SIW’s). He found that about 50 percent of cases came from new divisional replacements. This survey, supported by the division surgeon, influenced the Division Commander to establish battle indoctrination for infantry replacements. The investigation by Major Betts made it logical to conclude that relative unfamiliarity with weapons plus numbing cold permits some persons to accede to more or less unconscious wishes for accidental injury and medical evacuation. The institution of a seven to ten-day training period in the 7th Infantry Division produced decreases of SIW's. It proved to have further beneficial effects of giving the newcomer more self-confidence as battle tactics were learned under experienced combat personnel. Under these training conditions insecure replacements were especially motivated to absorb imparted knowledge when frankly told that the instruction was akin to life insurance. In the process of battle indoctrination the new infantryman came to appreciate group identification when taught that one could best survive as a team member.
The training period also demonstrated that combat leaders were concerned with health and safety of personnel. All in all the preliminary instruction for the newcomer was a pertinent and valuable morale factor and represented a major improvement over placing new and tremulous recruits into battle with no alleviation of inevitable anxiety. The success of the training program as publicized in a Sunday Supplement of the Stars and Stripes, Far East Command edition, spurred other divisions to adopt similar training. [Footnote 2, pp. 71-72]
From both Captain Stimson, 1st Cavalry Division Psychiatrist, and Major Krause, 25th Infantry Division Psychiatrist came information that over half of their psychiatric casualties had eight to nine months of combat beginning with the early fighting in July and August 1950. These patients were designated the “Old Sergeant Syndrome” as their manifestations seemed identical with the syndrome described in World War II. One can argue whether there were sufficient combat days in number and severity endured in Korea as in World War II; yet, there was the same clinical picture of the previously excellent soldier often becoming promoted to a noncommissioned officer who gradually became ineffective in battle with or without accompanying guilt. However, with the beginning of rotation in April 1951 such cases were removed from Korea. [Footnote 2, pp. 72, 3]
In all combat divisions the division psychiatrist made the holding platoon of the clearing company the permanent base of operations. Psychiatric cases were sent to this platoon for evaluation or treatment. The holding platoon was located in a rear position relative to the other two clearing platoons which moved according to the needs of the tactical situation. Patients with mild organic diseases were also treated at the holding platoon to which two general medical officers were assigned. The presence of other medical officers in the treatment platoon obviated the need for a professionally trained assistant division psychiatrist. In actual practice it was not difficult to orient one or more of these young medical officers in utilizing the relatively simple physical and psychological measures employed at this level for psychiatric casualties. The division psychiatrist was seldom absent for more than a 24-hour period so that all evaluations and major decisions were made by the division psychiatrist. The “assistant division psychiatrist” was mainly concerned with initiating or continuing routine treatment.
Each division psychiatrist had several enlisted assistants with more or less psychiatric experience. Their services were invaluable in the management and observation of patients. They were also useful in obtaining history data and gathering information for routine reports. The chief enlisted assistant of Captain Barritt (3rd Infantry Division Psychiatrist) was a former bartender with no psychiatric experience, but who possessed a keen intuitive ability in understanding and managing mental disorders. Rarely were there available trained social workers or clinical psychologists who were utilized mainly by psychiatry at the Army level.
A frequent complaint of division psychiatrists involved difficulties in obtaining transportation for trips to visit divisional units. This was a chronic problem in combat areas where it seemed that every staff officer needed a personal vehicle. Actually, necessary visits by division psychiatrists were only delayed rather than blocked; and, although it required pleading, ingenuity, and cooperation, visits by division psychiatrists were accomplished. Naturally, it would have been more convenient and would have facilitated the work of the division psychiatrist to have a jeep similar to the transportation advantages of division chaplains. [Footnote 2, pp. 73-74]
New Informal Theater Policy
During March 1951, an informal Far East Command Theater policy was gradually established that gave the division psychiatrist control over decisions for return to combat duty of psychiatric casualties who originated from combat personnel of his division. The policy was based upon experience that the division psychiatrist could more correctly estimate the potential of such casualties to perform combat duties than rear colleagues. When the division psychiatrist determined that a psychiatric casualty was temporarily disabled for combat, the initials DSB (Don’t Send Back) were added to the diagnosis of “Combat Exhaustion” on the Emergency Medical Tag. This decision was honored by psychiatrists at the Army level. Division psychiatrists were enjoined never to predicate the decision of the receiving psychiatrist as to fitness for non-combat duty in Korea or Japan by avoiding such a recommendation either directly to the patient or on the medical record. In such cases decisions for combat duty avoided iatrogenic trauma to patients who were not promised duty in Japan or evacuation to the ZI, thus allowing receiving psychiatrists to make their own disposition.
Division psychiatrists did not abuse their control over criteria for assignment to combat duty as uniformly they were motivated to maintain as many personnel as practicable on duty within the division. To further this goal, division psychiatrists were active in obtaining reassignment within the division for battle-weary riflemen or other neurotically handicapped persons who could be effectively utilized at less strenuous positions in regimental and division headquarters or the service units of quartermaster, ordinance, and the like. The author has a distinct recollection that Major Hausman, 24th Infantry Division Psychiatrist, initiated the DSB technique. [Footnote 2, pp. 74-75]
Administrative Discharges
Another aspect of formal psychiatric disposition involved personnel with so-called personality or behavior disorders who in peacetime received administrative discharges under AR 615-369 [Footnote 4] and AR 615-368 [Footnote 5]. Experiences in World War II and the Korean War indicated that few cases could be discharged under AR 615-369 in a combat unit because first, there was little time for administrative procedures and second, such a general discharge under honorable conditions would in the combat environment be construed as a reward for ineffectiveness with a consequent negative impact upon morale. Moreover, in wartime with increased situational needs, persons who fall under AR 615-369 can be profitably employed in non-combat assignments since their personality defects were not so severe as to preclude functioning under less stressful conditions.
It was agreed that the division psychiatrist was to medically evacuate mild personality problems who could not be reassigned within the division. The next psychiatric echelon would then re-profile the evacuee and recommend a rear assignment. By this procedure, it was demonstrated that the bulk of such cases could and did function effectively. Even enuretics became useful rear soldiers when it was made clear that the problem was laundry facilities of which there was no dearth in Korea or Japan. Generally the enuretic was considerably less bothered by his uncomfortable habit when reassigned out of combat. In time discharge by AR 615-369 became rare in the entire Far East Command. Such a gain producing reward was impractical in an overseas wartime theatre. AR 615-369 was only utilized in severe instances of inadequate personality where it was clearly evident that marked ineffectiveness in military service duplicated a borderline civilian adjustment and the person was literally incapable of being motivated toward effective work of any kind.
Individuals with pathological personalities who belonged in the category of AR 615-368 for undesirable discharge were not evacuated through medical channels, but were handled by administrative and disciplinary measures within the division. Such cases included narcotic and alcohol addicts, habitual shirkers, antisocial personalities, and chronic disciplinary problems. This policy was based on the assumption that such persons cannot be rehabilitated by reassignment. In actual practice, infantry divisions had few cases when in the combat zone. There was little opportunity for usual disciplinary disorders and AWOL was a serious offense at this time. Alcohol and drugs were scarce and addiction much less of a problem. In one infantry division (25th Infantry Division) only 12 AR 615-368 dispositions were made during one year of combat.
The Non-effective Combat Officer
The disposition of non-effective combat officers was resolved during March 1951. Previously, officers who demonstrated unsuitability as combat leaders at the company or battalion level, for whatever reason, were either evacuated through medical channels or referred for administrative action under AR 605-200. [Footnote 6] Neither method proved to be effective. On the one hand combat units did not have the time or administrative ability to cope successfully with the unwieldy process of AR 605-200. On the other hand medical evacuation was an obvious gain for poor duty performance. As a result, Eighth Army in early March 1951 established a permanent 605-200 Board at the main Army headquarters under direct supervision of the Eighth Army Judge Advocate General to process all cases that arose in Eighth Army. This action promptly removed the administrative burden from combat units who were then more willing to recommend this procedure rather than press medical officers to use medical evacuation. Because of more expert guidance and accumulated experience, the permanent 605-200 Board was able to readily accomplish the procedure assisted by prompt medical or psychiatric consultation as needed.
The utilization of the permanent Board proved to be an effective solution to this difficult problem. After six months of operation, 45 cases had been processed under AR 605-200 with 13 cases pending approval from Washington, DC. In this regard was demonstrated a major problem as final action from Department of the Army required about three months during which the individual concerned was useless to himself or others. During wartime it seems advisable to permit final action by the overseas Army or Theater Headquarters involved or allow return of the already boarded officer to the ZI to await final decision of Department of the Army. [Footnote 2, pp. 74-78]
Psychiatry at the Army Level
In the early phase of this period, the 4th Field Hospital at Taegu with the psychiatric team of Captains Kolansky and Cole continued to be the major psychiatric center of Eighth Army. There were no special changes in the clinical syndromes of psychiatric casualties at this time except a proportional decrease of patients with free floating anxiety in favor of those with somatic complaints. Headache was most common, followed by backache, fatigability, urinary frequency, and gastrointestinal disorders. Physical hardships from cold and inclement weather coupled with monotonous diet seemed almost as stressful to the soldier as combat trauma. Indeed, battle casualties (KIA and admissions for WIA) during this period (January-April 1951) were decreased whereas admissions for disease and non-battle injury including frostbite were increased; also psychiatric casualties slowly decreased.
Thus mild injuries, disease and diagnostic problems comprised a high proportion of evacuees from combat areas. The trend toward treatment and disposition of such cases at the Army level (2nd echelon) rather than evacuation to Japan was especially fostered during this period. Colonel Hanson, the commanding officer (CO) of the 4th Field Hospital, strongly encouraged the professional staff toward treatment. He constantly improved and expanded the facilities of the hospital toward this end. It was his characteristic boast that the 4th Field Hospital had "beds unlimited" so that space requirements did not deter the hospital from holding patients for treatment. The salvage of men for duty was also stimulated by a directive from General Ridgeway, who enjoined the Army Medical Service to make all possible efforts toward prompt rehabilitation and prevention of unnecessary hospitalization or evacuation. [Footnote 7, p. 79] In addition to the treatment of psychiatric casualties, Captains Kolansky and Cole received a number of inpatients and outpatients from the many service units of Eighth Army. The main Eighth Army Headquarters was also located in Taegu, thus placing the psychiatric center of the 4th Field Hospital in a strategic position to give advice and consultation to the various administrative and medico-legal problems commonly encountered in a large headquarters.
From the beginning, Captain Kolansky established an excellent relationship with Colonel Silvers, the Judge Advocate General of Eighth Army. Colonel Silvers was pleased with the comprehensive reports that he received relative to referred disciplinary problems. He came to appreciate the psychiatric position which insisted on administrative handling of ineffective officers and men rather than abusing medical evacuation channels.
In contrast to the policy of Eighth Army Headquarters was the stubborn refusal of 2nd Logistical Command (Pusan, Korea) to alter their stand that courts-martial was the proper method of elimination for the behavioral problems of enlisted personnel rather than administrative discharge. It was their fear that employment of administrative discharge would result in a wholesale loss of manpower. At best they agreed to consider a limited number of cases referred by local psychiatrists. 1LT (later Captain) Richard Conde (one year civilian psychiatry residency) arrived at the 10th Station Hospital in February 1951 to initiate another psychiatric unit in Pusan. This was a welcome relief to overworked Captain Steve May whose psychiatric section of the 3rd Station Hospital (previously the 8054th Evacuation Hospital) was kept busy with consultations and referred patients from local organizations. 1st Lieutenant Conde received the strong support of Col. John Baxter, the CO of the 10th Station Hospital, who, like Colonel Hanson, was convinced of the need to hold patients for treatment and return to duty, rather than accenting the number of patients passing through the hospital. 1st Lieutenant Conde combined forces with the orthopedic section in the treatment and evaluation of patients with backache and, by the use of hypnosis or pentothal interviews, demonstrated psychological causation in most cases with improvement. [Footnote 7, pp. 80-81]
In the Prisoner of War Hospital for captured North Korean prisoners, Dr. Jun Doo Nahm lived up to expectations as he steadily enlarged the scope of the psychiatric section and demonstrated rare tact and ability to work with Korean psychiatric cases. All of his cases were carefully evaluated. Because Dr. Jun's professional training was mainly in descriptive psychiatry, considerable attention was paid to diagnosis and prognosis. But his approach to patients was one of concern and help. An ECT machine was obtained to be used mainly for psychotic disorders.
The 121s Evacuation Hospital, after withdrawal from northeast Korea in late December 1950, was placed near Pusan for staging. In late January 1951, the hospital became operational at Toxond-dong, about twenty miles from Taegu. Their site was a frozen rice paddy. Rarely has the author seen hospital personnel in such poor spirits. They were cold, miserable, living in tents, and off the main channels of evacuation. There was not even the stimulus of hard work, which usually acts as a tonic to medical personnel. In late February 1951 the hospital was moved to Taejon. Morale promptly improved as all became occupied in establishing and operating a winterized hospital using the existing station hospital buildings as a nucleus. Captain Glasscock, the psychiatrist, maintained the psychiatric section at a high peak of interest. Initially, he received few patients in this location because conditions of the airfield at Taejon did not permit its frequent utilization and mainly mild surgical and medical cases evacuated by train were received. In late March 1951, the hospital moved to Yongdongpo near Seoul and in early April 1951 it was established in Seoul. Here, the 121st Evacuation Hospital was in the most favorable location to receive casualties from the combat area. The psychiatric section soon became quite active and at the close of this period an addition of another psychiatrist was contemplated. [Footnote 7, pp. 81-83]
Base Section Psychiatry in Japan and Okinawa
This phase saw further progress in the organization and development of psychiatry in Japan. One change was in the air evacuation of patients from Korea. The usual policy had been to evacuate the majority of cases by air to southern Japan from which most patients were transhipped by air or rail to hospital centers around Tokyo and Osaka. This method involved considerable duplication of handling and hospitalization in Japan which required additional personnel and delayed definitive treatment.
For sometime Brigadier General S. Hays, Surgeon, Japan Logistical Command, had endeavored to have air evacuation from Korea routed directly to the various hospital centers in Japan, but apparently there were insufficient planes for this purpose. But in January 1951 direct evacuation as proposed was placed in operation. Each of the hospital centers in the Tokyo and Osaka areas were to receive 40 percent of the casualties from Korea with 20 percent sent to medical facilities in south Japan (Fukuoka area). Thus was created the then well known "40-40-20" distribution of evacuees from Korea based upon the number and types of hospital facilities in various areas of Japan. [Footnote 8, p. 84]
From a psychiatric standpoint, the changes in air evacuation was fortunate because the three psychiatric centers were strategically located along the 40-40-20 axis, thus completely obviating the transfer of psychiatric patients within Japan. The location of the two convalescent hospitals near Tokyo and Osaka allowed for the triage of non-psychotic psychiatric casualties directly to the convalescent hospital, thus bypassing fixed hospitals in Tokyo and Osaka for a more realistic treatment environment. However, psychotic, neurological, or mother severely-ill neuropsychiatric patients were sent to fixed hospital facilities. [Footnote 8, pp. 84-85]
The greater effectiveness of a convalescent hospital type environment over that of a fixed general hospital, in the treatment of non-psychotic psychiatric patients became quite evident in the early part of this period. As time passed, convalescent psychiatry was steadily exploited as indicated by accumulated evidence to insure a growing belief that only severe mental reactions, as psychoses or neurological disabilities required the facilities of a fixed hospital. The minor mental reactions (combat psychiatric casualties), not only did not need to be in the "good beds" of a general hospital, but such accommodations served as a deterrent to recovery by increasing gain in illness through providing an artificial and suggestible atmosphere that militated against return to even non-hazardous daily tasks. Fortunately the two assigned psychiatrists, 1LT Francis Hoffman, at Nara Convalescent Hospital (near Osaka) and LTjg Richard Blacher, his U.S. Navy counterpart at Omiya Convalescent Hospital (near Tokyo), were enthusiastic young therapists. Both developed objective methods of brief treatment, learned to deal realistically with gain in illness complications, used abreactive techniques of hypnosis and barbiturate interviews, and fully utilized the daily activities of the convalescent hospital to discourage tendencies toward neurotic helplessness.
At Omiya, Dr. Blacher treated about 350 patients during this period and performed 75 hypnotic and barbiturate interviews. The great majority of this caseload was returned to non-combat duty (90 percent). The remainder were transferred to the 361st Station Hospital because of psychotic manifestations or organic neurological disabilities. Similar results were obtained a the Nara Convalescent Hospital except that a larger percentage was returned to combat duty. The author believed that the reason for the difference was that the Osaka triage was more successful in sending patients directly to Nara Convalescent Hospital; whereas, in Tokyo it seemed almost impossible to prevent similar patients from being first sent to the 361st Station Hospital where 3.5 days were required to effect their transfer to Omiya Convalescent Hospital. Apparently even this brief period at a general type hospital was sufficient to produce a fixation of symptoms. [Footnote 8, pp. 85-86]
Limited Duty Assignment
The many difficulties inherent in the reassignment of reprofiled (Limited Service) personnel were clarified during this period, also through the efforts of Brigadier General S. Hays, Surgeon, Japan Logistical Command. It will be recalled that in the early months of the Korean War (July, August, September 1950), there was an improvised theater (FEC) policy that covered the return to duty of patients whose physical or mental defects permitted only a limited type service. But "Limited Service" had been deleted by Army Regulations following World War II. Because hospitals in Japan were still under the control of Eighth Army during this time, the Eighth Army Surgeon gave verbal permission to return suitable cases to limited type duty. The G-1 (Personnel) Section of GHQ FEC promptly changed this designation to "general service with waiver for duty in Japan only" to be accompanied by an appropriate change of the physical profile on a temporary basis not to exceed 90 days. The geographical limitation to Japan was not a medical recommendation but a G-1 stipulation for the purpose of filling depleted service requirements in Japan. The need for a limited service category is a virtual necessity in a wartime overseas theatre, otherwise large numbers of individuals would be medically returned to the ZI who were capable of performing service but not combat type duty. This procedure operated satisfactorily so long as there were sufficient vacancies in Japan. However, in January 1951, it became increasingly difficult to find non-combat assignments in Japan. [Footnote 8, pp. 16, 86]
The entire problem of limited assignment was brought to a head by the following circumstances. In latter January 1951 GHQ FEC ordered the 34th Regimental Combat Team (RCF) reconstituted and put in combat readiness. This unit, previously a part of the 24th Infantry Division, had been withdrawn from Korea after severe losses in July and August 1950. There were no "pipeline" replacements for the project. The G-1 Section of GHQ FEC directed the utilization of recently re-profiled hospital returnees waiting at the Japan Replacement Training Center (JRTC) for limited assignment.
Due to an apparent misunderstanding the JRTC officials assigned all re-profiled persons to the 34th RCT, regardless of physical or mental defect. Replacements numbered about 1500, and included mainly individuals improved from frostbite, wounds, injuries, and disease. Former psychiatric casualties were about 1/6 (250) of the total group. The CO of the 34th RCT was informed that his training mission should be construed as a "sense of urgency." Accordingly he began a vigorous program designed to reach efficiency in several weeks. Curiously in none of the above arrangements was medical advice sought or obtained from either the medical section of GHQ FEC or the Surgeon, Japan Logistical Command.
The effects of strenuous battle training upon recent reprofilees was immediate, as sick call became inundated by hundreds of complaining and bitterly protesting soldiers who felt that promises made to them were broken and their mainly physical condition made it impossible to perform such duty. Brigadier General Hays as made promptly aware of the problem from dispensaries and hospitals near Zama, the training area of the 34th RCT. He called for a general conference to reach a reasonable solution of the Zama situation. The meeting was attended by theatre medical consultants to the Far East Command (medical section of GHQ) including the author, representatives from G-1 and G-3 (operations) GHQ, General Hays and members of his staff and ranking officers of the 34th RCT. In the ensuing discussion it became obvious that there was confusion in use of the term non-combat duty, doubt as to accuracy of medical recommendations, and difficulties in finding suitable assignments for non-combat personnel in Japan. It was decided that a team of medical specialists would review all re-profiled assignments to the 34th RCT. It was also agreed to reexamine existing directives to prevent similar future difficulties. [Footnote 8, pp. 86-88]
The medical team found that three-fourths of the reprofiled members of the 34th RCT were unfit for continuation of battle training. The remainder were permitted to continue with the unit, but with a decreased intensity of training. A medical and administrative group under the supervision of Brigadier General Hays brought forth the following changes in the utilization of limited duty personnel that were in the main, accepted and incorporated in directives of GHQ and Japan Logistical Command:
The limitation "for Japan only" was deleted from recommendations for assignment. This increased opportunities in the use of non-combat personnel for vacancies in rear Korea and Okinawa.
Reexamination was made mandatory for all reprofilees at the expiration of temporary disability. It should be realized that raising physical profiles of hospital returnees was necessarily temporary (up to 90 days) since Army regulations did not provide authority for permanent limited service except under special circumstances. Individuals found fit for full duty were made eligible for combat assignment. Those still unable to perform full duty had their status continued for another period of one to three months. This procedure served to offset the ever increasing number of limited personnel. All previous reprofilees in Japan were reevaluated during February and March 1951. A surprising result was obtained from those in the psychiatric category when 30 percent to 50 percent were judged to be fit for full duty by many examiners in various areas of Japan. Although criteria employed for the determination of full duty were not uniform, psychiatrists were instructed to consider individuals fit for combat when free of overt anxiety or its somatic displacements, nightmares and insomnia, and when capable of considering return to combat duty without a recurrence of disabling symptoms. Examiners reported that many psychiatric reprofiles welcomed a full duty decision, expressing a desire to prove themselves and avoid feelings of inferiority that had been present since removal from combat. This formal process of reclaiming psychiatric casualties after several months of non-combat duty was a new practice in military psychiatry. Unfortunately, no follow-up studies were performed to determine effectiveness after restoration to combat duty. However, on repeated questioning of division psychiatrists in later months, the author found it was rare to find a history of restoration to combat duty among their cases. Perhaps this apparent favorable result was due to rotation that became fully operational in May 1951 and gradually removed the personnel restored to combat duty. Despite the absence of more exact information as to effectiveness, there is sufficient data to indicate that such a reclaiming process as so stated is of much benefit and should be given further trials in future wars. [FDJ: Israeli experience with psychiatric casualties of the 1973 war who were returned to combat duty in the 1982 Lebanon War showed this same lack of increased psychiatric breakdown.] There are powerful forces which impel psychiatric casualties to return to combat. They are discernible in battle dreams and irritability of the psychiatric casualty who constantly returns to the traumatic situation that he was unable to master. When forward psychiatry operates effectively, salvageable psychiatric casualties were usually returned to duty at division or army level. But when circumstances did not permit efficient combat psychiatry as occurred early in the Korean War, many reclaimable psychiatric cases were rapidly evacuated and placed in non-combat assignments.
Hospitals were enjoined to give special consideration to accuracy in reprofiling and required to create a special board of senior medical officers (Chiefs of Service) to review and approve all profile changes made by members of the medical staff. It was further stipulated that the physical or mental limitations stated on the individual disposition form be in understandable lay terminology in order that proper placement was facilitated. [Footnote 8, pp. 88-90]
Arrival of Psychiatric Assets in Theater
279th General Hospital
A major event during this period, was the arrival in Japan of three numbered general hospitals. The 279th General Hospital became operational in early March 1951 at Camp Sakai near Osaka; the 382nd General Hospital was established also near Osaka at Konoka Barracks and began receiving patients in latter March 1951. The 343rd General Hospital was placed on a standby basis at Camp Drew, 50 miles from Tokyo, and did not become operational until 1 October 1951. The pre-existing psychiatric facilities in Japan were adequate for current and future foreseeable needs. Accordingly it was proposed and accepted by Brigadier General Hays that the three new general hospitals delete their planned psychiatric services except for consultative functions. The personnel thus made available would be absorbed in other psychiatric assignments as needed.
The 279th General Hospital arrived with a complete complement of psychiatric personnel as follows:
Maj. Marvin Lathrum - board certified psychiatrist, civilian psychiatric training
Cpt. James Reilly - 2 1/2 years civilian neurology residency under Army auspices
1Lt. Otto Thaler - six months civilian psychiatry residency
Maj. Susan Stimson - psychiatric social worker
1Lt. George Humiston - clinical psychologist
A full quota of enlisted neuropsychiatric ward technicians, psychological assistants, and social work assistants, including six nurses with special psychiatric training, was available.
Arrangements were made to utilize the psychiatric staff of the 279th as follows: Their major function was to provide psychiatric consultative services for the entire Osaka-Kobe-Kyoto region. More specifically Major Lathrum and his staff became responsible for consultations from the 8th Section Hospital at Kobe and the 35th Section Hospital at Kyoto besides referrals from his own hospital and the 382nd General Hospital. It was agreed that Major Lathrum was to maintain an open neuropsychiatry ward for the diagnosis and treatment of referred patients considered to warrant further study or recoverable by brief psychotherapy. All closed ward patients were to be transferred to Osaka Army Hospital that had closed ward facilities and ECT apparatus. Major Lathrum found it convenient to visit one day each at Kobe and Kyoto on a regularly scheduled basis. This avoided travel by patients, enabled Major Lathrum to become familiar with local problems, and allowed him to furnish written reports as well as to be available to discuss findings in appropriate cases with referring line or medical officers. Generally he was accompanied by Major Stimson on these visits. The 279th General Hospital received no patients directly from Korea as they were triaged directly to Nara Convalescent or Osaka Army Hospitals. These various functions allowed for the effective utilization of Major Lathrum and some specialized personnel. The remainder were absorbed by other psychiatric units, mostly in Japan.
382nd General Hospital
The following officer personnel were included in the psychiatric service:
Cpt. Avrohm Jacobson - completed civilian psychiatry residency and board certified
Cpt. Pust - two years experience with chronic mental patients in a VA Hospital
Cpt. Dunaef - two years civilian psychiatry residency under Army auspices
1Lt. Gordon McKay - psychiatric social worker
1Lt. Philip Barenberg - clinical psychologist
Captain Jacobson was delayed, arriving in the theater in late April 1951. He was sent to the Nara Convalescent Hospital to aid 1st Lieutenant Hoffman and become familiar with this type of treatment. Captain Dunaef and 1st Lieutenant Barenberg were sent to the Neuropsychiatry Service of the 141st General Hospital in early April 1951. Captain Pust was permitted to continue his work as an anesthetist on the surgical service of the 382nd General Hospital. He was not particularly interested in psychiatry. 1st Lieutenant McKay was eventually transferred to the 361st Station Hospital in Tokyo.
118th Station Hospital
With decrease of the casualty flow through southern Japan after implementing the 40-40-20 ratio of patient distribution from Korea to Japan, the 118th Station Hospital and the 141st General Hospital received relatively few psychiatric admissions; but, the 118th Station Hospital, steadily increased its outpatient function. Captain Allerton of the 118th Station Hospital assisted by 1Lt. Pamella Robertson (psychiatric social worker) continued to maintain a small number of inpatients, but most of Captain Allerton's caseload comprised evaluation and treatment of referred outpatients. In the course of time, Captain Allerton could not fail to note the relative frequency of referrals from nearby units. This led to a discussion with Brigadier General Hays, Surgeon, Japan Logistical Command to determine what channels, if any, could be used to transmit such information. It was evident that while the frequency of disciplinary and psychiatric disorders fall in the realm of preventive psychiatry, any remedial action was the very essence of command. Brigadier General Hays informally transmitted information gathered on one organization which was investigated by General Clark, the Commanding General of the Southwest Base Command that included southern Japan, who found evidences of poor leadership with mismanagement and lowered unit morale. Thus Brigadier General Hays demonstrated that the channels required should be comparable to those employed with the bimonthly division psychiatric reports which are routinely sent to the Commanding Officer of each combat Division through the Division Surgeon.
141st General Hospital
In early March 1951 Lieutenant Commander H. Wilkinson, Chief of the Neuropsychiatry Service, was medically evacuated to the ZI. He was replaced by Major Henry Segal from Tokyo Army Hospital who reorganized and further developed the Neuropsychiatry Service. Plans were made and approved to rebuild the closed facilities. ECT apparatus was obtained and placed in operation.
Osaka Army Hospital
The Neuropsychiatry Service of Osaka Army Hospital became a smoothly functioning team under LTC Philip Smith. It was further strengthened by the addition of 1st Lieutenant F. Hammer, clinical psychologist. A study of self-inflicted wounds (SIW's) was begun at this time to determine if any specific personality traits of dynamic mechanisms could be demonstrated.
361st Station Hospital
The Neuropsychiatry Service of the 361st Station Hospital continued to function as the major center for psychiatry and neurology in the Tokyo-Yokohama area. However, the policy of decentralization had steadily decreased the inpatient census until it remained fairly constant at about 150 psychiatric and neurological patients of all types including prisoners for pre-trial examination. More than half the patients came from local sources. New arrivals to the Neuropsychiatry Service, 361st Station Hospital included:
1Lt. L. Laufer - two years civilian psychiatry residency
Cpt. James Rafferty - one year civilian psychiatry residency under Army auspices
Maj. Philip Steckler - board certified psychiatrist, completed three years civilian psychiatry residence and necessary professional experience
LTjg. Mariner - enlarged the scope of the psychiatric outpatient and consultation service at the 155th Station Hospital Yokohama
In February 1951, he was joined by Ltjg. Austin (one year civilian neurology residency) who, soon became fully occupied with neurological referrals both inpatient and outpatient. An account of their experience can be found in the Symposium of Military Medicine in the Far East Command (FEC) published as a Supplemental Issue of the Surgeon's Circular FEC, September 1951.
Cpt. James Corbett (two and a half years civilian psychiatry residency) replaced Major Segal as psychiatric consultant at Tokyo Army Hospital. Also at Tokyo Army Hospital, Cpt. Philip Dodge (one year civilian neurology residency under Army auspices) worked with both the neurosurgical and medical services as neurology consultant. He organized weekly evening seminars on neurological topics which was given strong support by LTC William Caveness (board certified neurologist), Chief of Neurology US Naval Hospital at Yokosuka near Tokyo. The evening seminars were well attended by neuropsychiatry specialists from the Tokyo-Yokohama area. [Footnote 8, pp. 90-94]
40th and 45th Infantry Divisions (National Guard)
The 40th and 45th Infantry Divisions (National Guard) arrived in Japan during March and April 1951. The 45th Infantry Division from Oklahoma was sent to Hokkaido, the northern island of Japan, and the 40th Infantry Division from California to the northern area of Honshu, the main Japanese island. Both divisions had as their mission the defense of Japan, and both began active training programs calculated to reach combat readiness as soon as possible. Each division arrived with a psychiatrist. In the 45th Infantry Division Major H. Witten (three years civilian psychiatry residency and board eligible) was properly assigned as the division psychiatrist and prepared to function as such. It was arranged that Major Witten would also act as psychiatric consultant to the 161st Station Hospital in Sapporo, Hokkaido, the hospital support for the division. The 40th Infantry Division refused to assign Captain Bramwell (two years civilian psychiatry residency) as division psychiatrist because of a shortage of medical officers and their insistence that he was needed as the clearing company commander. It was agreed that Captain Bramwell would be released to serve as the division psychiatrist when additional medical officers were assigned to the division; but, this did not occur until August 1951.
Here was another instance of the misuse of division psychiatrists either due to ignorance of their functions or an inability to appreciate the need for all efforts to prevent loss of manpower. The contention of the 40th Infantry Division Surgeon that he lacked sufficient medical officers was technically correct. But of the 15 medical officers in the division that were available, four (the division surgeon, the medical inspector, the CO of the Medical Battalion, and the clearing company commander) were utilized in mainly administrative duties. Yet the largest loss from the division at this time came from persons hospitalized for anxiety or vague somatic complaints; thus, it seemed unrealistic at such a time to be without a division psychiatrist while four medical officers were not professionally utilized. The author's suggestion that the CO of the Medical Battalion who had few professional duties also act as the clearing company commander fell on deaf ears. [Footnote 8, pp. 94-95]
Psychiatric Problems on Okinawa
Psychiatric problems on Okinawa increased to troublesome proportions during this period. The early phase of the Korean War saw a depletion of the Okinawan garrison for services in Korea and a subsequent decrease in the psychiatric caseload. 1LT. Daniel Casriel (eight months civilian psychiatry residency), replaced Captain Clements (one and a half years Army psychiatry residency) who was returned to the ZI in November 1950 to complete residency training. Psychiatric consultations during this time were less than 100 per month with a small inpatient census of 10-15 per month. 1st Lieutenant Casriel was assisted by a civilian clinical psychologist and several enlisted social workers.
In December 1950 and January 1951 there began a rise in psychiatric consultations as the strength in Okinawa was increased in both ground and air elements. As the winter months brought its discouraging tide of battle and continuation of the lengthened tour of duty in Okinawa, there ensued inevitable loss of morale that occurs when military personnel stationed on an island do not have an obvious mission or stated length of time to serve. The result was a sharp upswing in disciplinary problems, psychiatric referrals, and suicidal attempts.
A visit to Okinawa by the author in early April 1951 confirmed the impression of typical irritability and low morale common in an island setting with little effort made to utilize recreational, social, and other outlets that were available. Despite the increase of suicidal attempts, there had been no fatalities from this source since the onset of the Korean War. In the author's opinion, this fact demonstrated such attempts were not the result of serious intrapsychic conflict, but rather represented anger against the environment with an effort to influence the outside world. The attitude of many on Okinawa that they were neglected, unappreciated, and not given due consideration, as even shared by senior officers. Any attempt to make favorable comparisons of their situation with those fighting or living in Korea, brought forth angry outbursts that displayed an oversensitivity toward any argument that seemed to be against their right to complain and feel unhappy. It was clear that while living conditions on Okinawa were not elegant and there were decreased opportunities for recreational and social outlets, the major difficulty was the need for a definitely stated tour of duty.
1st Lieutenant Laufer (two years civilian psychiatry residency) was sent to Okinawa to join with 1st Lieutenant Casriel, so as to enlarge the psychiatric facilities required for the increased patient load. An enlisted psychologist was transferred to Okinawa from the 361st Station Hospital to replace the civilian psychologist who had returned to the ZI. It was recommended that certain behavior and disciplinary problems characterized by restlessness and aggression in persons with a relatively good military record prior to Okinawa be transferred to the replacement center in Japan for shipment to combat units in Korea. This procedure, which became known as "Operation Vital," functioned quite effectively to salvage worthwhile soldiers who found it difficult to tolerate monotony and welcomed a change that gave an opportunity to externalize aggression.
It is believed that morale in Okinawa was certain to improve in the future as the reestablishment of a stated length of a tour of duty was expected. Dependent travel had resumed in April 1951 and was to continue in larger increments since considerable housing construction was nearing completion. In general the building program was making good progress with a reasonable expectation of providing better barracks, roads, and recreational projects. [Footnote 8, pp. 96-97]
Discharge of Undesirable Personnel
The elimination of undesirable personnel by the provision of AR 615-368 came up for considerable discussion during this period. There were many inconsistencies in the use of this regulation in Japan as various local headquarters utilized individual interpretations relative to what constituted proper criteria for administrative discharge from the service. In some instances, as in the 2nd Logistical Command in Korea, no cases were approved for discharge; court-martial was deemed the logical method of elimination. They feared that undesirable discharge by AR 615-368 would result in a wholesale loss of manpower. In other instances, AR 615-368 was used freely as a punitive measure. The entire question was taken up with Brigadier General Hays, who submitted a more uniform procedural data to MG Walter Weibel, the Commanding General (CG) of Japan Logistical Command. This resulted in a well-written directive on the subject by Japan Logistical Command Headquarters, to its subsidiary branches. In time, there was definite improvement as indicated by a decrease of referrals for alcohol addition, chronic behavior disorders, and various other pathological personalities who were a burden to their units and not amenable to any type of punishment or treatment. [Footnote 8, pp. 97-98]
In the above connection, the question of narcotic addiction will be mentioned. Before the Korean War, narcotic addicts were well-known to be relatively common, particularly among American troops based in port cities of Kobe and Yokohama in Japan, and also Pusan, Korea. As in civilian life, this problem was difficult to control, especially so in the Far East where opiate drugs were cheap and easy to obtain. Previous attempts to solve narcotic addition by lectures to the troops, unannounced inspections for drugs, and undercover investigations by the Central Intelligence Division (CID) had not been successful. At this time it was stated that there had been no increase in narcotic addition since the onset of hostilities in Korea. This statement was later found to be erroneous.
Also, at this time, it seemed logical to conclude that the prompt removal of confirmed narcotic addicts by AR 615-368 would decrease the extent of the problem and prevent to some degree the contamination of susceptible soldiers. Further, it was argued that action should be taken whenever the diagnosis of narcotic addition could be made by the psychiatrist on the basis of withdrawal symptoms, the presence of typical venous puncture marks, and a characteristic history in an effort to present evidence to warrant trial by court-martial.
However, later experiences and investigations indicated that most of the above stated characteristic manifestations of narcotic addition were found to be incorrect as follows:
The well known withdrawal symptoms seldom occurred when confirmed users were held in locked wards of a psychiatric service. Also, the lack of withdrawal symptoms was found related to the relative youth of subjects and the low dosage of opiates involved. Civilian experience with teenage addicts demonstrated that little or no distress was exhibited during drug withdrawal.
Moreover there was some evidence that the withdrawal syndrome was a learned process compounded out of physical discomfort from physiological dependence and anxiety from psychological dependence. Thus, teenage users at the Federal Narcotic Hospital in Lexington, Kentucky had severe withdrawal symptoms in contrast to the mild or no distress displayed by similar youthful offenders incarcerated in hospitals such as Bellevue in New York City. Presumably association with confirmed and older offenders at the federal institution may have influenced the newcomers to exhibit a heightened response to drug withdrawal.
Experience with physical inspections indicated that needle scars must be looked for not only in the forearms, but also in the feet, legs, buttocks, neck and abdomen. Random and well distributed needle scars could readily be explained away by suspects who rarely exhibited weight loss or physical stigmata that characterizes confirmed and older addicts. [FDJ: Furthermore, a habit can be maintained by nasal inhalation (snorting) heroin, the preferred route during the subsequent Vietnam War.]
In general, psychiatry in the Far East Command did not foster or favor punitive discharges either by AR 615-368 or by courts-martial. Such a discharge only further handicapped the antisocial or disciplinary problem in civilian life. Various efforts were made, including transfer of narcotic addicts from port cities to remove them from supply sources after complete withdrawal was accomplished.
It was further proposed that senior noncommissioned officers of port companies serve as "vigilantes" in protecting their men against known suppliers of narcotic drugs to their organizations. Also proposed was the selective reassignment of completely withdrawn addicts to combat units where opiate supplies were as yet unknown. However, none of the above noted later proposals were placed into operation during the author's tour of duty in the Far East Command, which ended 13 September 1951. [Footnote 8, pp. 98-99]
References - Chapter 9
1. Schnabel, J. United States Army in the Korean War: Policy and Direction: The First Year. Washington, DC: Office of the Chief of Military History, United States Army; 1972: 331.
2. Glass, A.J. Psychiatry at the division level. In: Notes of the Theater Consultant, Section VI. Unpublished manuscript held by The Medical Division, Office of the Chief of Military History, US Army, Washington, DC. [Compilation of data obtained from Medical Corps, Medical Service Corps and line officer participants who were present in Korea during the period 25 June 1950 to 30 September 1951.]
3. Sobel, R. Anxiety-depressive reactions after prolonged combat experience: The "old sergeant syndrome." Combat Psychiatry. Bulletin US Army Medical Department. 1949; 9:137-146.
4. AR 615-369
5. AR 615-368
6. AR 605-200
7. Glass, A.J. Psychiatry at the Army level. In: Notes of the Theater Consultant, Section VI. Unpublished manuscript held by The Medical Division, Office of the Chief of Military History, US Army, Washington, DC.
8. Glass, A.J. Base section psychiatry. In: Notes of the Theater Consultant, Section VI. Unpublished manuscript held by The Medical Division, Office of the Chief of Military History, US Army, Washington, DC.
9. Not provided.
Chapter 10
[KWE NOTE: Unclassified copies of
Psychiatry in the U.S. Army: Lessons for Community Psychiatry
do not have the text for Chapter 10.]
References - Chapter 10
1. Glass, A.J. Psychiatry at the division level. In: Notes of the Theater Consultant, Section VI. Unpublished manuscript held by The Medical Division, Office of the Chief of Military History, US Army, Washington, DC. [Compilation of data obtained from Medical Corps, Medical Service Corps and line officer participants who were present in Korea during the period 25 June 1950 to 30 September 1951.]
2. Glass, A.J. Psychiatry at the Army level. In: Notes of the Theater Consultant, Section VI. Unpublished manuscript held by The Medical Division, Office of the Chief of Military History, US Army, Washington, DC.
3. Glass, A.J. Base section psychiatry. In: Notes of the Theater Consultant, Section VI. Unpublished manuscript held by The Medical Division, Office of the Chief of Military History, US Army, Washington, DC.
Chapter 11
Truce Negotiations and Limited Offensives By the United Nations
(10 July 1951 - 1 October 1951)
By Albert J. Glass, MD, FAPA
The beginning of truce talks in July 1951 continued for several weeks the lull in ground activity that began in latter June 1951. Soon it became apparent that optimism regarding an early end to the Korean fighting was not warranted.
Limited United Nations Offensive Actions
Offensive moves by United Nations forces began in latter July 1951 and were periodically renewed in August and September 1951, when severe combat produced a large number of battle casualties. The attacks were aimed toward improvement of United Nations positions, particularly in the east central sector in Order to obtain a shorter and more defensible battle line. These efforts were largely successful, but the capture of stubbornly-defended hill masses was a slow and painful process. Although patrol actions and limited engagements took place in the western area, the units in the east central zone, particularly the 2nd Infantry Division, the 1st Marine Division, and to a lesser extent, the 7th Infantry Division, and the 24th Infantry Division, bore the brunt of offensive combat during the period.
The Psychiatric Rate
The psychiatric rate was only slightly elevated in response to increased battle casualties. This was especially true in September 1951 when he psychiatric rate rose to 36/1,000/year from the August 1951 rate of 32/1,000/year despite an increase of battle casualties from 68/1,000/year in August to 227/1,000/year in September.
Influence of Rotation
Perhaps the principal reason for the continued relatively low incidence of psychiatric admissions was the influence of rotation. For this reason any adverse reaction from the pessimistic progress of the peace talks was not evident. Relief from combat had become an individual affair obtainable by the person regardless of the outcome of negotiations. Rotation became the chief topic of conversation among troops in Korea; for, upon it depended their hopes and dreams. As practiced in the Korean War, it was a new phenomenon for American combat forces.
While rotation was a mighty step forward in preventive psychiatry and already has proved its value, there were inevitable and undesirable by-products. The most pertinent defect of rotation, aside from logistical problems inherent in such a mass replacement of personnel, lies in the disruption of the sustaining power of group identification that occurred when the combat veteran was notified or became aware that soon he will rotate home. The increase of tension that followed was well known. Such a person has been aptly named the "short-timer."
The "short-timer" has shifted his thoughts and feelings away from the group; and, often for the first time, battle fear became unbearable as now all of his love was returned to the self. Emotionally at least the "short-timer" was disengaged from his buddies and only concerned about himself. The subsequent rise in anxiety produced in some an inability to function and mental breakdown. In most, tension noticeably increased in the last few days of combat as if it were now dangerous to tempt fate. One could often hear stories, undoubtedly exaggerated, of the unlucky person who was killed the day before being scheduled to leave on rotation.
Others of the group readily identified with the "short-timer" as demonstrated by spontaneous actions of units in sending rotatees to rear safe positions or insuring relief from patrol or similar hazardous duties. The "short-timer" often had mixed feelings about leaving as ties to buddies did not loosen so easily. However, it was rare for one to give up the rotation opportunity as such behavior would be regarded as queer or unusual by the group. An excellent description of combat rotation problems by the 25th Infantry Division psychiatrist, Major Krause, can be found in Appendix I. (Here the "short-timer" was labeled the "short-timer's attitude.")
Perhaps the most effective form of rotation would be removal of entire combat units or at least its older or original members. However, such a process would be most difficult to accomplish from a logistical standpoint.
Misassignment of Limited Service Personnel
The misassignment of reprofiled (limited service) personnel to combat units was satisfactorily corrected in late July 1951. An Eighth Army circular (see Appendix II), clearly set forth the utilization of limited type personnel by service units and enjoined against return to their original combat unit. This directive also made official in Korea a policy of mandatory periodic reevaluations of personnel classified as "general service with waiver," identical with the procedure in Japan. Individuals found fit for full duty were available for reassignment to combat units. Subsequent follow-up surveys with division surgeons and psychiatrists in August and September 1951 confirmed that the policies laid down in the Eighth Army directive were being carried out.
2nd Infantry Division Psychiatry
The 2nd Infantry Division had taken a major share of the uphill offensive fighting. As a result, Major Bolocan was perhaps the most busy of the division psychiatrists during this period. He collaborated with Brigadier General (BG) Bootner, the assistant division commander, in establishing an intra-divisional training program for replacements that was probably the most comprehensive effort of this type. A copy of the 2nd Infantry Division training memorandum is included as Appendix III. The report of Major Bolocan that led to the adoption of the replacement training program is listed as Appendix IV.
Combat Psychiatry for Battalion Surgeons
Periodic visits by division psychiatrists to Battalion Aid Stations strongly encouraged and influenced battalion surgeons to participate in the evaluation and treatment of combat exhaustion. More and more the first echelon of psychiatric treatment became the battalion aid station and the collecting station in suitable cases, particularly in secure tactical situations. To further this program Captain Glasscock, the 3rd Infantry Division Psychiatrist, distributed a divisional memorandum, a copy of which is included as Appendix V.
Rotation of Psychiatrists
In latter July 1951 among the first medical officers rotated to the ZI were the following two division psychiatrists: Captain Paul Stimson, veteran psychiatrist of the 1st Cavalry Division, had served continuously with his division since latter August 1950. He was one of the pioneers of combat psychiatry in the Korean War. His well-deserved promotion to major was approved while he was in Japan awaiting shipment home. Captain R. Cole became the 1st Cavalry Division Psychiatrist by volunteering for this position from Japan. Major W. Krause was the second division psychiatrist to earn rotation. He had been in Korea since 7 July 1950, but with the 25th Infantry Division since October 1950. He was replaced by Captain (later Major) Robert Yoder (three years civilian psychiatry residency), formerly assigned to the United States Air Force Hospital at Nagoya, Japan. Both incoming division psychiatrists were oriented by their predecessors and had no difficulties in maintaining the high level of the two psychiatric programs.
In mid-September 1951, Major T. Glasscock (one year civilian psychiatry residency), 3rd Infantry Division Psychiatrist, was returned to the ZI to resume residency training. He was replaced by Captain Dermott Smith who also volunteered for a divisional post from Japan. [Footnote 1]
Psychiatry at the Army Level
121st Evacuation Hospital
The 121st Evacuation Hospital continued to serve as the principal psychiatric center of Eighth Army throughout this period. The psychiatric service had developed excellent physical facilities sufficient to care for 100 patients. Major Segal, head of the service who replaced 1st Lieutenant Jensen, began reorganizing the Neuropsychiatric Service. He was given invaluable support by Major Ralph Morgan, psychiatric social worker, who arrived in early August 1951. His assignment was facilitated by Colonel Page, the new Eighth Army Surgeon. Major Morgan took over most administrative details, assisted in consultations, oriented new admissions, began group therapy sessions, and supervised the recreational program. An enlisted clinical psychologist joined the service in late August 1951, and another psychiatrist, 1Lt. Alan Clarke (one year civilian psychiatry residency) was added in September 1951. The gradual shift of Eighth Army Headquarters from Taegu to Seoul brought the psychiatric staff in greater contact with administrative and medico-legal problems that required psychiatric consultation.
The Psychiatric Team
Experiences in the utilization of psychiatrists at Army level in Korea had consistently demonstrated the value of the psychiatric team. Such a professional team functions in a similar manner to a surgical team. The small group of trained personnel could be moved to any medical facility that was strategically located to receive casualties, be it a separate clearing company, field hospital, or evacuation hospital. When thee was continued static warfare as in World War I or a large production of psychiatric casualties as occurred in the European Theater of Operations (ETO) of World War II, a separate psychiatric unit may be preferable. In Korea, with its many tactical reverses, difficult transportation problems, and at times dangerous rear areas, especially in the first year of the Korean War, it was necessary to have alternate or reserve treatment capabilities. The psychiatric team could begin functioning almost immediately in any unit that provided housekeeping facilities. Eighth Army accepted the elastic use of psychiatric personnel and agreed to utilize Major Morgan and a psychiatrist of the 121st Evacuation Hospital as the psychiatric team that would be moved in the event the 121st Evacuation Hospital was dislocated or psychiatric casualties became large at another hospital.
Professional Medical Consultants at the Army Level
Colonel Paige, Surgeon Eighth Army, appeared to be more receptive than his predecessor to the acceptance of professional consultants on his staff. In September 1951 he agreed to an Eighth Army Surgical Consultant and indicated that perhaps consultants in medicine and psychiatry would be included in the near future.
11th Evacuation Hospital
In mid-September 1951 the 11th Evacuation Hospital moved forward from Chungju to above Wonju. The new site was conveniently located for air and rail transportation so that the hospital was in position to play a more active role by receiving casualties directly from forward units. Captain Levy, the assigned psychiatrist, had previously only a small caseload but the future might make this unit of larger importance as a psychiatric center.
4th Field Hospital
The 4th Field Hospital in Taegu had become a relatively minor medical facility with a low patient census. Thus the psychiatric section headed by Captain Corbett was relatively inactive.
Pusan Area
The Pusan area remained important as a major communication zone, a port facility, and a reserve hospital center for battle casualties. In September 1951 Colonel Paige, Surgeon Eighth Army, agreed to a consolidation of the psychiatric section of the 3rd and 10th Station Hospitals.
Discharge by AR 615-368 Versus Courts-Martial
A final effort was made in September 1951 to influence 2nd Logistical Command (Pusan area) to alter their opposition toward discharge by AR 615-368 [Footnote 2] in appropriate cases rather than discharge by courts-martial. A conference was held with Brigadier General (BG) Young, the Commanding General, 2nd Logistical Command. In this meeting the author was supported by five senior medical officers from the Pusan area and the Medical Section, GQ, FEC. A thorough airing of conflicting viewpoints occurred between the Chief of Staff 2nd Logistical Command and the author. The conference ended with Brigadier General Yount's decision that undesirable individuals in the 2nd Logistical Command would be eliminated by AR 615-368.
It was further arranged that copies of the psychiatrist's recommendations for such a discharge be sent directly to Brigadier General Yount's headquarters to insure that action would be taken. Apparently this meeting brought results as follow-up information by reliable sources found that by early December 1951 13 cases had been processed and discharged by AR 615-368 in the Pusan area. [Footnote 3]
Base Section Psychiatry
There was no essential change in the organization and operational procedures of psychiatry in Japan during this period. The decentralization policy for psychiatric patients along with an emphasis on outpatient and convalescent type therapy for minor reactions was by this time a well established development. Major mental disorders, neurological cases, and diagnostic problems were hospitalized at one of three well-staffed neuropsychiatric centers, each equipped with closed ward facilities, ECT apparatus and an EEG machine.
Visit by Colonel Caldwell
Col. John Caldwell, Chief of the Psychiatry and Neurology Consultant Division, Office of the US Surgeon General, visited the theater in latter July 1951. He made a comprehensive tour of psychiatric units in Korea and Japan. Colonel Caldwell offered valuable suggestions on psychiatric policies, personnel, and organization.
Important Changes in Rotation
Two important improvements were made in the reassignment of limited duty personnel in late July 1951. The first and most important change was brought about by a GHQ FEC request for an extra rotation quota in order that some of the combat personnel reprofiled to non-combat duty, because of wounds or disease, could be returned home. The request was granted in part. Authority was given for a rotation quota of up to 200 reprofiled Korean veterans per month, who could not be effectively utilized in the Far East Command (FEC). A conference with the G-1 and AG sections of GHQ produced agreement that selections for the additional quota be made at the Japan Replacement Training Center that served as the funnel through which all hospital returnees designated "general service with waiver" were concentrated. It was further agreed that Lieutenant Commander Buhrig, the capable surgeon of the Japan Replacement Training Center, would make the actual selections based upon length of combat service in Korea, the number and severity of battle wounds incurred, and the total length of service in the FEC that must include combat. Only the most deserving Korean combat veterans would be chosen for return to the ZI under this additional quota. The rotation of limited service personnel began 1 August 1951. Two months of operation proved that the above criteria for selection could be carried out in a practical manner. It operated to prevent return to Korea of non-combat personnel who were sufficiently high in rotation eligibility so that a new assignment would have been only temporary. At the same time it lessened the assignment problems in Korea for non-combat positions.
The second and relatively minor change arose out of the need to assign certain limited personnel specifically in Japan rather than Korea. Individuals in this category included epilepsy controlled by medication, tension states in persons of marked passive personality, and injuries or organic disease that were improved but required routine treatment or evaluation. Arrangements were made with the AG (Adjutant General) of GHQ to permit up to 25 so-called convalescent assignments per month. The selection of cases would again be determined by Lieutenant Commander Buhrig at the Japan Replacement Training Center upon the request of the particular professional service in which the individual was hospitalized. The procedure also operated successfully in that greater elasticity in assignment for special cases was provided.
New Arrivals to the Theater
New arrivals to the Far East Command in later July and August 1951 were:
1Lt. T. Sclhaug - seven months civilian psychiatry residency
Cpt. William Lorton - one and a half years civilian psychiatry residency
1LT. Frank Norbury - one year civilian psychiatry residency
In September 1951, the following professional neuropsychiatric personnel arrived in the theater:
Cpt. Samuel Bullock - three years civilian psychiatry residency
Cpt. Rhead - two years civilian psychiatry residency
1LT. Thorndike Troop - one year civilian psychiatry residency
1LT. Walter Easterling - one year civilian psychiatry residency
1LT. Bernard Hanson - one year civilian psychiatry residency
1LT. Francis Vazuka - one year civilian neurology residency
In addition, Cpt. Harold Collings MC (Medical Corps) RA (Regular Army) was transferred to the 361st Station Hospital both to initiate training in neurology, that he requested, and to aid Captain Reilly in the large neurological caseload at the 361st Station Hospital.
The usual indoctrination lectures by the author and other senior medical officers were held with both groups of incoming psychiatrists and neurologists at the 361st Hospital in Tokyo. With addition of the September 1951 arrivals the theater was in an excellent position insofar as the availability of psychiatrists was concerned.
Changes of Assignment
Assignment changes of neuropsychiatry personnel in Japan during this period were as follows:
In July 1951 1Lt. Gordon McKay, psychiatric social worker, was transferred from the 382nd GH to the 361st Hospital to replace Major Morgan.
In August 1951 1LT. George Humiston, clinical psychologist, was transferred from the 279th General Hospital to Okinawa. 1Lt. Pamella Robertson, psychiatric social worker, from the 118th Station Hospital, was assigned to the 361st Hospital in Tokyo. Also in August 1951 Captain Lorton was sent to Nara Convalescent Hospital to understudy 1st Lieutenant Hoffman and perhaps serve as his replacement in the event 1st Lieutenant Hoffman was transferred to Korea. At the same time 1st Lieutenant Schlhaug was assigned to Omiya Convalescent Hospital for training with Cpt. Dermott Smith. Maj. Lucinda DeAguiar was given a 30-day compassionate leave in August 1951.
In September 1951 1st Lieutenant Schlaug replaced Captain Smith, who became the 3rd Infantry Division Psychiatrist. Also in September 1951, 1st Lieutenant Vazuka was assigned as neurologist to the Neuropsychiatric Service of Osaka Army Hospital, a position that had been vacant since July 1951. In this month also Captain Rhead was sent to the Neuropsychiatric Service of the 141st General Hospital.
Change of Theater Consultant in Psychiatry
On 19 August 1951 Col. Donald Peterson arrived in the FEC to assume the position of Theater Consultant in Psychiatry. Colonel Peterson and the author made a complete tour of psychiatric facilities in Korea so that he could obtain a first hand acquaintance with the various psychiatrists and their special situations. A similar tour was made of most psychiatric facilities in Japan. Colonel Peterson also collaborated in the indoctrination talks for incoming personnel at the 361st Station Hospital. In general it was the author's belief that Colonel Peterson became well oriented on the various neuropsychiatric problems in the Far East Command. The author left the FEC on 10 October 1951.
This concludes the history of psychiatry in the Korean War up to this author's departure. An integral part of this review not previously mentioned was the splendid cooperation and strong support given the psychiatric program by various members of the medical sections of GHQ FEC, Japan Logistical Command, and Eighth Army. [P. 314]
FDJ:
This ends Col. Albert Glass's contribution to this volume except for appendiceal material. When Colonel Glass arrived at Far East Command, psychiatry was in disarray with combat stress casualties erroneously being evacuated out of country and often back to CONUS. This is reminiscent of the disastrous policies in the beginning of World War II in North Africa in which stress casualties became psychiatric cripples by being evacuated out of combat to languish in VA hospitals in the United States.
Colonel Glass quickly established correct policies for treating stress casualties with steadily increasing numbers of casualties being returned to combat or non-combat duty reaching 80-90 percent in the latter months of Colonel Glass's tour. Following Colonel Glass's rotation, Col. Donald Peterson was theater Neuropsychiatry Consultant until the war ended. Both he and Colonel Glass were later Psychiatry and Neurology Consultant to the Army Surgeon General. Major (later Colonel) Ralph Morgan became the Social Work Consultant to the Army Surgeon General and Captain (later Colonel) William Hamill specialized in neurology and as a reservist served as Neurology Consultant to the Army Surgeon General.
Colonel Glass achieved fame in the military and civilian psychiatric community. He edited the two-volume definitive history of military psychiatry in World War II and was working on this history of military psychiatry in the Korean War when he died suddenly at his desk.
Chapter 12
Military Psychiatry After the First Year of the Korean War
by Franklin D. Jones, MD, FAPA
The United States had been engaging in a massive demobilization at the end of World War II. The Army was reduced from 89 divisions and eight million men in 1945 to ten divisions and 591,000 men in 1950. {Footnote 1, p. 540] When the North Koreans crossed the 38th parallel to invade South Korea on Sunday, 25 June 1950, the United States had only a small advisory group in the entire country. The United States had only a small advisory group in the entire country. The United States was able to gain support from the United Nations to counter the North Korean aggression since the Soviet Union had refused to participate in the United Nations because of its refusal to seat Communist China in place of the defeated Nationalist Chinese.
Chartered in San Francisco in 1950 with 50 member states, the United Nations had been unable to take action against communist aggression previously because of the veto power accorded to the Soviet Union (as well as the United States, the United Kingdom, France, and China). This absence allowed the United Nations to pass a resolution supporting military action in Korea.
In early battles the Republic of Korea (ROK) forces were crushed followed by the defeat and retreat of a hastily assembled and under-supported group of 540 Americans (Task Force Smith) dispatched from elements of the 24th Infantry Division in Japan. Three later American delaying actions with larger forces failed and by August 1950 United Nations forces were reduced to a small foothold in the southernmost part of Korea (Pusan Perimeter). General MacArthur placed ground troops in the Eighth Army under the command of General Walton Walker. On 15 September 1950 General MacArthur counterattacked at the Incho'on harbour in an amphibious maneuver that ultimately cut off most of the North Korean forces in the South and resulted in their deaths or capture. About 30,000 North Korean troops were able, however, to escape to the north.
The United Nations forces then drove north until the North Koreans eventually took refuge in Manchuria. On 25 October 1950, United Nations forces found themselves fighting Chinese forces at the town of Ch'osan. By 24 November 1950 it was known that United Nations forces were facing 300,000 well-armed Chinese troops. A retreat was ordered to avoid envelopment and eventually the Chinese drove the United Nations forces back once again to south of the 38th parallel. The floating bridges over the nearly frozen Han River were blown and Seoul was left to the advancing Chinese forces. Not only Seoul, with a third of the South Korean population, but also the important Kimpo Airport and Inchon harbor were lost. Ridgeway established a firm defensive line in mid-January running due east from Pyongtaek 75 miles south of the 38th parallel to the coast about 40 miles south of the parallel.
By mid-January 1951 United Nation forces under command of General Matthew Ridgway (General Walton Walker had been killed two days before Christmas in a motor vehicle accident) began a cautious drive north and recaptured Seoul by mid-March 1951. During this time there had been a great deal of political maneuvering in the United Nations and a call for a ceasefire and the removal of all foreign troops from Korea. This was rejected by China.
MacArthur continued to demand a policy of victory in Korea and unification of the country. He called for blockading the Chinese mainland and opening a second front with the Chinese Nationalists. Finally he made these suggestions in a public setting despite President Truman's patient explanation to him of the risks of Soviet intervention in Europe if such a policy were initiated. President Truman had little recourse but to recall General MacArthur, which he did on 11 April 1951 and named General Ridgway as his successor. Ridgway's forces included units from 15 nations, all less than brigade size, except American, ROK, British and Turkish units. Lin Piao, the Chinese commander, had 485,000 men in 21 Chinese and 12 North Korean divisions.
When Ridgway stabilized his line in mid-January, he had 365,000 men in three American and three ROK corps. The air situation had improved with the arrival of F104 Sabres which quickly established superiority over the Russian Mig15's flown by the Chinese (and probably by some Soviet volunteers).
Stalemate and Negotiations
The war entered a period of stalemate with small exchanges of territory between opposing forces. In the ensuing year each side advanced and retreated but with little improvement in tactical situation for either. By the end of 1941, General Peng, who had replaced Lin Piao, had 1,200,000 men of which 270,000 were deployed in the front line. General Mark Clark, who replaced Ridgway in May 1952, had 768,000 men in Korea.
Two years after the North Korean invasion, peace negotiations began but the fighting continued. Negotiations and fighting dragged on for another year until 27 July 1953 when an armistice was signed. In May 1953 an initial exchange of prisoners (Operation Little Switch) had occurred and after the armistice a large number of prisoners of war (POWs) were exchanged (Operation Big Switch). In general the first ones released had been those who cooperated most and in some cases collaborated with the enemy. [Footnote 2] Following Col. Albert Glass, Col. Donald Peterson was FEC Neuropsychiatry Consultant from September 1951 until the end of the war in 1953. Neuropsychiatry Consultants to the 8th Army in Korea were, in order: Col. Harold D. Whitten (1951-July 1952), Col. Paul Yessler (July 1952-July 1953) and Col. James Green (July 1953-July 1954). Colonel Green replaced Colonel Yessler three days before the Armistice (27 July 1953). The replacement for an outgoing physician was called his "turtle" for obvious reasons.
Paul Yessler and Henry Segal had examined the released POWs at Operation Little Switch and after the armistice they examined the POWs from Operation Big Switch. Colonel Yessler did some of these interviews in Japan and on a two-week voyage to California.
Dr. William Mayer was also on a ship transporting the POWs and he gained a great deal of attention by reporting on the degree to which some soldiers collaborated. Dr. Mayer felt that the American soldiers lacked willpower due to overindulgent mothering. He felt that this caused them to collaborate but also made them prone to die more readily in harsh circumstances due to "giveupitis." A U.S. Army White Paper rebutted Mayer's assertions and revealed that most of the communist propaganda was accepted by only a small number of POWs, mainly among minority groups who had experienced discrimination due to their race or ethnicity.
The 37 months of fighting had produced 550,000 United Nations casualties including almost 95,000 dead. American losses numbered 142,091 of whom 33,629 were killed, 103,284 wounded and 5,178 missing or captured. The bulk of casualties occurred during the first year of the war. The estimate of enemy casualties, including prisoners, exceeded 1,500,000, of which 900,000, almost two thirds, were Chinese.
In the Korean War, three fairly distinct phases are reflected in the varying types of casualties reported. The mid- to high-intensity combat from June 1950 until November 1951 was reflected in traditional anxiety-fatigue casualties and in the highest rate of combat stress casualties of the war, 209/1,000/year in July 1950. [Footnote 4] Most of the troops were divisional with only a small number being less exposed to combat. This was followed by a period of static warfare with maintenance of defensive lines until July 1953 when an armistice was signed. The graduate but progressive build-up of rear area support troops was associated with increasing numbers of characterological problems.
Norbury [Footnote 5] reported that during active combat periods anxiety and panic cases were seen, while during quiescent periods with less artillery fire the cases were predominantly characterological. Following the armistice obviously few acute combat stress casualties were seen. The major difference in overall casualties other than surgical before and after the armistice was a 50 percent increase in the rate of venereal disease among divisional troops.
Commenting on the observation that psychiatric casualties continued to be present in significant numbers following the June 1953 Armistice of the Korean War, Marren [Footnote 6] gives a clear picture of the reasons:
The terrors of battle are obvious in their potentialities for producing psychic trauma, but troops removed from the rigors and stresses of actual combat by the Korean armistice, and their replacements, continued to have psychiatric disabilities, sometimes approximating the rate sustained in combat, as in the psychoses. Other stresses relegated to the background or ignored in combat are reinforced in the post-combat period when time for meditation, rumination, and fantasy increases the cathexis caused by such stresses, thereby producing symptoms. Absence of gratifications, boredom, segregation from the opposite sex, monotony, apparently meaningless activity, lack of purpose, lessened chances for promotion, fears of renewal of combat, and concern about one's chances in and fitness for combat are psychologic stresses that tend to recrudesce and to receive inappropriate emphasis in an Army in a position of stalemate... Sympathy of the home folks with their men in battle often spares the soldier from the problems at home. The soldier in an occupation Army has no such immunity... Domestic problems at home are often reflected in behavior problems in soldiers, particularly those of immature personality or with character defects. [Footnote 6, pp. 719-720]
The main result of the Korean War was that NATO was greatly strengthened. In June 1950 NATO was virtually without power but in 1953 NATO could call on 50 divisions and strong air and naval contingents. Also both the United States and the Soviet Union had become thermonuclear powers, the United States having exploded a hydrogen bomb in 1952 and the Soviet Union in August 1953. Furthermore, the despot, Stalin, was dead and there was some thawing of East-West relations.
Psychiatric Lessons of the Korean War
Just as in the initial battles of World War II, provisions had not been made for psychiatric casualties in the early months of the Korean War. As a result they were evacuated from the combat zone. Due largely to the efforts of Col. Albert J. Glass, a veteran of World War II, who was assigned as Theater Neuropsychiatry Consultant, the U.S. Army combat psychiatric treatment program was soon in effect and generally functioning well [Footnote 7]. Since only five years had elapsed, the lessons of World War II were still well known and the principles learned during that war were applied appropriately. Combat stress casualties were treated forward, usually by battalion surgeons and sometimes by an experienced aid man or even the soldiers' "buddies," and returned to duty. Psychiatric casualties accounted for only about five percent of medical out-of-country evacuations, and some of these (treated in Japan) were returned to the combat zone. To prevent the "old sergeant syndrome," a rotation system was in effect (nine months in combat or 13 months in support units). In addition, attempts were made to rest individuals ("R and R" or rest and recreation) and, if tactically possible, whole units. Marshall warned of the dangers to unit cohesion of rotating individuals, but this lesson was not to be learned until the Vietnam War.
These procedures appear to have been quite effective with two possible exceptions. One was the development of frostbite as an evacuation syndrome. This condition, which was the first psychiatric condition described in the British literature during World War I [Footnote 9], was almost complete preventable, yet accounted for significant numbers of ineffectives.
The other problem was an unrecognized portent of the psychiatric problems of rear-area support troops. As the war progressed, American support troops increased in number until they greatly outnumbered combat troops. These support troops were seldom in life-endangering situations. Their psychological stresses were related more to separation from home and friends, social and sometimes physical deprivations, and boredom. Paradoxically, support troops who may have avoided the stress of combat, according to a combat veteran and military historian, were deprived of the enhancement of self-esteem provided by such exposure [Footnote 10]. To an extent the situation resembled that of the nostalgic soldiers of prior centuries. In these circumstances the soldier sough relief in alcohol abuse (and, in coastal areas, in drug abuse) [Footnote 11] and sexual stimulation. These often resulted in disciplinary infractions. Except for attempts to prevent venereal diseases, these problems were scarcely noticed at the time, a lesson not learned.
The Korean War revealed that the appropriate use of the principles of combat psychiatry could result in the return to battle of up to 90 percent of combat psychiatric casualties; however, there was a failure to recognize the types of casualties that can occur among rear-echelon soldiers. These "garrison casualties" later became the predominant psychiatric casualties of the Vietnam War [Footnote 12]. Vietnam and the Arab-Israeli wars revealed limitations to the traditional principles of combat psychiatry.
References - Chapter 12
1. Matloff, M. American Military History. Washington, DC, Office of the Chief of Military History: US Government Printing Office; 1969.
2. Yessler, P. Personal Communication, 11 March 1987.
3. Mayer, W.E. Why did many G.I. captives cave in? US News and World Report. 24 February 1956: 56-72.
4. Reister, F.A. Battle Casualties and Medical Statistics: U.S. Army Experience in the Korean War. Washington, DC: US Government Printing Office; 1973.
5. Norbury, F.B. Psychiatric admissions in a combat division in 1952. US Army Medical Bulletin Far East. 1953; July: 130-133.
6. Marren, J.J. Psychiatric problems in troops in Korea during and following combat. Military Medicine. 1956; 7(5): 715-726.
7. Glass, A.J. Psychiatry in the Korean Campaign (Installment I). US Armed Forces Medical Journal. 1953; 4:1387-1401.
8. Marshal, S.L.A. Pork Chop Hill. New York: William Morrow Company; 1958.
9. Fearnsides, E.G., Culpin, M. Frost-Bite. British Medical Journal. January 1915;1:84.
10. Kirkland, F. Personal Communication, July 1991.
11. Glass, A.J. Personal Communication, January 1982.
12. Jones, F.D., Johnson, A.W. Medical and psychiatric treatment policy and practice in Vietnam. Journal of Social Issues. 1975;31(4):49-65.
About the Authors
Glass, Albert Julius, M.D., F.A.P.A., Col. (Ret), U.S. Army
Formerly Division Psychiatrist, 85th Infantry Division (World War II); formerly Chief Psychiatric Consultant to the Far East Command (Korean War); formerly Psychiatry and Neurology Consultant, Office of The Surgeon General, U.S. Army; formerly Director, Oklahoma Department of Mental Health; formerly Director, Illinois Department of Mental Health.
Jones, Franklin D., M.D., F.A.P.A., Col. (Ret.), U.S. Army
Clinical Professor, Uniformed Services University of the Health Sciences; Past President and Secretary and Honorary President of the Military Section, World Psychiatric Association; formerly Psychiatry and Neurology Consultant, Office of The Surgeon General, U.S. Army