Front-line Medicine in the Forgotten War
Front-line Medicine in the Forgotten War
In November 1952, 4 months after completing an internship in surgery at the University of Michigan, as a very young doctor I was assigned to the 1st Battalion, 179th Infantry Regiment, 45th Division as the Battalion Medical Officer, usually referred to in those days as the "Battalion Surgeon" (Figure 1). My unit was stationed in an area ultimately known as Heartbreak Ridge, a definitive portion of the front-line combat zone separating North Korea from South Korea. Heartbreak Ridge (Figure 2) was a 7-mile long, rugged hill mass close to the demarcation line between North and South Korea. It became known as such when an operation to take these hills, initially expected to be completed in 1 day, continued for a full month of bitter sacrifice. An unnamed colonel in the Army speaking to a reporter about the assault on Hill 894, said, "To send battalion after battalion up this ridge only to have them slaughtered, with no reinforcements to back them up, is such a heartbreak for me." Newspapers and magazines picked up the words and the battle had a name, Heartbreak Ridge. In company with my arrival, the frigid winter was beginning, as was the bitter reality of the vicious and ghastly violence with which the infantry and medical soldiers ("medics") would be confronted.
(Enlarge Image)
Battalion Medical Officer, 1st Lieutenant R.T. Schorr.
(Enlarge Image)
Heartbreak Ridge.
While there, records were kept of consecutive casualties treated. A report, originally written in 1954 in an attempt to document the types of medical problems one battalion medical unit confronted during the final months of conflict in Korea, was never published. After returning to the United States, I was stationed in a military hospital near my medical school in Philadelphia, where I decided to try to publish an article about this experience. I received so much contradictory feedback from the journal, I decided that I had had enough of the war, and abandoned the effort. Now, on the 50th anniversary of the Korean War armistice, I am finally given the opportunity to share my experience.
The final 8 1/2 months of front-line combat in Korea consisted primarily of trench warfare conducted by infantry units on both sides of the main line of resistance, with the usual artillery support from the rear. For the inexperienced medical personnel in this makeshift setting of a trauma emergency room facility, the constant flow of casualties served to improve the capabilities and judgment of the caregivers while concurrently providing unforgettable memories of the real life-and-death horrors of war.
Most studies on battle casualties have emanated from medical installations where equipment and personnel were available for the accurate diagnosis and early definitive care of the victims. This report by the author at the most forward echelon includes only initial descriptive diagnoses in cases where the extent of internal injuries could not be readily ascertained at the time of initiation of treatment at the front-line aid station, aka the emergency room. The combat injuries reported herein are only those resulting from the actions against an armed enemy. A number of wounds were sustained from accidents involving vehicles being used by engineering, medical, or military transportation units, as well as explosive devices used for construction purposes; these were not included in this account of combat injuries.
The war in Iraq was different from the Korea War in a number of ways. There was no uniformed enemy in Iraq; and they had no artillery or widely separated combat sites. Thus, the enemy was never clearly visible, and enemy activities seemed more like criminal activities than military activities. In Korea, most of the military battle casualties on Heartbreak Ridge were due to rifle injuries and large arms fire. On the basis of information reported from Iraq, injuries were mostly due to sniping, self-demolition with dynamite, and a significant number of land mines. Our soldiers, especially since the war in Iraq was declared over, have been savagely attacked with the types of explosive devices and gunshots resulting in similar types of injuries and deaths as those that I witnessed in my battalion on the front-line trenches in Korea.
My introduction to the violence occurred when a soldier working on road construction was struck by dynamite (that he had planted), which completely destroyed the long bones and tore apart the soft tissues of the left calf and thigh. These wounds were treated by splinting, pressure control of bleeding, and the usual intravenous fluid resuscitation and narcotics for pain control, prior to helicopter transfer to the Mobile Army Surgical Hospital (MASH) for definitive care (Figure 3). The only antimicrobial agents available to us at the time were sulfadiazine, chloramphenicol, streptomycin, and penicillin, which were primarily used for infectious disease problems, usually venereal in origin.
(Enlarge Image)
Soldiers and battalion surgeon waiting for a helicopter to take 2 wounded men to the MASH (Mobile Army Surgical Hospital).
Injuries occurred as a result of small arms fire from hand-held weapons, including (but not limited to) handguns, machine guns, rifles, and automatic weapons, and large arms fire from grenades, mortar, artillery, tank guns, and shells from recoilless rifles. Other injuries occurred by contusion, usually associated with some blast effect or concussion, chemical burns, and lacerations. Twenty-seven soldiers were killed in action and 232 were wounded in action. The majority (91.5%) of wounds were inflicted by large-arms fire. All injuries attributed to any source are listed in Table 1 . The data reflect the number of soldiers wounded or killed by a device rather than the number of injury sites on each victim, and no data were available to delineate the type of weapon that resulted in those killed in action or wounded in action.
The injury sites and relative incidence of each are recorded in Table 2 . As might be expected, a large preponderance of extremity wounds over other anatomic sites is confirmed by these data. More than 75% of the soldiers wounded or killed in action suffered extremity wounds. When first examined, there were 26 compound fractures identified (12.7%) among all extremity wounds. However, this number was probably higher at the MASH, where x-rays undoubtedly revealed some that we missed.
The wound characteristics defined in Table 3 again illustrate a large number of extremity wounds compared with other anatomic sites. The incidence of multiple wounds in soldiers killed in action is understandably high, and the initial status and prognosis bear a direct and inverse relationship to the multiplicity of wounds. Only 2 soldiers who were killed in action were wounded in just 1 anatomic site.
The value of the armored vest in saving lives at first glance seems inconclusive; only 40% of the soldiers killed in action sustained chest wounds. In those wounded in action, however, many of the wounds that proved to be superficial most likely would have penetrated the pleural cavity had it not been for the protective vests. One soldier sprayed by an automatic weapon suffered wounds in both upper extremities, but his chest was uninjured even though his vest was partially shredded. Examination of this man provided convincing evidence for the efficacy of the armored vest.
On July 27, 1953, the Korean War was supposed to end at 10 PM. For many hours that night, artillery blasting on both sides of the front line made for one of the most agonizing and frightening periods of my entire life. About a half hour before the fighting was supposed to end, suddenly everything became eerily quiet. The agonizing fighting in Korea began in 1950; our army struggled for 2 years, advancing and retreating, until a stable main line of resistance was finally established in 1952. It was then that I arrived at my Battalion Aid Station at Heartbreak Ridge. Fifty years later, the United States Army in Iraq again ended another war, but this time, using new types of weaponry, it took only a few weeks for our President to state that the enemy was defeated.
In November 1952, 4 months after completing an internship in surgery at the University of Michigan, as a very young doctor I was assigned to the 1st Battalion, 179th Infantry Regiment, 45th Division as the Battalion Medical Officer, usually referred to in those days as the "Battalion Surgeon" (Figure 1). My unit was stationed in an area ultimately known as Heartbreak Ridge, a definitive portion of the front-line combat zone separating North Korea from South Korea. Heartbreak Ridge (Figure 2) was a 7-mile long, rugged hill mass close to the demarcation line between North and South Korea. It became known as such when an operation to take these hills, initially expected to be completed in 1 day, continued for a full month of bitter sacrifice. An unnamed colonel in the Army speaking to a reporter about the assault on Hill 894, said, "To send battalion after battalion up this ridge only to have them slaughtered, with no reinforcements to back them up, is such a heartbreak for me." Newspapers and magazines picked up the words and the battle had a name, Heartbreak Ridge. In company with my arrival, the frigid winter was beginning, as was the bitter reality of the vicious and ghastly violence with which the infantry and medical soldiers ("medics") would be confronted.
(Enlarge Image)
Battalion Medical Officer, 1st Lieutenant R.T. Schorr.
(Enlarge Image)
Heartbreak Ridge.
While there, records were kept of consecutive casualties treated. A report, originally written in 1954 in an attempt to document the types of medical problems one battalion medical unit confronted during the final months of conflict in Korea, was never published. After returning to the United States, I was stationed in a military hospital near my medical school in Philadelphia, where I decided to try to publish an article about this experience. I received so much contradictory feedback from the journal, I decided that I had had enough of the war, and abandoned the effort. Now, on the 50th anniversary of the Korean War armistice, I am finally given the opportunity to share my experience.
The final 8 1/2 months of front-line combat in Korea consisted primarily of trench warfare conducted by infantry units on both sides of the main line of resistance, with the usual artillery support from the rear. For the inexperienced medical personnel in this makeshift setting of a trauma emergency room facility, the constant flow of casualties served to improve the capabilities and judgment of the caregivers while concurrently providing unforgettable memories of the real life-and-death horrors of war.
Most studies on battle casualties have emanated from medical installations where equipment and personnel were available for the accurate diagnosis and early definitive care of the victims. This report by the author at the most forward echelon includes only initial descriptive diagnoses in cases where the extent of internal injuries could not be readily ascertained at the time of initiation of treatment at the front-line aid station, aka the emergency room. The combat injuries reported herein are only those resulting from the actions against an armed enemy. A number of wounds were sustained from accidents involving vehicles being used by engineering, medical, or military transportation units, as well as explosive devices used for construction purposes; these were not included in this account of combat injuries.
The war in Iraq was different from the Korea War in a number of ways. There was no uniformed enemy in Iraq; and they had no artillery or widely separated combat sites. Thus, the enemy was never clearly visible, and enemy activities seemed more like criminal activities than military activities. In Korea, most of the military battle casualties on Heartbreak Ridge were due to rifle injuries and large arms fire. On the basis of information reported from Iraq, injuries were mostly due to sniping, self-demolition with dynamite, and a significant number of land mines. Our soldiers, especially since the war in Iraq was declared over, have been savagely attacked with the types of explosive devices and gunshots resulting in similar types of injuries and deaths as those that I witnessed in my battalion on the front-line trenches in Korea.
My introduction to the violence occurred when a soldier working on road construction was struck by dynamite (that he had planted), which completely destroyed the long bones and tore apart the soft tissues of the left calf and thigh. These wounds were treated by splinting, pressure control of bleeding, and the usual intravenous fluid resuscitation and narcotics for pain control, prior to helicopter transfer to the Mobile Army Surgical Hospital (MASH) for definitive care (Figure 3). The only antimicrobial agents available to us at the time were sulfadiazine, chloramphenicol, streptomycin, and penicillin, which were primarily used for infectious disease problems, usually venereal in origin.
(Enlarge Image)
Soldiers and battalion surgeon waiting for a helicopter to take 2 wounded men to the MASH (Mobile Army Surgical Hospital).
Injuries occurred as a result of small arms fire from hand-held weapons, including (but not limited to) handguns, machine guns, rifles, and automatic weapons, and large arms fire from grenades, mortar, artillery, tank guns, and shells from recoilless rifles. Other injuries occurred by contusion, usually associated with some blast effect or concussion, chemical burns, and lacerations. Twenty-seven soldiers were killed in action and 232 were wounded in action. The majority (91.5%) of wounds were inflicted by large-arms fire. All injuries attributed to any source are listed in Table 1 . The data reflect the number of soldiers wounded or killed by a device rather than the number of injury sites on each victim, and no data were available to delineate the type of weapon that resulted in those killed in action or wounded in action.
The injury sites and relative incidence of each are recorded in Table 2 . As might be expected, a large preponderance of extremity wounds over other anatomic sites is confirmed by these data. More than 75% of the soldiers wounded or killed in action suffered extremity wounds. When first examined, there were 26 compound fractures identified (12.7%) among all extremity wounds. However, this number was probably higher at the MASH, where x-rays undoubtedly revealed some that we missed.
The wound characteristics defined in Table 3 again illustrate a large number of extremity wounds compared with other anatomic sites. The incidence of multiple wounds in soldiers killed in action is understandably high, and the initial status and prognosis bear a direct and inverse relationship to the multiplicity of wounds. Only 2 soldiers who were killed in action were wounded in just 1 anatomic site.
The value of the armored vest in saving lives at first glance seems inconclusive; only 40% of the soldiers killed in action sustained chest wounds. In those wounded in action, however, many of the wounds that proved to be superficial most likely would have penetrated the pleural cavity had it not been for the protective vests. One soldier sprayed by an automatic weapon suffered wounds in both upper extremities, but his chest was uninjured even though his vest was partially shredded. Examination of this man provided convincing evidence for the efficacy of the armored vest.
On July 27, 1953, the Korean War was supposed to end at 10 PM. For many hours that night, artillery blasting on both sides of the front line made for one of the most agonizing and frightening periods of my entire life. About a half hour before the fighting was supposed to end, suddenly everything became eerily quiet. The agonizing fighting in Korea began in 1950; our army struggled for 2 years, advancing and retreating, until a stable main line of resistance was finally established in 1952. It was then that I arrived at my Battalion Aid Station at Heartbreak Ridge. Fifty years later, the United States Army in Iraq again ended another war, but this time, using new types of weaponry, it took only a few weeks for our President to state that the enemy was defeated.
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