Abigail Cline, PhD
Medical College of Georgia, Augusta, United States (Winter 2015)
November 22 was an unusually cold day at the American hospital in Kumchon County. Otherwise, it was business as usual in the sixty-bed facility. The doctors were scrubbing for surgery, nurses were moving patients among the wards, X-ray technicians were developing radiographs, and the pharmacy was dispensing prescriptions. There was nothing out of the ordinary. By the end of the day, the entire hospital—doctors, nurses, patients, equipment—would be gone.
The year was 1950, the place North Korea, and the hospital was the 8076th Mobile Army Surgical Hospital, or “MASH.” While many people are familiar with MASH units from the exploits of the fictional 4077th in the novel, movie, and television series, M*A*S*H, few know anything about their background or their actual wartime service. The real history of military medicine tracks the history of military technology. In World War I, the mostly static nature of trench warfare saw little need for mobility in medical treatment. Ambulances could patrol the battle lines, delivering the wounded to fixed hospitals. But the mechanized and mobile warfare of World War II brought a demand for medical facilities that could follow along with armies on an ever-moving front. The standard at the time was mobile aid stations, backed up by more permanent, but distant, evacuation hospitals. Experience during that war showed that more substantial care was needed. Thus, mobile surgical hospitals were conceived to push surgeons closer to the combat. Doctors and nurses had been at the front lines of fighting before, but MASH units represented the first time that a hospital was constructed to operate so close to combat. They saw a small amount of use at the very end of World War II, but it was in Korea that they were first fully staffed and deployed.
At its inception, the 8076th personnel included ten doctors and twelve nurses, along with eighty-nine enlisted men. Training for MASH doctors during the early years was spare to say the least. The Army drafted civilian doctors, many of whom were residents or interns, and assigned them to the newly organized hospitals. After being drafted, they had only three days of formal army training. These three days were filled with army service, both in the field and in the hospital. But that was not all. Training included the study of nuclear, biological, and chemical defense; military correspondence, courtesies, and law; medical supply procedures; military neuropsychiatry; and legal and personal affairs. Later, a five-week training program was implemented, but the adequacy of even that was questionable. Training in battle medicine was on-the-job. According to the 1953 “Annual Report of Medical Activities of the Far East Command,” “Most of the young doctors coming to Korea have not been given the word on the simple fundamentals of the care of the wounded man, or of the problems involved in the management of battle casualties.” Not only were doctors unfamiliar with the particulars of battle medicine, there was no guarantee that they were trained as surgeons. There was a story that circulated around the MASH units about the first nine doctors to arrive for service in the 8076th. When they informed the chief surgeon that they were tissue pathologists, he laughed and replied that they had just been promoted to battalion surgeons. As the 8076th’s chief of surgery Otto Apel wrote “in military medicine, all doctors become surgeons” (emphasis added).
M*A*S*H depicted a hospital constructed entirely of tents, and this was generally accurate. It was a mishmash of dark brown tents that could quickly be disassembled so that it could keep in step with the fighting. Although other MASH units occasionally made use of abandoned buildings available nearby, the 8076th rarely had such luck. Despite the impermanence of its structures, the 8076th was separated into divisions reminiscent of any hospital of the time. It had operating rooms, pre- and post-operative wards, a pharmacy, a medical laboratory, and an X-ray section. There were even dental and optometric sections. The hospital was served by a motor pool that provided ambulances (later supplemented by helicopters) as well as by sections dedicated to the necessities of daily life. There were a laundry unit, a dining area, units for supplies, and, of course, living quarters, showers, and latrines. Guard and ordinance sections protected the hospital in hostile territory. In less than six hours, the entire unit could be disassembled, loaded onto vehicles, and ready to depart for a new destination. Upon arrival, the hospital would be operational within four hours.
November 22, 1950, marked the beginning of one of the most harrowing periods in the history of the 8076th. The unit had received orders to “bug out”—military jargon meaning that the hospital had to pack up and move. The relocation point was Kunuri, approximately 150 miles to the north. The weather was harsh, the coldest on record, with falling snow and temperatures plunging to thirty degrees below zero. The tents had space heaters to keep them warm, but engineers struggled to keep them working. This would be a serious problem over the next several days as the bitter cold continued. In the six days following the 8076th’s arrival in Kunuri, the hospital admitted 1,836 patients. This included 661 admissions in a single day. There were too many casualties and not enough room or heat. With the tents completely packed and no place to put incoming patients, the ambulances had no choice but to leave them in the snow. Both outside and inside the hospital, soldiers froze waiting for treatment. During this time, the medical officers had to make the most difficult decision any doctor can ever face. The most seriously injured patients were given palliative medicine and allowed to die so that others could be saved. It was triage in its most dire form.
Five days later, on November 27, the Chinese entered the war and began to advance toward Kunuri. The following day, the 8076th received orders to bug out once again. That evening, the convoy was loaded up and ready to depart. But the high number of admissions over the previous several days meant that the ambulances could not carry all of the patients. About forty patients would have to be left behind, with one doctor and several corpsmen remaining to care for them. As the 8076th departed, the marooned men did not know what lay in store for them. Whether it was rescue by U.N. forces or capture by the Chinese, either fate was better than freezing to death. Fortunately, help did arrive, and none of the men were killed or captured.
It was on road to Pyongyang that the 8076th was also saved by a bit of good luck. Its commanding officer, Lt. Col. Kryder Van Buskirk, had been ordered to follow a certain route to Pyongyang. When the convoy encountered a fork in the road, Van Buskirk’s order was to take the left path. But he did not. Determining that the route was unsafe, he instructed the convoy to go right instead. He could not know it at the time, but down the left road was a trap, and almost every troop that had taken it had been killed or captured. With that disaster averted, the convoy of the 8076th continued on to Pyongyang. It arrived in the North Korean capital (then occupied by South Korean forces) at 2:00am on November 29. There, the 8076th found waiting for it over a thousand patients whom a retreating evacuation hospital had been forced to leave behind. And so, in the middle of Pyongyang with patients in need of care, the convoy unpacked and set up. The 8076th MASH unit became a hospital once again.
Kryder Van Buskirk was a doctor. The man who bravely stayed behind with the forty patients was a doctor. They and the other doctors and nurses of the 8076th were medical men and women, trained for care, not combat. The 8076th, like all of the MASH units in Korea, was an ad hoc hospital, something as much cobbled together from drafted personnel and jury-rigged equipment as designed by the Army Medical Department. Most people probably think of a hospital as a location—a building staffed by professionals where treatment happens. But MASH units turn that idea on its head. The hospital is not the location. Locations can change, even within a day, as the 8076th demonstrated. The hospital is the people—the doctors, nurses, and support personnel—working in cooperation and dedicated to the care of their patients, as best they can manage under even extraordinary circumstances.
“MASH Units.” Olive-Drab.com. 3 Nov. 2013. Web. 20 Jan. 2015. <http://olive-drab.com/od_medical_treatment_mash.php>.
“8076th MASH / 45th Surgical Hospital.” Korean War Educator. Web. 20 Jan. 2015. <http://www.koreanwar-educator.org/topics/docs/8076th_mash.htm>.
Apel, Otto F., and Pat Apel. MASH: An Army Surgeon in Korea. Lexington: U of Kentucky, 1998. Print.
ABIGAIL CLINE, PhD, received her doctorate in biochemistry and molecular biology from the University of Georgia. She is currently a second-year medical student at the Medical College of Georgia with an interest in translational medicine and medical ethics. She currently resides in Augusta, Georgia with her husband, John Hunter Appler.