Casualty and Morbidity Experience
UNITS AND STRENGTH
At 0400 on Sunday, 25 June 1950, the Russian-trained North Korean Army swept south across the 38th Parallel in four major drives. The U.S. Government, which maintained a small military mission in South Korea at the time, reported the aggression to the U.N. (United Nations) Security Council.
On 27 June 1950, the Security Council recommended all member nations act to assist South Korea to repel the armed attack and restore peace. The same day, President Harry S Truman ordered U.S. military forces to assist in this effort, and on 1 July 1950, the first U.S. Army combat units landed in Korea.
During the 3 years of fighting and periods of peace negotiations, nearly half a million American soldiers served in Korea, including medical evacuees, those rotated to the United States, units moved out of Korea to Japan and other areas, and individuals discharged from the Army. This resulted in a turn-over of strength in the Eighth U.S. Army of almost three times the average monthly strength of approximately 208,000 men for the 37-month period- July 1950- July 1953.
Table 1 presents the U.S. Army monthly mean strength for the total U.S. Army in Korea as well as for U.S. Army division and non-division units. Eight U.S. Army divisions and two separate regimental combat teams served at one time or another in the Korean War in addition to the 1st U.S. Marine Division, the ground force contingents of other United Nations, and the Armed Forces of the Republic of South Korea. Twenty-two nations joined forces under the U.N. flag in providing ground, air, naval, or medical support to resist the Communist aggression. The major U.S. Army division units were as follows: the 24th Infantry Division, the first to enter Korea on 2 July 1950, fought until 4 February 1952 when it was ordered back to Japan; the 1st Cavalry Division returned to Japan on 30 December 1951 after serving in Korea from 18 July 1950; the 25th Infantry Division served from 9 July 1950; the 2d Infantry Division from 30 July 1950; the 15th Regimental Combat Team from 3 August 1950; the 187th Airborne Regimental Combat Team first entered Korea on 17 September 1950, left the war zone on 27 June 1951, and returned to Korea on two occasions- 12 May- 17 October 1952 and, again, on 22 June 1953; the 7th Infantry Division from 18 September 1950; the 3d Infantry Division from 10 November 1950 (although the 65th Regimental Combat Team, a part of the 3d Infantry Division, arrived in September 1950); the 45th Infantry Division, 5 December 1951; and the 40th Infantry Division), 11 January 1952.
Eighth U.S. Army headquarters completed its movement to Korea on 25 August 1950. The X U.S. Corps, previously activated to direct the amphibious landing at Inchon on 15 September 1950, acted as an independent force directly under the Supreme Commander. Upon the withdrawal from North Korea in December 1950 and the return of these units to Pusan, X Corps became a part of the Eighth U.S. Army and remained so throughout the period of the war.
The total U.S. Army strength in Korea represents midmonth averages of end-of-month strength as reported by The Adjutant General (1). The division and separate regimental combat team mean strengths included in table I and the breakdown by organic division units (table 2) are the average monthly strengths served as reported to the Army Surgeon General on summary health reports (2) received from separate units operating medical treatment facilities. The non-division average strength was derived by subtracting the division strength from the total.
After the buildup of the U.S. Army Forces, division units, which bad peaked at almost 90 percent of the strength in August 1950, averaged about one-half of the U.S. Army strength in Korea, while regimental units averaged almost one-third of the strength. Table 3 and figure 1 reflect these relative distributions by type of unit. Regimental troops, which consistently averaged 58 to 60 percent of division strength, ranged from a high of 51
Figure 1.- U.S. Army divisions and regiments as percent of U.S. Army strength and regiments as percent of U.S. Army division strength, Korea, July 1950-July 1953.
percent of total U.S. Army strength in Korea in August 1950 to a low of 26 percent in November 1951. The relative proportions for the organic division units show a fairly stable distribution over the complete period of the war.
BATTLE CASUALTIES AND ADMISSIONS
The responsibility of the Medical Department of the U.S. Army for battle casualties, as well as for nonbattle (disease and nonbattle injury) patients, lies in proper diagnosis and treatment and also in providing for the timely evacuation and hospitalization of these patients. Consequently, medical interest in battle casualty statistics relates directly to information needed (such as diagnosis, anatomical location, and nature of trauma) to provide medical care for personnel who become battle casualties. Inasmuch as this information can be obtained only from medical records, they are the basic source of data. Tabulations of these individual medical records, by day of occurrence, organizational element, diagnosis, causative agent, surgical operation, and anatomical location of wound, provide the chief source of the data presented. The official battle casualty counts, however, are compiled by The Adjutant General and are based on casualty reports forwarded through command channels. Obviously, because casualty information is derived from different source record systems, patient data on certain categories of battle casualty and the generally corresponding categories compiled from command channel casualty reports may differ slightly with respect to totals.
Records received by The Surgeon General show the following counts: 18,769 killed in action, 77,788 wounded in action and admitted to medical treatment facilities, and 14,575 slightly wounded in action and carded for record only- making a total of 92,363 wounded. The official totals included in The Adjutant General's report (3) show 19,585 killed in action (including 251 killed after capture) and 79,526 wounded in action. Although these differences are not significant in analysis for operations research, planning, or similar purposes, nevertheless for completeness, The Surgeon General's killed-in-action count was increased from 18,769 to 19,353 by matching serial numbers from The Surgeon General's individual records of death with The Adjutant General's records. With respect to the differences between the wounded-in-action counts, the command channel casualty reports were generally submitted only for those wounded in action who were "unit losses" (evacuated rearward and admitted to a medical treatment facility and for which next-of-kin notifications were required). However, at the very beginning of the Korean War, there was slight ambiguity concerning reporting requirements, and some of the wounded who were treated at division clearing stations and
not lost to their units were inadvertently included in the command channel reports. On the other hand, medical records were submitted not only for the "unit losses" but also for all of the slightly wounded, even those who were not admitted but could be treated in the vicinity, usually at an aid or clearing station, and returned to their units before the close of the morning report day. The latter, not officially excused from duty for as much as 1 day for medical care, were, as previously noted, the CRO (carded for record only) cases.
The reporting of DNBI (disease and nonbattle injury) cases is solely the responsibility of the Medical Department, U.S. Army, and information pertaining to these cases relates directly to the complete episode of their respective periods of medical treatment. The term "admission" as used in both text and source tables refers to instances of medical treatment given on an excused-from-duty basis. These patients may have been treated in a hospital or infirmary bed or "in quarters" (in a dispensary bed, at an aid station or clearing company, or in the person's usual quarters). Admissions to all medical treatment facilities in Korea numbered 443,163 for all causes during the complete period of the war, July 1950-July 1953. In addition to the 77,788 wounded admissions, there were 365,375 nonbattle admissions, (82.4 percent of the total), of which 290,210 resulted from disease and 75,165 from nonbattle injury.
In terms of annual rates per 1,000 average strength, for the complete period of the war, the overall counts represent 30 per 1,000 for killed in action, 121 per 1,000 for wounded in action admissions, and 570 per 1,000 for disease and nonbattle injury admissions. All of these rates are lower than the corresponding annual rates for the June 1944-May 1945 period of operations in the European theater during World War II, where rates of 44 killed in action, 152 wounded admissions, and 859 DNBI admissions per l,000, respectively, occurred. Table 4 shows the decline, on a yearly basis, of approximately 90 percent from the high rates experienced in 1950 for both killed in action and wounded admissions for total U.S. Army, Korea, compared to the overall drop of about 46 percent for DNBI admissions. The decline for division units shows sharper drops for disease and nonbattle injuries, while non-division units experienced a much smaller decline in nonbattle patients.
Since this report is concerned chiefly with the presentation of combat medical statistics, both text and source tables that show admissions reflect data related mostly to division combat units. Data are given for non-division and for total U.S. Army, Korea, to achieve perspective. For example, while division units comprised slightly more than one half the average total U.S. Army strength in Korea, (table, 5), they suffered almost 95 percent of the killed and wounded in contrast to slightly less than one-half of the DNBI admissions. The differences are more pronounced at the regimental level, where units comprising only 31 percent of the average U.S. Army strength in Korea accounted for more than five-sixths of the killed and wounded compared to about one-third of the DNBI admissions. The respective unit annual rates also are highest at the regimental level, being 85 per 1,000 for killed in action, 337 per 1,000 for wounded admissions, and 641 per 1,000 for DNBI admissions. While these data cover all of the U.S. Army divisions and regiments, that fought in the Korean War, the figures for headquarters and service companies and for artillery, engineer, medical, and tank battalions reflect only the assigned organic division or attached units of the respective type. Separate combat units such as corps or army troops are included with non-division units which represent combat
Table 4.- Annual rates for killed in action and admissions to medical treatment facilities,
U.S. Army, Korea, July 1950-July 1953
Table 5.- Distribution of average mean strength and killed in action; battle and nonbattle
admissions to medical treatment facilities, by type of combat unit: number, percent, and rate, U.S. Army, Korea,
July 1950-July 1953
1 An additional 135 admissions (130 disease and five nonbattle injury) occurred before July in
calendar year 1950.
support and communications zone troops as well. These non-division troops comprised about 48 percent of the average U.S. Army strength in Korea and provided slightly more than one-half of the admissions to medical treatment facilities for disease arid nonbattle injuries. The extremely low annual rates of 2 per 1,000 for killed in action and 16 per 1,000 for wounded admissions reflect the relatively low level of risk and exposure to combat for most of these non-division troops.
All of the detailed cross-tabulations of data included in the source tables presented for overall counts of disease and nonbattle injury cover admissions through December 1953 and, therefore, reflect a slightly larger number of admissions than does the shorter period through July 1953. The overall annual admission rates, however, are somewhat smaller. From the data presented in table 6, it may be seen that this reduced annual rate is due, largely, to the lower rates experienced during the August-December 1953 peacetime period. In addition, the changeover from combat permitted more nonbattle patients to be treated within the division medical service as CRO outpatients and, undoubtedly, contributed to the overall reduction of the division admission rate. Non-division troops, on the other hand, did not experience a comparable shift between inpatients and outpatient.
The most frequent traumatism diagnosed as the cause of battle admissions was wounds of all types (62 percent). Penetrating wounds were the most prevalent type, representing 57 percent of wounds of all types, and 35 percent of the total number of admissions to medical treatment facilities for wounds. Fractures accounted for 23 percent of the total wounded, with compound fractures amounting to 19 percent. The distribution of the balance of wounds (table 7) shows each of the other types of traumatisms, was less than 3 percent of the total wounded. For division and separate regimental combat teams, the relative distribution was identical to total U.S. Army, Korea. The nondivision units show slightly less proportionately for fractures and slightly more for other types of wounds, such as burns, contusions, and concussions. Figure 2 graphically depicts similar distributions for nonbattle injury admissions through December 1953. Fractures, amounting to 18 percent of the total, were the leading cause of admission for division units, followed by sprains, strains, and dislocations (17 percent), cold injury (16 percent), and wounds of all types (15 percent). Contusions contributed 12 percent of all nonbattle injury admissions for divisions. Although fractures caused 19 percent of all nonbattle injury, admissions in the non-division units, they ranked second to sprains, strains, and dislocations, which accounted for almost 25 percent of the total. Wounds of all types represented 16 percent of the total nonbattle injuries for non-division units, followed by contusions (13 percent). Cold injury, which was a leading cause of nonbattle injury admissions for
Figure 2.- Percent distribution, nonbattle injury admissions, by nature of traumatism and type of unit, U.S. Army, Korea, July 1950- December 1953.
division troops (16 percent), amounted to slightly less than 3 percent for non-division units. This latter phenomenon results from the degree of exposure to the elements required of combat troops.
The most important cause of disease admissions among U.S. Army troops in Korea was acute respiratory infections, which accounted for one-fifth of all disease admissions for all Army units. This condition was responsible for 15 percent of the disease admissions among division troops and 26 percent of the disease admissions in non-division units. The second most frequent cause of admission for divisions was symptoms and ill-defined conditions, closely followed by infective and parasitic disease. This latter diagnosis and diseases of the digestive system, with annual admission rates of 53 and 47 per 1,000, respectively, were the second and third leading causes of disease admissions for non-division units. Psychiatric conditions represented over 9 percent of disease admissions for division troops, producing a rate of 36 per 1,000 average strength per year. This compares with 5
percent for non-division units and a rate of 25 per 1,000 per year. The frequency of admissions for the various other diagnostic classes is shown in figure 3.
OUTPATIENT CARE AND CARDED FOR RECORD ONLY
During the period, July 1950-December 1953, U.S. Army medical treatment facilities in Korea treated 128,790 patients who did not require admission, but who, for one reason or another, were carded for record only. About one-third of the GRO cases from divisions were wounded and the balance, was due to nonbattle conditions (table 8). For non-division units, almost all (98 percent) were nonbattle cases. It should be noted that these patients do not, represent the total number of outpatient visits or treatments at U.S. Army medical treatment facilities in Korea, but only those cases for which a record was specifically required by appropriate Army regulation (4). The CRO cases generally include all of the wounded who are treated as outpatients and all nonbattle cases which are received "dead on arrival." In addition, certain nonbattle patients with conditions which might possibly result in a claim against the U.S. Government, those for whom a record is required for ad-
Figure 3.- Disease admissions, by diagnostic class and type of unit, U.S. Army, Korea, July 1950-December 1953.
ministrative or other reasons, and all venereal disease cases treated as outpatients are carded for record only.
Wounds of all types accounted for 85 percent of all wounded CRO cases, with abrasion and blisters (6 percent), contusions (3 percent), burns and concussions (2 percent each), sprains and strains (1 percent), and other and unqualified (1 percent) accounting for the balance of 15 percent. The nonbattle injury CRO cases were distributed as wounds of all types (35 percent), fractures (11 percent), drowning victims (10 percent), sprains and
strains (7 percent), contusions (7 percent), multiple injuries (6 percent), burns (5 percent), abrasion and blisters (3 percent), poisoning (2 percent), avulsion (1 percent), and other and unqualified (13 percent).
Infective and parasitic disease (largely venereal disease) accounted for almost 90 percent of the CRO cases for disease conditions. Urinary and male genital disease, with 6 percent of the total, was a distant second, followed by skin disease (2 percent) and bones and organs of movement (about 1 percent). None of the other diagnostic classifications was responsible for more than 0.5 percent of the total disease CRO cases in Korea.
The requirement for submission of Outpatient Report (DD Form 444) was instituted by Army regulation (5) beginning with the month of June 1951. Before that time, outpatients were recorded locally by medical treatment facilities through use of an outpatient register. The regulations (4) in effect at that time required submission of a register card on each individual entered on the register at every medical treatment facility. The available data for U.S. Army, Korea, are taken from the Outpatient Report and, consequently, cover the period 1 June 1951-31 December 1953.
About 10.1 million outpatient visits to Army medical facilities in Korea during this period required the performance of about 10.9 million outpatient treatments. In addition, Army medical treatment facilities in Korea performed more than 40,000 complete physical examinations (including flight physical examinations), 5.5 million immunizations, and 32,000 specified periodic examinations or tests. It should be noted that these data exclude all dental outpatient care.
Of the 10,0 million outpatient treatments given by Army medical treatment facilities in Korea during this period, approximately 43 million (40 percent) were received by active-duty military personnel, almost all of whom were Army personnel. The remaining 6.6 million (60 pereent) were received by "all, other" personnel, chiefly enemy prisoners of war. In terms of an index per 1,000 average strength, the annual outpatient treatment rate was 6,954 per 1,000 for U.S. Army personnel in Korea during the June 1951-December 1953 period. This rate, however, is considerably lower than the individual year total Army worldwide annual outpatient treatment rates of 8,200 for 1952 and 8,600 for 1953.
The distribution by type of treatment among various categories of personnel, as shown in table 9, indicates that active-duty military personnel received less than one-half of the various other types of treatments, with the exception of general surgery; ear, nose, and throat; neuropsychiatry; psychological tests; gynecology; physiotherapy; and X-ray and radium therapy. For example, 60 percent or more of general medicine, dermatology, surgical dressing room, ophthalmology, obstetric, and pediatric treatments were received by other than military; principally, enemy prisoners of war.
In comparing the various outpatient treatments by type of treatment, general medicine, with almost three-quarters of the workload, constituted the most frequently required treatment. Surgical dressing room with 9 percent of all treatments was second, followed by dermatology (6 percent), ear, nose, and throat (6 percent), ophthalmology (4 percent), and general surgery (1 percent). None of the remaining types of treatment represented as much as 0.5 percent of the total.
AVERAGE DURATION OF STAY
Data on average duration of patient stay in hospital are important from the standpoint of planning for inpatient medical rare. The number of beds that must be provided, as well as the amount of professional and ancillary personnel needed, are directly related to the numbers and types of patients requiring inpatient care and to the length of stay that is, likely to result.
These data on duration of stay relate to all cases admitted to medical treatment facilities (hospital and quarters) and exclude all CRO cases, which involve no loss of time from duty. The data on average duration for division and separate regimental combat teams cover all of their cases, originating in Korea during 1950-53, regardless of where the final disposition eventually occurred. For example, table 10 shows that the overall average duration per division wounded was 96 days compared to 93 days for total U.S. Army, Korea, and 129 days for World War II. An average of 34 day's per case was spent in the Far East Command (Japan-Korea), 37 days in all overseas areas (including the Far East Command); for wounded cases evacuated to the United States, an average of 258 days was lost for each wounded case hospitalized in the United States. Disease and nonbattle injury combined cases averaged 20 days in both World War II and the Korean War. However, by type of case, nonbattle injury had the longer duration. In fact, for divisions, the nonbattle injury average duration was almost three times as long as that for disease cases.
When duration-of-stay data for divisions in Korea are distributed by type of final disposition, large differences are noted. Wounded admissions from division units in Korea who were eventually returned to duty anywhere averaged 65 days in hospital or quarters, whereas the died-of-wounds cases averaged only 10 days. All other wounded dispositions, including separations for disability, and for administrative reasons, had the largest average duration (371 days). Returns to duty among nonbattle cases, originating in divisions in Korea averaged 19 days, nonbattle deaths 17 days, and all, other dispositions 233 days. For disease cases, the average duration of stay was 14 days per case for returned to duty, 23 days for deaths, and 200 days for all other disease dispositions. Comparable average durations for division nonbattle injury cases were 36 days for returns to duty, 9 days for deaths, and 299 days for all other dispositions.
The longest average durations, obviously, occur among those cases separated from the Army, usually among the disability separations. Most of the reasons for this have to do with the nature and severity of these cases from a medical viewpoint and the type and amount of treatment provided. Some of the reasons also result from the administrative processing required as well. The data included in table 11 show the average duration for all nonbattle cases worldwide separated for dis-
ability in the U.S. Army each year from 1950 through 1953.
One of the most significant indexes used to measure the health of the Army is the noneffective rate. This index is usually represented as the average daily number of patients in hospital and quarters on an excused-from-duty basis per 1,000 average strength during the period considered. This measure of time lost from duty not only indicates the nonavailability of personnel for the performance of their assigned duty, but also is important from the standpoint of providing medical care for them by the Army Medical Department. The amount of noneffectiveness depends primarily on two factors: (1) the rate of admission to hospital and quarters on an excused-from-duty basis, and (2) the average length of stay in hospital and quarters once the patient is admitted. The noneffective rate of 35.8 for the Far East Command means that, on the average day during the period July 1950-December 1953, roughly 36 individuals out of each 1,000 division troop strength in Korea were not available for duty because they had been admitted to hospital or quarters for medical reasons. This may also be expressed as 3.6 percent of division strength in Korea being noneffective for medical reasons on the average day during this period. The other rates shown in table 12 reflect the cumulative effect of noneffectiveness among division troops in Korea, as additional time is lost in other areas. For example, the noneffective rate of 36 per 1,000 per day is increased almost three times when all of the days of noneffectiveness are considered, although these days of noneffectiveness are not usually charged back to the command of origin when computing noneffective rates.
The admission rate through December 1953 for disease cases from divisions in Korea (386 admissions per 1,000) was more than three times that from nonbattle injury (114 per 1,000), while total days lost was only one-third more than the days lost from nonbattle injury. The difference results in all average duration of stay for disease cases (15 days) of about one-third that for nonbattle injury eases (40 days). The noneffective rate, however, is higher for disease (19 per 1,000 per day) compared to 15 per 1,000 per day for nonbattle injury, when all days lost are considered. For the Far East Command, the noneffective rate for disease is twice that for nonbattle injury. Obviously, some of the specific disease diagnoses, such as tuberculosis, with a low admission rate, contribute heavily, to the noneffective rate because of the lengthy hospitalization required for the average case. The noneffective rate of 21 per 1,000 per day for all nonbattle causes in the Far East Command compares favorably with the U.S. Army worldwide noneffective rate of 22 per 1,000 per day for the 1950-53 period. The wounded, on the other hand, with an admission rate of 220 per 1,000, about two-fifths of the combined nonbattle admission rate for divisions (500 per 1,000), contributed heavily to the noneffectiveness experienced during the war. The average duration for division wounded of 96 days was four and one-half times the 21 days for the average nonbattle case, while the total days lost for wounded was almost twice that for nonbattle cases. The noneffective rate for wounded of 15 per 1,000 per day in the Far East Command was higher than either the disease or the nonbattle injury noneffective rates; when total days lost is considered, the wounded noneffective rate is higher than that for disease and nonbattle injury admissions combined.
TYPE OF DISPOSITION AND PLACE OF FINAL TREATMENT
Dispositions by place of final treatment provide information related to the echelon-wise structure of Army medical support and to the different types of final disposition that occur at the various levels of medical care. This information can be important to those concerned with developing patient flow by
Table 12.- Noneffective rates, U.S. Army division and separate regimental combat teams,
Korea, July 1950-December 1953
echelon of medical support and with providing various configurations of medical support by type of hospital.
Final dispositions among admissions from division units in Korea during the combat period, July 1950-July 1953, are shown in table 13. For division wounded patients, 73 percent had a final disposition in the Far East Command. Ten percent of all wounded dispositions occurred at medical facilities forward of hospital (such as aid, clearing or collecting stations, and dispensaries), 57 percent occurred at Army hospitals, and 6 percent at non-Army medical facilities in the Far East Command (Air Force and Navy facilities). The remainder consisted of 1 percent with dispositions at "other overseas hospitals" (usually in Hawaii or Puerto Rico) and 26 percent in continental United States. When the distribution by type of disposition is considered, marked differences result. For example, 96 percent of the died of wounds occurred in the Far East Command, the largest number occurring at surgical hospitals. The second highest number died of wounds at medical facilities forward of hospital in Korea. Of all division wounded with
disposition to duty, 80 percent were returned to duty in the Far East Command. The largest proportion (50 percent) was returned to duty from Army hospitals in the Korean Communications Zone and in Japan (other Army hospitals, Far East Command), and 10 percent returned to duty at the aid, clearing, or collecting stations in Korea. Almost all separations were processed in continental United States, although a few separations occurred at Tokyo Amy Hospital in Japan (other Army hospitals, Far East Command) and a few at military hospitals in Hawaii and Puerto Rico (other overseas hospitals). The distributions by hospital in the United States were about the same for both types of separations: approximately two-thirds processed at class II hospitals and most of the remainder separated at class I specialized treatment hospitals. In terms of the relative types of disposition for division wounded, 2.2 percent died of wounds, 87.9 percent returned to duty, 8.5 percent were separated for disability, and 1.4 percent were administrative separations. This compares with the distribution for total U.S. Army in Korea, of 2.5 percent died of wounds, 88.3 percent returned to duty, and 9.2 percent separated for disability and administrative reasons.
The distribution of final dispositions for division nonbattle admissions is markedly different from battle dispositions. Almost 96 percent of all DNBI cases had final dispositions in the Far East Command, with 41 percent occurring at medical facilities forward of hospital. Only 4 percent of all nonbattle final dispositions occurred in continental United States. Nonbattle deaths were distributed as 19 percent at either dispensary or aid clearing, or collecting stations, 16 percent at surgical hospitals, 26 percent at evacuation hospitals, 3 percent at field hospitals, 24 percent at other Army hospitals (station and general), and 1 percent at non-Army medical facilities, totaling 89 percent in the Far East Command. The balance (11 percent) expired in United States hospitals. The division nonbattle admissions with it final disposition to duty in the Far East Command amounted to 97 percent of the total. The largest proportion (42 percent) were returned to duty without being admitted to hospital. The balance (55 percent) were largely nonbattle duty dispositions from evacuation (19 percent), station and general hospitals (25 percent), and surgical, field, and nonArmy facilities (11 percent). Separations were processed mainly at class II and class I specialized treatment hospitals in the United States. A few separations were processed at Tokyo Army hospital (other Army hospitals, Far East Command) and at "other overseas hospitals" (Hawaii and Puerto Rico). The distribution by type of final disposition for division nonbattle admission cases shows that 0.3 percent died, 98.6 percent returned to duty, 0.9 were separated for disability, and 0.2 were other separations. The comparable distribution for total U.S. Army, Korea, was 0.2 percent died, 99.1 percent returned to duty, and 0.7 percent were separated for all causes.
The Adjutant General's battle casualty report (3) shows a total of 27,704 battle deaths among U.S. Army personnel in Korea. In addition to the 19,585 killed in action (of which 251 were killed after capture), there were reported 2,034, died of wounds (including 104 died while captured), 3,791 declared dead from missing in action, and 2,294 died of nonbattle causes while captured or missing. In terms of an annual rate per 1,000 average strength, all 27,704 deaths due to combat represent a loss of 43.2 per 1,000 for Korea compared to 51.9 per 1,000 for all battle deaths in the European Theater of Operations from June 1944 through May 1945. When the number of deaths (killed in action plus died of wounds) turning the total number hit (killed in action plus wounded in action, including died of wounds) are considered, 21.8 percent resulted in death in Korea. In all theaters of operation during World War II, 28.0 percent died of all those hit, and in the European theater, 25.1 percent died. If percentage ratios of all battle deaths to the total surviving wounded plus battle deaths are computed, 26.3 percent died in Korea compared to 25.4 percent in the European theater and 29.3 percent in all of World War II.
Another index of the measure of combat mortality is the ratio of the number killed in action to the number wounded in action, including the died of wounds. This ratio was 3.1 (including Air Corps) and 3.9 (excluding Air Corps) wounded to one killed in action for all theaters of operation during World War II compared to 4.1 wounded to one killed in Korea.
Of all the numbers of battle deaths, only The Surgeon General's counts of the died of wounds can be related to wounded admissions to medical treatment facilities. Among the 77,788 wounded
admitted to medical treatment facilities in Korea, 1,957 died of wounds, representing a case fatality rate of 2.5 percent. This rate is markedly lower than the 4.5 percent recorded for all of World War II.
Since the killed in action are not routinely examined by medical personnel, less than one-half (46 percent) had the type of traumatism recorded as cause of death. The died of wounds, on the other hand, are all seen, while still alive and a record (usually the Emergency Medical Tag WD AGO Form 8-26 (4)) is initiated at the time of first medical care. The traumatism, however, was not recorded, or was recorded as "unknown" for 9 percent of the died-of-wounds cases. Table 14
shows that more, than four-fifths of the killed in action with a recorded traumatism resulted from wounds of all types, while traumatic amputations were the cause of death in 5 percent of the known cases. Fractures were involved in about 4 percent of the recorded killed-in-action cases. More than 59 percent of the died of wounds could be accounted for by wounds of all types: largely, penetrating, perforating, and puncture type wounds. Fractures were responsible for 20 percent, and traumatic amputation in 4 percent, of the died-of-wounds cases.
The majority of those either killed in action or died of wounds in Korea occurred in the 20-24 year age group (table 15). Ninety percent of all of these deaths were men under 30 years of age, while those 19 and under incurred 22 percent of the deaths.
Nonbattle deaths resulting from vehicular accidents, drowning, homicides, and suicides are most likely to be "dead on arrival"; therefore, the total count of nonbattle deaths must also be distinguished from the smaller number of deaths which occur after admissions to medical treatment, such as those presented in table 13 for division units in Korea. For example, there were 10,220 nonbattle deaths in the U.S. Army, during the 4-year period 1950-53, of which 2,410 were due to disease and 7,810 to nonbattle injury. The number of CRO deaths amounted to 6,760; 575 were due to disease, and the majority (6,185) to nonbattle injury. The total
number of nonbattle deaths (including CRO) for U.S. Army nonbattle admissions in Korea, was 2,452, with 509 resulting from disease conditions and 1,943 from nonbattle injury. In terms of annual death rates per 1,000 average strength, 3.25 per 1,000 died of nonbattle causes among U.S. Army personnel in Korea during 1950-53, compared to 4,57 per 1,000 for the European theater from June 1944 through May 1945.
Approximately two-fifths of the disease deaths in U.S. Army, Korea (table 16), resulted from infective and parasitic disease. Acute poliomyelitis, infectious encephalitis, and epidemic hemorrhagic fever, the latter first encountered in Korea, were largely responsible. Another 40 percent of the disease deaths resulted from four broad groups of causes: neoplastic diseases, diseases of the circulatory system, diseases of the digestive system, and diseases of the urinary system. Acute respiratory disease, largely pneumonias, contributed over 6 percent of the deaths from diseases.
More than four-fifths of the nonbattle injury, deaths can be accounted for by the seven types of traumatism listed in table 17. Skull fractures and other head injuries were responsible for one-third, of all nonbattle injury deaths. The balance were largely from internal injuries of chest, abdomen, and pelvis (21 percent) and to lacerated and open wounds (18 percent). Burns and poisoning, each with about an equal number of deaths, caused 4 percent of the deaths, separately. Included in the 1,943 nonbattle injury deaths were 131 suicides and 101 homicides among U.S. Army personnel in Korea during the 1950-53 time period.
SEPARATIONS FOR BATTLE DISABILITIES
There were 7,057 individuals separated during the period 1950-53 for disabilities caused by battle wounds. The highest number of these separations occurred in 1952; at the end of 1953, there still remained in hospitals 1,032 individuals admitted for treatment of battle disabilities. These separations, by type and year of separation, are included in table 18.
Except for 105 World War II cases, these disabilities relate to U.S. Army patients with wounds incurred in the Korean War.
Impairments and diseases of the bones and organs of movement were mainly responsible for permanent retirement, and disabilities involving impairments of the nervous system, chiefly peripheral neuropathy, were responsible for most of those on the temporary duty retired list. One might expect this latter situation since these disabilities often require longer periods of observation for evaluating their ultimate effects. These differences might be noted from table 19, which shows selected diagnostic categories by type of separation.
Distribution by broad category of causative
Table 19.- Distribution of U.S. Army personnel separated for disability due to battle injuries and wounds, by primary diagnostic cause of separation, by type separation, and by causative agent, 1950-53
1 Flame throwers, bayonets, chemicals, fire, and explosions.
agents shows that explosive projectiles caused more battle casualty separations than any other group of causative agents, while small arms were second in importance. When causative agents are related to the diagnostic causes of separation, explosive projectiles, for example, caused 41.5 percent of the amputations; grenades and mines, 29.1 percent; small arms, 20.9 percent; and all other causative agents, 8.5 percent. In cases of paralysis of the extremities, 45.5 percent were caused by explosive projectiles, 7.4 percent by grenades and mines, 45.4 percent by small arms, and 1.7 percent by all other causative agents. Table B-12, included in appendix B, presents the primary diagnostic causes of separation in detail by rank, type of separation, and causative agent.