SURGERY AND THE WOUNDED
Information on surgical operations is fundamental knowledge for a variety of medico logistical problems.
It points up the need for surgical specialists and for ancillary personnel. It indicates the need for plasma
and whole blood and for preoperative and postoperative care. It forms the basis for staffing, supply, and
for supporting requirements for committing surgical and evacuation hospitals as well. And those most in need
of surgery establish the priority for swift evacuation of the wounded from the battlefield, since, in
wartime, emergency surgery cannot be postponed with the same degree of freedom that might be applied to
other medical support considerations, such as alternate methods of treatment or optional means of evacuation
and hospitalization.
In Korea in 1950, hospital support was austere and adequate surgical care could not always be rendered in
country, especially because of the shortage of highly qualified surgeons. Early evacuation of the wounded
either before or after their surgery was necessary under the circumstances. Not until October 1951 were
sufficient skilled surgeons available to enable the Eighth U.S. Army Surgeon to organize professional
specialty teams (9). Despite these handicaps, U.S. Army patients received life-giving surgery in
Korea and Japan along with other improved medical procedures to the extent that the case fatality rate for
wounded achieved a new low of 2.5 percent compared to the 4.5 percent experienced in all of World War II.
When surgical operations are related to the number of wounded requiring surgery (table 75), and when
surgery such as debridement of wounds is excluded, 59 percent (46,024) of the 77,788 admissions to medical
treatment facilities required one or more surgical operation. There were 89,974 surgical operations
performed, for an average of 1.2 operations per total wounded or an average of two surgical operations per
wounded patient for whom an operation was performed. When the number of operations are considered by type of
surgery performed, genitourinary surgery averaged 4.5 operations per wounded who received genitourinary
surgery; oral surgery averaged three operations, and neurosurgery and gastrointestinal and abdominal surgery
averaged slightly over two operations for these specialties. All other specified types of surgical operation
averaged two operations or less. With regard to anatomical location of wound and surgical specialties
associated with the various body regions, the thoracoabdominal region averaged 1.4 operations per total
wounded with wounds of the thorax and abdomen, compared to one operation for each wounded of either the
head, face or neck area, or of the upper or lower extremities combined. When the number of surgical
operations are restricted to those who received the operations, the distribution is slightly different.
Surgical specialties associated with wounded of the head, face and neck area for whom operations were
performed, averaged 2.2 operations, those with thoracoabdominal wounds and operations were almost identical
with an average 2.1 operations, and those with extremity wounds and surgical operations averaged 1.8
operations. Although plastic surgery was undoubtedly performed on such body regions as the head, face, neck,
and the extremities, this specialty was not separately identified in this connotation, and only those
surgical procedures classified as plastic surgery, "not elsewhere classified (n.e.c.)" were identified.
Attesting to its magnitude, however, even this restricted classification shows an average of 1.7 operations
per wounded for which plastic surgery "n.e.c." was recorded.
Table 76 shows the surgical specialties by type of operation performed separately for wounded division
and non-division troops. Of the 46,024 wounded with one or more surgical operations, 43,803 (95.2 percent)
were division troops and only 2,221 (4.8 percent) were non-division troops. This, of course, is added
testimony to the constant, and immediate need for surgical hospital support of frontline divisions. Other
than order of magnitude, there appear to be no marked differences between the distributions by type of
specialty. However, there were slightly larger proportions of thoracic surgery,
84
Table 75.-Admissions for wounded in action and surgical operations, anatomical
location and type of surgery, U.S. Army, Korea, July 1950-July 1953
|
Anatomical location
and type of surgery
|
Wounds
|
Number of
Operations
|
Average number
of operations
|
|
Number
|
With surgery
|
For admissions
|
For cases with operations
|
|
Number
|
%
|
| Body region and type of surgery |
77,788
|
46,024
|
59.2
|
89,974
|
1.2
|
2.0
|
| Head, face, and neck |
14,349
|
6,603
|
46.0
|
14,294
|
1.0
|
2.2
|
|
Neurosurgery |
(1)
|
1,659
|
11.6
|
3,984
|
(1)
|
2.4
|
|
Eye, ear, nose, and throat |
(1)
|
1,668
|
11.6
|
3,341
|
(1)
|
2.0
|
|
Oral surgery |
(1)
|
408
|
2.8
|
1,237
|
(1)
|
3.0
|
|
General surgery, head and neck, not elsewhere classified |
(1)
|
2,868
|
20.0
|
5,732
|
(1)
|
2.0
|
| Thorax-abdomen |
12,541
|
8,179
|
65.2
|
17,118
|
1.4
|
2.1
|
|
Thoracic surgery |
(1)
|
2,106
|
16.8
|
3,140
|
(1)
|
1.5
|
|
Gastrointestinal and abdominal |
(1)
|
1,827
|
14.6
|
4,148
|
(1)
|
2.3
|
|
Genitourinary surgery |
(1)
|
356
|
2.8
|
1,614
|
(1)
|
4.5
|
|
General surgery, trunk, not elsewhere classified |
(1)
|
3,890
|
31.0
|
8,216
|
(1)
|
2.1
|
|
Upper and lower extremities |
50,489
|
26,668
|
52.8
|
48,787
|
1.0
|
1.8
|
|
Orthopedic surgery |
(1)
|
10,624
|
21.0
|
16,041
|
(1)
|
1.5
|
|
General surgery, extremities, not elsewhere classified |
(1)
|
16,044
|
31.8
|
32,746
|
(1)
|
2.0
|
| Body generally |
114
|
(1)
|
(1)
|
(1) |
(1)
|
(1)
|
| Anatomical location unknown |
295
|
(1)
|
(1)
|
(1)
|
(1)
|
(1)
|
| Plastic surgery, not elsewhere classified |
(1)
|
3,118
|
(1)
|
5,327
|
(1)
|
1.7
|
| All other surgery |
(1)
|
1,456
|
(1)
|
4,448
|
(1)
|
3.1
|
Table 76.- Admission for wounded in action with surgical operations, annual rates,
and percent distribution, by type of surgery and type of unit, U.S. Army, Korea, July 1950-July 1953
[Rates stated as cases per year per 1,000 average strength]
|
Type of surgery
|
U.S. Army, Korea
|
Type of unit
|
|
Division
|
Non-division
|
|
Number
|
Rate
|
%
|
Number |
Rate
|
%
|
Number
|
Rate
|
%
|
| Total with surgery |
46,024
|
71.81
|
100.0
|
43,803
|
132.20
|
100.00
|
2,221
|
7.18
|
100.0
|
| Neurosurgery |
1,659
|
2.58
|
3.6
|
1,559
|
4.71
|
3.6
|
100
|
0.32
|
4.5
|
|
Brain and meninges |
1,067
|
1.66
|
2.3
|
996
|
3.01
|
2.3
|
71
|
0.23
|
3.2
|
|
Other neurosurgery |
592
|
0.92
|
1.3
|
563
|
1.70
|
1.3
|
29
|
0.09
|
1.3
|
| Eye, ear, nose, and throat |
1,668
|
2.60
|
3.6
|
1,587
|
4.79
|
3.6
|
81
|
0.26
|
3.6
|
| Oral surgery |
408
|
0.64
|
0.9
|
374
|
1.13
|
0.9
|
34
|
0.11
|
1.5
|
| General surgery, head and neck, not elsewhere classified |
2,868
|
4.48
|
6.2
|
2,689
|
8.12
|
6.2
|
179
|
0.58
|
8.1
|
| Thoracic surgery |
2,106
|
3.28
|
4.6
|
2,030
|
6.13
|
4.6
|
76
|
0.25
|
3.4
|
|
Heart, pericardium, and great vessels |
27
|
0.04
|
0.1
|
27
|
0.08
|
0.1
|
0
|
--
|
--
|
|
Other thoracic surgery |
2,079
|
3.24
|
4.5
|
2,003
|
6.05
|
4.5
|
76
|
0.25
|
3.4
|
| Gastrointestinal and abdominal |
1,827
|
2.85
|
4.0
|
1,759
|
5.30
|
4.0
|
68
|
0.22
|
3.1
|
|
Esophagus and stomach |
52
|
0.08
|
0.1
|
48
|
0.14
|
0.1
|
4
|
0.01
|
0.2
|
|
Other gastro-abdominal |
1,775
|
2.77
|
3.9
|
1,711
|
5.16
|
3.9
|
64
|
0.21
|
2.9
|
| Genitourinary surgery |
356
|
0.56
|
0.8
|
344
|
1.04
|
0.8
|
12
|
0.04
|
0.5
|
|
Kidney |
93
|
0.15
|
0.2
|
93
|
0.28
|
0.2
|
0
|
--
|
--
|
|
Other genitourinary |
263
|
0.41
|
0.6
|
251
|
0.76
|
0.6
|
12
|
0.04
|
0.5
|
| General surgery of trunk, not elsewhere classified |
3,890
|
6.07
|
8.4
|
3,695
|
11.15
|
8.4
|
195
|
0.63
|
8.8
|
| Orthopedic surgery |
10,624
|
16.58
|
23.1
|
10,261
|
30.97
|
23.4
|
363
|
1.17
|
16.3
|
| General surgery, extremities, not elsewhere classified |
16,044
|
25.03
|
34.8
|
15,190
|
45.84
|
34.7
|
854
|
2.76
|
38.5
|
| Plastic surgery, not elsewhere classified |
3,118
|
4.87
|
6.8
|
2,893
|
9.00
|
6.8
|
135
|
0.44
|
6.1
|
| All other surgery |
1,456
|
2.27
|
3.2
|
1,332
|
4.02
|
3.0
|
124
|
0.40
|
5.6
|
85
Table 77.- Comparison of admissions excluded to total nonbattle admissions
processed, by type of admission with surgical operation, U.S. Army, Korea, July 1950-December 1953
|
Type of admission
|
Admissions processed
|
|
All nonbattle causes
|
Disease
|
Nonbattle injury
|
| U.S. Army, Korea, admissions |
409,490
|
328,395
|
81,095
|
| Number processed in surgery count |
404,540
|
323,940
|
80,600
|
| Number not included |
4,950
|
4,455
|
495
|
| Percent of admissions excluded |
1.2
|
1.4
|
0.6
|
| Non-division admissions |
215,170
|
178,235
|
36,935
|
|
Number processed in surgery count |
210,220
|
173,780
|
36,440
|
|
Number not included |
4,950
|
4,455
|
495
|
| Percent of admissions excluded |
2.3
|
2.5
|
1.3
|
gastrointestinal and abdominal surgery, and orthopedic surgery among division troops, whereas
non-division troops showed a slightly higher relative proportion of neurosurgery (brain and meninges) than
did the division wounded. This latter situation may result from the chance of non-division seriously wounded
receiving medical treatment in contrast to division seriously wounded surviving to reach medical care.
SURGERY AND NONBATTLE ADMISSIONS
Unfortunately, nonbattle admissions were not processed to the same degree of detail as were the battle
admissions and, therefore, only the number of admissions in Korea with surgical operation recorded by type
of operation is available. The number of procedures and the specialties required, identified by specific
area or origin, as Japan-Korea, are not at hand. Another difficulty arose in processing the nonbattle
admissions for total U.S. Amy, Korea, by type of unit. Some of the cases which would ordinarily fall into
the non-division category (after all division cases were properly identified) were inadvertently omitted at
the time of processing. The number involved was small, however, and amounted to about 1 percent of the total
counts for nonbattle admissions in Korea during the period July 1950-Deceber 1953. Table 77 provides a
comparison of the differences related to total U.S. Army, Korea, and to the non-division group to which they
apply. Even when compared with the overall counts for non-division admissions in Korea, the excluded cases
amount to about 2 percent of the total, a not too significant proportion for the introduction of bias.
Unlike the wounded where almost all of those requiring surgery originated in division units, the surgical
requirements for nonbattle admissions were about even by type of unit (table 78). There were, however,
slightly higher proportions of nonbattle injury admissions with surgery originating from divisions (57.5
percent,) and slightly, lower proportions of disease admissions with surgery from divisions (46.0 percent).
The relative proportions were reversed for nonbattle admissions with, surgery from non-division units, being
42.5 percent of all nonbattle injury admissions with surgery in Korea and 54.0 percent of all disease
admissions in Korea with surgery.
When the comparison is made within each type of unit rather than between units, the divisions showed 53.5
percent of their nonbattle admissions with surgery were due to disease and 46.5 percent were due to
nonbattle injury. With the nonbattle admissions with surgery restricted to those originating in non-division
units, 64.7 percent were due to disease and 35.3 percent were due to nonbattle injury. For total U.S. Army,
Korea, the overall proportions with surgery were 59.0 percent, due to disease and 41.0 percent due to
nonbattle injury.
Tables 79 slid 80 present information by type of unit, and type of surgical specialty for disease
admissions with surgical operations and for nonbattle injury admissions with surgical operations,
separately. Excluding the relatively higher proportions for oral surgery among division troops and
relatively lower proportions for genitourinary surgery, there are no major differences between these two
types of units for disease admissions with surgical operations. The two surgical specialties with the
highest proportionate shares of disease operations were (1) gastrointestinal and abdominal, and (2)
genitourinary surgery. Nonbattle injury, admissions with surgical operations show only very
86
Table 78.-Number and Percent of nonbattle admissions processed, by type of
admission with surgical operation, U.S. Army, Korea, July 1950-December 1953
|
Type of admission
|
Admissions processed
|
|
All nonbattle causes
|
Disease
|
Nonbattle injury
|
| U.S. Army, Korea |
404,540
|
323,940
|
80,600
|
| Admissions with surgery |
56,400
|
33,325
|
23,165
|
| Percent with surgery |
14.0
|
10.3
|
28.7
|
| Percent with surgery by type of admission |
100.0
|
59.0
|
41.0
|
| Division |
194,320
|
150,160
|
44,160
|
|
Admissions with surgery |
28,645
|
15,315
|
13,330
|
|
Percent with surgery |
14.7
|
10.2
|
30.2
|
|
Percent with surgery by type of admission |
100.0
|
53.5
|
46.5
|
|
Percent with surgery by type of unit |
50.7
|
46.0
|
57.5
|
| Non-division |
210,220
|
173,780
|
36,440
|
|
Admissions with surgery |
27,845
|
18,010
|
9,835
|
|
Percent with surgery |
13.2
|
10.4
|
27.0
|
|
Percent with surgery by type of admission |
100.0
|
64.7
|
35.3
|
|
Percent with surgery by type of unit |
49.3
|
54.0
|
42.5
|
slight variations between division and non-division troops for oral surgery, thoracic surgery,
genitourinary surgery, and plastic surgery. The highest proportions are concentrated in orthopedic surgery
and general surgery of the extremities. In terms of nonbattle admissions, with operations per 1,000 average
strength per year, disease admissions with an operation rate of 52 per 1,000 exceed those for nonbattle
injury of 36 per 1,000 per year. For disease, the non-division troops are highest with a rate, of 58 per
1,000 per year compared to 46 per 1,000 for divisions. On the other hand, the nonbattle injury admissions
with operations show the highest annual rate (40 per 1,000) among the division troops with non-divisions
amounting to only 32 per 1,000.
Table 79.- Admissions for disease with surgical operations, annual rates, and
percent distribution, by type of surgery and type of unit, U.S. Army, Korea, July 1950-December 1953
[Rates stated as cases per year per 1,000 average strength]
|
Type of surgery
|
U.S. Army Korea
|
Type of unit
|
|
Division
|
Non-division
|
| Number |
Rate |
% |
Number |
Rate |
% |
Number |
Rate |
% |
| Total with surgery |
33,325
|
52.00
|
100.0
|
15,315
|
46.22
|
100.0
|
18,010
|
58.19
|
100.0
|
| Neurosurgery |
605
|
0.94
|
1.8
|
220
|
0.66
|
1.4
|
385
|
1.24
|
2.1
|
| Brain and meninges |
85
|
0.13
|
0.2
|
25
|
0.07
|
0.1
|
60
|
0.19
|
0.3
|
| Other neurosurgery |
520
|
0.81
|
1.6
|
195
|
0.59
|
1.3
|
325
|
1.05
|
1.8
|
| Eye, ear, nose, and throat |
2,330
|
3.64
|
7.0
|
980
|
2.96
|
6.4
|
1,350
|
4.36
|
7.5
|
| Oral surgery |
2,035
|
3.18
|
6.1
|
1,145
|
3.46
|
7.5
|
890
|
2.88
|
4.9
|
| General surgery, head and neck, not elsewhere classified |
1,130
|
1.76
|
3.4
|
505
|
1.52
|
3.3
|
625
|
2.02
|
3.5
|
| Thoracic surgery |
435
|
0.68
|
1.3
|
195
|
0.59
|
1.2
|
240
|
0.78
|
1.3
|
| Heart, paricardium, and great vessels |
5
|
0.01
|
0.0
|
5
|
0.02
|
0.0
|
0
|
0
|
0
|
| Other thoracic surgery |
430
|
0.67
|
1.3
|
190
|
0.57
|
1.2
|
240
|
0.78
|
1.3
|
| Gastrointestinal and abdominal |
10,475
|
16.34
|
31.4
|
4,925
|
14.86
|
32.2
|
5,550
|
17.93
|
30.8
|
| Esophagus and stomach |
85
|
0.13
|
0.2
|
55
|
0.16
|
0.4
|
30
|
0.10
|
0.2
|
| Other gastro-abdominal |
10,390
|
16.21
|
31.2
|
4,870
|
14.70
|
31.8
|
5,520
|
17.93
|
30.6
|
| Genitourinary surgery |
5,970
|
9.32
|
17.9
|
2,210
|
6.67
|
14.4
|
3,760
|
12.15
|
20.9
|
| Kidney |
105
|
0.16
|
0.3
|
65
|
0.20
|
0.4
|
40
|
0.13
|
0.2
|
| Other genitourinary |
5,865
|
9.16
|
17.6
|
2,145
|
6.47
|
14.0
|
3,720
|
12.02
|
20.7
|
| General surgery of trunk, not elsewhere classified |
1,500
|
2.34
|
4.5
|
655
|
1.98
|
4.3
|
845
|
2.73
|
4.7
|
| Orthopedic surgery |
1,435
|
2.24
|
4.3
|
665
|
2.01
|
4.3
|
770
|
2.49
|
4.3
|
| General surgery, extremities, not elsewhere classified |
3,320
|
5.18
|
10.0
|
1,635
|
4.93
|
10.7
|
1,685
|
5.44
|
9.4
|
| Plastic surgery, not elsewhere classified |
140
|
0.22
|
0.4
|
40
|
0.12
|
0.3
|
100
|
0.32
|
0.6
|
| All other surgery |
3,950
|
6.16
|
11.9
|
2,140
|
6.46
|
14.0
|
1,810
|
5.85
|
10.0
|
87
Table 80.- Admissions for nonbattle injury with surgical operations, annual rates,
and percent distribution, by type of surgery and type of unit, U.S. Army, Korea, July 1950-December 1953
[Rates stated as cases per year per 1,000 average strength]
| Type of surgery |
U.S. Army, Korea |
Type of unit |
| Division |
Non-division, |
| Number |
Rate |
% |
Number |
Rate |
% |
Number |
Rate |
% |
| Total with surgery |
23,165
|
36.15
|
100.0
|
13,330
|
40.23
|
100.0
|
9,835
|
31.77
|
100.0
|
| Neurosurgery |
270
|
0.42
|
1.1
|
170
|
0.51
|
1.3
|
100
|
0.32
|
1.0
|
| Brain and meninges |
166
|
0.26
|
0.7
|
80
|
0.24
|
0.6
|
85
|
0.27
|
0.9
|
| Other neurosurgery |
105
|
0.16
|
0.4
|
90
|
0.27
|
0.7
|
15
|
0.05
|
0.1
|
| Eye, ear, nose, and throat |
1,210
|
1.89
|
5.2
|
635
|
1.92
|
4.8
|
575
|
1.86
|
5.8
|
| Oral surgery |
495
|
0.77
|
2.1
|
210
|
0.63
|
1.6
|
285
|
0.92
|
2.9
|
| General surgery, head and neck, not elsewhere classified |
1,660
|
2.59
|
7.2
|
805
|
2.43
|
6.0
|
855
|
2.76
|
8.7
|
| Thoracic surgery |
210
|
0.33
|
0.9
|
85
|
0.26
|
0.6
|
125
|
0.41
|
1.3
|
| Heart, pericardium, and great vessels |
5
|
0.01
|
0.0
|
0
|
--
|
0
|
5
|
0.02
|
0.1
|
| Other thoracic surgery |
205
|
0.32
|
0.9
|
85
|
0.26
|
0.6
|
120
|
0.39
|
1.2
|
| Gastrointestinal and abdominal |
345
|
0.54
|
1.5
|
200
|
0.60
|
1.5
|
145
|
0.47
|
1.5
|
| Esophagus and stomach |
20
|
| |
