MASH: An Army Surgeon in Korea (review)

Otto F. Apel, Jr., and Pat Apel. MASH: An Army Surgeon in Korea. Lexington: University Press of Kentucky, 1998. xv + 222 pp. Ill. $25.00.

Sent through medical school by the Navy in World War II and released without active duty, Otto Apel was recalled from his surgical residency to serve in the Korean War in 1951 (the Navy assigned a number of such physicians to fill Army shortages). With brief assignments at Fort Knox, Kentucky, and at a general hospital in Japan, he was sent to the 8076th MASH in Korea in the late spring of 1951 and was immediately operating on wounded soldiers. He had received no training in military medicine.

Dr. Apel provides an excellent description of the work of his MASH. Periods of operating around the clock as mass casualties flow in alternate with periods of respite and time for picnics. He cannot praise the new helicopter evacuation system too highly, a system that brings him wounded patients so severely damaged that his surgical competency is stretched to the limits. The arrangements for moving a "mobile" hospital are well discussed, as are the logistic and operational requirements (power, fuel, water, heat) of forward surgery. Living conditions--with rats, flies, mud, latrines--are primitive. Apel enjoyed working with allied medical units; his MASH cared for patients from several of the allied forces, and language could be a problem.

The valuable contributions of the nurses and enlisted men are appropriately presented, as are those of the Korean employees. Apel notes the "jokes" in the unit--most of which appear to have been peeking at the nurses during their showers. Even so, his comments on the buffoonery of M*A*S*H are worth quoting: "In the case of the film and television series, the interpretation is several times removed from the reality it purports to depict. The artistic presentation is always four or five times removed from the reality" (p. 95).

The 8076th MASH gradually enlarged and began to admit nonwounded sick patients. In 1951, 21,048 patients were admitted: 8,675 were wounded, and 19,143 were evacuated further to the rear; 2,000 returned to duty from the MASH. Three surgeons with three assistants operated on 5,176 patients, of whom 4,993 were battle casualties. The average pace was 100 operations a week. Only 188 died at the MASH.

Apel presents fascinating new data on arterial wound repair. In the late summer of 1951 his slightly senior colleague proposed that instead of ligation--the official doctrine (to prevent gangrene)--they try arterial repair with vein grafts. Neither one had ever seen the operation in their residencies. They practiced on wounded Chinese and North Korean prisoners (innocent of Geneva and the Nuremberg Codes--recall that they had had no military medical education). Further cases in South Korean and then American soldiers polished their techniques. An arterial clamp was invented by them and was made in Tokyo by a silversmith while they were on leave. Higher medical headquarters were not at all pleased by their entrepreneurial surgery and issued "cease and desist" orders; Dr. Charles Mayo made a consultant visit and approved their work. Two successive commanders of the 8076th told them to continue, and eventually their program was approved. They did arterial repairs on more than two hundred patients. Dr. Apel wrote a paper on ten of those cases in the fall of 1952, but never sent it to a journal (the paper is in the book). He mentions a visit by Major John M. Howard "in the fall of 1951" (this would have really have been in January or February 1952): he says that Howard admonished him about doing arterial repairs (p. 163). This seems odd, because a part of Howard's mission was to establish research groups to do arterial repairs.¹ Had Apel published, he would have had a splendid priority in contributing data about arterial repair in...