Medical Support Provided by the UN's Scandinavian Allies during the Korean War.

The humanitarian motivation of medical support from the three Scandinavian countries during the Korean War cannot be doubted, but the countries also had to be politically sensitive during this period. The fact that these countries only dispatched medical support, and that the team was not only for military purpose but also intended to help the civilians is a different point from the U.S. military medical support, which distinguished military medical support that is the U.S. Eighth Army, from the civilian treatment and relief, which is the UNCACK. In addition, medical support activities from the Scandinavian countries were bound to be flexible depending on the rapidly changing trend of war, active regions, and their support methods. At a time when the battle was fierce and the number of wounded soldiers increased, they had no choice but to concentrate on treating wounded soldiers, whether in Busan or Incheon. However, even while treating these wounded soldiers, they tried to treat and rescue civilians around the base area whenever they had chance. It is easily imaginable that in the urgent situation of war, the nature of medical support cannot be clearly divided into military or civilian if there is only one team that is operating. It is clear, however, that the common humanitarian purpose of rescuing and treating civilians affected the establishment of the National Medical Center in Seoul after the war. The Scandinavians had indeed remained even after the end of the war in to provide full support of establishing modern medical system in Korea. This suggests that modern Korean medical or public health system did not start to be developed in the 1960s like some researchers argue, but started a few years earlier during the time of the war with the support from the countries world-wide.

Joseph Needham's 'Motivations for Participation' and 'Major Roles' in the International Scientific Commission on Bacterial Warfare during the Korean War.

This paper analyzes the motivations of the British biochemist Joseph Needham for participating in 'the International Scientific Commission for the Investigation of the Facts Concerning Bacterial Warfare in Korea and China (ISC)' and his major roles within it during the Korean War. Needham stayed in China for four years starting in 1942 as a scientific counselor and director of the British Scientific Mission in China, which enabled him to interact with many Chinese scientists and politicians. Surprisingly, during this period (1944), Needham conducted an investigation into the Japanese military's use of bacterial warfare. Through his personal records, Needham repeatedly stated that his experience with bacterial warfare research in 1944 was one of the most important reasons for his participation in ISC activities. In addition, Needham secretly but very actively sought to recruit other investigators within Britain. Needham repeatedly tried to persuade fellow professors at Cambridge University, William Thorpe and Vincent Wigglesworth, to be included in the investigation team. Although Needham had doubts about his own expertise in investigative activities, he actively expressed his desire to become a member of the investigative team through various channels. Primary documents show that he actively and voluntarily led the investigation activities after joining the team in professional discussions, document analysis, and witness interrogations. Needham's passion and sincerity demonstrated in internal meeting minutes dispel some misunderstandings that the investigation team's activities were limited to passively approving Chinese data.

Unstable Expansion: The Development of the Military Medical Evacuation Chain in Korea, 1948-1953.

This research examines the expansion and characteristics of the Korean Army's chain of medical evacuation in 1948-1953. The most important goal of the chain of medical evacuation was to conserve fighting strength, which cannot be achieved only by sending the sick and wounded to the rear for treatment. It was more important to maintain as many mission-capable wounded soldiers on the frontline. Therefore, triage for conserving strength was the priority in the evacuation process, and military doctors conducting triage played a significant role. Focusing on military doctors, this article studies the instability of the Korean Army's medical evacuation chain. Although Korea was liberated from Japanese colonial rule in August 1945, Korea had no army or army medical services. With the support of KMAG, the Korean Army was able to build a nationwide evacuation chain during the Korean War. However, the expansion of the medical evacuation chain resulted in instability. At the heart of the instability was manpower, rather than organization and transportation. Koreans had almost no experience with the military medical services before 1948, and during the Korean War, most doctors, who had been conscripted after the outbreak of the war, were not trained as military doctors. Therefore, the Korean Army had no other choice but to conduct medical evacuations using mobilized civilian doctors who were not sufficiently trained as military doctors. The escalating war revealed the problems of civilian doctors in military uniforms. Unlike the goal of the chain of medical evacuation, they easily evacuated patients and were reluctant to release patients to return to their duties. Korean Army doctors who were not sufficiently trained as military doctors struggled between the goals of military medical services and those of medical care. Consequently, the military doctors and the instability of the medical evacuation chain during the Korean War reflect the fundamental tension between war and medicine.

A Foundation for a "Cheerful Society": The Korean War and the Rise of Psychiatry.

One of the most remarkable medical achievements of the Korean War was the development of psychiatry. During the Korean War, soldiers and prisoners of war (POWs) experienced "gross stress reaction" and manifested poor concentration and memory as well as clinical depression and social alienation. Rest and relaxation rotations served as the primary treatment for their conditions. Civilians also bore the brunt of the war's effects. Delusions of grandeur and megalomania appear to have been common among Koreans, but there were few mental health facilities to provide treatment and care. Out of the furnace of war, psychiatry emerged as a newly specialized field, and in the 1950s, Korea became the very place where military psychiatry training under the U.S. military laid the groundwork for civilian psychiatry. This essay aims to enrich the study of mental illness during and after the Korean War by providing a more detailed picture of the mental problems experienced not only by veterans and POWs, but also by civilians in Korea. Examining mental health issues from this period is challenging due to the scarcity of resources for delving into the minds of the civilians involved. Taking military psychiatry as a starting point, this essay goes beyond existing scholarship to discuss psychiatry-related responses to the Korean War, including the influence of military psychiatry on civilian psychiatry, the endeavors of medical professionals and government policies, and contemporary expressions of mental distress during and after the war.

Anesthesia in the Korean War.

Relying on original, primary source documentation from the National Archives, we describe the practice of anesthesia in mobile army surgical hospital (MASH) units and the 171st Evacuation Hospital during the latter part of the Korean War in 1953. Values were scaled and reported as percentages. These Essential Technical Medical Data Sheets reveal a surprising proportion (12.9%) of men received spinal anesthetics, despite official recommendations to the contrary. Still, the majority (69.2%) of the wounded underwent general anesthesia, most commonly through a mixture of thiopental and nitrous oxide. Despite data from World War II demonstrating the advantages of endotracheal intubation in these patients, few patients (20.6%) were intubated. Six percent benefited from the new curare-based drugs. This is the first English-language article that describes the practice of anesthesia during the Korean War. Utilizing primary source documentation, we found that general anesthesia was the most common type utilized. Newer techniques were not as commonly adopted, despite official recommendations and data from the time. The care provided closely resembled that delivered in the Second World War but inspired a series of technological and pedagogical reforms through the 1950s to improve military anesthesia for the next conflict.

Lessons Learned From the U.S. Military Experience With Hantavirus During the Korean War.

INTRODUCTION: The Korean War (1950-1953) consisted of two phases. The first was a rapid mobile phase, and the second was a slow and stationary phase. During the stationary phase, approximately 3,000 UN troops became infected with a then unknown agent. The resulting illness began with flu-like symptoms and often progressed to a severe hemorrhagic fever leading to kidney failure and death. However, the cause was not to be identified until well over 20 years following the conclusion of the war when Dr. Ho Wang Lee succeeded in isolating Hantavirus from field rodents. The U.S. Military experience with Hantavirus during the Korean War is a case study of the potential impact of war-related environmental change on disease transmission. The lessons learned from this experience should inform future military medical planning and serve as a reminder of the impact that an unknown agent can have on military operations. MATERIALS AND METHODS: A literature review of all available records with respect to the U.S. Military experience with Hantavirus was conducted. PubMed was the primary search engine used for this review. However, primary literature and historical accounts were also evaluated. All records were examined for environmental, epidemiological, and public health data regarding hemorrhagic fever outbreaks among U.S. forces during the Korean War. The quantitative and qualitative data from these sources were analyzed and evaluated within the context of military medical planning and force health protection to derive lessons learned that should be applied to the management and mitigation of viral disease in future wars. RESULTS: Widespread deforestation resulting from war-related efforts most likely played a significant role in the outbreaks of Hantavirus among UN forces during the war. A lack of cultural literacy and an overreliance on erroneous assumptions most likely delayed the identification of the true causative agent. It is conceivable that these delays led to an increased casualty rate and that they had a negative impact on military operations during the war. CONCLUSIONS: A basic understanding of the ecological mechanisms that maintain species diversity in the local environment coupled with an appreciation for the impact of environmental change on this diversity is of paramount importance for the prevention and mitigation of viral disease outbreaks in the deployed setting. Military medical planners should become familiar with the medical literature of the region in which they will be operating as this literature often describes the agents that will most likely be encountered by U.S. forces.

Observations from the Korean War for Modern Military Medicine.

This paper reviews developments in military medicine during the Korean War and places them in the evolution of military medical lessons from the Second World War and the subsequent development of military medicine through the Vietnam War to the present day. The analysis is structured according to the '10 Instruments of Military Healthcare.' Whilst there were incremental developments in military medicine in all these areas, several innovations are specifically attributed to the Korean War. The introduction of helicopters to the battlefield led to the establishment of dedicated medical evacuation helicopters crewed with medical personnel and the evolution into the DUSTOFF system during the Vietnam War. Helicopter evacuation was the primary medical evacuation system in the wars in Iraq and Afghanistan. The establishment of the Mobile Army Surgical Hospital during the Korean War were founded upon the US Auxiliary Surgical Groups or the UK Casualty Clearing Stations of World War II. The requirement for resuscitation and surgical teams close to the battlefield has endured through the development of mobile hospitals of varying sizes from Field Surgical Teams to the current 'modular' Hospital Centre and other international equivalents. There were many innovations in the clinical care of battle casualties covering wound shock, surgical techniques, preventive medicine, and acute psychiatric care that refreshed or advanced knowledge from the Second World War. These were enabled through the establishment of medical research programs that were managed within the theatre of operations. Further advances in all these clinical topics can be observed through the Vietnam War to the wars in Iraq and Afghanistan - all of which were underpinned by institutional directed research programs. Finally, collaboration between international military medical services and the development of Korean military medical services is a major theme of this review. This 'military-tomilitary' and 'civil-military' medical engagement was also a major activity during the Vietnam War and more recently in Iraq and Afghanistan. Overall, the topics and themes in military medicine that were important during the Korean War can be considered to be part of trajectory of innovation in military medicine have been replicated in many subsequent wars. The paper also highlights some 'lessons' from World War II that had to be relearned in the Korean War, and some observations from the Korean War that had to be relearned in subsequent wars.

Development and Influence of Military Medicine during the Korean War: the Medical Field Service School and Training in the U.S.

This study investigates the development of military medicine during the Korean War, with a focus on the role of the Medical Field Service School and training programs in the United States. It also explores the nuanced acceptance of American medicine by South Korean doctors. Military surgeon education and training emerged as pivotal catalysts, initiating a qualitative transformation in South Korean medicine and serving as a catalyst for the advancement of modern medical practices. Military surgeon education went beyond imparting military knowledge to civilian doctors; it also acted as a vehicle for disseminating fundamental medical knowledge essential for the progress of Korean medicine. Noteworthy is the strategic selection of exceptional military surgeons for overseas training, serving as a vital link for the assimilation of 'advanced medicine' across diverse medical domains. Contrary to unilateral acceptance, South Korean doctors embraced American medicine based on subjective judgments aligned with the specific needs of South Korean medicine. Acknowledging American medical knowledge and technology through the Medical Field Service School and U.S. training, military surgeons refrained from mere praise, recognizing the substantial gaps between South Korean and American military medicine. Beyond material achievements, South Korean military surgeons also discerned and valued the spiritual legacy of American medicine. These military surgeons actively determined the essential medical majors for South Korea, introducing cutting-edge medical technology, and leveraging relationships with U.S. military surgeons to facilitate opportunities for themselves and their students to study abroad. This proactive approach highlights the independent thought processes of South Korean military surgeons, addressing both material and spiritual needs and serving as internal driving forces for the development of South Korean medicine.

Psychiatric Casualties during the Korean War: Focusing on American and Common Wealth Soldiers.

A crucial gap in the medical history of the Korean War is the history of psychiatry during the Korean War. War puts those who participate in it through physical and mental extremes, inflicting not only physical injuries but also psychological trauma and damage. However, studies of the medical aspects of the Korean War have been limited to topics related to physical injuries and their treatment, and there are no studies that systematically summarize the traumatic effects on the human mind thrown into the midst of the war, the consequences of these effects, and the medical efforts made to deal with these problems. As the Korean War was fought only five years after the end of the Second World War, the experiences and achievements of the Second World War were used in the Korean War. In terms of personnel, many of the soldiers who fought in the Second World War also fought in the Korean War. This continuity with the Second World War had both positive and negative aspects. On the positive side, treatment and transport systems were quickly put in place to respond to the large numbers of soldiers with psychiatric problems on the front lines early in the war. This is an example of a positive use of the legacy of the Second World War. On the other hand, the negative side of the coin was the much higher frequency of psychiatric symptoms among veterans of the Second World War. This could be explained by the fact that the psychological trauma experienced on the battlefield during the Second World War remained latent and was reactivated in the Korean War as a kind of conditioned reflex. In addition, the brainwashing of prisoners of war and their subsequent psychological problems are also characteristic of the Korean War in the context of the Cold War. These psychiatric features of the Korean War will provide a useful historical example for understanding and helping those who are inevitably involved in war and suffer from mental distress.

The United Nation's Civil Assistance Command in Korea's (UNCACK) Public Health Measures on Koje Island during the Korean War.

This study focuses on the health and sanitation projects carried out on Koje Island by the United Nations Civil Assistance Command in Korea (UNCACK). Koje Island was unique as it served as a destination for dispersed refugees and as an area for housing prisoners of war. Unlike in other regions, UNCACK was actively involved in the implementation of health and sanitation projects on Koje Island. Their infectious disease control projects on Koje Island serve as a valuable example for studying infectious disease prevention initiatives and local medical projects in modern and contemporary Korea. In this study, I examine the documents produced by UNCACK to assess the status of infectious disease control and vaccination plans. Additionally, I analyze the disease prevention initiatives implemented among the residents of Koje Island, including isolation, treatment, and improvement of living conditions. Finally, I explore the characteristics of the Koje Island preventive measures and assess the efforts and limitations of both UNCACK and the Korean government in addressing health issues during the Korean War. Despite the presence of refugees and POWs, Koje Island managed to implement systematic public health initiatives in a controlled environment, widely regarded as highly successful. The public health initiatives on Koje Island, led by UNCACK, provided an opportunity to utilize limited resources, manpower, and Korean health professionals, cultivating the skills necessary to manage infectious diseases effectively. Moreover, these initiatives on Koje Island, although modest, continued into the postwar period, influencing medical missionary activities, the demand for health services among residents, the establishment of independent medical institutions, and the implementation of local health projects.

The 'Korean' Resolution of the Doctorless Village Crisis and the Entanglement with the Conscription System in South Korea in the 1950s-70s.

This article reviews how the crisis of doctorless villages in South Korea in the 1950s-70s was closely linked to the conscription system. In the second half of the twentieth century, South Korea's public health system faced a dual challenge: the colonial legacy of medical shortage and urban concentration, and the massive conscription of military doctors after the Korean War. The term 'doctorless village' was a signifier that reflected these historical contexts, symbolizing the chronic medical crisis in rural areas. Behind the crisis, there as a growing idea of reversing the constraints from conscription and using it as a solution for the doctorless village problem. Initially, the Ministry of Health and Social Affairs planned two alternatives to fill the gaps in the public health network. One was to station military doctors in doctorless villages, and the other was to dispatch civilian doctors in doctorless villages and exempt them from military service. After a series of doctor mobilizations since the May 16 coup, the medical community generally agreed with this plan and publicized it. They developed arguments for alternative services through public health work and strengthened its logic. By the 1970s, the plan culminated in the establishment of the current Public Health Doctor system. In terms of condition and momentum, the introduction of alternative service in other sectors, as well as the extension of the consensus among the government and medical community, accelerated this trend. As a result, the doctorless village crisis in South Korea, which had been a critical issue for a quarter of a century, entered a phase of resolution by utilizing the conscription system as its institutional foundation. It represented an aspect of the 'Korean' public health system characterized by the entanglement with conscription. However, another aspect to consider is that it has imposed additional limitation on medical care in rural areas by institutionalizing the public health system relying on mobilization and minimum budget.

Arnold Max Meirowsky: champion of the American mobile neurosurgical unit during the Korean War.

Dr. Arnold Max Meirowsky (1910-1984) was enormously influential to military neurosurgery during the Korean War, introducing to the American military the concept of the mobile neurosurgical unit. After implementation of the neurosurgical detachment, meningocerebral infections saw a decrease from 41% to less than 1%, with similar improvements in mortality and complication rates. Additionally, Meirowsky developed many techniques and improvements in neurosurgery, specifically in the field of neurosurgical trauma, which he dedicated himself to even after reentering civilian practice. Furthermore, his mentorship of Korean surgeons and the influence of his mobile neurosurgical unit were major influences cited to be pivotal to the founding of neurosurgery as a specialty in South Korea. As he is underrecognized for these accomplishments in the neurosurgical literature, the authors seek to review his wartime and career contributions. They also specifically present details of his standardization of the mobile neurosurgical unit and showcase several of his other advancements in the treatment of neurosurgical trauma.

Ancient DNA Methods Improve Forensic DNA Profiling of Korean War and World War II Unknowns.

The integration of massively parallel sequencing (MPS) technology into forensic casework has been of particular benefit to the identification of unknown military service members. However, highly degraded or chemically treated skeletal remains often fail to provide usable DNA profiles, even with sensitive mitochondrial (mt) DNA capture and MPS methods. In parallel, the ancient DNA field has developed workflows specifically for degraded DNA, resulting in the successful recovery of nuclear DNA and mtDNA from skeletal remains as well as sediment over 100,000 years old. In this study we use a set of disinterred skeletal remains from the Korean War and World War II to test if ancient DNA extraction and library preparation methods improve forensic DNA profiling. We identified an ancient DNA extraction protocol that resulted in the recovery of significantly more human mtDNA fragments than protocols previously used in casework. In addition, utilizing single-stranded rather than double-stranded library preparation resulted in increased attainment of reportable mtDNA profiles. This study emphasizes that the combination of ancient DNA extraction and library preparation methods evaluated here increases the success rate of DNA profiling, and likelihood of identifying historical remains.

DDT Resistance Korean Body Lice and Development of Insecticide Resistance Knowledge during Korean War.

DDT exemplifies success and failure of modern science and technology. Once it was heralded as technological wonder that will deliver human from misery of insect-borne infectious disease. However DDT took dramatic downturn after failure in global malaria eradication program initiated by World Health Organization, with advent of DDT-resistant strain of mosquitoes. Although insecticide resistance has been know since late 19th century, the definitions and mythologies for finding resistance has not been settled until 1950s. This paper argues that discovery of DDT-resistant strain of body lice in prisoners of war camp in Korea during the Korean War provided essential knowledge and opportunity for advancing insecticide resistance studies. Since 1945 to the end of Korean War, US Army sprayed thousands of tonnes of DDT on Korean body and soil. DDT was only went into wide field application since 1943, was still a very new technology. The ways to deliver and utilize DDT was still under the investigation. And Korea, especially during the War, was ideal place to construct such knowledge and place it in the application. The main focus was to control public health threats, such as louse-borne typhus fever. Korean soldiers and prisoners of war exposed to regular dose of DDT, which soon gave rise to DDT-resistant strain of body lice. It was the first major outbreak of insecticide-resistance appeared in insect that has major public health importance. Until early 1950s, mechanisms of resistance, or even definition of insecticide resistance was unclear. Researchers in US Army and Department of Agriculture rushed to find the ways to quantify insecticide resistance. Network of laboratories, connecting Korea-Japan-US, had to devise new laboratory methods to rear, and test body lice. These body lice later migrate to laboratories in US, providing valuable asset for future insecticide resistance research in US. At the same time, laboratory methods of testing resistance in body louse became a standard across the globe, setting new research agenda through World Health Organization. This shows flow of knowledge, along with migration of body louse, during the Korean War. At the same time, this case show who new knowledge is constructed through the expense of involvement of minority populations, such as natives, soldiers, and prisoners of war.

The Changing Face of Older American Veterans.

The demographics of the Veterans in our care are everchanging, we are currently seeing a major shift in our geriatric Veteran population. World War II (WWII) ended in 1945, meaning that the youngest WWII Veterans are no more than 93 years old. There are currently close to 300,000 WWII Veterans and this number is expected to drop to <50,000 by 2024. Conversely, there are currently nearly 1 million Veterans of the Korean Conflict (1950-1953) and nearly 6 million Vietnam Era (1964-1975) Veterans. As the Vietnam Era Veterans age, we are seeing a surge in the number of Veterans aged 75 and older. There are currently less than 4.6 million Veterans in this age group and that number is expected to exceed 5 million by 2023.

Establishment and Operation of Wartime Health Care System in North Korea during the Korean War and Support from the Korean Society in Yanbian.

North Korea's health care system during the Korean War has a significant meaning in North Korean medical history and is also an appropriate research topic for understanding North Korea's wartime system. However, previous studies on North Korean medical history has been focused on before and after the war. This study traces the formation and operation of North Korea's wartime health system to fill the gap in the literature, aiming to identify that the support of the North Korean community in China's Yanbian community was key to North Korea's wartime health system. North Korea reorganized its health care system, centered on the military, such as establishing field hospitals concurrently with the outbreak of the war. However, as time went on, the North Korean health care project began to put an emphasis on protecting the lives and health of the civilians behind the frontline. In addition to the primary need to prevent infectious diseases, the hygiene and prevention project functioned as a means to control and mobilize the public by emphasizing broad public participation. Although North Korea tried to meet the demand for a large medical personnel through short-term training, medical personnel were always in short supply during the war. During the war, it was the Korean society in Yanbian that replenished medical personnel in North Korea and provided a space for a relatively stable hospital operation. Numerous Koreans in Yanbian participated in the Korean War as nurses, paramedic staff, transfusion donors, and army surgeons for North Korea. Such large-scale participation of medical personnel in Yanbian was based on the long-established medical exchanges between Yanbian and North Korea. Koreans in Yanbian also accommodated North Korean wounded, refugees, and war orphans and provided various medical assistance to them. During the war, Yanbian was a "secure rear" capable of performing medical actions that could not be done in North Korea. This study has confirmed that North Korea's current participation in public health projects, which is a characteristic of its health care sector, has its origins in the Korean War. Moreover, it demonstrates that North Korea's medical history needs to be viewed from an East Asian perspective, including the Korean society in Yanbian, rather than a national-only perspective. The application of this view to the analysis of North Korean's health care system in other historical periods would facilitate richer discussions.

The Importance of Blind Forensic Odontology Analyses.

Forensic odontology cases examined from 2012 to 2019 at the Defense POW/MIA Accounting Agency (DPAA) laboratory were reviewed. Five cases from World War II and the Korea War were selected. Three of the cases presented involve dental assemblages, which were built by previous analysts. Postmortem radiographic analyses at the DPAA laboratory of these cases were complicated by the use of an older version of a digital x-ray program and the assumption that teeth placed in the parent bone (maxilla and mandible) did not fully articulate due to the presence of debris at their root apices. Conflicting mitochondrial DNA test results for the submitted teeth and previously believed to be parent bone indicated these elements were not from the same individual. The remaining two cases are examples of how knowledge of findings from other disciplines may sway an opinion and could possibly lead to the rendering of erroneous opinions by the forensic odontologist. Having knowledge of previous examinations or results from other scientists, disciplines, and lines of evidence may lead to a bias in findings or opinions. If not careful, even the best-intended scientist may fall victim to a bias in their opinion/analysis. The forensic odontologist should perform all analysis in the blind, not knowing any information which may bias their opinion, and utilize current versions of digital x-ray software available and their tools when performing their examinations.

The Norwegian Mobile Army Surgical Hospital in the Korean War (1951-1954): Military Hospital or Humanitarian "Sanctuary?"

During the Korean War (1950-1953) the Norwegian government sent a mobile army surgical hospital (MASH) to support the efforts of the United Nations (UN) Army. From the first, its status was ambiguous. The US-led military medical services believed that the "Norwegian Mobile Army Surgical Hospital" (NORMASH) was no different from any other MASH; but both its originators and its staff regarded it as a vehicle for humanitarian aid. Members of the hospital soon recognized that their status in the war zone was primarily that of a military field hospital. Yet they insisted on providing essential medical care to the local civilian population as well as trauma care to UN soldiers and prisoners of war. The ambiguities that arose from the dual mission of NORMASH are explored in this article, which pays particular attention to the experiences of nurses, as expressed in three types of source: their contemporary letters to their Matron-in-Chief; a report written by one nurse shortly after the war; and a series of oral history interviews conducted approximately 60 years later. The article concludes that the nurses of NORMASH experienced no real role-conflict. They viewed it as natural that they should offer their services to both military and civilian casualties according to need, and they experienced a sense of satisfaction from their work with both types of patient. Ultimately, the experience of Norwegian nurses in Korea illustrates the powerful sense of personal agency that could be experienced by nurses in forward field hospitals, where political decision-making did not impinge too forcefully on their clinical and ethical judgment as clinicians.