We are speaking today with Brigadier General Crawford F. Sams, who was born in East St. Louis, Illinois on April 1, 1902. He received his Bachelor of Science degree with a major in psychology at the University of California; a Master of Science degree in neuroanatomy at Washington University, St. Louis, Missouri, and received his M.D. degree at Washington University, St. Louis, in 1929. In January, 1922, he enlisted as a private in the 159th Infantry, California National Guard, and was commissioned second lieutenant in the Infantry in 1923. He was transferred to the 143rd Field Artillery and subsequently promoted to the grade of captain in 1925 While on active duty, he graduated from the Field Artillery School at Fort Sill in 1925. He resigned in December, 1925 to study medicine at Washington University. While a student at the medical school, he was re-commissioned as first lieutenant, Field Artillery Reserve. He was commissioned first lieutenant, Medical Corps, upon receiving his M.D. degree in 1929 and ordered to active duty at Letterman General Hospital, where he completed his internship in July 1930, after which he accepted a commission in the regular Army Medical Corps. Dr. Sams had a distinguished military career, serving in the United States, in Panama, in the Middle East, in Europe, and in the Far East during World War II. His military decorations and ribbons are listed in his curriculum vitae, which will be placed with this copy of the oral history interview. His awards and decorations are really too long to be listed.
Dr. Sams, you have had such a brilliant and long career, but I thought first of all we might start off by asking you why you chose army life.
When I was a boy in high school, I became interested in the military service through reading books – historical books – about military leaders. At the same time, I had an older cousin, who was a doctor, who let me accompany him on his house calls in literally the horse and buggy days, and I was also interested in medicine. My initial interest was in military service, however. I had intended to pursue a career in the line – as we called it – in the field artillery, at the urging of my commanding officers and other senior advisers, including the president of the University of California. The pull to pursue a career in medicine was very strong and I decided to combine the two, and therefore, I went on in medicine at Washington University. My faculty advisor at the University of California had urged me to study medicine and said [that] with my academic standing that since I could enter any school [to] which I applied, as far as academic standing was concerned, I should pick the best school I could in the field in which I was interested.
Since I had a background in psychology and done a little research and published my first scientific paper in that field, I was interested in [the] functioning of the human brain, as it turned out to be a transducer instead of a philosophical vacuum as it was perceived in psychology. In reviewing the faculties and the curriculum at Harvard, Northwestern, Washington University, and Hopkins, at that time, which were the outstanding medical schools, I decided that Washington University with [Stephen Walter] Ranson, the Chairman of the Department of Neuroanatomy, and [Ernest] Sachs, one of the five recognized neurosurgeons, second only to [Harvey Williams] Cushing of Harvard, that this was the place that I should come to pursue the particular type of research and training that I was interested in. Therefore, I entered the graduate school here to take my Master’s degree under Ranson. I went to the University of Minnesota for one summer session to take some work which Ranson recommended, and then came back and subsequently worked with Dr. Sachs.
Could you tell us a little more about Dr. Sachs?
Ernie Sachs was one of the kindest gentlemen I have ever met. He was a terror to the student class and he had a great (call it) gift – no not a gift – but use of sarcasm which he used to embarrass them so that they were always being embarrassed when he asked certain questions, in clinical conferences in particular. But when you really got to know him, as I did, he was a very kindly and thoughtful man, and I was very grateful for the opportunity to work under him as a protégé. Because in those days, we didn’t have formal lessons, training for specialty boards. The system then was that a man like Cushing had [Percival] Bailey and Sachs had [Roland M.] Klemme, who was his permanent Number 2 man, and then he took younger men. Like when I was here, Wilkes [ed. note: a Harry Wilkins, M.D. is listed as a Fellow in Neurological Surgery in the Washington University School of Medicine Bulletin dated March 20, 1929] and myself became protégés and you worked your way up. This was the old European system of the master and the protégés; we didn’t have the formal training in those days.
And so Sachs asked me to do a particular field of research for him. He had a young daughter about eleven years old, as I recall it, who developed a meningococcal meningitis. In accordance with the recent findings of [Walter] Dandy, one of the other recognized neurosurgeons at Hopkins – Dandy had postulated a circulation of the cerebrospinal fluid in a different pattern and therefore advocated trephining and doing an irrigation through the lateral ventricles down through a cisternal puncture in the case of meningitis. This was done by Klemme for Sachs, and the little girl died. Sachs was, of course, very much emotionally upset and he said, “Sams, something is wrong with our knowledge of the cerebrospinal fluid circulation.” [It was] supposed to originate in the lateral ventricles and then flow down through the spinal cord and back up and be absorbed by the pacchionian bodies and so on. It was called a “third circulation” in the published works of Dandy, who had done his work on frogs.
To make a long story short, I developed a methodology, using dogs, for [doing] laminectomies, and ventricular functions, and so on. I was able to show that there was no true circulation of the cerebrospinal fluid in [the same] terms as blood circulation or lymph circulation and so on. The movement and diffusion of substances injected into the cerebrospinal fluid follows the laws of physics and the laws of gravity and so on. This paper was subsequently published and upset our previous knowledge. It was also very worthwhile, according to Sachs, because at that time we were just beginning to use subdural spinal anesthetics and nobody knew how to control the diffusion of spinal anesthetics. Some people were being killed by rapid diffusion. Of course, this new knowledge of the diffusion of hyper- or hypotonic or isotonic solution into the anesthetic, into the cerebrospinal fluid, subdurally. And then using gravity as well, we could control the level of the spread of the local spinal anesthesia. Well, this was all work under Sachs. So as I say again, I’m very grateful to Dr. Sachs. For some years after I went in the military medical service, Dr. Sachs corresponded with me wanting me to come back and work here at the University.
It’s just like Dr. Ranson went from here up to Northwestern because he didn’t like to even teach his six weeks. (Laughs) He wanted to devote full time to research. He became the Director of the Institute of Neurology up there. He wanted me to come up and do research with him. Again, I was flattered by both people, but particularly by Dr. Sachs who persisted for a number of years after I went into service, about five or six years, wanting me to come back here and work with him as Klemme had done.
But you decided to choose Army life?
Well, after I graduated, I went into the military service. I was able to combine the military aspects with my previous line background, along with the medical field. I wanted to start a neurosurgical service in the military Medical Corps because, you remember, neurosurgery at this time was a new field. The recognized neurosurgeons were five in this country, that’s all. There was Cushing and Dr. Sachs, [Howard C.] Naffziger out at the University of California, Dandy at Harvard, and [Loyal] Davis. That’s all there were. And they had trained in England with – I can’t recall his name now – but the original of neurosurgeons [ed. note: Dr. Sams is referring to Sir Victor Horsley]. So I tried to start a neurosurgical service in the Army Medical Service for some years. However, I had to give it up and I was torn very much by my desire to continue in that field and work on the central nervous system and my desire to stay in the military service. Back and forth.
I finally was told after consulting with these people in the professional service, as we called it, Chief Professional Service and the Surgeon-General’s Office, Surgeon-General, that at that time, there was no opportunity to start a separate neurosurgical service – a neurological surgery service as it’s known now. [Because of] this simple reason of economics – there were so few cases. In those days, neurosurgery was largely brain tumor work. For instance, with Sachs we had an operative mortality of about 35 percent because the people were morbid when we first operated on them. It was brain tumor work. In the military service with a young, highly-selected population of young males, there were very few brain tumor cases – maybe five or six a year. So their solution had been to put Dandy, on the East Coast, on a retainer fee – at that time $100 a month was quite a lot – and Naffziger, on the West Coast, on a retainer fee.
When I was out at Letterman [General Hospital, San Francisco, California] and trying to get started this neurosurgical thing, they said, “Well, now, Sams, there are not enough cases for a full-time man. You can go into psychiatry since you’ve got a psychological background and so on. Then if a brain tumor case just comes in, you can operate on it.” I said, “Well, that’s fine except how can I keep my technique and my surgical hands and procedures going?” They said, “Well then, you can go into general surgery and if a brain tumor case comes in, you can get him from the neuropsychiatric service, where most of them are done.”
To make a long story short, in those days, in the early ’30s and so on, it was not possible to have a full-time neurosurgeon in the military medical service, so I was very tempted to respond to Dr. Sachs and come back to Washington University and work with him. But some of my senior friends in the military medical service thought that I should stay in the medical service. [My] commanding officer at Letterman, for instance, wanted me to accompany him when he was transferred to the East Coast. He flattered me by that kind of thing and suggested I should stay in the military service. So I did. That’s how I got out of the neurosurgical business. Yet when the Second World War came on, I was able to help Sachs’s son get an assignment in neurosurgery and he did more neurosurgery during the second war in Europe than his father did in his whole lifetime. Nevertheless, this is how this thing developed. Sometimes you’re a victim of the environment, so you can’t always pick what you want.
But I am a very fortunate person in that after I had gone into many other fields in the military service, when I retired I was invited by the University of California to come there to head some research projects. I was ultimately able to get back into the field I had started in – doing research in low-level radiation on the central nervous system, which is what I ended up with by doing some far-out work using mathematical modeling and so on as well. I got my hands back in operating again – on implanting electrodes and that kind of thing and measuring electro-physiological responses. So this has now become a major field of interest: what are the effects of low-level radiation on the central nervous system? (You just see it in the newspapers today about the little accidents and so on.) I was one of the pioneers, although I would say that the Russians have gotten way ahead of us in that field. You have to stop me because you get me off; I’m like an old man on a field. I can go off forever. Sorry.
I’ve read some of your articles on low-level radiation, but before we get to that I’d like to go back a little bit. I noticed you were in Panama and you published an article on your experiences there with heat.
Oh, the heat syndrome.
[In] 1939. Could you tell us a little about that before we go into World War II?
Yes. We had a problem. Of course, malaria was one of the major ones, but in the heat syndrome, very little work had been done on this and we had a high rate of pneumonia among our enlisted men in Panama. You say, “How can you have so much pneumonia in a tropical climate?” and so on. So I did a little research on it and found that I was actually dealing with a phenomena related to a high humidity, comparatively moderate thermal combination. We used to say, “Well, your blood gets diluted if you live too long [in], when you adapt to the tropics,” and as it turned out, of course, a red cell count was normal down there with three and a half million instead of five million [red blood cells] because you increase your plasma volume to get rid of heat and so on. This is why we got interested in that particular thing. Incidentally, that type of heat syndrome, or the knowledge of that, was most useful to me when I was in the Middle East and we had a different combination of very high thermal temperatures and low humidity, which caused a great many deaths, in heat stroke, etc. So, you get into one field and it helps you somewhere else, usually.
Yes, I can see that it does. I read your article on medical problems in the Middle East where you described the various diseases and the way in which they were controlled, but I noticed in the article that you said for reasons of security, you could not say anything about battle casualties. I was wondering if you could tell us now about this.
Everything was secret, you couldn’t talk about anything. Of course, when I came back after two years in the Middle East, as I said, I was sent back up to school at Carlisle and then they put me on what I call the banquet circuit and all that kind of thing. You had to be very careful of what you could say. You couldn’t talk about personnel and so on or even where we were fighting.
Well, battle casualties, of course, was one of our major concerns. For the first time in military medical history, deaths from disease in troops in wartime were on a one-to-one basis with deaths from casualties from weapon-produced factors. That actually occurred first – we got almost down to that in the First World War and through immunization, typhoid and so on, we were able to cut disease down. In the battle casualties in a combat area, we were fighting around a lot in the western desert and I was concerned with the casualties in particular from air attack and from armored combat. Because in our army we had never been in armored combat as the Germans and the British, etc. had, except for a small unit of old French Renault tanks in the First World War. The modern concept of whole divisions, armored divisions, fighting each other as we were doing in the western desert was new.
While I had been at the infantry school and was trying to work out two kinds of medical services, one for airborne casualties and the other for armored [casualties], one of the things we tried to learn from what the British and the Germans had [done]. When I got to the Middle East whenever there was a good battle coming up, I had a little system worked out with the surgeon of the Seventh Armored Division of the British Eighth Army, which was equipped with our tanks and so on. He’d say, “Bring up the beer,” because you know in a war you spend maybe a week fighting; you spend a month moving; and the rest of time you’re waiting – to build up supplies, etc. So I had other work to do, but when we had a good offensive, or we expected Germans, I’d go up and take part in the armored combat. I was able to learn a great deal about the types of casualties we were actually incurring, the percentage and so on. More important, I was able to learn about the casualties from air attack.
Now I have to digress a moment. After each war, for political reasons, you’d try to find a deterrent to prevent the next war. After the First World War, it was gas warfare and people – you probably wouldn’t remember – but after that we even had motion pictures (the movies) about gassing New York City and so on till somebody figured out the air currents were such [that] you couldn’t hold a concentration of gas to gas New York City if the people stayed in the buildings and closed the windows. So that failed.
The next deterrent was air power, and so from the time of Billy Mitchell in 1925 to the Second World War, [the belief was that] if we ever had another war, air power would destroy civilization. Sound familiar? So, the theoretical production of air casualties, the catching of troops in defiles and their obliteration was the thesis in which we were all indoctrinated up until the beginning of the Second World War.
So, fighting in the western desert then, I was quite surprised in analyzing British casualties. Of course, the Eighth Army was a hodgepodge of all kinds of troops – South African, New Zealanders. We had the equivalent of American tank troops. We activated the Ninth Air Force over there and so on. The idea that you could wipe out troops in combat by air attack turned out to be completely fallacious. All you do is to disburse. When you have an air alert from grounds traffic and so on, you dig slit trenches whenever you halt so that you can get below the surface of the ground. Less than 10 percent of the casualties were caused by air attacks, and at that time, the Germans and the Italians had air superiority. So that any plane you saw was German or Italian. I’ve been strafed so many times. All you do is disburse, and if you hold a call for a ten minute break, anything, you disperse away from the vehicles. These are the things we learned – in other words, why you have such low casualties.
The men that got killed by air attack and grounds traffic were the men that finally got too lazy to get out of the vehicles after so many false alarms, you see. They got a little careless, and then they got caught. I almost got caught up there in the battle of the Little Maginot Line, we called it up there, west of Tripoli. In that I had been up in the front lines for quite a little while and I came back out and there was an olive grove and I didn’t dig a slit trench. That would be the night, and I was under an olive tree there, when the Germans introduced their butterfly bombs. This is the thing they make such a big thing of now, in which you have a bomb and it explodes at fairly high altitudes, a couple of hundred feet, and then you have multiple small bombs – anti-personnel. Well, I really had to dig on that to get myself below ground; I pretty near got it that time because the shell fragments had just come down. So the casualty factor was – I sent back reports on this – that air power was not a major casualty producer. But when you have a whole senior echelon, like in Washington, indoctrinated over years, growing up with the idea that you could stop armored columns with air power and so on, it’s hard to get that reversal.
I had to do the same thing with the atomic bomb when I came back. It’s all right to put out propaganda, but don’t believe your own propaganda. That’s what happens too often in this business. That’s why you had the hysteria about this radiation thing up here. So I had a job of de-glamorizing, if you like, no that’s not the word – debunking the myth that air power alone could win a battle against ground troops, or that air power could win a war.
How do you go about doing this then?
Oh well, this says you have to make reports that ____(?) the file. Then you have to do like you do in the practice of medicine: you have to give talks to this one group and that one and so on. Finally, you get, through your senior friends and so on, access, and this takes quite a long time sometimes. It took me about four years to get some facts straightened out about the atomic bomb at Hiroshima with our high echelon people and now you’ve got a generation of diplomats who still are swallowing the old nonsense and putting it out. But anyway, this has been the kind of a thing I’ve gotten into, not because of choice, but because when I found something that doesn’t fit the generally-accepted thing, I try to find what’s true and what’s fallacious. In this case, we found that air power was not the controlling factor. They had to re-learn it at Normandy.
We even had in the Middle East a group – now this is hard for you to believe probably, because they probably weren’t aware in the newspapers about this – we had a group of B-17 bombers come to the Middle East secretly, led by Colonel [Harry A.] Halverson – called Halpro Group. He was allowed to pick any crews he wanted to fly this group of heavy bombers. Now this shows how far you can go in believing your own propaganda. This was the beginning of the war. They came there and he was to bomb the Ploesti oil fields; that would end the European war. We based him there and Raymond David(?) and so on up in Palestine and what not. Then, that group was to fly to China. They would end [by] bombing Tokyo-Yokohama, and that would end the Pacific war. This was [a] serious mission! Of course, what happened was that Halverson’s group got lost and never got to the Ploesti oil fields. The fact that American aircraft were in that area became public knowledge when (I think) five aircraft came down in Turkey and Turkey interned them. This is the ridiculous kind of thing you have to debunk.
As you know then again, the myth of strategic bombing carried on and finally “Tooey” [Gen. Carl A.] Spaatz, who was an ex-classmate of mine and so on, was given [command of the] Eighth Air Force [with] the authority, together with the RAF, to bomb Germany. And Germany industrially was to collapse. But of course it failed. So tactically, we had to unlearn years of indoctrination. Strategically, we had to unlearn. So my little part was about the casualties and the fact that if you dispersed and took cover, you had [a] very low percentage of casualties from air attack. This strategic thing was another thing. It’s just like – I was part of the Strategic Bomb Survey Group in the theater to assess damage as we progressed across where we had been bombing Tobruk, for instance, and supposedly had cut off [the enemy’s] oil supply. When we got there, we found, of course, we had knocked down the warehouses and so on, but he dispersed his supplies in the desert, so we hadn’t cut off anything. This is the kind of thing you get into from a medical standpoint, as well as combining medical and military knowledge.
What were your experiences in the European theater when you were there in the winter of 1944 or ’45? Were you assigned there for a particular purpose?
Yes. This was a case where General [George C.] Marshall had received a request from the European theater. At that time I was in G-4 on the general staff, after I had come back from the Middle East. He had received a request for another 100 thousand general hospital beds staffed. This was in preparation for the renewal of the offensive. Actually, this was to begin the final push in the spring. We were scraping the bottom of a medical manpower bowl here in this country with a shortage of doctors, so General Marshall sent me over instead of the Surgeon-General. That was a personality deal there, I won’t go into that. [Surgeon-General Norman] Kirk and Marshall didn’t do well. He picked me and sent me over as his representative to try to solve this problem. So I reported to General [Dwight D.] Eisenhower’s headquarters which I operated out of.
The army surgeon, theater surgeon, was Al – I can’t recall his name now – a friend of Marshall’s. He was on Eisenhower’s staff. The so-called SOS surgeon, who actually operated the theater medical services, was down in the SOS staff; they were both good friends of mine. But there was a problem. I went all through the theater to see what the problem was. On Eisenhower’s staff, Al – sorry, I can’t remember [his last name] – was concerned with coordinating the military operations between allies, that is, the French and British and ourselves. The American theater really had no commander; Eisenhower was supposed to be both. The theater surgeon, the SOS surgeon who actually operated the hospitals and the ground forces and so on, medical service – he was back in SOS. They had a disagreement. He had general hospitals, which were being used for taking care of prisoners-of-war, being used as staging areas for battle casualties coming back from the front. He wanted to move them up into Twelfth Army and Sixth Army group areas in preparation for his offense, but the army group surgeon, under [General] Omar Bradley, and the Sixth Army group surgeon wanted those buildings, etc. for their own things. There was nobody to arbitrate between the SOS support services and the combat army group because the man who should have been able to do it – he was up one level too high. So I found it was an organizational defect in the theater of operations, not only pertaining to the medical service, but to some other logistics operations.
I came back after making my study and reporting to Eisenhower and so on, the SOS surgeon and so on. I reported to General Marshall that they didn’t need 100 thousand-man beds. I had found enough German prisoners-of-war, medical personnel, that if we turned equipment over to them that was now being operated by American doctors to care for American POWs under the Geneva Convention, and let the German doctors and the German nurses operate it for their own people, we would save a good many thousand beds. The German POWs preferred to have their own medical people, etc.
Likewise, the medical requirements of the – oh they had a term for them, I’ve forgotten the word now – but these were Frenchmen, Czechoslovaks, Poles and so on who had been brought into concentration camps in Germany and used as slave labor and held in camp. They also, instead of requiring American doctors to run American hospitals for them which is what this 100 thousand basis was, had enough doctors in their own groups that if we gave them the medical equipment, they could do their own medical service. So the solution then was – what we had to do was ship over the equivalent of 100 thousand general hospital beds – station hospitals, general hospitals, and so on – and equip them. [We] then turned this over to the liberated people in their own concentration camps and the refugee camps that they eventually got into. And then also the German POWs and the Italian POWs – let their medical people look after them. We gave them the equipment because they were short of medical equipment.
So this was satisfactory. I will make a statement – since everybody is dead I guess I can make it now. General Marshall was a great administrator – I had great admiration [for him] – but he had a vicious streak. He always wanted to can somebody if something happened like this that was wrong. He wanted to know [if] didn’t I recommend relieving the Surgeon SOS, the Surgeon so-and-so, and I said “No.” I knew both of these men [were] highly competent people; it was not their fault, it was an organizational fault. There was nobody to sit on top and arbitrate – one man too high and one too low. So he agreed not to relieve those two people. But that’s the kind of thing that you got into. See you got me way off.
No, this is very interesting.
So we saved a lot of medical people.
After the termination of the war in Europe, [you] were assigned as Chief of Public Health and Welfare Division, Military Government Section, U.S. Armed Forces in the Pacific and joined general headquarters in the Philippines. What problems did you face there?
Well, first, I had been offered many other assignments [while] in the military service. For instance, before the end of the war in Europe, [I had been offered the job] to go as deputy to the surgeon there. Then I was offered Tenth Army surgeon and so on in the Pacific, and again deputy to the surgeon _____(?). I also had been offered assignments in the line and general staff, in logistics, where I had been in the War Department. However, this assignment was offered to me by John Heldring(?), who was Head of Civil Affairs in the War Department; we had served together at Carlisle. General [Douglas] MacArthur, on John’s recommendation, approved and asked for my assignment.
This offered a challenge. I had been a theater surgeon in the Middle East in combat and so on. I knew responsibilities and what not, but this was a whole new thing. I had seen what happened in Europe, as I said; why the military medical service got bogged down in caring for the civil population in terms of prisoners–of–war who were flooding their military medical installations and in terms of the liberated people from Germany. I knew, in the plans for the Far East, we were going to invade Kyushu in November of ’45 and then the Canton Plain in April, [and] that we would have a tremendous problem in freeing our own medical service (military) of being swamped by the civilian casualties which would occur when we made those invasions, as well. After the war was over – at that time one school of thought [said] it would be two or three years more and others thought it might terminate soon – we would have the job of picking up the pieces (as I call it) and trying to put the nations back together again – Korea and Japan. Korea had not been fought over much, but Japan certainly would have been badly hit.
So this offered a challenge: to use the experience of a good many years in various theaters to tackle what I thought would be the biggest medical problem I had ever faced in my life or [that] anybody else [had faced] – take a nation that’s been bombed and bombed and bombed and shelled and what not and eventually overrun, because they anticipated a great deal of ground fighting. I took this job and had developed plans as to provide again equipment. As chief of health and welfare, I knew I would have a tremendous problem with refugees in the countries we overran, not only in the medical field but in feeding, clothing, shelter, all this kind of thing. So I took this as a challenge in preparation for the invasion of Japan.
After Japan was conquered, you were made chief of Public Health and Welfare Section of the General Headquarters, Supreme Allied Powers from the second of October, 1945 until June, 1951. I’ve read your articles, “American Public Health Administration Meets the Problem of the Orient” and “Medical Care Aspects of Public Health and Welfare in Japan.” These articles describe the efficient system you set up in Japan. What kind of obstacles did you have to overcome to set this system up?
(Laughs) Oh, boy! That’s all in a volume about this thick. Here, I’ll try to summarize. First, I had fourteen and a half million refugees. Six million of those were people who were repatriated – from Manchuria, from Singapore, and so on, where many of them had been born and raised. All they could bring back was what they could carry on their backs and many of them had never had a home in Japan. The others’ homes had been destroyed. We had about two million and a half (roughly, as I recall the figures) homes destroyed [from] the bombing of the cities. They had been short of food for several years because of the naval blockade. These were some of the problems. All the Koreans who had been brought into coal mines and so on during the war and [to] work in factories, were making a big exodus down near Shimonoseki and so on and back to Korea. This movement of people from the bombed-out cities into the countryside for food and those who had been evacuated from major cities for protection and so on and so on trying to get back into the cities, was like a bunch of ants going all directions. [It was] the ideal situation for major epidemics to develop, and they already had started when we got there. Typhus was being carried by lice transmitted from one to the other. They were all lousy because [in] that kind of a situation people can’t take baths; they had only the clothes on their backs and so. So we had a tremendous outbreak of typhus. Smallpox. We had, of course, the usual typhoid outbreaks and dysentery and so on. Diphtheria. The country was paralyzed.
Now theoretically, General MacArthur— You have to recognize now why this delay. General MacArthur was made Supreme Commander Allied Powers for the occupation of Japan. He was, in other words, the Executive Agent for the United Nations in terms of – there wasn’t really a United Nations, but an Allied Council of thirteen nations who’d taken part in the war, who were set up in Washington. They were the ones supposed to set policies and [General MacArthur] carried them out. People never heard of them, [in any] publicity back here. He had to make a decision. One of them was to try— He was the greatest military commander we had, but he became the greatest proconsul this country ever had in history. He perceived that we must use the Emperor [of Japan] as a symbol, not hang him, as people thought. We must try to use the Imperial government, as a symbol, again, to ensure stability instead of abolishing the government like we had to do in Korea because the Japanese had occupied Korea for a couple of generations and when they were repatriated [from] Japan, there was nobody to run the government. So we had to take Americans and put them in charge, you see.
We tried to use this existing government, or what was left of it, but they were paralyzed at all levels. Then we tried to reorganize it and so-called make a peaceful, stable, democratic Japan and rebuild the nation. Anyway, this was the fiction we tried to use. Actually, I was one of the six men, as he called us, who rebuilt Japan. We had absolute authority. You had to look on Japan at that time as a concentration camp in terms that nobody could leave Japan without authority. There was actually literally life and death authority over everybody. If I said, “You’re going to be immunized against smallpox, the whole nation,” it was done because I had to see it was done. I had to set up an organization to do it, for instance. I tried to keep my own staff very small and I had people down at the prefecture level. I had to set up a national – reorganize the whole government in terms of the health organization and welfare. They had a head – a so-called safety-welfare ministry, which had no counterparts at the prefecture or state levels. The police ran the health department, and we abolished the police. That’s kind of the chaos I had to deal with. So I had to set up a national organization which could function, not as we do here where you had a federal government, but as we had evolved in it, where the federal government has gotten into everything, because their federal government controlled everybody including their thoughts. They used the police, the national police, to run what things they had.
I had to first reorganize the ministry; then I had to set up a state Health and Welfare Department. I had to set up health center districts. I controlled all the doctors, all the nurses, all the hospitals, [and] all the medical schools. I had to change the medical school system because they had adopted the two-doctor system like we’re doing now. They had a second class group— [For comparison] you’d have to turn our country back till about the 1920s, when we had our major overhaul of our medical schools, as a result of a survey. I did away and abolished the so-called, well— Kosekis [ed. note: Prior to the U.S. occupation of Japan, the vital statistics of births, deaths, marriages, etc. were registered at the ancestral home of the family, known as the honseki. The local registration office, the koseki, forwarded reports of these events to a national bureau of statistics, which then compiled and published national statistical reports.]. [In Japan] we had university-grade medical schools and the second level, shimonosekis [ed. note: Sams misspeaks here – he likely means to say “senmongakko”], were like some of our medical schools [used to be]. [If] you study the history of this medical school back at the turn of the century, where you took a kid out of high school [and] gave him a couple years of lectures – they didn’t even have cadavers to dissect in anatomy. And then you made him a doctor. [There was] no examination; you went out in the country, like my older cousin practicing over in Granite City. He practiced medicine and he made his money selling drugs – not narcotics – but he dispensed his own drugs and made more money out of selling drugs than he did out of their professional knowledge in terms of office fees versus drugs. He always had three days’ worth. This is the kind of situation I fixed.
I had to reform the whole thing. I reformed nursing education, eliminated this shimonoseki [ed. note: Sams probably means “senmongakko”], and I concentrated, revised, and set up an educational council. We changed the curriculum so that it more or less equaled our class A medical schools today. We graded the schools and so on. This was following a pattern that we had done in this country for over thirty years. I had to do it in a matter of two or three years.
At the same time, to control these epidemics I had to introduce new things. [For instance], they had never used typhoid vaccine before so you had to start mass immunizations. I had 360 thousand men organized into so-called sanitary teams on a nationwide basis. So as the cities were knocked down, they actually cleaned them up, they instructed people on insect control and actually did rodent control because we had typhus and so on. This is a kind of nation down on its feet and I had to build up and establish a nationwide organization. By controlling these epidemics, the statisticians have said, “Well, Sams, you saved some five million lives in the first three years.” This scale of thing had never been done before. You say, “How do you do it?” Well, you just have to do the best you can with what you’ve got and have a sound medical knowledge as well as organizational capacity. I used my people, as we called it, behind the Bamboo Curtain, to direct at all levels after setting up – I had to set up training schools for health directors for the prefectures and all this. Nutritionists set up a nationwide statistical— You can’t do one [project] without hitting all the things because it will fall down just like a two-legged table. You say, “How do you do it?” Well, this is how you did it. It was a terrible situation and we were very lucky in controlling it. The saving of lives was a purely statistical thing of taking the death rate that was there – at the pre-war [level], etc. – and three years later we cut it down to about one-fourth. Then you apply that to the population and that’s how they come up with the five million.
This was a eye-opener to the Japanese. In terms that, first, we were able to show that human life was worth something because under Shintoism, they were the servants and the Emperor, who was the head of the national religion and, therefore, the greatest honor was to die for the Emperor and all that. We had to show that human life was a part of democracy and its value was worth something, and so this is why we gave all this.
You anticipated my next question which was going to be, “Was there any opposition on the part of the Japanese to do these things?”
The opposition – well, let’s put it this way. When I was first controlling – the first year – you have to set priorities controlling the epidemics and so on and finally clean up things. I ran into the Buddhist religion. We had a nationwide rat control program and I found that the Buddhist temples were holding memorial services for the lives of these rats. You see, you’re not supposed to kill any living thing – it might be your grandmother. So this was an opposition.
When I was reorganizing the (what we called) separation of medicine and pharmacy, and upgrading the quality of medical education and closing up the senmongakko and so on, I ran into opposition. I had to reorganize the Japan Medical Association, which was an organization to control the doctors and set the fees and so on. I tried to make it a professional organization again and so on. I ran into opposition from the second-class doctors. Now I had, I’ve forgotten, seventy-six thousand doctors. But anyway, the opposition came from those who were making a living out of selling drugs. You can’t just take those people and say, “Now you’re out of business.” You have to have a grandfather clause and say, “Well, you’ve got to die off eventually.” This is what happened; most of those people are dead now.
I had to take what they called ten-bed hospitals and abolish them because many people were dying. These half-trained people, the second-class doctors, were trying things in surgery in a ten-mat room and so on and people died. Likewise, analysis showed that most of the drugs used, because the patient always got three days of medicine, was baking soda, either in powder form or liquid. For almost every disease, that was the major drug they were selling – about 150 yen for three days’ medicine. They got fifty yen for an office call, diagnosis and so on. I’d upset this [system]. So you can understand there was opposition from the medical people who thought I was going to take their livelihood away from them. I’d overcome that by direct orders to begin with, because I had the authority to order “This will be done.” It was done because I had the authority to do it. People said, “How did you do it out there and why don’t you come back and do it in this country?” And I said, “I was in a position where I had the full support of General MacArthur.” As he said, I had shown I was capable, had been through the test of fire and so. So he backed me on all these programs. So when I spoke, it was in his name. But this took (what do you call it?) political savvy to get the medical profession, the part who were afraid they were going to be eliminated, to cooperate in carrying out these things. Eventually, I just closed up the medical [schools] like we did in this country – the diploma mills and so on – years ago. You always have opposition from those that are going to be hurt. So yes, I had opposition, but [that] we overcame and on the whole then when they saw the benefits.
I had two things as a neurosurgeon. One, there are people there, the men behind the Bamboo Curtain, who never run for permanent public office. They’re like the people in this country who decide who’s going to be president, [their] nominee and so on. One [of these] was the Emperor’s uncle and he asked for a meeting with me one time. We went to a little teahouse and he said through the interpreter, “What are you trying to do in this country?” I explained to him what I was trying to do with all these immunizations, because we were doing mass immunizations that had never been done before in terms of magnitude, seventy or eighty million people at a time and so on. I explained to him what I was doing and why I was trying to improve the quality of medical care and [how] I had to set up a nationwide welfare organization to take care of these [things] and to start schools of social work. Sanitary engineers – they had two of them. (Laughs) They were trained in America; they weren’t even doing engineering when I got there. So this was a major upheaval. I explained it to him; then he said, “You will never have any trouble from the Japanese government in the Diet or anywhere else.” Because, you see, our objective was to work ourselves out of a job. We had absolute power – we wanted to get rid of that power – just the opposite of what you have, we’ll say, in Washington.
When we put into law, later on, all the orders I’d issued on health codes and all this kind of thing, standardization of hospital procedures and all this, a new nationwide reporting system on disease and so on, and setting up all these government agencies – these all were then eventually put into law in ’50 and ’51. Most of those laws have been unmodified. They have kept in touch with me all these years. In fact they have Japanese who are writing books about this stuff come and visit me, so I know fairly well what’s been going on.
The other thing was, [Shigeru] Yoshida was the prime minister, and one of the problems I had was nutrition in the children. Many of them had been subsisting on sweet potatoes for quite a time. They were undernourished and so on and highly susceptible to things like TB and terms of resistance and what not. They even had a disease called “ikiri” – ikiri literally translated means “cholera.” This actually, we found, was not cholera, but was a case of children who had inadequate calcium. They would get bacillary dysentery or whatnot and they’d die very quickly, much like a cholera case. [They would] fall down, were usually dehydrated, [and] they’d die. Well, in standards of nutrition – and of course, I was responsible then for the level of feeding of all these people and [for] setting the nutritional standards – we started nationwide nutrition surveys. Again, something on that magnitude had never been done. In which we actually had teams go and determine what [the people] were eating, not just what the ration was – of course they had gardens and this – but actually what they were consuming. Then looking for deficiencies and so on, which we found.
So to get back to Yoshida – I said, “What you’ve got here and the reason you people over the years are small—” He was about five foot tall, as big around as he was tall, and very sensitive about his height. I said, “Why you are small is [that] your children are—” This was in the days in this country even, when we were just beginning to learn the great primary role, at that time, of essential amino acids and adequate nutrition for growth for children. In fact, I had a nutritionist from here in the Department of Agriculture who was back in the vitamin days. He didn’t know about this role of adequate protein. I said [to Prime Minister Yoshida], “Your people have been on a rice diet. You are inadequate in protein as far as the children go.” I started a demonstration program. I imported powdered skim milk from this country. Our surplus commodity corporation was buying—
[Interruption in interview]
This is the continuation of the interview with Crawford F. Sams, M.D., on May 3, 1979.
[I told] Yoshida that I would take 250 thousand children in the Tokyo area and start a school lunch program and use powdered skim milk as a basis to give them adequate protein, because our nutrition survey showed that they had never been adequately nourished, particularly during the war, as far as protein was concerned. I would use a comparable control group and I would show that the children who were on an adequate “complete protein,” as we called it, diet would have a more rapid growth; they would be taller and heavier, etc., within one year. And so we did. Thereafter, I expanded that to eighteen million children eventually. And Yoshida, after that first year, was so impressed that I never (laughs) had any problems with the education ministry or anybody else in the Japanese government in getting all the funding I needed for the schools and so on. Today, the Japanese who have been raised under that program of adequate complete proteins are now from two to three inches taller than their counterparts were two generations ago. Their complete proteins, animal proteins you can call it, have been the basis for that – changing their dietary habits.
My biggest problem was convincing the people in the Department of Agriculture that instead of shipping over shiploads of sugar, which caused diarrhea in the children – [they] have a buck of sugar for a week’s rations of food, which they did, calories times carbohydrates, how they figured for time – that it was more important to have the proper quality of food than quantity. And so Mr. Hoover came over – Herbert Hoover, on a mission. He had been responsible for feeding some Belgians and so in the First World War. He understood what I was talking about. He got back there to Washington and it was his lobbying, if you like, that made it possible for me to get my share, if you like, of powdered skim milk imported into Japan to carry on this program. These are the kinds of problems you have to overcome. Sometimes you have to call in some unusual people.
Herbert Hoover had been President, [and] General MacArthur was Chief of Staff of the Army, and this is how I got invited to the _____(?) and so on. But that’s how I overcame this resistance. We were only concerned with shipping surplus foods. We had a very critical time, [with] competition between us, the Far East and the European theaters, both needing all those foods. We had this Food and Agricultural Commission set up allocating food between the various countries. So this was a problem and we finally worked it out. We changed to dietary pattern and it’s paid off. All right, I’m sorry to get so far off in details on this.
No, this is very interesting and something that probably isn’t written down anywhere.
I’ve put all this down and have written about this thing and it’s never been published. I wrote it for my children and I use it as a reference to refresh my memory when various people who are doing research in various aspects come to me and I’m a resource for information.
Among your other responsibilities, there’s a list here of research projects that you established and supervised activities on. It’s much too long to go into every aspect of it although I’m sure it’s all very interesting. I picked out here the Atomic Bomb Casualty Commission in Japan from 1946 to ’51.
You’ll find it’s still in existence. Again, nothing could be established in Japan by any agency from the United States without our permission. The Manhattan Project was very interested in assessing the damage done by the atomic bomb, and so other agencies were. The Public Health Service sent over a mission, the Navy sent over people. I had a dozen different groups of medical people in, wanting to know about the effects of the atomic bomb, which was under my control. I had taken the first group down on the second of September, I guess it was – no, no, it was about the third, because the ceremonies were the second – into Hiroshima. I sent down six plane loads and went down to introduce some of our medical people, Staff [Stafford] Warren and Shields Warren, from what later was the Atomic Energy Commission (medical director) [ed. note: Shields Warren served as medical director of the AEC from 1947-1952], but at that time they were consultants to the Manhattan Project that developed the atomic bomb. They had all these groups and we had just this one to get into monitoring radiation levels and all that. We had the usual furor. When I was first in Hiroshima and landed this group, got on the radio some professor from Columbia was saying that “anybody who got into Hiroshima in the next fifty years would die of radiation.” We’d get this nonsense all the time. We just went through it here a few days ago.
I found that in Hiroshima, when I first went down there, we didn’t know [what] the reaction of people would be. We didn’t have any troops in there. The first directive then came to the government of Japan to pertain to the civil population. We had to work out a process as to who we would address it to, all this, whether it would be the Emperor, the Imperial Government, [or] the Imperial General, whatnot. We worked it out anyway (the staff), giving the Japanese responsibility for protecting us (that went there). I found that one of the – [from] what would correspond to our National Research Council – Japanese had gotten down there just after the bombing and figured [from] the effects, that there was radiation involved. I was able to contact him and get his first-hand report and so on. So I decided that I had to get this thing in hand with all these groups coming and all wanting to get all the same information. So, the Atomic Energy Commission was set up by law, subsequently, and we wanted to do research because of all this speculation. You know, you get the extremists, you get a lot of theoretical physicists or a lot of radiologists who said, “Oh boy, genetic effects are going to be so-and-so for this.” We wanted to find out the facts and it would be a long-term project.
The Atomic Energy Commission then back here – they had sent over Staff [Warren] and Shields [Warren] and Warren had been over there originally – they were interested in setting up an American research group there. If that was done then it had to be under my control, and I said, “No.” I had said “no” to some other things like this. In the first place, this thing has to go on for at least a generation. If you set it [up] as an American thing and excluded the Japanese, they’re going to throw you out of here as soon as the peace treaty is signed and your research will go to the board. So it has to be a joint thing. I set up, out there then, a Joint Atomic Bomb Casualty Commission. The American thing was authorized and financed from the United States – the Atomic Energy Commission – but we got the Ministry of Health and Welfare to set up a commission there and so it was jointly staffed with the Japanese and so on. We had some good statisticians, we used Kure as a control group, and so we set up a long-term project on the effects of this radiation. Then the reports came back. Well, I have to tie some things in because we’re still suffering.
I mentioned deterrents against war. There was a letter brought over by this first group that came up to Japan from the Philippines with me, from the Manhattan Project, in which the President was looking for a new deterrent against a future war, because air power had failed. You know, “If you have another war, air power will destroy civilization,” and it failed because it hadn’t even brought Germany to its knees. A strategic bomb survey over there showed that military production had increased actually during our bombings. So the object of this instruction, called Letter of Instruction, was “You will play up the devastating effect of the atomic bomb.” All right? So I was the one who set the deadline this time. Anybody who had been in Hiroshima and died within six months, whether they got run over by a bicycle or whatnot, would be credited to the atomic bomb. We had to set some kind of order to this. Most of the casualties occurred, of course, from thermal readings. You had the bomb – now I’ll just summarize this very quickly because all the reports that came back were the result of these studies that came over my desk.
The atomic bomb went off and that city had about 250 thousand people in it. In other words, you had a high density population exposed, compared to Tokyo which had a population of nine million, but where they anticipated being bombed early in the war after the Doolittle raid. They had taken all “nonsense” people out so there were about three million exposed to the fire and napalm and high explosive bombs that were dropped there. When the bomb went off, about 2 thousand people out of 250 thousand got killed – by blast, by thermal radiation, or by intense x-ray, gamma radiation. Then, what happened is like an earthquake. The blast knocked down houses, hibachis had turned over and started fires. When you have an earthquake or an atomic bomb, you start fires and then people are trapped in the buildings. And again, by endless interviews, “Where were you?” “Where was your great uncle?” “Where was grandma when this occurred?” We built up the evidence to show on a cookie-cutter basis that it took about thirty-six hours for about two-thirds of that town to burn.
You see, it wasn’t “Bing” like the publicity here [said]: a bomb went off and a city disappeared. No such thing happened. That was the propaganda for deterrent. They’re talking about after that, “One bomb and away goes Chicago,” you know? All you’ve got to do is look in Life magazine and whatnot back in ’45, ’46, and so on. What I’m trying to do is to show how it’s like “End the war with one B-17.” Well, you have to keep your feet on the ground. As near as we could figure then, about twenty-one thousand people died in thirty-six hours as a result of being trapped and burned and so on. It’s like those who died in the ’23 earthquake [and subsequent] fire. Then, as I say, I set the six months’ deadline for anybody who had been there, even though they went away and so on, to put a deadline on deaths from delayed radiation effects as far as it takes six months or so for deaths from (what do they call it?) delayed effects.
One of us – Norman Trenton(?), somebody – got a priest there to say he guessed 100 thousand people died when the bomb went off. Well, you see, it didn’t. There never was 100 thousand people [who] died. I recall the figures to the ultimate, six months’ deaths from untreated burns, thermal burns – they didn’t have any drugs or anything else, except what we could get in to them – and the delayed effects of radiation which take several months. You can get acute death from maybe 3,000 rem [roentgen-equivalent-man] to the central nervous system; you can get that right now. Then you get GI symptoms which cause death in a matter of a couple of weeks. Then you get the leukopenias and so on, which occur over a period of several months. So you have three kinds of radiation deaths. It was about, 67 or 76 [thousand], I got my figures transposed, [who] ultimately died in six months, out of 250 thousand. So we got things going on treatment of radiation effects and all this. That’s the facts of Hiroshima.
When I came back to this country, I was appalled, from a military standpoint, to find that our major planners in the War Department were using their own propaganda, 100 thousand deaths, Bing! And [they were] comparing it – saying it was the greatest killer in comparing it to the number of deaths in Tokyo, which had been literally destroyed by high explosives. Actually, the atomic bomb was a damn poor killer in comparison to the exposed population. Tokyo was dispersed, a third of the total. They were using the nine million figure back there, you see. They said, “Well, 250 thousand people were exposed to it and 76 thousand and whatnot died in six months.” It took me a couple of years to get that comparison straightened out in our official training doctrine in this country. I used to tell them back in the general staff and so on and including the chief of staff, “I believe _____(?) if you can deter a war, for God’s sake, let’s do it and blow up the effects all you want. But don’t believe your own propaganda if you are applying it to your military planning.” Unfortunately, we created such hysteria in this country that the mere mention of radiation, or thermal nuclear power, or a couple of millirems of radiation and you have a hysteria. So this is a fact. Actually, the atomic bomb was a poor killer.
Down at Nagasaki, they missed the ground zero they tried to hit, but there’s still the fact that it hit Nagasaki Medical School and Hospital there and killed a lot of patients and so on – from the _____(?) of the concrete building. But the blast effected this and knocked down part of the concrete and so on. But you don’t hear much about the effects of Nagasaki because actually it was pretty ineffective. That was a narrow corridor from the hospital in _____(?) down to the port, and the effects were very limited as far as the fire spread and all that stuff. So you don’t hear much about Nagasaki. It was a different kind of bomb, but still [dangerous] as far as radiation and things happening. So you have to get your facts and keep them in mind and not let hysteria take over. We’re still paying for that hysteria following the atomic bomb, which is deliberately blown up for a very good reason, and which I participated in, in accordance with policy of the government. Well, I hope that [this information] is not too much. That’s all detail and it’s all in reports. The Atomic Bomb Casualty Commission, of course, is now running under the auspices of the Japanese because of the genetic effects, you see, we have to keep [an eye] on it.
Incidentally, leukemia – you hear about leukemia all the time – this is technical questions. (Got a piece of paper?)
(Is this on the record – we can take this off the record.) I’ll show you. Whenever you talk about leukemia and radiation, I get a little irritated because they say, “Oh, everybody’s going to die of leukemia from radiation, from years age.” [ed. note: Dr. Sams is apparently writing or drawing something and showing it to the interviewer.] This is leukemia radiation in the population – [it] increases with age. I have said [that] nobody ever proved that leukemia was ever caused by radiation. Because what happened in Hiroshima – this was the big thing everybody was looking for. It went on like this. Here’s the grade(?) it comes from. Now let’s take 1945. And here’s the age it _____(?). This is how it went up. And then it came down. In other words, this area [ed. note: Dr. Sams is apparently showing the interview something he’s just written] _____(?). What radiation does is trigger, not cause, leukemia. You talk to people here on the faculty and they don’t know this. In other words, if you look at the charts we _____(?) what had triggered it early. The total number of cases – this is what, when I got down below this, all the people back there began to [get] quiet. You hear about this propaganda about the radiation down here and at Pennsylvania. It won’t [cause leukemia]. All it does is trigger at an earlier date what was already going to happen. That’s a very interesting thing and unknown to a lot of radiologists. They don’t teach this in medical school. It was certainly an eye-opener to me when we got that [report] done.
I noticed that following the outbreak of the Korean War in June, 1950, you were designated as Chief of Public Health and Welfare Section, United Nations Command. What were your duties in this position?
When that war started, I had had an additional assignment from ’45 to 8, when we had, literally, American occupation of Korea and tried to set up a government under Syngman Rhee. Because, as I mentioned, the Japanese had held all the top jobs. When they were evacuating, nobody [could] run the country, so we had to use American officers at first and then try to find people. I had a pharmaceutical company [in which] I had to take the janitor and make him the president. (Laughs) [That] shows you the kind of material we had to work with. So we turned them loose in ’48, then the war came in ’50. Syngman Rhee appealed for help and supplies when they hit. His army collapsed and Mr. [Harry S] Truman took the bull by the horns and first was going to stem the tide by air power. (Laughs) Which of course, he didn’t. So we had a little _____(?). And then Syngman Rhee escaped down to the Pusan perimeter – that was of course in the Southeast corner – and had his cabinet down there. He wanted food and clothing because he had about six million men in his _____(?).
The boss called me in and said, “Sams, here’s your baby.” So I gave him what I had done five years before in Japan. This time, Korea was devastated. In the first time, we had no qualified people – I won’t go into detail here – six medical schools all staffed by Japanese and the professors all gone, and that kind of thing, we lacked doctors and so on, but there wasn’t the physical destruction that we had in the Korean War in ’50. So I had to do what I had anticipated doing if we invaded Japan, but which I had to do anyway when we got there, even though we didn’t have to invade it.
We had epidemics started of smallpox and typhus and we had these people living in the fields and perimeter and all this. In this case, I had built up the pharmaceutical industry in Japan _____(?) so I was able to get most of our stuff there. We had our vaccine program and used that as a base, and saved the American dollars, in that sense, and time. I set up medical supplies and what you call mobile hospitals and so on to take care and instruct the Korean doctors I could find. We took departmental staff over there and we had to provide food, clothing, shelter, medical care, etc., and control communicable diseases. Then, as we broke off, after the Inchon invasion, we broke out of Pusan perimeter. Then we went north into North Korea, [and] I found there that – as we encountered the civilian population – that the North Korean medical service was almost, almost non-existent. In [treating] battle casualties, they’d throw the inhabitants of a village out and put [the wounded] in their village in the huts and they’d either live or die – this kind of thing. They were being swept by epidemics of smallpox, typhus, typhoid, the usual.
I was working through Intelligence and interrogating prisoners and so on for an outbreak of the plague, because plague is endemic in Manchuria. And the Chinese, when they entered – you see, I had gone up into North Korea and tried to reorganize, so I could control what I called the “little bonfires” of these epidemic diseases occurring – tried to control them before they became a wipeout. _____(?) and all this and I had my people supervise. Well, I was concerned about plague because when the Chinese Communists came in, they came from Manchuria. I was also concerned about cholera. But they captured a lot of our supplies when they swept down that we had left there with the Koreans in ’48, and they were using them _____(?).
When the Chinese Communists came in and we had to pull out – we were ordered to withdraw from North Korea – I had about 100 thousand North Korean civilians who wanted to come down with us, and we evacuated them. So I had about 100 thousand refugees. I’d seen the smallpox and typhoid cases occurring up in there and I knew they would become really epidemic after we pulled out, but they been out of control. I found they had a so-called institute in Pyongyang headed by a woman, a Russian doctor. Their typhoid vaccine, we checked it, and it was non-potent. (Chuckles) So was their smallpox vaccine, so I knew they had no means of controlling anything. I used to teach at the entry(?) school, the impact of diseases on war. I don’t know – [for instance,] Canada might have been a part of this country if it were not for measles, and so on. [Unintelligible sentence] So diseases frequently have affected military campaigns, more than all the bullets. Measles killed more people [than bullets] in the Civil War. I did a paper on that at one time, and all those complications of pneumonia. But anyway, I was concerned about this plague. So, when we pulled out I left intelligence agents behind – rather, we had Korean agents left behind – and we pulled out of Wonsan and so on and Hwangju, to report on troop activities, but one intelligence question that I [wanted answered] was to report any increase in the epidemics. Pretty soon I got reports that they had what they called the Black Death. This was very important to us from a military standpoint. Plague starts out (and I’d seen plague in the Middle East) – as bubonic plague transmitted by rat fleas, but it can then become pneumonic plague. It spreads like influenza and has a very high mortality rate. At that time, we didn’t have any drugs to stop it. Now, if we were going to launch a counter-offensive and go back to North Korea again, our troops were not immunized against bubonic plague because that was a very unstable vaccine. You don’t immunize with that unless you have a _____(?). But I knew it would incapacitate the Chinese Communist troops, and this kind of report was very important from a military standpoint.
I got bits and pieces of reports [from] interviewing prisoners: “Half my unit’s sick. They turned black when they were dying” and so on. We got reports of villages being practically wiped out. So it was necessary to find out what this was. So I ran to the G-2 and Chief of Staff. [Unintelligible sentences] I took a good commando, a navy boy by the name of Clark, and two Koreans, and got the Navy to take me up off of Wonsan. We tried to get ashore there in fishing boats and I had a little LST, but the Communists knew I was out there. Because there were a couple of islands out in the Wonsan Harbor and I’d found terrific epidemics of smallpox and typhus and _____(?). I wanted to get in to see some of these cases of this Black Death. So I got the Navy people to take me down. Every time we tried to approach the shore, they were looking for an invasion and they’d open fire on us and so on. So I finally had to get the Navy to take me down to a little town, _____(?) a few miles down below Wonsan Harbor, and then we went in a whale boat and then in a rubber raft to try to get in and they damn near got us. They had gotten some of our agents, tortured [them] and so on, broke them down, and they said, “An American General’s trying to get in.” So they were looking for us. They didn’t know a code word for the people we had left in there.
So anyway, we got ashore and found that this was not bubonic plague or pneumonic plague, which they themselves thought, the Chinese. But it was hemorrhagic smallpox, which can kill you damn near as fast as plague. So we got out. This was very important because had General MacArthur been permitted, we could have walked back up to the Yalu [River] because their troops were just being decimated by it – hemorrhagic smallpox – and they couldn’t control it. From a military standpoint, this again is a case where the impact of disease on military operation was a major factor. But, of course, you know the political situation. General MacArthur was not permitted to go north, not permitted to win the war, so we couldn’t take advantage of it. But this was a very critical thing and in his own memoir, of course, he mentions it. This is what the Korean War was. I had the same responsibility [for problems of] food, clothing, and shelter. But this was a special operation.
Was this the military operation listed in your biography as a special mission, September ’50 to June ’51?
Yes. This was the impact of these epidemics on the Chinese Communist forces. It was actually in March that we made a little three man amphibious invasion.
I see. And you got out to tell about it.
Well, we were lucky because we got hit. Our Air Force people were hitting the Chinese Communist convoy coming down just along the coastal road there, out by ____(?), a little fishing village, when we were trying to get in, and there were Chinese running all over the place while I was trying to pick up some of these people. So we were lucky to get out.
In your curriculum vitae, it says that you retired from the military service on the thirty-first of July, 1955 and became a research physician with the Operations Research Center, University of California, Berkeley, and a research physician with the Department of Neurology, University of California Medical Center, San Francisco. Could you tell us about some of your work there?
Yes. I was asked to join the University of California there at the Institute of Engineering Research and Operation Research Center because the University had a contract with the Defense Department to attempt to determine a basis for radiological defense of this country. Being known somewhat as an authority by that time on the effects of atomic weaponry on big populations, I was asked to head up the medical part of this program, and we did determine that there was – you could – using existing shelters save about 90 percent of our population, if you used it, from destruction from a thermonuclear war. This was our recommendation.
As an incidental part of this, I was interested in pursuing the effects of low-level radiation on the central nervous system because I’d seen the high level and what it can do. I found the usual biphasic curve, just as though you have drugs. You know, you give somebody an anesthesia ether and he becomes excited and then becomes depressed and so on. The same thing occurs [in radiation]. You excite the nerve cells – you can excite tactile sense, you can excite the retinal cells, [the] auditory cells with low level radiation. You can measure the electro-physiological response. So I was doing two things. After the major conclusions, then the University asked me to continue this research to medicine. We were doing _____(?) and doing low-level radiation on beagle dogs and so on.
But the main thing, and the important thing is, again the hysteria. I want to emphasize this. We have adopted a policy in this country as a result of the attempt to use mutual terror [as] it’s called diplomatically – we adopted a policy that a nuclear war is unthinkable. Therefore, because we’ve used it as a deterrent against war, therefore we will take no steps to protect our civilian population. On the other hand, the Russians know as much as I know about the effects of radiation and the probability and possibility of saving 90 percent of your population from an all-out nuclear war, and they have taken steps to protect [their population]. This is one reason today we are in such a bad shape in this country and why now you hear the President talking [about] maybe we’ll revive civil defense and so forth. We have enough protection in our building right here in this complex, for instance, as we find on a nationwide basis – we did a system analysis and so on – to really survive, our people. I don’t mean we’re not going to have a few million killed, but it’s better than this ultimate threat. If we reach a confrontation sometime about 1985, the Russians will have completed their rearmament program by then. [If] we have a confrontation, and I’m afraid with the hysteria – this thing just shocked me the other day – hanging over from Hiroshima, we’ll have the people in this country say, “Well, better Red than dead; we can’t do anything.”
And this, as both a military man and a doctor, I hate to see. But I’ve been to Communist countries and I know what they’re like. But this is again, we know – we’ve made these studies over quite a few years for our government. If they surveyed our existing things that we could provide enough protection from radiation and so on for our population, we could save nine out of ten people. Without it, we’re going to really have a fantastic loss, because we have two different attitudes. “Well, that’s politics” but “that’s for our top people to decide.” So, you have a political controversy now about how inferior we are to the Russians and so on. But their philosophy is [that] they can win and survive a nuclear war. Our philosophy is “No defense, you can’t do anything.” This is contrary to everything scientific that we found about protecting our population from radiation effects. So this is more or less a side issue, as you call it. It’s personal, but based on some experience.
It’s a very important aside. Is it based on things like CNS functional response to irradiation?
No, it’s based on a study of radiation effects on the Hiroshima [population] versus high explosive and napalm bombing of cities and casualty production both ways and so on. Otherwise – mass casualty production.
I notice you have a study on that, too.
That was what the university asked me to come [to do]. In fact, the contract was written because of the fact that I had raised a question on the highest levels back in Washington that this “one bomb and away went a city and buildings and people all together” [theory] was false. We wanted to find out what the facts were – and we tried to – using thermonuclear weapons with [the] hydrogen bomb.
That report was on the possibility of mass casualties and how to handle them. There’s one other area of research we haven’t mentioned that I know of, and that is the application of mathematics and computer systems to biological systems. I read your article on that.
I was one of the pioneers.
You were a pioneer in that?
That was when we working on this radiation effects. I was a consultant to Rand Corporation, that’s a think tank, down in Santa Monica. I was attached to George B. Dantzig, who was one of the top mathematicians. He’s the father of so-called linear programming. Remember, you have to go back to the early days of computers. George was interested in trying to apply linear programming and computer techniques to biological problems, and I had some problems – this effect on whole body versus partial body radiation, etc. In the initial studies of effects of radiation on Hiroshima, it told about whole body radiation. There is no such thing because of _____(?) of age, _____(?) of the patient and so on. It’s different on this side and this if you get this way, all that kind of stuff. It became too complex to think it out using a slide rule or anything else.
So I needed an expert in mathematics. At that time, Rand had an analog computer down there, and we had the first one in Berkeley – it was [a] 707 computer, an IBM, and we had a handmade one. I persuaded (eventually), after working with George – we commuted back and forth – that we could solve some of these complex problems, just like we’ve been talking here about – membrane transfer, charged particles and so on – I was interested in membranes, nerve cells, and others. We found, to make a long story short, that we could not apply linear programming techniques; it was not a linear function. Membrane transfers and so on, and change in potentials, cell membrane, is a function of radiation, it’s one of the effects of radiation – they shouldn’t change.
We actually had to develop – and George being the theoretical mathematician that he is, and I did the medical CBM(?) – and it took us a couple of years before we could talk together. I had calculus and all that but when he takes off, he leaves me way behind. But he didn’t know anything about medicine, so I talked about metabolic changes and metabolism and all this. We had to educate each other. Anyway, it worked pretty good. I finally persuaded him to leave Rand and come up and join us and we set up [the] Operation Research Center.
We did a lot of early mathematical modeling using various compartments, as we called it, on the fluid movement between the inulin space, the vascular and the lymphatic system and so on. As frequently happens in research, you work on a broad thing and pretty soon you get it narrower and narrower. We finally got it down to ion transports and membranes. We scoped some papers on it. It was the first attempt to develop complex mathematical modeling. As I said, we couldn’t use linear programming. George was the father of this. He wrote the first textbook on linear programming which is used now over all the nation, in Washington. This was a far-out business.
Likewise, when I had a problem of power spectral analysis on doing electroencephalographic measurements of these metabolic changes, because your brain’s nothing but a transducer converting chemical energy of activation to molecular energy. You can measure these things, but I had to know the power changes within that squiggle. This was something that no one knew how to approach. We did an awful lot of struggling and got a lot of different people involved. I finally got to the point where I had to get the Navy, who had a very high-speed analog-digital converter. We finally had to convert from the analog data, as we called it, into digital to get a power spectral analysis. I got the Navy to let me use their high-speed analog-digital converter – of course, I had to pay for it out of my research funds – down at Lockheed, which they use in their rocket business and satellite business. We were able to solve this problem and I gave a paper on that for the Electroencephalographic Society on the power spectral analysis. But this was, at that time, after all it’s only ten, twelve years ago, (laughing) it was hard finding people you could talk to about it. Now it’s so universal that it’s one of our major research tools today. I think you finally have it here in this medical school computer center haven’t you? For biomedical research. There was no such thing when I started in medicine.
Yes. It’s called the Biomedical Computer Lab.
That’s right. Now they’ve all got it. But when I started there wasn’t anyone anywhere. We didn’t have at that time – I needed amplifiers that had to be very small. I was using microvolts, of course, and people in the field like Bell Labs, [and the] big research outfit that sponsors Sandia Corporation, which does a lot of atomic work at Albuquerque and _____(?) in radiation, were just beginning to talk about solid state amplifiers. Now, you can put everything on a little bitty chip the size of your fingernail. So when we were working on this, we were feeling – it’s called far-out. We had no precedents. So that was a lot of fun and we made a little progress.
Have you retired from active research now?
No, no, no. People, I say, use me more as a resource. [They] write me stuff and they come to me, like I said. My field of research now is in genealogy. I’ve had that as a hobby for many years and right now after this meeting, I’m going back to Virginia and get some old records.
That’s very interesting, too.
Tying in with history is interesting. So this is comparable to this particular thing, but we’ve got a lot of problems still to solve. [Unintelligible sentence]
You had such a long and distinguished career. Are there any other aspects of it that we’ve left out? I know we haven’t been able to cover everything, there was just too much to cover.
Oh, there’s too much to cover because you’re working with a whole mesh, and that challenge was the greatest thing that ever happened to me. That was the peak of my life. You couldn’t duplicate [it]. I had people say, “Why didn’t you do this in this country?” I was invited to go to China. I said, “Under certain circumstances, you cannot do, in the time period—” Well, you can’t do it in this country with our form of government. In fact, at an interview after giving a paper before the AMA four years ago, one of the science writer/people had an interview; and the lady said, “Well, now, you’ve cut all these desks down in doing this, so don’t you think we ought to change our—?” I said, “It’s because we had the authority. The form of government we established there – which was a national form of government, not a federal government. So you could do these things on a nationwide basis.” She said, “Should we have that form of government in this country?” and I said, “No, you have to balance one thing against the other and I value [the] freedom we have in this country more than being able to do the things I could do by dictate where I had absolute power.” In Japan, where you had a form of government if somebody up at the top says this [gives an order], it goes down. All the local governments do under that form of government is carry out what the national authorities say. Unfortunately, we’re going in that direction while a few are tearing it down. So, freedom was more important to me.
But that was the peak. I knew anything I did back here – and I’ve had many opportunities – would be an anti-climax because that was a dramatic thing on a scale that had not been attempted before. And we were lucky; [we had] full cooperation.
One of the things the archival program does is to collect the papers of faculty and alumni. Have you been approached on this by someone else?
Oh, yes. The Hoover Institute for War and Peace wanted me to leave my papers with them. The Army War College wants me to. The University of Mississippi wants me to— The [history] department [sent] a fellow out about this. I’ve had many people interested if I would turn over my papers. Right now I say, “Well, people come and ask me about this and I’m getting old and I have to have them to look at myself to refresh my own memory because too many years have passed.” So, yes, I’ve had many people [ask].
Well, Washington University is interested too. You can add us to the list.
That’s fine. I have to someday work this out. Of all places, York University in Toronto, Canada sent a historian down. [He] first talked to me – the chairman of the department – a year or so ago, and sent a man down. [He] spent six months [working], spent about four hours a day, one day a week for that six months, recording things, all the details. I let him have full access to my papers and then he would do like we’re doing, he would ask me questions to get it on tape. So I don’t know how many reels of tape he got because he wasted an awful lot of tape. So there’s an awful lot of junk sitting up in the archives in York University in Toronto, Canada.
That’s interesting to know that.
But I do appreciate it and as I say, when I get to the point where I see the end coming, and it could happen any time, I have to figure where to leave this junk. [ed. note: Sams’ papers were left to the Hoover Institution on War, Revolution and Peace, Stanford University]
We appreciate your giving this interview to us very much, Dr. Sams.
I’m glad to cooperate with anybody who’s interested.