From the M*A*S*H Library 2: Back Down the Ridge

What is it?

White, W. L. Back Down the Ridge. New York: Harcourt, Brace and Company, 1953.

Why should M*A*S*H fans care?

It has been said that Back Down the Ridge was required reading for the writers of M*A*S*H as it provided first hand accounts of MASH units. The book also provides a technical analysis of the process of treating wounded at the front, something the series would have to bring to life.

As a M*A*S*H fan, what part should I read?

All of it! But if you are only interested in reading the chapters specific to MASH units, read chapters three, four, and five. However, MASH units are discussed in every chapter.

TL;DR Review

Back Down the Ridge offers a period, first-hand account of the experience of those wounded in Korea during the war. The detail provided about the technical processes in battalion aid stations, MASH units, Tokyo General Hospital, and the state-side Army hospitals contributed to the writing that made M*A*S*H more real.

Full Review

William L. White’s Back Down the Ridge was published in 1953 before the signing of the armistice that ended the fighting of the Korean War. This is a unique book in two key ways. First is its “in the moment” relevance. White would researched and wrote the book as the war was being fought and as the men and women we meet in the book recovered from wounds or continued their work treating the newly wounded. The second unique trait of this book we find in its tagline, “The story of what happens to the men who get ‘clobbered’ in Korea.” This is why the book is relevant to M*A*S*H as it provided a point of view during war time, and it introduced the reader to MASH units, which were new in the early 1950s.

There are not many books that tells the story of a war from the point-of-view of someone who has been wounded. What happened at the front? How did they get off the line? What was a MASH like? How long does it take to recover? These are all questions White answers in Back Down the Ridge. It is a clever bit of writing as he puts you on the litter as the wounded soldier and explains what happened each step of the way. The story is told using real wounded soldiers, front line medics, MASH doctors and nurses, and state-side doctors at Walter Reid National Military Medical Center.

White begins by introducing 11 soldiers. You learn their names, what happened to them, and the nature of their injuries. The story is told from their perspective so that you feel like you are on the litter beside them. As he explains in his introduction, White had planned on writing about the medical procedures and processes, but he explains that the center character became an abstract “average American boy, just under 20,” who faced the horrors of war, then the dangers of being wounded. This central, unnamed character is the reader as White describes what is going on around you. It is an effective literary device.

Throughout the chapters, you learn the step by step process of treating a wounded soldier at the front. Something that was key in ensuring their survival. There are many variations of how a soldier was treated depending on the type and severity of their wound. Using his sources, White pulls together a fascinating general overview of what happened to the wounded men:

  • The solider is wounded at the front, often in a foxhole
  • A medic attached to their unit finds them, places them on a litter, and transports them to the nearby battalion aid tent
  • The battalion aid medics stabilize and prepare the soldier to be transferred to either a MASH (serious cases) or an evacuation hospital (minor cases)
  • A MASH surgeon repairs the damage, keeps vitals stable, and prepares the solder to be moved to Tokyo
  • Tokyo is a large hospital where follow-up surgeries can be made if necessary since it is farther from the front line fighting and a fully equipped hospital
  • Those returning to the United States fly with a stop over in Hawaii
  • Then a stay in San Francisco where they are evaluated and sent to hospitals near their homes
  • In the Army hospital, more surgeries are performed to further repair the damage and prepare them to return home

The wound dictated how long a soldier would stay at each phase, but they were likely only in Korea for a few days or perhaps two weeks after they are wounded. Those with head, chest, and belly wounds were more likely to stay in hospitals longer as it is important to prevent infection and ensure they were sable enough to travel. Amputees are prepped for prosthetics that they are fitted for back in the United States. Those with broken limbs may return to combat after they have healed. The book discussed psychiatric cases. Psychiatrists are stationed near the front so patients were treated near their unit so they could be quickly returned to combat.

How does the book relate to M*A*S*H besides the fact that is was required reading for writers? The book provided a general framework that the series did a good job of following to reconstruct how a MASH functioned. There are some differences that would have been difficult to recreate. For example, MASH units were much larger than the fictional 4077th. MASH units consisted of two complete ORs. This was practical since a MASH moved frequently. When a bug-out was necessary, OR A could remain functional while OR B was moved down the road. Then, once OR B was set up in the new location, OR A followed. In the series, they seldom move. In fact, a real MASH was 100% tents for quick movement.

Another surprising difference I learned was that MASH units didn’t use operating tables or have beds in post-op. The wounded solder was brought in on a litter, they would be operated on while on that litter, and they would remain in post-op on that same litter. It was not uncommon for a soldier to remain on the same litter from the time they wounded until they got to Tokyo (the planes were set up to hold 40 litters when flying between Korea and Japan). In M*A*S*H, we see operating tables and beds in post-op.

Of course, M*A*S*H was made for television audiences, so it wasn’t possible to capture war in its true form. While some aspects of a MASH were “cleaned up”, the horrors doctors and nurses experienced at a MASH unit were not. The constant flow of wounded followed by days of nothing was fairly common. Long working hours with little sleep was required of everyone. The reality of death was all around them, especially the nurses in the post-op wards. All of this was accurately presented in the show and all too real to the doctors, nurses, and corpsmen of a MASH.

The 8055th Mobile Army Surgical Hospital (MASH) as seen from the air.

As I read the book, I looked for storylines that might have made it into M*A*S*H, and I found a few. White tells the story of a chopper pilot who reported a patient who tried to get off of his litter mid-flight. The pilot was able to land preventing the soldier from falling to his death and the helicopter from crashing since it would have been thrown off balance. This scene was recreated in the episode “Smilin’ Jack” (04×21). In another episode, “Out of Sight, Out of Mind (05×03),” Hawkeye temporarily loses his sight when a stove in one of the tents blows up in his face. The stoves used in MASH units were known to blow up due to the use of fuel oil.

But the story that surprised me most, a story that actually happened, was a soldier believed he was Jesus Christ. This leads me to believe that the episode “Quo Vadis, Captain Chandler” (04×09) came from Back Down the Ridge. The circumstances are very similar, although the events didn’t take place at a MASH. Another episode that was likely influenced by the book is “Point-of-View” (07×10). In the episode, we see the soldier get wounded, flown to the MASH, in the OR, in post-op, and finally leaving MASH. What makes the episode unique is that it was filmed from the soldier’s point of view on the litter. That is the premise of this book, and I wonder if Ken Levine and David Isaacs were inspired by this book.

Back Down the Ridge is a powerful book. It puts the reader in the position of being a wounded soldier. This also proved beneficial to the show runners at M*A*S*H. The book was used as a guide and led to some great story lines based in fact. The series often touted the success rate of MASH units, and White does that as well. He gave an interesting stat that showed how MASH units had changed the game in terms of saving lives. In World War I, out of every 1,000 wounded soldiers to reach a hospital, 80 died. In World War II, that number had dropped to 45. And in Korea, that number was down to 24. MASH units were a great success, and the concept of treating wounded at the front is used by the Army today. Back Down the Ridge is a book I highly recommend reading if you want to learn more about MASH units, and as an added bonus, you will gain added appreciation for the television series we love.

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