Z>. , HE SURGEON'S CUlCIT

DEC- 1951

V 0 L U M E - V I Letter N U M B E R - 1 2

A FAR EAST PERIODICAL

IEDICAL SECTION-GHQ-FEC, SCAP AND UNC OF ARMY APO 500 MEDICAL SERVICES INFORMATION UNCACK employee gives medioal aid to a young Korean on the cover at a refugee collecting point, Charraul, Korea* RESTRICTED Security Information

Volume VI - Number 12 THE SURBEON'S DECEMBER 195l| General Headquarters Circular Far East Command Medical Center Letter • APO 500

ADMINISTRATIVE

JLC0M Medical Conf®r®nc® Held At Tokyo Army Hospital. 237

Quartermaster Trains Troops In Prev-ntion Of Cold Injuries. .. . 258 Rec-nt Department Of Th® Army Publications 238 Medical Chiefs Meet 239 Colonels Leedham arid McNinch Join Medical Section, GHQ 239 Italian Red Cross Hospital Unit Begins Operations in Korea 239 Reprints of Pr®v®ntiv® Medicine Publications Outlin® Availabl® 239 L-19 Aircraft Used for Evacuation by XVI Corps 240 JLC Surgeon Decorated for S®rvices in Atomic Bomb T®st 241 GHQ Medical Section Moves to New Offic® 241 Requisitioning Proc®dure for Armed Services Catalog of Medical Materi®l 241 Awards to Army Medical Service Personnel 242

JLCCM MEDICAL CONFERENCE HELD AT TOKYO ARMY HOSPITAL

The first of a planned series of medical conferences for the purpose of presenting papers on the subject on internal medicine was held at Tokyo Army Hospi- by all medical officers who had worked with the dis- tal 22-23 December. This oonferenoe, sponsored by ease and to stimulate discussion and exchange of in- the Surgeon, Japan Logistical Command, was attended formation. The symposium was divided into four by more than 100 military physioians of the Army, phases — basic pnase, early clinical phase, the Navy and Air Force, from Japan, Korea and Okinawa, late clinical phase and speoial aspects phase. Colo- and included representatives from medical facili- nel Joseph H* McNinch, MC, Preventive Medicine Con- ties of Canada, Denmark, Great Britain, Norway and sultant to the Surgeon, F3C, and Colonel Charles L. Sweden, leedham, MC, Medical Consultant to the Surgeon, FEC, acted as moderators for the spirited and enthusias- The meeting was opened with addresses of welcome by tic discussion periods that followed each presenta- Brigadier General William E. Shambora, Chief Surgeon, tion. Medical officers presenting papers were Capt. FSC, Brigadier General James P. Cooney, Surgeon, JLC, Ralph M. Takami, MC, Medical Intelligence Section, and Colonel Kenneth A. Brewer, MC, Commanding, Tokyo FSC; Lt. 'Col. Irvin Marshall, MC, Preventive Medi- Army Hospital. cine and Public Health, Eighth Army; Lt. Col. Arthur Steer, UC, 406th Medioal General Laboratory; Capt. The conference, divided into two parts, began with Marc Crilly, MC, 8063d Mobile Army Surgical Hospi- discussions of general medical interest designed tal; Lt. Col. Charles J. Hornisher, MC, and Major chiefly to orient internists in seme of the newer William E. Swift, 1C, US Army Hospital, 8167th Army phases of the care, treatment and convalescence of Unit; Colonel George M. Powell, Osaka Army Hospi- military patients. Speakers at the first day's con- tal; Capt. Walter Kessler, MC, 121st Evacuation Hos- ference included Colonel Ryle Radke, MC, Tokyo Army pital; Capt. W. H. Wallop, MC, USAF, and 1st Lt. Hospital; 1st Lt. Alvin J. Schrager, MC, Osaka Army H. C. Zaenger, MC, USAF, 6162d Hospital Group; Capt. Hospital; Major Phillip P. Steckler, MC, and Colo- Joseph H. Watson, 1C, 382d General Hospital; Capt. nel Franklin H. Grauer, MC, US Army Hospital, 8167th Giulio Barbero, MC, 21st Evacuation Hospital; 1st Army Unit; Lb.Col. Bernard J. Copple, MC, and Lt. Lt. Irwin Hoffman, MC, 11th Evacuation Hospital; Col. Henry C. Harrell, Tokyo Army Hospital; Lt. Col. and Lt. Col. George B. Potter, MC, US Army Hospital, Tyron Huber, MC, and 1st Lt. Andrew Wiley, MC, US 8167th Army Unit. Army Hospital, 8168th Army Unit; Colonel Carleton Godiel, MC, US Army Hospital, 8079th Army Unit; and Colonel Angvald Vickoren, MC, Surgeon's Office, JLC. It is anticipated that the papers pr°sent®d at the symposium will be submitted to the Surgeon General's The second part of the conference on the following office by Colonels McNinch and Leedham with a view day was a symposium on epidemic hemorrhagic fever to publication in the near future.

237 QUARTERMASTER TRAINS TROOPS IN PREVENTION OF COLD INJURIES

The Army Medical Service has conducted and is con- ’’Here’s ehy we say that. tinuing to conduct extensive research in the ficid of cold injury control with particular emphasis on "Due to their training sinc<=> they've **nter~d the of cold treatment injuries. Cold injury teams,com- service they have a natural tendency tc protect posed of Medical Service Army personnel, are now on thems-lves from the enemy soldier. Dint hazard may duty with troops and facilities medical in Korea normally be number one priority in their scheme of treating cases resulting from military operations 3eit-preservation. Cold is just as dangerous, if in that theater. not more so, because if you don't take the proper precautions, it sneaks up on you when you are occu- Other cold injury groups, however, are presently pied with other things." engaged in the equally difficult task of prevent- ing cold injuries. Little known to many Medical Service personnel are the Quartermaster Cold Weath- er Training Treams operated from General Headquar- In World War II, cold injury cost the United States ters, Far East Command, under the direction of Lt. Army th® equivalent of all the rifleman in ten full Col. Howard F. Kuenning,QMC. These traveling con- divisions, and in Korea last winter there were trol groups are normally attached to divisions and about 5,000 cold injury casualties. Many of thes® separate units for a specified length of time in casualties could have been prevented if proper pre- order to train personnel in methods of protection cautions had been taken, stated the Captain. Cold against cold weather injury. Their mission is to injury, he explained, wasn't something new. It had explain the causes and prevention of cold injury inflicted casualties on armies down through history. with emphasis on frostbite, the necessity for prac- The Prussian armies and Napoleon's infantry suffered tice by the individual of foot hygiene to include from cold injuries just the same as our troops. cleanliness, foot, ankle and leg exercises, daily foot massage and the proper use of winter clothing "But," he said, "we know more about how. to prevent and equipment. it. We nave th® answers. I know how to prevent cold injury and when I am through with my lectures Typical of one of the Quartermaster control groups the troops are going to know as much about it as I is the team composed of Captain James G. Monteith, do." an earnest young officer, and his assistant. Ser- geant T. B. Bowlan. Captain Monteith explained All of the winter clothing, not only the footgear, the difference between w®t cold and dry cold and has a lot to do with whether or not on** gets frost- the precautions to be taken when operating under bitten. Though that sounds strange to most of the field conditions in that type of climate. In at- trainee, Captain Monteith explained that cold re- tempting to make comparisons in climate he pointed tards circulation but if the body is kept warm it out that Seoul can be compared to Chicago, and con- will be more willing to circulate warm blood out ditions north of the 38th Parallel are comparable into the extremities. to those found in Maine, New Hampshire and the Dakotas. "Air space in your clothes," he continued, "gives you added insulation without added weight. The air doesn't weigh anything, materially, but it does "When we make comparisons like these," Captain help the body to keep itself warm. Several layers Monteith continued, "someone may say 'I come from of medium weight clothing will k***»p you wanner than Baltimore or Minnesota or North Dakota and I've on® heavy layer. That is why tn® combat uniform is been hunting and fishing in all kinds of weather designed on the layer principle. If the day is back home. What's so dangerous about that kind of warm and you decide to remove some of your clothing, climate?' I tell them that wh**n they were in Bal- you should t&xe off sane of the inner layers first. timore, Minnesota or Iowa or any other place state- Sergeant Bowlan, my assistant, demonstrates th® side, they no doubt had the facilities and comforts proper wearing of th® winter field uniform while of modern civilization. They didn't have to sleep I explain how and why it is worn that way. If out-of-doors and be exposed to the weather day and someone should ask m® if this uniform alon® will night on end. Cold climate is a dangerous enemy. prevent cold injury, the answei, of course, is a In some respects more dangerous than the enemy sol- capital N-0. The men have to do that and they can dier. do it if they remember what we teach them."

RECENT DEPARTMENT OF THE ARMY HJBLICATIONS

AR 40-35, 4 Dec 51: Medical Service - Appointment, T/O&E 8-552, 24 Oct 51: General Hospital, 1500-3ed, Duties, and Responsibilities of Professional Communications Zone Consultants TC 37, 19 Nov 51: General Hospitals, Conr.uni cations AR 40-510, 4 Dec 51: Medical Service - Dental Care Zone (T/C&E 6-551, 8-552, and 8-553) DA Cir 90, 1 Nov 51: Sec II - Records of Personnel SR 600-145-11, 16 Nov 51: Personnel - Assignment Returned from FECQM of Hospital Patients DA Cir 96, 23 Nov 51: Sec II - Clarification of Ac- SR 40-515, C-l, 10 Dec 51: Hospitalisation of Army counting Classifications Patients in Naval Medical Facilities DA Cir 100, 5 Deo 51: Sec III - Annual Physical Ex- amination of Officers and Warrant Officers, T/A 20-7, 22 Oct 51: Equipment for Oversea Mortu- Sec IV - Rates of Compensation for Civilian Medi- aries (included in Current Death Program) cal and Veterinary Services

238 M2DICAL CHIEFS MEET

More than 30 commanding officers from medical in- by General Cooney for discussion of medical problems stallations throughout Japan Logistical Command met The first was held last May. in Yokohama Monday, December 3rd, in a two-day dis- cussion of service medical problems. During the two-day conference, officers lectured on various medical subjects, after which special prob- Addresses by Major General Walter L. Weible, Com- lems were aired at question and answer sessions. manding General, JLC, Brigadier General, William E. Shambora, Chief Surgeon, FEC, and Brigadier General Speakers included: Maj. Paul A. Ievault, chief of James C. Cooney, Surgeon, JLC, opened the confer- the JLC Medical Section's Personnel Division; Col. ence at the U. S. Array Hospital, 8168th Army Unit, Angvald Vickoren, chief of the section's Operations Out-Patient Building. Division; and Lt. Col. Charles A. McAllister, Capt. Bernard Rappaport, Capt. Grayson Smith, and Capt. Representatives from all JLC hospitals attended, as Douglas C. Chitwood, all of the Operations Division. well as officers from the Japan Medical Depot, the 406th Medical General Laboratory, Tokyo General Dis- Other lecturers on the program were Col. R. G. Bel- pensary, and Tachikawa, Johnson and Nagoya Air Force anger, chief of the M»dical Section's Supply Divi- hospitals. sion; Maj. Edith A. Aynes, Chief Nurse, JLC, and Dr. Anna R. Manitoff, Dir-ctor of Public Health and The convention is the second to be called this year Welfare, GHQ, FEC.

COLONELS LEEDHAM AND McNINCH JOIN MEDICAL SECTION, GHQ

The Medical Section, GHQ, recently welcomed to its sistant Chief, Preventive Medicine Division,under staff of consultants Colonel Charles L. Leedham,MC, Colonel Tom F. Wayne. and Joseph H. McNinoh, MC. Colonel Leedham has been assigned to the Consult- ants' Division to replace Colonel Francis W. Pruitt, As Preventive Medicine Consultant, Colonel McNinch Medical Consultant, who departed the command for has replaced Colonel Arthur P. Long. Colonel Long his new assigment with the medical service at Let- was assigned to the Surgeon General's Office as As- terman Army Hospital, San Francisco.

ITALIAN RED CROSS HOSPITAL UNIT BEGINS OPERATIONS IN KOREA

The first non-United Nations country to serve with The Italian doctors, nurses and medical corpsmen the UN foroes in Korea opened its doors for busi- worked swiftly bathing them, giving them medical ness on December 16th. The Italian Red Cross Hos- attention and instructions on medicine to take and pital Unit which arrived in the Far East Command when to return to the clinic. Each little ohild was last month is now set up in permanent-type build- given a stuffed toy that the Italians brought with ings with added tents for their out-patient clinics. them from Italy.

Although all facilities are not functioning yet, the Italians are assisting a local Korean hospital All-in-all, the Italians considered their first day by taking its overflow of civilians requiring medi- of operations a success. All patients who came cal and out-patient care. were cared for and the gratitude they expressed as they left the clinic assured the Italian volunteers The Italians' first patients were mostly babies and that they were very much needed in Korea. small children. Some of them were brought in strap- ped on their mother's backs — Korean style. Others were carried in their mothers' arms, because they were too ill to travel to the clinic in the usual "Now we are all happy," beamed Maj. Luigi Coia, manner. Some of the patients werfc victims of frost- Naples, commanding officer of the unit, "for we are bite—some were oovered with festering sores, others doing what we have so willingly volunteered to do - had abscesses. helping these unfortunate people."

REPRINTS OF PREVENTIVE MEDICINE PUBLICATIONS OUTLINE AVAILABLE

In response to many requests, reprints of the "Out- Special Regulations, Teohnioal Bulletins, etc., of- line of Publications Pertinent to Preventive Medi- fers to the preventive medicine officer an authorita- cine Policies and Practices," which appeared as the tive guide to reference material. center spread in the October 1951 issue of The Sur- Requests copies of this reprint will be promptly geon’s Circular letter, have been made available. for filled upon application to: The This tabulation of publications, as supplemented by Chief Surgeon, GHQ, FEC, 500, Attn: A the monthly listing of pertinent Army Regulations, APO Publications Editorial Branch.

239 L-19 AIRCRAFT USED FOR EMERGENCY EVACUATION BY XVI CORPS

During the past few months floor anchor. the L-19 light airoraft, 4. Unanap plastic curtain which forma the recently adopted by the rear partition of the baggage compartment and fold Army as its standard liai- forward. son-type airoraft, has been 5. Lengthen the rear safety belt to full ex- enthusiastically accepted tent. by all units to which it 6. Using one general purpose carrying strap, has been issued because of slip strap over V struts at the rear of the canopy its excellent flight char- allowing snaps to hang freely equi-distant. acteristics. 7. Disengage front shoulder harness from over- head hanger. One of the problems con- 8. Open all windows - remove door if desired. fronting the XVI Corps sur- geon, Lt. Col. F. W. Timmerman, was the considera- tion of this oraft for use in emergency air evacua- After the airplane is prepared the patient, secured tion of seriously ill or injured patients. It was in the modified Stok®s litter, may be easily loaded found that none of the standard Army litters oould using a four-man team as followsi be placed in an L-19 due to the site of the door and the conformation of the airplane's fuselage. Modi- 1. Place litter on the ground to the right fication of the airplane to aoccmmodate a standard front of the plane at a 45° angle to the fuselage Army litter of any type was obviously not a feasible with foot of the litter to the rear. or an economical solution. 2. lift the litter, pass it over the right wing strut, tilt slightly, and slide along the back Und°r the direction of Colonel Timmerman, aided by seat to the proper position. The head of the litter technical advioe from Lt. Col. James L. Townsend, will be opposite th® rear throttle control. Artillery, XVI Corps Light Air Section, the problem 3. The previously placed snaps of the general was placed under study. As a first step, a Stokes purpose carrying straps are then engaged in rings on litter was modified in the welding shop, 8062d AU, the side bars of the modified litter thus stabilis- Army Aircraft Maintenance Team, Lanier Field, Sendai, ing the foot of the litter. Japan. This simple modification required about one 4. Hook the rear safety belt over the litter man-hour of work and could be accomplished at any and patient. Army installation at little expense or trouble. (Fig. 1). 5. Slip second general purpose carrying straps through the braces at the head end of the In order to use the L-19 for an ambulance plane, litter and engage both snaps in floor anchor. This the following steps should be followed! will stabilize the forward end of the litter.

1. Slide the front seat all the way forward As a test the plane carried a 190 lb "patient." The or remove if desired. pilot stated that the flight characteristics were 2. Remove back rest from rear seat. unchanged and the "patient" reported that he enjoy- 3. Disengage rear shoulder strap cable from ed complete comfort with no shifting of the litter.

(Fig- 1)

240 JLC SURGEON DECORATED FOR SERVICES IN ATOMIC BOMB TEST

Brigadier General James P. Cooney, Japan Logistical Crossroads" in th® South Pacific. He was also radio- Command Surgeon, has reoeived the legion of Merit logical safety officer with Task Force Seven during for his work in developing and executing th« radio- "Operation Sandstone" from October 7, 1947 to May 30, logical safety policies us«d in one of America's 1948. atomic bomb tests. General Cooney also participated in the atomic weap- Major General Walter L. Weible, Commanding General, ons tests in Nevada. He had been, previous to his JLC, made the presentation to General Cooney in a assignments with JLC, liaison officer during "Opera- ceremony at JLC headquarters Friday, November 30th. tion Crossroads," chief of the Medical Service Ra- diological Division with the Armed Forces Special The citation covers General Cooney’s service from Weapons division in Washington, D. C., and chief of March 1, 1950 to May 30, 1951. It states in part: the Special Projects Division in the Surgeon Gener- al's Office in the capital. "General Cooney was responsible for the development and execution of all radiological safety policies General Cooney's home is Silver Spring, Maryland. essential to the success of 'Operation Greenhouse.’ He is a member of the American Medical Association, His contributions were of great significance to the a fellow of the American College of Chest Physicians, success of the operation. His actions have been of and a member of the Radiological Society of North major importance to our national atomic energy pro- America. gram and reflect great credit on him and the mili- tary service." General Cooney has been an Army officer for a quar- ter of a century'. He was graduated from the Army General Cooney participated in the experiments with Medical School in 1929. He is a graduate, with M.D. A-bombs"A" and "B" during the now famous "Operation and fl.S. degrees, of the University of Iowa.

GHQ MEDICAL SECTION MOVES TO NEW OFFICE

Moving day came on 27 November for the GH3 Medical staff operating on the second floor of the Empire Section. Activities were suspended temporarily as House, a city block west of the Mitsubishi-Shoji the section left the Mitsubishi-Shoji Building, its Building. The move brought together on the same quarters since the Occupation began, and reopened floor the GHQ Medical Section and the Public H®alth offices nearby in downtown Tokyo. and Welfare Division, which became part of the Med- ical Section several months ago. Also sharing the new quarters is the Tokyo Office of the Atomic Bomb Visitors will now find the Chief Surgeon and his Casualty Commission.

REQUISITIONING PROCEDURE FOR ARMED SERVICES CATALOG OF MEDICAL MATERIEL

In order to effect a broader distribution of the unit. limited number of Armed Services Catalogs of Medi- cal Materiel available within the Far East Conxnand, (b) Japani The supply point or unit resupply of the catalog or any section thereof should forward extract requisitions, showing requis- should be handled as follows: itioning unit and address, through normal Adjutant General publications supply channels to the Far East 1. Amy Medical Service Units requiring the Command Printing and Publications Center, APO 503. cathlog or any section thereof should submit requis- The requisition should be forwarded to the Medical itions through normal Adjutant General publications S-ction, Japan Logistical Command, for approval of supply channels. quantity and actual requirements and then returned to the Center. The item can then be shipped direct 2. The publications supply point or unit re- to the requisitioning unit by the Center. ceiving the requisition for catalogs should take action as follows: (c) Okinawa: The supply point or unit (a) Korea: The supply point or unit should forward extract requisitions, showing requis- should prepare an extract requisition of th» item, itioning unit and address, through normal Adjutant showing requisitioning unit and address, and for- General publications supply channels to the Far East ward to the Medical Supply Officer, Medical Section, Canaand Printing and Publications Center, APO 503. Eighth Army, for approval as to quantity and actual The requisition should be forwarded to the Judical requirement. Upon approval by the Medical Supply Section, Ryukyus Command, for approval of quantity Officer, the requisition should be forwarded to the and actual requirements and then returned to the Far East Cotmand Printing and Publications Center, Center. The it®m can then be shipped direct to the APO 503, for direct shipment to the requisitioning requisitioning unit by th«» Center.

241 AWARDS TO ARMY MEDICAL service personnel

Die following additional Army Medical Service personnel have been awarded the Silver Star, Legion of Merit, the Bronze Star Medal with "V", Bronze Star Medal or Commendation Ribbon for exceptional bravery in face of enemy and meritorious service during the Korean conflict.

SILVER STAR 1st Lt., MC Selley, Harold V., Sgt Barden, Landon D., PFC Williams, Neil S., PFC Staley, Albert E., Jr,, Capt, DC Pvt Willieons, Paul J., O'Grady, Clifford J., Samuel DC PFC Stein, E., Capt, Pringle, Alvin J., Taggart, Robert S., Capt, MSC Sgt BRONZE STAR MEDAL Prottas, Soloman, W«, Tinkle, James W., Capt, DC D,, Capt, DC LEGION OF MERIT Banister, Wellman R», Capt, MSC Vetstein, Arnold Daniel SFC Bolocan, Hyam, Maj, MC Volla, Della, White, Lee R., M/Sgt Arohuletta David 0«, Gpl Bortner, Richard B., Maj, DC Bukovitz, Steve L,, Maj, MSC Zielazinski, Harry, Capt, MSC BRONZE STAR MEDAL with "V" Camoesas, Afonso, SFC Cintron, Andres A., 2d Lt, MSC COMMENDATION RIBBON Theodore Collier, Charles N., Capt, DC Allen, L., PFC Capt, MSC Bartholomay, Eugene, M/Sgt Dally, Richard H., Cpl Bertea, Cotavian, Bowers, Joe W., Sgt John J» M/Sgt Devlin, Laurence P., Lt Col, MC Becker, 3d, Bukovitz, Steve L., Maj, MSC Bennett, Charles R., PFC Dupree, Richard H., Maj, MC Eveland, Charles L., Cant, MSC Burgio, Joseph C«, Capt, MSC Bleile, Paul P., PFC Cave, Clifford G., M/Sgt James Cpl Fisher, Franklin C., M/Sgt Burton, E., Chapman, Wyatt SFC Burton, Mack E., Cpl Hart, William T., M/Sgt D., Jr», Dyer, William S, Jr., 2d Lt, MSC Gladysz, Edward Cpl Jesse Capt, T., Heck, E., Jr., MC James Cpl Hostelling, Roger Cpl Hembree, J., H., Huggins, Lewis H., Capt, MSC Hill, Elmer E., Sgt Huggins, Lewis 1st Lt.,MSC Robert H«, Jensen, T«, Ma1, MC Holsey, Stanley, M/Sgt Cpl Jackson, Leon, LaStrapes, Thomas, Capt, MC Joseph, Fred E., M/Sgt Johnson, Milton K., Cpl Langlois, Alfred MC E., Capt, LaCates, Aloys F., Sgt Kirk, Wiggo., F. C., Cpl Heamon Lister, L«, M/Sgt James L», SFC John Livingston, Maiten, O'Brien, D., PFC Woodrow, Capt, MSC Morgan, John M/Sgt Phillips, Howard L., Sgt W., Loyd, Reginald C., 1st Lt, MSC Harold SFC Leo Morrison, D«, Richardson, F., Sgt Marks, Edward, Maj, MSC Vance SFC Miguel Sgt Penney, E., Rivera, A., Moller, Charles F., Maj, MC Ferrigin, Lyman M., SFC Shaffer, Richard G., FFC Montes-Cardone, Juan, SFC Prescott, William J,, Capt, MSC Silveira, Lino F., PFC Jasper P* Maj, MC Munson, Jr., Sanchez, Jose T«, Sgt Smith, John C., PFC Olsen, Lloyd MC L., Capt, Stofferahan, Arnold, Cpl Spenoe, Marion D.,PFC Rioux, Conrad, Capt, DC Stropes, Lloyd R., Lt Col, MC ' Wilder, Calvin C», SFC Sarrell, Warren, 1st Lt, MC Williams, Lonnie, Cpl Tisor, Lester D», Sgt Sawyer, Howard P. J r ., Capt, MC Young, Claude Capt, MSC Wetzelberger, Charles, Sgt E., Schwartz, Frank E., Maj, MC Zynda, Steven J., Sgt

TECHNICAL

Doctrin® for Artificial Respiration 242 Department of Virus and Rickettsial Diseases 246

AMENDED DOCTRINE. FOR ARTIFICIAL RESPIRATION PROCEDURES

On December 6, 1951 the Department of Defense an- training circular covering the recent changes in ar- nounced the issue of a new publication, "Manual Ar- tifical respiration methods will be published and tificial Respiration." Methods more successful tnan distributed in the near future. For interim use in the widely used Schafer prone pressure method are the Far East Command, the following information is described, letter from Surgeon General'6 Office, published: Department of the Army, dated 27 November 1951, in- dicates that the present Schafer method of artifi- 1» Use of Artificial Respiration. Artificial res- cial respiration will be supplanted and that a piration is used to induce breathing in persons

242 whose respiration has stopped. The common causes recent experimental work on manual artificial res- of respiratory failure where artificial respiration piration, the new method has been adopted by the has value, are drowning, suffocation, electric shock, Armed Forces, the Amerioan National Red Cross, the and poisoning by illuminating gas or carbon monoxide. Federal Civil Defense Administration, the Public Artificial respiration is also used occasionally in Health Service, the Bureau of Mines, the Boy Scouts certain illnesses, such as poliomyelitis. Poison and Girl Scouts of America, the American Telephone gases and nerve gases used in warfare may cause res- and Telegraph Company, the Counoil on Physical Med- piration to cease. Attempts to start respiration icine and Rehabilitation of the American Medical after breathing has stopped, are made either by Association, and others. Additional national agen- mechanical or manual methods. Mechanical methods cies,utilities corporations, fire departments, and require the use of machines which usually are not police departments will probably adopt the method on hand when most needed. Manual artificial respir- later. ation, which can be conducted by anyone familiar with the methods, can be started immediately and can 6. Effective Date. Although the back-pressure arm- be continued until breathing has started or until lift method of manual artificial respiration is be- mechanical respirators become available. ing adopted by many agencies, it cannot be taught to all operators overnight. However, it will sup- 2. Present Methods. The present method of manual plant the Schafer method as rapidly as the adopting artificial respiration used extensively in the agencies can instruct their teachers and operators. United States is the Schafer prone pressure method. Meanwhile, the Schafer method will continue to be This is the method used by almost all life guards used. It must be borne in mind Hiat, although the and industries. It consists of placing the victim back-pressure arm-lift method of manual artificial face downward and then having the operator compress respiration is considered to be superior, the Schaf- the victim's chest by pressure on the lower ribs of er method has saved many lives and should not be the back. This pushes air out of the chest and abandoned until the new method has been learned. hence is a "push" method. It depends upon the elas- 7. Research leading to Adoption of New Method. tic recoil of the chest and internal organs for air to be drawn into the lungs. Since this latter proc- a. Historical. Although the Schafer method of ess is not given assistance by the operator, tiiere manual artificial respiration has be«n used exten- is no "pull" maneuver in the Schafer method. sively in the United States for many years, there have been a large number of research investigations 3. Other Methods. There are several other methods into the entire artificial respiration problem. Be- widely of manual artificial respiration which are fore World War II, observations by a growing number used in Europe and by skilled anesthetists in the of investigators cast doubt upon the belief that United States, but seldom used by lay personnel. the prone pressure method was of superior effective- principle both These other methods all follow the of ness. Then during and soon after World War II im- pushing the air from the chest, as in the Schafer portant contributions to our knowledge of respira- method, but in addition incorporating a second step tory physiology and of the asphyxial process were oth- which then pulls the air into the chest. These made by investigators working under grants from er methods are: (1) The back-pressure arm-lift meth- the Armed Forces, particularly the Air Force. This od (Holger Nielson), in which the patient is placed work gave further evidence that a change from the face down hands the cheek and the op- with his under prone pressure method should be made. In 1947, the erator rhythmically presses on the back of the chest American Red Cross requested th« Council on Physical and then pulls upward t the arms; (2) The back Medicine of the American Medical Association to pressure hip-lift or hip-roll method, in which the review the problem. A oommittee of the Council patient is placed face down and the operator rhythm- reported that the prone pressure method appeared ically presses on the back and then raises the hips to be inferior to certain other methods, but recom- or rolls the hips upward on the operator's thigh; mended that further study be made before selecting (3) The modified Silvester method, in which the pa- a method to be adopted. Accordingly, the Red Cross tient is placed faoe upward and the operator rhythm- made grants during 1948 and 1949 to evaluate vari- , ically presses on the abdomen and then manipulates OU8 methods of artificial respiration. The work the arms upward. so done was highly fruitful. Meanwhile, the mili- tary services were also pursuing problems of respi- 4. Comparison of Methods. Recent research activi- ration and asphyxia. Then, approximately two years ties have led to the following conclusions: ago, the Army Chemical Corps had to consider the problem of giving artificial respiration to a large a. The back-pressure arm-lift method of manual number of people in the event of warfare when poi- artificial respiration (Holger Nielson) is the meth- son gas or nerve gas might be used. In view of the od of choice. growing question of the most effective method of artificial respiration, the Chemical Laboratories, b. The back-pressure hip-lift method of manual Army Chemical Center, Maryland, requested Dr. David artificial respiration should be used, adien indicat- Bruce Dill, Scientific Director of the Laboratories, ed, on victims with injuries of the arms. to organize concerted research into the problem and recommend the best possible method of artificial c. The Silvester method of manual artificial respiration. respiration, with the victim lying on his back, should only be used when the victim cannot be plac- b. Research Teams. Dr. Dill made immediate ed faoe down. arrangements with the following experts to organ- ize research teams and to begin res°arch in Janu- d. The Schafer method, which is less effective, ary 1950 s should be supplanted by the back-pressure arra-lift method. 1. Dr. Julius H. Comroe, Professor of Phys- iology, University of Pennsylvania, Graduate School 5. Agencies Adopting New Method. As a result of the of Medicine.

243 2. Dr. Archer S. Gordon, University of ten minutes; (3) Experiments relating to ease of Illinois Medical School. operation revealed that both the Schafer method and the back-pressure arm-lift method could be per- 3. Dr. Peter V. Karpovich, Professor of formed by a half-grown child or a woman upon a Physiology, Springfield College. heavy adult victim without undue fatigue. The back- pressure hip-lift method, however, was very fatigu- 4. Dr. James L. Whittenberger, Professor ing and probably could not be performed by a light of Physiology, Harvard University. individual upon a heavy adult. Experiments with the modified Silvester method of artificial respira- c. T£)e_ of Experimental Work. Many studies tion, where the victim is placed on his back, re- made of were using the various methods artificial vealed that it had one serious drawback. That was respiration. Included in the studies were animals, the inability to keep the throat clear. Although volunteers holding their breath, freshly deceased the method could be used by skilled anesthetists, cadavers, and sick or injured patients who had it could not be used extensively by lay personnel stopped breathing. Experiments were also perform- due to the fact that the victim's tongue, or water ed upon volunteers who were given drugs which com- and debris might stop up the air passages. pletely paralyzed their ability to breathe for a short period of time.* These experiments, which From these experimental results it was de- were extremely necessary, were conducted under termined that the back-pressure arm-lift method of carefully controlled conditions. The ease and ef- manual artificial respiration provides for suffi- fectiveness of teaching the various methods of ar- cient exchange of air, can be easily taught, and tificial respiration and ease or difficulty in ad- easily performed, and therefore is the method of ministering the various methods of artificial res- choice. In addition, inquiry to the Danish and piration were also tested. Norwegian Red Gross Societies where this method had been used for years, revealed that -there had d. Results of Experimental Work. The results never been any injuries in the practice of the fell into three main classes: (T) Experiments to method or in its actual use in resuscitation of determine which method gave the greatest exchange the asphyxiated. The only potential drawback to of air; (2) which method was thp easiest to learn; the use of this method would be in cases where the and (3) which method was the easiest to perform. victim had severely injured arms which could not be These were as follows: (l) ffhen measurements were raised. In this ca3e, results of the experiments taxon to determine how much air was exchanged indicate that the back-pressure hip-lift method through the mouth in the various methods of manual should be used. Finally, results of the experi- artificial respiration, it was determined that when ments indicate that the modified Silvester method, the Schafer method was used, only 485 cc's, or ap- or supine method, should only be used when an in- proximately one pint, of air was exchanged with dividual cannot be placed on his stomach, i.e., each application of pressure. Compared to this, after operations. the push-pull methods, such as the back-pressure arm-lift or hip-lift; or the Silvester method with e. Action of National Research Council. In the individual lying on his back, provided an ex- view of the compelling evidence and the recoramenda- change of over or over one quart, of 1,000 cc's, tions made to the Department of Defense in the Chem- air with such application of pressure combined ical Corps Medical Laboratories Research Report Ho. with arm or hip manipulation. Inasmuch as the num- 79, in August, 1951, the American Red in ber of cycles of manipulation per minute are essen- Cross, co- operation with the Public Health requested tially the same in all methods, this revealed that Service, the National Research Council to call a conference the Schafer method was less than one-half as effect- of agencies interested in the problem of artificial ive as the other methods in the exchange of air. respiration. At this conference, held on October Experiments also that the effectiveness 1, revealed 1951, top scientists and authorities presented find- of the Schafer method depond«»d upon the natural ings of the research, and agency representatives tone and elasticity the victim's This of muscles. had an opportunity to consider thoroughly the prob- is due to the fact that the pressure on the small lem of manual artificial respiration. As a result of the baok, used in this method, expels air from of this conference the following statement was made: lungs and it is only when the ribs spring baok in- to that air sucked back when place is in. However, "IT IS THE RECOMMENDATION OF THE CONFER- a victim is deeply asphyxiated and near death,there ENCE THAT THE METHOD GENERALLY PREFERRED IS THE ARM- is a loss of natural muscle tone, less elasticity LIFT BACK* PRESSURE METHOD ORIGINALLY DESCRIBED BY of the chest, and less tendency for air to be suck- HOLDER NIELSEN: THAT OTHER METHODS ACCEPTABLE UN- ed This makes the Schafer method least effect- in. DER SPECIAL CIRCUMSTANCES INCLUDED THE HIP-LIFT ive when most needed. BACK-PRESSURE METHOD AND THE MODIFIED SILVESTER Many deaths in the asphyxiated, and espe- METHOD. THE TECHNIQUES OF THE FIRST TWO METHODS cially in electrocution, are due to ventricular RECOMMENDED ARE THOSE DESCRIBED IN CHEMICAL CORPS fibrillation, or heart failure, and sometimes this LABORATORIES REPORT #79, MANUAL ARTIFICIAL RESPIRA- cannot be avoided, However, it is less liable to TION, AUGUST 1951, EXCEPT THAT THE FIRST PHASE WILL happen if there is sufficient oxygen in the blood. BE EXPIRATORY RATHER THAN INSPIRATORY. THE TECH- The exchange of a large volume of air in manual ar- NIQUE OF THE SILVESTER METHOD IS DESCRIBED IN THE tificial respiration helps keep the blood oxygen BUREAU OF MINES FIRST-AID MANUAL." level high; (2) Experiments with ease of teaching the various methods of manual artificial respira- ♦At the implementation meeting h**ld on Oc- tion indicate the Schafer method is the easiest to tober 2, 1951 at the American National Red Cross teach. However, the teaching of the back-pressure headquarters, it was agreed that this term should arm-lift and back-pressure hip-lift methods was on- be altered to "back-pressure arm-lift," to indicate ly slightly more difficult and this method can be that back-pressure should be applied first as a taught to most people in a period of approximately means of clearing the airway.

244 f. Adoption of New Method. Because manual bp applied to a patient's face, it can be employed artificial respiration is taught and practiced so when physical manipulation of the body is impos- widely and by so many different organizations in- sible or would be harmful, as during surgical pro- cluding the Armed Forces, Red Cross, various indus- cedures, in accident cases with extensive burns, tries, Boy Scouts, Girl Scouts, Police and Fire De- broken vertebrae, ribs, arms, etc., for victims partments, and others, it was apparent that the trapped under debris of excavations, overturned back-pressure arm-lift method of manual artificial vehicles, etc., and during transportation of the respiration could not be adopted overnight, and victim. Furthermore, some resuscitators signal that the Schafer method would have to be continued when the airway is and provide an as- until it could be supplanted by the more effective pirator. method. Therefore, on October 2, a meeting of mili- tary and civilian representatives of organizations interested in the problem of artificial respiration 9. A Standard Technique for Executing the Back- was held at Headquarters, American National Red pressure Arm-td.fi Method of Artificial Respira- Cross, to determine the most effective method of tion. disseminating information on the back-pressure arm- lift method to the agencies and personnel who would a. Position of the Subject. Place the sub- use it. Also, immediate, plans were made for teach- ject in the face down, prone position. Bend his ing and publicizing the newly advocated method. At elbows and place the hands one upon the other. Turn this time manuals are being printed, instructors in- his face to one side, placing the cheek upon his doctrinated, and the back-pressure arm-lift (Holger hand. Nielsen) method will soon be taught on a large scale. b. Position of the Operator. Kneel on «ither the right or left knee, at the head of the subject, facing Place the knee at the side of th® sub- General Instructions for Manual Artificial Res- him. 8. jects h®ad close to the forearm. Place the oppos- piration. Certain general principles must always ite foot near the elbow. If it is more comfortable, be kept in mind in performing any m®thod of artifi- kneel on both knees, one on either side of the sub- cial respiration. ject's head. Place your hands upon the flat of the subject's hack in such a way that the heels of the a. Time is of prime importance, Seconds Count. hand lie just below a line running between the arm Do not take time to move the victim to a more satis- pits. With the tips of the thumb just touching, factory place; Do not delay begin at once. resusci- spread the fingers downward and outward. tation to loosen clothes, warm the victim, apply stimulants, etc. These are secondary to the main purpose of getting air into the victim's lungs.

b. Quickly place the victim in the prone posi- tion, that is, on his abdomen with the face turned to one side, the elbows bent, and the cheek resting on the back of the hand.

c. Quickly sweep your fingers into the victim's mouth, removing froth and debris and drawing the tongue forward.

d. Begin artificial respiration and continue c. Compression Phase. Rock forward until the it rhythmically and uninterrupted until spontaneous arms are approximately vertical and allow the pronounced breathing starts or the patient is dead. weight of the upper part of your body to exert slow, steady, even pressure downward upon the hands. This e. As soon as the subject is breathing for him- forces air out of the lungs. Your elbows should be self, or when additional help is available, see k®pt straight and the pressure exerted almost di- that the clothing is loosened (or removed, if wet) rectly downward on the back. and the patient is kept warm. However, do not in- terrupt the rhythmical artificial respiration to accomplish these measures.

f. If the victim begins to breatho on his own, adjust your timing to assist him. not fight the victim's attempts to breathe. Synchronize your ef- forts with his.

g. Do not wait for a mechanical resuscitator, but when an approved model is available use it.A we11-performed "push-pull" type manual method is immediately available and effective and accomplish- es adequate ventilation. The mechanical resusci- d. Expansion Phase. Release the pressure, tator is no more effective than a properly perform- avoiding a final thrust, and commence to rock slow- ed "push-pull" manual technique. The most impor- ly backward. Place your hands upon the subject’s tant advantages of good mechanical resuscitators are arms just above his elbows, and draw his arms up- that they require less skill to operate, are not ward and toward you. Apply just enough lift to fatiguing and can furnish 10C$ oxygen. There are feel resistance and tension at the subject's shoul- otter advantages. Since the resuscitator need only ders. Do not bend your elbows, and as you rock

245 backward the subject's arms will be drawn towards The cycle should be repeated twelve times per minute at a steady, uniform rate. The compres- sion and expansion phases should occupy about equal time, the release periods being of minimum duration.

e. Additional Related Directions. It is all important that artificial respiration, when needed, be started quickly. There should be a slight in- clination of the body in such a way that fluid drains better from the respiratory passage. The head of the subject should be extended, not flexed you. Then drop the arns gently to the ground. This forward, and the chin should not sag l*»st obstruc- completes the full cycle. The arm-lift expands the tion of the respiratory passages occur. A check chest by pulling on the chest muscles, arching the should be made to ascertain that the tongue or for- back, and relieving the weight on the chest. eign objects are not obstructing the passages. These aspects can be cared for when placing th« subject into position or shortly thereafter, be- tween cycles. A smooth rhythm in performing arti- ficial respiration is desirable, but split-second timing is not essential. Shock should receive ad- equate attention, and the subject should remain recumbent after resuscitation until seen by a phy- sician or until recovery seems assured.

DEPARTMENT OF VIRUS AND RICKETTSIAL DISEASES 406th Medical General Laboratory, APO 500

Procedures for Collection and Submission of Spec- 2. COLLECTION AND SHIPMENTS OF SPECIMENS FOR SE- and imens- for Diagnosis of Virus Rickettsial Dis- ROLOGICAL TESTS: * eases a. In order to make a definitive diagnosis of 1. INTRODUCTION: virus or rickettsial disease by serological means, it is necessary to demonstrate an increase in anti- a. The informative material outlined herein body titre in the blood of the patient during the is published to familiarize medical officers, es- course of illness and convalescence. For this rea- pecially those newly arrived in the Far East Com- son, a minimum of two serum specimens must be ob- mand, with the services wnich are available to tained from each patient suspected of having a vi- tnem in the Department of Virus and Rickettsial rus or rickettsial disease. One of these specimens Diseases, 406tn Medical General Laboratory, APO should be collected during nhe active phase of ill- 500. Tuis augments methods and procedures outlin- ness. The time of collection of specimen for virus ed in Section J, J1L Cir 9, April 1951, "Diagno- disease is shown in Table 1 and for the rickettsial sis of Virus and Rickettsial Diseases." In large disease in Table 2. Specimens of whole blood submit' part this information is also contained in TM 8- ted for serological t»sts should not be frozen. The 227, Methods for Laboratory Technicians, Aug 1951, 406th Medical General Laboratory will render reports a publication not yet available in this command. of serological testing on all specimens submitted, at a time when all serum samples on a given patient b. This material should not be considered to have been tested. be a laboratory manual for the conduction of virus procedures but is intended to make known the tests that are conducted, the specimens required for b. Procedures for Collection of Blood for Se- testing and the proper method of collection and rological Evaluation* shipment of specimens. (1) Withdraw, aseptically, approximately c. In order to facilitate and expedite diag- 25 ml. of blood from the patient's vein with a ster- nostic procedures it is requested that each ini- ile, dry syringe and place in a sterile tial specimen submitted for serology or isolation t“st tube and allow to clot firmly at room tempera- attempts be accompanied by a clinical abstract of ture for several hours. A blooding venule (vacuum the date of onset of disease, the clinical diagno- tubejmay be employed for this purpose. Place serum, sis, and pertinent clinical and laboratory find- obtained after separation from the clot by slow cen- ings. Such information is essential to help this trifugation, in a sterile Vasserman tube which is laboratory choose the proper procedures necessary sealed with a sterile rubber stopper held in place to confirm or disprove these clinical diagnoses. with adhesive tape. If it is not possible to sep- arate serum from the clot, whole blood, in a tight- d. Direct correspondence with the Department ly-stoppered tube, may be forwarded provided freez- of Virus and Rickettsial Diseases, 406th Medical ing temperatures are not encountered. General Laboratory, APO 500, on technical matters is authorized by SR 40-305-10, 28 December 1949, in (2) Affix a typewritten or clearly printed order to standardize, facilitate laboratory methods, penciled label to the tube, giving the full Lane control investigation and prevent misplaced effort. of the patient, together with serial number and

246 rank and the date on which th<=» specimen was taken. specimen and plac° in a mailing tube adequately packed with cotton and forward to the 406th Medical General Laboratory, APO 500, by th» most expeditious (3) Wrap the clinical abstract around the means.

Table 1.

SUMMARY OF SEROLOGICAL TESTS FOR DIAGNOSIS OF COMMON VIRAL DISEASES OF MAN WITH TIME WHEN SPECIMENS SHOULD BE COLIECTED

Approximate Day of Disease o[•i Bleeding Suspected Disease Tests Commonly Performed Acute Specimen Convalescent Specimen 1st Spec 2nd Spec 3rd Spec

Respiratory Group! Influenza A A B Red cell agglutination inhibition before day 2 after day 8 NCT** Primary atypical oneumonia Cold hemagglutination before day 7 after day 21 NCT Psittacosis Complement fixation before day 10 after day 21 NCT

Aseptio Meningitis Lymphocytic choriomeningitis Complement fixation; neutralization before day 10 after day 21 and 42 Mumps meningitis Complement fixation before day 6 after day 21 NCT

Dermotropic Group: lymphogranuloma venereum Complement fixation before day 10 about day 21 and 42

Neurotropic Group:* Japanese B encephalitis Complement fixation; neutralization before day 6 about day 21 and 35 Russian Spring and Summer encephalitis Complement fixation; neutralization before day 6 about day 21 and 35

1 * - In cases of encephalitis of other viral origin, St. Louis Encephalitis, Western Equine Encephalomyelitis, Eastern Equine Encephalomyelitis, Venezuelan Encephalomyelitis (equine) and West Nile Disease, serum should be submitted at the times indicated for Japanese B encephalitis.

** - Not Commonly Tested

Table 2.

SUMMARY OF SEROLOGICAL TESTS FOR DIAGNOSIS OF COMMON RICKETTSIAL DISEASES OF MAN WITH TIME WHEN SPECIMENS SHOULD BE COLLECTED

Approximate bay of Disease for Bleeding Suspected Disease Tests Commonly Performed Acute Specimen Convalescent Specimen 1st Spec 2nd Spec 3rd Spec

Epidemic Typhus Weil-Felix; complement fixation;1 rickettsial agglutination before day 6 about 15th and 21st

Murine Typhus Weil-Felix; complement fixation;► rickettsial agglutination before day 6 about 15th and 21st

Scrub Typhus Weil-Felix before day 6 about 15th NCT*

Q Fever Complement fixation before day 10 after 21st NCT

* - Not Commonly Tested

NOTSi For other suspected rickettsial diseases (Spotted Fever, Rickettsial Pox, Fievre Boutonneuse and South African Tick disease), serum should b« drawn on or about the 6th, 15th and 21st day of disease.

247 3. COLLECTION AND SHIPMENT OF SPECIMENS FOR ISOLA- packed in a suitable sealed container surrounded by TION AND IDENTIFICATION OF VIRAL AND RICKETTSIAL formalin-soaked cotton and shipped to the Depart- AGENTS. ment of Pathology, 406th Medical General Laboratory, APO 500, iTokyo, Japan. a. The attempted isolation of these agents is a laborious and expensive procedure. Most virus (b) For Rickettsial Diseases - In fa- and rickettsial diseases can be diagnosed much more tal rickettsial diseases, specimens of brain and rapidly by serological means. Isolation procedures spleen should be taken, and prepared for shipment should therefore be limited to the following condi- as indicated in paragraph 3b(2)(a) below. tions i (c) For fatal diseases of unrecog- (1) From brain tissues obtained at necropsy nized etiology - in such instances sections of from cases diagnosed as encephalitis, aseptic meningi- brain, kidney, liver hnd spleen should be taken tis, or rickettsial disease. (See para 3b(l) below.) and prepared for shipment as indicated in paragraph 3b(2)(a).

(2) From the cerebrospinal fluid collected (2) Preparation of necropsy tissue for during the early febrile period only in cases of sus- shipment pected lymphocytio choriomeningitis or meningitis Associated with lymphogranuloma venereum. (See para (a) Ideally, each tissue specimen ob- WJ'D>T7 tained at autopsy should be placed in separate ster- ile wide-mouthed rubber-stoppered bottles and frozen (3) From the blood collected during the as quickly as possible. The specimens should then febrile states of early only suspected lymphocytic be transported, packed in dry ice, by the most ex- choriomeningitis . (See para 3b (3) (a.) ) peditious means to this Laboratory. However, since solid carbon dioxide is not generally available in (4) Fran throat washingB obtained from pa- this theatre, the alternate method is to ship such tients suspected of having influenza. (See para tissues in sterile buffered glycerin to the Depart- 3b(3)(c) ) ment of Virus and Rickettsial Diseases, 406tk Medi- cal General Laboratory, A?0 500, Tokyo, Japan. (5) From various organs obtained at neo- ropsy if a localized outbreak of fatal disease of (b) Sterile buffered glycerin solu- unrecognized etiology oocurs. (See para 3b(l)(2) ) tion is prepared as followsi

Specimens of serum for antibody studies must be 1. Citric'acid, 21 gm to 1,000 ml submitted on all living patients from whom materi- double distilled water. als are sent for isolation of virus. 2. Anhydrous Ha HPO. 28.4 gm to b. The following paragraphs describe in de- 1,000 ml. double dTstilled water. tail the proper procedure for obtaining and ship- ping tissue and body fluids.from which viruses or 3. Take 9.2 ml of 1) above and rickettsiae may be recovered. To expedite and in- 90.8 of 2) above to make 100 ml. of buffer solution sure the proper handling of such specimens, they pH 7.4; check the pH. should be transported only after telephoning the Commanding Officer, 406th Medical General Labora- 4. Mix equal parts of 3), preced- tory, APO 500. ing paragraph, andT.P. glycerin; half-fill cotton- stoppered specimen bottles and sterilize at fifteen (1) Procedure for taking tissues for iso- pounds of steam pressure for 30 minutes. Replace lation attempts cotton plug with sterile rubber stopper.

(a) For neurotropic virus infections- 5. In emergencies, freshly boil- perform the autopsy as soon as possible after death. ed, double-distilled water may be substituted for The brain and the spinal cord should be examined, the sterile buffer solution in preparing the 50 and specimens taken before the thoracic and abdom- percent glycerin. inal cavities are opened. In practice, the calvar- ium is opened in the usual manner using a saw and chisel previously well washed with alcohol. After (3) Procedures for obtaining and shipping the calvarium is removed, the dura is washed with body fluids for isolation attempts. 100 cc of 70 % alcohol and allowed to drain. Wear- ing sterile gloves, the dura is opened with pre- (a) Blood - to be suitable material ~ viously sterilized scissors and forceps. Using a for isolation of viruses o~ riokettsiae, whole seoond set of sterile instruments, blocks of grey blood must be frozen immediately upon collection matter, about 1 cm on a slide, are taken from each and shipped in sufficient dry ice to insure itsar- of the frontal, parietal, oocipital and temporal rival at this Laboratory in the frozen state. When lobes (including hippocampus) and the cerebellvm. dry ice is not available locally, the Department These blocks of tissues are then placed in sterile of Virus and Rickettsial Diseases, 406th Medical wide-mouthed bottles and prepared for shipment as General Laboratory should be consulted that time outlined in paragraph 3b(2)(a) below. The entire and effort may not be needlessly wasted. In a lim- brain is removed after severing the cranial nerves ited nanber of instances this laboratory will fur- and cervical and as deep within the spinal canal as nish dry ioe and r»efer boxes when circumstances possible. This brain should be suspended by the warrant. Such services are available only after basilar artery in a container holding 3500 cc of telephone consultation with Commanding Officer, 10* formalin. The formalin should be replaced on 406th Medical General laboratory, APO 500, Tokyo, the seoond day. After ten days the brain should be Japan.

248 1. Blood for isolation should 36 hours. The box is 3ealed with tape and wrapped be collected as foTlows - as soon as virus infec- with several layers of heavy paper. tion is suspected, withdraw 12 ml of blood in a dry, sterile syringe and transfer to a sterile centri- 3_. Label the package Specimen fuge tube. Centrifuge after clct reaction, with- For Bacteriological Diagnosis - RUSH - K3BP COOL, draw serum carefully, and plac® it in a small ster- and designate that it is fragile and must not be ile bottle or vials with rubber closures, prefer- dropped. Send this specimen and a history of the ably of the sleeve type. If air shipment is used, case in duplicate by Air Courier or RTO Express the stopper should be secured by adhesive tape or to the department of Virus and Rickettsial Diseases, wire. Both serum and clot should b» forwarded. 406th Medical General Laboratory, APO 500, Tokyo, Japan. Telephoning this Laboratory is advised when 2. Freeze contents by immersing the specimen is sent sb that its handling can be ex- the glass container’s in a mixture of alcohol and pedited. dry ice. Rotate while freezing; this distributes Spinal - place about the contents over a greater surface ar°a and pre- (b) fluid 3.0 ml. spinal in each of three Pyrex Was- vents breakage from expansion of fluid. Wrap the of fluid sterile containers in cotton held in place with adhesive serman tubes or, preferably, clean, sterile vacoine Stopper, label and ship to the De- tape and pack carefully in a half gallon or gallon vials. freeze, of and Rickettsial as di- siz° vacuum bottle. Fill the remainder of the vac- partment Virus Diseases, rected for uum thermos bottles with small pieces of dry ice. blood. (The dry ice may be broken up by wrapping it in a (c) - piece of cloth and then crushing it with a hammer.) Throat washings throat washings for influenza should be the first Cut a small notch down the side of the stopper of collected during the bottle, stopper the bottle and pack carefully 48 hours after onset of disease. These are best allowing the to gargle 15 to in a strong corrugated cardboard box. If vacuum taken by patient with bottles are not available, an impervious m»tal 20 co of nutrient broth, with the patient expector- the into a wid°-mouthed mailing container, such as is used for shipping ating washings sterile speci- ordinary bacteriological specimens, and a cardboard men bottle. Such material should then be frozen im- box may be substituted. The vial or tube contain- mediately, and sent in the frozen state to the De- partment and 406th ing the frozen specimen is packed in ootton in the of Virus Rickettsial Diseases, metal container, which is then placed in a stout Medical General Laboratory, APO 500, Tokyo, Japan. cardboard box filled with small pieces of dry ice Since such shipment necessitates the use of dry ic®, Commanding of 406th General and enough sawdust or similar material, to fill the the Officer the Medical be telephone before spaces and provide insulation. This box should be Laboratory should notified by large enough to hold at least eight to ten pounds shipment is initiated in order that this material expeditiously. of dry ice if the shipment is expected to be 24 to be handled most

HEALTH OF ARMY TROOPS, FEC

/per looo Admission Rate (all causes) , U.S. Army Personnel, Far East Command \per year

1951 1950

249 Admission rates per 1,000 troops per anoun, Army personnel, for the five-week period ending 31 October 1951, were as follows»

1 PHILCOM FSC JAPAH KOREA MARBO .url RTCOM All Causes 735 487 874 282 298 437 Diseases 427 433 429 246 267 378 Injuries 86 54 103 36 31 58 Battle Casualties 222 0.09 342 0 0 0 Psychiatric 40 15 55 7.2 7.6 7.6 Common Respiratory Diseases and Flu 67 114 45 36 115 59 Primary Atypical Pneumonia 2.0 2.5 1.9 7.2 0 0 Bacillary Dysentery 0.48 0.17 0.62 0 0 0.84 Amebiasis 0.94 1.2 0.87 0 0 0 Malaria, new 7.7 7.3 8.4 0 7.6 0 Infectious Hepatitis 7.6 8.0 7.3 0 0 13 Dermatophytosis 3.7 3.6 3.2 7.2 0 15 Rheumatic Fever 0.45 0.09 0.66 0 0 0 Venereal Diseases 185. 201 177 36 69 202

DAILY NON-EFFECTIVE RATE

all Causes 29 65 13 8.3 39 11

DISEASE, NON-BATTLE INJURY &■ BATTLE CASUALTY (per IOOO per year) U.S. ARMY PERSONNEL, F.E.C

disease non battle inj. battle cas.

ALL CAUSES ADMISSION RATS:

Amy personnel of the Far Bast Command were admitted the major commands the rateB for reportable diseases to medioal treatment facilities and quarters for all remained fairly static, reflecting slight seasonal oauses at a rate of 735 per thousand troops per an- changes in diseases such as malaria, dysentery, dis- num during Ootober. The September rate was 689* In- eases of the oentral nervous system and common re- creases were reported from all commands except MARBO. spiratory diseases* As in the previous month, the increase in Korea of the all causes rate is due entirely to a rise in battle casualties. The nonbattle injury rate for Ootober dropped from The disease component of the all causes admission the previous month’s rate of 96 to 86 for October. rate decreased from the 448 rate in September to 427 The rates decreased in all oommands except RYCOM. in October. This Far East Command decrease is due The nonbattle injury rate in Korea decreased from to a drop in the Korea rate. The only command to re- 111 in September to 103 in Ootober, in sharp con- flect a lessened rate for disease. The rate for in- trast to the battle oasualty rate which rose from fectious hepatitis remained the same. Throughout all 227 to 342 during the same period*

250 DAILY NON-EFFECTIVE RATE] VENEREAL DISEASES]

The Far East Command daily non-effective rate in- The venereal disease rate of 185 for Ootober remain- creased to 29 in Ootober from the 23 rate for Septem- ed the same as for the previous month# Only slight ber. The most significant rise is reflected in the changes were reported in Korea and Japan. The RY- September to 65 in Japan rate, from 51 in October, CCM rate rose from 172 in September to 202 in Octo- due to the increased number of evacuations from ber. Korea, especially of battle casualties. The non- effective rate for all other commands remained stat- It should be noted that venereal disease rates ic. shown throughout this report differ from other rates cited in that venereal disease rates include DISEASES: the new cases treated on a duty status (out-patient basis) in addition to those treated on an excused COMMON DISEASES AND INFLUENZA: RESPIRATORY from duty status. Other rates reported include on- ly the cases admitted to hospitals and treated on diseases The rate for common respiratory and influ- an excused from duty status. enza increased from 64 in September to 67 in Ooto- ber. This increase is to be expected at this time EPIDEMIC HEMCRRHAGIC FEVERj of year. The rate in Korea is especially favorable, showing a decline from the September rate. The 1950 Information on this disease as reported herein will October rate was 64 as compared to the 1951 rate of cover the months of October and November inasmuch 45. Japan and PHILCCM (AF) reported increases, the as special reporting procedures for this disease MARBO and RYCOM rates decreased. make possible more current collection of data. The incidence of the disease dropped off during the month of August and the first half of September. During the last week in September, the number of PSYCHIATRIC] cases again began to increase. This rise contin- ued throughout the month of October and reached a A substantial increase occurred in the psychiatric peak during the first two weeks in November. It rate for the Far East Command. The rate rose to 40 is too early to predict that the epidemic is or is in October, while the rate for the previous month not nearing its end. However, the number of cases was 28. This rise is due almost entirely to the reported showed a marked reduction during the last Korea rate which rose approximately 50%, from 36 to two weeks in November. At this time it would ap- 55. This increase is consistent with the increased pear that the oocurrence of this disease in United incidence of battle casualties. RYCOM reported a Nations troops is consistent with the experience deorease, while the rates for Japan, MARBO and FHIL- of the Japanese Army in Manchuria. The total num- C0M (AF) remained statio. ber of cases occurring by the end of November was approximately 700 with 62 reported deaths. Studies MALARIA] to determine the causative organism, the most ef- fective treatment, and the methods of control are The rate for new malaria in the Far East Comnand continuing. decreased from 13 in September to 7.7 in October. Korea and Japan shared equally in the decrease. No OTHER REPCRTABIE DISEASES] cases were reported from MARBO or RYCCM. This les- sened incidence of malaria is commensurate with the No epidemics of smallpox, scarlet fever, measles N season and compares favorably with past experience. or mumps occurred in the oommands during October. Diseases falling into the oategory of undiagnosed DYSENTERY] and ohronic conditions continue to be the principal contributors to the all diseases admission rate. The incidence of dysentery continues to deorease in Poliomyelitis, encephalitis and meningitis reflect- all the major commands. No cases were reported from ed a seasonal decline. No Japanese "B" encephalit- PHILCCM (AF) or MARBO. The Korea rate of 3.2 for is cases occurred during October. Six cases of Ootober continues to be higher than the Far East cold injuries were reported, 5 from Korea and 1 Command rate of 2.6. Of the classified dysentery from RYCOM. cases reported, amebiasis cases are in the majority. DEATHS] INFECTIOUS HEPATITIS: During the five-week period covered by this report, No change occurred in the incidence of infeotious 182 deaths of U. S. Army personnel were reported by hepatitis ooourring in Army troops in the Far East all medical treatment facilities in the Far East Command, rate remained 7.6. The Korea rate Command. Of this total, 139 were battle casualties, dropped slightly, while the Japan and RYCOM rates 25 resulted from disease 18 from nonbattle casual- increased. No cases were reported from MARBO or ties. Eighteen of the battle casualty deaths oc- PHILCCM (AF). curred after evacuation to Japan.

HOSPITALIZATION; Tne percent of designated b°ds and operating beds in Army hospitals occupied as of 31 0ctob°r was as follows;

Percent of Designated Beds Occupied Percent of Operating Beds Occupied

JAPAK 68 85 K0R3A 59 51 MARBO 13 6,4 PHILCOU (AF) 55 47 RYCOM 51 55

FSC 64 71

251 The bed status as of 31 October 1951 was as follows: (Th«se data cover all pati«nts, Army, Air Force and others). AVERAGE BEDS OCCUPIED All Patients Army Fatients Designated Beds Op- rating Bed8 Army Hospitals USAF Hospitals japan 11,700* 9,390 7,938 605 korsa 4,700 5,358 2,758 4 UARBO 200 390 25 0 PHILCCM (AF) 100 116 55 S RYCOM 400 368 202 C

FiC 17,100 15,622 11,028 616

In Aorea, tnere vjere 13,000 PsVJ operating beds, 9, 536 of which were occupied.

(♦Includes 2,000 TD beds)

EVACUATION:

Tabulated below is the number of patients (all typ*>6 of personnel) evacuated from the major commands to the ZI during the four report weeks in October and the number of patients awaiting evacuation as of 26 October 1951: By Air By Water TOTAL Patients Awaiting ’Evacuation

JAPAK 2,034 12 2,046** 126 liARBO 1 0 1 0 PlilLCOK (AF) 16 0 16 2 93 94 10 RYCOU 1_ — FSC 2,144 13 2,157 138

(**1,690 patients originated from Korea)

INDEX OF ADMINISfRATIVE ARTICLES IN SURGEON'S CIRCULAR•LETTERS - 1951

Issue Page ANC, Fiftieth Anniversary Feb 21 Evacuation, Railroad Medical Van May 85 Army Medical Service Observes 176th Fellowship, A.C.S., Reserve Medical Anniversary Aug 149 Officers Eligible to Apply for Aug 156 Army Surgeon General Visits Far East Film, Army Medioal Catalog Published Oct 198 Command Aug 150 Frostbite Classes Jan 4

Army Nurse Corps, Educational Program of •• May 83 General Armstrong Sends Thanks to FEC Medioal Personnel Jul Blood Bank, 406th, Generous Donor Response. Sep 167 121 General Bliss Retires - General Brig Gen William E. Shambora, New Chief Armstrong New Surgeon Surgeon, Nov 221 General Jun 101 FEC General Cooney Fills Bus Ambulances Jan 3 JLCOM Post Aug 151 Hays Appointed Deputy Surgeon Chinese Wounded, Treatment of Jul 131 General Commissions, Regular Army Feb 47 General Aug 151 Ridgway Complaints, Procedures for, Concerning General Compliments Navy Doctors... Aug 150 General Ridgway Lauds Record of Service- Unsatisfactory Ordnance Material ...... •• Feb 22 in Conference, Medioal, JLCOM Deo 23? women FEC Nov 226 Helicopter Unit Performs 227 Conference, Medioal, at Osaka Apr 61 3,000th Rescue...• Nov Command ...... 129 Colonels Leedham and McNinch Join Medical Hospital Team, The Jul Section, Dec 239 Hospital, Fixed, Management of Mar 42 Hospital, Eighth Army Medical Credits, Battle; Medical Units Entitled to. Sep 166 PsW, Service Decorations, Army Medical Service Person- in Korea Jun 113 Hospitals, nel, Outstanding Number of Sep 165 Army,Redesignation of Nov 228 Hospital Added to UN Med- Dental Corps Celebrates 40th Anniversary... Mar 41 Ship, Danish, ical Facilities Dental Report, Monthly, Preview of Jul 127 Feb 22 Dental Patients, Register of Jul 129 Hume, Maj Gen Edgar E., Departed Far East Command Oct Dentistry, Military, As a Career Aug 152 193 Indian Field Ambulance Unit Merits Oct Departing Women Officers Decorated at Praise.. 196 Yokohama Nov 222 International Congress of Military Medi- Dispenser, Paper Cup, Improvised.• Nov 230 cine Held in Paris Jul 123 Drugs end Treatment, Non-Approved, Author- Interservice Transfer Jan 2 isation For Use Nov 229 Italian Hospital to Serve UN Effort Oct 194 Evacuation, Emergency,L-19 Aircraft Used Italian Hospital Arrives for Korean Duty .. Nov 223 For Deo 240 Italian Hospital Begins Operations in Evacuation, Medioal Helicopter Mar 46 Korea Deo 239

252 Jutlandia Departs for International Regulations, Military Hygiene and Sani- Voyage Aug 156 tation pet 27 Jutlandia, UN Hospital Ship, Visits Japan.. Jul 122 Requisitioning Procedure For Armed Services Jutlandia, Danish Hospital Ship, Returns Catalog of Medical Materiel Dec to Far East Nov 229 241 School, Medical Service Specialist, FEC ... Aug 153 Library, Central Medical 166 AMEDS Sep Scientists, Research, Cataloging .... Feb 29 Major Aynes, New Chief Nurse, Japan Scrub-sink, Field, Expedient May 88 Logistical Command Nov 222 Supplies, Conservation of Jul 125 Management Improvement, Notes on Aug 154 Supply, Medical, Informal Requests and Medical Care, Authorization For ...... Sep 170 Unauthorized Procurement of Apr 64 Medical Chiefs Meet Deo 239 Sutures, Conservation of May 88 Medical Officers Professional Training .... Jan 2 Table, Cystoscopic, for Field Use Sep 171 Medical Regulating Officer, or Screening Table, Bedside, Improvised Sep 170 Process Pusan Jul in 126 Table, Operating, Portable, Improvised .... Jun 104 Medical Tent Section, GHQ, Preparing Supple- Liners, Salvage and Replacement ...*.. May 88 mentary Issue of Surgeon’s Circular Term Echelon Dropped as Applied to Medi- Letter Aug 156 cal Service Jun 103 Medical Section, GHQ, Moves Deo 241 New Course in Clinical Psychology Jan 2 Terminology, Non-Battle Casualty Nov 230 Norwegian MASH Reaches FEC Jun 102 Thialand Medioal Teams Train for Air Nursing Care of Korean PsW Feb 24 Evacuation Jan 2

Opthalmic Pathology Course Mar 47 Three Months in Korea with 8055th MASH ....Jan 4 Oxygen Unit Adapted for Litter Use ...... Jul 129 Train, Hospital, Removes Wounded in North Preventive Medicine, Military, in Korea ...May 81 Korea Oct 197 Public Health Program, General Simmons Training, AMEDS Personnel, Civilian Surveys Jun 102 Educational Institutions Apr 62 Public Health and Welfare, SCAP, Discon- UNCACK Observes First Anniversary of tinued Jul 121 Korean Operations Nov 223 Publication, Preventive Medioine, Reprints Veterinary, Reclassification of Certain of Dec 239 Products Apr 64 Purple Heart, Award of Sep 165 Veterinary Treatment, Rates of Charge for.. Sep 167 Quartermaster Trains Troops Dec 238 Water Purification in Korea Jun 103 Reassignments, Army Medical Service X-Ray, Technical Recommendations for Small Officer Personnel Sep 166 Medical Units Feb 29

INDEX OF TECHNICAL ARTICLES IN SURGEON’S CIRCULAR LETTERS - 1951

Issue Page

Anaesthesia, Notes on Use of in FEC Apr 65 Granuloma Inguinale, Aureomyoihx Treatment Antibiotic Therapy Feb 35 of Feb 35 Asthma Sep 180 Hepatitis Commission, Information to Assist Sep 179 Backache Jill 131 Histopathology Study Sets May 98 Barbiturio Acid Derivative Poisonings, Hospital, MASH, Activities of (Extract Treatment of Apr 72 Annual Report 1950) Mar 54 Notes Immunization Battle Casualties, on Care of Jan 8 and Poliomyelitis ...... Aug 160

Blood, Whole, Preserved, Use of ...... Jun 112 Immunization Requirements, FEC Jul 133 Boards, Certificates and Psychiatric Influenza Jan 7 Reports Sep 184 Influenza Nov 234 Burns Jan 14 Lesions, Penile, Management of in the Cardiac Patient, Role of Physician in Field Aug 161 Education of Jun 115 Malaria in Korea ...... Jun 109 Chancroid Jul 143 Maxillo-facial War Wounds, Emergency Treatment of Chest Injuries, Emergency Management of ... May 95 Jan 13 Chlorination, Water Oct 203 Mitral Stenosis, Surgery of Oct 215 Convalescent Hospital, Experiences in Neuropsychiatric Service, Field Hospital •• Mar 49 Operation of Nov 232 Obesity Jan 7 Cyst, Brachial Cleft, A Case Report Jul 146 Obstetrics, Medical Problems in Feb 31 Debridement, Past and Present Mar 52 Pancreatitis, Acute Nov 231 Dental Materials, Notes on Jul 145 Pentothal, Notes on Feb 36 Dental Materials, Notes on Jun 111 Poliomyelitis and Immunization Aug 160 Diet, Reduoing Jan 10 Preventive Medicine, Outline of Publica- Diseases, Department of Virus and tions Pertinent to Oct 205 Rickettsial Deo 246 Psychiatric Problems in the FEC, Orienta- Dyscrasias, Acute Blood Sep 175 tion to Jul 141 Encephalitis, Japanese "B" Apr 73 Juncture, Femoral, Clinical Use of May 90 Epilepsy, Grand Mai, Comments on Oct 201 Research in the Field, Problems for Erythema Multiforme and Its Variants May 94 Study by Sep 176 Evaluation, Medical, Non-Effective Soldier. Apr 74 Respiration, Artificial Feb 36 Evacuation, Medical, and Gain in Illness... Jan 16 Respiration, Artificial, Amended Doctrine Exhaustion, Combat Jun 106 For Procedures Deo 242 Frostbite, Treatment of Feb 30 Schistosomiasis Japonica in the Far East... Jun 118

Frostbite Oct 198 Schistosomiasis Japonica in Japan ...... Jun 116 Gingivitis, Acute, Necrotic, Ulcerative Smallpox, Hemotological Changes in Sep 179

(Vincent’s Infection) Oct 209 Surgery, Psychological Aspects of ...... Sep 172

253

Syndrome, Loeffler's Aug 157 HUNTER, George W., III, Col., MSC a MASH. Jun Thoracic Wounds, Experiences within 110 Schistosomiasis Japonica in Japan ....Jin 116 Transfusions, Rapid Intravenous and Schistosomiasis Japonica in the Arterial, Improvised Pump for 162 Par East Jun 118 Transfusion, Arterial, in a MASH Jul 139 HYMAN, Julian B., Lt (jg) US® Tubes, (Screw-capped), Bacteriological Hemotological Changes in Smallpox Sep 179 Use of Sep 180 JETLAND, Robert L., Maj., MSC May 91 War Wounds, Secondary Closures of ...... Improvised Bedside Table Sep 170 War Wounds, Secondary Closure of, KIRKHAM, Dunham, Lt. Col., MC Statistical Analysis of Oct 212 Acute Blood Dyscrasias Sep 175 Wound, Gunshot, Abdomen, with Multiple KUHL, Ivan 17., Capt, MC Complications Mar 57 Management of Penile Lesions in the Field Aug 161

CONTRIBUTORS TO SURGEON’S CIRCULAR LETTERS - 1951 KOLANSKY, Harold, Capt., MC Neuropsychiatric Service, Field Issue Page Hospital (Co-Author) Mar 49 LaCONTE, Phyllis M., Capt., ANC ALTSHULER, Louis N., Lt.Col., MC Three Months in Korea with the 8055th Chancroid Jul 143 MASH (Co-Author) Jan 4 AMATO, Vincent J., Lt. Col., MC LENTZ, Alice A., Capt,ANC Medioal Regulating Officer or Screen- Educational Program of the Army ftirse Corps ing Process in Pusan Jul 126 May 83 ANGELICH, Phyllis M., Capt., ANC LYNCH, Charles L., Capt., MC Case Report of a Brachial Cleft Three Months in Korea with the 8065th A MASH (Co-Author) Jan 4 Cyst Jul 146 MINERVA, F. D., Lt. Col., MC BLANCHARD, Gerald E., Maj., MC Eighth Army Medical Service in Korea Experiences with Thoracic Wounds in and the Prisoners of War Hospital .... Jun 113 a MASH Jun 110 OTT, Harold G., Col., DC BOLIBAUGH, Oral B., Col., MC Notes on Dental Materials •••.. Jun 111 Debridement, Past and Present Mar 52 Notes on Dental Materials Jul 145 Raymond Sgt, AMEDS BOYD, A., Donald MC Improvised Portable Operating Table PETERSON, B., Col., Comments on Grand Mai Epilepsy ...... Oct 201 (Co-Author) Jun 104 Boards, Certificates and Psychiatric BROWN, Ralph E., Maj., MC Reports Sep 184 Clinical Use of Femoral Puncture .....May 90 PLOWMAN, Floyd C., Lt. Col., MSC CHARDACK, William M., Capt., MC Notes on Management Improvement...... Aug 154 Improvised Pump for Rapid Intra- The Hospital Command Team Jul 129 venous and Arterial Transfusions ..... Aug 162 Management of Fixed Hospitals Mar CIEVE, Edward A., Col., MC 42 Sep 180 POLLOCK, Jack P., Maj., DC Asthma Emergency Treatment of Maxillo- Bachache (Co-Author) Jul 131 faoial War Wounds ...... Jan 13 COIE, Richard K., Capt., MC Military Dentistry as a Career 152 Neuropsychiatric Service, Field Aug POWELL, G. M., Col., MC Hospital (Co-Author) ...... Mar 49 Acute Pancreatitis Nov 231 COOCH, Joseph W., Maj., MC F. MC Experiences In The Operation of HUJITT, W., Col., a Medical Problems in Obstetrics Feb 31 Nov 232 Convalescent Hosoital Obesity Jan 7 CORNELIUS, Rex, WOJG, ‘USA Erythema Multiforme and Its Variants.. May 94 ...... Nov Improvised Paper Cup Dispenser 230 of Deriva- MC Treatment Barbituric Acid DODGE, Philip R., Capt, tive Poisonings Apr 72 Backache (Co-Author) Jul 131 REINERS, Charles R., Capt., MC Laurence MD ELLIS, B., Improvised Pump for Rapid Intravenous of Oct 215 Surgery Mitral Stenosis and Arterial Transfusions (Co-Author). Aug 162 Lt Col, MC FISHER, David, RITCHIE, L. S. Statistical Analysis of Secondary Schistosomiasis Japonica in the Far of War Vfounds ...... Oot 212 Closures East (Co-Author) Jun 118 Closure War Wounds ...... May 91 Secondary of Schistosomiasis Japonica in MC Japan GLASS, Albert J., Col., (Co-Author) Jun 116 of Non-effective Medical Evaluation Capt., MC Apr 74 SAWYER, Howard P., Soldiers Arterial Transfusion in a MASH Jul 139 Orientation to Psyohiatric Problems Grayson, Capt., MSC in the FEC Jul 141 SMITH, Medical Service Specialist School, Combat Exhaustion Jun 106 FEC Aug 153 and Gain in Medical Evacuation Capt., MC Jan 16 SOLOMON, Robert, Illness Improvised Portable Operating Table

(Co-Author) ...... Jun 104 GREGORY, Lloyd, Capt., MC SUMNER, Charles F., 1st Lt., DC Loeffler's Syndrome Aug 157 Acute, Neorotio, Uloerative Gingi- GUILLAUDEU, Robert L., Capt., MC vitis (Vincent's Infection) ...... Oct 209 Aureomycin Treatment of Granuloma THOMAS, Ralph G., Maj., MC Inguinale Feb 35 Gunshot Wounds of the Abdomen with HAGMAN, Frank E., Col., MC Multiple Complications Mar 57 Notes on Use of Anaesthesia in FEC.... Apr 65 VALLE, A. R., Maj., MC Problems for Study by Research in Emergency Management of Chest 176 the Field Sep Injuries •••••.••••••• May 95 Notes on the Care of Battle WEIDBNKOFF, Stanley J., Lt. Col., MSC Casualties Jan 8 Water Chlorination Oot 203

22057—FEC P&PC—1/52—2.7M The Chief Surgeon extends an invitation to all Far East Command medical personnel of the U. S. Army, Navy and Air Force, or of the United Nations, to prepare and forward with view to publication, articles of professional or administrative nature. It is assumed that editorial privilege is granted unless author states otherwise.

Capt# Charles A* Copeland, MSC EDITOR