EUROPEAN THEATER OF OPERATIONS
UNITED STATES ARMYOffice of the Chief Surgeon8 DECEMBER 1944CIRCULAR LETTER NO. 142GUIDANCE TO DISPOSITION BOARDS* * * * * * *
2. Attention is invited to Circular Letter No. 124, thisoffice, subject, "Evacuation of Patients to the Zone of Interior,"dated 17 October 1944. In the event that there is an insufficient number of120-day cases to fill lift provided, enough cases will be selected which would fallwithin a 90-day evacuation policy to make up the deficit.
3. The decision as to disposition should bemade as soon after the patient reaches a hospital as possible; i.e., when a diagnosis ismade. Hospitals have been lax in this relation and must expedite evacuation.Further guidance, chiefly relating to fractures of long bones, is outlined inCircular Letter No. 131, this office, subject, "Care of BattleCasualties," dated 8 November 1944.
4. The following list of medical and surgicalconditions is published for the guidance of Hospital Disposition Boards. Itis to be remembered that this list is to be used only as a guide, each caseto be decided on its individual merits.
a. Medical Conditions: * * *
b. Surgical conditions. The following list ofsurgicalconditions demand return of personnel to hospitalization in the Zone ofInterior.
(1) Maxillo-facial, plastic and burn cases.
(a) Severe maxillo-facial injuries associatedwith loss oftissue, which will require long-term reconstructive plastic surgery.
(b) Extensive loss of oral tissue in an amount thatwould prevent replacement of missing teeth by a satisfactory denture.
(c) Malignancies about face or mouth whichwill requireextensive surgical treatment.
(d) Deep, extensive burns of the hands and face andextensive burns of other parts of the body.
(e) Wounds of other parts of the body whichwill requireextensive plastic surgical procedures for correction.
(f) Severe compound, comminuted fractures of mandible ormaxilla, with or without loss of bony substance.
(g) Patients with deforming but not disabling injuries inwhom plastic repair should not be done within the 90-day period.
(2) Ophthalmic cases
(a) Those cases (officers) covered by AR 40-105, par. 9, 14Oct. 1942.
(b) Those cases covered by MR 1-9, par. 18, 15 Oct.1942,except "g," also changes 22 Jan. 1943.
(c) Retinitis, pigmentosa, organic night blindness.
(3) Neurosurgical cases
(a) All cranio-cerebral injuries in which there has beengross injury to brain tissue, as in penetrating wound of the head and compoundcomminuted fracture of the skull, with indriven bone.
(b) All injuries to major motor peripheral nerves.(Disposition of VIIth [sic] Cranial nerve injuries should be decided accordingto the severity of the disability.)
(c) Tumors of the brain or spinal cord.
(d) Cases of chronic low backache associated with sciaticnerve pain, and accompanied by objective neurological signs. Exceptions may bemade in officers occupying key administrative positions and noncommissionedofficers with special skills.
(4) Orthopedic cases
(a) All compound fractures of upper and lower extremitiesinvolving major joints, or where the infection incident to compounding will not permit solid bony union to occur in four months, orwhere the healing willcause enough scar tissue formation in the overlying soft tissue to interferematerially with the function of the extremity. This in general will involvecompound fractures of humerus, radius and ulna, femur, tibia, and extensiveinjuries of carpal and tarsal bones, shoulder, elbow, wrist, hip, knee andankle joints. Possible exceptions may be made in certain selected instances ofcompounding forces resulting from clean, high velocity missiles where thecontinuity of the shaft of the bone has not been extensively disturbed.
(b) Simple fractures of femur and tibia, where thecontinuity of the shaft has been completely broken.
(c) Extensive compression fractures of vertebrae withor without dislocation.
(d) Osteoarthritis of joints with disability.
(5) General surgical cases
(a) All cases of proven malignant disease (pre- orpost-operative) except those of the integument which seem capable of completelocal removal. (Exceptions may be made where surgical excision offers hope ofcure and the patient desires to remain in the ETO.)
(b) Perforated gastric and duodenal ulcer.
(c) All complicated cases of cholelithiasis.
(d) Large recurrent postoperative hernias.
(e) Abscess of lung, unless acute and making rapid recoveryfollowing operation.
(f) Established vascular disease, such as Raynand'sSyndrome, thromboangiitis obliterans, serious thrombophlebitis with edema andcases with frostbite, immersion foot and trenchfoot in which there isdemonstrable severe organic disease.
(6) Genito-urinary cases
(a) All cases of malignant disease except solitarypapillomaof urinary bladder.
1. Diseases or injury requiring plastic operation of the kidney pelvis.
2. Bilateral renal disease-calculi-hydronephrosis.
(c) Ureter. Disease or injury requiring secondary or lateplastic repair.
(d) Bladder. Neurogenic bladder without definite improvementin 1 month.
(e) Prostate hyperplasia causing symptoms incompatible withduty.
(f) Urethra and external genitalia. Wounds and injuriesrequiring extensive plastic procedures.
(7) Otolaryngological cases.
(a) Hearing loss below a level which makes a patientincompetent for all military duty.
(b) Chronic polypoid sinusitis, with severe symptoms
(c) Allergic rhinitis (severe)
(d) Chronic suppurative otitis media and mastoiditis which requiresradical mastoidectomy.
(e) Permanent tracheotomy.
(f) Destructive deformities interfering with mastication,speech and breathing.
By order of the Chief Surgeon:
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H. W. Doan
H. W. DOAN
Colonel, Medical Corps,