APPENDIX A
Circular Letters, Mediterranean Theater
Instructions and other information on blood transfusion and allied subjectsappeared in the following circular letters from the Office of the Surgeon,Headquarters, NATOUSA (North African (later Mediterranean) Theater ofOperations, U.S. Army):
5 April 1943-Letter No. 8, on the treatment of burns,outlined the treatment of shock and provided for plasma therapy and for thelater use of blood to combat secondary anemia (1).
15 May l943-Letter No. 13, on forward surgery (2), providedthe information on blood donors which later appeared in Letter No. 3, Office ofthe Surgeon, Headquarters, II Corps, 7 August 1943 (3) (p. 422).
20 August 1943-Letter No. 27, on the donation of blood fortransfusion and other purposes, provided for payment of donors (4) (p. 423).
12 May 1944-Letter No. 30, on blood transfusions (5), dealtwith the establishment of blood banks at field, evacuation, general, and stationhospitals, with a transfusion officer responsible for the administration of eachbank; the provision of blood from a theater bank; the administration of blood:the indications for transfusion; requirements for donors; dating ofblood; reactions; and payment of donors. In this letter, it was stated that theRh factor had no practical importance in forward areas.
10 March l945-Letter No. 8, on the care of battle casualties (6),was concerned with initial wound surgery and mentioned resuscitation, withplasma and blood transfusions, only in passing.
The following medical circulars and circular letter were issued from theOffice of the Surgeon, Headquarters, Fifth U.S. Army, NATOUSA:
22 April 1944-Medical Circular No. 7, stated that group O bloodwould be provided for all the needs of field hospitals at all times (7). Bloodwould also be provided for evacuation hospitals in periods of great activity;otherwise, these hospitals must procure and process their own blood. Directionswere given for collecting and administering the blood, and criteria for donorswere outlined.
6 May 1944-Medical Circular No. 10 (8) was prepared butnot issued. It dealt with the hemoglobinuria nephroses which had followed theuse of group O blood in group A recipients and the decision in the future tosupply group A blood for group A recipients. The urgent necessity for groupingand crossmatching these bloods was emphasized. Since this decision wasoverruled, this circular was not issued.
Circular Letter No. 3, issued on 7 August 1943 (3), has already beenmentioned. It dealt with the care of the wounded in Sicily. Section III, onshock, stated that plasma was "unquestionably the most effective weapon incombating shock," but directed that, when hemorrhage was the major factor,whole blood was to be used, in adequate quantities, as soon as crossmatchingwould be completed.
References
1. Circular Letter No. 8, Office of the Surgeon, Headquarters, NATOUSA,5 Apr.1943, subject: The Treatment of Burns.
2. Circular Letter No. 13, Office of the Surgeon, Headquarters, NATOUSA, 15 May1943, subject: Memoranda on Forward Surgery.
3. Circular Letter No. 3, Office of the Surgeon, Headquarters,II Corps, 7Aug. 1943, subject: Care of the Wounded in Sicily.
4. Circular Letter No. 27, Office of the Surgeon, Headquarters NATOIJSA, 20Aug. 1943, subject: Donation of Blood for Transfusion and Other Purposes. Act, 30July 1941 (Public Law 196, 77th Cong.).
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5. Circular Letter No. 30, Office of the Surgeon, Headquarters, NATOUSA, 12May 1944, subject: Blood Transfusions.
6. Circular Letter No. 8, Office of the Surgeon, Headquarters, MediterraneanTheater of Operations, U.S. Army, 10 May 1945, subject: Notes on the Care ofBattle Casualties.
7. Medical Circular No. 7, Office of the Surgeon, Headquarters, Fifth U.S.Army, 22 Apr. 1944, subject: Blood Transfusions (paragraph II).
8. Medical Circular No. 10, Office of the Surgeon, Headquarters, Fifth U.S.Army, 6 May 1944, subject: Blood Transfusions.
