APPENDIX A
Organization and Operation of the Board for the Study of the Severely Wounded
North African (later Mediterranean) Theater of Operations, U.S.A.
ORGANIZATION
The background of events and observations leading to recognition of the need for an organized study of the severely wounded in an active theater of war has been described in the Introduction to this volume. The Chief Surgeon, North African Theater of Operations, Maj. General Morrison C. Stayer, U.S.A., discussed this problem with two members of his staff, Colonel Edward D. Churchill, MC, Surgical Consultant, and Colonel William S. Stone, MC. On their recommendation he initiated action from which stemmed the Board whose work has been presented in this volume. His memorandum to the Commanding General follows.
HEADQUARTERS
NORTH AFRICAN THEATER OF OPERATIONS
Office of the Surgeon
1 September 1944
SUBJECT: Appointment of Medical Board to Study the Treatment of the Severely Wounded
TO: Quartermaster, Ordnance, G-1, G-4 and AG
1. Outstanding progress in the treatment of the wounded has been made by the Medical Service in this theater. Many lives have been saved by this work and many individuals that would have been hopeless wrecks, if they survived, have been rehabilitated into normal or near normal individuals. Further progress in improving the Medical Service will depend upon proper and timely employment of the
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skilled and experienced medical personnel present in the theater. There are several urgent problems that should have additional study if a progressive medical service is to be maintained. On the Surgical Service, there is increasing evidence that the recovery of some of the severely wounded is handicapped by renal lesions that complicate treatment or are sequelae of the original injury. In addition, there have been some observations made on wounded troops that a clinical condition which has been labeled pulmonary edema is frequently encountered. Because of the above it is considered desirable that the whole problem of resuscitation of wounded be critically studied by competent, experienced clinicians and that the results of this work be made available to the Medical Service of this and other theaters.
2. It is therefore requested that a Board be appointed by the Commanding General, NATOUSA, for the study of designated phases of the treatment of the severely wounded, the Board to operate directly under the Surgeon, NATOUSA, who will be responsible for the administration and supervision of the technical and professional details of the Board`s work.
a. The Board will be made up of the following personnel:
MEDICAL PERSONNEL
Lt. Col. Tracy B. Mallory, O-518569-15th Medical Gen. Lab.
Lt. Col. F. A. Simeone, O-400993-Surgeon`s Office, NATOUSA
Lt. Col. H. K. Beecher, O-526881-Surgeon`s Office, NATOUSA
Major E. R. Sullivan, O-398217-6th General Hospital
Captain C. H. Burnett, O-356977-94th Evacuation Hospital
CHEMISTS
Captain S. L. Shapiro, O-509728-15th Medical Gen. Lab.
NURSES
2nd Lt. Gladys E. Maroon, N-742599-21st General Hospital
2nd Lt. Helen G. Woodman, N-741233-21st General Hospital
OFFICER Branch Immaterial (may be limited service).
One (1) Lieutenant or Captain. Request that temporary detail be made from Replacement Pool.
ENLISTED PERSONNEL Ten (10)
1 Sergeant-Showstack, Paul J., ASN 31297297-Medical Museum
2 Chemistry Technicians:
-T/4 Babb, Benjamin F., ASN 33521601-15th Med. Gen. Lab.
-T/3 Guin, Carlos F., ASN 18033517-15th Med. Gen. Lab.
1 General Laboratory Technician: 2nd Medical Laboratory
2 Clerks, Typists)
4 Enlisted Men ) Qualified as drivers, tent handlers, general utilities, etc.
To be obtained on Temporary Duty from Replacement Pool.
TRANSPORTATION
2 C & R Cars
1 1½-ton personnel carrier truck
1 Mobile Laboratory (complete with equipment and supplies (as defined by the Board) to be obtained from the 15th Med. Gen. Lab.)
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TENTAGE Seven (7) Pyramidal Tents
3. Personnel involved will be on a temporary duty status while assigned to the Board and will be relieved of all other duties whileso assigned. Upon completion of their work, the Board will render a report of their findings and recommendations to the Surgeon, NATOUSA. Progressreports will also be made when findings would indicate that immediate advantage should be taken of the scientific data obtained by the Board.
4. If requested by the Board, all Medical Installations coming under the jurisdiction of this Headquarters will, in every way possible,aid the Board in its work.
5. Medical supplies and equipment not obtainable at units where the Board is functioning, will be furnished, as requested by theBoard, from Medical depot stocks on 90-day shipping ticket. All supplies, equipment and transportation to be returned to proper organization or depotupon completion of temporary duty.
6. Verbal concurrence has been obtained from all other Headquarters and units involved.
For the SURGEON:
E. STANDLEE, Colonel, MC
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Lt. General Jacob B. Devers, Commanding General, North African Theater of Operations, recognizing that lives might be saved by means of such a study, gave his immediate support to the project. Only two days after the date of the original memorandum from his Chief Surgeon, he published the following order establishing the Medical Board to Study the Treatment of the Severely Wounded. (This title was later commonly abbreviated to the Board for the Study of the Severely Wounded.) The Board was made directly responsible to the Chief Surgeon of the Theater.
HEADQUARTERS
NORTH AFRICAN THEATER OF OPERATIONS
UNITED STATES ARMY
3 September 1944
SUBJECT: Appointment of Medical Board to Study the Treatment of the Severely Wounded
TO: All Concerned
1. A Board of Officers, consisting of the following officers:
LT COL TRACY B. MALLORY O-518569 MC 15th Medical General Laboratory
LT COL FIORINDO A. SIMEONE O-400993 MC Medical Section, AFHQ
LT COL HENRY K. BEECHER O-526881 MC Medical Section, AFHQ
MAJOR EUGENE R. SULLIVAN O-398217 MC 6th Gen Hosp on T/D Med Sec, AFHQ
CAPT CHARLES H. BURNETT O-356977 MC 94th Evac Hosp, Semi mobile
CAPT S. L. SHAPIRO O-509728 SnC 15th Medical General Laboratory
2nd LT GLADYS E. MAROON N-742599 ANC 21st General Hospital
2nd LT HELEN G. WOODMAN N-741233 ANC 21st General Hospital
is appointed for the study of designated phases of the treatment of the severely wounded. Officers involved will be on a temporary duty status while assigned to the Board and will be relieved of all other duties while so assigned.
2. The Board will operate directly under the Surgeon, NATOUSA, who will be responsible for the administration and supervision of the technical and professional details of the work of the Board. Upon completion of work, the Board will render a report of their findings and recommendations to the Surgeon, NATOUSA.
By command of Lieutenant General DEVERS:
R. E. LINES, Captain, AGD
Asst. Adj. Gen.
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PERSONNEL AND EQUIPMENT
In addition to the members of the Board, the nucleus of which consisted of those officers who had already been working both individually and asa team on various preliminary studies, a sizable group of full-time technical and administrative assistants was found necessary and was attached to the Board on temporary duty. First Lieutenant William H. McMahon, INF, of the 7th Replacement Depot served for a short time as administrative officer. Captain Louis D. Smith, SnC, who had been working with the Board from the beginning, was formally assigned to the Board in December.
The two nurses originally assigned to the Board, Second Lieutenants Gladys E. Maroon, ANC, and Helen G. Woodman, ANC, 21st General Hospital, were succeeded by Second Lieutenants Rose C. McDonnell and Marguerite V. Cronin, ANC, 6th General Hospital, who later were succeeded by First Lieutenants Florence L. Giberti and Phyllis G. Madden, ANC. Also attached to the Board were Second Lieutenant (then T/Sgt.) Louis Breslow, MAC, and Sergeant Paul J. Showstack, 3d Medical Detachment, Museum and Medical Art Service, the former as documentary artist and the latter as photographer.
The following enlisted laboratory technicians were assigned to duty with the Board: T/3 Carlos F. Guin, Jr. and T/4 Benjamin F. Babb, of the15th Medical General Laboratory; Pfc. Earl R. Zea, Pfc. George L. Williams, Pfc. James A. Donaldson, and Pvts. Clyette S. Alligood, Donald M. Campbell, and Walter C. Huhn, Jr., all of the 7th Replacement Depot. T/Sgt. Carl A. Sauget, T/Sgt. Anthony N. Ashute (later replaced by T/3 Edwin A. Rooney),and T/4 Billy D. Ashley (replacing Sgt. Guin) were later added to the enlisted personnel. Sergeant Babb was chief medical technician.
Basic equipment available was as listed in the original memorandum from the Chief Surgeon. Supplies and equipment not obtainable at units where the Board was functioning were to be furnished from depot stocks on a 90-daybasis. In addition, arrangements were made for a continuous supply of distilled water and standard solutions, and for replacements of supplies and expendable laboratory equipment from the 15th Medical General Laboratory via the "blood-plane"(a plane placed at the disposal of the 6713th Blood Transfusion Unit to forward blood from the base section bleeding unit to the advance distributing unit). It was planned to set up as much laboratory equipment as possible in a tent. Since, however, some delicate apparatus might be inadequately protected under canvas, the mobile laboratory truck of the 15th Laboratory was
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placed at the Board`s disposal. Details of the organization and operation of the field laboratory appear in Appendix B.
DEFINITION OF OBJECTIVES
After discussion among Board members in consultation with Colonel Churchill and Colonel Stone, it was agreed that the major problems for investigation should be: (1) Physiologic and metabolic studies of the severely wounded;(2) adequacy of shock resuscitation therapy; (3) possible hazards of transfusion with type O blood, and (4) the mechanism of renal insufficiency following resuscitation from shock. The investigative program of the Board, although developed along diversified and varied lines, remained focused on these primary broad objectives.
MANNER OF OPERATION
It was evident that the objectives of the study as defined could be approached only by selection of a base of operations which would meet all of several essential requirements: 1. Facilities for rationing, housing, and other administrative support of the Board. 2. Access to an adequate number of severely wounded men. 3. Observation of the severely wounded at the earliest possible time after wounding but under such circumstances that patients included in the study normally would remain available for observation through the period of resuscitation (including surgery) and at least the immediate postoperative phase of treatment. 4. Utilization of an installation in the established chain of evacuation, thereby avoiding establishment of special facilities. Obviously aid stations, collecting stations, and clearing stations met only the second of these requirements. General hospitals failed to meet either the second or third. Forward hospitals, i. e., either evacuation or field hospitals as employed in the combat zone in Italy, satisfied the general requirements. The size of the research unit, however, precluded attachment to a platoon of a field hospital. It was not too great for an evacuation hospital and selection of a base was thus determined.
On 19 September 1944, therefore, with equipment loaded on a 2½-tontruck, two Command and Reconnaissance cars and the overload transported by the "blood plane," the personnel of the Board reported to Fifth Army Headquarters and proceeded to the 94th Evacuation Hospital at Pratalino, a few miles north of Florence, Italy. During the greater part of the 8-month period of the study
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(September 1944 to May 1945) the Board remained with this hospital. For a 2-month period it was attached to the 24th General Hospital, and during that time two members of the Board alternated at B platoon of the32nd Field Hospital while another was making biochemic tests at the 8th Evacuation Hospital. This was at the time of the push of the 10th Mountain Division, and illustrates one method by which extensive data were obtained on casualties in several areas during periods of maximum military activity.
A system of study gradually evolved as work poured in. The hospital provided a special ward tent in which all patients under study were concentrated following operation. The Board supplied the nursing service, but primary responsibility for professional care remained in the hands of the hospital staff. The clinical members of the Board supervised the study ward and looked over new admissions to the hospital shock ward to select cases suitable for study. Liaison was rapidly established with nearby field and evacuation hospitals whose staffs kept the Board informed of cases appropriate for inclusion in the main study. Daily trips were made by two or more members of the Board to many of these hospitals to examine patients, record intakes and outputs, keep follow-up notes, copy histories, pick up blood and urine specimens, and occasionally take part in necropsies. Suitable clinical cases were abundant and the laboratory was often hard pressed to keep up with material.
The Board functioned in a close and unified manner, with all members contributing to the whole task. Individual members assumed responsibility for various phases of the work. Lt. Colonel Mallory, who acted as chairman of the Board, was in charge of the pathologic aspects of the work and directed the laboratory. He made numerous postmortem examinations, supervised others, and from time to time took the accumulated material back to the 15th General Laboratory for histologic study. Lt. Colonel Simeone was primarily responsible for determinations of blood volume, as well as cardiovascular findings. Lt. Colonel Beecher was responsible for the liver function studies, and, with Lt. Colonel Simeone, for almost all the admission blood volume data. He was collator of the final report. Lt. Colonel Sullivan was in charge of hematologic aspects and, with Captain Smith, made the studies of blood groups and isoagglutinins, and worked with Lt. Colonel Mallory on some of the pathologic studies, particularly on pigment. Major Burnett carried out the kidney function studies and directed, with Lt. Colonel Simeone, the postoperative therapy and the collection of biochemic data. Captain Smith handled bacteriologic prob-
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lems. Captain Shapiro was in charge of laboratory work and collaborated in the preparation of the biochemic data.
All medical installations within the Theater had been directed to aid the Board in its work, and everywhere the Board met whole-hearted cooperation. Since it was not administratively self-contained, the Board and its ancillary personnel were dependent on the various hospitals to which they were attached for quarters, rations, standard supplies, and other administrative essentials, including transportation beyond that immediately available. (As stated previously, special supplies were obtained from the 15th General Laboratory.)In addition, a high degree of professional cooperation was essential in selecting cases for special study and making them available for such study without interference with required treatment which remained the responsibility of the hospital staff.
DISSEMINATION OF PROGRESS REPORTS
It was recognized that observations and tentative conclusions based on the Board`s work should be disseminated as promptly and widely as possible. This policy would have the double advantage of making significant findings available for immediate general application and of facilitating the Board`s work as the result of understanding and interest on the part of the medical staffs from whom cooperative effort might be required. Therefore from time to time, findings were published in the Theater medical bulletin, discussed at medical meetings in the Theater, and circulated throughout other theaters and through The Surgeon General`s Office by means of Essential Technical Medical Data reports. Personal contacts, however, were probably the most rapid and effective means for widespread dissemination of reports of the progress of the Board`s work. For example, the 2d Auxiliary Surgical Group, attached to a hospital where the Board was working, split up in the fall of 1944 and one-half went to the support of the Seventh Army invading Southern France. The group in the European Theater kept in close contact with the Mediterranean group, through which reports of the study were received and disseminated as various phases were developed.
