APPENDIX D
Survey of Case Records
COMPOSITION OF GROUP
The 186 patients studied, the majority of them American infantrymen, were largely battle casualties classified under U. S. Army policy as "wounded in action" (WIA). Wounds were inflicted by gunshot, bullet, shell fragmentation, grenade, mine explosion, and collapse of buildings. In addition, there were two patients seriously injured in truck accidents, one in a plane crash, one in a tent fire, and three who had been accidentally shot or stabbed. Two medical cases were included for comparison of renal lesions. Six patients were civilians wounded during combat, and 13 were wounded German prisoners of war. The term "severely wounded" (nontransportable wounded or injured patients) has been used to designate the entire group because the distinctions between those wounded by direct enemy action, by other agent, or injured accidentally are military ones, and because the causative agent was not a significant factor in any phase of this report.
DEATH RATES
Of the 186 patients studied, 65 died, a case fatality rate of 35 percent. With few exceptions, these deaths all occurred in the forward hospitals. It was impossible in most instances for the Board to follow a case once the patient had left the forward area, so the death rate applies only to the evacuation or field hospital level (field hospital as it operated in the Mediterranean Theater of Operations). The death rate of these seriously wounded was approximately double that of the field hospital average death rate, which included all wounded, at the time this study was being made.
Fifty, or nearly 70 percent, of the 73 patients with high azotemia included in the study died, and of these 73 patients, uremia appeared to be the major cause of death in thirty-five. The importance of uremia as a cause of death
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in the severely wounded is evident when the number dying of this complication is compared with the total number of severely wounded. Of the 35 patients dying of uremia, 32 were battle casualties. Since it was estimated that there were, during the period of this study, between 201 and 252 severely wounded men among the 10,073 battle casualties admitted to forward hospitals in the area where the study was conducted, it is apparent that at least14 to 17 percent of the severely wounded were dying of uremia.
CLASSIFICATION OF CASE RECORDS
A table in which the cases have been classified so that they may be readily located according to various aspects of the study follows. Cases10, 46, 59, and 94 were discarded because data were inadequate; hence the omission of these numbers between Cases 1 and 150.
The "A" series (A-1 through A-40) represent a group in which attention was focused primarily on blood-volume data. For these data to have significance, a large number of determinations was needed. Therefore a temporary branch of the Board`s activities was established in a field hospital during a period of heavy combat activity in the vicinity. All pertinent data possible were obtained on these patients at the time of their entry to this forward hospital but, with the exception of a few cases and of outcome, no follow-up studies were made by us, and no intake-output records were kept on these cases. Therefore the A series records are, for the most part, very brief. Two patients of this group died.
Résumés of the case records on which the study is based are on file in the Treadwell Library, Massachusetts General Hospital, Boston, Massachusetts.
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