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Early in the World War II, the Surgical Consultants` Division, Office of The Surgeon General, realized that some sort of standardized care and treatment of battle casualties had to be developed for implementation throughout the Medical Department. It was critical that as casualties moved down the chain of evacuation that physicians and surgeons knew how the patients had already been treated. Much of this work fell to then Lt. Col. Michael DeBakey, MC, a member of the Surgical Consultants` Division and today world-famous surgeon. DeBakey was instrumental in crafting various Circular Letters and War Department Technical Bulletins Medical (TB Meds) that were distributed to all Medical Department organizations and Medical Corps officers.

Circular Letters from the Surgeon General`s Office had been used for many years to provide information and guidance on the proper methods and procedures for surgical and medical care of sick and wounded soldiers. They were often transitory in nature and not intended to provide guidance such as that contained in Army Regulations (ARs), Field Manuals (FMs),or Technical Manuals (TMs). They were a quick way of disseminating information throughout the Medical Department.

The initial effort of The Surgeon General`s Office to standardize treatment of battle casualties came with the distribution of Circular Letter 178, "Care of the wounded in theaters of operation," 23 October 1943. Mainly derived from surgical experiences in the North African and Mediterranean Theaters of Operations and the various Pacific theaters to date, CL 178 laid out the procedures that were to be followed in handling various types of casualties. As much more experience was gained with more extensive combat operations and large casualty flows after the invasion of Europe on 6 June 1944, DeBakey drew heavily on the efforts in the Fifth U.S. Army and Mediterranean Theater of Operations where standardization of procedures for handling combat casualties was the most advanced. In March 1945,largely through DeBakey`s efforts the War Department Technical Bulletin Medical(TB Med) 147, "Notes on the Care of Battle Casualties," was issued for worldwide distribution.  The new TB Med 147 rescinded CL 178 and provided a much more comprehensive approach to care and treatment of battle casualties.  TB Med 147 was only slightly modified in 1947 and remained in effect during the opening year of the Korean War. On 22 June 1951, a newly revised TB Med 147, "Management of Battle Casualties," based on the experience of the Korean War and developments in medical and surgical care since1945 was issued that rescinded the former version.

SGO Circular Letter 178,"Care of the wounded in theaters of operation," 23 October 1943.

War Department Technical Bulletin Medical (TB Med) 147, "Notes on the Care of Battle Casualties," March 1945.

John Greenwood, Ph.D.
Chief, Office of Medical History
Office of The Surgeon General, U.S. Army
Falls Church, Virginia