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NavMed 369 



RESTRICTED 




Editor. - Comdr. F. R. Bailey, (mc) u. s, n. r. 



Vol. 5 Friday, March 16, 1945 - No. 6 



TABLE OF CONTENTS 



Yaws, Penicillin in 1 

Weil's Disease, Penicillin in 3 

Oxygen Poisoning 3 

Rations: Nutritional Value 7 

Food Intake of Patients 8 

Potatoes: Loss of Vitamins ....8 

Chemotherapy Guide 8 

Pyrogenic Factor in Inflammation. .. . 12 

Pentothal Anesthesia 13 

Bed Rest: Physiological Effects 14 



Meningococci: Culture Methods 15 

Biochemistry of Plasmodia 16 

Sucrose: Rate of Digestion 17 

Amino Acids in Urine. 18 

Protecting Lenses from Fungi 18 

Gas Detector Kit 19 

Air Transportation of Deaf 20 

Serum Albumin 20 

Medical College of South Carolina... 21 
Public Health Foreign Reports 21 



Form Letters: 

BAL in Oil and BAL Ointment in Systemic Poisoning BuMed 22 

Penicillin Therapy of Early and Latent Syphilis BuMed 25 

Alnav 29 - Use of Nupercaine as Anesthetic SecNav 27 

Alnav 36 - Identification of Bodies ' SecNav 27 

Asphyxia Requiring Resuscitative Measures BuMed 28 

Hospital Corpsmen, Assignments and Distribution CircLtr 30 



Penicillin in the Treatment of Yaws: The Medical Department of the Navy 
is conducting on Samoa an investigation of the effectiveness of penicillin in the 
treatment of yaws. A preliminary report of this study, (Burned News Letter, 
Dec. 8, '44), presented evidence that penicillin was effective in yaws, as it is 



Burned News Letter, Vol. 5, No. 6 



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in syphilis, in producing rapid disappearance of the clinical manifestations of 
the disease. At the time this report was made, it was too early in the course 
of the investigation to draw any definite conclusions as to the resultant sero- 
logical changes, but it appeared that following treatment with penicillin there 
was a tendency toward reduction in titer of the positive quantitative Kahn 
reaction. 

A second report has recently been received by the Bureau which concerns 
observations made by the research group on Samoa during a period of about 
three months following the preparation of the preliminary report. 

Twelve more early cases and 15 late cases have been added to the series. 
There are now 37 early and 27 late cases under study. All cases after being 
discharged from the hospital are followed as closely as possible, clinical ex- 
aminations being made and quantitative Kahn tests performed at two-week in- 
tervals . 

The only clinical developments noted, scabies, pustular skin eruptions, 
and abrasions of the skin were apparently not associated either with yaws ,or 
its treatment. 

Up to the time of the recent report there had been no clinical relapse or 
recurrence of yaws in any of the patients treated withpenicillin. Later, however, 
two patients (one early and one late case) developed ulcers in the scars of previous 
yaws lesions. These scars were on the lower extremities and in areas, subject to 
trauma. Each patient was hospitalized, and repeated darkfield examinations 
were made, with negative results. Following rest in bed and simple surgical 
care the ulcers healed. 

In spite of the rapid clinical improvement, the quantitative Kahn tests of 
these patients have not shown a tendency toward early reduction in 
titer of the positive reaction. Indeed, there has been no uniformity in the sero- 
logical pattern. Most patients have had a noticeable reduction in titer only to 
have subsequent tests become more positive. However, the general tendency 
over the period of observation in all cases but one has been toward a reduc- 
tion in titer of the positive reaction. (It is possible that this lack of uniformity 
in the course of the Kahn response may be due to the presence of concomitant 
infections giving rise to false-positive reactions. Ed.) 

It is too early to predict the eventual effect of penicillin on the positive 
Kahn reactions in these patients. It is planned to add cases to the series until 
a total of 60 early and 30 late cases are under observation and to follow them 
with repeated clinical examinations and quantitative Kahn tests over a period 
of about two years. (Research Project X-378 (Gen. 56). Summary of Research 
to Jan. 26, '45; J. K. Gordon) 



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Penicillin in Weil's Disease; The effectiveness of penicillin in the treat- 
ment of guinea pigs infected experimentally with Leptospira icterohemor - 
rhagiae was mentioned in the Burned News Letter of April 14, 1944. Clinical 
trial of penicillin in the therapy of Weil's disease in man has been made in a 
number of instances. A few reports now are available regarding the tr eat - 
ment of small numbers of cases. However, no series is large enough for ade- 
quate appraisal on a basis of controlled studies . 

In a series of five cases reported to the British Medical Research Council, 
penicillin appeared not to be effective. On the other hand, Bulmer has re- 
cently reported (Brit. M. J., Jan. 27, '45) six cases of Weil's disease which 
appeared to be benefited by penicillin. In Buhner's cases penicillin seemed 
to shorten the febrile stage and to diminish the number of febrile relapses. 
As would be expected, it did not influence the degree and duration of the jaun- 
dice or retention of nitrogen, and it did not hasten the disappearance of albumi- 
nuria. It would be expected that if penicillin is to be effective in Weil's dis- 
ease, it must be given early and in adequate dosage in an effort to limit damage 
to the parenchyma of the liver and kidneys. 

In view of the conflicting evidence with regard to the efficacy of penicillin 
in spirochetal jaundice, reports of its use in the therapy of this disease in the 
Navy would be welcomed by the Bureau. 

sft ^ ^ ^ ^ ^ 

1 Oxygen Poisoning : Historical; That oxygen may produce toxic symptoms 
when breathed under increased pressures is not a recent discovery. Paul 
Bert in his classic experiments about 1873 showed that animals placed in a 
closed chamber under pressure with various oxygen concentrations mani- 
fested toxic symptoms terminating in convulsions and death. These symptoms 
came on earlier and with increased severity when the partial pressure of oxy- 
gen was increased. 

The term "oxygen poisoning" itself was proposed by Paul Bert. Since 
his time, particularly recently, considerable research has been done on this 
interesting physiological and pathological effect of oxygen. However, little 
has been added to the original findings and concepts of this ingenious investi- 
gator of over 70 years ago. 

Practical Uses of Oxygen: The subject of oxygen poisoning has assumed 
great importance during recent years particularly in the fields of (1) deep sea 
diving, where the toxic effects of oxygen may become manifest during deep 
dives using air or helium-oxygen mixtures, (2) shallow diving, utilizing pure 
oxygen with either the open mask or the self-contained unit, or (3) treatment 
of compressed-air illness, where oxygen is employed either in the pure or 
mixed state. 



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Oxygen administered at normal barometric pressures is extensively em- 
ployed therapeutically for the alleviation of anoxic symptoms. In aviation 
medicine it is used prophylactically prior to take-offs on high altitude flights 
for the purpose of denitrogenation to prevent aeroembolism. During high- 
altitude flights it is imperative that it be breathed routinely at altitudes of 
more than 12,000 feet to prevent anoxia. However, the danger of oxygen 
poisoning at these levels is much less than it is in diving, because of the 
relatively lower partial pressures encountered at high altitude. 

It is therefore highly important that all personnel assigned to duties in- 
volving diving be thoroughly acquainted with the early symptoms of o x y g e n 
poisoning. They should know what are the maximal pressures and time limits 
that can be safely tolerated, since they are the individuals directly concerned 
with this hazard. 

Symptoms : The early signs and symptoms of oxygen poisoning in man 
manifested in 192 instances among 338 various types of oxygen dives, made 
at the Experimental Diving Unit of the Navy Yard, Washington, D. C. and the 
National Naval Medical Research Institute, Bethesda, Maryland, were, in order 
of their frequency: (1) anxiety, "inward trembling", or nervous irritability; 
(2) marked pallor of the skin; (3) paresthesias, particularly in the tips of the 
fingers and toes and in the circumoral area of the face; (4) periodic waves of 
nausea, often followed by vomiting; (5) dizziness; (6) visual disturbances, as 
pupillary dilatation and tubular vision or loss of lateral vision; (7) tinnitus; 
(8) muscular twitchings, most commonly of the facial muscles'; and (9) con- 
vulsions. The convulsion may or may not be preceded by any of the other 
warning signs or symptoms. It is generalized, clonic or tonic in character, 
closely resembles the epileptiform seizure and, like the latter, is followed 
by postconvulsive symptoms of headache, mental torpidity, disorientation 
and drowsiness. The striking feature of poisoning by oxygen is the varia- 
bility of the onset and the type and frequency of symptoms, not only among 
different individuals, but also in the same individual exposed at different times 
to the same increased oxygen tension under identical environmental conditions. 
It has been noted that an individual who can tolerate oxygen without any symp- 
toms at a pressure of 60 feet on one day will, on another day, have a convulsion 
at 40 feet after the same period of exposure. Apparent recovery from symp- 
toms of oxygen poisoning is quickly and dramatically brought about by. substi- 
tuting air for the oxygen or by lowering the pressure at which the oxygen 
is breathed, thereby indicating that a rapidly reversible physiological process 
takes place. 

Tolerance: The variability of oxygen tolerance among different individu- 
als or in the same individual at different times has been mentioned. Brief in- 
termittent periods of air breathing interspersed throughout the period of oxy- 
gen administration definitely prolong the time that increased pressure and 



- 4 - 



Burned News Letter, Vol. 5, No. 6 RESTRICTED 



concentration of oxygen can be tolerated. It has also been noted that an in- 
crease in the carbon dioxide content of the breathing medium, as well as an 
elevation in the partial pressure of carbon dioxide in the tissues, presumably 
play a considerable role in decreasing oxygen tolerance. 

The influence of other factors 6n tolerance time is illustrated in the ac- 
companying table. With few exceptions, healthy men at rest in a dry chamber 
can breathe pure oxygen at a depth of 60 feet for two hours without symptoms 
of oxygen toxicity, but serious symptoms of oxygen poisoning appear after an 
average time of 10 minutes when moderate work is performed at this depth. 
Another interesting finding is that toxic symptoms are less often experienced 
during dives in the dry chamber than they are at the same pressure under 
water. This may be due in part to slight mask leakage around the face in the 
dry chamber. In the case of working dives under water, the incidence of toxic 
symptoms is less in those subjects using a self-contained breathing system 
(carbon dioxide concentration being kept at a minimum by means of an absorbent) 
than in those who use a free-flowing exhaust type of mask. This probably is the 
result of dilution of the oxygen in the self-contained outfit by the nitrogen 
eliminated from the body and retained in the closed system.. 

As mentioned in the Burned News Letter of May 14, 1943, the period of 
time that pure oxygen can be safely breathed at sea-level pressures is still 
debatable. Here, too, the tolerance of different individuals varies. Patients 
with cardiac insufficiency or other diseases accompanied by anoxic symptoms 
appear to tolerate oxygen better than healthy subjects. Reports of longperiods 
of oxygen breathing at sea level can be found in the literature, but such reports 
usually reveal that the inhalation was interrupted or the concentration reduced 
for short periods during meals or when nursing procedures were carried out. 
However, it is again emphasized that oxygen therapy as clinically employed 
is usually well within the limits of tolerance. Stadie, in his review of the 
literature, concludes that the maximal concentration of -oxygen which can be 
safely inhaled for indefinite periods appears to be 0.6 atmospheres (60 per 
cent at sea level). Oxygen at one atmosphere (100 per cent sea level) should 
not be administered continuously for more than 24 hours. Behnke states that 
oxygen of one atmosphere can in most cases be inhaled for 17 hours without 
injury, although some subjects have complained of substernal distress in 7 
hours. 

In summary, the following are the maximal pressures and durations which 
may be tolerated with relative safety when pure oxygen is used in diving: (a) 
for water dives with minimal exertion - 60 feet for not longer than 30 minutes; 
(b) for water dives with work performed - 30 feet for not more than 60 minutes. 
When the self-contained underwater outfit is used, it is imperative that fresh 
carbon- dioxide absorbent be supplied prior to each dive and that extreme care 
be exercised to keep this absorbent dry throughout the period o f u s e . In the 



TABLE OF OXYGEN DIVES 





DRY CHAMBER 


1 UNDERWATER 


REST 
Open Circuit 


WORK 
Open Circuit 


REST 
Open Circuit 


WORK 
Open Circuit 


WORK 
Closed Circuit 


30 ft. 








18 2-hr. dives 
1 case (5.6%) 
111 minutes 


17 2-hr. dives 
1 case (5.9%) 
87 minutes 


40 ft. 


32 2-hr. dives 
No symptoms 






23 2-hr. dives 
8 cases (35%) 
69 minutes 


48 2-hr. dives 
11 cases (23%) 
44 minutes 


50 ft. 










5 2-hr. dives 
3 cases (60%) 
32 minutes 


60 ft. 


11 2-hr. dives 
No symptoms 


13 1-hr. dives'- 
13 cases (100%) 
10 minutes 


20 2-hr. dives 
8 cases (40%) 
62 minutes 






oU It. 


48 2-hr. dives 
37 cases (77%) 
50 minutes 




67 1-hr. dives 
67 cases (100%) 
37 minutes 






* 100 ft. 


29 1-hr. dives 

26 cases (90%) 

27 minutes 




20 1-hr. dives 
20 cases (100%) 
18 minutes 







Minutes indicate average time at onset of symptoms. 



Burned News Letter, Vol. 5, No. 6 



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recompression chamber where oxygen is used in the treatment of compressed- 
air illness, the maximal safe duration of time and "depth" for oxygentherapy are 
not more than 2 hours at 60 feet with the individual at complete rest. If the oxy- 
gen is not tolerated at the 60 and 50-foot levels, it is usually safe to continue 
its administration at the 40 and 30 -foot levels. (From the Experimental Div- 
ing Unit - Navy Yard, Washington. - 0. E. Van Der Aue) 

The Nutritional Composition of Rations: Certain Army emergency rations 
are used by the Navy and Marine Corps. The table reproduced below gives the 
composition of some of these rations with respect to certain essential nutri- 
tional elements: 



Ration 


Cnlories 


Protein 
(gm) 


Fat 


Carbo- 
hydrate 
(gm) 


Calcium 
(gm) 


Iron 
(mg) 


Vitamin 
A (1. u.) 


Thia- 
min 
(mg) 


Ribo- 
flavin 
(mg) 


Niacin 
(mg) 


Ascorbic 
acid 
(mg) 


Field ration B 


3, 915 


122 


141 


532 


0. 996 


27 


9,430 


1.98 


2. 42 


26.7 


103 


C ration: 
























Upto July 1944. 


2,775 


121 


78 


379 


. 818 


33 


18, 370 


1. 0 


1. 8 


28 


87 


July to October 1944 . 


3,240 


143 


114 


410 


. 800 


24 


9, 450 


2. 5 


3. 0 


28 


80 


October through Decem- 
























ber 1944 


3, 396 


143 


122 


436 


. 800 


22 


5,410 


2. 8 


3. 0 


29 


72 


1 January 1945 forward 


3, 709 


148 


132 


482 


. 925 


23 


5, 430 


2. 7 


3. 0 


28 


112 


10-in-l ration: 
























April to December 1944 


3, 927 


124 


171 


473 


1. 310 


22 


5, 220 


2. 3 


2.7 


24 


80 


1 January 1945 forward 


4, 150 


130 


170 


525 


1. 150 


25 


3, 100 


2. 7 


3. 6 


26 


75 


K ration: 
























June to December 1944 


2, 786 


89 


129 


317 


1. 282 


14 


4, 674 


2. 1 


2.4 


15 


65 


1 January 1945 forward 


2,860 


93 


122 


343 


1. 350 


17 


4, 695 


1. 8 


2. 5 


17 


70 


D ration.. 


1,770 


32 


95 


200 


. 700 


10. 8 




1. 50 


0. 50 


1.2 




Recommended daily al- 














lowances .... 


a 3, 000 


70 






. 800 


12 


•5, 000 


1. 80 


2. 70 


18 


75 


Minimum daily allow- 
























5 3, 000 


50 






.600 


6 


3, 000 


1.00 


1. 50 


10,0 


60 





















i Food and Nutrition Board, National Research Council. 

i For a man of TD kilos, moderate activity. Calorie need will of course depend on energy expenditure. 



(War Dept. Tech. Bull. - TB MED 141) 
* * 

It is apparent that the content of certain important items of nutrition i s 
adequate in all of the rations except the D ration, which is intended only for 
emergency survival conditions and should be used only when other food supply 
is lacking. 

It must be remembered that in order to obtain a balanced diet from one 
of these rations all of the food must be eaten. For example, in the K ration 
as well as in the 10-in-l and C rations synthetic fruit beverage powders are 
included for the purpose of providing vitamin C , in which these rations are 
otherwise poor. 



Burned News Letter, Vol. 5, No. 6 RESTRICTED 



Actual Food Intake of Hospital Patients : Dietary histories were taken 
and measurements were made in two R.C.A.M.C. hospitals of the food intake 
of patients who had no evidence of disease of the gastrointestinal tract. These 
measurements were analyzed statistically. All aspects of hospital catering, 
including the food supplies, ordering of food, kitchen equipment, ability of 
cooks, methods of serving food and the attitude of the medical and nursing 
staffs and of the patients toward food intake were observed. In one typ ic al 
hospital the results were as follows: 

Protein Calories 

Ration allowance 156 Gm. ■ 4,135 

Plate wastage 21 Gm. (13%) 772(19%) 

Underdrawn (or kitchen wastage) 81 Gm. (52%) 1,507 (36%) 

Actually eaten by patient 54 Gm. (35%) 1 ,856 (45%) 

(Report to the Nat 'I Res. Council of Canada, Stevenson et al. - CMR Bulletin #26) 

****** 

Effect of Large-Scale Restaurant Operations on Vitamin Content of Potatoes: 
A detailed report is presented on the vitamin content of potatoes, and on the 
losses incurred in various large-scale cooking and serving operations. "Sig- 
nificant losses of all vitamins occurred during peeling. Significant losses of 
ascorbic acid, as total and reduced, occurred in the mashing and holding after 
mashing." Ascorbic-acid content was not significantly altered by steaming 
alone, and thiamine, riboflavin and niacin were not significantly reduced in 
amount by the steaming, mashing and holding procedures employed. (OEMcmr- 
474, Progress Report #2, Koch, Pentagon Post Restaurant Council, CMR Bul- 
letin #25) 



A Guide to Chemotherapy: The field of chemotherapy is expanding 
rapidly, and the addition to our therapeutic armamentarion of a number of 
new chemotherapeutic and antibiotic compounds may lead to some confusion 
as to which is the drug of choice in certain instances. The tables presented 
below have been compiled following a comprehensive review of the literature 
and in the light of deductions made from experiences with therapy in the Armed 
Forces. 

An attempt is made to furnish a practical guide to therapy. The first 
table lists those organisms sensitive to penicillin and those resistant to it . 
A list of organisms thus far found to be susceptible to the action of streptomycin, 
in vivo and in vitro, is included for general information. This drug is not 
available for clinical use. - 



Burned News Letter, Vol. 5, No. 6 



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The second table consists of a list of diseases, arranged in alphabetical 
order, the response of which to sulfonamide and penicillin therapy has been 
tested. Opposite each disease is indicated the effectiveness of one or the 
other agent and which is the agent of choice. 

Obviously, in view of the currently rapid progress in the field of chemo- 
therapy and antibiotic therapy, any such data must be revised as new informa- 
tion and new compounds are obtained. 

CHART I 



Sensitive to Insensitive t o Sensitive to Strepto- 

Penicillin Penicillin mvcin (in vitro and in vivo) 



i_JipiuLL)t_.L.u.»3 pneumoniae 


Hi. typnutid. 


XP f T TY~\ r"i f~\ C O 

Hi ■ lypiiood. 




O* ^JcLl CtLy kJlll 


13 J- * ctUUX LLlo 


OLCLkJlJ.. alUUO \k3UIUC OLXCLlllO^ 


£1 f^rrl - £sT*i'H r\i ^ 

O . 1L1U.XO 


"IV/r i"iiT^£iy , r , ii1r\Q'ic: 


in . gonorrnoeae 


i^roteua vuigarib 


Ji * con 


IN . 1I1L.I d.CcilU.Id.1 Is 


.tro. cLCl UgXIlUod. 


OUlg elicit! 


Actinomyces bovis 


(B. pyocyaneus) 


P, pestis 


B. anthracis 


Serratia marcescens 


Proteus vulgaris 


B. subtilis 


(B. prodigiosus) 


Strep, hemolyticus 


CI. botulinum 


H. influenzae 


Staph, aureus 


CI. tetani 


H. pertussis 




CI. welchii 


H. ducreyi 




CI. septicum 


E. coli 




C. diphtheriae 


Staph, albus 




Micrococci (most strains) 


(some strains) 




Streptobacillus monili- 


Micrococcus albus 




formis 


(some strains) 




Borrelia Novyi (spiro- 


Blastomyces 




chete of relapsing fever) 


M. tuberculosis 




Treponema pallidum 


Strep, faecalis 




L. icterohaemorrhagiae 


Brucellae 




Spirillum minus 


Kl. pneumoniae 




Psittacosis virus 


P. pestis 




Ornithosis virus 


P. tularensis 




Strep, hemolyticus 


Plasmodium vivax 




Non-hemolytic streptococ- 


Toxoplasma 




cus (most strains) 


Vibrio cholerae 




Strep, viridans 


Yeasts 




(most strains) 


Molds 

- 9 - 





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CHART n 

DISEASES AND THEIR RESPONSE TO CHEMOTHERAPY 



KEY: Drug of Choice 

Value undetermined 



Favorable response + 



No value 



0 



Disease 


Sulfa- 


Peni- 


Disease 


Sulfa- 


Peni- 


diazine 


-cillin 


* 


diazine 


cillin 


AHc:r*P»c;c!AQ ^ ti H 
nUotcijoCij ctliU. 






Granulocytopenia (7) 


+ 


++ 


L-ctl L/ LlXlL.lt; o 


+ 


++ 


Granuloma inguinale 


+ 


0 




i 

T 


++ 


Hemolytic -strep. 






jriHd.cI ULiiL b LI try • 






infections 


+ 


++ 






++ 


Hepatitis, epidemic 


0 


0 


Anthrax (9) 




++ 


Histoplasmosis 


± 


0 


/il III! ILlo 






Hodgkin's disease 


0 


0 




J_ 
i 


++ 


Influenza 


0 


0 


Vipn tti ^tni c\ 


n 


0 


Leprosy 


0 


0 


jdxc+cj LvJiiiy tUuiu \ kj) 


o 


0 


Leptospirosis 






^-IlctllL-I Ulvi 


_l l_ 


+ 


(Weil's disease) (5) 


0 


++ 




1 

X 


0 


Leukemia 


0 


0 


Coccidiomvcosis 


4- 


0 


Lupus erythematosus 


0 


0 


Cnlitif! uIcpt*- 






Lymphocytosis, acute 






ativp (4) 


4* 


0 


infectious 


0 


0 




J 

T 


++ 


Mastoiditis 


+ 


++ 


T) TT p Kl f Q T» TT 






Measles 


0 


0 


TTI PYnpT 


,L i 
t r 


0 


Meningitis 






Shi P"?} 


_!_ 


0 


Meningococcal (8) - 


-bf 


++ 


m nnpl 1 3 

OCL± 111 \J1 -L±CL 


0 




Pneumococcal (9) 


++ 


++ 


pntPTfiti dis 


o 


0 


Staphylococcal (53 




++ 


Empyema 






Strep, hemolyticus 


+ 


+4 


Pneumococcal 


+ 


++ 


Moniliasis (3) 


0 


0 


Staphylococcal 


+ 


++ 


Mononucleosis, infectious 


0 


0 


Encephalitis 


0 


0 


Mumps 


0 


0 


Endocarditis (5) 






Ophthalmia 






Gonococcal 


+ 


++ 


Gonococcal 


+ 


++ 


Pneumococcal 


+ , 


++ 


Ornithosis 


0 


± 


Staphylococcal 


± 


++ 


Osteomyelitis 






Strep, hemolyticus 


± 


++ 


Staphylococcal 




++ 


Strep, viridans (6) 


+ 


++ 


Pemphigus (10) 


+ 


0 


Filariasis 


0 


0 


Peritonitis 






Gas Gangrene , 






Mixed 


+ 


++ 


CI. welchii and 






Gonococcal 


+ 


++ 


CI. septicum 


+ 


++ 


Pneumococcal 


+ 


++ 


CI. oedematiens 


0 


++ , 


Staphylococcal 


+ 


++ 


Gonorrhea 


+ 


++ 


Strep, hemolyticus 


+ 


++ 



Burned News Letter, Vol. 5, No. 6 



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Disease Sulfa- 


Peni- 


Disease 


Sulfa- 


Pen 


diazine 


cillin 




diazine 


cill: 


Til f~i m i /~\ 

Plague 


+ 


0 


Salmonella infections 






pneumonia 






S. paratyphi (para A) 


0 


0 


Pneumoc o c c al 


+ 


++ 


S. schottmuelleri 






dl d,p ny i o c o c c ai 


+ 


++ 


(para B) 


0 


0 






++ 


Sinus thrombosis (5) 


+ 


+4 


v ii u.t> ki .u 




+ 


Staphylococcal infections 


+ 


+4 


i^oiioixiyeiiiiK 




0 


Syphilis (12) 


0 


+4 


T) o 1 4-4" q r"» f \ c* i c 


0 
u 


± 


Tetanus 


0 


+4 


Oil A*F , T*jOT b £>1 CpnCJi C* 
JT U.CI MCI al OCUiJlu 


_L 

1 


+4 


Toxoplasmosis 


+ 


0 


Q Fever 


0 


0 


Trichinosis 


0 


0 


Rabies 


0 


0 


Tsutsugamushi disease 


0 


0 


Rat Bite Fever 






Tuberculosis 


0 


0 


Spirillum minus (2) 


0 


44- 


Tularemia 


± 


0 


Streptobacillus 


0 


4-4- 


Typhoid fever 


0 


0 


Relapsing fever (5) 


0 


++ 


Typhus fever 


0 


0 


Rheumatic fever 


0 


0 


Undulant fever 






Rocky Mountain 






(Brucella) 


± 


0 


Spotted Fever 


0 


0 


Yellow fever 


0 


0 



Footnotes: 

(1) Potassium iodide effective but not preferable to penicillin. 

(2) Arsenicals effective but not preferable to penicillin. 

(3) Potassium iodide is drug of choice. 

(4) Sulfonamides useful in controlling secondary infection. 

(5) Requires two to three times the dosage of penicillin usually given. 

(6) Subacute bacterial endocarditis (Strep, viridans) requires 300,000 units of 
penicillin daily for 21 days. 

(7) Secondary infection in granulocytopenia not due to sulfonamides may re- 
spond to sulfonamides, but penicillin is recommended. 

(8) Sulfadiazine and penicillin are equally effective, sulfadiazine being simpler 
to administer. When penicillin is used, it must be given intramuscularly 
in usual dosage, as well as intrathecally 10,000 units daily. Combined 
therapy is indicated in the fulminating type. 

(9) Best results from combined sulfadiazine and penicillin therapy. 

(10) Arsenicals also useful. 

(11) Penicillin often helpful but response unpredictable. 

(12) Ideal penicillin dosage not determined. For the present the recommended 
40,000 units every 3 hours for 60 doses should be used. 

No mention has been made in the above table of the use of sera and anti- 
toxins which in certain conditions are the therapeutic agents of choice and in 
others should be used as adjuncts to therapy with penicillin or sulfonamide or both. 



Burned News Letter, Vol. 5, No. 6 



RESTRICTED 



Sulfadiazine is at present considered the sulfonamide of choice whenever 
the action of the drug depends on its concentration in the blood and tissues 
and when idiosyncrasy to it does not exist. 

Sulfasuxidine (succinylsulfathiazole) is preferred to sulfaguanidine. These 
poorly absorbed sulfonamides have a limited range of usefulness, 'but may be 
of value under the following purposes: 

1. Reducing the number of bacteria in the intestinal tract - 

(a) Preparatory to operations on the large intestine or rectum; 

(b) In the presence of wounds in the region of the buttocks or rectum 
to lessen contamination of the feces. 

2. In eliminating the carrier stage of S. sonnei infections. 

The usual initial dose of sulfadiazine is 4 Gm. Ordinarily this is followed 
by 1 Gm. every 4 hours. Average dosage of penicillin varies from 80,000 units 
to 120,000 units per 24 hours. The intervals between individual intramuscular 
injections of penicillin should not be more than three hours, if an effective 
level is to be maintained. In general, higher dosage schedules must be used 
in fulminating infections or in conditions where the pathogenic organism i s 
relatively resistant, as indicated in the second chart. 

The topical application of sulfonamides is of limited usefulness. It is not 
considered of value in the presence of established surgical infection. It may 
be of some value immediately after wounding in those cases when a consider- 
able delay may occur before definitive surgery can be carried out. For local 
application only sulfanilamide is recommended. 

Penicillin is indicated for irrigation of deep sinuses leading down to in- 
fected bone, and for instillation into empyema cavities, infected paranasal 
sinuses, and suppurative joints. Local use must be combined with general 
administration. 

Both drugs may have a limited use as topical application in the treatment 
of infections of the eye. (Prof. Div., BuMed. - A. G. Lueck) 

£ 3|C + * 5)S ' 

A Pvrogenic Factor Isolated from .Inflammatory Exudate: In a series of 
studies on inflammation, Menkin has demonstrated in inflammatory exudates 
the presence of a leukocyte -promoting factor called leukotoxin and atoxic 
inflammation-producing substance called necrosin. 

Recent observations by this investigator indicate that there is also a pyro- 
genic factor in inflammatory exudate. This factor, termed pyrexin, is found to 



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Burned News Letter, Vol. 5, No. 6 RESTRICTED 



be associated largely with the relatively insoluble component of the whole 
euglobulin fraction of exudative material. It appears to be a proteolytic- 
split product produced by the action of necrosin which, in its present state 
of purification, displays proteolytic activity and may even be an enzyme. 
Purified necrosin seems to be either a true euglobulin or at least a sub- 
stance linked with that protein fraction of exudate. It is nonpyrogenic. (For 
other items on necrosin see Burned News' Letter, Vol. 1, No. 2, page 11, and 
Vol. 3, No. 4, page 12.) 

The chemical nature of pyrexin is still unknown. It is insoluble in dis- 
tilled water, in isotonic solution of NaCl and in the presence of ammonium 
sulphate. It is soluble in relatively weak alkalies but is insoluble in strong 
acid. It is indiffusible and is heat stable. 

Pyrexin is essentially absent in.normal non-hemolyzed blood serum, but 
it is present to some extent in hemolyzed serum and also in the serum of an 
animal with a concomitant inflammation. In experiments on dogs in which an 
experimental progressive inflammatory reaction was produced in the pleural 
cavity, a pyrogenic factor was recovered in increasing amounts from urine. 

It is believed that pyrexin offers a reasonable explanation for the primary 
mechanism of the fever frequently accompanying inflammation. Preliminary 
studies suggest that its mode of action may possibly be via the hypothalamic 
heat-regulating centers. (Arch. Path., Jan. '45) 

Pentothal Anesthesia: In the May 1944 Bulletin of the U. S. Army Medical 
Department, attention was directed to a report fr'om overseas on pentothal 
anesthesia, which brought to light a high death rate attributable to sodium 
pentothal. In this article the opinion was expressed that this high death rate 
was the result of the occasional unwise use of pentothal rather than to its inade- 
quacy as an anesthetic for use in the Armed Forces. (See Burned News Letter, May 
26, '44.) Another report from the same overseas theater has been submitted which 
compares present experience with that previously recorded and demonstrates 
the improvement that has been achieved through education in the more rational 
use of this anesthetic agent. It is stated that a year ago the death rate from 
pentothal anesthesia was so high that the question was raised of abandoning the 
agent. Examination of the fatalities that occurred, however, indicated that two 
conditions exist which lend themselves to correction: (1) the use of pentothal 
by completely inexperienced individuals, and (2) its use in cases in which 
pentothal was actually contraindicated. Because of the advantages of the use 
of pentothal in military surgery, the decision was made to continue its employ- 
ment, at the same time taking measures to correct these two factors. 

The collected data show that whereas the overall pentothal death rate a 
year ago was 1 to 450, the present rate is 1 to 5,500. That this great decrease 

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Burned News Letter, Vol. 5, No. 6 



RESTRICTED 



in the death rate from pentothal anesthesia has not come about at the expense 
of abandoning pentothal is shown by the fact that although a year ago this agent 
was employed in 53 per cent of the cases requiring anesthesia, at present it 
is employed in 62 per cent of these cases in the forward hospitals. The figures 
for the hospitals in the rear are 28 and 48 per cent respectively. Thus de- 
spite the fact that the relative use of pentothal as compared with other anes- 
thetics has actually increased during the past year, a great reduction in the 
anesthesia death rate has occurred, clearly showing how well, through educa- 
tion and experience, the intelligent application of this anesthetic has been 
effected. As previously emphasized, pentothal has proved especially valuable 
as an anesthetic in military surgery in procedures in which relaxation is not 
essential, and particularly in short (half -hour) operations and those on indi- 
viduals in good condition. The routine use of atropine as preanesthetic medi- 
cation, the administration of oxygen throughout the period of anesthesia, and 
frequent observations of pulse and blood pressure during the anesthesia are 
considered important factors in the safe use of pentothal. The employment 
of pentothal should be avoided when the operative position or procedure may 
interfere with the airway or make respiration difficult, as in the case of opera- 
tions performed in the face-down position and operations on maxillofacial in- 
juries, or infection about the neck, and other conditions involving the airway. 
Pentothal is not considered a wise choice in intracranial surgery, in burns , 
and in conditions in which it is believed that liver damage may exist. (Bull. 
U. S. Army M. Dept., Feb. '45) 

Effects of Bed Rest on Healthy Young Men; Simple bed rest, in the ab- 
sence of disease or injury, produces a variety of metabolic and functional 
alterations many of which are deleterious and are similar to the changes as- 
sociated with debility in disease or following injury. 

Simple bed rest for about three or four weeks consistently produces the 
following changes which are considered to be important: reduction in the total 
volume of circulating blood; relative tachycardia in all conditions including 
basal rest; reduction in the size of the heart both in systole and in diastole; 
decrease in vasomotor adjustment to postural changes; electrocardiographic 
changes indicating decreased resistance of the heart to postural stress; de- 
creased capacity to transport oxygen in work; increased lactacidemia and 
pyruvinemia during and following muscular work; decreased respiratory 
efficiency; decreased proprioceptor adjustment to posture; decreased intesti- 
nal tone and constipation; decreased endurance for simple muscular work; 
relative negative balance for nitrogen; relative negative balance for potassium; 
increased excretion of thiamine and of riboflavin in the urine; and decreased 
coordination in bodily movements. 

Simple bed rest up to three or four weeks produces no changes or only 
small and relatively unimportant changes in the following: simple muscular 



Burned News Letter, Vol. 5, No. 6 



RESTRICTED 



strength, thermodynamic efficiency in walking or running; the relation of oxy- 
gen debt following work to blood lactate; the composition of the blood; the 
basal metabolism; the rectal temperature; speed of small movements; the 
blood flow through the kidneys; the fusion frequency of flicker; and the calci- 
um and phosphorus balance. 

No individual fitness test yet tried has more than a small correlation with 
total fitness, and the significance of the several fitness tests and indices must 
be evaluated separately with reference to the particular function or functions 
concerned. 

In general, after three or four weeks of simple bed rest a considerable 
restoration of lost or deteriorated functions will be gained in the first four 
days out of bed, but full restoration, even with a physical training program, 
takes at least several weeks. The aberrations in nitrogen, potassium, thia- 
mine and riboflavin balances are almost immediately redressed. Blood vol- 
ume and work-pulse rate require weeks for restoration. (OEMcmr- 413; 
Keys - Univ. of Minn. - CMR Bulletin #27) 

J^C 5^ ^ i|c 

Meningococcal Infections - Bacteriology : The hemorrhagic rash charac- 
teristic of the early phase of meningococcemia may be difficult to differentiate 
from other types of purpura. In view of the importance of early institution of 
sulfonamide chemotherapy in meningococcal infections, a rapid method of 
diagnosis is desirable. A paper by Bernhard and Jordan calls attention to the 
fact that meningococci can often be demonstrated in smears from the purpuric 
lesions of patients with cerebrospinal fever. 

The authors describe their technic as follows: After cleansing the pur- 
puric area with alcohol, a needle puncture is made by inserting an ordinary 
20 gauge needle into the center of the petechial spot at an angle almost paral- 
lel with the surface of the skin. After withdrawal of the needle, the skin sur- 
face should be scratched over the purpuric area until a slight oozing of blood 
is obtained. Gentle pressure around the area will produce sufficient blood and 
serum so that, using a sterile platinum loop, smears and cultures may be made. 

Using this technic meningococci were demonstrated in smears from the 
purpuric lesions in 67.5 per cent of 40 cases of cerebrospinal fever and on 
culture in 87.5 per cent. 

Bernhard and Jordan also describe a medium which in their hands gave 
excellent results in the cultivation of meningococci and gonococci. They de- 
scribe its preparation as follows: 



15 - 



Burned News Letter, Vol. 5, No. 6 RESTRICTED 



14.0 Gm. Bacto dextrose proteose No. 3 agar 
15.3 Gm. Bacto nutrient agar 
3.2 Gm. soluble starch 

Dissolve above in 1,000 c.c. of water and autoclave. Bring the 
medium to a temperature of 90°C. and add 5 per cent of rabbit 
or human blood. Dispense under sterile conditions into 6-inch 
test tubes, and slant. 

They found that the culturing of fairly large quantities of spinal fluid was 
necessary to obtain satisfactory results. At the same time, it was noticed 
that organisms from less purulent fluids grew more readily than those from 
fluids with very high cell counts. They therefore made two sets of cultures 
of purulent fluids. The uncentrifuged spinal fluid was inoculated, 1.0 c.c. into 
a brain heart infusion broth and 0.5 c.c. into the starch chocolate agar slant, 
described above. The remaining portion was centrifuged; the supernatant fluid 
was poured into a tube of broth, and a slant was inoculated with the entire 
sediment. In many cases growth was obtained on both sets of cultures, but in 
several instances colonies developed only on the medium inoculated with the 
unsedimented fluid. Their blood-culture method has been the inoculation of 
100 c.c. of brain heart infusion broth with 10 c.c. of blood, and in certain 
cases a poured plate also was made, using an enriched nutrient agar base to 
which was added 3 c.c. of blood. To counteract sulfonamide, para-aminobenzoic 
acid, 50 mg. per liter of media, was added. 

To supply the carbon dioxide requirements of the meningococcus, 1 Gm. 
of sodium bicarbonate and 100 c.c. of 3 per cent sulphuric acid were added 
for each 2,500 c.c. volume of the incubation jar, using an ordinary mason 
jar. (J. Lab. & Clin. Med., March '44) 

****** 

Biochemical Activity of the Malaria Parasite : Plasmodium gallinaceum 
can be used satisfactorily for the experimental study of the metabolism of the 
erythrocytic phase in the development of the malaria parasite. 

Technics have been devised for obtaining washed suspensions of para- 
sitized chicken erythrocytes and of estimating the active parasitic mass present 
in such suspensions. It is possible to show that such suspensions oxidize glu- 
cose with the intermediate formation of lactic and pyruvic acids. Some 20 or 
30 per cent of the glucose used by the organisms cannot, as yet, be accounted 
for, although such possibilities as the conversion of this missing glucose into 
fat, cholesterol, etc., have been explored. 

Under anaerobic conditions the organism retains its infect ivity, provided 
sufficient quantities of glucose are present. Under these circumstances the 



Burned News Letter, Vol. 5, No. 6 



RESTRICTED 



glucose used can be accounted for quantitatively as lactic acid. The study of 
cell-free extracts of the parasite has demonstrated that the process of form- 
ing lactic acid from glucose by the parasite proceeds by a mechanism similar 
to, or identical with, the phosphorylating glycolysis that occurs in mammalian 
muscle and other tissues. 

Simultaneously with the aerobic utilization of glucose by the Plasmodium 
there occurs an intensive breakdown of intracellular protein (hemoglobin) to 
give large increases in amino nitrogen. This proteolytic breakdown is ap- 
parently coupled with the aerobic utilization of glucose, since it is inhibited 
by anaerobiosis or agents tending to inhibit the oxygen uptake of the organism. 
Also, it has been possible to prepare cell -free extracts from the parasite capa- 
ble of hydrolyzing hemoglobin. 

The oxidation of lactic and pyruvic acids to carbon dioxide and water by 
the parasite is catalyzed by small amounts of fumaric acid and is inhibited 
by malonic acid. It seems probable, therefore, that 'the oxidative removal of 
pyruvic acid by the parasite follows a mechanism similar to the tricarboxylic - 
acid cycle of carbon oxidation in mammalian muscle. 

Studies have been made of the effect of atabrine and quinine on the various 
enzymes of the system discussed above. A concentration of 0.001 M quinine 
inhibits the overall process of lactate formation from glucose by enzyme ex- 
tracts from the parasite as well as by the enzymes, hexokinase and lactic 
dehydrogenase, which are part of the glycolytic mechanism. However, it 
seems improbable that sufficient concentrations to cause these effects are 
obtained in vivo. With "physiological" concentrations of quinine the principal 
effect seems to be on the mechanisms of pyruvate oxidation. It should be 
possible, therefore, to localize the effect of the drug on the enzyme system 
of the parasite if complete information about the mechanism of pyruvate oxi- 
dation becomes available. (OEMcmr-77 - Speck & Evans, Jr., Univ. of Chic. - 
CMR Bulletin - to be published.) 

****** 

Rate of Digestion of Sucrose : There is a widespread impression that in 
providing fuel for immediate muscular work dextrose is superior to sucrose 
because, unlike the latter, It does not require digestion before it is absorbed 
from the alimentary tract. Patients with diabetes who require insulin and 
who suffer from hypoglycemic reactions are ideal subjects for testing the 
rapidity with which sucrose is hydrolized as well as the rapidity with which 
the products of this hydrolysis are absorbed from the alimentary tract, by 
observation of (a) the subjective response to sucrose ingestion and (b) the 
rapidity with which the ingested sucrose increases the concentration of sugar 
in the blood. Blood-sugar time curves were, therefore, obtained in such 



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Burned News Letter, Vol. 5, No. 6 RESTRICTED 



cases at one-minute intervals following; ingestion of sucrose and, of the ten 
experiments reported here, a definite increase of blood sugar was noted 
within one minute in two cases, within two minutes in two cases, within three 
minutes in three cases, within four minutes in two cases and within five min- 
utes in the remaining case. "Emotional" hyperglycemia was excluded as a 
possible cause of the increase of sugar noted. The combined data clearly 
demonstrate that, although sucrose must be hydrolyzed before it is available 
as a source of energy, the hydrolysis is very rapid. Sucrose is, therefore, 
as rapidly available as dextrose as a source of energy. CI. M. Rabinowitch, 
J.. Nutrition, Feb. '45) 

****** 

Distribution of Amino Acids in Urine of Normal Men: Prior to under- 
taking a study of the excretion patterns of amino -acids in pathological condi- 
tions, Holt obtained data on their excretion in the normal male adult. To this 
end, 24-hour specimens from 25 normal adult males were analyzed for a num- 
ber of the common urinary constituents as well as for 10 amino acids. The 
average distribution of these amino acids in per cent of the total amino nitro- 
gen was found to be: 

4.6% 
9.3% 
12.0% 
20.0% 
0.0% 

Johns Hopkins 



afc 3^c a|c sfc ajc 

Protection of Microscope, Lenses from Fungi : A problem confronting 
workers in certain tropical areas has been the growth of fungi on and between 
the lenses of optical instruments. This growth etches the surface of the glass 
and eventually renders the instrument unusable. Berner suggests a method 
which may protect optical instruments from such damage for years. This 
consists simply in placing a small piece of cotton impregnated with creosote 
in an out-of-the-way corner of the microscope case. Care must be exercised 
as to where the cotton is placed because of the fact that creosote tends to re- . 
move the black paint from metal parts. The cotton need not be disturbed for 
as long as a year, when it will become necessary to soak it again in creosote. 
Camera lenses may be protected in the same manner. (Trop. Med. News , 
Feb. '45) 



Arginine 2.4% 

Histidine 9.4% 

Methionine 8.2% 

Cystine 1.3% 

Tryptophane 4.8% 

(OEMcmr-454, Progress Report #3 
Univ. - CMR Bulletin #26) 



Tyrosine 

Phenylalanine 

Valine 

Leucine 

Isoleucine 

Holt, Jr. & Albanese 



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Burned News Letter, Vol. 5, No. 6 



HSSTRICTEP 



Chemical Agent Vapor Detector Kit: Vapor -detect or kits are designed 
to detect the presence of and to identify certain war gases in concentrations 
sufficient to be dangerous. There are two types of kit available: (1) Chemical 
Agent Vapor Detector Kit Ml (Navy) , and (2) Chemical Agent Vapor Detector 
Kit M9 CArmy). They are supplied to naval vessels by the Bureau of Ships 
and to shore installations by the Bureau of Yards and Docks. They will b e 
supplied also to any naval activity conducting training courses i n chemical 
warfare. 

The mechanism of action of the kit is as follows: Air to be tested is 
drawn by means of a pump or suction-bulb through a small glass tube con- 
taining a chemical reagent. This reagent will change color on contact with 
those gases which the tube is designed to identify. The change in color takes 
place immediately in certain tubes; in others to obtain the final color a liquid 
reagent must be added. Complete instructions for the use of each kit are fur- 
nished with it. 

Gas masks should be put on and appropriate protective measures taken 
before tests are carried out. 

The kits will detect the presence of certain gases in concentrations not 
perceptible by means of the olfactory sense. They are particularly valuable 
in detecting the presence of dangerous concentrations of the vapor of mustard. 
Owing to the presence of an odorous impurity in plant-grade mustard , the 
sense of smell cannot be trusted to determine the extent of contamination or 
the persistency of mustard gas. Chemical warfare personnel should be taught 
to regard the presence of the so-called mustard-gas odor as indicative only 
of possible contamination with this gas, and to rely on the results obtained 
by using the kit. The odor of nitrogen mustard is imperceptible except in high 
concentrations. Air over a contaminated area will not contain uniform amounts 
of vapor, because the concentrations in different localities will be influenced by 
temperature, velocity of the wind and distance from the contaminated surface. 
Therefore, samples should be taken at several points and at different distances 
from the surface. 

The detector kits may be used to determine when it is safe to remove 
masks and when decontamination procedures have been adequate. They are 
useful in detecting the presence of leaking gas shells or containers by sampling 
the air of magazines. With them food, clothing and other articles in the field 
can readily be tested for vapor contamination. 

The Navy Gas Detector Kit Ml will detect the presence of dangerous con- 
centrations of the vapors of mustard, nitrogen mustard, lewisite, phosgene, 
hydrocyanic acid and cyanogen chloride. The Army Gas Detector Kit M9 will 
detect dangerous concentrations of the vapors of mustard, nitrogen mustard, 
lewisite , ethyldichlorasine, methyldichlorazine , phosgene and cyanogen chloride . 



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Burned News Letter, Vol. 5, No. 6 RESTRICTED 



Chemical warfare vapor detector kits Ml and M9 are available at the 
following stations: 

(a) Naval Supply Depot, Oakland, California 

(b) Naval Supply Depot, Norfolk, Virginia 

(c) FRAY- 7 3 

(d) LEFT- 73 

(e) EBON- 73 
Cf) DISH- 65 

;({;+:**** 

Air Transportation of the Deaf : Patients with defective hearing requiring 
rehabilitation are currently being transferred to the U. S. Naval Hospital , 
Philadelphia, Pa. The Medical Officer in Command of that hospital has in- 
formed us that the condition of such patients may in certain instances be ad- 
versely affected when they are transported by air. In some the eardrums are 
found to be retracted, with hyperemia around the margin of the drum, around 
Shrapnell's membrane and along the manubrium. Such patients may complain 
of pain and a sensation of pressure in the ears lasting as long as three or four 
days, and during this period there may be further temporary reduction in audi- 
tory acuity. These symptoms may also have a deleterious effect on the patient's 
morale. Frequently, owing to such effects of altitude, a satisfactory audio - 
metric measurement is not possible during the first six or seven days after 
arrival. 

It is recommended that patients with defective hearing to be transferred 
to Philadelphia for rehabilitation not be transported by air. (Prof. Div., BuMed - 
G. C. Thomas) 

****** 

Normal Serum Albumin (Human). Stock No. Sl-1945: The National Institute 
of Health now allows a five-year dating period of Normal Serum Albumin. 
(Human), Stock No. Sl-1945. All Serum Albumin now in stock having an expira- 
tion date ending in 1945, 1946 or 1947 should have this date extended two years. 
The dating period may eventually be extended beyond five years; therefore, 
Serum Albumin should not be discarded as out-dated without first obtaining in- 
structions from the Bureau of Medicine and Surgery. 

Official notification of the above is contained in an official dispatch to all 
ships and stations (Alnav 33-080425/33 of 8 Feb 1945). (Mat. Div., BuMed - 
■K. C. Melhorn) 

****** 



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RESTRICTED 



Notice to Graduates of the Medical College of the State of South Carolina : 
This school is collecting data concerning all of its graduates who are in the 
Armed Services. All those who have not sent in the questionnaire contained 
in one of the issues of the Bulletin of the Medical College are requested t o 
advise the Dean as to their full name, date of graduation, permanent home 
address, present address and rank. The letter should be addressed to the 
Dean, in care of The Library, Medical College of the State of South Carolina, 
Lucas Street, Charleston 16, South Carolina. All 'changes of address should 
be sent as well. 



Public Health Foreign Reports : 



Disease 
Plague 



Smallpox 



Typhus Fever 



Typhus Fever 



Place 

Algeria 
Belgian Congo 
Madagascar 
Morocco (French) 
Senegal 

British East 

Africa 
Rhodesia, 

Northern 
Togo (French) 



Venezuela 

Algeria 
Egypt 
Greece 
Guatemala 

Morocco (French) 
Peru 

Rhodesia, 

Northern 
Turkey' 
Venezuela 



Date 

Dec. 10, '44 
Oct. 1-28, '44 
Dec. 1-20, '44 
Dec. 21-31, '44 
Dec. 11-31, '44 



Dec. 2-9, '44 

Nov. 26-Dec. 2, '44 
Dec. 11-20, '44 
Jan. 1-6, '45 
Dec. '44 

Dec. 1-10, '44 
Dec. 2-9, '44 
Aug. -Sept. '44 
Dec. 1-20, '44 

Dec. 21-31, '44 
Nov. '44 

Dec. 2-9, '44 
Jan. 1-13, '45 
Dec. '44 



Number of Cases 

3 
12 
16 
15 

3 



83 

48 
156 
23 

123 (6 fatal) 
69 

148 (16 fatal) 
85 

83 (9 fatal) 

29 
63 

25 
200 



Gold Coast, Nsawam 
Venezuela 



Yellow Fever 
(Pub. Health Reps., Feb. 2 & 9, '45) 



Dec. 16, '44 
Dec. '44 
Jan. '45 



1 (fatal) 
1 (fatal) 
1 (fatal) 



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Burned News 'Letter, Vol. 5, No. 6 



RESTRIC TED 



To: 



All Ships and Stations. 



i3UMED-Z-BLW:II 



L5-2/JJ57 



Subj: 



BAL in Oil and BAL Ointment in Treatment of 
Systemic Poisoning Caused by Lewisite and Other 
Arsenical Blister Gases, Use of. 



10 Jan 1945 



Refs: (a) BuMed ltr F34- 5(052- 37), 21 May 1943, Prevention and Decontami- 
nation of Mustard Gas and Lewisite Casualties by Use of S-461 Ointment 
and BAL Ointment, Directions for; N.D.Bui. Cum. Ed., 1943,43-1094, 



(b) BuMed ltr All/Al 6-3(093) , 6- Jan 1944, Personal Decontamination: 
Liquid Vesicant Gases; AS&SL Jan-Jun 1944, 44-97, p. 345. 

The following information is based on recent recommendations submitted by 
the War Department Technical Bulletin TB MED 101, 4 October 1944. Permis- 
sion to publish to the Naval Service was granted to BuMed by the War Department 

1 . This letter is issued as supplementary to and in amplification of references 
(a) and (b) . The point that the use of BAL in oil does not preclude the necessity 
for self -decontamination should be emphasized. 

2. GENERAL 

Lewisite and other arsenical blister gases in liquid form can readily penetrate 
the human skin and may lead to dangerous systemic poisoning. The severity of 
the toxic effects is roughly proportional to the amount of the arsenical absorbed 
per pound of body weight. The amount of arsenical absorbed through the skin 
from exposure to field concentrations of the vapor of the arsenical agents is too 
small to cause systemic poisoning. The greater and more extensive the skin 
contamination with liquid arsenical blister gases and the longer the period of con 
tact before decontamination, the greater will be the amount of arsenical blister 
gas absorbed. The fatal doses of the arsenical blister gases for man are not 
known, but 1 to 2 cc of liquid lewisite absorbed through the skin is believed to 
be sufficient to produce a serious or fatal result. Half this amount may cause 
alarming symptoms and a protracted illness. A manifestation of this systemic 
poisoning is a change in capillary permeability which permits the loss of suf- 
ficient fluid from the blood stream to cause hemoconcentration, shock and death. 
In nonfatal cases, hemolysis of erythrocytes has occurred with resultant hemo- 
lytic anemia. Although lewisite is oxidized within the body, the oxidationproduct 
may still be toxic. Its excretion into bile by the liver produces focal necrosis 
of that organ, necrosis of the mucosa of the biliary passages with peribiliary 
hemorrhages, and some injury to the intestinal mucosa. Acute systemic poison- 
ing from large burns in animals causes pulmonary edema, diarrhea, restless- 
ness, weakness, sub-normal temperature, and low blood pressure. 

3. PERSONAL DECONTAMINATION 

It is important that all liquid arsenical gas be removed from the skin by the 
injured man himself, by personal decontamination with protective ointment at 



p. 473. 



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RESTRICTED 



the earliest possible moment. If this is done with sufficient promptness to 
prevent immediate signs of skin damage Ca gray or dead white appearance of 
the outer skin layers) or to prevent the appearance of erythema during the 30 
minutes following decontamination, there is little likelihood that a toxic dose 
of the arsenical will be absorbed. 

4. INDICATIONS FOR SYSTEMIC TREATMENT WITH BAL " 

(a) Cough with dyspnea and frothy sputum, which may be blood tinged, and 
other signs of pulmonary edema. These are manifestations of early damage 
to the lung capillary bed caused either by the absorption through the skin of large 
amounts of the arsenical blister gases or by the inhalation of dangerous amounts 
of their vapors. Regardless of the portal of entry, serious respiratory damage 
requires prompt systemic treatment with BAL. 

(b) A skin burn the size of the palm of the hand, or larger, caused by a liquid 
arsenical blister gas, which was not decontaminated within the first 15 minutes: 
Prompt treatment with BAL ointment locally and BAL in Oil by injection for 
systemic poisoning is indicated. 

Cc) A large skin contamination covering 5 per cent (about 1 square foot) or 
more of the body surface, caused by a liquid arsenical vesicant, provided there 
is evidence of immediate skin damage (gray or dead white blanching of skin) 
or erythema develops over the area within 30 minutes. Such extensive contami- 
nation may result in dangerous absorption through the skin within 15 minutes 
even though decontamination has been accomplished within these 15 minutes. 
Treatment for systemic poisoning with BAL is therefore indicated. 

(d) Cases which have been seen late, where there are blisters the size of the 
palm of the hand or larger. 

5. TREATMENT OF SYSTEMIC POISONING WITH BAL 

Two types of treatment are required: First, neutralization of the absorbed 
arsenical by the intramuscular injection of 10 per cent BAL in Oil; and second 
neutralization of the deposit of liquid arsenical on and within the skin at the 
site of contamination by the local application of BAL ointment. For the BAL 
treatment of direct injury to the respiratory tract caused by the inhalation of 
vapor, only the intramuscular injection of BAL in Oil is used. 

6. REACTIONS CAUSED BY BAL IN OIL 

The signs and symptoms may include a feeling of constriction in the throat, 
a sense of oppression in the chest, a burning sensation of the lips, mildlacri- 
mation, slight reddening of the eyes, dryness of the mouth, tenderness' and in- 
creased muscle tonus at the site of injection, mild restlessness and nervousness 
accompanied by sweating of the hands, apprehension on the part of some patients, 
and mild nausea and vomiting, on eating, in a few. There may be a transient 
rise in blood pressure. 

Slight tenderness at the site of injection may persist for several days. All 
reactions are generally transitory, beginning 15 to 30 minutes after injection 



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Burned News Letter, Vol. 5, No. 6 



RESTRICTED 



and lasting approximately 30 minutes. Elevation of blood pressure or other 
reactions, unless unduly severe and prolonged do not contraindicate the con- 
tinued administration of the full course of four injections of the drug. 



7. DOSAGE OF BAL IN OIL 

(a) An immediate intramuscular injection of 10 per cent'BAL in Oil should 
be given deep into the muscles of the buttocks. Particular care should be ex- 
ercised to avoid injecting the solution into a blood vessel. Dosage must be 
adjusted to the weight of the patient, as follows: 

125 pounds - 2.5 c.c. 
150 pounds - 3.0 c.c. 
175 pounds - 3.5 c.c. 
200 pounds - 4.0 c.c. 

(b) The intramuscular injection of 10 per cent BAL in Oil should be repeated 
at different sites in the same general area at 4, 8 and 12 hours after the initial 
injection, making a total of four intramuscular injections of equal dosage. 

(c) If pulmonary symptoms or other evidence of severe arsenical poisoning 
are present, the interval between the first and second dopes may be shortened 
to 2 hours. In severe cases, subsequent daily intramuscular half doses should 
be given at the rate of one injection per day for 3 or 4 days. These small doses 
should produce no symptoms. 

8. ESSENTIALS FOR PREVENTION AND BAL TREATMENT OF SYSTEMIC 
POISONING DUE TO ARSENICAL BLISTER GASES 

(a) Prompt self-decontamination with protective ointment. 

(b) If any of the indications for systemic treatment exist, as outlined in para- 
graph 3, protective ointment should be thoroughly removed and the local skin 
burn should be treated promptly with a liberal inunction of BAL ointment, and 
left covered with a layer of the ointment. 

(c) An immediate intramuscular injection of an appropriate dose of 10 per 
cent BAL in Oil followed by further injections at proper intervals. 

9. MATERIAL 

The material is put up in a 10 per cent solution in peanut oil, containing 20 
per cent benzyl benzoate as a solvent. It has been added to the Medical Supply 
Catalog as: Stock NcSl-llO BAL in Oil, 10%, 5-cc ampul, 10 ampules inbox, 
unit - box. It may be obtained on NavMed Form 4 requisition from the Naval 
Medical Supply Depot, Brooklyn, Naval Medical Supply Depot, Oakland, Naval 
Medical Supply Depot, Navy 128. Original distribution should be to activities 
in the forward areas and on the basis of 4 units (40 ampules) per 1 ,000 men. 
Requisitions should be submitted to the nearest Naval Medical Supply Depot 
listed above and material will be furnished at the earliest possible date. 

--BuMed. W. J. C. Agnew. 

, ?K 5^ + ^ *fc ^ 



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Burned News Letter, Vol. 5, No. 6 



RESTRICTED 



To: 



All Ships and Stations. 



BUMED-WM-CM 
L8-2/JJ57C042-43) 



Subj: Penicillin Therapy of Early and Latent Syphilis. 13 Feb 1945 

Ref: (a) BuMed Itr BuMed-W-EB/L8~2/JJ 57(042-43), of 15 Sep 1944; 
N.D. Bui. of 30 Sep 1944, 44-1119. 

Ends: (A) Sample of Form NavMed 621. 

(B) Sample of Form NavMed 622. 
CO Sample of Form NavMed 623. 

1. Penicillin therapy to date has been free from severe reactions. However, 
Herxheimer-like reactions have been observed. In those cases of latent syphilis 
where the stage of latency is unknown and where there may exist some visceral 
complications of syphilis, untoward reactions are quite possible. Reduction in 
the number of Oxford units of penicillin in the early doses or lengthening of the 
time interval between those injections may be indicated. If no reaction has oc- 
curred during the first 3 or 4 doses, the recommended schedule can usually be 
resumed within 24 to 36 hours. The recommended total dosage of 2,400,000 
Oxford units of penicillin should, of course, be administered. 

2. When penicillin is used for retreatment, in no case shall the dosage be 
less than the original 2,400,000 units. 

3. All cases of syphilis treated by penicillin are to be reported. It is directed 
that medical officers use the format of the following forms in reporting each 
case to BuMed, this to supersede previous method of reporting by letter: 

(a) NavMed-621 to be forwarded in single copy at completion of therapy. 
Cb) NavMed-623 to be submitted monthly for one year, 
(c) NavMed- 622 to be forwarded between the third and sixth month after 
completion of penicillin treatment. 

These three forms may be obtained from any naval medical supply depot and 
appear in the Navy Medical Department Supply Catalog as follows: 

Stock No. NavMed No. Item Unit 

S16-3083 621 PENICILLIN THERAPY REPORT - ' 



S16-3090 
S16-3095 



622 
623 



EARLY AND LATENT SYPHILIS sheet 
SPINAL FLUID TEST REPORT sheet 
MONTHLY KAHN TEST REPORT 20 in pad 



—BuMed. W. J. C. Agnew. 



* * * 



PENICILLIN THERAPY REPORT 
EARLY AMD LATENT SYPHILIS 

NAVMED 621 (1-45) 



INSTRUCTIONS 
Forvard one copy at completion of therapy 
to Bureau of Medicine and Surgery 
Washington 25, O.C. 



STATiON REPORTING 



DATE 



NAME (surname first) 


SERVICE »0. 




RANK OR RATE 


DATE OF 6IRTH 


MCE 


PATjENT'S WEIGHT (J'ounis/ 



DIAGNOSIS livdicatet 

□ EARLY SYPHILIS 



INDICATE OPINION WHETHER: 

□ FIRST INFECTION □ 



RELAPSE 



□ 



LATENT SYPHILIS 



□ K , 



NFECTION 



DATE OF 
ONSET 



DURATION IN DAYS BEFORE 
THIS COURSE OF TREATMENT 



PRETREATMENT TESTS 

BLOOD KAHN TEST (last before treatment! 



DARKF I ELD 



10, ±, 1+ to Ur) 

SPINAL FLUID TESTS (required in case of latent syfMlis) 



KAHN 



(0, ±, 1* to 1+! 



CELL COUNT . 



COLLOIDAL GOLD CURVE tiive figures) 

□ POSITIVE □ 



GLOBULIN Itaniy) 



NEGATIVE 



PREVIOUS TREATMENT 

n yes nn no 



IF "YES", SPECIFY BELOW 



PENICILLIN, TOTAL UNITS . 



DATE BEGUN 



DATE COMPLETEO_ 



ARSENlCALS, TOTAL GRAMS . 



DATE FIRST COURSE BEGUN 



NUMBER OF COURSES 

DATE LAST COURSE COMPLETED 



BISMUTH, TOTAL GRAMS 



DATE FIRST COURSE BEGUN 



NUMBER OF COURSES 

DATE LAST COURSE COMPLETED 



PRESENT TREATMENT 



PENICILLIN, TOTAL UNITS 

MANUFACTURtR 

OF 

PENICILLIN 



DATE BEGUN 

TYPE 

TYPE 

TYPE 



DATE COMPLETED . 

LOT 

LOT 

LOT 



ido n ot fill in btanHs belov this line; will be completed by Buffed) 

RESULT fF MONTHLY KAHN TESTS AFTER COMPLETION OF PENICILLIN TREATMENT 



_5_ 



10 



11 



12 



RESULTS OF 5 TO 6 MONTHS FOLLOW-UP SPINAL FLUID TESTS 
KAHN CELL COUNT 



COLLOIDAL GOLD CURVE 



GLOBULIN. 



26 



Burned News Letter, Vol. 5, No. 6 RESTRICTED 


SPINAL FLUID TEST REPORT 


MONTHLY KAHN TEST REPORT 


KAVMED 622 ( 1-45) 


HAWKED 623 (1-45) 


INSTRUCT tOfi^i - Fnmnrri thin rannrt */i RtlMPf) hatnaon 


WTMCTIOMS - Submit this report to BuMed 


third and sixth month after completion of penicillin 


monthly for one year after treatment 


t r~o t vftA 

fr f fs QumBrlti * 


of syphilis with penicillin. 




STATION 




REPORTING 


STATION 


DATE — 


RFPfiRTiwr, 




DATE 


NAME (jtti-no»e first/ 


NAME (Surnats first) 


SERVICE NUMBER 


SERVICE NUMBER 


DATE 0>" TREATMENT 


**HN (0, + , 1+ to H+) 


DATE OF THIS KAHN TEST 


COLLOIDAL GOLD CURVE (Give figures) 


RESULT OF KAHN TEST (0 , *, J+ to 1*1 


CELL COUNT 


REMARKS : : — 


GLOBULIN (Pandy) 




Ll POSITIVE CH NEGATIVE 





<g> 



<3> 

ALNAV 29 

Subj: Use of Nupercaine as Anesthetic. BuMed. 2 Feb 1945 

Use of Nupercaine as an anesthetic shall be discontinued immediately. Medi- 
cal Supply Catalog Item Nupercaine SI -3320 on hand shall be turned in to near- 
est naval medical supply depot or storehouse. 

Medical supply facilities discontinue issue. — SecNav. James Forrestal. 

****** 

ALNAV 36 

Subj: Identification of Bodies. BuMed. 12 Feb 1945 

Alnav 5 being misconstrued by some commands to require resubmission of 
fingerprints of all personnel. Procedure specified in Alnav 5 is for application 
only to unidentified bodies. —SecNav. Ralph A. Bard. 

****** 



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Burned News Letter, Vol. 5, No. 6 



RESTRICTED 



To: All Ships and Stations. BUMED-X-BLW:II 

P3-2 

Subj: Cases of Asphyxia Requiring Resuscitative 

Measures, Reports on. 8 Feb 1945 



1. The armed forces have agreed that a clinical study of existing methods used 
in artificial respiration would be of immense value in the planning and evalua- 
tion of measures and devices for this purpose. It is therefore directed that in 
each case of asphyxia requiring treatment, a report be submitted to the Bureau 
of Medicine and Surgery, Washington 25, D. C. The following form, to be pre- 
pared locally, will be used for submitting subject reports: 

REPORT ON CASE OF ASPHYXIA REQUIRING RESUSCITATIVE MEASURES 

U. S. Ship or Station 

(Specify) Age 

Patient's Name Sex 

A. Cause of Asphyxia or Anoxia: (Encircle one number) 



1. 


Immersion 


6. 




(Specyfy Type) 


2. 


Electric Shock 


7. 


Cardiac 




3. 


Injury - Thoracic 


8. 












(Specify Drug) 


4. 


Injury - Head 


9. 










• 


' (Specify Gas) 


5. 


Suffocation 


10. 


Miscellaneous 





(Specify) 



11. Undetermined - 

B. Elapsed Time (Estimate): 

1. From beginning of Asphyxia or Anoxia to time of rescue: 
Minutes 

2. From time of rescue to application of resuscitative measures: 
Minutes 

C. Condition of Patient at Time of Rescue: 

1. Were mouth and airways clear ? Yes, No 

2. Breathing when first observed (Check) 

No ....Yes; If Yes, Gasping, Shallow, 

'.....Rapid, Weak 

If No, Rhythmic motion of edges of nostrils? 

3. Pulse palpable or heart beat detectable (Check one): 
Yes No 

4. Color of Skin (Check one): 

Red, Pale, Bluish 



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Burned News Letter, Vol. 5, No. 6 RESTRICTED 



D. Resuscitative Measures: 



1. List type of Resuscitative Measure, giving (if more than one) order in 
which used and length of time used. _ 



Type (specify)* 


By whom administered^ 


Time used 


Remarks 


Hrs. 


Mins. 


(a) 










CM 










:o 











♦Manual, state method; Mechanical, specify type. 
E.g., hospital corpsmen, medical officers, etc. 



2. Total time Resuscitative Measures Continued: .Hrs Mins. 

3. If Spontaneous breathing began, 

A. Was it supplemented with 

(1) Oxygen Yes, No. If yes, estimate duration; 

minutes. 

(2) Aid to chest movements by 

(a) Manual methods Yes, No. If yes, estimate 

duration; minutes. 

(b) Mechanical methods Yes, No. If yes, esti- 
mate duration; minutes. 

B. Time from start of artificial respiration to first spontaneous re- 
spiratory effort Hrs Mins. 

4. Reason for discontinuing resuscitative measures (Check one): .. 

Normal Breathing returned; Dead; 

Other 

(Specify) 

E. Condition of Patient Following Recovery 

1. Complications or Sequelae 

Specify: 

2. Length of time on Sick List 

Days 

F. Critical Comments on Method(s) Used, Including any Suggestions For 
Improvement of Resuscitative Techniques. 



G. Give brief chronological narrative of the incident. 



Sig. 

• ....Rank 

■ Date 

— BuMed. W. J. C. Agnew. 



* Jft * * £ Jjc 



Burned News Letter, Vol. 5, No. 6 



RESTRICTED 



CIRCULAR LETTER NO. 26-45 

To: All Ships and Stations. PERS-bcSUd-DW-i^ 

P16-3/MM 

Subj: Enlisted Personnel - Assignment and Distribu- 
tion of Hospital Corpsmen. 1 Feb 1945 

Ref: (a) BuPers Circ Ltr 348-44; N.D. Bui. of 30 Nov 1944, 44-1322. 

1 The policy of assigning hospital corpsmen by name is discontinued. Here- 
after, the transfer in hospital corpsmen will be by rate, in lieu of by name, ex- 
cept in unusual cases where personnel are required for specific billets. 

2. Assignment and distribution oi hospital corpsmen shall be as follows: 

"THE BUREAU OF NAVAL PERSONNEL WILL MAKE ASSIGNMENTS 
OF HOSPITAL CORPSMEN: 

TO AND FROM 

(a) Commander in Chief, United States Fleet; Flagship and staff. 

(b) Ships assigned special duty under the Chief of Naval Operations. 

(c) 1st, 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 11th, 12th, and 13th Naval Dis- 
tricts, Severn River Naval Command, Potomac River Naval Command, 
NATechTraComd, NAIntermTraComd, NAOpTraComd, NAPrimTraComd, 
Naval Airship Training and Experimental Command. 

(d) Indoctrination at naval hospitals, including WAVE (HospCorps V-10) 

personnel. . . 

(e) Instruction at hospital- corps schools and special courses of instruc- 
tion in medical-department technical specialties. (See subparagraph (e) 
under assignments by commandants.) 

(f ) Navy Department. (Includes Naval Dispensary and enlisted hospital 
corps personnel attached to the Naval Barracks, Washington, D. C. for 
duty in the Navy Department.) 

(g) Naval Missions. 

(h) Recruiting and Induction Service. 

(i) Naval Officer Procurement Offices. 

(i) Office of Strategic Services, Naval Unit. 

(k) The Commander Service Force, Atlantic Fleet (Subordinate Command), 
and Commander Western Sea Frontier (Subordinate Command Service 
Force Pacific Fleet). 
(1) USS Semmes. 

TO 

(m) New construction (except submarines), acquired ships, special proj- 
ects, and advance base components until such ships, projects, or advance 
base components report to a fleet commander or other command charged 
with the assignment and distribution of personnel, at which time they shall 
come under that command. 



Burned News Letter, Vol. 5, No. 6 RESTRICTED 



(n) Construction battalion units being formed at construction battalion acti- 
vities on the east and west coasts. Upon arrival and attachment of hospital 
corpsmen to construction battalion units at construction battalion training 
centers, construction battalion advance base receiving barracks and con- 
struction battalion replacement depots on the respective coasts, prior to 
departure outside and upon return to the continental limits of the United 
States, they will be administered by Service Force, Subordinate Command, 
Atlantic Fleet and Commander Western Sea Frontier (Subordinate Command 
Service Force Pacific Fleet). Hospital corpsmen attached to ships' com- 
panies of construction battalion training centers, construction battalion ad- 
vance base receiving barracks and the construction battalion replacement 
depot shall be administered by commandants of naval districts in the same 
manner as for other district personnel. 

FROM 

(o) General detail at receiving ships and receiving stations in the United 
States. 



THE COMMANDER SERVICE FORCE ATLANTIC FLEET (SUBORDINATE 
COMMAND) IS CHARGED WITH THE ASSIGNMENT AND DISTRIBUTION OF 
HOSPITAL CORPSMEN UNDER THE DIRECTION OF THE COMMANDER IN 
CHIEF, ATLANTIC FLEET, AS FOLLOWS: 

(A) (a) Atlantic Fleet, including all hospital corpsmen attached to the 
U. S. Marine Corps activities serving with and under the jurisdication of 
the fleet, (b) U. S. Navy fleet hospitals and hospital facilities assigned to 
the Atlantic Fleet on outlying bases in the Atlantic, (c) construction bat- 
talions immediately upon arrival at a construction battalion training center, 
construction battalion advance base receiving barracks or a construction 
battalion replacement depot on the Atlantic or Gulf Coast prior to depart- 
ure outside and upon return to the United States, (d) the Field Medical 
School, Fleet Marine Force, New River, N. C. 

(B) AH other forces, including outlying naval districts and activities 
assigned to the Atlantic Fleet for administrative purposes. 

THE COMMANDER WESTERN SEA FRONTIER (SUBORDINATE COMMAND 
SERVICE FORCE PACIFIC FLEET) IS CHARGED WITH THE ASSIGNMENT 
AND DISTRIBUTION OF HOSPITAL CORPSMEN, UNDER THE DIRECTION OF 
THE COMMANDER IN CHIEF, PACIFIC FLEET, AS FOLLOWS: 

(A) Pacific Fleet, including all hospital corpsmen attached to (a) U. S. 
Marine Corps activities serving with and under the jurisdiction of the 
fleet, (b) U. S. Navy fleet hospitals and hospital facilities assigned to the 
Pacific Fleet; (c) construction battalions immediately upon arrival at a 
construction battalion training center, construction battalion advance 
base receiving barracks or the construction battalion replacement depot 
on the Pacific Coast prior to departure outside and upon return to the 
United States, (d) the Field Medical School, Fleet Marine Force, San Diego 
Area, Camp Joseph H. Pendleton, Oceanside, California. 

- 31 - 



Burned News Letter, Vol. 5, No. 6 RESTRICTED 

CB) All other forces, including outlying naval districts and activities 
assigned to the Pacific Fleet for administrative purposes. 

The commandants of all naval districts, the Commandant of the Severn 
River Naval Command, the Commandant of the Potomac River Naval 
Command, and Chiefs of Air Functional Training Commands, will make 
assignments of enlisted hospital corps men, including V-10 personnel and 
including hospital- corps ratings of ships' companies of construction 
battalion training centers, construction battalion advance base receiving 
barracks and the construction battalion replacement depot, within their 
districts and commands, including all new activities, and all ships in com- 
mission and in service assigned to the districts or commands; except 
activities under the direct administrative control of BuPers, those assigned 
to the Atlantic and Pacific Fleets and units under the jurisdiction of the 
Commanding General, Marine Barracks, Parris Island, S. C, and the Com- 
manding General, Quantico, Va. 

(a) The' Commandant, Sixth Naval District, will make assignments of 
hospital corpsmen to and from the Commanding General, Marine 
Barracks, Parris Island, S. C, and will include hospital corps ratings 
attached to the Commanding General, Marine Barracks, Parris Island, 
S. C.,in weekly combined report of hospital-corps ratings on board sub- 
mitted to BuMed. 

Cb) The Commandant, Potomac River Naval Command, will make assign- 
ment of hospital corpsmen to and from the National Naval Medical Center, 
Bethesda, Md., Marine Barracks, Washington, D. C, the Commanding 
General, Quantico, Va., and will include hospital-corps ratings attached 
to above commands in weekly combined report of hospital-corps ratings 
on board submitted to BuMed. 

(c) The Chief of Naval Air Training is authorized to make transfers of 
hospital-corps personnel between the Naval Air Operations, Naval Air 
Intermediate, and Naval Air Primary Training Commands without refer- 
ence to the Bureau. 

(d) The Commanding General, Marine Barracks, Parris Island, S. C, 
and the Commanding General, Quantico, Va., will make assignments of 
hospital- corps personnel to duties in the activities under their jurisdiction. 

(e) Hospital corpsmen assigned to courses of instruction in medical- 
department technical specialties by authority of BuPers directives and 
are subsequently found to be not qualified to continue under instruction 
by their commanding officer shall be dropped from instruction and 
assigned to other duty by the commandant." 

3 Reference Ca) is modified by deleting all reference to hospital-corps assign- 
ments where appearing, and inserting as an addenda thereto the specific in- 
structions pertaining to the assignment of hospital-corps ratings as detailed 
in paragraph 2 above. - BuPers. L. E. Denfeld. 



32 -