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Full text of "Navy Department BUMED News Letter Vol. 8, No. 5, August 30, 1946"

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NavMed 369 



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NAVY DEPARTMENT 




HH 



a dicjcst of titnelij information Jji 



Editor - Captain F. W. Farrar. (MC). U.S.N. 



Vol. 8 Friday, August 30, 1946 No. 5 



TABLE OF CONTENTS 

Typhoid Fever Therapy: Report on. ..2 Dental Officers: Transfer to USN 17 

Re Use of Fluorides in Dentistry 3 Re Ocular Prosthesis 17 

Study re Influenza Vaccination 4 Course for Dental Officers 18 

Re Histoplasmin and Tuberculin 5 Re Training in Civilian Hospitals 18 

Schistosomiasis Japonica ....6 Re Training in Naval Hospitals 25 

Study re Streptomycin Resistance 6 Transfer to USN (NO: Deadline Date... 25 

Plague Control with DDT and 1080.. ..8 Note for Nurses Transferring to USN . .25 
Ef f e cts of "DFP" on the Normal Eye . . .9 Re Salt - Poor Human Serum Albumin. . . 25 

Re Masking of Syphilis by Penicillin.. 10 Arctic Institute Fellowships 25 

Q Fever: Re Reports'on Study of.... 13 Graduate Fortnight re Tumors ..26 

Reports on Research Projects 14 Re Dental Mechanical Amalgamator ...26 

Public Health Foreign Reports 15 Reserve Consultants Board Meeting ...27 

'Course in Epidemiology 17 Exams for Appointment in (MC) USN . . .28 

Circular Letters: 

Annual Syphilis Report: NavMed-A CRev. 8 7 45) BuMed 29 

Re Enlisted Personnel (HO; Submission of NavMed 590 BuMed 30 

Re Dental Technicians (HO; Submission of NavMed 590 BuMed .....30 

Re HC-3 and HC-4 Forms on Dental Technicians (HO BuMed 30 

Modifications for Compressed Air Supply for Dental Use BuShips 31 

Disestablishment of Fleet Hospital No. 116, Okinawa SecNav 31 

Alnav 441 - Transfer of Nurses USNR to USN: Deadline SecNav 32 

Normal Human Serum Albumin: Salt -Poor BuMed 32 

Liquid Plasma: Preparation of in Naval Districts ..BuMed 34 

Appointment of Officers (NO USNR to (NO USN BuMed 35 

Separatees (NO: Forwarding of Copy of Final Orders for BuMed 36 

NavMed Forms: Requisitioning Procedure for BuMed 36 



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Report on Treatment in Typhoid Fever with Sulfathiazole and Penicillin : 
Because of the results of Bigger's researches on the combined action of sulfa- 
thiazole and penicillin on E. tvohosa (see Burned News Letter of 10 May 1946), 
McSweeney, Medical Superintendent of the Cork Street Fever Hospital, Dublin, 
decided to treat with both therapeutic agents those patients admitted to the 
hospital with typhoid fever of such severity that their survival was not con- 
sidered likely. 

During a period of 11 months, six such patients were treated. All re- 
covered. 

The first case was disappointing because the blood cultures remained 
persistently positive after what was considered intensive penicillin and sulfona- 
mide therapy. It was concluded that the reason for this was that the therapeutic 
agents were not present in the blood in sufficient quantity to sterilize it. Even 
with low blood levels it was evident that the toxemia was considerably lessened, 
and there were no complications due to ulceration. 

The next five patients treated received two four-day courses of penicillin 
and sulfathiazole. Each course consisted of 10,000,000 units of penicillin given 
intramuscularly in doses of 200,000 units every 2 hours, and concurrently about 
34 grams of sulfathiazole given intravenously for the first dose of 2 grams (sodi- 
um sulfathiazole) and followed by 1-gram doses orally every 3 hours. The sec- 
ond course of combined therapy was started from 2 to several days following 
completion of the first course. 

The most striking results in the five cases given the high dosages were the 
early disappearance of toxemia, the rapid subsidence of pyrexia (which normally 
would have persisted for weeks), and the rapid return of formed stools. 

No general or local adverse effects of the disease occurred after the end 
of the second course of intensive treatment, and the patients were bright, cheer- 
ful and eager for solid food. 

The system of dosage followed in these cases was arbitrary and may re- 
quire modification with further experience. (From a study of the case histories 
as given, it appears that it might be advantageous to begin treatment earlier and 
to continue the first course to a point where a second course would not likely be 
necessary - Ed.) 

The author believes that there is strong reason for extending this method _ 
of treatment to chronic carriers of typhoid "fever bacilli, and states that investi- 
gations alone this line are in progress in Ireland. (Lancet, July 27, '46) 

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Re the Use of Fluorides in D entistry, in view of the increasing interest in 
the use of fluorides in dentistry the following iniormation on that subject is re- 
printed from the Report of the Seventeenth Annual Meeting of the American 
Dental Association Council on Dental Therapeutics. 

A large number of products which contain fluorides and are proposed for 
use to prevent dental caries or to relieve hypersensitive dentin have appeared 
on the market during the past year. None of these products has been accepted 
by the Council on Dental Tnerapeuties, and it is the Council's understanding 
that verv few of them nave been granted iicenses by tne Food ana Drug Adminis- 
tration. 

Experimentation with fluoride medication by qualified scientific investiga- 
tors is encouraged by the Council. However, routine dental practice is not the 
place for such experimentation. Tne Council has partially supported the work 
of Knutson and Armstrong on tne topical application of fluorides. 

The use of fluorides is still largely experimental, and 'their routine appli- 
cation in any form by dentist or patient should be discouraged at this time, 
since the mechanism of their action and tne luil extent of their possible harm- 
ful effects are not Known. 

It appears that fluorine preparations may devitalize puips if they are 
sealed in freshly cut dentin. The precise manner and extent to which such 
preparations may be applied without endangering the vitality of the puip nas 
not been determined, so far as the Council is aware. 

Recently published findings indicate that the addition oi sodium fiuoriae 
to dentifrices is without beneficial effect. 

Evidence adequate to support the rationale of administering fluorides in 
the form of bone-meal preparations or other pharmaceutical dosage forms is 
lacking . 

The incorporation oi fluorides in public water supplies under adequate 
dental, medical and engineering control is being carried out in a number of 
cities. A study of the results from this method of making fluorine available 
to human beings will demonstrate the suitability of the future application of 
fluorides' to community waters. The evidence at the present time indicates a 
strong possibility of partially controlling dental caries by this method. (Dental 
Div., BuMed) 

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Comparison of Intracut aneous and S ubcutaneous Vaccina tions Against 

^fi^£hgg: : The value of inactivated influenza virus vaccine has been demon- 
strated convincingly. The combined Type "A" and "B" influenza vaccine, 
prepared from chick embryo allantoic fluid, concentrated and eluted from 
embryonic RBC, given in a single dose of 1 c.c. subcutaneously, was shown 
to have a striking protective effect in the epidemic of Type "A" influenza in 
November and December, 1943. The same vaccine proved to have an equally 
striking protective effect in an outbreak of Type "B" influenza in December, 
1945. In addition to field studies, the Red Blood Cell Agglutination -Inhibit ion 
test of Hirst has been used by most investigators as an index of the serum 
antioody response to immunization. 

It has been known for a long time that a small Intracutaneous Inoculation 
will often yield an immune response similar to that produced by a much larger 
subcutaneous dose. Intracutaneous immunizations with minute doses of im- 
munizing agents have produced highly satisfactory Immune responses with 
Typhoid Vaccine, Diphtheria Toxoid, and Scarlet Fever Toxin. Because of 
the expense and difficulty of obtaining large amounts of inactivated influenza 
! /irus vaccine, an investigation was undertaken to test the efficacy of intra- 
cutaneous influenza vaccination as compared with that of subcutaneous vac- 
' nation. 

A total of 1953 men attached to the U.S. Naval Training and Distribution 
Center, Treasure Island, California, took part in this experiment. Study and 
control groups were set up. The serum antibody response to injected vaccine 
was studied at two and four weeks following inoculation. 

From a study of the results it appears that following a single intracutane- 
ous injection of inactivated influenza virus vaccine, a rise in serum antibody 
titer occurs which is considerably greater than that following a single subcu- 
taneous injection. This occurred both against the "A" virus and the "B" 
virus. 

Although a direct relationship between the antibodies concerned in the 
Hirst RBC Agglutination-Inhibition test and those which are concerned in im- 
munity to Influenza has never been demonstrated, there is some evidence that 
is strongly suggestive that such a relationship does exist. This evidence may 
be summarized as follows: (1) There is a correlation between the RBC 
Agglutination-Inhibition power of immune serum (either postvaccinal, or con- 
valescent), and the virus -neutralizing power of the same serum as tested by 
the mouse protection test. This was noted by Hirst in his original article and 
has been confirmed since. (2) There is a correlation between the RBC 
Agglutination-Inhibition power of the serum of a person and his susceptibility 



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to experimental influenza. Henle et al. demonstrated very clearly, in producing 
experimental influenza in vaccinated and unvaccinated persons, that there was 
a direct relationship between the pre -inhalation antibody titer and susceptibility 
. to influenza. (3) There is a correlation between the antibody titer of postvac- 
cinal sera, and the protection against naturally occurring influenza. 

Because the workers engaged in this study have shown that a single dose 
of U.I c.c inactivated influenza virus vaccine injected intracutaneous^ results 
in a rapid and considerable rise in the serum antibody titer (reaching a level 
in one month of several times that obtained by a single dose of 1 c c of the 
Sai S? I aC . Clne inj ' ected subcutaneously), they conclude that the intracutaneous 
method should be further studied to determine whether it will give adequate 
protection against influenza. (Report on Research Proj. X-705 by U S Naval 
Epidemiology Unit #82 - Van Gelder et al.) 

MPle: Opinions or conclusions contained in this report are those of the authors 
xbey are not to be construed as necessarily reflecting the views or endorse- 
ment of the Navy Department. Reference may be made to this article in the 
same way as to published articles, noting authors, title, source, and project 
number. J 



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, g0me Epidemiological &sgeclg of Sensitivity to Histoplasmin and Tubgr- 

During the past year several reports have shown that there is a close 
relationship between sensitivity to histoplasmin and pulmonary calcification 
Except for these several preliminary studies, little information has been avail- 
able concerning the major epidemiological characteristics of histoplasmin 
sensitivity and of its relationship to pulmonary calcification. 

In a study begun early in 1945 to establish the major epidemiological 
characteristics of histoplasmin sensitivity, histoplasmin and tuberculin skin 
tests and chest x-rays were made on over 17,000 persons in Kansas City, Mo. 

The percentage of positive histoplasmin reactors among white persons 
was found to be slightly higher than among Negroes, higher among males than 
females, and higher among nonlifetime residents than lifetime residents. 

The percentage of positive tuberculin reactors was three times higher 
among Negroes than among white persons. Very little difference was observed 
between males and females, and between lifetime and nonlifetime residents. 

The frequency of pulmonary calcification was over twice as high aumre 
reactors to histoplasmin alone as to tuberculin alone. The frequency of 



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calcification among those who reacted to neither test 'was very low (2^ per 
cent). Among tnose wno reacted co either tuberculin or histoplasmin there 
was a marked increase with age in the occurrence of calcification. (Pub. 
Health Reps., Aug. 2, '46 - Furcolow and Alien; 

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Rr.hhstosom i a s i s lap onica: Four hundred and eighty-one cases of schisto- 
somiasis laoomca acquired on Levte. an isiano in Che Philippines, were studied 
at an Army general hospital in the United States, 

Recurrent epigastric cramps and tenderness were the most frequent com- 
plaints on admission, but in almost ail cases these had disappeared by the time 
of discharge. 

Reseated stool examinations bv more tnan one method were necessarv to 
demonstrate the eegs oi ;scmstosoma ja^icum. a persistent eosmopnuia 
was suggestive but not diagnostic of continued activity of the disease. 

On the basis of comoarable series, treatment with tartar emetic was 
found 10 oe mucn more effective tnan ma: with luaam. significant toxic re- 
actions with tartar emetic were rare. 

it is urged that stool examinations be made repeatedly and by multiple 
methods on men who have been exposed to this disease so that treatment may 
be instituted if ova are found. (New England M. J., Aug. 8, 4b - Mason et al.) 

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TPypprimfintal -Study of t b* Development nf Resistance to Streptomycin by 
Some Bacteria Commonly Found in U rinary Tract Infections: A study has 
be^n~n^ade of the ability of a number of strains of bacteria commonly found 
in infections of the urinary tract to develop resistance to streptomycin. 

The organisms were isolated from cultures of urine which had been made 
in the clinical bacteriologic laboratory. Thirteen different strains were studied. 
They consisted of two strains of Escherichia coll, two of colon-aerogenes niter- 
mediates two of Aerobacter aeroerenes . three of Streptococcus fecahs, two of 
Pseudomonas aeruginosa, and two of Proteus of uncertain species. 

- The sensitivity to streptomycin was determined by streaking the organisms 
on a series of nutrient agar plates containing twofold increments of the ^anti- 
Static substance. The results agreed with those already reported m the litera- 
ture for bacteria isolated from urinary tract infections. 



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The development of resistance was shown most rapidly by the two strains 
of Pseudomonas and the three strains of Streptococcus fecalis . Only from 
three to seven transfers 'were required to make the strains of Pseudomonas 
resistant to 1,000 units of streptomycin per cubic centimeter, and between 
four and seven transfers sufficed to obtain the same result for the strains 
of St reptococcus fecalis . The two strains of Escherichia coli required be- 
tween seven and twelve transfers. The Aerobacter aerbgenes and colon- 
aerogenes intermediate strains required between two and seventeen transfers. 
The strains of Proteus were sensitive to between 3.1. and 6.2 units of strepto- 
mycin per cubic centimeter, and from seven to eleven transfers were required 
to make the organism resistant to a concentration of 1,000 units of streptomycin 
per cubic centimeter of broth. A different reaction, however, was found when 
the cultures of Proteus were grown in urine. SeveraPattempts to make these 
strains of Proteus resistant to 1,000 units of streptomycin per cubic centi- 
meter of urine failed because the organisms died, and each time a new start 
had to be made from the original culture. Finally the two strains became 
resistant to 1,000 units of streptomycin per cubic centimeter of urine after 
twelve and twenty-four transfers, respectively. The explanation for the dif- 
ferent behavior of Proteus in broth and in urine is probably that Proteus splits 
urea and thus increases the pH of the medium to more than 8, which in turn 
increases the activity of streptomycin. 

The significance of this study lies in the fact that all the bacterial strains 
could be made resistant to a concentration of 1,000 units of streptomycin per 
cubic centimeter of medium. It appears evident that if an infection of the 
urinary tract is to be treated with streptomycin, the initial doses should" be 
high in order to control the infection as rapidly as possible. Otherwise , 
the possibility exists that the bacteria causing the infection may develop in- 
creasing resistance to the antibiotic substance. Also, it should be remembered 
that in the treatment of infections of the urinary tract with streptomycin an at- 
tempt should be made to maintain the reaction of the urine as alkaline as possi- 
ble since the activity of streptomycin increases with elevations in pH. 

In an attempt to determine whether the resistant microbes would again 
become susceptible to streptomycin if cultivated in the absence of this anti- 
biotic, these bacterial strains which had been made resistant to 1,000 units 
of streptomycin per cubic centimeter were transferred daily in nutrient broth 
and tested. After twenty-nine daily transfers it was found that the bacteria 
lost none of their resistance. The clinical deduction to be drawn from this 
phase of the study is that an infection caused by bacteria which have developed 
resistance to streptomycin is unlikely to respond to a second treatment after 
the lapse of a few weeks. (Proc. Staff Meet. Mayo Clinic, July 24, '46 - Knop) 



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A Report on Plague Control with DDT and 1080: in the city of Tumbes, 
Peru, which has a tropical climate, 10,000 inhabitants, the majority of the 
houses constructed of bamboo or wattle (mud and sticks), and no public water 
supply system or sewerage, an epizootic of murine plague, followed by a 
-human epidemic, broke out in the last trimester of 1945. Among the epidemio- 
logical factors of importance were the intense over -population with Rattus 
alexandrinus , with a flea -Index of 4.5 among the rats (11.3 in the epizootic 
zone) , and the fleas being chiefly Xenopsylla cheopis : an abundance of rat 
fleas in the rat nests with an average of 5.03 fleas per nest (8.6 in the epi- 
zootic zone), practically all JL cheopis: an abundance of free-living fleas on 
the floors of houses, predominately Ctenocephalus canis, Pulex irritan s, and 
Tunga penetrans : and the presence of X cheopis on floors, and in the clothing 
of plague cases. Other important factors in the outbreak were the proximity 
of the rainy season, which began in December, a temperature fluctuating be- 
tween 26° C. and 34° C, and a relative humidity between 75 and 94 per cent. 
The plague epizootic may have begun in July or August, which are not in the 
plague season, and progressed slowly until the beginning of the plague season 
at the end of September. A total of 21 foci developed, of which 2 were intense, 
the first of these being in the Public Market. In these plague foci 27.3 per 
cent of rats found were plague-infected, as were 56 per cent of the fleas found 
on these rats or in their nests. In all, 40 cases were involved- in the epidemic 
which was not recognized as due to plague until the middle of November when 
more than a dozen cases had occurred. All of the cases were bubonic in type. 
The case fatality rate was 35 per cent. 

The only control methods used were DDT in powder form - diluted to 10 
per cent in talc or pyrophyllite, and diluted to 5 and 2 per cent in refined wheat 
flour - followed by the application of sodium fluoroacetate (1080) as a raticide. 
The DDT was applied first to the floors of all 1,357 houses (containing 3,820 
rooms and 7,388 inhabitants), using an average of from 2.5 to 3.0 Gm. of 10 
per cent DDT per sq. meter (140 Gm. per house, 50 Gm. per room) to prevent 
infected fleas from biting the populace. This dusting was carried out over a 
period of 11 days. The second application, requiring 10 days for completion, 
was made to the spaces between ceilings and roofs, on the flat roofs, beneath 
floors, between double walls, etc., using 5 per cent DDT powder. The first 
method is termed, "surface application, " and the second "subsurface applica- 
tion." From 20 December 1945 to 19 January 1946 the application of DDT as 
above was carried out again. Simultaneously with this re- application of DDT, 
the raticide <£ 1080" was brought into use. Three types of 1080-poisoned baits 
were employed: a 1/1000 solution in water, a 5/1,000 mixture in rolled oats, 
and a similar concentration in small dried cakes. In placing the baits, 1,200 
domiciles received a total of 2,086 visits, with 4,608 baits being set out, locat- 
ing them in both upper and lower parts of the houses, outside as well as inside, 
and also in rat burrows. 



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The effectiveness of the application of DDT can be appreciated by: (a) the 
stopping of the epidemic 4 days after finishing the first application of DDT (one 
case occurring over a month later was due to the incomplete treatment of a known 
focus); (b) the 81 .6 per cent lowering of the flea infestation of the rats, and the 87.9 
per cent diminution in the number of fleas found in rat nests after the first applica- 
tion of DDT. There was a final reduction in the number of fleas in the epizootic 
foci of over 90 per cent. Rat plague was reduced 75.6 per cent after the first 
application of DDT, and 100 per cent after the second. 

The results from the use of sodium fluoroacetate C1080) were excellent, as 
could be judged by partial controls. In one district of the city 40.4 rats per 
100 baits were killed, and 1.2 rats per house succumbed to the effects of 1080. 
In other sectors fewer dead rats were found, but the checking of this factor 
was deficient and irregular. The population was well satisfied with the results 
of the poisoning. 

The application of DDT, followed by poisoning with 1080, promises to be 
the procedure of choice in the control of epidemics of bubonic plague. 

A later paper will present a discussion of the toxicity of 10 per cent DDT 
for rats (which regularly and carefully lick their fur) in dosages of from 1.0 
to 2.0 Gm. of the powder applied to the body surfaces of the rat, and the toxi- 
city of sodium fluoroacetate (1080) for rat fleas which die by secondary poison- 
ing from ingesting the blood of poisoned rats. (Am. J. Pub. Health, Aug. '46 - 
Macchiavello) 

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Effe^ts_of_I3iisopropyl Fluor op hosphate ("DFP") on the Normal Eve ; 
During the past few years many investigators have studied the physiologic 
and pathologic effects of the fluorophosphates. Of these, the diisopropyl 
derivative ("DFP") has received most attention. It has been shown to be a 
powerful inhibitor pf cholinesterase and, therefore, has pronounced para- 
sympathomimetic and nicotinic actions. It is much more potent than physo- 
stigmine in these respects. In the eye, DFP has been shown to produce pro- 
longed and marked miosis, spasm of the ciliary muscle, false myopia, and 
decrease in intraocular tension. The ocular effects of DFP far outlast those 
produced by other known miotic agents. For example, miosis in the rabbit 
was found to last two. days, in the cat, from ten days to two months, and in 
man, from three to nine days (by one observer) and from fourteen to twenty- 
seven days (by another observer). The spasm of the ciliary muscle in man 
has been found to last from three to seven days. 



Because of the useful potentialities of this long-acting, powerful miotic 
agent In the treatment of glaucoma, further studies of its ocular pharmacologic 



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properties were undertaken. These studies were directed mainly toward in- 
vestigating the mode of action of DFP, the possibilities of i ystemic absorption 
from its local use in the eye and the problem of DFP-atropine antagonism. 

In the course of their studies, the authors had opportunity to confirm and 
extend previous observations of other investigators. These were: 

1. DFP locally instilled in the eye in low concentrations will produce 
prolonged miosis, ciliary spasm, false myopia and decrease in intraocular 
tension. Quantitative species variations were found to exist, but the effects 
were most marked and prolonged in man. 

2. A 1 per cent solution of DFP will produce a more prompt, pronounced 
and prolonged miosis than a 5 per cent solution of neostigmine bromide. 

3. DFP in the concentrations used has no direct effect on the iris muscle 
itself since it fails to constrict the totally denervated cat iris. Its effects, 
therefore, are due entirely to inactivation of cholinesterase. 

4. A 0.1 per cent solution of DFP is able to overcome the cycloplegic 
effect in human eyes of 4 per cent homatropine hydrobromide, and a 0.2 per 
cent solution of DFP, that of 1 per cent atropine sulfate. 

5. DFP was shown to increase the capillary permeability for fluorescein 
but not for inulin. 

6. A slight decrease in the plasma cholinesterase was noted after ocular 
instillation of DFP, indicating that minimal systemic absorption occurs. 

7. No significant difference could be demonstrated between oil and water 
as a vehicle for DFP for ophthalmic use except that DFP was found to be de- 
cidedly more stable in peanut oil than in water. (Arch. Ophthalmol., July '46 
Leopold and Comroe) 

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Masking of Early Syphilis bv Penicillin Therapy in Gonorrhea : Early 
workers in penicillin therapy for gonorrhea recognized the danger of this 
treatment as being sufficiently spirocheticidal to alter or mask the usual de- 
velopment and evidences of a syphilitic infection acquired with or prior to the 
gonococcal infection. More recent experience has tended to confirm this early 
impression and to point out a sequence oi signs and symptoms which may be 
helpful in the early recognition of dual infections. 



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In a recent report, Leifer and Martin recite specific instances in which 
the progress of an oncoming syphilis probably was influenced by the treatment 
with penicillin of an intercurrent gonorrhea. These authors mention the oc- 
currence of chills, fever, and malaise developing early in the course of the 
therapy as a possible indication of dual infection. Buchholtz and Cutler, in an 
unpublished review of an enormous amount of material on experience with 
penicillin in venereal disease, are also of the opinion that a febrile reaction 
to the penicillin therapy of gonorrhea may be considered as strongly indicative 
of the coexistence of syphilis, either active, latent, or in the stage of incubation. 

In the patient treated for gonorrhea with penicillin, a syphilitic infection 
acquired either before, at the time of the gonorrheal infection, or later, may or may 
not be appreciably delayed in development, and then run a usual course with 
the formation of a chancre, or without the appearance of a chancre may be 
manifested by the presence of generalized lymphadenopathy, or clinical evi- 
dence of secondary syphilis or by a positive blood test. Thus, any patient 
treated for gonorrhea with penicillin must be instructed to have, at the least, 
monthly blood tests for syphilis for 4 months after receiving the drug. 

In the course of treatment of about 1,000 patients with early syphilis, 66 
were seen who gave a history of having had penicillin therapy for gonorrhea 
within the incubation period of syphilis. None of these patients gave a history 
of a penile ulcer at the time of the course of penicillin treatment for gonorrhea. 
Eighteen of these men gave a history of a chilly sensation and/or fever accom- 
panying the treatment; 16 remembei ?d no systemic manifestations; and in the 
others there was no record of reaction. 

Treatment of early syphilis with penicillin is accompanied by a Herxheimer 
reaction in about 90 per cent of all cases, while treatment of gonorrhea with 
penicillin is very rarely accompanied by fever. According to a personal com- 
munication from Dr. Maurice Buchholtz, in the penicillin treatment of over 
2,000 patients with simple, acute or chronic gonorrheal urethritis unaccom- 
panied by clinical evidence of syphilis, only 2 or 3 patients were observed to 
have a febrile reaction which could not be explained on the basis of a toxic 
reaction to penicillin or to the coexistence of syphilis. Thus, it seems that the 
occurrence of fever with the penicillin treatment of gonorrhea should strongly 
suggest the coexistence of syphilis. 

The Herxheimer reaction is assumed to be the result of the liberation of 
toxic substances in the course of the destruction of the spirochetes by therapeutic 
agents. The phenomenon, appearing usually within from 3 to 8 hours of the 
first injection, consists of chills, fever, headache, nausea, edema of or pain 
in the primary ulcer and surrounding tissues, swelling of or pain in enlarged 
lymph nodes, appearance of a secondary eruption, or enlargement, brightening, 



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and extension of an existing secondary eruption, or of any combination of these 
signs or symptoms. In the course of treatment of this large group of patients 
the impression has been gained that patients receiving therapy for primary 
syphilis of only a few days' duration show febrile reaction less frequently than 
those whose disease is of longer standing. The most probable 
explanation for this fact is that the body harbors spirochetes in greater 
numbers in older infections, the treatment of which Will liberate larger 
quantities of reaction-producing substances and thus produce a more severe 
response. 

The occurrence, then, of a Herxheimer reaction and its degree of Intensity 
or the nonoccurrence of such a reaction in any patient infected with syphilis 
and gonorrhea may be explained on a basis of (1) when the syphilis was acquired 
with respect to the gonorrhea and (2) the incubation periods of the two diseases. 
A patient may have acquired syphilis and be in the incubation period prior to 
becoming infected with gonorrhea, he may have acquired the two infections 
simultaneously, or he may have acquired the syphilis subsequently to acquiring 
gonorrhea but before the institution of treatment for the gonorrhea. The incu- 
bation period of gonorrhea may run from 7 to 30 days, or even longer, while 
that of syphilis may run from 7 days to 4 months. If the incubation period of 
syphilis is short, and that of gonorrhea long, the patient may be heavily infected 
by the time the gonorrhea is treated and thus react to the liberation of products 
of spirochetal destruction. But if the invasion of the host by the TV, pallidum 
is slow, and the incubation period of gonorrhea short, the quantity of toxic 
material of spirochetal origin liberated by penicillin may not be sufficient to 
give rise to a reaction. 

While only 66 of these 1,000 patients treated for early syphilis gave a history 
of having been treated for gonorrhea not acc ompanied by a penile ulcer within 4 months 
prior to the development ofrecognized syphilis, it was found that 18 of these 66 pa- 
tients at the time of the treatment for gonorrhea showed signs and symptoms which 
may be considered as constituting a Herxheim er reaction and thus an indication of 
the presence of syphilis in the absence of other clinical evidence of the disease. 

In summary, the occurrence of chills or fever accompany*" ' nenicillin 
therapy for gonorrhea not obviously complicated by syphilis is strong presump- 
tive evidence of the coexistence of syphilis. Although there are exceptions to 
the rule, it appears to be a safe precaution to subject a patient displaying a 
febrile reaction to penicillin to close scrutiny, clinically and serologically, for a 
period of 4 months following therapy. Within that period additional evidence 
of an oncoming syphilis may be expected to develop. (J. VD Information, 
July '46 - Fromer et al.) 



Burned News Letter, Vol. 8, No. 5 RESTRICTED 



(Not Restricted) 

Q Fever: The American Journal of Hygiene for July 1946 contains eleven 
papers reporting upon a series of studies of a disease which occurred endemi- 
cally and epidemically in the Mediterranean Area and sporadically in Panama 
during the latter part of World War II. This disease has been identified as Q 
fever, a rickettsial infection originally discovered in Queensland, Australia, 
in 1935. 

The occurrence of Q fever in the Mediterranean Area and in Panama adds 
two new geographic regions to the known distribution of the disease. Heretofore, 
Q fever has been recognized under natural conditions chiefly in Australia. Al- 
though ticks infected with Rickettsia burneti , the cause of Q fever, have been 
found in many parts of the United States, only a few naturally occurring infec- 
tions have been established in this country. The failure to detect serologically 
more cases of Q fever in the United States in the past may possibly have been 
due, not to the absence of the disease, but to the use of a weakly reactive strain 
of the specific Rickettsia as antigen. It appears that Q fever is more widespread 
than originally thought, and that further investigations are needed to determine 
the extent of its distribution throughout the world. It is important that a proper 
antigen be employed, and the use of the highly reactive Italian strain (Henzerling) 
as an antigen for serological tests may greatly facilitate such studies. 

The mode and manner of spread of Q fever in the Mediterranean Area and 
in Panama have not been determined. While an air-borne spread of the infec- 
tion is a possibility, spread by an arthropod vector is also to be suspected in this 
disease because of its occurrence in other rickettsial diseases. Evidence from 
Australia indicates that the tick ( Haemanhysalis humorosa ) and the bandicoot 
( Isoodon torosus ) may constitute an important vector and host reservoir, re- 
spectively, in that country. Similar evidence is lacking for either a vector or 
host reservoir in the new endemic regions. The discovery of mites in the 
straw of a barn-loft, around which one outbreak centered, provides a lead for 
further investigation. 

The occurrence of pulmonary infiltration as a clinical feature of naturally 
acquired Q fever is emphasized by the findings reported upon in the studies 
presented. Hornibrook and Nelson pointed out the pulmonary infiltration aspect 
of the disease in patients infected during a laboratory outbreak at the National 
Institute of Health. Symptoms and signs of such involvement elicited during 
physical examination may be minimal or absent, but pulmonary infiltration can 
be expected to be demonstrable by roentgenogram of the chest. This feature 
of the disease was not noted in the Australian cases although 4 of the original 
9 cases reported had cough or rales in the chest. (Robbins et al.) 

>(C + + 9|( + * 



- 13 - 



Burned News Letter, Vol. 8, No. '5 RESTRICTED 

(Not Restricted) 



Abstracts of Reports on Research Projects: 



X-542 Study of the Effectiveness of Glasses, Sun. N-l. Contra ct 

(Av-282-p) No. NXsX 66844 
27 May '46 

The object of this study was to determine the effective- 
ness of sunglasses, N-l, Contract No. NXsX 66844 in elimi- 
nating the cumulative effects on light threshold of intense 
exposure to sunlight. 

Thirty-two subjects were given training on the Hecht- 
Schlaer Adaptometer for one week and, on the basis of 
average threshold, divided into three groups. For the next 
three weeks, all subjects were tested each morning and 
then transported to Onslow Beach. During this period, one 
group had maximum protection from the sun by wearing 
dark -adaptor goggles; another group was issued sunglasses, 
N-l; and the third group had no protection for their eyes. 
Average thresholds for each group were computed and 
compared. 

No significant differences were found between any of the 
groups, and it is impossible to evaluate the effectiveness of 
sunglasses, N-l, from the present results. This may be at- 
tributed to two factors: - 

(1) Great variability of threshold determinations on untrained 
subjects, a fact which tends to obscure minute changes in 
threshold. 

(2) Lack of concrete evidence for the existence of a cumula- 
tive effect of exposure. (Med. Field Res. Lab., Camp Lejeune, 
N. C. - Ross et al.) 

X-686 Tolerabilitv Studies on New Antimalarial Drugs 

(Gen. 146) 

2 April '46 Four experimental drugs, (SN-6911, 7618, 8137, and 11437), 

quinacrine, and a lactose placebo were administered on a volun- 
tary basis to 1,127 Marine recruits in suppressive doses for six 
weeks for the purpose of determining the relative acceptability 
of each to a military population. Subjects were interviewed 
each week and their complaints analyzed. 

All of the experimental compounds were found to be 
superior to quinacrine from the point of view of acceptability 
to a military population. Of the four experimental drugs, 



- 



Burned News Letter, Vol. 8, No. 5 



RESTRI CTED 



X-686 
(Cont.) 



X-426 
Report No. 3 
22 May '46 



(Not Restricted) 
SN-6911 was significantly less tolerable than any of the 
others, while SN- 7618 was as acceptable as the lactose 
placebo. (Med. Field Res. Lab., Camp Lejeune, N.C. - 
Hering et al.) 

An Evaluation of the Relative Safety of Intravenously Ad- 
ministered Antimalarial Drugs. 



Two new antimalarial drugs, SN-10,492 and SN-10,751, 
were administered by intravenous infusion to unanesthetized 
dogs, and the effects of various doses were carefully observed. 
An attempt was made to increase the maximum tolerated doses 
)y the simultaneous administration. of pentobarbital. 

The maximum tolerated doses of these compounds were 
compared with those of drugs of comparable antimalarial 
potency which had been previously studied. 

SN-10,492 and SN-10,751 exhibit margins of safety for 
intravenous use approximately equivalent to that of SN-7618 
(chloraquine). These drugs do not have as high a margin of 
safety for intravenous use as SN-6911 and, therefore, intra- 
venous trial in man is not warranted. (Nav. Med. Res. Inst., 
NNMC, Bethesda, Md. - Stormont) 

Note : Those interested in seeing copies of the complete reports may address 
their request to the Research Division, BuMed. 

Opinions or conclusions contained in these reports are those of the author. 
They are not to be construed as necessarily reflecting the views or the en- 
dorsement of the Navy Department. Reference may be made to those reports 
marked "Not Restricted" in the same way as to published articles, noting 
authors, title, source, date, project number, and report number. 



Public Health Foreign Reports: 



(Not Restricted) 



Disease 
Cholera 



Location 

China, Amoy 
Hong Kong 
Kiangsu Prov. 

Kwangsi, Prov. 
Kwangtung Prov., 

Canton 
Shanghai 



Date 

June 1-18, '46 
June 15-29, '46 
June 1-20, '46 

May 11-31, '46 

June 1-20, '46 
June 21-30, '46 



No. of Cases 

1 (fatal 
128 (48 fatal) 
96 (65 suspected, 

12 fatal) 
189 (27 fatal) 

697 (247 fatal) 
488 (29 fatal) 



Burned News Letter, Vol. 8, No. 5 RESTRICTED 



Public Health Foreign Reports (Gont.) 



(Not Restricted) 



Disease 



Cholera 



Plague 



Smallpox 



Typhus Fever 



Yellow Fever 



Location 

Indochina (French), 
Cambodia 
Pnom-Penh 

Japan, Formosa, 
Keelung 
Tainan 

Malay States Con- 
federated) 
Kelantan 
Trengganu 

Manchuria 

Canada, Nova Scotia, 
Cape Breton Is., 
Sydney 



Date 



June '46 

June 22-29, '46 

April '46 
April '46 



June 30- July 13, '46 
June 30- July 6, '46 
July 20, '46 (date rep.) 



July 9, '46 (date rep.) 



China, ChekiangProv. June 1-10, '46 



Fukien Prov. 
Kwangtung Prov. 
Ecuador, Chim- 
borazo Prov., 
Avinag 
Egypt, Matariya 
Indochina (French), 
Cochinchina 

Indochina (French), 
Cambodia 

Ecuador 

Morocco (French) 

Ivory Coast, Bobo 

Diulasso 
Nigeria, Oyo Prov. 

Oshogbo 



May 11 -June 10, '46 
May 21-31, '46 



June '46 

June 30- July 6, '46 



June '46 



June '46 

June '46 

June 21-30, '46 



July 17, '46 
May 18-25, '46 
July 1 , '46 



No. of Cases 



162 
2 

15 (5 fatal) 
33 (23 fatal) 



106 (84 fatal) 

3 (1 fatal) 
312 (fatal) 



1 (imported, 
suspected) 
17 (3 fatal) 
386 (213 fatal) 
16 (10 fatal) 



2 (1 fatal) 
2 



467 

133 (8 fatal) 
126 



1 (suspected) 

1 (fatal) 

2 (suspected ■ 
1 fatal) 



(Pub. Health Reps., Aug. 2 and 9, '46) 



Burned News Letter, Vol. 8, No. 5 RESTRICTED 

(Not Restricted) 

Training in F. rnderniology Available: Requests from regular Navy medical 
officers are desired for training in epidemiology in a three -months' course 
Riven at the Naval Medical School, Bethesda, Maryland. It is contemplated that 
Sl neS class will start about 1 January 1947. After training m this specialty, 
officers will be placed in some very desirable billets, including epidemiology 
and ™ch units located in Cairo, Egypt, NMRI Bethesda, Md., Dublin Ga., 
Guam M I University of California, and research in medical science pro- 
fee^ sponsored by the^avy in civilian institutions. Also, certain well quali- 
fied officers will be employed in teaching assignments in various Naval medi- 
cal activities. 

Although previous training is not necessary, previous experience in basic 
sciences is desirable. Medical officers of the rank of commander and below 
are eligible. (Professional Div., BuMed) 

****** 

(Not Restricted) 

IT..!. I i TTr-n Egserve D^aj Cjfjcegg Concerning Eli^ibmtvjorjr^fer 

Those nn Duty with the Navy. Naval Reserve dental officers may submit 
aPP UcatTons for transfer to lnTregular Navy immediately upon reporting for 
active duty It should De understood that the final action on such apph- 
faUons cannot be taken until the applicant has completed six 

months of active duty. 

Those nn Duty with the Army. Naval Reserve dental officers assigned^ 
duty with the Army are eligible to submit applications for transfer ^fromU^R 
status to USN status. Credit is given for active duty in the Army ^ablish 
mg the six months' active duty period required before action can be taken on ■ 
such applications. 

Naval Reserve dental officers are again reminded of ^.^f.^ 5 fer 
Weraber 1946 set by ALNAV 416 for submission of applications for transfer 
tothel S. Navy Thi deadline does not apply to officers with less than one 
year 's active duty as of 15 September. (Dental Div. , BuMed) 

****** 

(Not Restricted) 

r 1 -■ 11-11-1— ^ P ^ fnrTT1 AP ' rvliC ° C Ular PrOSthe y The 

completion of acrylic^udar prosthesis for the majority of war casualties re-v 
quS?ng Sis type of treatment has permitted a decrease in the number of activi- 
ties authorized to perform this specialty. 



- 17 - 



Burned News Letter, Vol. 8, No. 5 



RESTRICTED 



NavDentScol Bethesda 
NavHosp Philadelphia 
NavHosp San Diego 
NavHosp Oakland 
NavHosp Seattle 
NavHosp Great Lakes 
NavEosp St. Albans 



January 1946 
22 
9 
2 
2 
6 
8 
4 
53 



July 1946 
12 
11 
8 



31 



(Not Restricted) 

i ^LH^f 11 ^ "° """"l"",-- n-i, mnenttotne a.^h 

signment to the Armed FoSes staff PnnL» 1 £ '° a PP licatIons '°r as- 
1947. (Dental Dtv., BuMed) C0UrSe be e innin e 1 February 



Announcement of 



furtherance of ^T^^^^^^rcgreB. made to 
^otS^^ 



18 - 



Burned News Letter, Vol. 8, No. 5 



r CTED 



(Not Restricted) 

™ n«t included in this report shows the number of places and the civil- 

it will be necessary for the medical giului 

The Bureau hopes to elfect additional arrangements during the e^ulng 
mentis untU a total of 200places incivilian institut 10 ns are available for training. 

j . . Qf . h -„ HmP f or training which starts on and after 
1 fS^riS^X^ of candidates is made 2-3 months 
prior to the starting dates. 

Exility for this ^to^^gU^fS'g^ 
may be officers of any rank with duty outside the con- 

f Lt^U^Tsero'r' store? or" e mSt ionof « and soon will be eligible 

r"a U r e S now onTdu* mtbe -*>^^r- be 
shore duty in the U.S. and who otherw se qua!*, their P^m 12 

such that they would normally be due '° r «~ Xger in civilian institutions 
months. Applications for training o six pontes . V^g. and t0 remain 

must include a signed agreement not to resign during ^ ™ iate endorse . 
in the Navy three years after completion , a ^ e ^rse Anaw P b 
m ent by the commanding officer ^ ^^^^^Ja^le on page 

mately 2 x 3 inches in size. (Professional Div., BuMed) 

tpiTNINQ OB 1 6 yrwn»H«i OR LOK&EB PURATI01 



Ho. of 
Place a 



Inatltutlon 



Mayo Clinic 



Type of 
Specialty Training 



iffESTHESIA 



BBONCHOSCGFY 



Jefferson Medical College 
(Continuous) 



Course 



Fellowship 



Duration Starts 
6 Months 10-1-46 
8 Months 10-14-46 



- 19 - 



No. of 



Burned News Letter, Vol. 8, No. 5 



mmm of § months. r.^ am nmAiprnv 



(Not Restricted) 



(Cont.) 



2 

1 



1 
1 
Z 
5 
1 
1 



1 

1 
1 



6 
2 
1 



. ^Vpe of 

Specialty. Training 



OaHDIOLOQY 

Massachusetts General Hospital Fellowship 



Northwestern University 

(Continuous) 
New York Medical School, NYC 
Harvard University 



Course 

Course 
Course 



INTERNAL MEDICINE 



Northwestern University 
State Univ. of Iowa 
Univ, of Pennsylvania 
Cornell Univ. Med. School 
Mayo Clinic 

Strong Memorial Hospital 



NEUBOSUfiflwr 

Marquette University 
Massachusetts General Hospital 
Lahey Clinic P 



Course 

Fellowship 

Course 

Course 

Fellowship 

Residency 



Precept or ship 
Precept or ship 
Fellowship 



OBSTBTBICS & GYNECOLOGY 
Univ. of Pennsylvania Course 

ONCOLOGY 

Memorial Hospital, NYC Hesidency 

OPHTHALMOLOflY 



Univ. of Pennsylvania 
Washington Univ. of St. Louis 
Illinois Sye & Bar Infirmary 



Course 

Fellowship 

Residency 



Duration Starts 



12 Months 3-1-46 



9 Montns 2-18-46 

11 Months 10-1-46 
11 Months 10-1-46 



9 Months 
12 Months 
8 Months 
6 Months 
12 Months 
12 Months 



10-1-46 
10-1-46 
10-1-46 
10-1-46 
10-1-46 
7-1-47 



12 Months 9-1-46 
12 Months 7-1-46 
12 Months 10-1-46 



8 Months 10-7-46 



12 Months 6-15-46 



8 Months 10-1-46 
12 Months 10-1-47 
12 Months 7-1-47 



- 20 - 



Burned News Letter, Vol. 8, No. 5 



RESTRICTED 
(Not Restricted) 



No. of 
Places 



2 
1 
1 



2 
1 
1 
1 
1 



1 
1 
1 
1 
1 
1 
1 
2 



Institution 



TRAINING OF 6 MONTHS 1 OR LONGER DURATION (Cont.) 

Duration St ay t a 



Specialty 

ORTHOPEDICS 



Type of 
Course 



James W. Riley Mem. Hospital 

Indiana Univ. (Children 1 s Ortho.) Residency 
Duke University (Children's Ortho.) Residency 
Lahey Clinic Fellowship 
Washington Univ. of St. Louis Fellowship 

OTOLARYNGOLOGY 



PATHOLOGY 

Indiana Univ. School of Medicine Residency 

Henry Ford Hospital Fellowship 

Mayo Clinic Course 

Wayne Univ. Med. College Fellowship 

Univ. of Michigan Fellowship 



PHYSICAL MEDIC INS 



Mayo Clinic 



Fellowship 



PSYCHIATRY 



Payne Whitney Psych. Div., NYC 

Jefferson Ho sp. , Phlla. » Pa. 

N.Y. Neurological Inst. 

N.Y. Psych. Inst., NYC 

Langley Porter Clinic, Univ. Cel. 

Bellevue Hospital, NYC 

Univ. of Louisville 

Perm. Hosp. for Mental & Nervous 

Diseases, Phila. Pa. (Fit. Surge) 

Penn. Hosp. for Mental & Nervous 

Diseases, Phlla. Pa. 

Phil. Child Guidance Clinic 



12 Months 1-1-47 

12 Months 1-1-47 

12 Months 10-1-46 

12 Months 10-1-46 



1 


Hew York Hospital, NYC 
(Continuous) 


Fellowship 


12 Months 


2-1-46 


1 


University of Illinois 


Course 


8 Months 


9-30-46 


1 


Northwestern Univ. 


Course 


9 Months 


10-1-46 


1 


Univ. of Pennsylvania 


Course 


8 Months 


10-7-46 


1 


Washington Univ. of St. Louis 


Fellowship 


8 Months 


9-16-46 



12 Months 
12 Months 
12 Months 
12 Months 
12 Months 



10-1-46 

7-1-47 

10-1-46 

10-1-46 

10-1-46 



12 Months 10-1-46 



Fellowship 


12 


Months 


6-1-46 


Fellowship 


12 


Months 


4—4-46 


Fellowship 


12 


Months 


4-1-46 


Fellowship 


12 


Months 


4-1-46 


Fellowship 


12 


Months 


4-1-46 


Fellowship 


12 


Months 


4-1-46 


Fellowship 


12 


Months 


4-1-46 


Fellowship 


9 


Months 


8-1-46 


Fellowship 


12 


Months 


5-1-46 


Fellowship 


10 


Months 


10-1-46 



- 21 - 



Burned News Letter, Vol. 8, No. 5 



RESTR.THTF.n 
(Not Restricted) 



TRAINING' OF 6 MONTHS' OR LONGER DURATION (Cont.) 



Institution 



Specialty 

PIT3T.TC HTBAT.TH 



Harvard University 
Johns Hopkins University 



Type of 
Training 



Course 
Course 



Duration Starts 



8 Months 
8 Months 



9-1-46 
9-30-46 



Leading to the Degree of Master of Public Health 
RADIOLOGY 



Johns Hopkins University 

(Continuous) 
Washington Univ. of St. Louis 
New York Hospital, NYC 
Lahey Clinic 

Harper Hospital. Detroit, Mich. 
State Univ. of Iowa 
Henry Ford Hospital, Detroit 
Indiana Univ. School of Medicine 

SURGERY 

Cleveland Clinic 
Northwestern University 

(Continuous) 
•Philadelphia General Hospital 
Univ. of Pennsylvania 

(Cont inuous) 
Univ. of Pennsylvania 
State Univ. of Iowa 
Lahey Clinic 
University of Illinois 
University of Illinois (Basic) 



fellowship 


12 


Months 


7-1-46 


Fellowship 


12 


Months 


6-1-46 


Fellowship 


12 


Months 


7- 


1-46 


Fellowship 


12 


Months 


10 


-1-46 


Residency 


12 


Months 


1- 


1-47 


Residency 


12 


Months 


7- 


1-47 


Residency 


12 


Months 


10 


-1-46 


Residency 


12 


Months 


1- 


1-47 


Fellowship 


12 


Months 


10 


-1-46 


Fellowship 


12 


Months 


1- 


24-46 



Residency 
Precept orship 

Course 

Fellowship 

Fellowship 

Fellowship 

Course 



12 Months 
12 Months 

8 Months 
12 Months 
12 Months 
12 Months 

9 Months 



9- 1-46 
11-21-46 

10- 7-46 
10-1-46 
10-1-46 
10-1-46 
1-1-47 



•Open only to officers who interned at this hospital 

UROLOGY 



University of Michigan 
James B. Brady Foundation 

(Continuous) 
Washington Univ. of St. Louis 
State Univ. of Iowa 



Residency 
Fellowship 

Fellowship 
Fellowship 



12 Months 
12 Months 

12 Months 
12 Months 



1-1-47 
6-25-46 

10-1-46 
5-1-47 



Burned News Letter, Vol. 8, No. 5 



RESTRTCTEI 
(Not Restricted) 



Ho. of 
Places, 



tpatwthQ. or 6 MONTHS' OR LONGER DURATION (Cont.) 

Type of 

Institution Specialty Training Duration St art g 



20 



1 



LAW 

George Washington Univ. Course 36 Months 9-23-46 

1 Officer will he started in Law each September for (3) three years. 



TRAINING OF LESS THAU 6 MONTHS' DURATION 
ACCELERATION (Research) 

Univ. of Southern California Course 

ANATOMY 



Daniel Baugh Inst., Jefferson Course 
Medical College 

BRONCHO -ESOPHAGOLOGY 
University of Illinois Course 

CAUDAL ANALGESIA 
University of Tennessee Course 

endaural surgery 

Lempert Otologics! Inst., NYC Course 



2 Months p.ny time 



20 Weeks 10-15-46 



2 Weeks any time 



2 Weeks any time 



6 Weeks any t'ime 



4 Months 1-16-46 



OPHTHALMOLOGY 
Northwestern University Course 

OTOLARYNGOLOG Y (Surgical Anatomy) 
Jefferson Medical College Course 10 Weeks 10-15-46 



SUMMARY ; Long Courses - 6 Months or more - 103 
Short Courses - 2 Weeks to 6 Months - 29 

132 



23 



Burned News Letter, Vol. 8, No. 5 



RESTRICTED 
(Not Restricted) 



Ho. of 
Plac es 



5 
6 
1 



3 
1 



3 
1 



ADDITIONAL OPPORTUNITIES FOR TRAINING AVAILABLE IN 1947 

Pi ration Starts 



Type of 
Specialty Training 



I net 1 tut Ion 

DERMATOLOGY 

Indiana Univ. School of Med, Residency 

INTERNAL MEDICINE 

Cornell Univ. Medical School Course 
Univ. of Pennsylvania Course 
Indiana Univ. School of Med. Residency 

GENERAL SURGERY 

Univ. of Pennsylvania Course 

. OPHTHALMOLOGY 



Univ. of Pennsylvania 
Indiana University 



Course 
Residency 



OTOLARYNGOLOGY 



Univ. of Pennsylvania 
Indiana University 



Course 
Residency 



OBSTETRICS 

Univ. of Pennsylvania Course 

RADIOLOGY 

Univ. of Pennsylvania Course 



12 Months 7-1-47 



6 Months 
8 Months 
IS Months 



4-1-47 

10-1-47 

7-1-47 



8 Months 10-1-47 



8 Months 
12 Months 



8 Months 
12 Months 



10-1-47 
7-1-4? 



10-1-47 
7-1-47 



8 Months 10-1-47 



8 Months 10-1-47 



(Professional Div., BuMed) 



* * * * * • * 



L 

- 24 - 

1 

I 

: 



Burned News Letter, Vol. 8, No. 5 RESTRICTED 

(Not Restricted)' 

^' Mi'-J^T'" 11 of Bes ii-n— XraiQing in Naval Hospitals: it is 
anticipated that many queries will be directed to the Medical-Officers-in- 
Command and Senior Medical Officers by medical officers who are under tram- 
ins? or who are interested in residency-type training in Naval hospitals alter 
they have perused the August 17, 1946 issue of the Journal^ the American 
Medical Association. It will be noted that some of the major specialties at the 
larger U S. Naval Hospitals are not listed in this issue of the Journal as ap- 
proved for residency-type training. This has been occasioned by the fact that 
certain American Specialty Boards have not as yet begun action on the recom- 
mendations made by the Council on Medical Education of the American Medical 
Association. Explanation of these facts is made in order to avoid misappre- 
hension on the part of those medical officers who are now, or expect later to be, 
under this type of training. 

Additional approvals for residency training in Naval hospitals will be pub- 
lished in the next issue of the J. A.M. A., listing approved residencies and fellow- 
ships. It is anticipated that the next Educational Number will be published m 
about six months. 

The Bureau of Medicine and Surgery will notify each hospital promptly of 
additional approvals of residency-type training. (Professional Div., BuMed 

****** 

(Not Restricted) 

n^Hline Date for Reserve Nurses to Submit Application for Transfer to 
USNj See copy of ALNAV 441 on page 32 of this issue. 

****** 

(Not Restricted) 

Note for Nurses Tran sferring to USN: See Circular Letter 46-124 on 
page 35 of this issue. 

****** 

(Not Restricted) 

Information Concerning Salt- Poor Human Serum Albumin: See Circular 
Letter 46-122 on page 32 of this issue. 

****** 

(Not Restricted) 

Fellowships Mjdj Available hv the Arctic Institute of NQlllLAmerica: The 
Arctic Institute of North America announces two fellowships of up to $2,000 each 
(Canadian currency) for scientific work in the Canadian Arctic or Subarctic dur- 
ing 1947 The fellowships are open to anyone who has demonstrated his ability 
to carry out research work of superior quality in some field of science. 



- 25 - 



Burned News Letter, Vol. 8, No. 5 



RESTRICTED 



. . .. (Not Restricted) 

Applications must be received by 1 November 1946. Fellowships will be 
awarded on the recommendation of the Board of Governors of the Arctic Insti- 
tute and will be announced by February 1947. Application forms may be ob- 
tained from: The Arctic Institute of North America, 805 Sherbrooke Street 
West, Montreal, Canada. (Science, Aug. 16, '46) 



, T ^ T . (Not Restricted) 

New York Academy of Medicine Graduate Fortnight: The Nineteenth 
Graduate Fortnight of the New York Academy of Medicine will be held during 
the dates October 7 and 18, 1946, on the subject of Tumors. The Fortnight 
will include evening lectures, morning panel discussions, scientific exhibits 
and demonstrations at the Academy, and afternoon hospital clinics at leading 
hospitals of New York City. 

Physicians who are not Fellows of the Academy may secure registration 
by sending name and address, accompanied by check for five dollars to the 
Secretary of the Graduate Fortnight Committee, 2 East 103 Street, New York 
2,9, New York. 

Medical officers of the Army, Navy, and United States Public Health Service 
on active duty, will be admitted to all sessions without registration fee (Ann 
Int. Med. - May 1946) 



(Not Restricted) 

Instructions for ttbr of Dental Mechanical Ama1ffa.ma.i-nr- Tne recent addi _ 
tion of the mechanical amalgamator to the Catalog of Navy Material, Dental 
Equipment and Supplies, has resulted in many inquiries regarding its use 
This instrument is a valuable aid in that it provides an ideal plastic amalgam 
both rapidly and efficiently. Briefly, the following instructions should be closelv 
adhered to: 



1 . Keep capsule and pestle clean. Hardened amalgam in the capsule is 
difficult to remove. Scratches on the inner surfaces of capsule invite per- 
petual trouble. Hardened amalgam may be removed from the metal capsule 
by carefully heating the capsule, but the best precaution is to remove the ad- 
hering amalgam before it sets. 

2. Use scales in accordance with instructions furnished with the amalga- 
mator. Proportion the silver alloy and mercury as directed by the instructions 
supplied in the alloy package. The freshly mixed amalgam should appear rela- 
tively ' 'sloppy," and should be formed into a rope for segmentation. 



- 26 - 



Burned News Letter, Vol. 8, No. 5 RESTRICTED 

(Not Restricted) 

3 Triturate until the "clicking" noise in the capsule appears to have 
qt onne d No spe cif ic time for mixing can be given as alloys vary and the 
fotSfspeTds ofamalgaxnator motors differ. General speaking, the mixmg 
time should be from 8 to 12 seconds. 

4 Mulling may be effectively performed by removing the pestle and re- 
<i. Muiiiug may m j c aTr , a iffpmqtor Onlv one second of 

turning the capsule and amalgam to the amalgamator, uniy oi 

vibration is required to accomplish mulling. 

5 Because the time factor has been so reduced in preparing the amal- 

at one time as amalgamation may be incomplete. (Dental Div. , Buiviea an 
Naval Dental School, Bethesda, Md.) 

****** 

(Not Restricted) 

Tr ^ rr » f t^p™ consultants BQBXdt^heBmmM^^m^ 

Surg^~ITa~7ecent meeting of the B^sei^ 

MneanilurEea Vice Admiral Ross T.McIntire CMC 

rp-nlral of the Navy, expressed his deep appreciation for the assistance given 

byThe mlberfo/the^oard in establishing the residency-training program 

as part of the Bureau's post-war planning. 

Rear Admiral Winehell M. Craig, (MC), USNR, on inactive duty, now 
Professor of Neurosurgery at the University of Minnesota and Neurologies ^Sur- 
geon andNeurosurgical consultant at the Mayo Clinic, presided over h i Me - 
fnT aSsn! attendance - — ^ ~ 
Sard C ITcX^aV^l^n: Greeley, Captain Clar* 

j 4 in n-f fv, Amprirar MprHoal Association. In addition to Vice nu.mu.aj. 

furgery Ret AtoTral John Harper, (MC), USN; Commodore M D- WUlcu ts, 

M. V J Brown, CMC, USN (Re ^Captain ^ L. McDa.ie! 
(MC), USN; and Captain L. R. Newhouser, (MC), UoN. ine uiii^ ^ 1 , r v liqNR 
search Navy Department, was represented by Captain A. J. Vorwald, (MO.USNR. 

The Board considered matters of policy as well as ways and I means ^oi ex- 
panding the specialty courses offered and of otherwise furthering the framing 



27 



_ - ' 



Burned News Letter, Vol. 8, No. 5 RES'" 

program which is designed to afford Naval medical officers ™%^^£? a 
tram in medical specialties and to qualify for American Board Sn 

in f 0ne <* the American Colleges in aK^Sf^Jr 
professional proficiency and in improving the standards of medical practice 

will bTm^ AndreW a ^ and Donald E. Hale, 

now Prof Jssor of pT ! m6mbers of the Rese rve Consultants Board. Dr Ivy, 
ScLmc D?r Jl; If 7 a Northwest ern University, was formerly the 

land Dr *Z I hQ N , aVal Medical ^search Institute at Bethesda, Mary- 
World War n iq ? a Captain in the Naval Medical Corps du rfn f 
World War II, is now associated with the Cleveland Clinic, Cleveland, Ohio 



Examinations for- a ™™^™^ . s A _ ic3f!) . Q ,/ Not Restricted) 

sisj inf^nT r^n" i Ommmm ^ q Asl ant guggeog |gj as agtiag y 

=^cai°S^^ 

S-geon and asking Assistant Snrr.nn with the rank SS^f 

aFes T of ?r^ f J^ andidat ! S mUSt be CitlZ6nS 0f the United States, between the 
S ?L if ■ / mU be &raduates of approved medical schools and must 
meet the physical requirements for appointment. 

Graduates of approved medical schools in the United States or r.n.Hn 
who have completed internship in accredited hospitals are efigL? to tak^thP 
examination for Assistant Sn^op. Those selected, fo^^7cSta^i™ 

- d ~ — assigning^ra^aval 

i , ^ St ?u entS enrolled in approved medical schools who will have com 

nations are eligible to take the examinations for ActingAssistant Surp^nn 
Upon receipt by the Navy Department of certifie d aL t the t g g^ 
satisfactorily completed his medical education, those selected wOl be an 
pointed Acting Assistant Surgeons and issued active duty orders o Naval 
hospitals for intern training. uiueib lo in aval 

Buretfof ^T,f°r S H a S d additional formation may be obtained from the 
Bureau of Medicine and Surgery, Navy Department, Washington 25 D C 
or from Naval Officer Procurement offices ' 



- 28 



Burned News Letter, Vol. 8, No. 5 RESTRICTED 



Circular Letter 46-117 9 August 1946 (Not Restricted) 

To: All Ships and Stations 

Subj: Annual Syphilis Report, NavMed-A (Rev. 8-457 

Ref: (a) BuMed ltr. BuMed- Y-avr, A3-3/ENlO(A), of 4 Oct 1945 (N.D. 
Bull. Item 45-1432). 

(b) BuMed Cir. Ltr. 46-91, of 11 Jun 1946, (N.D. Bull. Item 46-1256). 

(c) MMD, par. 35D4.1. 

(d) BuMed Cir. Ltr. 46-101, (N.D. Bull. Item 46-1381). 

1. In many instances subject report is being submitted quarterly on outdated 
form NavMed-A. This report was changed from quarterly to annual by ref (a), 
and form NavMed-A was revised. NavMed-A (Rev. 8-45) may be procured in 
accordance with ref (d). 

2. Instructions for the preparation of NavMed-A (Rev. 8-45) are printed on 
the form and in ref (c). In the preparation of this form attention is directed 
particularly to the following: 

(a) The breakdown of syphilis cases into "negro" and "all others" 
(Item A). 

(b) Bismarsen is an arsenical and not a heavy metal (Item B). 

(c) Size of dose is not required when indicating number of doses of 
arsenicals administered (Item B). 

(d) A completed course of penicillin for purposes of this report is 

6 or 8 million units (See ref Cb)). The size of the course shall be 
indicated. 

3. Reports submitted improperly will be returned with a copy of this letter. 

--BuMed. Ross T. Mclntire. 

jjt 5)< 5(t s|c 5jC 

Circular Letter 46-118 12 August 1946 (Not Restricted) 

To: District Medical Officers (Except 10, 14, 15 and 17). 

Staff Medical Officers: PRNC; SRNC; CNATraCom; MarBaks, 
Quantico, Va.; MarBaks, Parris Island, S.C.; ComServSubordComLANT; 

ComServPAC. 



29 - 



Burned News Letter, Vol. 8, No. 5 



RESTRI CTED 



Via: Commandants and Commanding General, Marine Barracks, Quantico, 
Va., and Parris Island, S.C. 

Subj: General Instructions Relative to Submission of Weekly Combined 
Report o_f_Enlisted Hospital Corps Personn^lJForm NavMed_590) 
and Instructions Relative to Selection of Hospital Corps Enliste d 
Ratings for Transfer. 

Note: Because of the long list of references, the revised sample copy of 

NavMed 590, and its length, this letter in its entirety is not reprinted 
here. 

Circular Letter 46-119 12 August 1946 (Not Restricted) 

To: District Dental Officers (Except 10, 14, 15, and 17). 

Staff Dental Officers: PRNC; SRNC; CNATraCom; MarBaks, Quantico, 
Va.; MarBaks, Parris Island, S.C; ComServSubordComLANT; 
ComServPAC. 

Via: Commandants and Commanding General, Marine Barracks, Quantico, 
Va., and Parris Island, S.C. 

Subj: G gnera j_In struct ions Relative to_Submis sion of W eekly Com bined Report 
ofjlnlh s t^^ (Dent^jrejphnlci^ans) (F_orjm_ 

NavMed 590 DENTAL) and Instructions Rela tjyjJg_S^e cUono^ 
Corps En listed Ratings (Dental Technicians) for Transfer. 

Note; Because of the long list of references, the revised sample copy of 

NavMed 590, and its length, this letter in its entirety is not reprinted 
here. 

****** 

Circular Letter 46-120 14 August 1946 (Not Restricted) 

To: All Ships and Stations 

Subj : Subg^^^^ NayM e d-HC - 3 anji_Na vMe d^ HT>4 _ toJguMed. 
■ Bj^r JBo§B ital_Q Q£E MI^l D^i^a^^^^giiiil ■ 

Refs: (a) Paragraph 517 and 518, Manual of the Medical Department, U.S. 
Navy. (Rev. 1945). 

(b) AINav 343. 

(c) SecNavLtr., Op2iD-je Serial 3369P21 of 27 June 1946. 



Burned News Letter, Vol. 8, No. 5 RESTRICT ED 
1. Attention is invited to references (b) and (c). 

2 Reference (a) is modified by references (b) and (c). In accordance there- 
with the dental departments of ships and stations are responsible for the for- 
warding of NavMed-HC-3 and NavMed-HC-4 in the case of dental personnel 
who are assigned to the dental department of the ship or station in accordance 
with reference (c). 

--BuMed. Ross T. Mclntire 



Circular Letter 46-121 (See page 36.) 

****** 

To: All Ships and Stations 26 July 1946 (Not Restricted) 

Subj: Compressed Air forJtJs eJ^Den^ Operating J ^o_oms and Prosthetic 
Laboratories. 

Ref- (a) BuShips Itr. S37-1 (640-250), EN28/A2-11, of 10 May 1946; N. D. 
Bui. of 15 May 1946, 46-1036. 

Note- See the Navy Department Semimonthly Bulletin of 31 July 1946, page 

115 for this letter which modifies paragraphs 3(c) and 3(e) of reference 
(a) which was printed in its entirety in the BinnedNews Letter of 5 July, 
page 28. 

****** 

(Not Restricted) 

Disestablishment o fJ^a^aj_Me dical Activity: As published in the Navy 
Department Semimonthly Bulletin of 31 July 1946, the following Naval Medical 
activity was disestablished as of the date shown: 

Date of 

Name Address Disestablishment 

Fleet Hospital No. 116 Okinawa 30 June 1946 



- 31 - 



Burned News Letter, Vol. 8, No. 5 



RESTRICTED 



ALNAV 441 8 August 1946 (Not Restricted) _ 

Subj: DeadlineJDate for Reserve Nurses to Submit Annli cation for Trur^f^ 
to USN ~ — 

1. This Alnav establishes a deadline for the submission of applications for 
transfer of officers of the Navy Nurse Corps Reserve to the regular Navy 
Nurse Corps under the provisions of Alnav 279-45 and BuMed Circular Letter 
46-67. All eligible officers on active duty including terminal leave and all 
eligible officers on inactive duty who desire to request transfer to the regular 
Navy Nurse Corps must submit their applications on or before 1 October 1946. 
Commanding officers, commandants of naval districts and river commands, and ' 
other officers authorized to receive applications from individuals will not accept 
applications after 1 October 1946. Applications received on or before 1 October 
1946 will be processed and forwarded to the Bureau of Medicine and Surgery in 
accordance with Alnavs 271-45 and 279-45, and BuMed Circular Letter 46-67. 

2. Since this Alnav applies to nurses on terminal leave and inactive duty as 
well as to officers on active duty, all commandants of naval districts and 
river commands are requested to insure that the contents of this Alnav receive 
wide publicity, including press and radio, within their respective commands 



Circular Letter 46-122 15 August 1946 (Not Restricted) 

To: All Ships and Stations 

Subj: Normal JjujnanSerum Albumin, Ralt-Pnnr 
1- ACTJQN. 

Each bottle contains 25 grams of albumin obtained from pooled normal 
human plasma and 1.0 gram of d,l-acetyl tryptophane in 100 c.c. of solution 
This is the osmotic equivalent of approximately 500 c.c. of citrated plasma 
The acetyl tryptophane improves the stability of the solution and is a deriva- 
tive of an amino acid in which human serum albumin is deficient. The solution 
contains no preservative as it has been sterilized by filtration. 

When injected intravenously, 100 c.c. of 25 per cent albumin draw approxi- 
mately 350 c.c. of additional fluid into the circulation within 15 minutes except 
m the presence of marked dehydration. This extra fluid reduces hemoconcen- 
tration and blood viscosity. If hemorrhage has occurred, an anemia may follow 



Burned News Letter, Vol. 8, No. 5 RESTRI CTED 

(Not Restricted) 

hemodilution. This should be treated with whole blood. When the circulating 
blood volume has been depleted, the hemodilution following albumin persists 
many hours. In individuals with a normal blood volume it usually lasts only 
a few hours. 

In contrast to the original Standard Army and Navy Package of Normal 
Human Serum Albumin bearing expiration dates from November 1945 to April 
1950, and containing 0.6 to 1.0 Gm. per cent sodium, Normal Human Serum 
Albumin, Salt-Poor, contains only 0.3 Gm. per cent sodium. For comparison, 
the amounts of sodium in osmotically equivalent volumes of solution are as 
follows: citrated plasma (500 c.c), 2.1 Gm.; circulating plasma (450 c.c), 
1.6 Gm.; original standard albumin (100 c.c), 0.0" to 1.0 Gm.; salt-poor al- 
bumin (100 c.c), 0.3 Gm. This low sodium content is of value when large 
amounts of Normal Human Serum Albumin are administered to hypoproteine- 
mic patients with edema and poor kidney function, as the accumulation of sodi- 
um ion in the extracellular fluid is minimized. Normal Human Serum Albumin 
may be given in conjunction with or combined with other parenteral fluids - 
whole blood, plasma, saline, glucose, or sodium lactate. The addition of two 
bottles of albumin to 1,000 c.c. of normal saline or 5 per cent glucose gives 
a solution approximately isotonic and isomotic with citrated plasma. 

2. INDICATIONS AND. DOSAGE 

S hock - Albumin is indicated in the emergency treatment of shock due to 
trauma, hemorrhage, operation, and infection, or in the treatment of injuries 
of such severity that shock, although not immediately present, is likely to 
ensue. An initial dose of one to two bottles can be followed in 15 to 30 minutes 
by a third bottle if the response is inadequate. Administration of larger quanti- 
ties should be supplemented with or replaced by the use of whole blood to com- 
bat the relative anemia which would follow the use of three bottles of albumin 
(equivalent to 1500 c.c. plasma). The quick response to blood pressure which 
may follow the rapid administration of concentrated albumin necessitates care- 
ful observation of the injured patient to detect bleeding points which failed to 
bleed at a lower blood pressure. Because the bottle of concentrated albumin 
can be administered in 3 to 10 minutes, it is preferable for the earliest treat- 
ment of shock. If . dehydration is present, the administration of other fluids by 
any available route is desirable, either with albumin (two bottles of albumin 
per liter solution) or after albumin. Even in marked dehydration, however, 
concentrated albumin is not harmful. It is merely less effective. 

Burns - An initial dose of one to two bottles should be. followed by 5 per 
cent solution of albumin (two bottles per liter) in normal saline or in 5 per 
cent glucose in such quantities as are needed to prevent marked hemoconcen- 
tration, and to maintain appropriate electrolyte balance. 



33 - 



Burned News Letter, Vol. 8, No. 5 RESTRTOTFip 

(Not Restricted) 

Hvpoprotememia with or without edema - Two to three bottles daily over 
a period of days or weeks may be required to reduce edema and to raise the 
serum protein values to normal. Since these patients have approximately 
normal blood volumes, doses of more than one bottle of albumin should not 
be given faster than 100 c.c. in 30 to 45 minutes to avoid circulatory embar- 
rassment If slower administration is desired, in cases with hypertension or 
cardiac failure, 200 c.c. of albumin solution may be mixed with 300 c c of 10 
per cent glucose solution in water and administered by continuous drip at a rate 
of 10 Gm. of albumin (100 c.c.) per hour. Although diuresis may occur soon 
after albumin administered has been instituted best results are obtained if 
albumin is continued until normal serum protein and serum albumin levels 
are regained. 

3 Because salt-poor albumin contains no preservative it should not be used 
if the solution is cloudy. Sterility is maintained by careful handling in cold 
rooms throughout the processing, Seitz filtration to remove bacteria, and heat 
treatment for 10 hours at 60° C. to kill viruses. 

4. Satisfactory methods, for processing and preserving salt-poor albumin were 
not developed until late in the war. As a result only about 1 /20 of the Navy's 
supply of albumin was obtained in this form. It is necessary then to restrict 
the use of salt -poor albumin to treatment of those cases of hypoproteinemia 
with poor kidney function in which the extra sodium of regular albumin would 
throw an additional burden on these damaged organs. Requisitions for salt- 
poor albumin should be accompanied by a letter setting forth the reasons for 
requesting this type of albumin. 

--BuMed. Ross T. Mclntire 



Circular Letter 46-123 15 August 1946 (Not Restricted) 

To: District Medical Officers 
Via: Comdts, NDs (continental U.S.) 

Sub J : LiguMJP la^nia^Prep aration o f in Naval Districts. 

Ref: Ca) BuMed CirLtr. No. 45-139, dtd, 4 Jun 1945. 

(b) BuMed CirLtr. No. 46-82, dtd, 14 May 1946. 

1. The following naval activities are hereby released from the responsibility 
of supplying liquid plasma to other activities in their respective Naval Districts 
as established by Reference (a): 



- 34 - 



Burned News Letter, Vol. 8, No. 5 



RESTRI CTE D 



(Not Restricted) 



Fii st Naval District 
Third Naval District 
Fourth. Naval District 
Fifth Naval District 
Sixth Naval District 
Seventh Naval District 
Eighth Naval District 
Ninth Naval District 
Eleventh Naval District 
Twelfth Naval District 
Thirteenth Naval District 
Potomac and Severn River 
Naval Commands 



USNH, Chelsea, Mass. 
USNH, St. Albans, L.I., N.Y. 
USNH, Philadelphia, Pa. 
USNH, Portsmouth, Va. 
USNH, Charleston, S.C. 
USNH, Key West, Fla. 
USNH, Norman, Oklahoma 
USNH, Great Lakes, 111. 
USNH, San Diego, Calif. 
USNH, Oakland, Calif. 
USNH, Bremerton, Wash. 
U.S. Naval Medical School, 
NNMC, Bethesda, Md. 



2. All Naval Medical Activities will now procure dried plasma d ir ectl y from 
the Naval Medical Supply Depot as needed at any time according to their re- 
spective requirements and as a regular Supply Catalog Item No. 1-607-104 
Plasma, Normal Human Dried (500 c.c). 

3. Nothing in this letter shall be construed as forbidding the preparation of 
liquid plasma by any naval activity, or its distribution to other naval activities 
provided that (a) the technic of preparation at all times conforms to the mini- 
mum requirements of the National Institute of Health for the preparation of 
human plasma and that (b) no funds are used to purchase blood for the single 
purpose of plasma preparations. 

4. The Blood and Plasma Department at the Naval Medical School, National 
Naval Medical Center, Bethesda, Maryland, will be maintained as a pilot 
plant for the purpose of providing instruction in blood and plasma bank opera- 
tions, as a source of consultation on questions involving blood and plasma and 

to provide a more efficient operation of the National Naval Medical Center Blood 
Bank. Further, they will coordinate research activities with those of the Naval 
Medical Research Institute when practicable. 

- -BuMed. Ross T. Mclntire 



Circular Letter 46-124 15 August 1946 

To-. All Ships and Stations 



(Not Restricted) 



Subj: ftprrvintmPT* m the Nurse Corns. TT. R. Npvy of Reserve Nurse Corps 
Officers. 



- 35 



Burned News Letter, Vol. 8, No. 5 RESTRICTED 

Ref: (a) BuMed CirLtr 46-113, 30 Jul 1946, (Navy Dept. Bull. Ttem^f 158 
End: (A) (HW) Sample forms of Acceptance and Oath of Office. 

(B) CHW) " Acknowledgment of Temporary Appointment. 

1. The assignment of permanent dates of rank as outlined in enclosure (A) of 
reference a) has led to some uncertainty on the part of individuals relative to 

v 1 \ m T /T nT' ? e praCtiGe iS being disc °ntinued and the dates previous- 
y published shall be disregarded. Initial permanent appointments issued to 
transferring officers henceforth will not include a date of rank, pending legis- 
lation as stated in AlNav 365. s K 

2 Enclosures (A) and (B) outline sample forms to replace the samples con- 
tained m enclosure (B) of reference. -BuMed. Ross T. Mclntire 
Mote: Copies of enclosures not reprinted here. 

****** 

Circular Letter 46-125 16 August 1946 (Not Restricted) 

To: Medical Officers in Command, All Continental Naval Hospitals. 
Subj: Nurse Corns Separatees - Forwarding of C0DV of final Qrders fo fhp 
Bureau of Medicine a nd Surg-erv ~~ 

,11 Zrll n tt6r fr ° m th f Chi6f ° f BuM8d directs that a c °Py of fin al orders of 
all Nurse Corps separatees be forwarded to BuMed. 

****** 

Circular Letter 46-121 15 August 1946 (Not Restricted) 

To: All Ships and Stations 

Subj: NavMed Forms, requisitioning nf 

Ref: (a) BuMed CirLtr 46-101, 19 Jun 1946, (N.D. Bull., Item 46-1381). 

1. Requisitions submitted in accordance with reference (a) shall be prepared 

4 7 n m n a T? en 47> A C ° 1Umn f ° r the NavMed numbe ^ is Prided on NavGen 
4 f. On all future requests the NavMed number shall be. entered in this column. 

l'^^ ei ^n nCe t0 r r ? g , aph 2 ° f reference fe), the Potomac and Severn 
River Naval Commands shall forward requests for NavMed forms to the East 
Coast Publications Distribution Center, Cheatham Annex, Williamsburg 
Virginia, until further notice. B ' 

--BuMed. W. J. C. Agnew 



36