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Chapter 3, Part 1

Medical Science Publication No. 4, Volume II

TUESDAY MORNING SESSION
27 April 1954

MODERATOR
COLONEL FRANCIS W. PRUITT, MC


GENERAL ASPECTS OF MEDICINE IN KOREA AND JAPAN 1950-53*

COLONEL FRANCIS W. PRUITT, MC

The commitment of United States and United Nations troops to combat in Korea brought with it many medical problems. It was the first time in the history of the American Army that troops had fought in the environmental conditions experienced on the Korean peninsula. The immediate and most pressing problem was medical support of troops. In the summer of 1950 we were at an all-time low in Medical Corps personnel in the Far East. The Eighth Army staffed the medical units in Japan, as well as those committed to Korea.

At the onset of hostilities there were only 156 Medical Corps officers in the Eighth Army; 346 was the authorized strength. It was immediately necessary to staff the 8054th Evacuation Hospital and the 8055th, 8063rd and 8076th Mobile Army Surgical Hospitals. Obviously, there were not enough surgeons initially to staff these units and internists were assigned to augment the surgical staff. All personnel were taken from units in Japan, depleting these facilities to an extraordinarily low level. Tokyo General Hospital, for example, had only seven Medical Corps officers, including the hospital commander.

Immediately preceding the Korean War we had lost a large group of physicians returning to the United States upon completion of the ASTP obligatory service. The nation's residency program was to declare its first dividend on the 30th of June. We were to receive approximately 12 physicians by routine shipment; of these, 10 had completed their residencies and 2 had been dropped from the program. In June we had 66 medical officers in internal medicine or its subspecialties, divided as shown in table 1. There were only three certified internists in the Far East at this time. We were extremely fortunate, however, to have a large group of physicians participating in the residency program in our teaching hospitals in the Zone of Interior. The majority of these were immediately transferred by air to the Far East.


*Presented 27 April 1954, to the Course on Recent Advances in Medicine and Surgery, Army Medical Service Graduate School, Walter Reed Army Medical Center, Washington,
D. C.


98

Table 1. Eighth Army Medical Corps, June 1950

Authorized-346

D-3139-37

Actual-156

C-3139-11

Total-66

B-3139-3

Internists or

3112-2

Subspecialists

3116-13

By the end of July 333 Medical Corps officers, or more than twice the number assigned in June, were present for duty and 240 Medical Corps officers had arrived from the U. S. by the l6th of August. In addition to the incoming physicians, all Army Medical Service personnel present in the Far East were retained beyond their normal service tour category, commitment or statutory retirement. This resulted in a saving of 30 Medical Corps officers in the first 2 months alone. In October we were ready to reassign the internists who had originally gone to Korea to augment the surgical units to their proper MOS positions. At this time we had 112 Medical Corps officers in internal medicine or its subspecialties, which included the categories listed in table 2. These were all assigned according to their MOS with the exception of the excess pediatricians. Many of this category were assigned to dispensary duty in Japan and Korea.

Table 2. Eighth Army Medical Corps, 1950

June

October

D-3139-37

D-3139-52

C-3139-11

C-3139-30

B-3139-3

B-3139-8

3112-2

C-3112-1

3116-13

A-3112-1

66

D-3116-10

C-3116-8

C-3105-1

111

By December 472 medical officers were on duty in Korea alone. These included 1 certified internist, 10 grade C-3139 and 35 grade D-3139. This is essentially the same number of internists in various categories as we had throughout Japan and Korea at the end of June, as seen in table 1. Four Army dermatologists were augmented by four from the Navy. The arrival of personnel during July and August made it possible for us to augment the staff by appropriate MOS of four field hospitals, two evacuation hospitals, one station hospital and one Mobile Army Surgical Hospital alone. At one time all the medical officers, except the commanding officers of five hospitals, were physicians whose residency training had been interrupted; others were appropriately assigned to units in Japan. It goes without saying that the bulk of these physicians were not the finished product in their


99

specialty; however, the fact that 98 percent of all casualties arriving at a medical facility in Korea survived is a monument to this young group of surgeons and physicians staffing the field units.

It is obvious that a great medical catastrophe was avoided by having on immediate call physicians taking residency courses in military and civilian hospitals sponsored by the Army Medical Service. Had it not been for this residency program we would have faced a tragedy of a crippling inadequacy of physicians when called on to enter a suddenly precipitated and unanticipated conflict. Certainly, foresight in training could not have been turned to a better advantage.

With the arrival of the first contingent we realized that something should be done in the way of personal interest and orientation of these medical officers. In other words, we set about to establish a doctor-doctor relationship. The majority of these individuals were suddenly separated from their brides or little families and immediately faced with the horrors of combat in a strange land, far separated from their loved ones. The stories of Communist tactics and atrocities compounded their fears. On occasion one would see a physician whose anxiety was so acute that he begged with tears in his eyes not to be sent to Korea. Our approach to each newly arrived group was in the form of a team from the GHQ Surgeons Consultants Office. A consultant in surgery, preventive medicine, internal medicine, and so forth, depending on the availability, comprised the team. Each one of the consultants approached the group with calmness of purpose and explained, sometimes in detail, the various diseases or types of casualties the newly assigned medical officers could anticipate. Suggestions regarding their personal comfort and welfare were made. This proved extremely worth while. One might encounter a group somewhat noncommunicative in its behavior which, at the end of an hour or so of deliberate explanation of the work and problems lying ahead, would begin to relax and ask questions. The interviews were usually terminated by friendly discussions of Stateside mutual friends.

At the time, we who had been in combat in Korea did not realize the impact of the discussion of our experiences with these young physicians-untrained for the field and with fear for their personal safety in combat. The efforts were indeed rewarding, both to the Army Medical Service and the theater surgeon. As the war went on and many individuals were returned to the U. S. it was not unusual for one of these physicians to go out of his way to see us or write a letter regarding the reception and orientation given him on his arrival.

Upon arrival in the Far East each physician was given a 5 x 8 card on which he was to list his professional biography together with special interests, research, and any other pertinent remarks. This system had been established previously for all internists and the subspecialists in


100

internal medicine. It was now expanded to include other professional fields. This provided a ready office index which could be rapidly reviewed when searching for a physician with the appropriate background when organizing a special study or center. This was continued throughout the campaign.

The physicians whose residencies were interrupted were told that they would be returned to their residencies in approximately 6 months. As time went on, the arrival of additional personnel made it possible for The Surgeon General's Office to keep its promise in this regard. As would be obvious, this did much for morale among Medical Corps personnel.

Special Problems in Medicine

Diarrhea and Dysenteries

One of the major problems with troops fighting in Korea in the early days was diarrhea and dysenteries. Quite frequently troops were deprived of water, either by Communist infiltration or other disruption of water supply. Rice paddy water or heavily polluted streams were frequently the only source available.

During the early weeks of the operation in Korea both forward and rear units suffered severely from gastrointestinal cramps and diarrhea. The maximum rate of 120 per thousand average strength per year occurred in August of 1950. With the onset of winter this dropped strikingly and, with the exception of a sharp rise in August of 1952, never presented a problem throughout the remainder of the Korean conflict. The striking number of cases in the early weeks, however, was significantly lower than peak rates for troops in the China-Burma-India Theater during World War II, the highest being 376 in August of 1942, more than three times the incidence in the early weeks of Korea. The rates just given include common diarrhea and dysenteries. It is interesting to note that the rate for dysenteries alone in U. S. troops was approximately 14 cases per thousand initially, and showed a rapid decline thereafter. No deaths were reported.

Food poisoning was never a problem, and it is interesting to note that while there were practically no cases at the onset there were cases appearing the following year. This is likely on the basis of more messing facilities, including the availability of more fresh food and unit-prepared dishes; this would present a greater opportunity for food contamination.

One of the following etiological agents was generally found in each case; use of impure water, ingestion of indigenous food or drink, inhalation and ingestion of road dust, emotional disturbances associated with service in a combat area, and the ingestion of food, often unappetizing, during the first few months of the war. In order to


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afford efficacious management and to retain a high degree of combat effectiveness these were divided into three categories on clinical grounds: (1) Simple, acute diarrhea, a watery, light green, explosive type of diarrhea containing flakes of mucus, but void of blood. Nausea and vomiting may or may not be present. These were treated by six tablets of sulfaguanidine, given immediately, and three tablets with each succeeding bowel movement. (2) Bacillary dysentery. If bacillary dysentery was suspected, the local use of a microscope was encouraged. If macrophages were seen it was felt that the case could be considered as shigellosis and the patient treated with chloramphenicol as far forward as possible. (3) Amebiasis. If it was felt that one was dealing with amebiasis, evacuation to a hospital with appropriate staff and facilities was recommended. Amebic dysentery was treated in some hospitals with aureomycin and terramycin with good response.

Malaria

Malaria was endemic in the Korean peninsula. Although prophylaxis was available the highest rate experienced was 41.4 in August of 1950. Relatively fewer cases were seen except for a sharp increase in June and July of 1952. This is explained in part by the fact that malaria occurring in two divisions rotating to Japan was charged to the incidence in Korea. From the start of the war through December 1953 there were 6,199 cases reported in Korea and 2,290 in Japan with 1 death throughout the campaign.

Infestation by Plasmodium vivax was the cause of most clinical malaria in the campaign. We were on the alert, however, for the possibility of falciparum infestation, particularly after the entry of the Chinese into the conflict. Falciparum malaria is prevalent, particularly in South China. Fortunately, this did not materialize. The only case of falciparum malaria was that in a newly arrived Ethiopian soldier.

Of the number of antimalarial compounds developed during and since World War II, the 4- and the 8-aminoquinoline compounds have been the most efficacious. Chloroquine is the suppressant drug of choice, free of side effects and effective in weekly doses. Malaria prophylaxis will be discussed in detail later in the program. Chloroquine was discontinued in the middle of September 1950. By the middle of March 1951 clinical manifestations of tertian malaria were seen in troops who were in, or had been evacuated from, Korea. Presumably, these troops were parasitized in Korea during the time they were on suppressive therapy and the plasmodia were in the tissue phase during the winter months of 1950 to 1951. This phase has been well explained by Short (1). Medical personnel were urged not to


102

waste time in searching for the plasmodia in a thin smear and to use only the thick smear preparations. Camoquin, one of the 4-aminoquinoline compounds, was recommended for use (2). This compound is effective in a single dose of 10 milligrams per kilogram. As the quinoline nucleus is broken down the degredation products are toxic to the plasmodia. This provided a nontoxic compound which could be given to ambulatory patients for the control of clinical cases.

The tissue, or exo-erythrocytic phase was treated early with quinine and chloroquine and, starting in 1951, with pentaquine and quinine. Because of the toxicity of pentaquine and the other 8-aminoquinoline compounds, all patients were hospitalized. All medical personnel were urged to be on the alert for appearance of methemoglobinemia in patients treated with the 8-aminoquinolines. Personnel were also warned against the administration of sulfa drugs or atabrine during this regimen, as both compounds will greatly increase the toxicity. While instructions were sent out (3) for the management of cerebral malaria, fortunately no cases appeared.

In the summer of 1951 primaquine, one of the 8-aminoquinoline compounds, was considered safe to use in a dose of 15 mg. daily on troops returning to the U. S. by ship. As time went on, however, it became apparent that this regimen was not 100 percent effective. In the 6 months from July 1952 to January 1953, nine patients with positive Plasmodium vivax were admitted to Letterman Army Hospital. These had all received and retained 15 mg. of primaquine for 9 to 14 days aboard ship and all had been on 300 mg. of chloroquine, prophylactically, in Korea. There was also one case of laboratory-proven methemoglobinemia severe enough to cause cyanosis in a Caucausian male (4). There is ample evidence that the 8-aminoquinoline compounds should be used under supervision. With the use of chloroquine suppressively, the availability of the other 4-aminoquinolines for clinical relapse and the 8-aminoquinolines for the tissue, or exoerythrocytic phase, malaria no longer appears to be the devastating scourge of U. S. troops serving in endemic areas. The British had excellent success with paludrine, prophylactically. Quinine and pamaquine were used therapeutically in the Commonwealth forces.

Venereal Disease

Venereal disease is a common associate of hunger, famine, loss of homes and the presence of troops with funds and food. The highest reported incidence of 210 cases occurred early in 1952 when large numbers of troops were rotated to Japan; however, this does not quite equal the peak occurrence of venereal disease in the Mediterranean Theater in the post-combat years of World War II. It is interesting to note that 87 percent of 610 native girls examined in Seoul were


103

found to be infected with venereal disease, almost equally divided between syphilis and gonorrhea. No free clinic facilities were available for the natives and penicillin, although available, could not be afforded. Chancroid almost constantly paralleled the total of all other venereal diseases. Dispensary treatment for venereal disease was inaugurated by the Eighth Army while in Japan in 1949 and continued throughout the Korean campaign.

Japanese B Encephalitis

This presented a perplexing problem early in the war, with some 335 cases occurring in late 1950 with a 10 percent mortality. Following this, Japanese B encephalitis was no problem. There were only 2 cases confirmed serologically in 1951 and 11 in 1952.

Poliomyelitis

Poliomyelitis, meningitis and other infections of the central nervous system were no problem in the United Nations Command.

Smallpox

Korea is an endemic area for smallpox and this disease was frequently seen in prisoners of war. During 1950 and 1951, 39 cases of acute fulminating hemorrhagic smallpox were seen. In none of these cases was there a scar from primary vaccination. Colonel Arthur Long, Consultant in Preventive Medicine, deserves the credit for intensifying the immunization program with the result that no further cases occurred in United Nations personnel.

Hepatitis

The relationship of viral hepatitis to a military campaign is well known to all. Undoubtedly, many of the cases of jaundice recorded during the Civil War were cases of viral hepatitis. Shortly after our troops were committed in Korea we established a center for the management of hepatitis. The peak incidence occurred that fall and winter, with some 4,000 admissions to the center and 4 deaths. In spite of the adversities experienced and unfavorable sanitary conditions, the 1950 and 1951 incidence was below that experienced in the Philippines in 1944 and 1945. The incidence during the Philippine campaign was more than three times the greatest incidence in Korea. By late 1951 this had leveled off and continued at about the level of the post World War II occupation experience. It may be well to point out the fact that we felt we were definitely dealing with acute infectious hepatitis. This was based on the lack of receiving blood or blood products and the history of a rather abrupt onset of the disease.

Many interesting problems arose in connection with hepatitis. Considerable difficulty was experienced in maintaining a level of brom-


104

sulphalein to carry out a liver function test used in our criteria for ambulation. Rehabilitation was carried out locally prior to the opening of the Rehabilitation Center in Nara in January 1951. Other necessary corrective procedures were also carried out after ambulation and prior to discharge. All of these factors added to prolonged hospitalization during the first winter. In spite of this, hospital stay was shortened by the use of vitamin B-12, which also was effective in combating the anorexia and reducing the serum bilirubin at an earlier time (5). A still greater improvement was noted when folic acid was combined with B-12. There is an apparent place for these agents in the majority of cellular repair, particularly in a desoxyribosenucleic acid of the nucleus and the ribonucleic acid of the cytoplasm.

In an effort to make additional beds for wounded casualties we almost lost this vital treatment center. General Silas B. Hays realized the detriment that would come from moving hepatitis patients thousands of miles and saved the center for us early in 1951. It was our recommendation that these patients be assigned to duty in Japan. We soon learned that they were being returned to their units in Korea. We cannot statistically state the incidence of relapses but know that clinically it was negligible. In all cases of relapse the patients would normally have been evacuated to the center and we were constantly on the lookout for these patients who did not appear. When combat conditions became more favorable and nutrition improved, hepatitis ceased to be a major problem.

Cold Injury

Subsequent to the entry of the Chinese Communists into the war in November of 1950 ground-type frostbite became a major medical problem that winter. During the withdrawal of the Eighth Army many troops became pinned down by enemy fire and required evacuation because of frostbite. A center was established in Japan for the management of these cases. The first winter there were 2,257 admissions to this center, in 84 percent of which the diagnosis was frostbite (6). It was remarkable how much tissue could be saved in these individuals with conservative treatment. Patients with fourth degree frostbite, involving the toes and distal part of the foot, were placed at bed rest and given intravenous procaine and heparin. Within 30 to 40 days there was usually a reversal of the process with the patient losing perhaps only the tip of his great toe. After the first winter frostbite ceased to create a problem.

Hemorrhagic Fever

In the summer of 1951 we experienced a disease new to Western medicine. We felt, initially, that we were dealing with leptospirosis; however, many of the subjective symptoms and the lack of jaundice


105

directed our attention elsewhere. It soon became apparent that we were dealing with acute hemorrhagic fever, a disease previously described by the Japanese when they occupied Manchuria and also documented by the Russians. We soon learned that these highly febrile, toxic individuals could not tolerate intravenous fluids. After our people in Korea had observed a number of these cases a tentative brief on the clinical management was drawn up and distributed from this experience. To this day the therapeutic management is essentially the same. The initial mortality of 14.6 percent dropped to 2.7 percent as we learned more about the management of these cases. Since the establishment of a center for detailed study of this disease in early 1952 many interesting observations have been made and documented elsewhere (7). The British Commonwealth forces experienced 60 cases the first fall and recorded 94 during 1952.

Common Respiratory Disease

Because of the severity of the winter in Korea and the inadequacy of the housing in the early days we expected a high incidence of common respiratory disease and influenza; however, this was not extraordinarily high when viewed in the light of common respiratory disease and influenza elsewhere.

Pneumonia

Except for the first winter the incidence was not quite as high as that experienced in the Mediterranean during World War II.

Post-traumatic Renal Insufficiency

Early in the Korean War it was recognized that we were seeing post-traumatic acute renal insufficiency or, if you will, lower nephron nephrosis. Realizing that sulfonamides are a contributing factor, etiologically, to the entity in individuals already subjective to trauma and blood transfusions, it was recommended that sulfonamides not be authorized for use in advance of the semi-fixed hospitals. Penicillin was readily available. This recommendation was disapproved by the Chief Consultant and subsequently cases of acute renal insufficiency were seen following sulfonamide administration with inadequate fluid. It was estimated that 1 out of every 300 to 500 traumatized casualties developed post-wounding renal insufficiency. A surgical research team with an artificial kidney was set up during 1952 to care for these casualties. These were received by helicopter after the clinical diagnosis was made. No patients with transfusion reactions or diazine-precipitated reactions were treated by this group; hence, all cases were post-traumatic. These patients were dialyzed when the serum potassium reached 7 to 9 milliequivalents per liter and a nonprotein nitrogen upwards of 200 mg. per 100 cc. This usually occurred by


106

post-wound day 3 or 4. It was felt that such a rapidly developing biochemical course was greatly altered by dialysis. This is borne out by the fact that dialyzing reduces the mortality from about 80 percent to 50 percent.

It is interesting to note that of the fatal cases uremic coma was an infrequent cause of death. Pneumonia was commonly seen, and peritonitis in those with belly wounds. All organisms, both pulmonary and systemic, were sensitive to streptomycin. It is interesting to note that in these patients and in those who recovered, there was a failure of wound healing and granulation did not appear until the onset of diuresis. This may be delayed to post-wound day 19. As would be apparent, conventional sutures gave way, causing hemorrhage during this period of oliguria. Norepinephrine was useful where shock developed in the presence of adequate blood volume; oliguria is not a contraindication to its use (8).

Table 3 portrays the total number of diseases encountered in the Far East from the onset of the Korean War through December 1953.

Table 3. Diseases in Far East from Onset of Korean War through December 1953


Disease or condition

Number of cases

Number of deaths

Total FECOM

Korea

Japan

Total FECOM

Korea

Japan

Cold Injury

8,260

7,920

339

1

-----

1

Smallpox

24

24

-----

4

4

-----

Epidemic Hemorrhagic Fever

2,168

2,158

10

125

124

1

Tuberculosis (all forms)

1,130

615

419

9

-----

3

Venereal Disease (total)

183,830

115,946

60,419

-----

-----

-----

Gonorrhea

111,748

68,764

38,829

-----

-----

-----

Syphilis

3,277

1,696

1,423

-----

-----

-----

All Other1

68,805

45,486

20,167

-----

-----

-----

Dysentery (All)

3,549

2,877

498

1

-----

-----

Food Infection and Poisoning

1,125

936

157

-----

-----

-----

Typhus (Louse-borne)

1

-----

1

-----

-----

-----

(Tick-borne)

-----

-----

-----

-----

-----

-----

(Flea-borne)

-----

-----

-----

-----

-----

-----

(Mite-borne)

4

3

1

-----

-----

-----

Malaria

8,686

6,199

2,290

1

-----

-----

Infectious Hepatitis
(Incl. Serum Hepatitis)

9,487

6,969

2,152

20

3

17

Poliomyelitis

166

126

31

19

11

8

Encephalitis Infectious
(Incl. Jap. B)

427

377

36

29

22

6

Rheumatic Fever

471

302

163

-----

-----

-----

Scarlet Fever

51

29

21

-----

-----

-----

Pneumonia (all forms)

10,225

7,031

2,821

16

6

6

Common Respiratory Diseases
and Influenza

109,962

68,408

37,951

2

2

-----

1Includes chancroid and other venereal disease.


Neuropsychiatry

We were all aware of the problem of the psychiatric casualty during combat. Early in the Korean combat, and about 3 months before, we were fortunate in receiving the experience of a consultant in psychiatry and each division was staffed with a psychiatrist. It was interesting to see these casualties managed in a rear division area with the result that 50 to 60 percent of all psychiatric casualties were returned to duty without leaving the division area.

Prisoner of War Patients

The management of this category of patients presented a considerable problem, both from the standpoint of administration and from that of professional care. Dysentery was a constant problem and in December 1950 four thousand prisoners of war were hospitalized, with six hundred deaths. Tuberculosis was the second leading cause for admission of prisoners of war and during December 1950 five hundred were hospitalized. Late in 1951 a pilot study was made of five hundred North Korean prisoners of war and five hundred Chinese which revealed an incidence of new or old pulmonary tuberculosis in 6.6 percent.

Nutritional edema was common in the newly admitted prisoners of war. This was corrected by the addition of powdered milk and powdered eggs to the diet. The magnitude of the burden of caring for these people by the Eighth Army can be surmised by the fact that during the first 6 months 140,000 prisoners were in our custody.

Education

As the war became more stabilized in 1951 it was recommended that a medical group be organized in Korea for the purpose of conferences, clinics, and so forth. The first one of these was in the Pusan area. These were well attended. The 38th Parallel Medical Society was organized the same year and was a very stimulating group. When making out the itinerary for a Surgeon General's Office consultant a visit to this group was always planned for the day of their scheduled meeting. These conferences were later expanded to include short postgraduate courses within the Eighth Army area in 1952. Each visiting consultant from the United States would discuss a series of subjects or present papers. The regularly scheduled medical meetings in Japan were disrupted by the onset of the Korean conflict; however, one such meeting was held in the late spring of 1951 and these meetings were resumed regularly in 1952.

Consultants

In general, consultants from the Zone of Interior were invaluable, not only from the standpoint of presenting newer advances in medi-


108

cine from the United States, but because of their tremendous morale value to Medical Corps personnel, particularly in the forward area of Korea. The value of selected consultants interested in teaching and sympathetic with military problems in such a situation cannot be overemphasized. Frequent use was made of regional consultants in medicine or a subspecialty with gratifying results; for example, a dermatologist was assigned to an evacuation hospital which previously had evacuated 49 percent of the dermatological patients to Korea. This figure dropped to 18 percent after the assignment of a dermatologist.

Role of Our Allies

A medical document of this nature would not be complete without reference to the splendid support given by the Medical Services of our Allies. In the late summer of 1950 the Swedish Red Cross established a well-staffed hospital in Pusan. The Danish Government, a few weeks later, provided the well-equipped and staffed hospital ship "Juliana." In 1951 the Norwegians furnished an equally well-staffed Mobile Army Surgical Hospital for forward operation. The extremely effective role that these units provided cannot be overemphasized.

References

1. Short, A. G., et. al.: Pre-erythrocytic Stage of Human Malaria, Plas. vivax. Brit. M. J. 1 : 547, 20 Mar. 1948.

2. Pruitt, F. W.: Malaria. Symposium on Military Medicine in the Far East Command, p. 24, Sept. 1951.

3. Ibid.

4. Hansen, Howard, Cleve, E. A., and Pruitt, F. W.: Relapse of Vivax Malaria Treated with Primaquine and Report of One Case of Methemoglobinemia due to Primaquine. Am. J. Med. Sc. 227 : 9, 1952.

5. Campbell, R., and Pruitt, F. W.: Vitamin B-12 in the Treatment of Viral Hepatitis; a Preliminary Report. Am. J. Med. Sc. 224 : 252, Sept. 1952.

6. Pruitt, F. W.: Experience with Cold Injury in the Korean War. J. Neb. Med. Assoc., Jan. 1954.

7. Pruitt, F. W., and Cleve, E. A.: Epidemic Hemorrhagic Fever. Am. J. Med. Sc. 225 : 661, 1953.

8. Pruitt, F. W.: Acute Post-traumatic Renal Insufficiency and Its Management. Neb. State Med. J. 39 : 137, Apr. 1954.