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THE BOARD FOR THE STUDY OF THE SEVERELY WOUNDED. Left to right: Lt. Col. (later Colonel) Fiorindo A. Simeone, Capt, (later Major) Charles H. Burnett, Capt. Louis D. Smith, Capt. Seymour L. Shapiro, Lt. Col. Henry K. Beecher, Maj. (later Lt. Colonel) Eugene R. Sullivan, Lt. Col. Tracy B. Mallory. Monghidora, Italy, 1944.


Foreword

Severe surgical shock following trauma is not commonly encountered in the medical practice of any group during peacetime. When it occurs it is the result of unexpected accident, and adequate provision for careful study has seldom been available. Consequently, although considerable noteworthy experimental work had been done on shock in animals since World War I, little opportunity has existed to study this serious condition in man. When the United States entered World War II, much information required for handling battle casualties with serious injuries was not available. The need for whole-blood replacement for resuscitation was incompletely understood. The significance of blood volumes, infection, continuing hemorrhage, the anatomic location of the injury, and the limitations of analgesic and anesthetic agents was not fully appreciated although all these subjects had been understood in a seemingly adequate manner.

The brunt of this lack of information and training in U. S. Forces was carried by the Medical Service of the North African and later the Mediterranean Theater. Until June 1944, when their forward medical service was organized to study the severely wounded, they were the only theaters with sizable numbers of ground troops steadily in contact with the enemy. For nearly 2 years they experienced battle casualties at rates almost continuously above 50 per 1,000 per annum, and for nearly 10 months of this period their battle casualties were above 100 per 1,000 per annum. The ingenuity, resourcefulness, and thoroughness with which Medical Department personnel performed under these trying circumstances are exemplified by the work of the individuals of the MTO Board for the Study of the Severely Wounded and the progressive steps taken by them to initiate their studies without special provision or support.

The Board's studies on human casualties under battle conditions contributed much information of immediate practical value for the handling of wounded as well as pointed the way for many basic studies required for


the future. The data were accumulated under the rigors of field conditions, at times under fire, and the work was often begun in the shock tents a few minutes after a wounded subject fell. This research was unique for American Forces during World War II and provided information on the resuscitation and treatment of the severely wounded that cannot be procured from any other source. Aside from its significance as a contribution to medical knowledge, this report must stand as a tribute to the men who showed that it could be done.

                            GEORGE E. ARMSTRONG
                            Major General, U. S. Army
                            The Surgeon General

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