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Appendix C

APPENDIX C

HEADQUARTERS
EUROPEAN THEATER OF OPERATIONS
UNITED STATES ARMY

Office of the Chief Surgeon

8 DECEMBER 1944

CIRCULAR LETTER NO. 142

GUIDANCE TO DISPOSITION BOARDS

*    *    *    *    *    *    *

2. Attention is invited to Circular Letter No. 124, this office, subject, "Evacuation of Patients to the Zone of Interior," dated 17 October 1944. In the event that there is an insufficient number of 120-day cases to fill lift provided, enough cases will be selected which would fall within a 90-day evacuation policy to make up the deficit.

3. The decision as to disposition should be made as soon after the patient reaches a hospital as possible; i.e., when a diagnosis is made. Hospitals have been lax in this relation and must expedite evacuation. Further guidance, chiefly relating to fractures of long bones, is outlined in Circular Letter No. 131, this office, subject, "Care of Battle Casualties," dated 8 November 1944.

4. The following list of medical and surgical conditions is published for the guidance of Hospital Disposition Boards. It is to be remembered that this list is to be used only as a guide, each case to be decided on its individual merits.

a. Medical Conditions: * * *

b. Surgical conditions. The following list of surgical conditions demand return of personnel to hospitalization in the Zone of Interior.

(1) Maxillo-facial, plastic and burn cases.

(a) Severe maxillo-facial injuries associated with loss of tissue, which will require long-term reconstructive plastic surgery.

(b) Extensive loss of oral tissue in an amount that would prevent replacement of missing teeth by a satisfactory denture.

(c) Malignancies about face or mouth which will require extensive surgical treatment.

(d) Deep, extensive burns of the hands and face and extensive burns of other parts of the body.

(e) Wounds of other parts of the body which will require extensive plastic surgical procedures for correction.

(f) Severe compound, comminuted fractures of mandible or maxilla, with or without loss of bony substance.

(g) Patients with deforming but not disabling injuries in whom plastic repair should not be done within the 90-day period.

(2) Ophthalmic cases

(a) Those cases (officers) covered by AR 40-105, par. 9, 14 Oct. 1942.

(b) Those cases covered by MR 1-9, par. 18, 15 Oct. 1942, except "g," also changes 22 Jan. 1943.

(c) Retinitis, pigmentosa, organic night blindness.


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(3) Neurosurgical cases

(a) All cranio-cerebral injuries in which there has been gross injury to brain tissue, as in penetrating wound of the head and compound comminuted fracture of the skull, with indriven bone.

(b) All injuries to major motor peripheral nerves. (Disposition of VIIth [sic] Cranial nerve injuries should be decided according to the severity of the disability.)

(c) Tumors of the brain or spinal cord.

(d) Cases of chronic low backache associated with sciatic nerve pain, and accompanied by objective neurological signs. Exceptions may be made in officers occupying key administrative positions and noncommissioned officers with special skills.

(4) Orthopedic cases

(a) All compound fractures of upper and lower extremities involving major joints, or where the infection incident to compounding will not permit solid bony union to occur in four months, or where the healing will cause enough scar tissue formation in the overlying soft tissue to interfere materially with the function of the extremity. This in general will involve compound fractures of humerus, radius and ulna, femur, tibia, and extensive injuries of carpal and tarsal bones, shoulder, elbow, wrist, hip, knee and ankle joints. Possible exceptions may be made in certain selected instances of compounding forces resulting from clean, high velocity missiles where the continuity of the shaft of the bone has not been extensively disturbed.

(b) Simple fractures of femur and tibia, where the continuity of the shaft has been completely broken.

(c) Extensive compression fractures of vertebrae with or without dislocation.

(d) Osteoarthritis of joints with disability.

(5) General surgical cases

(a) All cases of proven malignant disease (pre- or post-operative) except those of the integument which seem capable of complete local removal. (Exceptions may be made where surgical excision offers hope of cure and the patient desires to remain in the ETO.)

(b) Perforated gastric and duodenal ulcer.

(c) All complicated cases of cholelithiasis.

(d) Large recurrent postoperative hernias.

(e) Abscess of lung, unless acute and making rapid recovery following operation.

(f) Established vascular disease, such as Raynand's Syndrome, thromboangiitis obliterans, serious thrombophlebitis with edema and cases with frostbite, immersion foot and trenchfoot in which there is demonstrable severe organic disease.

(6) Genito-urinary cases

(a) All cases of malignant disease except solitary papilloma of urinary bladder.

(b) Kidney

1. Diseases or injury requiring plastic operation of the kidney pelvis.
2. Bilateral renal disease-calculi-hydronephrosis.

(c) Ureter. Disease or injury requiring secondary or late plastic repair.

(d) Bladder. Neurogenic bladder without definite improvement in 1 month.

(e) Prostate hyperplasia causing symptoms incompatible with duty.

(f) Urethra and external genitalia. Wounds and injuries requiring extensive plastic procedures.

(g) Tuberculosis.

(7) Otolaryngological cases.

(a) Hearing loss below a level which makes a patient incompetent for all military duty.

(b) Chronic polypoid sinusitis, with severe symptoms

(c) Allergic rhinitis (severe)


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(d) Chronic suppurative otitis media and mastoiditis which requires radical mastoidectomy.

(e) Permanent tracheotomy.

(f) Destructive deformities interfering with mastication, speech and breathing.

(g) Ozena.

By order of the Chief Surgeon:

H. W. Doan 
H. W. DOAN 
Colonel, Medical Corps,
Executive Officer

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