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MEDICAL DEPARTMENT, UNITED STATES ARMY

SURGERY IN WORLD WAR II

THORACIC SURGERY

Volume II

Prepared and published under the direction of
Lieutenant General LEONARD D. HEATON
The Surgeon General, United States Army

Editor in Chief
Colonel ARNOLD LORENTZ AHNFELDT, MC, USA

Editor for Thoracic Surgery
FRANK B. BERRY, M.D.

Associate Editor
ELIZABETH M. McFETRIDGE, M.A.

OFFICE OF THE SURGEON GENERAL
DEPARTMENT OF THE ARMY
WASHINGTON, D.C., 1965


Contents

FOREWORD

PREFACE

Part I

SPECIAL TYPES OF WOUNDS OF THE CHEST

Chapter I. Special Types of Thoracic Wounds (Lyman A. Brewer III, M.D., and Thomas H. Burford, M.D.)

Wounds of the Chest Wall
Sucking Wounds
Fractures of the Ribs and Adjacent Structures
Wounds of the Lungs
Wounds of the Mediastinal Structures
Wounds of the Trachea and Bronchi
Wounds of the Esophagus
Crushing Injuries
Blast Injuries
Associated Wounds

II.  Wounds of the Heart (Including Retained Foreign Bodies), Mediterranean (Formerly North African) Theater of Operations (Lyman A. Brewer III, M.D., and Thomas H. Burford, M.D.)

Incidence
Clinical Picture and Diagnosis
Cardiac Tamponade
Pathologic Process
Pericardial Injuries
Contusions
Lacerations
Penetrating and Perforating Wounds
Migratory Foreign Bodies
Stab Wounds
Injuries of the Great Vessels
Management of Cardiac Wounds
Technique of Cardiac Surgery
Analysis of Cases

III.Thoracoabdominal Wounds (Lyman A. Brewer III, M.D.)

General Considerations
Pathologic Process
Diagnosis
Exploration
Resuscitation and Preoperative Preparation
Anesthesia
Surgical Approach
Incision
Technique
Special Surgical Considerations
Postoperative Care
Management in Base Hospitals
Case Histories
Experience of the 2d Auxiliary Surgical Group

Part II

COMPLICATIONS OF WOUNDS OF THE CHEST

IV.  Complications and Sequelae (Thomas H. Burford, M.D.)

Tension Pneumothorax
Hemorrhage
Acute Gastric Dilatation
Emphysema
Pulmonary Edema
Atelectasis
Hematoma of the Lung
Bronchopleural Fistula
Wound Disruption
Clostridial Myositis
Chylothorax
Lung Abscess
Mediastinal Abscess
Pneumonitis and Pneumonia
Traumatic Osteomyelitis
Chronic Sinuses of the Chest Wall
Defects of the Chest Wall
Adhesive Pleuritis
Diaphragmatic Hernia
Hernia of the Lung
Residual Symptoms

V.  Wet Lung (Thomas H. Burford, M.D.)

Concept and General Considerations
Pathogenesis and Pathophysiology
Etiologic Factures
Clinical Picture
Diagnosis
Prophylaxis
Management
Results of Therapy
Case Histories

VI.  Hemothorax and Hemothoracic Empyema (Thomas H. Burford, M.D.)

General Considerations
Incidence of Hemothorax and Its Complications
Pathogenesis of Organizing Hemothorax
Pathologic Changes in Chronic Traumatic Hemothorax
Bacteriology of Organizing Hemothorax
Physiopathology of Hemothorax
Clinical Picture and Diagnosis
Management of Simple Hemothorax
Clinical Picture and Diagnosis of Hemothoracic Empyema
Empyema in the World Wars
Management of Infected Hemothorax and Hemothoracic Empyema
Decortication of the Lung
Technique of Decortication
Postoperative Management After Decortication
Decortication in Empyema of Nontraumatic Origin
Special Studies of Pulmonary Decortication
Case Histories

VII.  Management of Retained Intrathoracic Foreign Bodies, Mediterranean (Formerly North African) Theater of Operations (Lyman A. Brewer III, M.D., and Thomas H. Burford, M.D.)

Incidence
Indications for Surgery
Surgical Timing
Techniques of Localization
Surgical Technique
Analysis of Cases

VIII.  Management of Retained Foreign Bodies in the Heart and Great Vessels, European Theater of Operations (Dwight E. Harken, M.D.)

Anatomic Location of Missiles
Foreign Bodies In and About the Heart
Foreign Bodies In and About the Great Vessels
Migratory Intravascular Foreign Bodies
Experiences at the 155th General Hospital Thoracic Surgery Center

Part III

OBSERVATIONS ON WOUNDS AND DISEASES OF THE CHEST IN THE ZONE OF INTERIOR

IX.  Management of the Sequelae of Combat-Incurred Wounds, Zone of Interior (Brian B. Blades, M.D., B. Noland Carter, M.D., and Michael E. DeBakey, M.D.)

Status of Returning Casualties
Clinical Considerations
Organizing Hemothorax
Hemothoracic Empyema
Retained Foreign Bodies
Chest Wall Defects
Draining Sinuses of the Chest Wall
Associated Wounds

X.  Surgical Aspects of Diseases of the Chest (Brian B. Blades, M.D., B. Noland Carter, M.D., and Michael E. DeBakey, M.D.)

Bronchiectasis
Pulmonary Tuberculosis
Lung Abscess
Empyema
Actinomycosis
Spontaneous Pneumothorax of Nontuberculous Origin
Malignant Neoplasms
Lesions of the Esophagus

XI.  Long-Term (1943-61) Followup Studies in Combat-Incurred Thoracic Wounds (Lyman A. Brewer III, M.D.)

Background of Study
Materials and Methods
Basic Data
Therapeutic Classification
Initial Wound Surgery
Subsequent Surgery
Mortality and Disposition
Wounds of the Chest Wall
Lacerations of the Lung
Mediastinal Injuries
Blast Injuries
Thoracoabdominal Wounds
Hematoma
Wet Lung
Hemothorax
Retained Foreign Bodies
Postdischarge Followup
Summary and Conclusions

APPENDIX

  Special Reports and Statistical Data (B. Noland Carter, M.D., and Michael E. DeBakey, M.D.)

Illustrations

FIGURE:

1.  Superficial bullet wounds of chest wall not involving bony structures
2.  Schematic showing of pathologic physiology of sucking chest wound
2b.Schematic showing of pathologic physiology of sucking chest wound (cont.)
3.  Schematic showing of pathologic physiology of flail chest
4.  Management of flail chest
4b.Management of flail chest (cont.)
5.  Schematic showing of results of laceration of main bronchus
6.  Thoracic laceration of esophagus
7.  Cervical laceration of esophagus
8.  Acute suppurative mediastinitis secondary to perforation of esophagus
9.  Large esophagopleural fistula with total right pyopneumothorax
10.  Schematic showing of pathologic physiology of blast injury
11.  Fatal cardiac contusion 
12.  Survivor of cardiac wound shortly after machinegun slug had been removed from his heart 
13.  Foreign body in left ventricle of heart
13b.Foreign body in left ventricle of heart (cont.)
14.  Foreign body in wall of left ventricle near cardiac apex
15.  Serial electrocardiograms taken after penetrating wound of heart
16.  Machinegun bullet in right side of heart near junction of right auricle and right ventricle
17.  Shell fragment in anterior wall of heart in region of right ventricle
18.  Schematic showing of pathologic physiology of acute pericardial tamponade
19.  Pneumopericardium with retained foreign body just behind heart
20.  Management of cardiac tamponade by aspiration
21.  Scattered petechial and confluent hemorrhages of right ventricle caused by penetrating bullet wound of sternum
22.  Electrocardiogram of patient with cardiac contusion
23.  Technique of cardiac surgery
24.  Technique of cardiac surgery
25.  Repair of through-and-through wound of heart
25b.Repair of through-and-through wound of heart
25c.Repair of through-and-through wound of heart
26.  Repair of through-and-through wound of heart
27.  Migratory intravascular foreign body
28.  Migratory intravascular foreign body
29.  Migratory intravascular foreign body
29b.Migratory intravascular foreign body (cont.)
30.  Retained shell fragment in close apposition to ascending aorta
31.  Retained .38-caliber bullet lying directly against ascending aorta for 20 years
32.  Technique of cardiac surgery
33.  Technique of cardiac surgery
34.  Suppurative pericarditis
35.  Types of wounds of diaphragm possible from penetrating or perforating missiles
36.  Schematic showing of maximum expiratory excursion of diaphragm
37.  Technique of transdiaphragmatic operation for left-sided thoracoabdominal wound 
38.  Thoracoabdominal wound requiring later drainage of anterior subphrenic abscess following laceration of liver
39.  Thoracoabdominal wound requiring later drainage of large intrahepatic abscess
40.  Management of subphrenic abscess secondary to laceration of liver
40b.  Management of subphrenic abscess secondary to laceration of liver (cont.)
41.  Coexistent bile empyema and subphrenic abscess
42.  Pathologic physiology of tension pneumothorax
43.  Tension pneumothorax of various origins
43b.  Tension pneumothorax of various origins (cont.)
44.  Pressure (tension) pneumothorax
45.  Lateral roentgenogram showing extreme degree of pressure pneumothorax with mediastinal shift
46.  Management of tension pneumothorax
47.  Schematic showing of pathologic physiology of mediastinal emphysema
47b.  Schematic showing of pathologic physiology of mediastinal emphysema (cont.)
48.  Management of mediastinal emphysema
49.  Management of mediastinal emphysema
50.  Technique of intermittent positive pressure oxygen administration in field and evacuation hospitals
51.  Postoperative atelectasis with complete collapse of lung
52.  Posteroanterior roentgenogram showing hematoma and clearly defined missile track in left lung
53.  Posteroanterior roentgenogram showing typical intrapulmonary hematoma
54.  Posteroanterior roentgenogram showing sharply defined intrapleural hematoma
55.  Hematoma of lung
55b.Hematoma of lung (cont.)
56.  Bronchopleural fistula
57.  Sinus of chest wall resulting from traumatic osteomyelitis of clavicle
58.  Defect of anterior chest wall
59.  Diagrammatic representation of infolded lung (adhesive pleuritis)
60.  Traumatic diaphragmatic hernia
60b.  Traumatic diaphragmatic hernia (cont.)
61.  Diaphragmatic hernia
62.  Diaphragmatic hernia
63.  Anatomic distribution of 28 diaphragmatic hernias
64.  Diaphragmatic hernia
65.  True hernia of lung 
66.  Technique of repair of pulmonary hernia
66b.Technique of repair of pulmonary hernia (cont.)
66c.Technique of repair of pulmonary hernia (cont.)
67.  Management of patient with wet lung
68.  Intercostal nerve block in management of painful wounds of chest wall
69.  Technique of tracheobronchial catheter aspiration
69b.Technique of tracheobronchial catheter aspiration (cont.)
69c.Technique of tracheobronchial catheter aspiration (cont.)
70.  Administration of oxygen under intermittent positive pressure in management of wet lung
70b.Administration of oxygen under intermittent positive pressure in management of wet lung (cont.)
71.  Hemothorax with recurrent pulmonary hemorrhage
71b.Hemothorax with recurrent pulmonary hemorrhage
72.  Posteroanterior roentgenogram showing clotted right hemothorax
73.  Massive liquid hemothorax without infection 
74.  Photomicrograph showing organizing hemothorax with replacement of acute fibrinopurulent deposit 
75.  Photomicrograph showing fibroblastic membrane from clotted hemothorax 11 days after wounding
76.  Photomicrograph showing section of peel of clotted hemothorax 4 weeks after wounding
77.  Photomicrograph showing section from clotting hemothorax
78.  Photomicrograph of section through membrane, pleura, and lung in posttraumatic empyema 12 weeks after wounding
79.  Cross-sectional diagram showing pathologic process in clotting, organizing hemothorax 
80.  Photomicrograph showing layer of fibrin 3 mm. thick, removed from visceral pleura in uninfected clotted hemothorax 11 days after wounding
81.  Fibrotic process in organizing hemothorax
82.  Photomicrograph showing calcium deposition in collagenous tissue layer of exudate on visceral pleura in organizing hemothorax
83.  Photomicrograph showing biopsied section of lung and pleura after removal of overlying exudate
84.  Photomicrograph showing replacement of fibrinous exudate, pleura, and adjacent lung
85.  Photomicrograph showing infected organizing hemothorax
86.  Spontaneous resolution of clotted hemothorax
87.  Posteroanterior roentgenogram showing right clotted hemothorax
88.  Lateral roentgenogram showing clotted hemothorax over right lower and middle lobes
89.  Clotted hemothorax with spontaneous clearing 
90.  Clotted hemothorax with spontaneous clearing
91.  Management of hemothorax by thoracentesis
92.  Schematic showing of recurrent hemothorax after thoracentesis
93.  Schematic showing of massive clotted hemothorax
94.  Decortication in hemothoracic empyema
95.  Management of hemothoracic empyema by rib-resection drainage
96.  Posteroanterior roentgenogram showing massive liquid empyema on right side 4 weeks after rib-resection drainage
97.  Management of clotted hemothorax with retained foreign body
97b.  Management of clotted hemothorax with retained foreign body (cont.)
98.  Management of clotted hemothorax with retained foreign body
99.  Technique of decortication
100. Techniques of decortication showing alternate methods of entering pleural cavity
101. Technique of decortication
102. Technique of decortication 
103. Technique of decortication
104. Technique of decortication 
105. Management of clotted hemothorax by decortication 
106. Management of massive liquid hemothoracic empyema 
107. Technique of decortication
108. Typical temperature charts of patients with hemothoracic empyema treated by primary decortication with penicillin coverage
109. Comparative results of management of empyema in World Wars I and II
109b. Comparative results of management of empyema in World Wars I and II (cont.)
110. Management of hemothorax by secondary decortication 
111. Management of hemothoracic empyema by primary decortication 
112. Management of hemothoracic empyema by decortication
113. Management of clotted hemothorax by primary decortication 
114. Spontaneous clearing of clotted hemothorax
115. Management of clotted hemothorax by decortication 
116. Management of hemothoracic empyema by primary decortication 
117. Management of clotted hemothorax by primary decortication 
118. Posteroanterior roentgenogram showing organizing clotted hemothorax on left side
119. Management of organizing clotted hemothorax by decortication 
120. Management of clotted hemothorax with retained foreign body and bronchopleural fistula by primary decortication 
121. Management of tension hemopneumothorax and total hemothoracic empyema by secondary decortication 
121b.Management of tension hemopneumothorax and total hemothoracic empyema by secondary decortication (cont.)
122. Management of infected clotted hemothorax by early primary decortication
123. Management of infected clotted hemothorax with complications by early primary decortication 
124. Retained foreign body in lung
125. Retained foreign body in lung
126. Retained foreign body in posterior chest wall
127. Localization of intrathoracic foreign bodies by division of chest into arbitrary sectors
128. Localization of intrathoracic foreign body
129. Localization of foreign body in chest wall
130. Localization of intrapulmonary foreign body
131. Localization of foreign body in lung
132. Localization of foreign body in chest wall
133. Localization of foreign body in chest wall
134. Localization of foreign bodies in chest wall
135. Localization of foreign body in lung
136. Localization of foreign body in diaphragm
137. Localization of foreign body in diaphragm
138. Localization of foreign bodies in right chest
139. Localization of foreign body in mediastinum
140. Localization of foreign bodies in lung and mediastinum 
141. Localization of foreign body in intrapleural space
142. Intrapleural foreign body associated with massive empyema
143. Specimens of metallic foreign bodies removed from lungs and pleural cavity
144. Gross location of foreign bodies removed from cardiac and vascular structures at 160th General Hospital
145. Missiles removed from chambers of heart, with their location
146. Roentgenograms showing original position of fragment in right ventricle
147. Electrocardiograms taken before first cardiotomy
148. Positioning of patient at successive cardiotomies
149. Roentgenograms showing position of fragment in right auricle after first operation
150. Electrocardiograms taken after first cardiotomy
151. Roentgenograms showing fragment again in right ventricle after second cardiotomy
152. Electrocardiogram taken after second cardiotomy
153. Electrocardiograms taken during third and successful cardiotomy
154. Migration of foreign body at successive cardiotomies
155. Electrocardiograms taken after third and successful cardiotomy with removal of fragment from right ventricle
156. Patient just before evacuation to Zone of Interior, after three cardiotomies
157. Electrocardiograms taken before cardiotomy showing left ventricular damage
158. Preoperative roentgenograms showing retained missile in left ventricle
159. Preoperative roentgenograms showing retained fragment in left auricle
160. Electrocardiogram taken before operation showing possible damage to anterior myocardial wall
161. Technique of removal of retained shell fragment from left auricle
162. Electrocardiogram after left auricular cardiotomy and removal of intra-auricular shell fragment
163. Incisions used to obtain exposure of foreign bodies in heart
164. Roentgenograms showing foreign body in chamber of right ventricle
165. Technique of removal of foreign body
166. Technique of combined intercostal-transsternal approach to right aspect of right ventricle
167. Roentgenograms showing missile in right auricle
168. Technique of removal of foreign body
169. Technique of posterior approach to pericardium and heart on right
170. Roentgenograms showing foreign body in interauricular septum and right auricle
171. Technique of removal of foreign body in right auricle by incision in superior vena cava
172. Roentgenograms showing foreign body in pericardial abscess well back on diaphragmatic surface of heart
173. Electrocardiograms taken during operation for removal of pericardial foreign body
174. Roentgenograms showing .30-caliber bullet in hilar region of left lung
175. Roentgenograms taken immediately after left thoracotomy
176. Technique of removal from right pulmonary artery of foreign body
177. Roentgenograms showing retained shell fragment posterior to right sternoclavicular joint in region of innominate artery
178. Technique of removal of retained missile from innominate artery
179. Roentgenograms 3 days after wounding showing clear lung fields
180. Roentgenograms 1 month later, 2 days after sudden onset of pain in left lower hemithorax
181. Migration of bullet from left pulmonary artery into main pulmonary artery and into right pulmonary artery 
182. Probable course of migratory missile from left auricle through left ventricle and aorta into innominate artery
183. Course of migratory bullet from entry into inferior vena cava through right auricle and ventricle
184. Encapsulated hemothorax managed by decortication
185. Traumatic hemothorax
186. Hemothoracic empyema managed by anterior drainage 
187. Retained foreign body with delayed manifestations due to infection 
188. Retained foreign body without symptoms
189. Retained foreign body without clinical manifestations
190. Bronchospirometric tracing 1 month after left lower lobe lobectomy for bronchiectasis
191. Bronchospirometric tracing 7 weeks after left lower lobe lobectomy for bronchiectasis
192. Bronchospirometric tracing 8 weeks after right middle and lower lobe lobectomy for bronchiectasis
193. Bronchospirometric tracing 7 weeks after resection of left lower lobe and lingula of the upper lobe for bronchiectasis
194. Patient after final closure of tuberculous sinus complicating thoracoabdominal wound 16 months earlier
195. Punchcard designed to secure data in long-term followup of veterans with combat-incurred wounds of chest 
196. Schematic showing of large defects of chest wall 
196b. Schematic showing of large defects of chest wall (cont.)
197. Serial roentgenograms in large defect of chest wall 
197b. Serial roentgenograms in large defect of chest wall (cont.)
198. Schematic showing of sucking wound with defect of chest wall
198b. Schematic showing of sucking wound with defect of chest wall (cont.)
198c. Schematic showing of sucking wound with defect of chest wall (cont.)
199. Serial roentgenograms in sucking wound with defect of chest wall complicated by severe infection
200. Sucking wound of left posterior chest with early infection
200b.Sucking wound of left posterior chest with early infection (cont.)
200c. Sucking wound of left posterior chest with early infection (cont.)
201. Serial roentgenograms of sucking wound with early infection
202. Anterolateral sucking wound of left chest
202b.Anterolateral sucking wound of left chest (cont.)
203. Serial roentgenograms in mediastinal injury with intrapericardial foreign bodies and hematoma 
204. Serial roentgenograms in blast injury 
205. Schematic showing of thoracoabdominal wound 
205b.Schematic showing of thoracoabdominal wound (cont.)
206. Serial roentgenograms in thoracoabdominal wound
206b.Serial roentgenograms in thoracoabdominal wound (cont.)
207. Schematic showing of thoracoabdominal wound 
207b.Schematic showing of thoracoabdominal wound  (cont.)
207c.Schematic showing of thoracoabdominal wound  (cont.)
208. Serial roentgenograms in thoracoabdominal wound
209. Schematic showing of thoracoabdominal wound 
210. Serial roentgenograms in thoracoabdominal wound 
210b. Serial roentgenograms in thoracoabdominal wound (cont.)
211. Schematic showing of thoracoabdominal wound 
212. Serial roentgenograms in thoracoabdominal wound
212b. Serial roentgenograms in thoracoabdominal wound (cont.)
213. Schematic showing of thoracic wound with massive hematoma of the right lung
213b. Schematic showing of thoracic wound with massive hematoma of the right lung (cont.)
214. Serial roentgenograms of hematoma of right lower lobe of lung
214b.Serial roentgenograms of hematoma of right lower lobe of lung (cont.)
215. Schematic showing of large sucking wound of chest 
215b. Schematic showing of large sucking wound of chest (cont.)
216. Serial roentgenograms of sucking wound of chest with wet lung syndrome
217. Schematic showing of chest wound with massive chest wall and intrapleural trauma
217b.Schematic showing of chest wound with massive chest wall and intrapleural trauma (cont.)
217c.Schematic showing of chest wound with massive chest wall and intrapleural trauma (cont.)
218. Serial roentgenograms in thoracic wound complicated by massive hemothorax
219. Schematic showing of chest wound with retained foreign body
219b. Schematic showing of chest wound with retained foreign body (cont.)
220. Serial roentgenograms in wound with intrapulmonary foreign body
221. Schematic showing of chest wound with retained foreign bodies in lung
221b. Schematic showing of chest wound with retained foreign bodies in lung (cont.)
221c. Schematic showing of chest wound with retained foreign bodies in lung (cont.)
222. Serial roentgenograms of thoracic wound with retained bodies in lung

Appendix figures:

1.  Posteroanterior roentgenogram showing large foreign body in contact with esophagus.
2.  Posteroanterior roentgenogram showing Lipiodol visualization of bronchopleural fistula, narrow empyema track, and drainage site at some distance from fistula.
3.  Posteroanterior roentgenogram showing pneumonitis and fibrosis associated with retained foreign bodies.
4.  Foreign bodies in contact with large blood vessels.
5.  Retained foreign bodies giving rise to infection. 
6.  Retained foreign bodies giving rise to symptoms. 
7.  Early thoracotomy without drainage in penetrating bullet wound of chest. 
8.  Early thoracotomy without drainage in penetrating shell-fragment wound of right chest.
9.  Early thoracotomy without drainage in perforating wound of right chest.
10. Observations at decortication.
11. Infected organized hemothorax managed by decortication.
12. Infected hemothorax and total empyema.

Color Plates

I. Appearance of heart at instant of incision into right ventricle
II.  Technique of dislocation of heart from pericardial sac
III. Marked ventricular dilatation following dislocation of heart

Tables

1.  Blast injuries of nonbattle origin, by numbers of admissions and deaths, and by area, 1942-45
2.  Battle-incurred blast injuries, by numbers of admissions and deaths, and by area, 1942-45
3.  Battle-incurred blast injuries of thorax and thoracoabdominal region, by numbers of admissions and deaths, and by area, 1944
4.  Battle-incurred blast injuries of thorax and thoracoabdominal region, by numbers of admissions and deaths, and by area, 1944
5.  Distribution of injuries and anatomic involvements in 56 combat-incurred cardiac injuries
6.  Distribution of 27 deaths in 56 combat-incurred cardiac injuries
7.  Frequency of wounds and case fatality rates in 903 thoracoabdominal wounds according to combinations of viscera
8.  Case fatality rate according to timelag in 854 thoracoabdominal injuries
9.  Case fatality rate according to surgical procedure in 903 thoracoabdominal wounds
10.  Number of admissions and deaths for lung abscess, by area, 1942-45
11.  Number of secondary cases of lung abscess, by area, 1944-45
12.  Incidence, admissions, secondary diagnoses, and deaths from diaphragmatic hernia, by area, 1944-45
13.  Admissions for empyema of the chest, by area, 1942-45
14.  Distribution of 20 percent sample of secondary cases of empyema of the chest, by area and type of admission 
15.  Admissions for bronchiectasis, by area, 1942-45
16.  Operations for pulmonary tuberculosis, Fitzsimons General Hospital, 1944-45
17.  Incidence of malignant neoplasms of respiratory system and of esophagus, by area,1944-45
18.  Morbidity and mortality from malignant neoplasms of respiratory system and of esophagus, 1944-45
19.  Deaths due to malignant neoplasms of respiratory system and of esophagus, by area,1944-45
20.  Thoracic damage in 167 followed-up thoracic casualties according to surgical procedure in forward hospitals 
21.  Associated injuries in 167 followed-up thoracic casualties according to surgical procedure
22.Intra-abdominal damage in 81 followed-up thoracic casualties according to surgical procedure
23.Complications in forward and fixed hospitals in 167 followed-up thoracic casualties according to surgical procedure in forward hospitals
24.Surgery required in fixed hospitals according to surgery performed in forward hospitals


MEDICAL DEPARTMENT
UNITED STATES ARMY
IN WORLD WAR II


NOTE

This volume was written and edited under the direction and supervision of Colonel John Boyd Coates, Jr., MC, USA, former Director and Editor in Chief, The Historical Unit, U.S. Army Medical Service.

ARNOLD LORENTZ AHNFELDT,
Colonel, Medical Corps,
Editor in Chief.


SURGERY IN WORLD WAR II

Advisory Editorial Board

  MICHAEL E. DEBAKEY, M.D., Chairman
 
FRANK B. BERRY, M.D. JOHN B. FLICK, M.D.
  BRIAN B. BLADES, M.D.  FRANK GLENN, M.D.
  J. BARRETT BROWN, M.D.  M. ELLIOTT RANDOLPH, M.D.
  STERLING BUNNELL, M.D. (dec.) ISIDOR S. RAVDIN, M.D.
  NORTON CANFIELD, M.D. JOSEPH R. SHAEFFER, M.D.
  B. NOLAND CARTER, M.D.  ALFRED R. SHANDS, Jr., M.D.
  EDWARD D. CHURCHILL, M.D. HOWARD E. SNYDER, M.D.
  MATHER CLEVELAND, M.D.  R. GLEN SPURLING, M.D.
  DANIEL C. ELKIN, M.D. (dec.)  BARNES WOODHALL, M.D.
  ROBERT M. ZOLLINGER, M.D.
  Brigadier General DOUGLAS B. KENDRICK, Jr. (ex officio)
  Brigadier General JAMES E. GRAHAM (ex officio)
  Colonel JOHN BOYD COATES, Jr., MC, USA (ex officio)

The Historical Unit, United States Army Medical Service

Colonel ARNOLD LORENTZ AHNFELDT, MC, USA, Director
CHARLES J. SIMPSON, Executive Officer
Lieutenant Colonel GILBERT A. BISHOP, MSC, USA, Chief, Special Projects Branch
CHARLES M. WILTSE, Ph. D., Litt. D., Chief, Historians Branch
ERNEST ELLIOTT, Jr., Chief, Editorial Branch
Lieutenant Colonel JEROME RUDBERG, MSC, USA, Chief, Information Activities Branch
RODERICK M. ENGERT, Chief, General Reference and Research Branch
HAZEL G. HINE, Chief, Administrative Branch

Library of Congress Catalog Card Number: 63-6000


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