Sir Neville Howse (VC), Private John Simpson Kirkpatrick and Private Martin O’Meara (VC) and their contributions to Australian military medicine

Medical personnel serving with the Defence Forces have contributed to the evolution of trauma treatment and the advancement of prehospital care within the military environment. This paper investigates the stories of an Australian Medical Officer, Sir Neville Howse, and two stretcher bearers, Private John Simpson (Kirkpatrick) and Private Martin O’Meara, In particular it describes the gruelling conditions under which they performed their roles, and reflects on the legacy that they have left behind in Australian society. While it is widely acknowledged that conflicts such as World War One should never have happened, as civilian and defence force paramedics, we should never forget the service and sacrifice of defence force medical personnel and their contribution to the body of knowledge on the treatment of trauma. These men and women bravely provided emergency care in the most harrowing conditions possible. However, men like Martin O’Meara may not have been given the same status in society today as Sir Neville Howse or Simpson and his donkey, due to the public’s lack of awareness and acceptance of war neurosis and conditions such as post traumatic stress disorder, reactive psychosis and somatoform disorders which were suffered by many soldiers during their wartime service and on their return home after fighting in war.

Fatigue fractures in military conscripts : A study on risk factors, diagnostics and long-term consequences

Fatigue fracture is an overuse injury commonly encountered in military and sports medicine, and known to relate to intensive or recently intensified physical activity. Bone responds to increased stress by enhanced remodeling. If physical stress exceeds bone s capability to remodel, accumulation of microfractures can lead to bone fatigue and stress fracture. Clinical diagnosis of stress fractures is complex and based on patient s anamnesis and radiological imaging. Bone stress fractures are mostly low-risk injuries, healing well after non-operative management, yet, occurring in high-risk areas, stress fractures can progress to displacement, often necessitating surgical treatment and resulting in prolonged morbidity. In the current study, the role of vitamin D as a predisposing factor for fatigue fractures was assessed using serum 25OHD level as the index. The average serum 25OHD concentration was significantly lower in conscripts with fatigue fracture than in controls. Evaluating TRACP-5b bone resorption marker as indicator of fatigue fractures, patients with elevated serum TRACP-5b levels had eight times higher probability of sustaining a stress fracture than controls. Among the 154 patients with exercise induced anterior lower leg pain and no previous findings on plain radiography, MRI revealed a total of 143 bone stress injuries in 86 patients. In 99% of the cases, injuries were in the tibia, 57% in the distal third of the tibial shaft. In patients with injury, forty-nine (57%) patients exhibited bilateral stress injuries. In a 20-year follow-up, the incidence of femoral neck fatigue fractures prior to the Finnish Defence Forces new regimen in 1986 addressing prevention of these fractures was 20.8/100,000, but rose to 53.2/100,000 afterwards, a significant 2.6-fold increase. In nineteen subjects with displaced femoral neck fatigue fractures, ten early local complications (in first postoperative year) were evident, and after the first postoperative year, osteonecrosis of the femoral head in six and osteoarthritis of the hip in thirteen patients were found. It seems likely that low vitamin D levels are related to fatigue fractures, and that an increasing trend exists between TRACP-5b bone resorption marker elevation and fatigue fracture incidence. Though seldom detected by plain radiography, fatigue fractures often underlie unclear lower leg stress-related pain occurring in the distal parts of the tibia. Femoral neck fatigue fractures, when displaced, lead to long-term morbidity in a high percentage of patients, whereas, when non-displaced, they do not predispose patients to subsequent adverse complications. Importantly, an educational intervention can diminish the incidence of fracture displacement by enhancing awareness and providing instructions for earlier diagnosis of fatigue fractures.

Dilemmas in Military Medical Ethics: A Call for Conceptual Clarity

Article

Baylor History of Medicine Society Schedule 2006-2007

After Western Medicine: From Hippocrates to Xavier Bichat (H. Tristram Engelhardt, Jr.) Who Goes First? The Story of Self-Experimentation in Medicine (David Sears, M.D.) Exercise and Health: From Pre-History to the Present (Carlos Valbonna, M.D.) Supernaturalism to Rationalism and the Man Between (Student Essay Contest Winners) (Don Lassus) The Fog of War’s Silver Lining: The Lasting Impact of Military Medicine (Student Essay Contest Winners) (Ajit Vyas) From Drummers to Detail Men: Medicine and the pharmaceutical industry in the United States, 1900-1960 (Howard Brody) Eyewash and Thunderbolts: The Medical Adventures of Lewis and Clark (Herbert M. Swick) Angry Arrows and Satin Dresses: Tales from the Annals of Plague (Herbert M. Swick) The Greatest Books in the History of Neurology (Robert Gordon) Franklin Delano Roosevelt’s Paralytic Illness: What was the cause? (Armond S. Goldman)

The military surgeon : journal of the Association of Military Surgeons of the United States.

Title from cover.

Recent advances in medicine and surgery (19-30 April 1954) based on professional medical experiences in Japan and Korea, 1950-1953.

Includes bibliographies.

Journal of the Association of Military Surgeons of the United States.

Title from cover.

Transactions of the ... Annual Meeting of the Association of Military Surgeons of the National Guard of the United States.

Description based on: 2nd (19th, 20th, and 21st of Apr. 1892).

Memoirs of military surgery, and campaigns of the French armies, on the Rhine, in Corsica, Catalonia, Egypt, and Syria; at Boulogne, Ulm, and Austerlitz; in Saxony, Prussia, Poland, Spain, and Austria.

Austin, R.B. Early Amer. medical imprints,

Options for change in military medical care.

"March 1984"--Preface

Design of a traumatic injury simulator for assessing lower limb response to high loading rates

Current military conflicts are characterized by the use of the improvised explosive device. Improvements in personal protection, medical care, and evacuation logistics have resulted in increasing numbers of casualties surviving with complex musculoskeletal injuries, often leading to lifelong disability. Thus, there exists an urgent requirement to investigate the mechanism of extremity injury caused by these devices in order to develop mitigation strategies. In addition, the wounds of war are no longer restricted to the battlefield; similar injuries can be witnessed in civilian centers following a terrorist attack. Key to understanding such mechanisms of injury is the ability to deconstruct the complexities of an explosive event into a controlled, laboratory-based environment. In this article, a traumatic injury simulator, designed to recreate in the laboratory the impulse that is transferred to the lower extremity from an anti-vehicle explosion, is presented and characterized experimentally and numerically. Tests with instrumented cadaveric limbs were then conducted to assess the simulator’s ability to interact with the human in two mounting conditions, simulating typical seated and standing vehicle passengers. This experimental device will now allow us to (a) gain comprehensive understanding of the load-transfer mechanisms through the lower limb, (b) characterize the dissipating capacity of mitigation technologies, and (c) assess the bio-fidelity of surrogates.

Assessment of revised recruitment standards for asthma in the Australian Defence Force

Objective To assess the impact of relaxed asthma recruitment standards adopted by the Australian Defence Force (ADF) in 2007. Methods A retrospective audit was conducted on clinical and administrative data for recruits, with and without mild asthma, in their first year of service. Results There was no evidence that mild asthmatics experienced worse outcomes than nonasthmatic recruits. Mild asthmatics had fewer illnesses and restricted duty days and were less costly compared to other recruits. There was no difference in the rate of discharge (attrition) between those with and without mild asthma. Conclusions The revised recruitment standards for asthma in the ADF have not resulted in unanticipated medical or administrative costs to the organisation. Health and administrative outcomes differed little between mild asthmatics and non-asthmatic recruits in their first twelve months of service.

Rintamamiesten muonitus Suomessa sotavuosina 1939-1945

This study analyzes the war-time rations the Finnish soldiers received on the front from 1939 until 1945. The main objective was to determine the contents of the rations and how they affected the soldiers' nutrition and morale. The information concerning food and feeding is mainly based on the official documents found in the Military Archives. Some additional material was from the historical literature, some from memoirs, or from the veterans who personally experienced the front. The documents in the Archives of Military Medicine provided information on the soldiers' deficiencies. During the Winter War, which took place from 30 November 1939 until 13 March 1940, ample food was available. The cold climate caused problems and the fresh food got frozen. However, no severe deficiency cases were reported and the morale was high. By contrast, during the Continuation War, which began in June, 1941 and ended in September, 1944, difficulties were experienced. At the time farming in the country faced serious problems due to the shortage of labour, fuel, etc. Furthermore, importing food was generally not possible. However, importing food mainly from Germany saved the Finns from hunger. In addition, the self activity of the soldiers on the front added somewhat to the food production. But the rations had to be reduced. Their energy values were consequently low, especially for the young men. Food was monotonous and occasionally caused complaints. The main sources of protein, vitamins and minerals were the whole cereal foods. Butter was fortified with vitamin A and vitamin C tablets were also distributed, to compensate for the scant food sources. Only approximately 300 serious deficiency cases required hospital care during the three years time, out of a total of 400 000 soldiers. Feeding the young soldiers during the war (1944 - 1945) in Lapland, which had been destroyed, was problematic but the increased rations also saved them from deficiencies. In spite of the severe difficulties experienced occasionally in feeding the soldiers during the wars, the system worked all the time. The soldiers were fed, the cases of nutritional deficiency and epidemics caused by food were kept very limited and the morale of soldiers remained high.

Ballistic Trauma in Finland : An Epidemiologic and Clinical Study of Firearm and Explosion Injuries

The occurrence and nature of civilian firearm- and explosion-injuries in Finland, and the nature of severe gunshot injuries of the extremities were described in seven original articles. The main data sources used were the National Hospital Discharge Register, the Cause-of-Death Register, and the Archive of Death Certificates at Statistics Finland. The present study was population based. Epidemiologic methods were used in six and clinical analyses in five papers. In these clinical studies, every original hospital record and death certificate was critically analyzed. The trend of hospitalized firearm injuries has slightly declined in Finland from the late 1980s to the early 2000s. The occurrence decreased from 5.1 per 100 000 person-years in 1990 to 2.6 in 2003. The decline was found in the unintentional firearm injuries. A high incidence of unintentional injuries by firearms was characteristic of the country, while violence and homicides by firearms represented a minor problem. The incidence of fatal non-suicidal firearm injuries has been stable, 1.8 cases per 100 000 person-years. Suicides using firearms were eight times more common during the period studied. This is contrary to corresponding reports from many other countries. However, the use of alcohol and illegal drugs or substances was detected in as many as one-third of the injuries studied. The median length of hospitalization was three days and it was significantly associated (p<0.001) with the type of injury. The mean length of hospital stay has decreased from the 1980s to the early 2000s. In this study, there was a special interest in gunshot injuries of the extremities. From a clinical point of view, the nature of severe extremital gunshot wounds, as well as the primary operative approach in their management, varied. The patients with severe injuries of this kind were managed at university and central hospital emergency departments, by general surgeons in smaller hospitals and by cardiothoracic or vascular surgeons in larger hospitals. Injuries were rarities and as such challenges for surgeons on call. Some noteworthy aspects of the management were noticed and these should be focused on in the future. On the other hand, the small population density and the relatively large geographic area of Finland do not favor high volume, centralized trauma management systems. However, experimental war surgery has been increasingly taught in the country from the 1990s, and excellent results could be expected during the present decade. Epidemiologically, explosion injuries can be considered a minor problem in Finland at present, but their significance should not be underestimated. Fatal explosion injuries showed up sporadically. An increase occurred from 2002 to 2004 for no obvius reason. However, in view of the historical facts, a possibility for another rare major explosion involving several people might become likely within the next decade. The national control system of firearms is mainly based on the new legislations from 1998 and 2002. However, as shown in this study, there is no reason to assume that the national hospitalization policies, or the political climate, or the legislation might have changed over the study period and influenced the declining development, at least not directly. Indeed, the reason for the decline to appear in the incidence of unintentional injuries only remains unclear. It may derive from many practical steps, e.g. locked firearm cases, or from the stability of the community itself. For effective reduction of firearm-related injuries, preventive measures, such as education and counseling, should be targeted at recreational firearm users. To sum up, this study showed that the often reported increasing trend in firearm as well as explosion-related injuries has not manifested in Finland. Consequently, it can be recognized that, overall, the Finnish legislation together with the various strategies have succeeded in preventing firearm- and explosion-related injuries in the country.