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Go Back   Armchair General and HistoryNet >> The Best Forums in History > Historical Events & Eras > Modern Wars & Warfare > Military Medicine

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Military Medicine Discuss aspects of this specialist field not covered in other forums.

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  #1  
Old 24 Feb 12, 11:54
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Traumatic Brain Injury and shell shock

The first wide scale cases of shell shock I know of are from World War I. Shell shock figures prominatley in histories from that war.

Many of the men with shell shock appeard to have no physical injuries. Mostly it seems like it was treated like a mental break down // psychiatric problem.

It is understandable that men would have breakdowns after enduring the prolonged artillery bombardments of World War I. It is almost hard to beleive any one could endure the days long bombardment some of these men had to suffer trough.

I wonder if a high % of the men who had shell shock had suffered mild traumatic brain injuries?

World War I was the first war that saw wide spread use of the newer more powerful explosives such as TNT and its derivatives. And the volume of artillery was on the scale that was unimaginable in early eras. The amount of explosive power soldiers were exposed to was a quantum leap compared to earlier wars.
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  #2  
Old 24 Feb 12, 14:31
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Quote:
Originally Posted by 17thfabn View Post
The first wide scale cases of shell shock I know of are from World War I. Shell shock figures prominatley in histories from that war.

Many of the men with shell shock appeard to have no physical injuries. Mostly it seems like it was treated like a mental break down // psychiatric problem.

It is understandable that men would have breakdowns after enduring the prolonged artillery bombardments of World War I. It is almost hard to beleive any one could endure the days long bombardment some of these men had to suffer trough.

I wonder if a high % of the men who had shell shock had suffered mild traumatic brain injuries?

World War I was the first war that saw wide spread use of the newer more powerful explosives such as TNT and its derivatives. And the volume of artillery was on the scale that was unimaginable in early eras. The amount of explosive power soldiers were exposed to was a quantum leap compared to earlier wars.
Generally speaking, "shell shock" is different from traumatic brain injuries, now known as "closed head injuries".

"Shell shock", which came to be known as "combat fatigue" during WWII,i is a mental breakdown under extreme stress, while closed head injuries are a result of trauma, but also of concussion form explosive force. The damage arises from the degree of brain swelling, which compresses vital components inwards because of the inability of the skull to expand, causing ischemia and cell death, as well as neurological problems associated with the area that is damaged.

Today, we speak about people with PTSd, which is just as debilitating an injury, yet after 'Nam we laughed at men who dove for the floor every time they were startled by a loud noise.

One thing to remember is that soldiers were much tougher and much more self-reliant during WWI and WWII. The soldiers of today are not as accustomed to the horrors of war.
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  #3  
Old 25 Feb 12, 12:43
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Even today Closed Head Injuries' or trauma to the brian from violent movement of impact on the skull are poorly understood. WWI was the first war where large numbers of such injuries were possible, but it is apparent such injuries were not well recognized. Looking over the the medical and related literature from WWI, or from earlier eras, one can find clear descriptions of the symptoms of brain injury -"concussion" but which were not diagnosed as such at the time. I dont know of any methodical studies of these old medical records, but qualified people who have looked at individual cases identifiy this or that veterans post war headaches, memory loss, general confusion, ect.. as clear symtoms of brain injury.

Somewhere buried on my shelves is a brief essay outlining the medical approach to stress casualties from WWI through Viet Nam. The approach in each era was influenced by the psychiatric philosohpies en vogue. ie: the mass for Freudian trained psychiatrists present during and shortly after WWI had no clue what they were dealing with. Trying to treat a stress casualty during or post war with questions about mother/son relationships was unproductive.

My take is veterans suffering from either brain injury, or stress disorders self medicated post war, mostly with alcohol, or various drugs. Long term psychiatric care in the US was very uncommon until the plight of the Viet Nam veterans brought some attention in the 1970s & 1980s.

One of the observations made about the wounded from Iraq is that a larger portion of the maimed survive due to advanced trauma care. This seems to mean a larger portion of survivors with significant brain injury. Wounded who would have died in past wars are returned with brain damage as well as missing limbs, faces, & other internal problems.
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Old 27 Feb 12, 11:46
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Quote:
Originally Posted by Carl Schwamberg View Post
Even today Closed Head Injuries' or trauma to the brian from violent movement of impact on the skull are poorly understood. WWI was the first war where large numbers of such injuries were possible, but it is apparent such injuries were not well recognized. Looking over the the medical and related literature from WWI, or from earlier eras, one can find clear descriptions of the symptoms of brain injury -"concussion" but which were not diagnosed as such at the time. I dont know of any methodical studies of these old medical records, but qualified people who have looked at individual cases identifiy this or that veterans post war headaches, memory loss, general confusion, ect.. as clear symtoms of brain injury.

.
And I think it would be much harder to treat and diagnose people who may have had true mild TBI (traumatic brain injuries) during World War I as opposed to now. The medical imageing equipment today as opposed to World War I is much more advance with MRI, PET and CAT scans.
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Old 28 Feb 12, 21:19
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Quote:
Originally Posted by 17thfabn View Post
And I think it would be much harder to treat and diagnose people who may have had true mild TBI (traumatic brain injuries) during World War I as opposed to now. The medical imageing equipment today as opposed to World War I is much more advance with MRI, PET and CAT scans.
It also appears the symptoms were not understood as they have been since then. Like I wrote earlier when picking through the literature of the era, particualry post war one can find the symptoms described, but the doctors, family, or friends writing it simply did not know what they were describing, at least in current medical practice. No one connected Uncle Joes confusion, headaches, periods of depression or anger, to the idea that he was too close to a artillery shell exploding fifteen years earlier.
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Old 03 Mar 12, 17:27
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One of the reasons why the diagnoses were not well recognized was the state of the art in medicine at the time. There were no x-rays in WWI, nor any CAT scans, MRI's, EEG's or any of the other tests now taken for granted.

There was no large body of literature for military doctors to study, as up until WWI, military medicine was pretty primitive. The major tools available were observation and the history, such as might be gotten, of the patient. Psychiatry was available, but shell shock was not well understood, because the psychiatrists were not exposed to the same experiences as the soldiers.

The British, right through WWII, labeled anyone who could not go on because of stress-induced dysfunction as "LMF", stamped across their personnel jacket - Lack Of Moral Fiber - i.e., a coward.

Such was the level of understanding during WWII, and the basis for Catch 22. If you don't want to fight, you;re normal and fit to go. If you do, you're probably insane, but you're still good to go.

Since the advent of advanced imaging techniques, closed head injuries are better understood than ever before, but still not understood or treatable in the same way as illnesses and injuries throughout the rest of the body. The mind remains the last frontier of medicine.
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Old 08 Mar 12, 11:47
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Quote:
Originally Posted by Carl Schwamberg View Post
It also appears the symptoms were not understood as they have been since then. Like I wrote earlier when picking through the literature of the era, particualry post war one can find the symptoms described, but the doctors, family, or friends writing it simply did not know what they were describing, at least in current medical practice. No one connected Uncle Joes confusion, headaches, periods of depression or anger, to the idea that he was too close to a artillery shell exploding fifteen years earlier.
I wonder if men who might have suffered mild undiagnosed brain injuries had an increase in dementia and alzheimers due to injuries suffered in World War I, World War II, Korea, Vietnam, and the more recent conflicts. These men would probably have an increase in strokes.
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Old 08 Mar 12, 12:21
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I wonder if men who might have suffered mild undiagnosed brain injuries had an increase in dementia and alzheimers due to injuries suffered in World War I, World War II, Korea, Vietnam, and the more recent conflicts. These men would probably have an increase in strokes.
The medical records are still existant. Searching through those you ought to be able to find several hundred clear cut cases of brain injury, preferablly several thousand. Out of those you might be able to locate medical records for a portion to the end of their life. You might also find a few surviving children or grandchildren to interview. With some hard work and time you could come up with a hundred or two hundred valid cases to base a study on. Drug companies base their trials on smaller samples Someone qualified could probablly find grant funding for such a study. Just a matter of motivation.
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Old 08 Mar 12, 20:26
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Quote:
Originally Posted by Carl Schwamberg View Post
The medical records are still existant. Searching through those you ought to be able to find several hundred clear cut cases of brain injury, preferablly several thousand. Out of those you might be able to locate medical records for a portion to the end of their life. You might also find a few surviving children or grandchildren to interview. With some hard work and time you could come up with a hundred or two hundred valid cases to base a study on. Drug companies base their trials on smaller samples Someone qualified could probablly find grant funding for such a study. Just a matter of motivation.
I'm sure you're right, and it would be an interesting study, but I'm not sure who would want to fund it since it wouldn't have any real impact of battlefield medicine of today.

It would be interesting to do it, though.
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Old 11 Mar 12, 12:05
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It could be helpfull in understanding the post war problem. Just having a pile of solid statistics is usefull in squeezing money out of the legislature. I suspect if the actual postwar economic and social cost were understood there would be even more effort to reduce the problem at the start.

My perspective here is from the last two years of observing veterans aid. Most of the applicants for emergency aid were also ill with some sort of long term medical problem. As often as not these developing problems are at the root of the clients financial problems, missing too much work of losing his job due to a illness he & the doctors have or had not effectively addressed. They are frequently at the stage where symptoms but not root causes are being treated. Perhaps a through study of the Viet Nam era brian injuries would be the most helpfull currently. The DoD is attempting now (however poorly) to study the long term effects on Iraqi/Afgani vets. A VN era study could be usefull as a comparison & perhaps a trend warning.
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