If you’re fortunate enough to have a day off today, it’s because of the sacrifices made by our military servicemembers. 

We have a beautiful Memorial Day tribute in Boston right now. For the 2nd year running, a garden of flags blankets the ground in front of the Soldiers and Sailors Monument on Flagstaff Hill on the Common. 33,000 flags are currently planted, in honor of Massachusetts’ servicemembers who’ve died in conflicts dating back to the Civil War.

Breathtaking, to say the least.

Be sure to thank a servicemember today.

This week I heard a radio interview with David Wood. A journalist since 1970, Wood is currently the senior Military Correspondent for the Huffington Post where he covers military issues, foreign affairs, and combat operations. He was talking about “Beyond the Battlefield”, a 10-part series that he recently wrote for the Huffington Post, exploring the challenges faced by severely wounded war veterans upon return home.

In contrast to the appalling numbers of war-related deaths faced by our military way back in history, thankfully today relatively fewer troops are being killed in combat – due to a combination of better technologies and equipment to protect them, as well as much improved medical care.

On the flip side, however, it seems that the enemy’s ability to catastrophically injure servicemembers in battle is increasing. In 2009 there were 86 US soldiers who lost at least one limb in combat, while in 2010 the number had increased to 187. Additionally from 2009 to 2010, the number of servicemembers who lost multiple limbs tripled from 23 to 72.

On The Battlefield

Wood told an amazing story about Tyler Southern, a 22 year old Marine who lost both of his legs and his right arm in Afghanistan in May 2010 when he stepped on an improvised explosive device. His close friend James Stoddard, a 19 year old Navy Corpsman, was now faced with attending to his first combat casualty.

Southern survived his horrific injuries, defeating all odds. This was largely thanks to the lifesaving actions of his friend James Stoddard who applied tourniquets to the stumps of his three injured limbs and his mangled left hand. He also inserted a breathing tube into Southern’s throat to maintain an open airway,  and administered intravenous fluid.

The young Marine was flown to a nearby military hospital where he was stabilized before being flown to a US military hospital in Germany. Somehow he survived the journey, despite flatlining on the way. Concerned that he was not going to survive, a decision was made to fly him home to the US, essentially so that he could die with his family.

Thankfully that didn’t happen. Tyler Southern survived his wounds, and despite everything that he has been through, he strives to see the silver linings and to maintain humor, saying “I have the world at my prosthetic feet. It’ll go well.”

Beyond The Battlefield

Inevitably the increase in such severe, complex injuries leads to multiple-fold consequences. In addition to the emotional and physical effects on the patient, they present challenges for military medical personnel who deal with such injuries on and off the battlefield, as well as for their loved ones.

Although we naturally celebrate the fact that so many individuals can survive despite their horrendous injuries, we cannot forget that these wounds last a lifetime. In addition to losing one or more limbs, servicemembers may have experienced an array of additional problems like traumatic brain injury, facial burns, infections, and inevitably deep depression. The issue of how we can best care for them even when the war is long over is one that we cannot afford to ignore.
It’s Veterans Day today. Please thank a servicemember if you get the opportunity.

The House of Representatives last week passed a bill introduced by NY Congressman Michael Grimm, himself a Marine veteran, that will help both dogs and servicemembers. The legislation establishes a pilot program in VA medical centers whereby veterans with PTSD will receive instruction in the handling and training of shelter dogs. 

Abandoned dogs in animal shelters will therefore be saved from euthanasia, while veterans with PTSD receive beneficial therapy through training them. Once trained, the dogs will then become service animals for disabled veterans – thus providing a two-pronged approach to helping servicemembers in need.


PTSD is a serious anxiety disorder that can arise as a consequence of exposure to situations such as a traumatic or life-threatening event. It is especially common in servicemembers returning home from combat deployments. Not everyone who experiences a traumatic event will develop PTSD, although it is not fully understood why some develop the condition but others don’t. While many sufferers will improve over time, about 1 in 3 people will continue to experience symptoms. 

The severity of symptoms can vary between sufferers, but they can seriously interfere with everyday life, affecting work, social activities and relationships. Symptoms typically fall into four categories:

  • Re-living the experience: This typically occurs when something happens to trigger memories of the traumatic event, often causing flashbacks. 
  • Avoidance of situations: Some people may avoid dealing with the emotions of the traumatic event by avoiding anything that reminds them of it.
  • Numbness: Sufferers may no longer have positive or affectionate feelings, and may report a general feeling of numbness.
  • Feeling Keyed-Up: Sufferers often describe feeling constantly jittery or on alert.

Although medications can be useful to help combat PTSD, counseling therapies tend to be most effective, especially cognitive behavioral therapy. With veteran suicide rates currently high, and increasing numbers of servicemembers returning from deployment with symptoms of PTSD, this bill meets an important need for additional treatment options.

Grimm remarked: “As a veteran, and an American, I am thrilled that this legislation has passed the House, and I urge my colleagues in the Senate to pass it without delay, so that it can be signed into law and allow us to begin providing assistance to our returning veterans.”

All in all a win-win solution that will help homeless dogs and support our deserving veterans.

Isn’t that the least we can offer?

Image Credit Website Of US Congressman Michael Grimm

This past weekend I had an enjoyable experience in Ogdensburg, upstate NY at their annual Founder’s Day commemoration of the region’s French colonial history. They held a re-enactment of the French-Indian War, bringing the mid-18th century to life for a couple of days.

One of the events I attended there was a lecture on “18th Century Medicine”, which was enjoyable, not just because of its fascinating content, but because the lecturer was one of the re-enactors, complete with accompanying props, including an amputation saw…….

Things have certainly changed in medicine over the past few centuries. Back then, only men trained as doctors.


Men who trained to be doctors would typically use one of two routes:

  • 7 year apprenticeship
  • 4 years university training combined with a 4 year apprenticeship


And these doctors came in one of 3 flavors:

  • Apothecaries would typically be responsible for selling medicines, as well as importing other sundries, such as cosmetics, metallics, and even coffee – basically anything that could be sold in a pretty, little jar! They were the professionals who would take advice from the physician or surgeon as to what the patient needed.
  • Surgeons could be found on the battlefield, on naval vessels, or in shops in town. Most surgeries at that time typically dealt with the limbs, predominantly by way of amputation – although others involved simple sutures, bullet extractions, removal of kidney stones, ophthalmology, dentistry, and rarely, caesarian section if called upon by midwives. Amputation around that time had a success rate of 25-40%, and infection represented the primary cause of death following this or any other surgery – especially so because antibiotics were not yet available, so there was no means of preventing infection in patients.  So if you happened to be the first surgical patient of the day, you definitely had a better chance of survival than the 25th patient of the day who was being operated on with the same instruments that probably hadn’t been cleaned since being first used that morning. Anesthetics also had not yet been developed, but at this time, surgical patients would be given a combination of opium and some kind of alcohol (usually rum, brandy, or wine).
  • Physicians would listen to a patient’s symptoms – they were the observers. So, as professionals, they represented the group that did the least, procedure-wise. Typically they’d be sending patients to either the apothecary or surgeon, based on their symptoms.



Women’s Work:

The role of women in the medical profession seemed to be mostly limited to midwifery and nursing. Although some complications of childbirth might be dealt with by a surgeon or physician, midwifery was typically the job of women.

Interestingly, nursing in the 18th century was considered the “lowest of the low” professions. Nurses tended to be prostitutes or criminals, and instead of healing their patients, they’d usually be found stealing their money, or providing “special comforts” to gentlemen patients…….a far cry from the pivotal role of nurses in medicine today!


So yes, thankfully medicine has changed dramatically over the centuries!



The latest edition of the New England Journal of Medicine describes the results of an interesting series of cases of respiratory symptoms in a group of soldiers returning from deployment to Iraq and Afghanistan.

Eighty soldiers at Fort Campbell, Kentucky, were referred for medical evaluation due to respiratory symptoms between 2004-2009. All were unable to meet US Army fitness standards upon return from duty in the Middle East, suffering exercise intolerance and failure to attain the fitness standard for the 2 mile run – despite having met it prior to deployment. They were otherwise apparently healthy.

Of the 80 soldiers evaluated, 49 of them underwent lung biopsy. Within the group that received biopsies, 38 soldiers were diagnosed with constrictive bronchiolitis – a condition that involves narrowing of the airways as a result of increased amounts of associated fibrous tissue and smooth muscle. Many of these biopsy sections also demonstrated the presence of foreign material in the airways – suggestive of some type of inhalational exposure.


The authors discussed the characteristics of these 38 soldiers with constrictive bronchiolitis:

  • Median age at enrollment was 33 years old
  • Various service positions within the Army
  • Normal cardiopulmonary exams, pulmonary function tests, chest x-rays, and CT scans

Many of the soldiers had been deployed to Iraq in 2003, and discussed having been exposed to smoke from sulfur-mine fire, dust storms, and incinerated human waste. So although all had been exposed to something, there was no single exposure that linked them all. Additionally, the constrictive bronchiolitis was not limited just to these soldiers who had been exposed to something.


Image from NEJM July 2011; 365:222-230

Constrictive bronchiolitis, a rare finding in healthy adults, is most typically described in patients with rheumatologic diseases, or in organ transplant patients. It has additionally been associated with inhalational exposure to inorganic dust, and a variety of chemical compounds.

Respiratory problems have frequently been reported in soldiers returning from duty in the Middle East, and although a possible link with some kind of exposure has been suggested, the exact cause remains unknown. This study unveils a key issue – the fact that so many soldiers suffered this problem after deployment raises the question of not just what is causing the problem, but just how many soldiers actually could become affected with by this condition, since no single cause has been identified. The exact nature of the particulate, foreign material found in the airways at lung biopsy also remains unknown, and will require further studies for evaluation.

Importantly too, the soldiers apparently continued to have respiratory symptoms as the study was being followed. Additionally, by 2010, most suffered continued dyspnea after climbing a flight of stairs. Half of the soldiers had even left the Army as a result of disability.


King et al: “Constrictive Bronchiolitis in Soldiers Returning from Iraq and Afghanistan” NEJM 2011; 365:222-230.


Hippocrates, the Father of Medicine, once said: “If you want to study medicine, go to war”.

In 1776 there were only 3,500 physicians in the colonies. These men clearly played a disproportionate role during the Revolutionary War, with around 1,300 of them serving as military surgeons at this time.

During the war, anyone with medical knowledge of any kind was drafted into service, and although all regiments had their own physicians, less than 300 of them actually had a medical degree. The minority had been trained in Philadelphia, at The Pennsylvania Hospital – the first medical school in the Americas, which opened in 1768. Since there were no laws or professional organizations to regulate medicine, however, this left anyone free to practice.

Inevitably therefore, more soldiers died due to health issues than combat during the Revolutionary War.

Anesthesia was not discovered until the mid 1800s, so alcohol and opium were typical agents used for surgical preparation of patients.  Medical equipment and drugs were in very short supply during the war, and physicians were frequently forced to work with what little equipment they had in their pocket kit. Additionally, they typically performed the only surgery that they knew to be useful – amputation. Surgeons had to work fast, since their patients were not anesthetized, and some reports describe things being stuffed into soldiers’ ears so they could not hear themselves screaming! And there was always the method of “biting the bullet”.

Wounded soldiers awaiting surgery were also first bled. Bloodletting was used to treat just about every type of medical illness, based on ancient beliefs that withdrawing large quantities of blood would purge the sick patient of “bad humors”. To add insult to injury, postsurgical procedures also often involved even more bloodletting! Unsurprisingly, surgical success rates were low at this time, with wartime surgeons having no idea that such blood loss could lead to death.

Overall though, despite the fact that professionally trained physicians were rare in the colonial military organization, Revolutionary Wartime surgeons did extremely well at treating the sick, and attempting to save lives. And although no major medical or surgical advances came from the war, one step forward did come in the form of smallpox control.

Smallpox was not a problem in America until introduced here by European settlers. The American Revolutionary War brought about numerous smallpox outbreaks. Patients who actually survive the disease develop lifelong immunity to it, so the British were at a distinct advantage since many of them had previously suffered the disease.

At that time, there were only two ways to deal with smallpox:

  • Isolation: Where susceptible soldiers were quarantined away from potentially diseased people.
  • Inoculation: Where material from smallpox lesions was extracted and injected under the skin of unexposed individuals.

By 1777, the ever increasing smallpox epidemics had led George Washington to order mandatory inoculation of all troops who had not had the disease. Medical historians actually credit this decision as a pivotal one – smallpox threatened to kill more soldiers than the British would, so it was this decision by Washington that allowed the Continental Army to turn the situation around and continue to fight at full strength.

Thankfully huge advances have been made in medicine since the era of the American Revolution. But one thing that remains unchanged is the fact that physicians continue to serve in the US military, helping not only fellow servicemembers, but foreign citizens too. “Service beyond self” clearly remains the mission of both the caring physician and proud military servicemember.

Happy July 4th everyone!