Diagnosing Historic American Military Medical Innovations

Article excerpt

The U.S. Navy hospital ship Comfort steamed toward Port-au-Prince, Haiti, days after the devastating January earthquake that killed more than 200,000 people. A fully equipped floating hospital and one of the largest trauma facilities in the United States, with the capacity of holding more than 1,200 military medical personnel and 1,000 hospital beds, the Comfort was launched in 1987 as a treatment facility for combat casualties and to support disaster relief and humanitarian operations. In a country that lacked adequate medical facilities even before the earthquake, the Comfort provided definitive care on its seven-week mission, treating 871 patients (540 critically injured) and performing 843 surgeries, according to the Navy.

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In one of the first medical procedures of her mission to Haiti, a young man who had sustained blunt head trauma was whisked to the radiology department and slid into the center of the donut-shaped, state-of-the-art CT scanner for diagnosis. The help provided him echoes critical antecedents in American military medical history. For it was in these same waters near Haiti, surrounding the Greater Antilles, during the 1898 Spanish-American War that the x-ray was first used by the American Medical Corps in wartime. As Haitians received vital treatment aboard the Comfort earlier this year, soldiers and civilians benefited from crucial cutting-edge U.S. military medical practices more than 100 years ago.

The period between the late 19,h and early 20"' century was marked by a radical transformation of medicine, especially in biomedicine, technology, specialization and rehabilitation. Wartime medical practice saved lives and served as a training ground and experimental laboratory, substantively influencing military and civilian medicine. New technologies like radiographic imaging saved soldiers in the field. The evolution of others such as prosthetics, coupled with the rise of medical specialization such as orthopedics and plastic surgery, also helped the wounded reclaim their lives and reintegrate into society.

X-ray developments marked the spot

X-rays were discovered late in 1895. Their usefulness in pinpointing the location of bullets within the body was immediately recognized and soon x-ray photographs were used by Italian, British and German military doctors in late 19Ih-century conflicts. By the time of the Spanish-American War less than three years after their discovery, practical diagnostic use of radiographs to treat wounded soldiers was conducted at permanent hospitals in the United States and on U.S. Army hospital ships such as the Relief. Dr. William Gray served as a photomicroscopist and roentgenologist (a specialist in imaging technology like the x-ray) aboard the Relief, which was characterized as the best-equipped vessel of her kind in the world. Gray, of the Army Medical Museum in Washington, D.C., had experimented with x-rays there as early as June 1896.

The shadows from x-rays revolutionized the diagnosis of war injuries by revealing fractured bones as well as locating bullets and shrapnel that often ripped haphazardly through the body. Before the introduction of the x-ray, military surgeons investigated wounds "by feel" with their finger, probe or other instrument. This was an inexact exploratory process that, even with antiseptic procedures, routinely compounded the projectiles' destructive effect and led to infection and other complications. In fact, seven soldiers died of infectious disease for each one who died from wounds sustained in battle. As a result of following a "do not touch" policy of limited surgical intervention when appropriate, 95 percent of those wounded in the Spanish-American war recovered, and x-rays factored into this success rate considerably.

Despite the technological revolution it helped introduce into the practice of military surgery, radiological progress in the Army Medical Department languished after the conclusion of the Spanish-American War. …