As History Repeats Itself, Unexpected Developments Move Us Forward

Article excerpt

As long as our country has been involved in war, men and women have sacrificed life and limb serving this great nation in the pursuit of freedom. The unwavering commitment to enter battle comes with a trust in their fellow soldier and the peace of mind that in the event of injury, our great nation will provide the very best for our veterans. The Departments of Veterans Affairs (VA) and Defense (DoD) have a long history of being the leaders in medical care and research in the quest for the most effective treatment interventions and devices with the mission of caring for those who have served.

The benefits for veterans of the United States dates back to 1636, when the Pilgrims of Plymouth colony were at war with the Pequot Indians and a law was passed by the Pilgrims which stated that any disabled soldier would be cared for by the colony. In 1776, the Continental Congress authorized half-pay pensions for life for those with loss of limb or other serious disability. Only 3,000 Revolutionary War veterans ever drew any pensions [1].

The Civil War was the bloodiest war in U.S. history with over 30,000 Union soldiers and 40,000 Confederate soldiers losing limbs during the 4 years between 1861 and 1865. Prior to the war, only 500 of the 11,000 Northern physicians and 27 of 3,000 Southern physicians had performed surgery. Most had 2 years or less of medical school and learned to perform surgery through on-the-job training. Because more than 70 percent of the Civil War wounds were to limbs, countless wounded overflowed field hospitals after battle, and because of doctors' limited surgical skills, amputations were the treatment of choice, especially because the average procedure took less than 10 minutes [2]. The mortality rate from a primary amputation was 28 percent; however, if a secondary amputation was performed, the mortality rose to 58 percent. If infections such as "pyemia," or "pus in the blood," occurred, the mortality rate was over 90 percent [3].

The post-Civil War era pushed the Government to embrace the care of soldiers returning home since every family in the United States had been touched in one way or another by the war. Accordingly, the VA's motto is taken from President Lincoln's second inaugural address in 1865, where he asked Congress "to care for him who shall have borne the battle and for his widow, and his orphan." However, not until 1873 did Congress authorize the revision of disability pensions to be paid based on the degree of disability rather than rank, establish the National Home for Disabled Volunteer Soldiers, and decide that Arlington National Cemetery would be the place for burial of honorably discharged veterans [1].

The postwar opportunities ushered in the age of entrepreneurship that was sparked by "Great Civil War Benefaction," or the U.S. Government commitment to provide prostheses to all veterans. The most famous was a young engineering student, J. E. Hanger, who lost his leg above the knee early in the war serving in the Confederate Army. Discontented with his prosthesis, he set about to improve the function of his artificial leg. He obtained an exclusive contract to provide limbs to Confederate amputee veterans and was constantly in competition for Federal contracts with another firm founded by Dr. Douglas Bly of Rochester, New York. Both companies claimed to offer veterans the lightest prosthetic limb, weighing just less than 12 pounds. The U.S. Patent Office received numerous prosthesis designs, most of which could be worn by only a select few amputees. With just over 200 prosthetic clinics serving veterans throughout the United States, many extraordinary claims were made about the capability of a prosthesis, few were comfortable, and most veterans found crutches to be a more efficient means of ambulation [4]. Many prostheses were provided by traveling salesmen who scouted potential amputee customers from newspaper articles, local hospitals, or word of mouth. …