During the First World War there were no special facilities for the treatment of head injuries until it was realized that early operation and the avoidance of slow and distressing evacuation gave much better results and less infection of the wounds. Hospitals located a few miles from the front were therefore designated for the reception of head-wounded soldiers, and postoperative cases were held there for two or three weeks before being sent on.
The principles of what came to be known as neurosurgery were formulated by Harvey Cushing, an American working in Boston. There were very few surgeons with expertise in the treatment of war wounds of the head; however, the need for a thorough exploration and the removal of all bone fragments was slowly appreciated and, when it was possible, primary wound closure soon after injury avoided herniation of brain into the skull defect and scalp wound—a very undesirable condition known as brain fungus.
The work of these pioneers was reported in several papers that were a valuable record, 1 - 7 though unfortunately not all their experience was remembered twenty years later. There were great advances in technique and equipment in the years between the two World Wars but neurosurgery remained a very small specialty practised by men who had also to care for general cases.
Hugh Cairns Figure 1 was a young and enthusiastic surgeon at the London Hospital who had been trained by Cushing in Boston and who had been appointed to the Queen Alexandra Military Hospital, Millbank.
In he was chosen to advise the War Office on the care of head injuries in the forces and to make recommendations for their treatment. Cairns had by now become the professor of surgery at Oxford, and it was here that he established a bedded Military Hospital for Head Injuries in St Hugh's College.
He also created two convalescent homes for their rehabilitation. These units served the Army and Air Force, the Navy having made its own arrangements.
St Hugh's Hospital treated some13 head-injured patients during the Second World War and a whole generation of neurosurgeons, neurologists and specialist nurses were trained there.
In order to provide specialist teams who could treat head injuries within hours after wounding, Cairns devised the concept of a mobile neurosurgical unit MNSU that could be deployed where the need was greatest. He had a genius for selecting the right person for a particular task and appointed William Henderson, from Leeds, to plan the prototype unit and advise on its establishment and equipment. The plan was for a unit to be attached to a hospital, casualty clearing station CCS or field ambulance, and this host unit would provide beds for postoperative patients, extra staff if they were needed, catering, laundry, pathology and radiology services etc.
The original vehicle had the appearance of a converted ambulance but this was replaced by a 3-ton and a hundredweight truck, both to be augmented later. There were originally two sets of neurosurgical instruments and one set for general use.
Each unit had its own electricity generator, tentage and water supply, as well as other necessary items such as two operating tables, suction apparatus, diathermy and illumination. In fact there was all the equipment needed to carry out at least operations without replacements. Soon after its arrival, personnel were evacuated through Dunkirk, and the unit's nursing sisters went with them. However, the surgeons belonging to the host CCS were deployed elsewhere, and Henderson found himself in charge of wounded soldiers.
The unit and its patients were taken prisoner and this MNSU took no further part in the war. A new unit was formed in November and designated No. It was sent to North Africa under the command of Peter Ascroft. Italy had attacked the defences of Egypt in September and their troops were driven back as far as Tunisia with heavy losses. The No. While it was in the desert, operations were carried out, but the Army had not yet learnt how an MNSU should be used or the necessity of separating the head-injured for specialist treatment; only 27 of the soldiers had head wounds.
When the management of head injuries had become properly organized neurosurgical patients were admitted to this unit, not only from the Western Desert but also from Mesopotamia. It was not until after the battle of Alamein that the units were used for the purpose for which they had been created.
Eden was not only a very good neurosurgeon but also an imaginative commander. He converted an ton Italian motor coach into a mobile operating theatre Figure 2 ; it was cramped, but could be packed up and on the move in an hour or two if necessary, and could be brought into use equally rapidly. The coach was attached to two Indian-pattern tents that formed a reception ward, the whole being hosted by a CCS. However, it became apparent that the unit was too far away from the actual fighting and so Eden split it into forward and rear sections.
For example, the forward section, attached to a field surgical unit, was at one time in Tunis, while the rear one, with a general hospital, was in Tripoli, about miles behind the lines to the east.
The forward section treated all the serious head injuries; others that were less critical were sent back to the rear section or to No.Food and nutrition are fundamental to military capability. Historical examples demonstrate that a failure to supply adequate nutrition to armies inevitably leads to disaster; however, innovative measures to overcome difficulties in feeding reap benefits, and save lives.
In barracks, UK Armed Forces are currently fed according to the relatively new Pay As You Dine policy, which has attracted criticism from some quarters. The recently introduced Multi-Climate Ration has been developed specifically to deal with issues arising from Iraq and the current conflict in Afghanistan. Severely wounded military personnel are likely to lose a significant amount of their muscle mass, in spite of the best medical care. Nutritional support is unable to prevent this, but can ameliorate the effects of the catabolic process.
Measuring and quantifying nutritional status during critical illness is difficult. A consensus is beginning to emerge from studies investigating the effects of nutritional interventions on how, what and when to feed patients with critical illness. The Ministry of Defence is currently undertaking research to address specific concerns related to nutrition as well as seeking to promote healthy eating in military personnel.
Nutrition and the military are fundamentally entwined. Without a regular supply of food and water, no army can hope, or expect to successfully prevail in its principal role: warfighting. Appropriate food, in terms of both quality and quantity, and adequate hydration are required to ensure that the physical capacity and mental performance of military personnel remain at optimal levels. Nutrition is a major contributor to the wound healing process in those who are injured, as well as influencing their subsequent recovery and rehabilitation.
This paper will initially present a brief historical overview of the military's understanding of the importance of good nutrition, before then discussing current UK feeding policy for military training and on operations. The role of nutrition in wound healing will be considered in relation to the current paucity of data to inform clinical dietetic practices in trauma medicine. Finally, this paper will introduce contemporary work that is addressing these knowledge gaps, with the aim of providing an evidence base to inform future clinical nutrition interventions.
There are many examples in history that illustrate the impact of feeding provision on the success or otherwise of military campaigns. Scurvy was responsible for the loss of more sailors than enemy action in the eighteenth century. During Lord Anson's circumnavigation of the world —of sailors in his fleet died [ 1 ]. While serving as ship's surgeon on board HMS Salisbury inJames Lind, Royal Navy RNfamously undertook the first prospective interventional trial, investigating the treatment of scurvy.
InCaptain James Cook RN wrote in the Philosophical Transactions of the Royal Society that the addition of malt, sauerkraut and wild celery to the diet, along with strict adherence to cleanliness and a regular supply of fresh water aboard ship, meant that not one crew member succumbed to scurvy during the 3 year voyage of the Resolution — [ 3 ]. Preservation of food during long voyages remained a problem until when a French chef, Nicolas Appert, responded to Napoleon Bonaparte's offer of a 12 franc reward for inventing a means of preserving food for the military.
Appert used airtight glass containers, laying the foundation for pre-packaged food. Appert's idea was further developed by Pierre Durand, a British merchant, who developed tin-covered iron canisters in Three years later, the British Army and the RN were supplied with food preserved in tin cans.
This mantra was dramatically highlighted during his failed invasion of Russia in the summer of Napoleon's army numbered soldiers.As a result of the nature of their employment members of the UK Armed Forces may, on occasion, be exposed to physical danger.
Although the nature of the occupational hazards they encounter may be predictable, such as enemy action or adverse climactic conditions, they are frequently far more uncertain.
Most military professionals acknowledge that they may face danger as part of the job — that is the nature of the military contract. However it is probable that personnel view such danger as resulting from enemy action rather than being caused by their own side.
Again the latter is inherent in the military contract — the former is not. In this paper we explore the occupational health concerns connected to the anthrax vaccination and depleted uranium ammunitions used by the UK Armed Forces and their coalition partners, both of which have been the cause of considerable controversy.
During the Gulf War, many service personnel received a combination of vaccinations, including anthrax, in order to prevent them from being injured by a variety of biological weaponry. Formal research investigating the health of Gulf War veterans found modest associations between receipt of the anthrax vaccination and reporting more physical symptoms. Although the UK military policy has always been to offer vaccinations only on a voluntary basis, prior to the Iraq War, the military decided to emphasize the voluntary nature of the anthrax vaccination offered to troops.
This was done by implementing a programme of information to help individuals to make informed choices.
Timeline of typhoid fever
There were several reasons for these changes. Second, vaccination safety in general was now an even greater cause of public anxiety following the MMR crisis, which contributed to, and was symptomatic of, a general scepticism toward vaccinations, and a reduction in public confidence. For instance, the medical profession is under increasing obligation to provide informed choice to patients when offering medical interventions. In fact, many personnel actually endorsed problems with the administration of the voluntary immunization programme as reasons for why they chose not to receive the anthrax vaccination.
It is clear that many soldiers wanted the information provided to have addressed the myths surrounding the anthrax vaccination, for example, possible links to infertility and birth abnormalities. Military personnel are not alone in having been offered the anthrax vaccination as protection against biological attack. US postal workers, following the anthrax attacks were offered the vaccination. Similar concerns were voiced by the postal workers offered the vaccination. In particular, lack of trust was reported to be a highly relevant reason for choosing not to accept the vaccination, with individuals citing the controversy over the military's use of the vaccination.
The parallels between the postal workers and the UK military personnel continue. Both groups were asked to sign consent forms to receive the vaccination and both groups reported that this only further damaged their confidence in the vaccination programme. Thus in a situation where employers realized that trust was in short supply and thus attempted to increase confidence through a shift in policy the opposite effect was achieved.
We argue that while informed consent may be desirable on ethical, or legal grounds, but it may not inevitably lead to the expected positive consequences. The anthrax vaccination is not the only uncertain, and coalition produced, threat faced by members of the Armed Forces.This is the popular view also cited by Beasley 1.
It is possible that this is an erroneous opinion akin to that previously perpetuated regarding the cause of Hunter's death—as syphilitic aortitis acquired in the dissecting room, when in fact he died of ischaemic heart disease.
An alternative view proposed by Dobson 2 is that Hunter enlisted in the Army primarily to advance his career. This seems more plausible considering the great risks from both injury and disease attendant on military service—a topic considered by Dr Gordon Cook in the subsequent issue of the JRSM.
Another point, as discussed by Oppenheimer 3is the controversy surrounding the relationship between Home and Hunter. Home, who destroyed Hunter's manuscripts and has been accused of plagiarism, might well have had nefarious reasons for impugning Hunter's health.
National Center for Biotechnology InformationU. J R Soc Med. J RosenbergHon. Author information Copyright and License information Disclaimer. References 1.
His wife Gertrude recalled that while he was in hospital. He shook all the time. He couldn't stand the noise of the guns. We got a letter from him, but it was in a stranger's handwriting.
He could write perfectly well, but couldn't hold the pen because his hand was shaking. It is now thought by professionals that Farr was possibly suffering from hyperacusiswhich occurs when the olivocochlear bundle in the inner ear is damaged, causing it to lose its ability to soften and filter sound, making loud noises physically unbearable auditory efferent dysfunction.
Despite this, Farr was discharged from hospital and sent back to the front with the 1st Battalion of the West Yorkshire Regimenta part of the 6th Infantry Divisionwith which he fought in the Battle of the Somme. Farr reported himself to the medical station several times over the following months. On 22 July he spent the night at a medical station and was discharged for duty the following morning. On 17 September he again attempted to seek the help of a medical orderly, but was refused as he was not physically wounded and the aid station was dealing with a high number of battle casualties.
Upon being found at 11 P. He had to defend himself against the formal accusation of 'misbehaving before the enemy in such a manner as to show cowardice'. The Divisional court martial, presided over by Lieutenant-Colonel Frederick Springthe Commanding Officer of the 11th Service Battalion of the Essex Regimentlasted 20 minutes, and questions have subsequently been raised about its competence.
Harry Farr's wife, Gertrude, then living in Kensington, London, was first told her husband had been killed in actionbut later when her pension was stopped, she was informed he had been shot for cowardice and she was not entitled to receive a war widow's pension.
InGertrude and her family discovered that some documents were being released by the government and that Andrew MacKinlay MP was involved in a campaign for justice for those in similar positions to Farr. When they got hold of the court martial papers, they were horrified to discover that Farr had been sent back to the front, when he in fact needed urgent medical treatment.
Despite a sustained campaign, Prime Minister John Major refused a pardon. Gertrude Farr died in On 15 AugustHarry Farr's family announced that Farr was to be granted a pardon. Des Browne told BBC Radio 4 's Today programme that, after 90 years, "the evidence just doesn't exist inside the cases individually". A group pardon would also exonerate those who had been properly found guilty of cowardice. A historian [ who? Historians have criticised such a move in the past as trying to apply modern standards retroactively.
The mass pardon of British Empire soldiers executed for certain offences during the Great War was enacted in section of the Armed Forces Actwhich came into effect on royal assent on 8 November However section 4 states that the pardon "does not affect any conviction or sentence.
From Wikipedia, the free encyclopedia. Harry Farr. Archived from the original on 31 August Retrieved 16 August JRSM Open is a peer reviewed online-only journal that follows the open-access publishing model. It is a companion journal to the Journal of the Royal Society of Medicine. The journal publishes research papers, research letters, clinical and methodological reviews, and case reports.
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Those submitting papers should carefully check that all those whose work contributed to the paper are acknowledged as contributing authors.Professor Andrew Roberts, international bestselling Author, globally respected Historian and a highly accomplished Public Speaker, will be joining Professor Sir Simon Wessely for a tantalising discussion of his successful career, plans for the for the future, and leadership in a time of crisis.
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John Hunter's teachings on gunshot wounds
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