Posts From Old Blog
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US Navy Medicine History Highlights by NHHC — 3/25/10
Naval History and Heritage Command has an excellent and concise page with references to many sub-topics within the realm of US Navy Medicine. As you might imagine, this is right up my alley, and I plan on spending time on each and every link. Unfortunately, a series of tests have kept me quite busy as of late.
You will notice that there are a series of interesting paintings and pictures detailing various actions of Navy medical corpsmen within several different venues, giving one a sense of the kind of conditions they had to work in, as well as what types of medical work they might do with men who have been injured in the line of duty. Several photographs are also available regarding the medical activities and staff aboard the USS Kroonland, depicting the specific medical facilities aboard that ship. It is a great chance to sample, through these images, the level of medical care available at that time.
Even more interesting, in my opinion, are the written works on the experiences of the US Navy medical personnel during the Spanish Influenza of 1918, and also at the Battle of Iwo Jima. Also available are a number of links regarding the hospital ships themselves, their history, and during what years they served, as well as photographs and history on some notable figures within the medical corps. It is a great place to find information regarding US Navy Medicine and can be found at: http://www.history.navy.mil/special%20highlights/medical/Medical-index.htm. Thanks to Naval History and Heritage Command for amassing these valuable works.
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A Great Maritime History Site — 3/23/10
After a random Facebook search for maritime history, I was fortunate to come across a site called Fyddeye (www.fyddeye.com). It is a relatively new maritime history-related website, created in 2009, that has any number of interesting and unique postings for all things maritime, from naval history to museums to shipwrecks, and is steadily growing in both quantity of work and number of members. As an aside, you can find one of my written pieces on there (Review: John Keegan’s The Price of Admiralty: The Evolution of Naval Warfare). However, I assure you this is not a shameless plug, but a real opportunity to get in on a great project in the early stages and really and truly make it your own place in which to both share and explore various topics within several maritime fields of interest.
After I became interested in contributing a few days ago, I contacted Joe Follansbee, the founder of the Fyddeye community, about writing for the website. He was not only very friendly and enthusiastic, he was also very willing to help promote both my efforts here, as well as on his website. I have very much enjoyed these first few interactions and will continue to post articles and add to his site in any way I can. If you are interested in the field, and even if you are not sure, I think his site is worth a look, and should you feel like contributing, I think you’ll find it a simple feat to do so. Thanks goes out to Joe, and good luck to him.
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Cruise Ship Attacked by Virus; Learning Ensues — 3/21/10
A story was just published by USA Today’s Cruise Log, detailing one of the most severe Norovirus outbreaks aboard a cruise ship run by Celebrity cruises, the Mercury. Old Salt Blog has run a story on this today, which is where I saw it. The story by USA Today can be found here, and the story by Old Salt Blog can be found here. Unfortunately, this is the third cruise in a row to be hit by such an attack, and all of them on the same ship! The latest outbreak had over 20% of the approximately 1,830 passengers sick with symptoms of nausea, vomiting, and diarrhea. From USA Today, “Outbreaks of such size are extremely rare, and to have three in a row is even rarer. In 2009, only two cruise ships visiting a U.S. port experienced an outbreak of illness that affected more than 10% of passengers, according to CDC data, and no ship experienced an outbreak that came close to 20% of passengers.”
I cannot help but feel for the poor passengers, and find it an interesting turn of events that this is the third outbreak on the same ship However, rather than rehash the same story, I figured I would give a little insight into something some people are likely wondering: what is a norovirus, anyway??
Without getting overly technical, a norovirus (also known as a Norwalk virus, seen in picture) is what is termed a single-stranded positive-sense (+), non-encapsulated RNA virus. What does this mean? Well, if we know that our body’s cells contain DNA, and that in order for those cells to make proteins and help our body to both take shape as we grow and to maintain a level of internal consistency as we live from day to day, we must also understand that between the DNA and the all-important proteins, there is a middle-man who must translate the DNA’s commands into the proteins functions. This middle-man is RNA. RNA is used by specific components of the cell, called ribosomes, to make proteins, and it is, unlike DNA, comprised of only a single strand. Proteins are everywhere in our bodies; from the hair on our heads to the lining of our intesines and the bones that make up our skeleton. It thus follows that, with proteins being so vital to our being, RNA is also an essential part of our cell’s, and therefore body’s, means of controlling functions. Viruses are very intelligent. They learned long ago that by mimicking our very own DNA and RNA, they could gain access to our cells and find the tools they need to proliferate and spread. Going back to what I said previously, noroviruses are single-stranded positive-sense (+), meaning their genetic component looks like our RNA, and the positive-sense just means that it can also function exactly as our own RNA by effectively tricking our cell’s ribosomes into thinking it is our very own RNA! So we start making proteins from this strand, thinknig it is our own, unknowingly creating the very proteins needed to assemble new viruses. They are a sneaky lot.
So we assemble many, and I mean many, new virus particles that can now invade our bodies and wreak havoc. Well, what exactly happens? The virus particles enter into the cells that line our intestines. The endothelial cells that line our gastrointestinal tract have something called villi on them, which help in absorption of food. You can think of them as many extremely small (microscopic) bumps that increase the surface area that food passes over on its way down the pipe, thereby giving our cells more time to absorb the nutrients from the food as it passes. The norovirus causes these villi to atrophy and flatten, and then decreases the number of enzymes, the ones we use to break down said nutrients so they are prime for absorption, lining our gut. This effectively gives us a temporary bout of malabsorption, and the result is massive diarrhea. Pleasant isn’t it? Food obviously also comes out the other end as well (vomiting), and many individuals also come down with a fever as a result of the body trying to fend off the attack. Fever can be a good thing since it is the outward manifestation of our immune system doing its job.
So that’s the norovirus, and, as might make sense with regard to the original news story, this virus is commonly found on cruise ships. So how do we combat it? Perhaps a miracle drug? A wonderous vaccine? The best and most effective means of combating norovirus infections is none other than washing one’s hands. And, as you might also imagine, people certainly do not engage in that practice as much as we would like to believe. Luckily, for anyone fortunate enough to contract the virus, the effects are often short-lived and do not last for more than a couple days. However, what a long 48 hours it must be.
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Not Giant Squid, but Colossal Squid — 3/20/10
I could not help but post this, since I thought it was pretty amazing. I came across this article on National Geographic from a few years back, describing the largest whole-body colossal squid specimen ever caught. The article can be found here. To quote National Geographic author Ted Chamberlain, ”[This species is] heavier than even the giant squid, colossal squid (Mesonychoteuthis hamilton) have eyes as wide as dinner plates and sharp hooks on some of their suckers. This new speciment weighs in at an estimated 990 pounds (450 kilograms).”
Photographs courtesy New Zealand Ministry of Fisheries, illustration by Paul Hannan, National Geographic Digital Media
The species was first discovered in 1925, only because two extremely large tentacles were found in the gut of a sperm whale. You can see the measurement comparison of the colossal squid with both a giant squid and a school bus; an object it is estimated to eclipse in length! It is discoveries like these which really make on contemplate how little we might know about our planet and the creatures dwelling at the bottoms of the oceans. The seas are a vast habitat, reaching depths of miles, and pressures unimaginable to man, but quite manageable to a multitude of species. Since I studied biology for some time, and had a particular interest in evolution, these stories always peak my interest.
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Librarything catalogs the books aboard the USS California — 3/19/10
Have you ever wondered what books were taken to sea by the sailors and crew of the USS California cruiser circa 1905? This might seem a slightly strange question, however, as an enthusiast of naval history and of reading, I would find it very interesting to know. Librarything, one of my favorite websites, has made it a specific goal of theirs to catalog a series of Legacy Libraries. The books taken aboard the USS California, a Pennsylvania-class armored cruiser put into commission before the First World War, is just one of these projects, and of course, one that I find to be of interest. The Librarything catalog can be found here: http://www.librarything.com/profile/USSCalifornia. There looks to be several very noteworthy history books that were taken aboard, so any history buffs might want to go check it out and get some new ideas for their next read (if they are still in print). Here is the “about me” section from the catalog’s profile page:
USS California, a 13,680-ton Pennsylvania class armored cruiser, was built at San Francisco, California. She was commissioned in August 1907, and spent the next ten years serving in the Pacific. California regularly operated along the North American west coast, with occasional cruises to Hawaii and other oceanic islands. In 1912, she briefly deployed to the western Pacific for service on the Asiatic Station.
In September 1914 California was renamed San Diego to make her original name available for assignment to a battleship. She frequently was employed as Pacific Fleet flagship between then and July 1917, when she was sent to the Atlantic for World War I service. San Diego operated as a convoy escort in the North Atlantic until 19 July 1918, when she was sunk off Fire Island, New York, probably by a German mine. San Diego was the only major warship lost by the United States in World War I.
I tried out several book-related online social websites, and can honestly say that Librarything is the best of them. This kind of cataloging is both historically relevant and just plain interesting. Go check it out! Thanks goes to Heather at Maritime Compass for originally pointing out this archive.
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The Evolution of War Wounds — Part II — 3/17/10
The horror of cannon wound. The ripping and tearing of flesh and bone amidst the screams of shipmates and the throws of the sea, as frigates of war bear down upon one another in the vast blue. The crack of the of shot as it bursts forth from the cannon, and the explosion as it penetrates the wooden wall in front of you, and in one fell swoop, takes your life or limb. We revisit the battle of Trafalgar after the first discussion on the wounds of war. The veritable scars of naval combat, at their zenith during the time of Napoleon with the development, perfection, and wanton usage of cannon. Yet despite this carnage, and the cataclysmic effect on the bodies of those left in the wake of such powerful armaments, there was, and is, an enemy more insidious and, in many ways, more dangerous than the gun powder weapons of the masted ships. This enemy is everywhere at once, and during Napoleon’s era, as with most eras in the course of history, was nearly unstoppable. I speak, of course, of the bacterium.
Bacteria are everywhere. They are on our clothes, our linens, our skin, under our nails, in our mouths, and thriving within our intestines. Most of them, most of the the time, are completely benign. In fact, they are largely beneficial. We rely on them to help us digest foods, to recycle bile (one of our most important and integral humors in said digestion), and to desensitize us to disease and make our immune systems more robust. They cover our skin on a constant basis, and, nearly always, cause us no harm. However, should a foreign object pierce our skin and provide a path for the bacteria to enter into areas where once there were none, a very different interaction takes form. One of infection, gangrene, necrosis, and possibly death. Let us step back for a moment and analyze how this might come into play on a ship fighting at the Battle of Trafalgar.
A wooden ship, often damp, musty, full of human beings, would be a prime refuge for bacteria. Many would thrive in such conditions. They would cover the walls, the floors and hammocks, and most importantly relative to our discussion, the cannon shot collecting dust in preparation for their chance at battle. They would sit, sometimes for months at a time, in the musty atmosphere of a ship at sea. Their stasis in between battles and the constant supply of humid air likely provided a prime location for the collection and colonization of bacteria. Once battle was again upon them, as at Trafalgar, the balls were quickly thrust into a dark and dirty chamber of the cannon, and then propelled forward by the effects of the gunpowder ignited to its rear. As the iron spheres tore through the wood of the adjacent enemy ship and into the limb of an unfortunate seaman within, the collection of organisms and grime that might have existed in the mediums between the muzzle of the cannon and its respective target would then be transplanted to the fresh and gaping wound. This potential outcome of one particular wound of sea warfare is somewhat of a conjecture on my part. Ostensibly, the heat of the cannon firing, and the speed with which the ball would be travelling might make such a theory less likely. A gaping wound would certainly provide a prime site for infection though; an unfortunate outcome of any sailor (un)lucky enough to survive the primary effects of the cannon shot.
There is, however, a separate effect of the ship’s penetration by the cannonball in its path of destruction which might lend itself to the spread of infection with more certainty. This is, simply, the splintering of wood. One might think of the cannonball’s secondary effect of splintering the wooden wall of the ship as a fragmentation mine, with sharp chunks of wood replacing metal shrapnel. These pieces of wood would have been irregular in shape and lacking the penetrating power of a bullet shot from the bored barrel of a gun; strong enough to penetrate flesh, but lacking the kinetic force and linear trajectory to make a clean exit, or any exit at all for that matter. These splinters, searing with pain through their persistence in the wounds of sailors, were likely some of the most debilitating of the cannon’s effects. Why might this be? If we imagine the potential threat of a cannonball, we can safely assume the incurrence of injury or death to at least one, maybe two individuals. This effect is, of course, multiplied should several seamen be standing in the same linear plane as the cannonball as it passes through the vessel. However, should they all be standing abreast of one another as the shot strikes an unlucky compatriot, then the damaging effect is less efficient (though the recipient might disagree with me). Conversely, the effect of the destructive force of the cannonball transferring to the wooden wall of the ship would create a mass of wooden projectiles spraying out in an arc from the point of penetration. This would, in effect, multiply the damage potentially done by the cannonball many-fold. Though these projectiles might not kill the sailors outright, they would certainly put them out of commission, at least to some degree depending on their proximity to the source of the wooden shrapnel. One cannonball might therefore incapacitate several sailors in the innards of a ship, when above it would only strike one.
The shotgun-like effect is central to the theory of grape shot. Unlike the more traditional conception of cannon and their relatively large, round shot, grape shot’s purpose was to maximize the spread of damage to as many individuals as possible with as few cannons shots as was necessary. Grape shot is comprised of many small metal spheres packaged together en masse. Once placed in a cannon and fired, though ineffectual against ships, their effect is devastating against human beings. From one shot, many sailors can be brought under fire. If we compare the “one shot-one sailor” theory relative to conventional cannon shot I proposed above, to the outcomes wrought on humans by grape shot, then the efficacy as a means of carnage is more than evident. It was a brilliant and horrible conception that proved its worth in many battles at sea.
Returning to splinters, where one might be likely to find infection from a bullet wound that passes through the body, one is all but certain to find it if the projectile becomes lodged within the body itself. A foreign object breaking through the skin and incarcerating itself within the tissues would bring with it all manner of ectopic organisms; all of them equally pleased to find a new medium as conducive to proliferation as the human body. During battles of the Napoleonic era, as in Trafalgar, there was as yet no means of combating such invasive nidi. Sailors who survived the battle at sea with splinter wounds, though physically alive and perhaps whole, were nonetheless not rid of the battle, it had merely morphed and been displaced. The body has defenses equivalent to any of the most complex, secure, and multifaceted compounds on the face of the Earth. It has several lines of defense, and within them, several specific means of combating most any type of infection from viral, to bacterial, and parasitic. A primary means of defense that kills off novel organisms entering the body for the first time, and a secondary line of defense that, through the use of cells specializing in memory, makes the process of eradication faster and more efficient. To clarify, this is not memory in the traditional sense, but more a means of rapid recognition of virulent organisms that have entered the body on a previous occasion. Through such means of protection, it is indeed possible that many sailors were able to fend off the potential of infection through nothing more than the strength of their immune systems. However, many people could not, and as a result, more so due to the lack of any more palatable recourse, amputations of infected limbs became a staple in the medical care of sailors during and after a battle.
The process of amputation, particularly before the development and administration of anesthesia as we know it, seems a ghastly and brutal affair. And indeed, it was. However, there was reason for it, good reason. It was as simple as lose your limb, or lose your life, and there was really no other choice. Once infection has taken hold of a part of the body, and overcome the initial defenses through vigilance or virulence, it now has the potential to spread, and often rapidly. Gangrene, or the decay of body tissues, is often the result of such infections. Toxins released by the bacteria can destroy the tissues surrounding the infective nidus and enter the bloodstream and lymphatics, causing a rapid onset of sepsis (or the immune system’s violent, systemic overreaction to the foreign toxin), and eventually death due to multiple organ dysfunction. If the surgeon at sea could isolate the source of infection before it spread, and then surgically remove it, then the seaman might have a chance at defying the grave and desperate course on which his infection had now set him. The lack of sterility, meager tools, and general lack of medical education amassed by most sea surgeons did not provide salvation with any certainty, despite a surgical intervention. However, the alternative could not be more finite. Such was the nature of medicine at sea. Though I only begin to scratch the surface, I am eager to discover other facets of this dangerous, somewhat gruesome, yet undeniably noble calling.
I will continue with the Battle of Jutland in the next post. The nature of wounds suffered and the subjective experiences of sailors aboard, not wooden masted ships, but iron hulks brought to bear against weaponry all the more devastating, and in circumstances wholly unlike those of the sailors aboard the ships-of-the-line at Trafalgar. Any comments are, as always, welcome.
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Patrick O’Brien Maritime Art on Display at US Naval Academy Museum — 3/15/10
I’m willing to bet you thought I meant that Patrick O’Brien (of Jack Aubrey fame). Well, worry not, I was fooled as well. I was perusing The Old Salt blog, and came across an article on Patrick O’Brien’s new maritime art exhibit at the US Naval Academy Museum and, thinking the nominal coincidence funny, decided to visit the linked site. This Patrick O’Brien, hailing from Maryland, is an exceptionally talented artist, with some very detailed and magisterial artistic works. I was very impressed and decided to share it here. Here is the link to the artists’s website: http://www.patrickobrienstudio.com/index.html.
He has won a number of accolades including the International Marine Art Exhibition at Mystic, CT and also provided paintings for the covers of both Naval History and Sea History magazines. I, and anyone interested in this type of art, would do well to keep a look out for his works.
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A Most Welcome and Humbling Surprise — 3/14/10
Today, I received a comment on the piece I wrote previously, A Battle of a Different Sort, regarding Iain McGilchrist’s Wall Street Journal article detailing the battle of dominance between the right and left cerebral hemispheres through history. The commenter was none other than the author himself! Dr. McGilchrist was kind enough not only to provide some of the background work that went into the book on which his article is based, The Master and his Emissary: the Divided Brain and the Making of the Western World, but to detail exactly why it was that some of the more essential components of his argument seemed to be missing or truncated. The response is pasted here if you did not see it on the comments page.
Dear Jared,
Thank you for your interest in my WSJ piece. What may not have been clear is that it was an invited piece based on my book published by Yale University Press in December, The Master and his Emissary: the Divided Brain and the Making of the Western World. This book is over 600 pages long and based on 20 years of research, with nearly 3,000 references to research papers, etc. I hope you will find it is a much more scholarly and nuanced work than the inevitable piece of journalism that was the article in the WSJ. It has been described as the most comprehensive survey of the topic ever written. I was as frustrated as you by the constraints of space and time to get across an extremely complex and I believe subtle series of arguments, and the finished article was edited to cut out much of the qualification that you would have liked - it doesn’t make for good journalism, apparently! Before making up their minds I would just urge your readers to go to my website www.iainmcgilchrist.com, where they can read more about it, and even download the first chapter, as well as read some of the responses to it. Thank you for your time,
Kind regards,
Iain McGilchrist
Upon reading this, I visited his website and can say with assuredness that he seems like a very interesting and scholarly individual with passions throughout the worlds of psychiatry and the evolution of the mind and ideas. I am also downloading the first chapter at present! He gives this novice hope that a practicing physician might really be able to engage in the art of writing in a meaningful way, and pursue their passions to successful ends. I encourage you to do as he suggests and go check out his webpage, and download the first chapter of his book. I thank Dr. McGilchrist for taking the time to reply to my posting, and he is of course welcome back any time.
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A Battle of a Different Sort — Perhaps, A Flawed Argument — 3/12/10
Though we often categorize and attempt to pinpoint with exacting accuracy where the functions of our daily lives (emotion, language, and memory) are mapped onto our brains, increasingly, we have found, that such functions are assumed by both hemispheres, at least in part. However, despite such sharing of control, it is still widely recognized that both the right and left hemispheres of our brains assess and evaluate the world in generally different means. It is within this divergence that a picture of battle can be drawn, one indirect and obscure yet absolutely integral to the progression of our interactions with the world and with the evolution of our society. A battle which defines who we are. This idea is the crux of Iain McGilchrist’s essay entitled, The Battle of the Brain - The Mind’s Great Conflict Spills Over on to the World Stage. The link is here: Iain McGilchrist’s article. He makes an incredibly insightful and surprisingly historical assessment, though I do think he needed more citations, of the evolving and constant struggle between the two hemispheres throughout history. He points to the creative mastery crafted in ancient Greece, in which the society indulged their right hemispheres, as the start of his historical timeline. This evolved into the Roman era where the right lost out to the left and resulted in structures of marble and concrete, development of laws, and the ideals of collective morality. A resurgence of the right brain during the Renaissance was again curbed by the left during the Reformation and Enlightenment. A very interesting theory, though perhaps flawed.
To give a little background on the brain, it is widely accepted that the right hemisphere of the brain interprets the world from a broader perspective than the left, and is responsible for the artistic, creative, and abstract elements of the human mind. A person who we call right brain-dominant, might excel at song and dance; poetry and painting. Conversely, a left brain-dominant individual might be exceptionally good at concrete reasoning, at science, math, and subjects that require deductive reasoning. Is this a simplistic view? Absolutely. However, taking into consideration how little we actually know about the functions, and definitive locations of said functions, it is without a doubt the most widely accepted, general viewpoint to this day. Though, as I said, we are aware that the functions of each separately do overlap somewhat.
McGilchrist’s argument explicitly states that, though I do find it to be somewhat of a generalization despite his definitive tone, that during our age the left brain has taken majority control over the right, in the Western world. Is this true? Well, if we go by stereotypes it can seem very true. Business men on Wall Street, corporate executives meeting to decide the fates of countless individuals based solely on numerical figures, and scientists dissecting humans down to their most basic of cellular and biochemical components. However, it is my belief, and again I am no expert, that much of the artistry and creativity from these former time periods stemmed from a much greater absence of understanding, and as a reaction of the people’s desire to gain such understanding. What do I mean? Much of the creativity, though of course not all, was pursued in an attempt to understand the human form, the depths of the mind, and the aspects of us which make us the complex and beautiful (and beautifully-flawed) creatures we are. Today, though far from complete in our understanding of such difficult and abstract concepts, we are several steps closer. Has this taken on a more scientific and rigid tone? Yes and no. I read many books, and I can say with certainty, that despite the subject and despite the content, concrete or abstract, some people are indeed creative. It is, in my opinion, ineffective to make such broad and sweeping generalization, as it robs many of the great minds, capable of great emotion and deep and fluid understanding of what drives humans in the endless threads of events and experiences which make up our lives. Is this type of creativity, the one which we can readily observe today, the same as that of the previous eras, one in which artists create beautiful works of stone, and paint masterful vistas, or subdued portraits of individuals providing a veritable window to their soul and being? No, it is likely not. But was the artistry that defines the Renaissance, da Vinci’s Mona Lisa and the works of Michaelangelo, the same as that which defined the ancient Greeks? A World Undone
I in no way wish to discredit Dr. McGilchrist, I found his essay to be one of the most thought-provoking and insightful essays in quite some time. His argument is novel and prime for debate. I encourage you to read it, and upon doing so, let me know what YOU think! Any feedback is, of course, welcome.
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Thanks to Maritime Compass — 3/11/10
Heather, the writer responsible for the Maritime Compass blog (http://maritimecompass.blogspot.com/) found the time to write a very kind word about me and my efforts here. I wanted to take the time to thank her as she has been very helpful and supportive since I started out. If you have not checked out her blog and you have interest in maritime history, then I strongly encourage you to do so. She is a very thoughtful writer and her blog covers a number of eclectic topics withing the realm of maritime history. Every day is something new and interesting, from book reviews to news stories to cartoons. Dennis Powers, a great author in the realm of maritime nonfiction recently wrote her concerning his new book, Tales of the Seven Seas, which incidentally I requested as an early reviewer on Librarything.com. It all comes together! Again, thanks to Heather for her kind words and respective efforts.
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The Evolution of War Wounds — Part I — 3/9/10
War is, according to Clausewitz, “politics by other means.” It is often a continuation of the small battle fought behind closed doors between men in suits, attempting to achieve some political or national aim. Depending on the belligerents, it can be either a first or a last course of action. However, despite all the intricacies and multiple motivations inherent in any specific country’s impetus to go to war, one thing is absolutely certain: people will die and often in mass numbers. This somewhat harsh reality is accepted by most everyone, yet the visceral and often pitiful nature of battle, and the huge spectrum of gruesome and disfiguring means of violence employed ubiquitously since the dawn of history are topics far less tread. If we utilize a simple comparison of blockbuster films like Steven Spielberg’s Saving Private Ryan, and Franklin J. Schaffner’s Patton, we see the divergence in representations of war and violence inflicted on soldiers very clearly. In Patton, though a great film, it is more than apparent that the goal was to glorify battle; to show war and death as honorable and somewhat sterile, with soldiers maintaining their dignity, and dying by means of “clean kills” without any apparent disfiguration or agony. The movie’s goal is of course to romanticize battle and its nominal general. When we view this relative to Spielberg’s film, we see the evolution and radical departure from that depiction of battle, and the gruesome nature of the wounds suffered by the combatants. As the Allied soldiers strive to capture and consolidate their position on the beaches at Normandy, we see the violence inflicted on them in vivid detail. Eviscerations, due to machine gun fire or explosives, are suffered by many soldiers and displayed in vivid detail. Several of the wounded clasp their bloodied limb stumps, where once their arm or leg had been, and call out for their mothers as they slowly die of blood loss and shock. This is anything but clean and honorable, however, it is real. War is ugly.
A comparison of naval battles and the armaments particular to that period of time, allows us to not only explore the evolution of wounds suffered by sailors and seamen, but also to formulate a picture of their respective experiences and the dangers inherent in the line of duty. I will use the Battle of Trafalgar in 1805 between the Royal Navy and the Combined Fleet of France and Spain, and the Battle of Jutland during World War I, fought between the Royal Navy and Germany’s High Seas Fleet in 1916. It is useful to dissect the battles to their components and means of war, in order to better picture and ascertain the origins of the dangers and wounds inflicted on sailors. The masted line-of-battleships at Trafalgar were, of course, large wooden gun platforms, built for the purpose of maintaining order on the high seas, all the while weathering the harsh elements of the oceans and maintaining the relative safety of the crew. Though this definition makes them sound almost simple, they were anything but. The massive assortment of spars, main and mizzen masts, sheets, shackles, riggings, jibs, and so on, made these warships exceptionally complex and required skilled hands to manipulate and maintain. It is this complexity that gives them their elegance and majestic presentation. Returning to the topic of wood, it was, in a word, everywhere. The entirety of the ship-of-the-line was wood, from mast to keel, and bowsprit to stern. The masterful work of the craftsmen who built these ships made them resilient beyond compare, and with proper maintenance, they would remain in commission for decades. However, going a level deeper, it was the wood which made them into the formidable ships of war they were renowned to be. It allowed them to divide the waters as the bows surged forward toward battle, both reflect and absorb powerful cannon shot from opponent warships, and provide support for gunwales that would shield sailors on the quarterdeck during the approach to combat. As means of protection, they were in many ways the perfect example given the armaments of the time. It was exceedingly difficult to penetrate their wooden walls with conventional cannon unless at point-blank range, and musket shot had no hope of penetration unless through the cannon’s gun port. However, there were casualties, and many at that. 8,500 people were killed or wounded at Trafalgar (Keegan, 1988). How did this happen, and in what manner did they generally meet their respective ends?
If we first take the means of violence which is most obvious in considering a battle between ships of war, by this I mean the cannon, during the Battle of Trafalgar, we can deduce one of the prominent means and methods by which the death and casualty figures reach such startling heights. During the age of sail, cannon shot was composed of a large, round metal spheres of varying weights. Explosive shot, though potentially usable during the time, was prohibited from sea warfare by means of an unspoken rule. As I said in a previous post, fire was by far the most dangerous of elements on these wooden ships. With combatants often in such close proximity to one another, even tangled up in one another, the possibility of fire spreading between ships was a real and valid danger. These heavy, dull metal cannonballs were, particularly at close range, proficient at penetrating the hull of the ship and causing sometimes severe damage to any crew unlucky enough to be within the cannon’s path of destruction. What types of wounds would this sailors suffer? Most prominently, and most ghastly, was the possibility of outright decapitation. This did occur from time to time, and though horrific, was likely the most merciful way to meet one’s end in such a morbid symphony of war. Separating the head, and therefore the brain and its attachments to the spinal cord through the brain stem, robbed the body of any sense of pain, injury, or mortal fear, since this means of death occurred in the most immediate of fashions.
Conversely, if the cannonball were to strike an upper or lower limb, there was a rather great possibility of having the limb severed by traumatic amputation. One may be able to live for period of time without an arm, however, the presence of the brachial artery within the most proximal part of the arm (the part nearest the shoulder) would create an immense amount of blood loss upon traumatic separation. This artery, the one that is often used when we have our blood pressures taken at the physician’s office, is the direct extension of the subclavian artery, which runs under our clavicle (or collarbone), which in turn is one of the branches off of our ascending aorta. The ascending aorta is the artery which distributes blood directly from our heart to the various other intermediate arteries of our upper body, and finally to our tissues to perfuse and nourish them with the oxygen and nutrients necessary for life. As you might imagine, due to its proximity to the heart, the brachial artery receives quite a large amount of blood, and at relatively high velocity due to the heart’s pump effect. Death from blood loss was often a likely result of this kind of traumatic injury. In the leg, an analogous artery, the femoral artery, would likely be severed if the separation occurred above the knee, potentially leading to a similar means of expiration. Though gruesome, these previous results say nothing of the nerves potentially severed by cannon shot. Extending from the side of the vertebrae in the neck is a bundle of nerves known as the brachial plexus. This series of nerves innervates the entirety of the arm, from the shoulders and axilla to the fingertips, sparing not an inch in between. Lesion, or in this case complete severance of these nerves, would lead to excruciating pain. Such a nerve bundle also exists in the leg, known as the lumbar plexus, which extends from the lumbar vertebrae at the base of the spine before becoming the sacrum and coccyx. This type of startling, sudden, and violent pain can, in and of itself, cause sudden death.
The body is an amazing matrix of functions interconnected to provide support for components affected by grievous injury. Wounds of such caliber as those above extend beyond the scope of the site of injury and the local effects. Blood loss causes, as a compensatory mechanism, an increased heart rate in order to bring blood (which is now lesser in quantity) to the tissues. The skin will assume a blue hue due to blood shunting in the opposite direction, in order to increase its availability for the internal organs. Rate of breathing would increase in kind as the body’s mechanism to increase the level of oxygen in the blood, and they would likely sweat profusely as a result of the increase in sympathetic stimulation (the nerve impulses that cause the heart to beat faster and the breathing rate to quicken). Collectively, these symptoms are known as hypovolemic shock; a lower volume of blood within the body. Should the sailor survive the initial infliction of traumatic and severe wounds, the massive blood loss, unless properly controlled, would shortly result in shock and a rapid decline in the likelihood of survival.
Though the information is not easily come by, I imagine a great number of individuals suffered in such a manner aboard ships in both the British and Combined Fleets. The relative isolation from land, and the short supply of surgeons and medical staff leads one to deduce that cannon-made wounds left untreated for an extended period would have caused many sailors to suffer and perish at the hands of blood loss, jarring pain, and the resulting shock inherent in their mangled state. I will continue in the next post with a discussion of the nature of grapeshot and splinter wounds. Additionally, one of the greatest and most notorious killers of the age was that of infection from septic wounds, giving rise to the period’s most infamous of treatment techniques: the amputation. This will also be included in the next posting. Any comments are welcome!
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Public Health/Film Noir Images and Iconography — 3/8/10
The title makes one wonder, I’m sure, but I came across an exhibit by the National Library of Medicine regarding the visual revolution that took place about 100 years ago. It is called The Iconography of Contagion. The original purpose of these images in the early 20th century was to raise awareness of diseases, their spread, and statistics, however, it is heavily influenced by film noir imagery and is fairly bizarre. I found it very interesting and so figured I would share it here. Here’s an example image warning against drinking contaminated water:
This image is from their website (Photomontage. War Department, United States, 1944), and there is plenty more like it on there. If you’re looking for a new spin on public health and awareness, as well as the history of medicine, I certainly suggest you check it out. Go here: http://www.nlm.nih.gov/exhibition/iconographyofcontagion/iconography1.html. Enjoy!
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Put on Alltop.com — 3/7/10
Hey all, Alltop.com, a fairly new and very promising website that allows you to aggregate and view all the headlines pertinent to a specific topic, country, or whatever you might be interested in. I was put in their history section (unfortunately at the bottom of the page since I’m one of the newer links) but still there nonetheless! Go check it out, I’m in their history section, at http://history.alltop.com/. I’m working on a new piece that meshes the nominal topics from my blog title, so more to come soon. Thanks!
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For all the readers out there… — 3/5/10
I recently became aware of the “Five Best” blog on WSJ.com in their Books section, which features the five best books for any specific genre. These categories can range from the interesting (British military deception) to the somewhat bizarre (hypochondria). I enjoy reading a great deal, however, I was doubly impressed when I stumbled upon a post made back in October 2008 concerning the five best books on the history of medicine. Perfect! I will include them here for anyone inclined to search them out (shameless plug: you can easily purchase them at my Amazon Associates store — link above). They are as follows:
1) The Greatest Benefit to Mankind: A Medical History of Humanity
2) The Social Transformation of American Medicine: The rise of a sovereign profession and the making of a vast industry
3) The Gospel of Germs: Men, Women, and the Microbe in American Life
4) The Discovery of Insulin: Twenty-fifth Anniversary Edition
5) The History of Medicine: A Very Short Introduction (Very Short Introductions)
Suffice to say, I am intending to read each of these. If you are looking for other types of books, the blog covers just about every genre imaginable, so it’s definitely a recommended source for deciding what to read next. Find it here: http://online.wsj.com/public/search?article-doc-type={Five+Best}&HEADER_TEXT=five+best
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A Heartfelt Thanks — 3/4/10
I wanted to say thank you to the people who, despite my exceedingly recent entrance into the world of blogging, have been kind enough to write up short pieces on both the content and potential of my site.
First, an emphatic thank you to Rene Tyree of www.wig-wags.com, for her kind post regarding the my blog. Her site is devoted to her research and thoughts on Civil War history, and it is, without a doubt, one of the most quality blogs I’ve seen in some time. She has a plethora (yes, plethora) of interesting and informative articles and links on everything Civil War. If you’re looking for the authoritative Civil War blog then head to her website.
Second, another thanks goes to the bloggers over at the Maritime Texas blog (http://maritimetexas.net/wordpress/) for their write-up as well. They feature a large amount of very interesting articles detailing the maritime history of, what else, Texas. Their posts cover both historical and contemporary maritime happenings, so go check them out.
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The Elusive Definition of Leadership — 3/4/10
Leadership. A quality that is at once intangible, unquantifiable, and seemingly almost undefinable. What give some men the impetus, or bravado as the case may be, to rise up amongst their peers and take a guiding rather than a following role. I in no way am an expert on the subject of leadership, in fact I do not even think of myself as one at all. However, I cannot help but attempt to contemplate and understand what it is that drives men to stand up over others, and relative to that, what it is that defines whether or not someone can be called a great or terrible leader. These concepts are ubiquitous. In medicine, there are, and have been, physicians who take the leading role in research, in surgery, and even in humanizing the profession. These qualities are vague. Can we define a physician as a good leader when he creates a sphere of influence around him and brings those who serve under him some measure of comfort that he is the one they turn to in a crisis? Is that what defines one as a leader? Or perhaps a physician whose empathy and compassion for his patients is unsurpassed, and whose every effort is spent toward their wellness of body and being? This physician may not command the same level of respect amongst colleagues (and this depends on their dispositions) when compared with the former example, however, what of the patients whom he cares for? Do they not see him as a beacon of hope, particularly in the most dire of illness states? I give these examples because, as I have said, I am a medical student, and as you might imagine, these nameless personalities belong to those that I see around me on a daily basis. There are those physicians-in-training who might assume either persona, and of course, the list of possible characters are in reality both infinite and amorphous.
Bridging the gap, and taking examples from history, the questions become more complicated. This is due to the fact that, although medicine has its personalities, it is a field far narrower in scope than that of history in the broad sense. We can think immediately of great leaders: Abraham Lincoln, Alexander the Great, Mohandas Gandhi, and the list goes on. However, it is when we come to defining leaders as “bad,” that the definitions and polarized classification of actions become blurred and more conceptually difficult. As with many, the first person who came to mind when I thought of terrible leaders was Adolph Hitler. He committed some of the most atrocious crimes against humanity imaginable and, through his own insatiable hunger for power and domination, led Germany to ruin following World War II. This inarguably rules out whether or not he could be considered a compassionate person (to say the very least), but was he a bad leader? If you asked a Nazi, I imagine the answer you might get would be drastically different than that you or I would give. He brought the Germans out of a state of deep depression following the debilitating losses and humiliating conclusion (the Treaty of Versailles) of World War I, both economically and psychologically, and set them on a path of conquest that, had he not betrayed Stalin and caused Russia to switch to the side of the Allies, might very well have succeeded. As you can see, the question of good or bad, particularly in the realm of history, is subject to factors that contort and complicate it. Perhaps the answer is not that one is a good or bad leader, rather that one is undeniably and irrevocably human, leader or not, and thus subject to the whims of their subjective experiences and idiosyncrasies. I in no way want to insinuate that the heinous actions committed by the Nazis and commanded by Hitler were the product of childhood neglect or a quirky personality trait. Some men are born evil. It is this very fact that renders the question of qualifying leaders largely irrelevant, and leads us to the next and, justifiably, most important question with regard to the concept of leadership: was this man a good or bad individual? As is often said: it is our actions that define us. With regard to leadership, this familiar adage is all the more applicable.
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Medicine Below Deck — 3/2/10
I came across this photo on the official website of the HMS Victory (I credit them for it, www.hms-victory.com) and was at once captured by the what this lone surgical table represented. If you can imagine, a boat full of hundreds of sailors, rocking back and forth with both the sway of the ocean and the jarring, thunderous assault of enemy cannon fire, and a ceaseless conveyor belt of wounded and near-dead filing down into your quarters in the depths of the ship on the orlop deck (the deck directly above the bottom-most compartment on the ship, the hold). With all of this, enough to break any man’s nerves, imagine it is now your job to heal those in most need by any means necessary, and with only a set of rusty and rudimentary tools at your disposal. You are a naval surgeon. Perhaps a bit dramatic, however, most of these men, especially during the Napoleonic wars in which sailing warfare commonly took place, were tasked with such a job and often had little in the way of medical training. What drove them to do this?
The answer to my question is one which I hope to discover through research. What drove these men to want, if they were even given an option, to practice medicine in such dire conditions and in such a tumultuous atmosphere. Love of the sea, perhaps? The desire to do good for their country and those who would fight for it? Adventurous aspirations and the desire to see the world? As of now, I have no idea. They were integral to our understanding of scurvy in sailors, and I imagine their experiences make for some fascinating and exciting anecdotes. They were not just on the naval vessels of the period either. Sea surgeons were present on almost all ships sailing out of England, including whaling vessels, and their specific encounters would likely be of a very different sort. I look forward to reading about their lives, and their contributions to both maritime and medical history. Just some thoughts…
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“Writing as catharsis” — 2/28/10
After my first anatomy lab session, I began to feel, with a much greater sense of clarity, what exactly is was that we were here to do. To learn about the human body, from bone to blood cell, however, this was the first time I had ever come face to face with a cadaver. I incorporated some of the feelings of other physician family members and tried to integrate their experience with my own. In a sense, it is a way to come to terms with the intense pressures and somewhat brutal methods of learning (as is the case with dissection) that all medical students must undergo. “Writing as catharthis,” as my grandfather says! Feedback is welcome.
My First Encounter
Dissection. A term, cold and technical, usurps true depth of meaning. An anatomy lab dimly lit, strewn with human forms obscured by opaque tarpaulins. Nervous excitement grasps me, to confront one once living, scalpel in hand. Noble intentions guide one to savage acts; the weight of Responsibility’s heavy hand arrests me, reminding me what actions, great and small, have led to this point.
My aspirations are not those of a surgeon, I seek to learn, to grasp that which to so many is unfathomable, unpalatable. To understand the grotesque beauty of the most visceral aspects of the human, parts connected and interconnected, a machine as complex as any comprised of steel and motherboards.Tubes and wiring, electricity, combined to function in perfect harmony,” homeostasis” we call it, churning and gyrating cogs of bone and flesh. A beating, thumping heart, cascading pipe works of blood penetrating through each layer of tissue, our veritable life-force. Lungs seething, expanding, fueling the body with oxygen; a molecule impalpable and at once ubiquitous, enveloping us and pervading our every pore. All structural support, scaffolding for the nerve center, the nexus of our very being, that which controls our every action and emotion; the human brain. The machine, now silent, spent of life; the shell is all that survives, devoid of warmth and essence of being. Despite this I know: not a machine at all, a person.
My contemporaries attempt to ease the air of tension, joking, making light of an act so morbid yet intellectual. I laugh too, guilty in my own discomfort. The lab aids remove the plastic blankets from those sleeping eternally. I glance at my cadaver; a woman. An unexpected question arises in my mind: Is this a person? Preservation methods have left her distorted, shriveled, and puppet-like. My eyes are drawn to her face, gray and pale, expressionless, yet distinctly human. I contemplate her expression, her smile, talking to a loved one. What did her voice sound like? Did she have loved ones? A family? Her decision to be here was all her own, yet what compelled her? I wonder if, in similar circumstances, I would have done the same. A question that arouses fear and anxiety, a confrontation of one’s own mortality and the courage to do so.
A classmate remarks in passing, and I am drawn to her fingernails. They are long, they look manicured. Was she concerned over her appearance? I think of my own grandmother, beautiful and dignified, never letting those not closest see her vulnerability, and always looking her best. Was this woman similar? I think of her getting a manicure, laughing with her friends. I think of her happy, I wonder if she was. I want to ask her. I want to ask her what brought her happiness when she was alive, and what brought her here. I am thankful for the opportunity to learn from her, to see that which so few can or will experience, and for her allowing me to do so. I express my gratitude silently.
My instructor arrives and places his hands on the edge of the dissection table. “Welcome to anatomy lab, everyone,” he says.
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The Essence of Medicine — 2/28/10
The task set before those training to be physicians is one of immense responsibility and considerable challenge. We are set on this path to gain knowledge of the human body, the organs and their functionality, the humors and the blood. We must understand the complex interplay between disease and the mechanisms inherent in their combat. This, as you might imagine, is no small task. Countless hours are spent behind countless texts, highlighted and dogeared pages encircling us in a dizzying world of disease mechanisms and Latin names. Yet, with all this knowledge, time, and energy spent, it still seems as though something is missing. There was a time when all physicians had instilled in them the knowledge that they were to not only be gifted students with unsurpassed knowledge and manual skill; they were also to be healers of people. It is this classic role of the doctor as a central figure in the community, as familiar as a family member, and full of genuine concern over whether or not the patients he treated were, in fact, healthy.
I love medicine, yet I feel this loss, likely more than some of my colleagues. I was raised in a family of physicians who, above all else, sought to treat the person, not the disease. This phrase has become cliche, oft repeated and yet never fully understood. Above, and at the base of my blog, is a thumbnail photo of Rembrandt’s famous painting entitled The Anatomy Lesson of Dr. Nicholas Tulp. Whenever I look at it, I can almost feel the sense of wonderment that his students felt at this event, a human dissection, which today are commonplace, but then only occurred about once per year. Though now the human body has been scoured and mapped to a tee (at least where anatomy is concerned), there are as yet many other discoveries to be made on a scale unobservable to the naked eye. This sense of medicine, of discovery and original explanations of events with no apparent causes, is alive and well. However, it is my belief that through the understanding of our profession’s history that we can truly make gains in understanding how we arrived at this place and what sacrifices and strides were necessary along the way; in a way, to connect the dots of past and present.
At least for me, a clearer picture of medicine’s past is needed for me to truly know my profession.
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My Introduction to the Wooden World — 2/28/10
My recent reading venture has been John Keegan’s The Price of Admiralty: The Evolution of Naval Warfare
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This ship carried over 100 guns, with 30 32-lbers on the lower gun deck, 28 24-lbers on the middle gun deck, and 30 12-lbers on the upper gun deck. These three levels were the main stores of devastation; however, they were supplemented by 12 12-lbers on the quarterdeck, and 2 12-lbers and 2 68-lber cannonades on the forecastle (or foc’sle, which is the most forward deck on the ship). A warship in every sense of the word! To bring this massive arsenal to bear on any ship was a sight unseen in land combat for many decades, arguably until the First World War. Keegan makes a brilliant comparison between the man and horsepower that would be necessary to move such a plethora of weaponry as to be found in Nelson’s Trafalgar fleet compared with that of Napoleon’s Army of the North at Waterloo. Among Nelson’s fleet at Trafalgar, there were a total of 2,232 guns, with 14,000 men to work them at twelve to every two cannons (it was usual for only one broadside to be manned at a time, and you can imagine what sorts of situations this created when enemy ships were abeam to port and starboard). When compared with Napoleon’s army of 366 guns, 9,000 men, and 5,000 horses, the Trafalgar fleet would require 50,000 gunners and 30,000 horses in order to moved across land in a similar fashion. This stunning comparison can be further clarified by adding in the amount of horse fodder and rations needed to feed such a legion! Not to mention that the movement across the sea allowed the fleet to travel at five times the speed of Napoleon’s army.
The sheer amount of weaponry on these floating fortresses is a telling portrayal of Britain’s power at sea in the Age of Sail. However, despite such immense destructive force, it was remarkably difficult to damage these ships with solid shot, and it was often the process of demasting or destroying the rudder that was the cause of defeat for a first rate ship-of-the-line such as the Victory. In fact, it was none other than the element of fire which posed the greatest risk to sailors of the age, since most components of the ship were composed of wood and rope, and thus were extremely flammable. The sturdiness of the hulls to cannon is a testament to the quality craftsmanship and expertise harnessed by the British shipbuilders. As I said, some of these ships, when properly maintained, lasted for several decades as a commissioned warship. In contrast to the British tanks of World War I, which usually broke down after only a short period in the field; this is a meritorious achievement. Their empire hinged on this mastery of the oceans, and is what propelled them to become the world power they once were, despite the minuscule size of their homeland. Thus, Britain’s command of the seas in the Age of Sail is no small wonder; the Royal Navy is the oldest of its military establishments, and one of its greatest sources of pride.
