Monthly Archives: November 2017

Thanksgiving 2012

I wrote this greeting 5 years ago. I still like it. Best wishes to my historical friends.

Of Ships & Surgeons

The cornucopia – horn of plenty – symbolizing the abundance of a good harvest, comes down to us from the ancient Romans. Americans have traditionally associated the symbol with Thanksgiving.

We have the great good fortune to live in a nation that is wealthy enough to be able to support a robust historical establishment. University programs and fellowships produce their own cornucopiae of newly minted historians each year. Many if not most cities and communities sponsor or at least encourage local historians to accession and preserve their communities’ stories. Some corporations have historians on staff (I retired from Kaiser-Permanente, a company that does this). Even our popular culture embraces – and purchases – the works of excellent historians who have plumbed the far reaches, and the nooks and crannies of our national history. The instant popularity of Jon Meacham’s biography of Thomas Jefferson is but the most recent example of this.

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Navy Medicine in Araby (Episode 8, the Final)

In seven previous episodes, I’ve told the story of combat casualty and general medical care given our sailors in conflicts in “Araby”, starting with 19th century battles against the Barbary States and finishing with our current military activities in Iraq and Afghanistan. Herewith is the final episode, in which I describe the truly innovative aerial ICUs of the U.S. Air Force.

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The final 21st century iteration of an earlier concept is the Air Force’s Critical Care Air Transport Team. The first reported aeromedical evacuation was during the Franco-Prussian War of 1870-71, when 160 French casualties were evacuated by observation balloons from Paris, then under siege. Fixed wing aircraft soon followed, and by the end of WW I, the British were using aircraft specifically modified for medical applications. The United States Army Air Corps created Medical Air Ambulance Squadrons starting in 1942, and by the end of WW II more than a million patients from both theaters of war had been evacuated by these means. The concept of critical care evacuation – that is, transporting medically unstable patients requiring such support as respirators and intensive physiological support (IVs, transfusions and blood pressure sustaining drugs and the like) – evolved quickly after Operation Desert Storm, when it was discovered that such a capability simply did not exist. This lack of capability at the time forced the Army and Navy to utilize huge and semi-permanent Field Hospitals in or near the theater of operations. Prior to 1994, aeromedical transport teams typically consisted of two or more nurses, sometimes with critical care training, and several medical technicians. In 1994, the Air Force launched a formal Critical Care Air Transport Team program. These teams include critical care physicians, critical care nurses, respiratory therapists and the required medical supplies to support what are essentially flying ICUs. This concept has permitted medical planners to reduce the size of in-theater medical facilities while enhancing their flexibility and mobility to keep them as close as possible to zones of combat. [1],[2] Once wounded warriors receive emergency stabilizing surgeries, they can be rapidly evacuated to more definitive care settings in Kandahar & Bagram in Afghanistan, or to Landstuhl Germany or even to the specialty care facilities like the Brooke in San Antonio.

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Intensive Care Unit in an Airplane (Credit: http://www.dodlive.mil)

In conclusion, there really is no comparison between the medical care offered our sailors in the Barbary Wars and that provided today. Hippocrates, the Greek father of western medicine wrote in ‘On the Surgery”, “He who desires to practice surgery must go to war”, and it is cliché’ nowadays to say that the surgical art and science advance with every war. The evolution of that art is clearly seen in this story of Navy medicine across three centuries. From bleeding and purging to antibiotics and transfusions, from amputations in the cockpit to damage control surgery in the field and intensive care in airplanes, the sophistication of knowledge and the resources brought to bear for the care of combat casualties are beyond comparison.

The one common thread throughout this story, however, is the dedication of medical people to the care of their sick and wounded military compatriots.

[1] Air Transport of the Critical Care Patient, http://www.cs.amedd.army.mil/FileDownloadpublic.aspx?docid=57ab806b-df57-42d7-85b4-5f96907faf92, accessed 5 October 2016.

[2] U.S. Air Force Website, Gulf War Created Need for Better Critical Care, http://www.af.mil/News/ArticleDisplay/tabid/223/Article/643126/gulf-war-created-need-for-better-critical-care.aspx?source=GovD, accessed 5 October 2016.

Veterans’ Day Greeting

Today, I wrote this to Naval Order Companions of the San Francisco and Continental Commanderies, and the members of the Albany Medical College – Military Affinity Group. I send the greeting now to followers of Of Ships and Surgeons, with my best wishes:

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The word “service” comes to us from the Latin servus / servitium, meaning “slave” and “slavery”. By the 13th century, the old French servise had come to mean “labor undertaken for or at the direction of another”. The Roman and “Scholastic” notion of work with body or hands as dishonorable servitude underwent further modification under the influence of the Enlightenment so by the early 1700s, the association of “service” with military duty, at least for higher ranks, was seen as completely honorable. The need for larger “citizen” militaries probably completed the transition to a view of “honorable” service being performed by all ranks.
 
Let us salute each other on this day set aside especially to honor the service and sacrifice of the Veterans among us. 
Very Respectfully,
Tom S
Tom Snyder MD ’69

Captain, Medical Corps, US Navy (Ret​.​)
Commander, San Francisco and Continental Commanderies,
Naval Order of the United States
Founder / Coordinator
Albany Medical College – Military Affinity Group