AMA Journal of Ethics®

Illuminating the art of medicine

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AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. May 2000, Volume 2, Number 5.

Images of Healing and Learning

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The Role of Physicians in Wartime

The journal invites students to share their medical training observations captured in photographs by highlighting three historical photographs depicting the casualties of war and the role that military and civilian physicians played in healing the wounded.

The arts of medicine and war have a long and entwined history. Medical knowledge is crucial for any war effort and war, in turn, has been a source for significant advances in medicine. In the last 100 years alone, the nature of war has evolved dramatically, and with it the role and obligations of military and civilian physicians has likewise been transformed.

At the time of the Civil War (1861-1865) the deadliest enemy of the soldier was disease. For every soldier who died in battle, two died from illness. Crowded camps, poor nutrition, and the lack of proper sanitation and hygiene contributed to outbreaks of dysentery and diarrhea, which alone claimed the lives of more men than did battle wounds.

Field hospital

Civil War Field Hospital, City Point, Va, near Petersburg, Va
http://wwwihm.nlm.nih.gov/ihm/images/A/21/091.jpg

Those who did sustain injuries in combat were subject to the dire consequences of treatment without benefit of sterile dressings and antiseptics. Lister’s developments in antisepsis would not become common medical practice until after the conclusion of the Civil War in 1865. Surgical techniques were primitive, and amputation was the most common treatment for limbs shattered by gunshot, prompting the nickname “sawbones” for the camp physicians. If a soldier survived the operating table, he faced the likely possibility of postsurgical fevers and gangrenous infections. The numbers of dead and wounded in the Civil War far exceeded those of any previous American war, with more than 620 000 killed and 50 000 survivors returning home as amputees. These statistics prompted the growth of military hospitals and sanitation plans, as well as the development of important surgical techniques to more effectively treat battlefield injuries.

Wounded soldier

World War II, Wounded Soldier in Sicily, Italy 1943
http://wwwihm.nlm.nih.gov/ihm/images/A/22/393.jpg

Destruction of the environment by the increasing technological reach of war now constitutes one of the greatest threats to the health of populations in warring nations. The impact of contemporary wars has produced long-term detrimental effects on the society, infrastructure, and ecology of entire regions of the globe [1-4].

Radiation

World War II, Radiation Effects, Hiroshima Japan October 1945
http://wwwihm.nlm.nih.gov/ihm/images/A/23/156.jpg

As the medical profession has been confronted with the problem of civilian mass casualties and environmental destruction brought about by the wars of the twentieth century, the profession has extended the scope of its role and responsibilities in the care of the individuals and populations assaulted by the ravages of war.

In addition to physicians actively serving in the military, several organizations of civilian physicians have developed to address the issue of war as a public health concern. The International Physicians for the Prevention of Nuclear War and its US affiliate, Physicians for Social Responsibility, recipients of the 1985 Nobel Peace Prize, are devoted to opposing all wars involving the use of weapons of mass destruction. As members of the medical community committed to the promotion of global health, their objective is "to share with all of humanity our understanding that eliminating weapons of mass destruction, preserving a sustainable environment and reducing interpersonal violence and its causes are the most realistic strategies for assuring global survival."

Doctors Without Borders, recipient of the 1999 Nobel Peace Prize, is the world's largest independent international medical relief agency aiding victims of armed conflict, epidemics, and natural and man-made disasters. The organization was established in 1971 by a group of physicians determined to offer emergency assistance wherever wars and man-made disasters occurred. The organization "operates independently of all governments, institutions, political, economic, or religious influences" and depends on volunteer health professionals in fulfilling its mission. In accordance with universal medical ethics and the right to humanitarian assistance, Doctors Without Borders observes "strict impartiality and demands full and unhindered freedom in performing its functions."

As the nature of war has evolved in the last century, the physician's role has shifted in scope from what once simply involved treating military casualties on the limited battlefields of the Civil War to what now involves treating the mass casualties of entire regions of the globe brought about by weapons of mass destruction. The rise of medical humanitarian groups in the late twentieth century seeks to address the problems of war and health by taking an active role, not only in the treatment of casualties, but in the social and political processes that have a substantial impact on human morbidity and mortality through warfare.



References

  1. Rhodes R. Man-made death: a neglected mortality. JAMA. 1988;260:686-687. Available at: PubMed. Accessed April 27, 2000.
  2. Nelson B. Herbicides in Vietnam: AAAS board seeks field study. Science. 1969;163:58-59. Available at: PubMed. Accessed April 27, 2000.
  3. NAS, AAAS to report on Vietnam defoliation. Nature. 1970;228:108-109. Available at: PubMed. Accessed April 27, 2000.
  4. Herbicide commission reports extensive damage. Nature. 1971;229:223-224. Available at: PubMed. Accessed April 27, 2000.

Healing and learning appear to be paired processes, occurring together throughout human activity. But nowhere are these processes as prominently seen as they are during medical training.

For most students, the medium that most readily lends itself to retaining some visual memory of a succession of fleeting moments is the camera. Through photographs, the highlights of yesterday's happenings remain vivid and communicable to others. The subtle interplay of light and shadow that renders a photograph unique may even be likened to the delicate shifts that characterize interactions between patient and physician or between student and teacher.

We invite students to send photographs portraying aspects of healing and learning. Accompany your photos with a description of what is captured in the image and the special significance the picture has for you. Through these images, students can communicate their personal perspectives on medical training and share their observations and reflections with others.

Each month, a selection of photos and descriptions will be posted on this page.

Include 1-6 large, glossy photos with:

1. Title and description of photograph(s)
2. Student's name, address, phone, e-mail, and medical school

Send your images of healing and learning to: Audiey Kao, MD, PhD, Institute for Ethics, AMA, 515 North State, Chicago, IL 60610

The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.