Attachment 37698

November 11th is the day we honor our veterans for their patriotism, and for their sacrifices made while preserving liberty, freedom, and peace not only for our country, but around the world. There are, however, other contributions our servicemen and women have made that are often overlooked.

When studying the history of medicine, one finds a striking relationship between war and major advancements in medicine. For example, the hospital concept was developed by the Romans to provide an efficient means of treating the large number of legionaries wounded in battle. Such advancements have continued to result from major wars right up to the present.

In the United States, the Civil War resulted in an unparalleled number of battlefield injuries, and restoring the battlefield victims became a national priority. Without returning as many as possible to productivity the nation’s economy would have been devastated. Thus, the rudiments of rehabilitation were born. World War I brought another large influx of war wounded to this country and efforts were expanded. It was recognized that those with severe disabilities could benefit from an array of services, such as physical and occupational therapy, and vocational training.

Among the World War I battlefield injured were a significant number of soldiers with spinal injuries who survived long enough to reach hospitals in England. That gave rise to more rigorous study of the medical treatments and outcomes in areas ranging from spinal surgery to urinary tract management. Intermittent catheterization and suprapubic catheters were experimented with. In one instance, surgeons removed a bullet from a partially divided cord and transplanted the spinal cord of a rabbit into the separated ends in an attempt to provide a cure. Although this procedure was criticized, it provides insight into the role war wounded have often played in the advancement of medicine in general and in the advancement of spinal cord injury treatment specifically. In effect, they have served as involuntary research subjects. When physicians and other practitioners are suddenly faced with substantial numbers of persons for whom there is no established effective treatment and are destined to die, desperate measures become acceptable. Additionally, the clustering of substantial numbers of persons with similar injuries enables quick comparison of results. Sadly, despite the heroic measures to save them, only about 20 percent of the WW I spinal cord injured soldiers survived more than two weeks. Of those remaining, only 30 percent lasted more than four years.

World War II, however, was a milestone in the treatment of spinal cord injuries. Because of the advent of sulfa drugs, penicillin and improvements in battlefield medicine, those with spinal cord injuries began surviving and arriving at military hospitals in large numbers. It is difficult to find a hard number of the sci that resulted from the war, but it was at least in the low thousands.

Physicians scrambled to get a grip on this severely disabled population. Through a combination of trial and error, intuition, and the best practices they could glean from journals, they began using interdisciplinary teams of therapists, physicians, and nurses to treat these servicemen. Notable were two urologists, Estin Comarr, and Ernest Bors, who were serving in military hospitals and who developed more effective ways of dealing with urological management. Two other notables, Air Force physician Howard Rusk and Navy physician Henry Kessler developed and refined therapeutic approaches and goals used in treating this population. Because of these efforts, the majority of those sustaining spinal cord injuries in World War II were surviving 20 years later.

Following the war, these physicians applied the knowledge they acquired working with veterans to the civilian population. Dr. Rusk, for example, had a regular column in the New York Times which he used to promote the rehabilitation concepts that had been developed and refined for treating the war injured servicemen.

The war-injured veterans also have helped to confront society over its habitual victim blaming and other pernicious attitudes toward persons with disabilities. It is difficult to suggest that a veteran has been injured as a result of punishment by God for some misdeed or that our veterans are disabled because they were irresponsible. Moreover, when returning to their communities, these veterans rejected the traditional shut-in or invalid role in which people with severe disabilities were forced to assume as a result of traditional attitudes. Quickly they became leaders in advocating for accommodation of their disabilities by the public, providing a foundation for the ADA movement. They served as role models demonstrating that there can be life after disability. As spinal cord injured persons, we are grateful for the contributions our veterans have made that extended well beyond the call of duty. Our lives have been both extended and enriched because of them.