War has often been a swift catalyst of medicine in general and military medicine in particular. The history of modern military medicine really begins with Dominique Larrey , surgeon to the Grand Armee and inventor of the 'flying ambulance' and triage. The Boer War saw the first portable X ray equipment and medicated field dressings. World War 1 blood transfusion in forward areas and plastic surgery. The Spanish civil war tetanus inoculation. World War 2 sulphonamides and penicillin. The Korean War , helicopter casualty evacuation.
- Emily Mayhew
In A Heavy Reckoning , Emily Mayhew has looked at the major trauma casualties of Iraq and too a much larger extent, Afghanistan. Advances in body armour and an enemy skilful in sophisticated IEDs, has led to a huge increase in blast casualties and multiple amputations. A scenario likely to be repeated in future asymmetric conflicts.
The author sets the scene with a brief look at First World War military medicine but then moves to the main part of the book. Afghanistan is examined over 122 pages looking at the medical challenges and procedures, but also through the eyes of 2 casualties who suffered appalling injuries, Mark Ormerod being the first surviving triple amputee.
The second portion of the book examines UK based treatment at Birmingham and the third section takes a longer look at the science and it's application to the new generation of high technology prosthetics.
A surprising area covered is how advanced major casualty treatment was by the end of the First World War, but much of the multi disciplinary approach was lost to medical infighting by 1925. (The Royal College of Surgeons do not come out of it well [p105-7] )
The Author develops the question of blast injury in depth, particularly supporting the hypothesis that it is a progressive and subtle injury that may be misdiagnosed as PTSD in some cases. Ongoing research is not confined to the military , since in the United States SWAT team members are also being studied for the condition, resultant on explosive entry techniques employed in training as well as live operations.
Dr Emily Mayhew is a serious academic, a military historian specialising in severe casualty treatment. Historian in residence at Imperial College and Research Fellow within the Department of Surgery and Cancer. Author of The Reconstruction Of Warriors and Wounded ; From Battlefield To Blighty 1914-1918.
In summary the book ,which was commissioned by the Wellcome Foundation, is that rare combination, a serious academic work that is also a good read for the general military or medical reader. For the researcher there are comprehensive notes , a concise index and plenty of cross references for further reading or research. The photographs are well printed on glossy paper with some useful notes at the end of the book. The book is priced at £16.99 or Kindle £6.64 although there are a few cheaper new copies on Amazon at the time of review.
Dr Mayhew is out promoting the book at a number of venues and her appearance at The Bath Festival with wounded veteran Harry Parker was a poignant afternoon leaving many of the audience deeply moved by the bravery of young soldiers today.