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I like to discuss what stress does. We all are stressed out at times. Some people are stressed all the time and this is called chronic stress.Acute stressLet’s say you were in a minor rear-ender accident. It is annoying, but at least you had no injury. But you have to deal with the insurance company, get the repair done and maybe get a car rental during the time of repair. Yes, you may have a few days where you feel that your hands are shaky and your heart pounds, or your sleep may not be restful. But when everything is done things are back to normal. This is an example of acute stress with a shorter running time. It has a limited severity, is an inconvenience, but it does not really affect your body on the long-term.Chronic stressLet’s assume the car accident was more severe and you received a personal injury with a broken leg. You end up in hospital and the orthopedic surgeon fixes the fracture with a surgical plate. The leg has to be in a cast for several weeks, and you have to use crutches. Every day you feel reminded of the car accident, because it is awkward to walk with crutches. After weeks you notice that you have gained weight. Your doctor is also worried about you because your blood pressure showed higher readings. You do not sleep as well, waking up frequently and having nightmares about another fictitious accident. On top of that you came down with the flu. What happened here? The stress reaction released cortisol, which weakened your immune system and may be responsible for catching the flu.High blood pressure and increased alcohol consumptionOn the long-term cortisol can also contribute to high blood pressure, but so can alcohol consumption. You may have increased your alcohol intake in the evening to relax more, but with the chronic stress and the cortisol increase this can cause high blood pressure. The weight gain that you noticed has to do with the fact that you cannot work out any more because of your healing leg fracture and you having to use crutches. Inadvertently you may also eat a bit more rich food; a lot of people do that as food can be used as comfort food.Disbalance of melatonin and cortisol with stressAnd why do you sleep less well? Chronic cortisol elevation leads to lower melatonin levels, as these two hormones are natural opponents. A high melatonin level leads to a low cortisol level and vice versa. With relaxation methods you can lower cortisol and the melatonin level increases normalizing your sleep. Chronically elevated cortisol can also lead to weight gain as sugar is converted into fatty acids that are stored as subcutaneous fat. Muscles can melt down when cortisol is high giving the appearance of spindly arms and legs.Causes of chronic stressHolmes and Rahe tested a stress scale in 1970, which has become the standard ever since. You get a certain amount of points for a stressful event, e.g. 100 for the death of a spouse; 45 point for retirement; 23 for trouble with the boss etc. Add up all of the points that are affect you right now; if the total score is less than 150 points there is only a minor risk of getting medical problems from the chronic stress; for 150 to 299 points the risk of illness is moderate and for 300 and more points you are at a significant risk for illness.Physical illness and mental illness from stressThere is physical illness and mental illness that chronic stress can cause. Physical illness can be high blood pressure, hardening of the arteries. The long-term risks from this are possible heart attacks and strokes. But chronic adrenalin and noradrenalin elevation associated with chronic stress can burn part of your brain cells in the hippocampus and medial prefrontal cortex. This can lead to memory loss, spatial memory loss and aggression. Mental illness caused by chronic stress can be anxiety, depression, social isolation, panic attacks and panic disorder. Psychosomatic symptoms can include headaches, back pain, abdominal pain and difficulties concentrating.Job stress and cancerPerhaps one of the best examples of job stress and cancer is a study where the amount of breast cancer was correlated to the amount of stress. Briefly, women with less responsibility had the lowest rate of breast cancer, but they too had some stress as there was a higher breast cancer risk after 15 years on the job versus only 5 years on the job. The same study showed that women with high responsibility had the highest breast cancer rates.How stress leads to higher breast cancer ratesA hormone disbalance can explain this based on high cortisol levels associated with chronic stress. If cortisol is high, the cortisol binding globulin (CBG) increases; this in turn also binds more circulating progesterone, as progesterone attaches to CBG. CBG is a transport protein for both cortisol and progesterone. The end result is that estrogenic compounds get the upper hand, a condition called estrogen dominance. I have explained under the above link that this was the real reason for the increase in breast cancer in the stressed women. Similar mechanisms are causing other cancers to occur more frequently with chronic stress.Chronic stress and cardiovascular diseaseHigh stress jobs were found to cause a 2.2 to 2.4-fold increase of strokes and heart attacks due to cardiovascular disease when compared to low stress jobs. This was based on a British Medical Journal study in October 2002. As I discussed above under a brief description of chronic stress cardiovascular disease is often what develops as part of chronic stress. People who are under chronic stress feel that they do not have enough time to prepare good, healthy food at home. They tend to eat out more often. Even well educated people just swallow a quick hamburger and other processed foods.Bad fats lead to heart attacks and strokeThis increases the bad fats like trans fats and omega-6 fatty acids in their system causing inflammation of the blood vessels. The LDL cholesterol and triglycerides get elevated, sugar from sugary snacks oxidizes the LDL cholesterol and your coronary arteries and brain arteries get clogged up. This sets anybody on the downward pathway, and it is now only a matter of time when the chronically stressed person will develop a heart attack or stroke.Chronic stress extremes: PTSD and burnout in soldiersDr. Thierry Hertoghe gave a lecture during the 22nd Annual World Congress on Anti-Aging Medicine in Las Vegas (Dec.10 to 14, 2014). The title was: “Burnout: A multiple hormone deficiency syndrome”. Burnout is the extreme of chronic stress. He said that burnout is a common condition where several hormones are affected, with the cortisol axis being the main one, but other hormone glands being stressed as well. As a result endocrine glands age prematurely. Symptoms are fatigue, exhaustion, gastrointestinal problems, anxiety, depression and aggressiveness. The underlying hormone abnormalities are a lack of cortisol, thyroid deficiency, growth hormone deficiency, testosterone and estrogen deficiency and oxytocin deficiency. Burnout is common in teachers and there is a questionnaire that has been developed for teachers (teacher’s burnout scale) to monitor them whether they are heading this way.Burnout or PTSDSoldiers who return from combative situations often suffer from burnout or from PTSD. The teacher’s burnout scale already mentioned can monitor their burnout severity. In suspected cases laboratory tests that measure hormone levels give concrete answers about hormone deficiencies. Treatment protocols were discussed in detail. Multiple bioidentical hormone replacements are necessary, possibly for prolonged periods, if not life long. In addition supportive counselling sessions from a counsellor or psychiatrist will help to tone down increased brain activity and help regain the internal balance. Why is this important? It is important, because hormones are necessary on a cellular level and regulate the energy metabolism of every cell in the body. Also, by recognizing what is going on and helping the affected individuals, a lot of pain and suffering can be prevented.Accelerated aging from telomere shorteningChronic stress has been shown to cause telomere shortening. So does a lack of sleep (insomnia), smoking and alcohol overconsumption, all conditions that can be associated with chronic stress. What can we do about this? Learn what shortens telomeres and ultimately your life. Cut out what you can and take supplements that lengthen your telomeres.Positive thinking combats stressNegative thoughts are draining you of energy. You want to stay optimistic within what’s reasonable. Be thankful for all the good things in your life. Minimize what’s negative, but think about positive solutions to get rid of energy draining parts in your days. Do this persistently until it becomes part of your life and you will have extra energy that you didn’t waste in negative thinking or needless, anxious anxiety. Worrying does not get us anywhere, but it depletes our energy.Relaxation methods counter stressSelf-hypnosis is a simple way to allow your whole body to relax. However, the various forms of yoga will do the same thing for you. Meditation is another way of finding peace and tranquility. Prayer is know to help people in sickness and in health. All of these methods will re-energize you. They calm your brain, help you to cope with stress and rebalance your hormones at the same time.Building social ties and mutually supportive relationships will also build you up. It makes you feel that you belong, you have your place in society, you help others, and they support you.Constant overdrive has physical consequencesWe need some stress to get us going, but we do not need “distress”. Dr. Hans Selye, the father of the general adaptation syndrome due to stress, gave a lecture about this topic in Hamilton, Ont. in 1977, which I attended. I vividly remember how he projected a picture of his skeleton showing bilateral hip replacements. He said that chronic stress could lead to arthritis. In his case, he said, he had developed end stage arthritis in his hips requiring total hip replacements on both sides. To illustrate further that stress leads to physical consequences, he explained that one person may develop a heart attack, another a stroke, a third could get arthritis. Constant overdrive has physical consequences.ConclusionStress can be deadly, particularly if it lingers on and becomes chronic. But we can reorganize our lives to minimize stress. Some people may decide to seek a less stressful occupation. Others may elect to stay at that job, but develop hobbies, learn how to relax and take relaxation classes to combat job stress. The key is to start thinking about what stress you may be under and then develop a plan to counter it so you can allow yourself to rebalance your life.NOTE: first published here: what stress does

BackgroundOf the 60 million soldiers who fought in the First World War, over 9 million were killed (about 14% of combat troops, or 6,000 dead soldiers per day).The armies of the Central Powers mobilised 25 million soldiers and 3.5 million of them died.The Entente Powers deployed 40 million soldiers and lost more than 5 million.The mortality rate ranged between 6% and 30%, with the highest in the armies of Serbia, Montenegro and the Turkish Empire, mainly due to large epidemics of cholera, typhoid and smallpox, against which the armies of other countries vaccinated their troops.(Infectious diseases did also spread in other armies, but with a lower mortality rate.)In absolute numbers, major battles on all fronts claimed the highest number of casualties, primarily because of the technology of warfare based on explosive artillery shells.The death toll among prisoners of war amounted to between 5 and 10 % of prisoners.British CasualtiesThe formation of the Royal Army Medical Corps (RAMC) on 23 June 1883 by Royal Warrant, and the associated reorganisation in 1902 of the Army Nursing Service into the Queen Alexandria’s Imperial Nursing Service allowed the British Army’s medical services to be put on a more professional and effective basis.A new Royal Army Medical College at Woolwich and a school of sanitation at Aldershot that for the first time oriented the army’s approach to the practice of good hygiene both on and off the battlefield.(In particular the preparation of sterilised drinking water was formalised and the means established of transporting this potable water supply to all the soldiers in the field.)By 1914, all these new procedures were well established throughout the British Army.Field Ambulances and Field HospitalsA further reorganisation that had greatly affected the role of the army medical officer on the battlefield was the creation of the Field Ambulances and Field Hospitals.(A ‘Field Ambulance’ was actually an RAMC mobile medical unit - an early form of the famous MASH units - with a strength of ten officers and 224 other ranks; later increased from early 1915 with another officer and twenty-five ORs who formed the Sanitary Section. The FA was charged with the collection, treatment and clearance of the wounded and the sick from the environs of the battlefield and for mobility purposes was usually housed in tents.)When the British Expeditionary Force (BEF) left for France in August 1914, on its strength were nineteen RAMC Field Ambulances – three for each of the six divisions and one for 19 Brigade.Each BEF Field Ambulance unit was responsible for the clearance of casualties from the field from a brigade area in the front line by means of their collection from Regimental Aid Posts and other casualty concentration points.The Field Ambulance provided these casualties with immediate medical treatment as necessary and, as indicated by their wounds/illness, ensured their onward transfer to the Casualty Clearing Station.Ultimately, the more serious cases entered the Base Hospital organisation that extended back to the UK; an amazing 40 percent of the wounded/sick were repatriated to the UK during the conflict.Non-Combatant CasualtiesWhilst initially the role of what were traditionally called ‘camp followers’ on the Western Front was practically nil in 1914, as the Great War progressed increasing numbers of Chinese, Black South Africans, Egyptians and Indians for example were employed in Labour Corps with numbers reaching some 150,000 in 1918.Special medical facilities were required to care for them. Inevitably, the further up the Lines of Communications these workers were employed, the greater the numbers of battle trauma casualties that occurred.Planning Medical ServicesBased on experience in the Boer War (fought only two decades earlier) the War Office expected that the medical services would have to deal with about 5 percent of the total soldiery suffering from trauma wounds. They also assumed that there would be an unpredictable, but significant, number of casualties due to the communicable diseases that were always associated with men at war.Although the range and efficacy of lethal weaponry had increased since the Boer War along with the impact of the new high explosives, generals still thought the majority of wounds would arise from bullets and shrapnel balls.They also allowed that there would be probably be some injuries due to the shrapnel shells themselves, and their explosive effect, and the sabre, bayonet and the lance (of which the latter two weapons, although relatively rarely deployed, produced surprisingly high fatality rates).Significantly in 1914 the British had practically no high explosive/splinter fragmentation type shells in their armouries.)The assumption was therefore the majority of the soldiers’ wounds would be of the simple penetrating type associated with open warfare. (Later in the war the lacerating wounds from the splinters of fragmentation shells, mortars and grenades became the majority.)It was not fully appreciated that when simple missiles such as bullets or shrapnel balls struck bone, serious and complicated injuries could arise.(The kinetic effect of even the standard rifle/machine gun round used in the Great War is often under-estimated. Leaving the barrel at 2,700 feet per second, if one struck the cranium of the skull it would usually totally destroy the brain and a limb-bone could be badly splintered beyond repair. In the case of such wounds to the limb-bones this could necessitate amputation and its associated complications.)In the Light of ExperienceIn the event, within a very short period after the outbreak of hostilities, open warfare quickly became untenable due to the level of lethality it assumed. The troops of the belligerent nations went to ground into a massive 460-mile long subterranean creation of barbed wire, trenches, dugouts and fortifications.Had the troops not done so, the enormous casualty rates associated with open warfare and modern weapons would have probably brought the war to an inevitable early end: the fighting armies would have literally run out of troops fit to fight.To deal with this radically changed scenario, machine guns became much more numerous, and produced an unprecedented range of multiple wounds. Also, high explosive fragmentation (splinter) shells, mortars and hand-grenades became the norm inflicting partial and total dismemberment and other mutilation injuries.In addition, crush and asphyxiation injuries became common as trenches and dugouts collapsed onto their occupants under heavy and prolonged shelling using high explosive.By the spring of 1915, toxic gas had been introduced by the Germans and became a major cause of disablement, if not proportionally leading to many deaths.As the war progressed the use of toxic gas in various forms, kinds and presentations became almost universal along the Western Front.Possibly for the first time in a major conflict, many more Great War soldiers were to die from wounds than did from disease, in a ratio of approximately 5:1… however there was a considerable drop in the numbers of deaths from wounds and 55& of these occurred whilst the servicemen were under medical care in casualty clearing stations or other field medical units.(The remainder died further up the treatment chain, confirming an improved system of patient care from that which pertained in the Boer War. A similar improvement occurred in the ‘ill and injured’ category.)Battlefield StatisticsAt the outbreak of the Great War in 1914 no plans had been made for the systematic collation of medical statistics. (Indeed, no provision had been made for the attachment of a responsible administrative medical officer to the Staff of the Commanding Officer BEF.)In November 1914 were clerical and statistical staff officially assigned to medical statistical duties, there was rarely enough resources to gather accurate data in a rapid and standardised way so casualty records from the early part of the Great War should be regarded as approximations.From June 1917 standardised recording procedures had been adopted universally by the War Office and funding regularised, although it is considered that only the Western Front records of the British Expeditionary Force actually achieved this universal level of application.Post-war, further efforts were made to rationalise and collate all the Great War medical records for statistical and pensions purposes; particular attention being made to casualty numbers, manpower resources and wastage.Comparative analyses of the primary weapons of the Great War on the Western Front shows that the bullet (rifle and machine gun) produced 39 percent of casualties, shells and other missiles 59 percent, hand thrown bombs and grenades 2 percent and bayonets/lances less than1percent.(Exotic weapons such as flame-throwers and tanks produced relatively low numbers of casualties although they possessed a strong shock effect, particularly when first introduced.)The distribution of the site of wounds receiving medical treatment is somewhat surprising:Just under 40% of wounds occurred in the feet and legs; 30% in the hands and arms: 17% percent in the face, head or neck; 6%–7% in the back; 4% percent in the chest and 2% in the abdomen.Flesh wounds accounted for a massive 80% of all the wounds that received medical attention and many more received unrecorded self-treatment.Each active service soldier was provided with an emergency field dressing; larger shell dressings were available within the infantry platoon. (Cotton bandages to which were attached wads of cotton wool treated with a microbicide. A safety pin was provided to secure the dressing in place over the wound. In use they were effective at staunching most non-arterial blood flows and for keeping the wound relatively clean until appropriate treatment was available.Unfortunately, major infection into the wound often occurred during the moment of trauma, and it was this deeply embedded detritus that later caused so much trouble, however, the simple, emergency field dressings had an important psychological affect in reassuring the wounded soldier that he was being medically cared for and to a certain extent that he could provide first aid for himself should the need arise.PainkillersFortunately, throughout the Great War the anaesthetic chloroform and the strong analgesic (painkiller) morphine were in good supply to the British surgeon.As the war increased in intensity and scope on the battlefield, greater availability of morphine to the wounded was ensured even at the furthest front line level.Once a wounded soldier did get to a source of trained medical care he could be sure of an adequate level of pain relief.(The French were less fortunate and they suffered from frequent shortages of both analgesics and anaesthetics on the battlefield.)Immediate Surgical CareIn 1914, the British military medical officer - including surgeons - had a rather limited armamentarium of remedial measures that he could employ to give succour to the wounded.(While there were increasing numbers of female physicians and surgeons during the Great War, no female doctors were commissioned in the RAMC.)Surgical interventions were haunted by the spectre of infection and shock (it took a courageous surgeon to step outside the officially recognised procedures).Moreover, at the outset of the war, surgery was only attempted at the Base Hospital level and that necessitated often long and painful transportation for the wounded soldier from the battlefield.(In the early months of the war, for example, chest surgery was limited to the drainage of pus and the surgical handling of the organs of the thoracic cavity was considered to be hazardous in the extreme. Consequently, the making of the necessary surgical incisions to permit the removal of foreign bodies, or for the suturing of internal chest wounds, was generally discouraged - a policy that cost of many lives.)By the end of 1916, the reality of the casualty situation, as was most forcefully demonstrated by the military disaster that was the Somme Offensive, obliged a rethink on the deployment of medical care facilities both on, and close to, the battlefield.Proper surgical teams were formed with the necessary back-up medical staff and other facilities. Accordingly, these teams were introduced much closer to the front line and a speedier and efficient flow of the wounded was created.This resulted in greatly shortened transport times and a reduction in the suffering and trauma that the wounded experienced en route.(While there were increasing numbers of female physicians and surgeons during the Great War, no female doctors were commissioned in the RAMC.)Also a more adventurous attitude was adopted in relation to the treatment of wounds:Blood transfusions were introduced, as were X-rays.Tissue debridement (surgical removal of flesh and muscle) was more aggressively applied, early forms of plastic surgery were practised and active cleansing and draining of infected wounds generally instituted.More strenuous efforts were also made to remove foreign bodies and close open wounds as soon as possible, as was the immobilisation of fractured bones by wooden splints (Thomas Splints) and other supportive means.All these measures greatly enhanced survival rates and gave better recovery and rehabilitation outcomes. These more favourable rates also proved to be a considerable factor in the ability of the belligerent nations to keep the fighting going despite the horrendous casualty rates.(The British claimed over 80 percent of their wounded were returned to duty; some on several occasions.)GangreneOne of the greatest and more intractable medical problems faced by the medical organisation on the Western Front were the two conditions known as dry and wet gangrene (the latter called lockjaw but which is more properly known as the potentially fatal condition, tetanus).Without recourse to modern antibiotics and other supportive measures, the treatment of either type of the gangrenes was largely based on aggressive surgery allied with intensive nursing care.TetanusThe bacteria is found in heavily manured soil and quickly establishes itself in penetrating wounds. It produces a deadly toxin for which there is no neutralising antidote. About 50 percent of those who demonstrate symptoms die a painful death.In late in 1914, the British Army introduced a preventative tetanus inoculation, but tetanus cases still occurred in the trenches of the Western Front with fourteen hospital admissions in 1915 (equivalent to 2 per 100,000 of the British Expeditionary Force serving on the Western Front) and five deaths.Subsequently, the number of tetanus cases was reasonably contained despite the huge increases in the numbers of British and Dominion troops on the Western Front.In 1915 14 admissions (2 per 100,000 strength) and 5 deaths.In 1916 254 admissions (19 per 100,000 strength) and 146 deathsIn 1917, 271 admissions (14 per 100,000 strength) and 134 deathsIn 1918, 112 admissions (6 per 100,000 strength) and 59 deaths.(At the end of the War admissions for and deaths from tetanus in the British and Dominion members of the BEF on the Western Front represented an extraordinary success against this battlefield scourge. The main innovator of this preventive inoculation work was Sir David Bruce, a much-acclaimed British military expert in tropical diseases.)Dry gangreneWhen blood circulation is seriously affected in an injured or diseased area, necrosis (tissue death) can set in and the only solution is rigorous debridement of tissue or as was more common at the time, amputation of the entire limb.(Later in the Great War concomitant infestations of wounds by fly maggots were observed by US Army Surgeon William Baer and others, to be highly efficient in the debridement process as they attacked only dead and damaged tissue and simultaneously sterilised the wound. Unfortunately, this promising therapy was not developed until after the Great War but it is still in use today.)The fungal disease associated with exposure to cold, wet conditions that caused the condition known as Trench foot led to many amputations due to gangrenous complications.Wet gangreneThis was an even more serious problem, and led to innumerable deaths of wounded soldiers.As mentioned earlier, it was caused by a bacteria commonly found in heavily manured agricultural soil. In the rural areas of France and Belgium wounded soldiers were infected by contact with the infected soil, particularly through mud caked uniforms: even the dirty straw that was widely found in soldiers’ barracks, billets and first aid centres could be a source of the infection.Trench FootIn addition the fungal disease associated with exposure to cold, wet conditions that caused the condition known as Trench foot led to many amputations due to gangrenous complications.)Toxic GasChlorine, released as a gas from high compression steel cylinders in 1915 (called ‘Oojars’ by the British) via a system of pipes that were routed over, or through, the parapet of the trench and so aligned that the toxic gas would be blown by a favourable wind into the Allied trenches produced numerous lung and mucous membrane affected casualties.(Chlorine gas in contact with the water in the lungs and the mucous membranes produces hydrochloric acid that is highly corrosive).Initially, there were no protective anti-gas masks and clothing against the toxic gas, and many soldiers died an agonising death. But the Allies acted with great speed and energy and within days ad hoc masks were deployed on the battlefield.Other more effective devices quickly followed. By the autumn of 1916 the British had produced a ‘box respirator’ that was highly effective against chlorine gas (if promptly and properly deployed).Later phosgene (late1915) and mustard gas (1917) were widely used by both sides. These gases were delivered by gas shells or other suitably designed missiles.Mustard gas also affected moist unbroken skin raising huge painful blisters. This latter gas, delivered in liquid form, often lingered for days contaminating whole areas of the battlefield and, occasionally, beyond.Eventually, special British Divisional Gas Treatment Centres were set up on the Western Front, as were gas casualty clearing stations and hospitals specialising in the treatment of gas cases.Numerically, the notified British toxic gas admissions to hospital for the war after 1915 were comparatively low – around 190,000 representing around 10 percent of the total British wounded hospital admissions, and the mortality rate proportionally lower still – around 6,000.Nevertheless, gas-warfare was generally considered by both sides as the one of the more horrid and mutually hated aspects of the War.By and large, the treatment that was available for exposure to toxic gas was mainly palliative and the degree of recovery largely depended on the recuperative power of the gassed soldier.Many seriously gassed soldiers were affected for the rest of their lives, particularly with pulmonary (lung) problems.However, of those admitted to hospital as a gas casualty (93 percent of those presenting to casualty clearing stations), around 94 percent subsequently returned to duty.Shell ShockThe condition known as ‘shell shock’ is not strictly ‘wound related’ trauma, so no survey of the treatment was undertaken but it merits attention:Accounts of nervous disorders associated with long military campaigns occur throughout history, often referred to by euphemisms such as ‘Nostalgia’ (Swiss mercenaries), ‘Longing for home’ (Germans), ‘Da Costa’s Syndrome’ (Americans – Civil War) and ‘Neurasthenia’ (British).However, as early as 1914 on the Western Front, during the Battle of Mons and the subsequent Retreat, considerable numbers of the British Expeditionary Force were found to be suffering from ‘a serious mental disability’ sufficiently acute to prevent them performing their duties effectively on active service.It was particularly notable that the majority of these men had not received any serious battlefield injury, thus rendering the then supposed causative reason of ‘proximity to an exploding shells’ as, at best, dubious.Also, in the class-oriented attitudes current in those days, officers were thought to suffer from a different condition from their men. (Officers’ symptoms were said to be due to ‘overwork’ or ‘the heavy burden of responsibility’ so terms like ‘Effort Syndrome’ and ‘Disordered Action of the Heart’ that was exclusively applied to officers (with other, far less generous terms being applied to other ranks.That said, some officers did bear an extremely heavy burden of responsibility that by itself inevitably led, in a few cases, to mental breakdown but the main cause of their mental and physical collapse was closely related to that affecting their men (which is to say various forms of combat fatigue or stress).From the time the term ‘shell shock’ was first used by Dr Charles S. Myers on the Western Front in 1915, it quickly came to be widely used by the soldiery and general public alike. However, for some time the medical officer cadre preferred such official terms as ‘Concussional or Commotional Shell Shock’ or ‘Nervous Shock or Emotional Stress’.By the end of the Great War the general nature of ‘shell shock’ was more clearly understood by all concerned and most civilians too had met, or heard of, BEF soldiers suffering from the condition.However, during the conflict on the Western Front, it took considerable time and bureaucratic vacillation for the British military authorities to come to terms with this problem of battle stress, and even when they did, some commanders continued to treat it as a military discipline problem. These officers reacted accordingly, with, at worst, cases of patently shell-shocked soldiers being executed for cowardice were not unheard of, and which today is still regarded as scandalous.Eventually, special facilities were created to deal with the shell shock problem, and this led to an increasing emphasis on treatment ever closer to the battlefield.* See Casualties | WW 1 and World War I Articles)

Ὦ πολλὰ δὴ καὶ θερμὰ καὶ λόγῳ κακὰ καὶ χερσὶ καὶ νώτοισι μοχθήσας ἐγώ· κοὔπω τοιοῦτον οὔτ’ ἄκοιτις ἡ Διὸς προὔθηκεν οὔθ’ ὁ στυγνὸς Εὐρυσθεὺς ἐμοὶ οἷον τόδ’ ἡ δολῶπις Οἰνέως κόρη καθῆψεν ὤμοις τοῖς ἐμοῖς Ἐρινύων ὑφαντὸν ἀμφίβληστρον, ᾧ διόλλυμαι. Πλευραῖσι γὰρ προσμαχθὲν ἐκ μὲν ἐσχάτας βέβρωκε σάρκας, πλεύμονός τ’ ἀρτηρίας ῥοφεῖ ξυνοικοῦν·Ah, many and hot and cruel not in name alone have been the labors of these hands, the burdens hoisted upon these shoulders! And yet no toil ever laid on me by the bedfellow of Zeus or by the hateful Eurystheus was as harsh [1050] as this thing which the daughter of Oeneus, fair and false, has fastened upon my back, this woven net of the Erinyes in which I perish! Plastered to my sides, it has eaten away my inmost flesh and sucks the channels of my lungs. Sophocles, Trachiniae Sir Richard Jebb, Ed. [1] see also [2]The word “doctor” i-ja-te, can be read on an inscription of Linear B from Pylos (PY Eq 146 c.1200 B.C.). It was identified by Ventris and Chadwick in 1953, after the successful decipherment of that script when it was demonstrated that it was Greek of the Mycenaean period. In particular, they identified the word as “iater”physician [ἰητήρ, Iliad 11.732+, Cypr. to-ni-ja-te-ra-ne acc... now yatros].This tablet refers to the amount of land held by a doctor. The reference which is provided by Ventris and Chadwick comes from a tablet from Idalion of Cyprus, dating to the 5th century B.C. and it is written in the Cypriot Syllabic Script which is related to Minoan Linear A.The inscription refers to payment that was given to a family of doctors who provided their services, free of charge, to victims after the destruction of their city as a result of the Persian siege.Today, more that 50 years after the decipherment of Linear B by Ventris, it is possible both to scientifically approach and to study the Linear A inscriptions of Minoan Crete.More specifically, on an inscribed pithos from the Pal- ace of Phaistos (PH Zb 4) in the Mesara dated to the 16th century B.C. and now in Heraklion Museum, we are able to read SI-MA I-JA-TE about Doctor Simas. [3]As he was called, the physician (i - ja - te) who portrayed in the written text of the palace archive should practice the art of the therapist at a high social level than the healers of his time.[4]In the hymns in abstract terms we will also include the Hymns in Ygieia Health: that of the Dithyrahmonographer of Chios (769 PMG), whose style was admired by Aristotle (Rev. 1413b12-16), as well as by Arifrona. The original elaborate invocation of the Hymn of Lycimnus is a kind of calling, frequent in the worshiping hymns, and requires a request of the type "listen to me", which in this way creates a close inter-relationship between the deity, and in the audience:λιπαρόμματε μᾶτερ ὑψίστα θρόνων σεμνῶν Ἀπόλλωνος βασίλεια ποθεινὰ πραΰγελως Ὑγίεια Lamp-eyed mother, supreme of the thrones of Apollo's respected queen, sweetheart Health. (Met.Galla with modifications)The adjectives given in YΓΙΕΙΑ come from the traditional vocabulary of praise and create an image visually appealing,THE ANATOMIC KNOWLEDGE OF THE EGYPTIANSWhat anatomical knowledge was a well-trained doctor of the time? He used a very rich vocabulary for anatomical body surface, who knew her well. But for internal organs, his vocabulary is very poor.When we see in the hieroglyphic representations of spleen, it is an animal and never a human gut. The ancient Egyptian doctor knew only the bones and some internal organs: the heart, the brain, the lungs, the stomach, the liver, the spleen, the kidneys, the intestines, the bladder. There was no distinction between muscles or veins and arteries. He knows that the vascular system belongs to the heart, but nothing more. [5]The first written evidence about Ancient Greek Medicine (Μedicine from Medusa see the myth about her vains) remains the Epic of Homer, which provides a wealth of information about the already advanced Medicine, especially Surgery of the 10th century BC, but also previously in Greece. Particular emphasis is given to Surgery, because it appears that this is the first developed branch of Medicine.The doctors of the Homeric heroes, but also these heroes, possessed considerable knowledge of painkillers, disinfectants and antiseptics. They knew ways and means of relieving bleeding, performing surgical procedures, extracting foreign bodies (eg arrowheads, etc.), attacking painkillers and a number of bandages, which they used "thoroughly" according to Homer, as well as and the use of stretchers.The description of the injuries to Homer is so perfect and documentary that some may claim that Homer was descended from an Asclepiad family or that he himself was a military doctor. (see Homer's surgeon by MYLONAS ANASTASIOS Deputy Director Oral and Maxillofacial Surgeon at the Metropolitan Treatment Center) [6][7] An extensive study of modern scientists who replicated ancient tactics concluded that if a 1,000-horse armed force had a 250-meter bend, 220 of its arrows would target a solid mass of infantry that would not be protected by shields. Of these, about 120 would be affected by unrestrained or other vulnerabilities, namely 18 to throat, which would bring about instantaneous death, 13 the abdomen (80% would follow death from infection within three days), 36 hands and 53 shins and thighs.Less than 2% of the wounds at the extremities would prove lethal and only if an artery was damaged.[8]Aretaius in his book[9] describes a trauma...πλήξας ξίφει αυχένα κωπήεντι.παν δ' υπερθερμάνθη ξίφος αίματι, τον δε κατ' όσσε έλλαβε πορφύρεος θάνατος και μοίρα κραταιή.”he with his s sword, and he hit him in his neck, his sword swathed from his blood, and red death found him by ruling Fate ... "The sword is overheated by the heat of the blood and this particular blood that offers this heat is reddish. If we seek help from the later Hippocrates, using his views and considering that he, outside of his own observations, wrote down the pre-existing medical knowledge, by deciphering these verses we conclude an indirect reference to arterial blood. Hippocrates recognizes the pulmonary artery and its discharge from the right atrium and reports that blood temperature is lower there due to the reciprocal air movement from the lung to the right atrium. Without being scientifically accurate, it approaches the venous blood and the function of the right heart system. see Αlexandropoulos THE TRAUMATOLOGY IN ANCIENT GREECE FROM THE URBAN TO THE XENOPHONE p.65A trauma report we get about Homeric medicine and wound healing.“...αιψά τοι αίμα κελαινόν ερωήσει περί δουρίν...”"... around the spear black as soon as blood runs out." (A.303)Blood on the epic is typically marked as black when bleeding is reported. Thus, the ignorance of venous and arterial blood, as well as the fact that the poet's medical diagnosis on traumatology comes mainly from the necropsy of the injured. Godquin[10] assumes that Homer was a surgeon, or that a physician contributed to the Iliad when he was presented as a written text. However, since there is no evidence of Homer's medical status, this knowledge obviously reflects the applied Traumatology of the time.“...ακρότατον δ' άρ' οϊστός επέγραψε χρόα φωτός, αυτίκα δ' έρρεεν αίμα κελαινεφές εξ' ωτειλής. Ως δ' ότε τις τ' ελέφαντα γυνή φοίνικι μιήνη... τοιοί τοι, Μενέλαε, μιάνθην αίματι μηροί ευφυέες κνήμαί τε ιδέ σφυρά καλ' υπένερθε. Ρίγησεν δ' αρ' έπειτα άναξ' ανδρών Αγαμέμνων, ως είδεν μέλαν αίμα καταρρέον εξ' ωτειλής ...” (Ilias D .139-149)Within ten lines the blood has been dubbed twice as black and one purple. This could be attributed to confusion or generalization to cover the poet's ignorance. But while studying the Iliad, we notice that the blood is described as black when it refers to bleeding through the trauma. Also black is used to describe anything painful or unpleasant such as pain (from black pains to save you -D191), misery, or death. We can conclude from this that only hemorrhage is recognized as a dangerous complication often leading to death.Diogenis Apollonia (430 BC) considered the left ventricle, the arterial or spiritual, as he called it, the seat of the hegemonic soul. Pythagoras Filolaos found the soul in the heart, but not the intellect. The seat of the intellect for both him and Hippocrates was the brain.[11]Galen studied the anatomy of the uterus, the ophthalmopathies and the movement of the chest and lungs during breathing. Describe the liver and the heart valves! He separated the arteries from the veins and said the pure blood was circulating in the first. Until then, they believed air circulated in the arteries. However, this is not entirely wrong because the blood gases - oxygen and carbon dioxide - are transferred to the blood dissolved. Mostly, however, they are found in the red blood cells from which they are bound and released into the bloodstream.[12]Sudden death in healthy athletes is an unusual phenomenon, but when it happens, the primary mechanism is cardiovascular.[13]Galenus, the greatest physician of the ancient world after Hippocrates, had direct contact with the field of sports medicine, since at the end of his nine-year post-traumatic journey he returned to the Roman occupation Pergamon.[14]There he was appointed doctor of the gladiators and thus he enlisted in traumatology and sports medicin. There he was appointed a doctor of the gladiators and thus he enlisted in traumatology and sports medicine. In the above passage, the Grand Doctor confirms the fact that the athletes of the Palaestra due to the nature of the sport and the intensity at which the sporting events took place showed sports injuries. [15] which in addition to scratches and bruises included splinters, disruptions and fractures "perverted", "broken".Another form of injury in a race is reported by Claudius Galinos (Pergamon 129 AD - Rome 199 AD): << Let's close this discussion now. I want to add to the benefits of playing with the little ball and the fact that it does not involve the dangers of most other exercises. The fast running killed many as they broke key blood vessels in their bodies >>.see Pausanias. Greece Exploration, VIII, 40. 1-5.Galen, referring to the benefits of gymnastics with a small ball over the other gymnastic exercises, says he does not contain the dangers of the other exercises. The fast running for the imperial physician caused many deaths:, He continues as a scientist of his time and mentions the reason why they broke key vessels of their body: << '<<’αγγειον ’επίκαιρον ‛ρήξαντες·>>.. >>The above events of "sudden death" of athletes are not a "privilege" of the ancient world alone. Modern literature, especially after 1985, is enriched by scientific studies that focus their scientific interest on the phenomenon of "sudden death" of athletes.Herofilos (circa 300 BC) and Erasistratus (about 330-250 BC), which were at the same time in Alexandria, are now referring to the history books of medicine mainly for their anatomical studies. With them, the Greek anatomy actually begins to develop. They described, for the first time, enough internal organs of the human body (eye, brain, heart, arteries, intestines, genitals, etc.) and gave names in their parts.[16]Interesting is the origin of the term "carotis", although it is later. This is what called the artery that carries the blood on the head because under its pressure the man remained speechless and carious, sleepy due to non-blood circulation of the brain «πιεζόντων καρώδεις και άφωνοι εγίνοντο». [17]In the area of ​​Gourni of Archanes, a Minoan skull with healed scars in parareg was found by E. & G. Sakellaraki.Surgery from the scar removal and remodeling marks on his scalp in the human skull confirms that there was healing from the scars in the bones, so the patient lived after the proceduresee Arnott R. Healing and medicine operation in the Aegean Bronze Age. J R Soc Med 1996; 89: 265-270.This finding came to confirm that the various tools found were likely to have surgical use. The high technology of the Minoans can be demonstrated by other finds such as seal stones, in which craftsmen were making fine-looking performances using magnifying glasses. [18]Similar cuts (scarification) made by a sharp tool were observed by McGeorge in a skull of the Late Minoan period from the Armenis cemetery, which belongs to a 25 year old man and carries 3 sections (17,5 mm, 11 mm and 16 mm) on the frontal bone.[19]Another skull that was found in Crete at the location of Alya (near Knossos) and dates back to around 1900 BC. there is a circular 16mm diameter in the left parietal and 7 small scapes of 3-10 mm, which look like a sharp tool. Angiographic techniques applied gave the incision to aneurysm and incisions in surgical treatment (possibly to control the headache). Similar convulsions, possibly due to traumatic aneurysms or post-traumatic arteriovenous communications, were found in 2 skulls of the Late Minoan period in the Armenian cemetery and belong to men aged 23 and 35.Galen knew that the heart was moving blood, but not that blood was circulating. He wrote 16 books devoted to the pulse. Use the pulse extensively to diagnose the diseases. He taught how to look at pulse, completeness, period and rhythm. He explained the nature of the pulse believing that the arteries were contracting and expanding independently of the heart and helping to form the vital "spirit". He wrote books on how different pulse changes reveal body diseases.[20]Erasistratus (330-225 BC) described the brain's convolutions. distinguished the brain and the cerebellum and noted that the organs had arteries, veins and nerves. He even distinguished the nerves in sensory and mechanical. But he believed that the arteries contained not the blood but the vital "spirit". There are indications that experimental surgery was performed during this period in live animal-experimental animals. The knowledge of the Egyptian taxidermists and the teachings of Plato and then Aristotle, that the soul is independent of the body and immortal, meant that the dead body was not sacred and could be "broken". The dissection was permissible and resulted in a much more accurate knowledge of the anatomy.Praxagoras the Koos (4th century BC) famous physician, a follower of the Dogmatics School. She thought there were 11 types of juice produced in the veins, while the arteries contained no juice but spirit. He considered the heart as the central organ of the body and the nerves as thin branches of the arteries. His major discovery was the distinction of the nerves in aesthetics and kinetics. [21]What is the relationship between air and spirit? Why did the ancient Greeks connect the air with the spirit?The soul in the dictionaries refers to stems from (psycho = blow = move = run = I am seen -θεω- theo-logy[22] ANEMOS (wind) is a phenomenon that involves - I breathe and move - The Latins called the soul ANIMUS to have it described but to differentiate it from the mother Greek Language..It is evident that for ancient human doctors, ΨΥΧΗ it is connected with AORTI αίρω < αρχ. αἴρω | ἀείρω, ιων. τ. "σηκώνω" ἀείρω < ιων. τ. Ετυμολογία: [<αρχ. ἀρτηρία, πιθ. από το ἀήρ + τηρεῖν ή ἀείρω "υψώνω"] αορτή From the Ancient Greek ἀορτή (aortḗ, “the arteries springing from the heart”). αορτή - Wiktionary ἀορτή: ἡ, (ἀείρω) κατὰ πληθ. τὰ κατώτατα ἄκρα τῆς τραχείας ἀρτηρίας, τὰ αὐτὰ καὶ βρόγχια Ἱππ. Περὶ τόπων 415· (ἔνθα ὅμως ὁ Littré ἀναγινώσκει ἀορτρέων, -τρῃσι).More about soul-air connection at my articles [23] [24] [25] [26] [27]Moreover, Empedocles stated that the navel has four vessels, two veins and two arteries. So she knew that the fetus in the uterus is running and growing through the placunta and umbilical cord.[28]Childbirth with a happy ending in Ancient Greece. Relief of the 5th century BC (Photographic Archive of the Greek Folk Medicine Museum).The rendering of divine substance in a personalized abstract sense is not problematic at all. The fact that the ancient Greeks willingly see in personal terms and treat as deities cultural or natural phenomena that affect their welfare (Adkins 1985, 122-3, 227 σημ. 29.) [29]In the Dark Middle Ages, much of the past medical knowledge and practice was left untapped and lost. The main body of health is the Church with Monastic Orders to provide medical services to hospital facilities created in the monasteries. At the same time it is common to seek miraculous healing by invoking healing saints.William of Shalist (1210-1277 AD) first separated bleeding from artery from vein bleeding.[30]I hope the analysis of the data will trigger brilliant doctors to engage in the knowledge of the doctors of the ancient world.For translating medical terms I used an automatic translator and I do not know if they are attributed to the fullest, so I quote the links for deepening. If a doctor thinks that the text wants a correction I will be happy to let me know.Yannis Pantazis“..Φιλοσοφούμεν τε γαρ άνευ μαλακίας….”Footnotes[1] Sophocles, Trachiniae, line 1044[2] http://See also http://www.perseus.tufts.edu/hopper/text.jsp?doc=Perseus%3Atext%3A1999.01.0180%3Atext%3DTim.%3Asection%3D70d[3] https://teicrete.gr/daidalika/documents/labyrinth_book/lineara.pdf[4] http://As he was called, the physician (i - ja - te) who portrayed in the written text of the palace archive should practice the art of the therapist at a high social level than the healers of his time.[5] http://www.pagkritio.gr/files/items/8/88/2.pdf[6] Ο χειρουργός του Ομήρου[7] Medicine: Achilles binding Patroclus’ wounds[8] Η ΙΑΤΡΙΚΗ ΣΤΗΝ ΑΡΧΑΙΑ ΕΛΛΑΔΑ Ο ΙΠΠΟΚΡΑΤΗΣ ΚΑΙ Η ΣΤΡΑΤΙΩΤΙΚΗ ΙΑΤΡΙΚΗ ΣΤΗΝ ΑΡΧΑΙΟΤΗΤΑ[9] Opera omnia ex recensione et cvm notis Samvelis Clarkii[10] http://same as above[11] https://www.didaktorika.gr/eadd/bitstream/10442/14867/1/14867.pdf[12] Η ΙΑΤΡΙΚΗ ΣΤΗΝ ΑΡΧΑΙΑ ΕΛΛΑΔΑ Ο ΙΠΠΟΚΡΑΤΗΣ ΚΑΙ Η ΣΤΡΑΤΙΩΤΙΚΗ ΙΑΤΡΙΚΗ ΣΤΗΝ ΑΡΧΑΙΟΤΗΤΑ[13] Sudden death and the competitive athlete: perspectives on preparticipation screening studies. - Semantic Scholar[14] Ιστορία της ιατρικής τ.1[15] Ιστορία της ιατρικής τ.1[16] ΣΤΑΘΜΟΙ ΤΗΣ ΑΡΧΑΙΑΣ ΕΛΛΗΝΙΚΗΣ ΙΑΤΡΙΚΗΣ[17] http://Gremk M. Paleopathology: the testimony of the ancient bones for diseases in Ancient Greece. Chapter 2. In: Gremk M. Diseases at the dawn of Western civilization. Athens: Fatzinikolis, 1989: 79-134.[18] Pylos Combat Agate - Wikipedia[19] http://ttp://www.eng.ucy.ac.cy/cpitris/courses/ECE001/Notes/Ch01-2005.pdf[20] http://ttp://www.eng.ucy.ac.cy/cpitris/courses/ECE001/Notes/Ch01-2005.pdf[21] http:// http://www.eng.ucy.ac.cy/cpitris/courses/ECE001/Notes/Ch01-2005.pdf[22] http://ebooks.edu.gr/courses/DSDIM-F102/document/4bd951f7tool/4bea7b5awiuw/4e254da819i6.pdf[23] In what ways are Mars and Ares different?[24] In what ways are Mars and Ares different?[25] What were the powers of the goddess Hera?[26] What was the relationship of Hera and Hercules according to Greek mythology?[27] What were the powers of the goddess Hera?[28] http:// https://eclass.teiwm.gr/modules/document/file.php/MAIA158/ΜΑΙΕΥΤΙΚΗ%20ΚΑΙ%20ΓΥΝΑΙΚΟΛΟΓΙΑ%20ΣΤΗΝ%20ΑΡΧΑΙΑ%20ΕΛΛΑΔΑ.pdf[29] Philosophical Hymns to Abstractions: Their Position in the Development of the Genre (co-authored; 2018)[30] http://www.eng.ucy.ac.cy/cpitris/courses/ECE001/Notes/Ch01-2005.pdf