Science
Q&A: How American medical institutions helped make D-day a success 80 years ago today
The beginning of the end of World War II occurred 80 years ago Thursday, when roughly 160,000 Allied troops made landfall in Normandy on D-day. The initial battle against some 50,000 armed Germans resulted in thousands of American, British and Canadian casualties, many with grave injuries.
Who would care for them?
By June 6, 1944, the United States medical establishment had spent years preparing to treat these initial patients — and the legions of wounded warriors that were sure to follow.
The curriculum for medical schools was accelerated. Internship and residency training was compressed. Hundreds of thousands of women were enticed to enroll in nursing schools tuition-free.
Conscientious objectors — and others — were trained to serve as combat medics, becoming the first link in a newly developed “chain of evacuation” designed to get patients off the front lines and into hospitals with unprecedented efficiency. Medics capitalized on tools like penicillin, blood transfusions and airplanes outfitted as flying ambulances that hadn’t existed during World War I.
“The nature of warfare was very, very different in 1944,” said Dr. Leo A. Gordon, an affiliate faculty member in the Cedars-Sinai History of Medicine Program. “Therefore, the nature of medicine was very, very different.”
Gordon spoke with The Times about an aspect of World War II that’s often overlooked.
How did you become interested in the medical aspects of World War II?
In my surgical training, I spent a lot of time in a [Veterans Affairs] hospital in Boston. That was probably the start of what has really become a career-long interest in World War II in general and the medical aspects of how America prepared for the invasion.
As veterans aged and the memory of June 6, 1944, has lessened its impact, it just stimulated me to keep up that particular interest.
How did the U.S. gear up to handle the medical aspects of the war?
After the Pearl Harbor attack on Dec. 7, 1941, it was clear to the medical establishment that we were going to need more doctors, more nurses and more front-line combat medics.
The U.S. surgeon general established a division to speed up the medical educational process. The 247 medical schools that existed at that time all had accelerated graduation programs that shrunk a year [of instruction] down to nine months. In addition, the Assn. of American Medical Colleges shrunk down the internship year to nine months, and all residencies were abbreviated to two years maximum, no matter what the specialty was.
When you were done with your training, there was the 50-50 program — 50% would be drafted and 50% would be returned to the community.
Since most of the injuries were going to be traumatic injuries, you had a very active role by the American College of Surgeons. They established a national roadshow and showed doctors how to deal with the injuries with which they were going to be confronted — fractures, burns and resuscitations.
How did they know what kinds of war wounds to prepare for?
They prepared for dealing with similar trauma to what they had seen in their practices, but on a larger scale. There were also other developments that were going to aid them in their ability to take care of wounded soldiers.
What kind of developments?
Number one was the availability of penicillin. Infection after wounds was a terrible problem in World War I and early in World War II until penicillin became widely available in 1943.
The problem was you had 200,000 men between 45 and 18 — many of whom were 16 and lied about their age to get into the military — who were headed to Europe to liberate the women of Europe. So venereal disease became a widespread and debilitating problem for the Army, the Navy and the Air Force. The dilemma for penicillin was, do you bring it to the battlefield or do you bring it to the bordello?
There was a large public relations poster effort throughout the country and on Army bases throughout Europe for preventing venereal disease because penicillin should go to wounded soldiers.
Were there other changes in the way injuries were treated?
In World War I, a guy gets shot and you put him on a stretcher, and it’s a long trek to the nearest hospital.
For World War II, the armed forces developed the chain of evacuation. It started with a combat medic. That fed into a system that went from a field hospital to a larger hospital to a general hospital and ultimately, if needed, to evacuation to England. It saved a lot of lives.
Were combat medics new in World War II?
The job existed before, but it became formalized. It was a very interesting nine-month tour of duty in military service, tactical training, and of course the medical aspect of evaluating injuries, administering morphine, splinting and stopping bleeding. They had the availability of plasma transfusions to support shock.
A lot of them were conscientious objectors. They were in basic training next to people who are going to carry a rifle and kill people. There was a friction between the two up until the time somebody got injured and started yelling, “Medic!”
What about nurses?
Frances Payne Bolton was a congresswoman from Ohio. She said essentially, “The doctors are going to do this and that. What about the nurses?” So she put through the Bolton Act of 1943, which created the U.S. Cadet Nurse Corps. It was essentially a GI Bill for nurses. This was a focused, expedited program, free of charge.
Prior to Pearl Harbor, there were only about 19,000 Army nurses. By the end of the war, if you combine the European theater with the Pacific theater, there were hundreds of thousands of nurses.
What about other new roles?
This was the first time in warfare that air evacuation was used to a large degree. That gave rise to the creation of the flight nurse, who had to be aware of many things other than caring for a patient on the ground. They had to learn crash survival. They had to learn how to deal with the effects of high altitude.
Did any of these innovations in medical care return to the States after the war?
The overarching theme in the history of military medicine is that once a war ended, there was very little interest in using that event for military progress — except for World War II.
The advances that came out of World War II start with penicillin. Number two was the management of chest injuries, abdominal injuries and vascular injuries.
Number three was advances in the use of plasma and blood banking, particularly through the work of Dr. Charles Drew, which is a story in and of itself. His contributions saved innumerable lives.
Number four was the explosive growth of the Veterans Administration and the veterans hospitals. You had tens of thousands of people who served the country coming back home, and the VA system was going to have to take care of them.
Number five was the involvement of the government in medical research. Before World War II, it was unusual for the government to fund medical research.
And the sixth advancement was the increase in knowledge of the neuropsychiatric effects of war. It started off as battle fatigue, and then it evolved into shell shock. Later it morphed into PTSD.
Has the U.S. medical establishment accomplished anything of this magnitude since World War II?
I’m not an expert in military warfare, but now with drones and computers and special operations, I can hardly imagine so many people headed for a beach in hand-to-hand combat.
This interview has been edited for length and clarity.
Science
Cluster of farmworkers diagnosed with rare animal-borne disease in Ventura County
A cluster of workers at Ventura County berry farms have been diagnosed with a rare disease often transmitted through sick animals’ urine, according to a public health advisory distributed to local doctors by county health officials Tuesday.
The bacterial infection, leptospirosis, has resulted in severe symptoms for some workers, including meningitis, an inflammation of the brain lining and spinal cord. Symptoms for mild cases included headaches and fevers.
The disease, which can be fatal, rarely spreads from human to human, according to the U.S. Centers for Disease Control and Prevention.
Ventura County Public Health has not given an official case count but said it had not identified any cases outside of the agriculture sector. The county’s agriculture commissioner was aware of 18 cases, the Ventura County Star reported.
The health department said it was first contacted by a local physician in October, who reported an unusual trend in symptoms among hospital patients.
After launching an investigation, the department identified leptospirosis as a probable cause of the illness and found most patients worked on caneberry farms that utilize hoop houses — greenhouse structures to shelter the crops.
As the investigation to identify any additional cases and the exact sources of exposure continues, Ventura County Public Health has asked healthcare providers to consider a leptospirosis diagnosis for sick agricultural workers, particularly berry harvesters.
Rodents are a common source and transmitter of disease, though other mammals — including livestock, cats and dogs — can transmit it as well.
The disease is spread through bodily fluids, such as urine, and is often contracted through cuts and abrasions that contact contaminated water and soil, where the bacteria can survive for months.
Humans can also contract the illness through contaminated food; however, the county health agency has found no known health risks to the general public, including through the contact or consumption of caneberries such as raspberries and blackberries.
Symptom onset typically occurs between two and 30 days after exposure, and symptoms can last for months if untreated, according to the CDC.
The illness often begins with mild symptoms, with fevers, chills, vomiting and headaches. Some cases can then enter a second, more severe phase that can result in kidney or liver failure.
Ventura County Public Health recommends agriculture and berry harvesters regularly rinse any cuts with soap and water and cover them with bandages. They also recommend wearing waterproof clothing and protection while working outdoors, including gloves and long-sleeve shirts and pants.
While there is no evidence of spread to the larger community, according to the department, residents should wash hands frequently and work to control rodents around their property if possible.
Pet owners can consult a veterinarian about leptospirosis vaccinations and should keep pets away from ponds, lakes and other natural bodies of water.
Science
Political stress: Can you stay engaged without sacrificing your mental health?
It’s been two weeks since Donald Trump won the presidential election, but Stacey Lamirand’s brain hasn’t stopped churning.
“I still think about the election all the time,” said the 60-year-old Bay Area resident, who wanted a Kamala Harris victory so badly that she flew to Pennsylvania and knocked on voters’ doors in the final days of the campaign. “I honestly don’t know what to do about that.”
Neither do the psychologists and political scientists who have been tracking the country’s slide toward toxic levels of partisanship.
Fully 69% of U.S. adults found the presidential election a significant source of stress in their lives, the American Psychological Assn. said in its latest Stress in America report.
The distress was present across the political spectrum, with 80% of Republicans, 79% of Democrats and 73% of independents surveyed saying they were stressed about the country’s future.
That’s unhealthy for the body politic — and for voters themselves. Stress can cause muscle tension, headaches, sleep problems and loss of appetite. Chronic stress can inflict more serious damage to the immune system and make people more vulnerable to heart attacks, strokes, diabetes, infertility, clinical anxiety, depression and other ailments.
In most circumstances, the sound medical advice is to disengage from the source of stress, therapists said. But when stress is coming from politics, that prescription pits the health of the individual against the health of the nation.
“I’m worried about people totally withdrawing from politics because it’s unpleasant,” said Aaron Weinschenk, a political scientist at the University of Wisconsin–Green Bay who studies political behavior and elections. “We don’t want them to do that. But we also don’t want them to feel sick.”
Modern life is full of stressors of all kinds: paying bills, pleasing difficult bosses, getting along with frenemies, caring for children or aging parents (or both).
The stress that stems from politics isn’t fundamentally different from other kinds of stress. What’s unique about it is the way it encompasses and enhances other sources of stress, said Brett Ford, a social psychologist at the University of Toronto who studies the link between emotions and political engagement.
For instance, she said, elections have the potential to make everyday stressors like money and health concerns more difficult to manage as candidates debate policies that could raise the price of gas or cut off access to certain kinds of medical care.
Layered on top of that is the fact that political disagreements have morphed into moral conflicts that are perceived as pitting good against evil.
“When someone comes into power who is not on the same page as you morally, that can hit very deeply,” Ford said.
Partisanship and polarization have raised the stakes as well. Voters who feel a strong connection to a political party become more invested in its success. That can make a loss at the ballot box feel like a personal defeat, she said.
There’s also the fact that we have limited control over the outcome of an election. A patient with heart disease can improve their prognosis by taking medicine, changing their diet, getting more exercise or quitting smoking. But a person with political stress is largely at the mercy of others.
“Politics is many forms of stress all rolled into one,” Ford said.
Weinschenk observed this firsthand the day after the election.
“I could feel it when I went into my classroom,” said the professor, whose research has found that people with political anxiety aren’t necessarily anxious in general. “I have a student who’s transgender and a couple of students who are gay. Their emotional state was so closed down.”
That’s almost to be expected in a place like Wisconsin, whose swing-state status caused residents to be bombarded with political messages. The more campaign ads a person is exposed to, the greater the risk of being diagnosed with anxiety, depression or another psychological ailment, according to a 2022 study in the journal PLOS One.
Political messages seem designed to keep voters “emotionally on edge,” said Vaile Wright, a licensed psychologist in Villa Park, Ill., and a member of the APA’s Stress in America team.
“It encourages emotion to drive our decision-making behavior, as opposed to logic,” Wright said. “When we’re really emotionally stimulated, it makes it so much more challenging to have civil conversation. For politicians, I think that’s powerful, because emotions can be very easily manipulated.”
Making voters feel anxious is a tried-and-true way to grab their attention, said Christopher Ojeda, a political scientist at UC Merced who studies mental health and politics.
“Feelings of anxiety can be mobilizing, definitely,” he said. “That’s why politicians make fear appeals — they want people to get engaged.”
On the other hand, “feelings of depression are demobilizing and take you out of the political system,” said Ojeda, author of “The Sad Citizen: How Politics is Depressing and Why it Matters.”
“What [these feelings] can tell you is, ‘Things aren’t going the way I want them to. Maybe I need to step back,’” he said.
Genessa Krasnow has been seeing a lot of that since the election.
The Seattle entrepreneur, who also campaigned for Harris, said it grates on her to see people laughing in restaurants “as if nothing had happened.” At a recent book club meeting, her fellow group members were willing to let her vent about politics for five minutes, but they weren’t interested in discussing ways they could counteract the incoming president.
“They’re in a state of disengagement,” said Krasnow, who is 56. She, meanwhile, is looking for new ways to reach young voters.
“I am exhausted. I am so sad,” she said. “But I don’t believe that disengaging is the answer.”
That’s the fundamental trade-off, Ojeda said, and there’s no one-size-fits-all solution.
“Everyone has to make a decision about how much engagement they can tolerate without undermining their psychological well-being,” he said.
Lamirand took steps to protect her mental health by cutting social media ties with people whose values aren’t aligned with hers. But she will remain politically active and expects to volunteer for phone-banking duty soon.
“Doing something is the only thing that allows me to feel better,” Lamirand said. “It allows me to feel some level of control.”
Ideally, Ford said, people would not have to choose between being politically active and preserving their mental health. She is investigating ways to help people feel hopeful, inspired and compassionate about political challenges, since these emotions can motivate action without triggering stress and anxiety.
“We want to counteract this pattern where the more involved you are, the worse you are,” Ford said.
The benefits would be felt across the political spectrum. In the APA survey, similar shares of Democrats, Republicans and independents agreed with statements like, “It causes me stress that politicians aren’t talking about the things that are most important to me,” and, “The political climate has caused strain between my family members and me.”
“Both sides are very invested in this country, and that is a good thing,” Wright said. “Antipathy and hopelessness really doesn’t serve us in the long run.”
Science
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