“The counter-argument to that, which I concurred with, was that this is a medical textbook that could save lives.”

August 5, 2008 4:58 PM

“I’m ashamed to say that there were folks even in the medical department who said, Over my dead body will American civilians see this”
posted by orthogonality (86 comments total)

I want to make a joke. But I'm not going to.

Thanks for an interesting link, Ortho.
posted by Dumsnill at 5:08 PM on August 5, 2008

You know, we're blithely discussing government deception in this thread, and one of the half-joking comments on how it will be spun is just more talk by the "anti-war" folks.

A post like this is a slap in the face moment that reminds me how mind-blowingly crazy that we live in a society where anyone would even consider being something other than anti-war. Where labelling something or someone anti-war is negative spin.
posted by Durn Bronzefist at 5:09 PM on August 5, 2008 [39 favorites]

.
posted by waraw at 5:12 PM on August 5, 2008

I think is fascinating. Thanks.
posted by sperose at 5:16 PM on August 5, 2008

That the army fought so hard to prevent this from ever going public is sad...
Pathetic little weenies.
posted by schyler523 at 5:16 PM on August 5, 2008 [1 favorite]

I wonder how many of these injured soldiers are going to die from drug related problems because they come out of treatment with a morphine or other painkiller addiction? I'd like to think that they are being given drugs in a responsible manner, but with injuries like that, it seems like it would be hard to deny them whatever painkillers they need. I'd also like to think that they're given help in weaning themselves from the drugs afterward, but I just don't have a lot of faith, but considering some of the coverage of veterans' hospitals lately and the refusal of the military to diagnose PSTD if they can possibly help it, I don't have a lot of faith.
posted by Caduceus at 5:24 PM on August 5, 2008

I read this article while still stunned by the interview with NYTimes freelance photographer, Zoriah Miller from NPR's "On the Media". His blog's photos are deeply moving.
What the US military learned from Vietnam was control the message. They got some practice at the rah rah rah Gulf War, but they have really gone all out to keep the general public from seeing that war is hell. Those that choose to, can get fair and acurate coverage of events in Irag and Afganistan, but it is not easy and certainly not at the top of the nightly news.
We keep it far away and never see it, so we just keep funding it and losing soldiers who are mostly economically disadvantaged and get to be called heroes.

The acceptance of censorship by the rank and file of the military establishment is galling.

But beyond that, this book has actual new and significant information, useful to medical practioners outside the scope of battle. What the hell?
posted by readery at 5:30 PM on August 5, 2008 [4 favorites]

I like to buy books with this sort of hard-won knowledge, doubly so when powerful people are trying to suppress it, triply so when it contains things so powerful that if you open the cover, you could never forget what is inside.
But I don't want to own this book. It would be too much. And I'm not a surgeon, so I wouldn't benefit professionally.

But I'm very glad it's available to those who can learn from it. That just seems right.
(Though that's got to be the most pathetic silver lining imaginable for the people who lost their future to this war)
posted by -harlequin- at 5:36 PM on August 5, 2008 [1 favorite]

I wonder how many of these injured soldiers are going to die from drug related problems because they come out of treatment with a morphine or other painkiller addiction?

Caduceus, my understanding is that if you are taking opiates to relieve pain you tend not to become addicted to said opiates. Which may be wrong, and I will cheerfully accept correction. But I have seen this firsthand many times. If you're taking opiates for pleasure, though--different story.
posted by Turtles all the way down at 5:52 PM on August 5, 2008

I wonder how many of these injured soldiers are going to die from drug related problems because they come out of treatment with a morphine or other painkiller addiction?

I'd bet on "less than would die of shock or related complications if their pain went unmanaged" being the answer to that. It's impossible to operate on people who are still awake and suffering.
posted by mhoye at 5:53 PM on August 5, 2008

“It was just a matter of getting around the nitwits.”

Good advice for life in general. Now, if we could get around all the nitwits in D.C....
posted by spicynuts at 5:56 PM on August 5, 2008 [1 favorite]

If the US Army published this book, does this mean its contents are paid-for by US taxpayers, thus belong to US citizens, thus it can be scanned in its entirety and posted on the web?
posted by ZenMasterThis at 5:58 PM on August 5, 2008 [2 favorites]

Well, I don't know. I admit I only skimmed the article because its relevance is somewhat out of my purview, but I think the value of such material to the American public is fairly limited, because war wounds without the context of actual battle would slip through the filter of "war is horrific" and into the "gross closeups of wounds" areas of memory. People on gurneys with their arms missing or in operating theatres with their skulls opened up, hey, did you catch that rerun of Chicago Hope? I sure love Mandy Patinkin! But on a smog-shrouded battlefield with their blood seeping into the dust, well, shit, I guess that's just Over There, but my point is that hospitalized injuries, not only do we watch that sort of stuff every night after dinner, but there's the tacit implication that everything's under control, look at all those doctors and all that fancy equipment! Dude's gonna be fine! But a young man or woman half-smeared across the desert, surrounded by screaming people in helmets with guns and dirt-streaked faces and a totally different context, well, there's a greater chance of a person taking more notice, and maybe a synapse fires off and they think "Fuck, Hank and Betsy down the street, their son was deployed only last week..."

I suppose what I am attempting to articulate, in a profoundly retarded fashion, is that this text runs the risk of actually damaging the increasingly negative public opinion of the various wars America is engaged in presently. Because all those pristine white bandages and that dense medical terminology, not only are these guys okay, but we're learing important surgical techniques as well! War's fuckin' great!

A fresh-faced Specialist slumped against a bullet-riddled wall, staring dumbstruck at the fourth-degree burns on both his legs, which will need to be amputated because of compartment syndrome, and that's only if he doesn't die of shock before the medevac? That's an entirely different story.
posted by turgid dahlia at 6:02 PM on August 5, 2008 [3 favorites]

Caduceus, my understanding is that if you are taking opiates to relieve pain you tend not to become addicted to said opiates. Which may be wrong, and I will cheerfully accept correction. But I have seen this firsthand many times. If you're taking opiates for pleasure, though--different story.

I did not know that, and I would have to take your word for it (or that of anyone else with medical knowledge). It was idle speculation on my part, partially informed by that scene in To Kill a Mockingbird with the old lady with cancer who didn't want to be addicted to morphine anymore. If you're, in fact, correct, that is at least one minor relief in a massive tide of horror.
posted by Caduceus at 6:04 PM on August 5, 2008

I SURE LOVE ME SOME GOD-DAMNED HYPHENS!
posted by turgid dahlia at 6:04 PM on August 5, 2008 [3 favorites]

opiates create a physical addiction. the purpose for which they were administered has no impact upon this.
posted by quonsar at 6:11 PM on August 5, 2008 [1 favorite]

Turtles all the way down is right; people don't tend to become addicted to opiates taken to relieve pain, at least not nearly as often as they would with recreational use. It seems that relief of pain involves a different brain pathway than the one involved with addiction: People treated with morphine in the hospital for pain control after surgery are unlikely to become addicted; although they may feel some of the euphoria, the analgesic and sedating effects predominate.
posted by vorfeed at 6:12 PM on August 5, 2008 [1 favorite]

i should have said physical dependence.

"This physical dependence is not equivalent to addiction. Many patients who take an opiate for pain are physically dependent but not addicted: The drug is not harming them, and they do not crave it or go out of their way to obtain it."
posted by quonsar at 6:17 PM on August 5, 2008 [2 favorites]

quonsar, physical dependence does not equal addiction. Even if a person is heavily physically dependent on morphine, as long as he or she is not psychologically addicted, he or she will be able to quit using it if the dosage is properly tapered off, as it is when taken under medical supervision.

on preview: exactly.
posted by vorfeed at 6:17 PM on August 5, 2008

opiates create a physical addiction.

Repeated use of opiates produces tolerance -- the need for increasing doses to produce the same effect, and withdrawal syndrome if stopped abruptly. However, these characteristics aren't what we generally regard as addiction. People who become physically dependent on opiates due to pain tend *not* to suffer addiction and rarely have any problem stopping use when the source of the pain is alleviated.

Or, on review, what vorfeed said.
posted by PeterMcDermott at 6:18 PM on August 5, 2008

I wonder how many of these injured soldiers are going to die from drug related problems because they come out of treatment with a morphine or other painkiller addiction?

Sam Stone
posted by nola at 6:20 PM on August 5, 2008 [2 favorites]

As for the book, I think honesty is generally a good thing. Good for the people who refused to give in to the censors; this'll be a much more useful manual thanks to their courage.

we're learing important surgical techniques as well! War's fuckin' great!

Historically speaking, much of what we know about severe wound care stems from experience gained in war, reaching all the way back to antiquity. Again, whether or not "war's fuckin' great", we might as well be honest about it. The war in Iraq has already led to significant advances in emergency stabilization, prosthetics, and head wound care. Pretending otherwise, especially for the purpose of propaganda ('scuse me, "public opinion"), seems somewhat counter-productive. If you want more honest war photography, attack the military censors or, better yet, our largely gutless mainstream media; attacking a book which really does contain candid photographs of the aftermath of the war won't help your cause.
posted by vorfeed at 6:34 PM on August 5, 2008 [4 favorites]

War sucks. War is horrifying. People suffer, die, and survive, in horrifying ways in all wars. Any pictorial showing battle wounds would horrify. I'm not going to feel deprived if I can't see these pictures. I'm not going to be pissed and cry about my rights to be a voyeur of the "new kind of battle wound". This book is for surgeons, not to drive the point home that this war is horrifying and terrible. We already know this. All war is.
posted by LoriFLA at 6:38 PM on August 5, 2008 [5 favorites]

vorfeed, no, you misunderstand me, or more likely, I expressed myself improperly. There's a difference between the general public and medical specialists. I absolutely 100% agree that many of the greatest advances in surgery and medicine have been brought about directly as a consequence of war, and I absolutely 100% agree that this sort of material should be distributed far and wide throughout the medical community and all support industries. But Joe Bloggs being able to order it through Amazon and show it to his buddies at parties, I think that runs a strong risk of propagating a false meme.
posted by turgid dahlia at 6:46 PM on August 5, 2008

Basically what LoriFLA said, is what I'm driving at.
posted by turgid dahlia at 6:51 PM on August 5, 2008

My father couldn't wait to get off his morphine drip and hated having to use it, though he did when his pain was too intense. Anecdotal - but one instance in which repeated use did not create longterm addiction.
posted by Miko at 6:55 PM on August 5, 2008

Sam Stone

Everyone should be made to listen to John Prine's first album.
posted by neuron at 7:08 PM on August 5, 2008 [1 favorite]

War is only terrible if you experience it, or if you look it in the face. Unfortunately those who experience it will continue to do so until enough Americans open up their eyes and look the results in the face. The face of the soldiers who've sacrificed, of the face of the parents who've lost a generation, the face of a family without a father. C'mon, America, you get all psyched to watch a horror movie, or read a Stephen King novel. Here's the real thing, just less glossy. After you get sick and see your vengeance dream for what it really is maybe you could wake the fuck up, wipe ur face, and call ur congressmen.

You probably have an Ain't Skeered sticker on your 4x4 don'tcha? Buy the book, and prove it.
posted by HyperBlue at 7:08 PM on August 5, 2008

For heaven's sake, don't tut-tut because people administered opiates in hospitals might become physically dependent. Pain is already insanely undertreated at hospitals because of this primitive superstition. The other ridiculous fear is that opiods will fatally depress respiration at dosages strong enough to relieve, say, terminal cancer pain. Thousands are in agony today because of these overblown fears.

On another note, the U.S. Government published a book similar to the one discussed in this article right after World War Two. It's in about four volumes, and shows the mind-blowingly horrid wounds our boys sustained in the "good war." You can find it in most medical libraries, although I wouldn't suggest giving it anything more than a cursory glance -- just see enough to remind you that all wars are insane.
posted by Faze at 7:09 PM on August 5, 2008 [7 favorites]

Wow. This is weird. But I have to agree with one thing: War = undesirable.
posted by humannaire at 7:10 PM on August 5, 2008

So, turgid dahlia, LoriFLA, you think this book should not be available to the public because it would give them wrong ideas ("false memes"), is that what you mean?
posted by lupus_yonderboy at 7:11 PM on August 5, 2008

Jebus, quonsar, way to talk outa your ass. Take it from me and everyone else in this thread who actually has, you know, medical training that the purpose for which opiates are administered has a great deal to do with whether they cause an addiction or dependence.
posted by delfuego at 7:14 PM on August 5, 2008

But Joe Bloggs being able to order it through Amazon and show it to his buddies at parties, I think that runs a strong risk of propagating a false meme.

No, I did not misunderstand you at all -- not if you want to keep this book out of the hands of civilians in order to avoid "propagating a false meme". Again, it is counterproductive to censor candid war photographs because they don't fit your political goals, especially if you're censoring in favor of other candid war photographs. This tactic is likely to backfire, especially since not everyone sees the same "meme" in pictures like these!

As far as I'm concerned, "War Is Hell"(TM) is as much a propaganda position as "dulce et decorum est, pro patria mori"; both are primarily concerned with scoring political points by downplaying certain aspects of war in favor of others, not with depicting war as it actually, physically is. No matter what one's personal opinion is, I think it's safe to say that we need more honest war photography, not less, especially since the government and the media don't really seem interested in putting much of it out there. So yes, the book is intended for military surgeons, but I can't really see how anyone is served by censoring it amongst the civilian population.

Besides, the vast majority of civilians ordering this $70 medical textbook are likely to be doctors, not bloggers or partygoers(??), and more power to them. IMHO, their access to emerging severe-trauma care techniques trumps any amount of "negative public opinion" that's actually likely to occur thanks to four postage-stamp sized photos in the online version of the NY Times... which isn't much.
posted by vorfeed at 7:20 PM on August 5, 2008 [1 favorite]

It's a bummer to note it, but it's true that war sometimes is the very thing responsible for medical and technological breakthroughs that then change civilian practice. When I used to go backpacking a lot, it was very clear that had the US not been struggling with the need to craft some sort of synthetic to replace supplies of parachute silk cut off by war with Japan, I wouldn't have the nice, light, quick-drying ripstop nylon tent and pack. It was nice last week to track the tornadoes that came through my state on RADAR, and heat up my lunch in a microwave oven. A smoke detector probably saved my family's life when I was eleven and our house burned.

I'm definitely not saying this is justification for war, but there is a relationship between war and innovation - not least because of political pressure and the availability of enormous amounts of budgeted funds to develop new technologies.
posted by Miko at 7:22 PM on August 5, 2008 [1 favorite]

This book is for surgeons, not to drive the point home that this war is horrifying and terrible. We already know this.

Your use of the word "we" does not appear to include approximately half of my countrymen.
posted by George_Spiggott at 7:23 PM on August 5, 2008

There are too many gruesome medical texts which Bloggs can already obtain on Amazon for this one to be singled out as the one that he'll use to entertain his party friends (unless they're all surgeons). Also, if this is the kind of thing that Joe Bloggs finds entertaining, he's probably already got a free internet source for all of his gore porn needs.
I can see your point, turgid dahlia, about the motivation for someone wanting to show this book off to make a political point, but the need for up-to-date information to be delivered to surgery students overrides politics. Which is why this book got published in the first place.
posted by Demogorgon at 7:24 PM on August 5, 2008

Faze, the tradition goes back even further than WWII. Surgeon General Joseph K. Barnes published "The Medical and Surgical History of the War of the Rebellion, 1861-65" from 1870-1888. It runs to 15 volumes. A few pages here.
posted by MonkeyToes at 7:25 PM on August 5, 2008 [1 favorite]

So, turgid dahlia, LoriFLA, you think this book should not be available to the public because it would give them wrong ideas ("false memes"), is that what you mean?

No. I don't believe in censorship. I'm not making any first amendment declarations. I'm just not going to be upset if it's not available to me. I think anybody that wants this should be able to put their hands on it. I don't wish it to be used to inflame. As if the death toll or disability rate isn't horrifying enough. That a horrific head injury caused by IEDs is somewhat more important or horrifying than a cannonball lobbing off a head or a soldier dying alone blinded and gangrenous on a battlefield. If a textbook can end a war, bring it on. It can't and I'm not going to be upset if I can't look at it.
posted by LoriFLA at 7:25 PM on August 5, 2008 [2 favorites]

We could help advance our knowledge of medicine and have fewer wars with one simple rule: Upon declaration of war, congressmen and their children are the first ones in.
posted by Benny Andajetz at 7:28 PM on August 5, 2008 [5 favorites]

The greatest advances in emergency medicine, particularly the treatment of trauma, generally come from war zones. That's because the chess game between force protection and antipersonnel warfare results in new and challenging injuries, often in great numbers. Wars also produce tremendous amounts of primary, secondary and tertiary blast injury, gunshot wounds, and secondary shrapnel injury.

All of these wound modalities, all of them, are entirely relevant to the practice of civilian trauma medicine in a major urban area. Advances in blast injury treatment come in handy when a propane tank explodes or someone tries to light their grill with a gasoline can. Advances in gunshot wound care come in handy in any area that has a high degree of gang activity. Advances in shrapnel injury treatment come in handy in automobile accidents where someone didn't tie down their toolbox.

As a very specific example, civilian physicians in trauma are learning a tremendous amount from the huge amount of head trauma occurring in Iraq: head trauma is increasing because improvements in force protection are forcing attackers to go for head shots.

This information is vital, and the ways in which the Army attempted to censor the information displays a profound ignorance of the ways in which the information is valuable. This is what happens when ideology gets in the way of science: you get people censoring the content without understand what they're censoring, or how they're affecting the informational payload of the content.

For many medical professionals, this issue has nothing to do with the rightness or wrongness of the war, because that's an ideological fight. What this is about is whether or not the flow of lifesaving information from Iraq to the continental US is going to be hampered by political considerations.

We need this information to save lives, anyone who works in medicine understands just how critical it is, and anyone who's arguing against this textbook being released as written by its authors is displaying a really regrettable ignorance of why this textbook is important.
posted by scrump at 7:37 PM on August 5, 2008 [7 favorites]

Not long ago I scoffed and mocked at the volunteers that volunteered to travel to strange, foreign countries, meet new, interesting people and kill them.

Now I have a rather large amount of pity and sympathy for the poor sons (and daughters) of bitches (and fine, upstanding mothers and fathers) who ended up in some dark alley of their life that left them with the option that signing up voluntarily for military duty left them in.

Some chose. Some chose because of a deep-seated anger and bloodlust.

Some chose to attempt to survive economic or educational or classist hardship.

All suffer at the insanity of war. The soldiers suffer, the insurgents suffer, the civilians suffer - and even each and every one of us (with the smallest mote of empathy) watching from the sidelines suffers.

We all suffer from the effects of war. Every single one of us. Some of us so much more than others. Why? God-fucking-damnit-all-to-fucking-hell, WHY?


I'm actually crying right now. I've cried for civilian Iraqis. I've cried for the Kurds. I've cried for many people I've never met. And right now I'm crying for the soldiers of the United States.


War is no answer to anything any more. It never has been. War is a failure of imagination, a failure of creative problem solving, a failure of communication.

War is failure. Violence is failure.

And together, we all fail.
posted by loquacious at 7:38 PM on August 5, 2008 [5 favorites]

there comes an awful moment in morphine withdrawal when you realize how many days it's been since you've had a bowel movement. suddenly, it's time and you realize there's something in your ass the size of a 74 buick and it's headed for the next exit. fear of what's about to happen makes you break into a cold sweat. panic has a pair of vice-grips on your sphincter. do you call the fire department and beg for the jaws of life? put aside all dignity and run to the nearest emergency room screaming for help? wait, the massive grill and headlights have cleared the tunnel and suddenly it roars out in flames and rolls end over end into the cold water. flushing the toilet, you feel like a failed suicide setting down a shotgun that didn't kill you when you fired it up your ass.
posted by kitchenrat at 7:39 PM on August 5, 2008 [7 favorites]

Some say war is a necessary evil in that it sublimates mankind's urge to destroy itself and provides somewhat of a framework for this destruction to take place in a somewhat controlled manner under somewhat established rules and somewhat followed guidelines, during which countries somewhat ignore those rules and somewhat torture each other anyway, thereby somewhat subverting those rules.

At any rate, I'd love to get my hands on this book, to fulfill my macabre curiosity about such issues, and I really am genuinely interested in seeing the new techniques they've developed to treat the new injuries this war is bringing about. Anyone know where to find it online? They should scan the whole thing and make it available on BitTorrent.
posted by ChickenringNYC at 7:39 PM on August 5, 2008 [2 favorites]

I'm not going to be upset if I can't look at it.

We're not talking about passively "your not having a look at it" we're talking "you and almost everyone else actively being prevented from seeing it".
posted by lupus_yonderboy at 7:40 PM on August 5, 2008

Oh and to paraphrase the great George Carlin from a few years back: this country is about 200 years old and had already had about 10 major wars.. we average a major war every 20 years in this country.. so WE'RE GOOD AT IT!

Or as I see it, war isn't going anywhere because it seems to be hardwired in the deepest realms of humanity. We'll keep finding different ways to wage it, but war is war and it always will be. Not condoning it, just saying.
posted by ChickenringNYC at 7:45 PM on August 5, 2008

Turgid Dahlia, as a medical student, I think I can say with some authority that medical textbooks are far and away a different experience from your typical Hollywood depiction of medicine such as seen in "ER" or "Chicago Hope."

I can assure you that most likely you're not going to see a lot of pristine white bandages in this book - I believe that's one reason the army wanted it censored. Here's some examples of *NSFW* "compartment syndrome" *NSFW* that the times article mentions, I can only imagine what the picture must look like for an open chest operation covered with saran wrap. The medicine we see on TV is watered down to the point of being unrecognizable to the kind of thing you find in any operating room, let alone a mobile OR in a war-zone. There's just parts of the human body that aren't meant to be looked at, and it can shock even the most detached of people to be confronted with that.

While I agree that this book is not meant for the public, its important that it is public, if nothing else than to verify that these horrible things are going on in Iraq and Afghanistan. I mean, a person in *NSFW* tetanus lockjaw? *NSFW* That just shouldn't be happening in this modern world! In addition, the sacrifices these soldiers make should be honored - and if the treatment strategy that was used to almost save one soldier's life can be learned from and improved upon, then shouldn't we use it? I know if I were a soldier in battle I would want my buddies back on the ground to benefit from the things learned from my own ordeal.

Medical knowledge must be freely available to the public because without that openness, the medical profession runs the risk of being even more distrusted by the lay public than it already is. Anything less than an Amazon release would be decried by critics as an attempt to keep the truth of the Iraq and Afghanistan injuries under wraps. Or it would be used as yet another example of the medical profession hiding behind jargon and exclusively held information.

*I'm sorry about the graphic images, but I felt it was necessary to illustrate my point.
posted by i less than three nsima at 7:49 PM on August 5, 2008 [4 favorites]

This book is for surgeons, not to drive the point home that this war is horrifying and terrible. We already know this.

Do we really?

"some higher-ups in the military had been worried that the pictures “could be spun politically to show the horrors of war."

Yeah. They could, but that'd only have an impact on a population that didn't really understand what the term "collateral damage" meant, that didn't understand the real, visceral, human impact of even a few thousand deaths and injuries.

In some ways, I think it's great that lots of us have the luxury of not understanding that, and that photos might be considered a big threat to that luxury.

In other ways, it makes the blood stain a little more casually on the hands of those of us who cast votes for warmongers.
posted by namespan at 7:55 PM on August 5, 2008

I didn't even realize that there weren't books like this out there and readily available - for the purposes of educating those that have to deal with these wounds. It blows my mind actually. How the heck did experienced military doctors get that experience in the first place? Just hacking away? Internships? That's insane. This stuff is totally different than what any other surgeons see, you've got to disseminate that information so that others can do better. There's no way they could just jump in without advice and guidance. I can't believe that an issue so important to the troops themselves has been criminally neglected by our government just so our perceived ability to wage war is not threatened. It doesn't even matter anyway, the general populace isn't looking at books like this. Heck they could just charge a couple hundred bucks for it like all the other medical texts, no one would ever bother. The idea that human beings would actually try to hamper this from being published... It's sick and diabolical. It's a whole new level of politics as usual.
posted by Craig at 8:01 PM on August 5, 2008

They ought to translate this book into Arabic and distribute it to Iraqi doctors...
posted by donkeymon at 8:03 PM on August 5, 2008 [1 favorite]

I suppose what I am attempting to articulate, in a profoundly retarded fashion, is that this text runs the risk of actually damaging the increasingly negative public opinion of the various wars America is engaged in presently.

I think you're overestimating how much attention this textbook would get from the type of joe you think would purchase it for $70 and pass it around for his friends to marvel at during parties.
posted by lullaby at 8:03 PM on August 5, 2008

Very interesting link. The real medical history of this war is still mostly untold, and every piece of truth is valuable.
posted by digaman at 8:26 PM on August 5, 2008

We're not talking about passively "your not having a look at it" we're talking "you and almost everyone else actively being prevented from seeing it"

I understand.

Again, I don't advocate censorship. I shouldn't have put that last sentence in my last comment. I think it should be made available to civilian surgeons and anybody that wants it. If there are groundbreaking techniques they won't be under wraps for long. We already do many of the techniques (Patient-controlled analgesia (around for eons), incisions to alleviate compartment syndrome, etc.) mentioned in the article.

If this textbook can end the war in Iraq, if it will prevent war in the future make it available. It should be available for no other reason than people want to look at it. Call me a pessimist but these images aren't going to change much. I would like to beat people over the head with these images if it would change their minds about war. We already have images to do that.
posted by LoriFLA at 8:36 PM on August 5, 2008

If a nation is going to make war, particularly if it's going to start one, it really ought to be doing with eyes wide open as to the risks and costs as well as the potential rewards. "The truth shall set you free" isn't just a nice bit of decorative engraving on a lot of public buildings... it's really true.
posted by LastOfHisKind at 8:45 PM on August 5, 2008

Man, I don't know. All I read these days anyway is XXL magazine.
posted by turgid dahlia at 8:45 PM on August 5, 2008

We could help advance our knowledge of medicine and have fewer wars with one simple rule: Upon declaration of war, congressmen and their children are the first ones in.

It's funny, but you're describing exactly how war used to work; you know, before we Americans convinced ourselves that War Is Hell, and thus a punishment chiefly to be experienced by the underclass. Throughout the ancient world, warriors were often of high caste (much like congressmen!), and many great kings and leaders died in battle beside their soldiers. Even as recently as the middle of the 20th century, every American who could physically fight was expected to be ready to do so. That meant that if his draft number came up, the congressman's son went, too. For example, Elvis Presley, who was arguably the most famous entertainer in the world at the time, was drafted and spent two years overseas in the Army during the 1950s. Can you imagine a young Brad Pitt or Tom Cruise getting drafted and sent to Germany in a uniform? Such a universal social relationship with war is not even within our experience anymore.

Our volunteer armed forces, combined with overtly divisive and simplistic attitudes about war (no one sane "would even consider being something other than anti-war" / no one sane would fail to "support the troops"), have led to a near-total inversion of what war means to society; the sad thing is that this seems to be making things worse, not better, even when considered from an anti-war standpoint. War is always "us versus them", but it should not and does not have to be "a bunch of people that the elite don't even know or care about versus them", nor, inevitably, "us versus the civilians back home". We will come to greatly regret allowing this to happen to our society.
posted by vorfeed at 8:49 PM on August 5, 2008 [4 favorites]

Look.. if photos of Abu Ghraib didn't make your populace revolt en masse, I'm not sure what these could do, referencing what turgid dahlia said.

And morphine: I had appendicitis a couple years ago, was on a morphine PCA drip for five days. I couldn't wait to be off it. Euphoria the first time, yeah, but after that it seriously fucks with things like balance, sense of taste, breathing (I had to have regular oxygen masks, one of those sits under your nose things all the time, and regular asthma inhalers to compensate); it's not pleasant at all.

For heaven's sake, don't tut-tut because people administered opiates in hospitals might become physically dependent.

I don't think it's "tut-tut", I think it's "oh look, another way that the government is failing those who have put themselves in the line of fire."

How the heck did experienced military doctors get that experience in the first place?

Inner-city hospitals in places like Detroit, mainly. Sadly, not a joke.
posted by dirtynumbangelboy at 8:52 PM on August 5, 2008

no one sane "would even consider being something other than anti-war"

I think that's a reasonable statement. Everyone should be anti-war; we should always try to find nonviolent methods of resolving a situation. When that's not possible--e.g., when a few million murderous Germans are intent on taking over the world--then you have to bite the bullet and fight. But there is a massive difference between being anti-war and not recognizing that sometimes war really is the only option. It's regrettable that those times occur, obviously.
posted by dirtynumbangelboy at 8:55 PM on August 5, 2008

Oh, and also, I just want to say that I never suggested that it shouldn't be public, because a) that would be censorship, which I am vehemently opposed to, and b) you guys paid for the fucking thing already anyway, in more ways than one. I can just see it being used in a manner for which it was never intended, which not only disparages the hard work of the people involved in the research and compilation of the text, but also turns guys who will have to spend the rest of their lives breathing through tubes into little more than political pawns. But that's the perspective of an outsider so, I don't know, probably of pretty limited value.

And I Less Than Three Nsima, yeah, I've seen a few medical textbooks in my time (I used to collect old 50s tomes when I was going through my "Hey, maybe it would be neat to be a serial killer" phase when I was 14), and I know they're not pretty.
posted by turgid dahlia at 8:55 PM on August 5, 2008

I'm not sure what these could do, referencing what turgid dahlia said.

That was the bad guys, though, remember? Not the Good Ole Boys.
posted by turgid dahlia at 8:57 PM on August 5, 2008

dirtynumbangelboy: you're right. it's kind of like what i said. being so anti-war as to cry over it is kind of ignorant since we wouldn't even be here if it weren't for things like the revolutionary, civil, and world wars. depressing point of view to take but it's true.
posted by ChickenringNYC at 9:04 PM on August 5, 2008

A photo of Emergency War Surgery 2004 edition in use sent to me by a friend who ran ICU in the hospital in Balad until 2006 or so.
posted by blaneyphoto at 9:19 PM on August 5, 2008 [4 favorites]

Wars are initiated by leaders, and the the desperate/gullible people who follow them.

No leaders, no wars.
posted by ZenMasterThis at 9:37 PM on August 5, 2008

dirtynumbangelboy: you're right. it's kind of like what i said. being so anti-war as to cry over it is kind of ignorant since we wouldn't even be here if it weren't for things like the revolutionary, civil, and world wars. depressing point of view to take but it's true.

Kind of. I guess it's the same as being anti-violence: what most of us mean is that we are anti-starting-violence, but that defence is often a necessary evil.
posted by dirtynumbangelboy at 9:59 PM on August 5, 2008

Everyone should be anti-war; we should always try to find nonviolent methods of resolving a situation.

I reservedly agree that the latter is a valid philosophical guideline, though it doesn't always work. There are many situations in which trying to find nonviolent methods of resolving a situation can be detrimental to one's cause, f.ex. Chamberlain; a more difficult question arises when striking first against an enemy would likely bring victory, and striking second defeat. And, as you said, a good defense is always necessary. But then, you know what they say about the best defense... and we're back to square one.

Also, to me, "everyone should be anti-war" and "we should always try to find nonviolent methods of resolving a situation" are not necessarily equivalent statements. My own views on this are complicated, but suffice it to say that I believe that being "anti-war" and "anti-violence" is a lot like being "anti-death" and "anti-pain"; congratulations for your high-minded stance, but I regret to inform you that the physical world cares not! I believe that it is better to deal with these things as they are, as an intrinsic part of mortal life, rather than attempting to hide them away or marginalize them as otherworldly "evils" or "wrongs". And, as ChickenringNYC points out, there is potentially as much to be gained in war as lost, both on a personal and societal level, which is enough in itself to justify the pervasive presence of war throughout history.

In short: individually, it often seems somewhat foolhardy to be pro-war, but culturally, it seems equally foolhardy for us not to be, and in the end we're all going to die regardless. Thus, war is as inevitable as death.
posted by vorfeed at 10:14 PM on August 5, 2008 [1 favorite]

War is a boon to medical research. Just ask Douglas MacArthur.
posted by mullingitover at 12:05 AM on August 6, 2008

suddenly, it's time and you realize there's something in your ass the size of a 74 buick and it's headed for the next exit.

Indeed. I refer to this as "the bridge of Khazad-Dum": "YOU SHALL NOT PASS!". With one's anus in the role of Gandalf.
posted by DecemberBoy at 12:05 AM on August 6, 2008 [1 favorite]

Jesus Christ died for nothin' ... I suppose.
posted by ws at 1:23 AM on August 6, 2008

but suffice it to say that I believe that being "anti-war" and "anti-violence" is a lot like being "anti-death" and "anti-pain"; congratulations for your high-minded stance, but I regret to inform you that the physical world cares not!

Which, y'know, is why I expanded. But keep ignoring, it seems to make you happy.
posted by dirtynumbangelboy at 1:36 AM on August 6, 2008

In short: individually, it often seems somewhat foolhardy to be pro-war, but culturally, it seems equally foolhardy for us not to be, and in the end we're all going to die regardless. Thus, war is as inevitable as death.

Might as well go ahead and kill yourself, then. The physical world cares not.
posted by Kirth Gerson at 4:57 AM on August 6, 2008

It's funny, but you're describing exactly how war used to work; you know, before we Americans convinced ourselves that War Is Hell, and thus a punishment chiefly to be experienced by the underclass. Throughout the ancient world, warriors were often of high caste (much like congressmen!), and many great kings and leaders died in battle beside their soldiers.

The British upper class still serves in the military (as officers, naturally) in large numbers.
posted by atrazine at 5:37 AM on August 6, 2008

This book is for surgeons, not to drive the point home that this war is horrifying and terrible. We already know this

no, no, no, no, no. who's "we"? really, who's "we", this elusive segment that just knows that "this war is horrifying and terrible". really. because you must have noticed how "the surge worked" and this magically makes the Iraq war O.K., and it's not anymore about "you all were wrong to trick America into invading and you provoked this disaster", the spin has been reversed and now it's the anti-war people who are guilty of not supporting the surge -- which, of course, means not supporting the troops, and there's a candidate out there who wants to trade America losing the war with his winning the election.

this is the current spin -- and those who argue it have not been laughed into oblivion, but they're doing well in the polls, and their guy might as well win in November.

so, as much as I like you Lori, " this war is horrifying and terrible. We already know this" is fantasy. wait until after Election Day if by that "we" you mean "a majority of the American people".

the issue here is not about you or Joe Sixpack being able to buy that book off of Amazon -- almost nobody out of the medical profession will, I guess. the problem is the military -- doctors in the military -- thinking as politicians, not as doctors, and soldiers. it's the politicization of everything Iraq that has shamefully been allowed to go down under the Bush-Cheney rule. it's not anybody's responsibility to think as a PR flack for the Pentagon except, well, PR flacks for the Pentagon. whenever people in the Armed Forces, military doctors, etc, act like this they act like PR flacks -- it's not their job, and it's dishonorable.

Iraq is a meat grinder? you shouldn't have invaded it in the name of KBR and Halliburton and Chevron. clumsily trying to hide the effects of the war on the poor people who were already there or were sent there is shameful, and a stain on the honor of anyone who does that.
posted by matteo at 5:51 AM on August 6, 2008 [1 favorite]

Which, y'know, is why I expanded. But keep ignoring, it seems to make you happy.

Wow, I'm sorry I bothered to try to expand, especially given how long it took me to type that up (I started probably half an hour before you expanded, and figured I may as well finish, since we were both thinking along the same lines). Guess you weren't really interested in discussing this in any depth, even with someone who's basically agreeing with what you said. My mistake, sorry -- I forgot that this is Metafilter, and I was just supposed to post a snarky one-liner!

Might as well go ahead and kill yourself, then. The physical world cares not.

Your second statement is entirely true. However, it doesn't necessarily imply that I "might as well go ahead and kill yourself", any more than the inevitability of war implies that we might as well throw a new one every alternate Tuesday. There are certain things which have to happen, eventually, but that doesn't mean they necessarily have to happen here and now, nor does it mean we can't work to mitigate their causes or effects. As I said above, it seems to me that blanket "anti-war" rhetoric often hurts rather than helps, but that doesn't preclude other harm-reduction strategies.
posted by vorfeed at 6:29 AM on August 6, 2008

Your second statement is entirely true. However, it doesn't necessarily imply that I "might as well go ahead and kill yourself", any more than the inevitability of war implies that we might as well throw a new one every alternate Tuesday.

It also implies nothing about the worth of blanket anti-war sentiments. It's not the physical world that needs to become less ready to use war. It's the people who think war is a tool to advance their ideology or their business interests or their religion, along with all those who enable them by saying, "Oh, OK, that seems like a good enough reason to start a war. Go ahead, then." None of those people have any real grasp of just how their support of war fucks up the lives of huge numbers of innocent people. They need to wake up. If having something like this book out in the world wakes a few of them up, that's progress.
posted by Kirth Gerson at 6:47 AM on August 6, 2008

i'm putting my political kvetching on hold in favor of talking about saving lives.

i'm glad medical technique -- and particularly *documented* medical technique -- is catching up with the changes in injury demographics, here. the faster the learning curve for folks going over there to do medical care, the better.
posted by rmd1023 at 6:48 AM on August 6, 2008 [1 favorite]

the problem is the military -- doctors in the military -- thinking as politicians, not as doctors, and soldiers. it's the politicization of everything Iraq that has shamefully been allowed to go down under the Bush-Cheney rule. it's not anybody's responsibility to think as a PR flack for the Pentagon except, well, PR flacks for the Pentagon. whenever people in the Armed Forces, military doctors, etc, act like this they act like PR flacks -- it's not their job, and it's dishonorable.

I agree wholeheartedly.
posted by LoriFLA at 7:17 AM on August 6, 2008

What was interesting to me about the article is despite that the book is available to the public, it is rather hard to find. A quick search revealed that only ten institutions have this book in their holdings, and only one of those is a public university (Unversity of South Carolina, Medical School). The other nine are military facilities like the US Army Research Lab, or vendors like the Government Publications Office or Baker and Taylor. There is one other resource that shares the subject headings of "Iraq War--Medical Care" or "Surgery, Military -- Iraq" and it's a Frontline ER video that was shown on the Discovery channel. So even if you want this information, there's just not all that much out there for doctors.

The brass may have released this work to the public, but it sure isn't doing anything to make sure the public knows about it. And to me, that's almost as bad as repressing the work entirely.
posted by teleri025 at 8:30 AM on August 6, 2008

Faze: ...the U.S. Government published a book similar to the one discussed in this article right after World War Two. It's in about four volumes, and shows the mind-blowingly horrid wounds our boys sustained in the "good war."

Does anyone know what this book is called? I'd love to know more about it.
posted by stinkycheese at 8:37 AM on August 6, 2008

It also implies nothing about the worth of blanket anti-war sentiments.

We'll just have to agree to disagree about that; it seems to me that the inevitability of war implies a great deal about the worth of blanket anti-war sentiments. Namely, that they're intrinsically unrealistic, and their aims could probably be better achieved through a more practical, real-world approach.

"Death is inevitable" does not necessarily imply "I should kill myself", but it does necessarily imply that statements like "I'll never die" are false. Likewise, "war is inevitable" means that we cannot ever have "a world without war" or a lasting "world peace", no matter how much we wish we could. Working toward impossible ends like these spends valuable time and resources which we could instead spend on developing ways to mitigate the harm of war, as these battlefield doctors are doing.

On a smaller scale, using blanket anti-war statements to work toward ending any given war ignores much of what's actually going on in that war. This ignorance tends to alienate everybody involved, including local civilians who are ostensibly being "saved". It also makes it much less likely that we can gain a nuts-and-bolts understanding of the particulars of the war, which we need in order to minimize suffering and damage. It may look good on TV, but the current amount of simplistic spin and myth-making (on both sides of the issue) is deeply counterproductive.

Also, as I said earlier, it's not as if we have to come up with some hypothetical example of the harm which might be done by simplistic, blanket anti-war sentiments. They have already led to some serious problems, including severe economic and social inequality in our armed forces and a significant distortion of what war means to our society.

If we were really serious about ending this war, and about minimalizing the harm done by all our wars, we'd be demanding a hard cap on military spending and the immediate instatement of either a universal mandatory-service system or universal draft, preferably for both sexes, with few deferments for anyone physically and mentally fit for duty. Instead, both sides of the debate seem to prefer a vastly unequal money-laundering system, one in which most individuals can safely be "pro-war" or "anti-war" without ever experiencing war at all. It's no surprise that this system has lead to an exploitative, profit-mongering corporate war -- it's practically designed for it.

I suspect that the change in our national character post-Vietnam, from "no one's son should have to die for such a foolish and meaningless war" to "my son should not have to die for a war, full stop", will prove to be one of the greatest social tragedies in American history, and I think the spread of blanket anti-war sentiment has a lot to do with it.
posted by vorfeed at 9:26 AM on August 6, 2008 [1 favorite]

It’s a shocking, heart-stopping, eye-opening kind of thing

I'm going to go a slightly different route: I think viewing of these kind of photos should be mandatory for anyone who wants to fight in this war. In drivers education they show movies like Blood On the Asphalt in an effort to shock people into understanding the kind of risks they face, these could serve that same purpose for kids thinking about enlisting to fight, politicians considering sending more soldiers to die, and people here at home who are still advocating that we continue this campaign.

Visuals like this are horrific and gruesome, and despite the claims that movies and video games have desensitized us, I don't think most people really understand what war looks like. I think if they were made to face it, it might change their mind about our need to have our children and friends and neighbors in a place where these things could happen to them.
posted by quin at 10:53 AM on August 6, 2008

Working toward impossible ends like these spends valuable time and resources which we could instead spend on developing ways to mitigate the harm of war, as these battlefield doctors are doing.

This presupposes that you're right about the inevitability of war. I don't think you are. I think the more we aim for resolution of problems without war, the less 'inevitable' it will become.
posted by dirtynumbangelboy at 1:26 PM on August 6, 2008

Could someone do the Clockwork Orange thing and force Limbaugh, Orly and the rest of them to read this.
posted by notreally at 1:31 PM on August 6, 2008

This presupposes that you're right about the inevitability of war. I don't think you are. I think the more we aim for resolution of problems without war, the less 'inevitable' it will become.

Unfortunately, "less inevitable" is a lot like "less infinite". Unless we actually completely eliminate war, forever, not only in our own society, but in all possible future societies, then war is still inevitable. To me, this level of complete control over the world (much less the universe) is pretty clearly in the realm of fantasy, and would probably be just as much a negative as war is, if it ever did exist. And, as I said above, I think a practical approach goes a lot further to minimize the number and severity of wars than an "anti-war" approach does. Thus, while I think we should certainly "aim for resolution of problems without war", we must acknowledge that war will occur despite our efforts, and we must meet these wars as they are, not as we wish they might be.

War, destruction, and violence aren't just a matter of human nature, or even animal nature. As far as I'm concerned, they're more like a consequence of the physical laws of the universe. This is pretty much the sort of thing which happens when you exist as fragile things in a world full of other fragile things.
posted by vorfeed at 3:03 PM on August 6, 2008

I just want to point out that scrump's comment on the medical advances that have come from war is brilliant and what I wanted to say, only more articulate.

Carry on.
posted by grapefruitmoon at 6:03 PM on August 6, 2008

Likewise, "war is inevitable" means that we cannot ever have "a world without war" or a lasting "world peace", no matter how much we wish we could.

Consider the question begged. Because you think we can't have a world without war, everyone who tries to achieve that world is naive and foolish, and actually causing harm?

Some people's feet of clay go all the way up to their hair.
posted by Kirth Gerson at 8:12 AM on August 7, 2008

Consider the question begged. Because you think we can't have a world without war, everyone who tries to achieve that world is naive and foolish, and actually causing harm?

Like I said above, unless we can get rid of war forever -- not just in our society, but in all future societies -- war is inevitable. As in, "will occur eventually". This means that a true end to war would require some form of total social and/or physical control over every society on Earth, with no possibility of a breakdown in order, right up until the end of humanity as a race. That's not realistic, to say the least. It is more than safe to say that there is no possible course of action we can take, as human beings today, which is likely to bring about this state within the foreseeable future; therefore, spending time trying to plot such a course seems far less effective than working on a practical, harm-reduction-based approach to the problem.

In short: sorry, but believing that one can simply get rid of something which has featured in every known human society throughout history, and even exists in the social behavior of some of our close primate relatives, is pretty much the definition of naive and foolish.

Also, I listed several ways in which simplistic anti-war sentiment has already been harmful to our society, so I don't see how the latter conclusion is begging the question at all.

Some people's feet of clay go all the way up to their hair.

And some people seem to prefer empty snark and "logical fallacy lol" bullshit to actual debate.

The "problem" you pointed out with my argument applies just as well to yours, because we're arguing about the future, and the future cannot be known for certain. However, I've at least explained my position and the reasoning behind it; you seem content to go "nuh-uh, nuh-uh, can so!" and call it a day. Good for you, have fun with that.
posted by vorfeed at 3:14 PM on August 7, 2008

Hello from Amazon.com.

We are sorry to report that we will not be able to obtain the
following item(s) from your order:

Bob Woodruff (Foreword), et al "War Surgery in Afghanistan and
Iraq: A Series of Cases, 2003-2007 (Textbooks of Military Medicine)"
http://www.amazon.com/gp/product/0981822800

Though we had expected to be able to send this item to you, we've
since found that it is not available from any of our sources at this
time. We realize this is disappointing news to hear, and we apologize
for the inconvenience we have caused you.

We have cancelled this item from your order.

Your credit card will NOT BE CHARGED for this item because you only
pay for items when we ship them to you.

Your order is now closed.

Bummer. Now I have to get creative.
posted by fantabulous timewaster at 10:40 AM on August 17, 2008