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War's Lingering Wounds

Post-combat syndrome afflicts veterans of many wars, study says

FRIDAY, Feb. 8, 2002 (HealthDayNews) -- The weapons designed to destroy the enemy have changed over time, as have the causes that sparked the conflicts.

However, a new study of English veterans of old and new wars finds one constant -- many of the men sent to the front lines suffered traumatic physical or psychological wounds that never fully healed.

"This is one of the eternal costs of war that men suffer. War is a risky and dangerous business," says psychologist and lead author Edgar Jones. His work appears in tomorrow's issue of the British Medical Journal.

Jones and his colleagues reviewed the war pension files of 1,865 English soldiers who had served in conflicts stretching from the Victorian era, through the two World Wars, up to the Persian Gulf War. They found the veterans reported health problems after each war that reflected the differing combat conditions and prevailing health knowledge of the time.

The researchers call the problems post-combat syndromes.

During the Boer War, for instance, which took place in South Africa from 1899 to 1902, soldiers suffered from dysentery and enteric fever, because of unsanitary water combined with the harsh living conditions in combat. At that time, enteric fever was thought to damage the heart, and, before the era of modern medicine, heart problems were a very serious health hazard. "If you had a heart attack, you were likely to die," Jones says.

So, the medical focus was on "disordered action of the heart," called "DAH" at the time, Jones says.

During the Gulf War, with the dangers of toxins, oil fumes and chemical and biological warfare, "the concerns were much more with neurological symptoms and the effect of poisons on the body," Jones adds.

Despite the variations due to combat conditions, the level of suffering was remarkably consistent.

"Gulf War veterans are suffering as badly as those who were in the trenches of World War I, in terms of the intensity and range of symptoms," Jones says.

Jones identified three clusters of post-combat syndromes.

The first cluster, called the debility syndrome, was most common in veterans of the earlier wars, with some overlap through World War I. Symptoms included fatigue, difficulty completing tasks, shortness of breath and weakness. The pension files contained no mention of any accompanying psychological symptoms.

The second cluster, called somatic syndrome, focused on the heart, and was most prevalent from the Boer War to World War I, with some reports from World War II. While sufferers complained of shortness of breath, fatigue and dizziness, the diagnosis reflected new medical interest in the health of the heart.

The third cluster, called neuropsychiatric syndrome, affected soldiers from World War II through the Gulf War, when medical advances focused increasingly on the psychological effects of combat stress.

Jones hopes his research will help others recognize that post-combat syndrome, whether physical or psychological, "happens after all major wars." He hopes the study will lead to preventive treatment to help soldiers look for signs of the syndrome.

"There is an increasing emphasis placed on preparation, but it's sort of a gradual process," he says, mainly because focus on the problem of post-combat syndrome diminishes when a war is over.

"If you're in a period of peace, you're hoping there isn't going to be another war," he says.

In the United States, there has been slow but growing awareness of the need to alert soldiers to the perils of post-combat syndrome, particularly post-traumatic stress disorder, says Dr. Jonathan Shay.

An expert in post-combat syndrome, Shay is a member of the Department of Veteran Affairs' Outpatient Clinic in Boston.

"The armed forces -- the Army is the furthest along -- is becoming quite aware in a constructive way of the fact that psychological injury is a casualty that will take someone out of circulation as easily as a physical wound," he says. "There is considerable interest in prevention, called 'combat stress control.' "

What To Do: To read about combat stress control, visit this U.S. Army site. For an interview with the head of an Army medical unit who went to Bosnia to treat combat stress, see PBS's Online News Hour.

SOURCES: Interviews with Edgar Jones, Ph.D., Guy's, King's and St. Thomas' School of Medicine, London; Jonathan Shay, M.D., Ph.D., Department of Veteran Affairs, Outpatient Clinic, Boston, and author, "Achilles in Vietnam: Combat Trauma and the Undoing of Character"; Feb. 9, 2002, British Medical Journal
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