Medicine on Troops
Varicoceles in War
Samuel Donnenfeld, MD
At the time of the American Civil War, varicoceles were considered a significant medical problem capable of causing lifelong disability. When a soldier was found to have a varicocele, he was deemed to be in urgent need of medical care and, in some cases, he was relieved of duty. Varicoceles also comprised a significant monetary expense for the nation's first military pension program.
If entry examination identified a potential soldier to have an asymptomatic varicocele or one in which the dilatation was more substantial than either testicle, he was denied entry into either army due to several pervasive beliefs: severity of the disease, marching led to varicoceles, and afflicted soldiers were unable to perform their duties. Varicoceles resulted in the highest rate of discharge of any urological condition during the Civil War. Other urological disorders including testis tumors, kidney stones, and urethral strictures were considered stable chronic diseases without the need for medical attention and rarely resulted in discharge.
Varicocele
Wikipedia
Varicocele Example
Wikipedia
Following the conflict, varicoceles occupied the twenty-second most common reason for lifetime military pension payouts - more common than asthma, spinal cord disorders, and all bladder conditions. Monthly pay for privates was over 36% and was equitable with other conditions today deemed much more serious including large hernias, loss of an eye, or loss of a thumb.
Today we are aware of how common varicoceles are; most estimates state that approximately 15% of adult men have some degree of varicocele. We are also more aware that the cause of varicoceles is related in part to the workings of the valves in the pampiniform plexus, either by not working appropriately or being missing altogether. Also, due to the venous drainage of the scrotum on the right leading directly into the inferior vena cava and the left into the renal vein, more pressure is necessary on the left side to keep blood flowing appropriately and preventing pooling of blood in the scrotum.
Even today, according to the Department of Defense, a varicocele is disqualifying from joining any American military branch unless it is on the left side only, asymptomatic, smaller than the associated testicle, reducible, and without associated testicular atrophy. While fixation of a varicocele (called a varicocelectomy) was rarely performed in the nineteenth century due to its morbid outcomes, urologists all over the world today perform the operation with very high rates of success. Urologists perform this surgery mostly as an outpatient procedure through microsurgery or as an open surgical procedure.
Chemical Exposure in Urologic Cancers
Jennifer Gordetsky, MD
Since 2001, over 2.5 million military personnel have been deployed to Southwest Asia, in particular Iraq and Afghanistan. Recent evidence has shown that many of these individuals were exposed to hazardous respiratory inhalants while on deployment. This can include emissions from burn pits, desert dust particulate matter, vehicular emissions, oil well fires, chemical weapons, pesticides, explosives, and industrial pollutants. In addition, studies have shown that soldiers deployed to Southwest Asia are at an increased risk of developing respiratory symptoms and impairment of respiratory function. In addition, chronic health problems and cancer risks are not limited to combat personnel. One study evaluated Norwegian military peacekeepers deployed to Lebanon during 1978-1998. Peacekeepers serve as cooks and mechanics but are nonetheless still exposed to hazardous chemicals. The study found that those who served during high-conflict periods had higher rates of lung cancer. However, not all cancers risks are equal, as the same group was found to have decreased rates of prostate cancer.
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World War II US Army Practice Gas Mask
Although poison gas was not used in World War II, gas masks were manufactured and worn to protect the military and civilians against the threat of mustard gas and chlorine gas, which had been used initially by the Germans in World War I. The actual US masks contained asbestos in the filters. Workers in the asbestos factories producing the masks had a significant increased incidence of pulmonary mesothelioma. So the asbestos in the gas mask filters designed to protect the wearer led to unintended consequences.
Are Gas Masks Better Than Urine Socks?
Troops in war are exposed to all kinds of harmful inhalants: mustard/chlorine gas in WWI, Agent Orange in the Vietnam War, desert dust and explosive emissions in Middle East conflicts. Early in WWI, soldiers were advised to soak socks in urine and tie them to their faces – this did not work well. During WWII, gas masks such as this were produced in US factories. Later studies on gas mask factory workers with pulmonary mesothelioma showed that asbestos in the mask filter exposed wearers to yet another carcinogen!
Exposure to hazardous compounds is not new to recent military personnel. During the Vietnam war, numerous enlisted military personnel were exposed to phenoxy herbicides contaminated with toxic levels of 2,3,7,8- tetrachlorodibenzo-p-dioxin (TCDD). Perhaps the most recognized of these herbicides is Agent Orange. TCDD is now classified by the International Agency for Research on Cancer as a Group 1 carcinogen, meaning it is known to be carcinogenic to humans. However, its role in GU cancers continues to be studied and debated. Older reviews of epidemiologic research concluded that there was no consistent relationship between exposure to TCDD and prostate cancer. However, more recent studies have shown a statistically significant overall increased risk of prostate cancer in men exposed to Agent Orange, with some showing an increased risk for higher grade tumor. In 2006, the National Academy of Sciences elevated the risk of prostate cancer from those exposed to Agent Orange to “limited or suggestive evidence”. In addition, there is evidence that exposure to Agent Orange may be associated with other genitourinary malignancies. Several studies have found that those exposed to Agent Orange have an increased mortality due to bladder cancer. In particular, the Korean Veterans Health Study, which looked at cancer cases from 185,265 Vietnam veterans confirmed in the Korea National Cancer Incidence Database, found increased incidences of prostate, bladder and kidney cancer.
The medical community should remain diligent in screening as evidence continues to emerge highlighting the health risks of military personnel deployed during times of war.