New technologies and tactics have added distinct peculiarities to American wars and in turn caused new types of injuries and new treatments. At the time of the American Civil War, newly invented cylindrical lead bullets called minié balls produced an advanced level of deadliness. Torso penetrations were usually fatal and hits on extremities tended to crush and mash bones. Amputation became the main form of “treatment” for arms and legs damaged by large-caliber minié balls. Wooden prostheses were so much in demand after the war that lumber shortages resulted. World War I is remembered for the introduction of chemical warfare and its attendant injuries. World War II and the Korean Conflict saw dramatic improvements in battlefield evacuation (the helicopter was introduced during the Korean War) and field hospital treatment. Agent Orange and post-traumatic stress disorder (PTSD) became associated with the Vietnam War. The recent War on Terrorism in Afghanistan and Iraq, a fight generally against insurgents, has developed a signature injury known as traumatic brain injury—or TBI.
The term “traumatic brain injury” covers a wide range of injuries to the brain from sudden trauma. Classified from severe to mild, the milder forms of TBI can be difficult to diagnose and treat because of latent symptoms. Severe trauma is quickly suspected when visible signs such as bleeding, bruising, swelling and object penetration are evident. The mild form, or MTBI, is not as easily identified because external wounds do not exist and telltale signs, such as memory loss, dizziness and confusion can be somewhat subtle and slow to emerge, making diagnosis difficult. In many situations, treatment goes beyond repairing physical wounds, requiring medical rehabilitation programs to restore motion functions, vision, speech and memory.