Researchers look to WWI soldiers for clues about traumatic brain injuries
The News & Observer
DURHAM — Second Lt. Eric Poole was sharp enough to earn a string of promotions and make that rare leap from enlisted man to officer, but his rise through the British Army ranks ended when his superiors ordered him shot.
Pvt. William Alfred Moon was, said a command sergeant major who knew him for two years, “one of the best of soldiers.” They executed him, too.
Pvt. Arthur Wild, as well, had been a solid soldier, one of his officers testified. Wild’s death by firing squad “was instantaneous” wrote the witnessing medical officer.
The trio fought in the French trenches of World War I in conditions almost unimaginably horrific, even by the terrible standards of war. All three were court-martialed for desertion.
They and other executed British soldiers were likely the innocent victims of a scourge that still stalks battlefields nearly a century later: blast-induced traumatic brain injury.
That’s according to the findings of an unusual, multidisciplinary team of Duke University researchers. They include a psychiatrist who served in Afghanistan, a psychologist, a biomedical engineer, and an engineer with a doctorate who is an expert in explaining the precise mechanics of explosions and other forces that can injure humans.
The psychologist, Alayna Panzer, a post-doctoral fellow at Duke, examined thousands of pages of records from the British National Archives and secondary sources on more than 300 troops in World War I who were executed after being convicted of offenses such as cowardice and desertion.
In cases where they could find enough information about blasts that may have injured the men, biomedical engineering doctoral student Garrett Wood used sophisticated software that could incorporate data about specific German artillery to model the likely effects.
The team used all that information and modern understanding of brain injuries to reconsider the cases where they found enough detail, said Dr. Bruce Capehart, an assistant professor of psychiatry at Duke University Medical Center who studies and treats post-traumatic stress disorder and traumatic brain injury in combat veterans.
The symptoms can be similar and make it hard to know which of the disorders a victim is suffering, or whether they are dealing with both. That has implications for what kinds of treatment they need.
Also, some medical professionals may still have trouble believing TBI can be caused by the shock waves of a blast.
And that makes the World War I cases relevant, Capehart said.
“Potentially, what this research can tell is that maybe some of these cases we thought of as PTSD were TBI and that we kind of missed that difference over the years,” he said. “That might change some of our perceptions about TBI . PTSD among soldiers coming home and may cause us to be more open to looking for TBI.”
Panzer presented the group’s findings two weeks ago during the National Neurotrauma Society’s annual meeting in Phoenix.
Taking another look
The kind of information the team needs, so many years later, is scarce. What researchers needed in each case was two things: something that offered reasonable clues about the men’s mental health before the trauma, and a report with at least some detail about his exposure to the effects of a blast.
They found it in enough cases to present the results formally at the neurotrauma meeting.
Some of the men, perhaps 10 percent to 15 percent, had poor excuses for deserting or their other behavior. In many of the other cases, there wasn’t enough information in the records to tell much.
But in the cases of about 10 percent of those executed, there appears to be evidence of neurotrauma, said Cameron R. “Dale” Bass, an associate research professor with Duke’s Department of Biomedical Engineering and director of the Injury and Orthopedic Biomechanics Laboratory.
Bass, Capehart and the researchers working with them on brain trauma are keenly interested in helping modern troops by figuring out better ways to protect them on the battlefield, and to treat them if they do get injured. For years, they have worked on Pentagon-sponsored research that has helped point the way to improvements in everything from body armor, helmets and military vehicle design to better clinical treatment techniques and drugs.
But when you are trying to bring more precision to the study of something as chaotic as the effects of explosions on battlefields, useful records can be hard to find, the researchers said.
They already were working in an odd set of overlapping disciplines – as Capehart says, neither a roomful of doctors nor a roomful of engineers could solve these kinds of problems on their own. But this hunger for data led them even further afield, into the realm of historians, and even linguists, as they studied the meanings of medical and military words that have changed over time.
Indeed, to a degree, the whole World War I study spins around the shift of a particular phrase: shell shock.
The term was coined in World War I and referred to those whose mental function had been damaged during combat. The causes weren’t split neatly into physical damage or damage caused by psychological stress.
But over the years and in wars since, said Capehart, the phrase became synonymous with PTSD, which has psychological causes.
The shift in the meaning of the phrase posed a troubling question about World War I troops who were said to be suffering from shell shock.
“Did we overlook a small number of troops injured physically by blast trauma, and are we still doing that today?” Capehart said.
The answer, he said, could bring more attention to physical injury, which isn’t treated in the same way as PTSD is.
Every war has its horrors, but World War I has a special place in the pantheon, with millions of men naively marching off to face industrial-grade machinery of death far beyond anything seen in previous conflicts, including machine guns, high-velocity modern bullets, tanks, airplanes and poisonous gas.
Among the new tools of death: artillery projectiles packed with high explosives, thousands of pounds of them falling onto combatants every day.
Earlier artillery had fired solid metal projectiles, then shifted to black powder. Black powder and gases such as propane behave in similar ways when ignited. Essentially, they simply burn quickly and don’t generate the same kind of shock wave, or the same kind of brain injuries, as high explosives, Capehart said.
“We think this was one reason the effects of the blasts weren’t fully appreciated in World War I,” he said.
Indeed, the full nature of the blast injuries to the brain still isn’t fully understood.
Bass, Capehart and others also are working on more elaborate research involving historical data. They are completing a scientific journal article based on records of U.S. troops in World War I, and are studying the experiences of troops in the Pacific theater of World War II, as well as French World War I records, though language is among the hurdles there.
World War I came during a coarser time, and there was not only less sympathy, but also less understanding among military leaders and the public regarding mental problems.
Still, even by measures much less enlightened than current thinking, the British Army was dealing out executions with an extraordinary lack of fairness or compassion.
Two men were executed for leaving their post – after an officer had ordered them to leave it. Another was executed for abandoning his weapon, though it had jammed badly and he had left it only because he wedged it across a trench to slow down pursuing Germans.
Some details in the records of the executed British troops studied by the Duke researchers are heart-rending.
One of Wild’s commanding officers testified: “… Pte. Wild was in the front trenches at Colincamps when some ‘coalboxes’ (massive artillery shells) landed near him. He was taken out with shellshock … on a later date whilst going up on a working party ... shelling was going on and the accused Pte Wild who was on of (sic) the party of which I was in charge, gave way completely and I sent him back to camp …”
A medical report from Moon’s court martial said: “The accused had been suffering from shock for several months. The shock was caused by an incident that occurred on Dec. 31st 1915 when a shell burst close to him and blew parts of a comrade’s head and brains into his face.”
And a medical report from Poole’s court martial said: “Disease. Shell Shock. At Contalmaison (7/7/16) was knocked out by clods of earth distributed by H.E. Shell… Did not lose consciousness but shaky and nervous since.”
That description of how Poole was affected was the kind of information that helped the researchers reach new “verdicts” in several of the cases.
“We interpreted that as, his bell was rung, he was dazed and confused, which is consistent with current TBI diagnosis,” Capehart said.
Delving deep into the cases to determine whether the men had TBI, PTSD or other problems is important to the Duke researchers.
But from the standpoint of the morality of the executions, it already had become clear that many were simply wrong.
In 2006, the British government pardoned 306 of those who are often referred to under the catchall term “shot at dawn.”
Each is worded like Wild’s: “The pardon stands as recognition that he was one of the many victims of the First World War and that execution was not a fate he deserved.”