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Genital Injuries, Prosthetic Devices and the War on Terror

The Hidden Cost of War

by DAVID ROSEN

Memorial Day has come and gone and all they media hype about America’s glorious "hero" soldiers can be put to rest, at least until Veterans Days next November. The failed "war on terror," the battle against al-Qaeda/the Taliban and the imperial occupation of Iraq, is devolving toward it’s eventually debacle.

In its wake, U.S. military casualties will litter the nation for generations to come. Like the physically and psychologically devastated soldiers who staggered back from Vietnam a generation ago, today’s "heroes" will be left to suffer for the failures of the political leadership never held to account.

Much has been made of Dana Priest’s "Washington Post" exposé of the terrible conditions at the Walter Reed Army Medical Center. And rightly so! Walter Reed had long been considered the crown jewel of the military hospital and veterans’ health-care system. Following up on Mark Benjamin’s earlier reports, a bright light has finally been focused on this terribly compromised system. One can only wonder if, as yet-another blue-ribbon commission of Washington insiders gets ready to spinout its findings, all will be effectively whitewashed and medical care for soldiers and veterans will return to their good-old corrupt ways. [Dana Priest, Washington Post, February 18, 2007; Mark Benjamin, Salon, February 5, 2005.]

The real story that has gone unreported is the refusal by the Department of Defense and military hospitals to release data about the casualties soldiers have suffered, the medical procedures being performed or other data that can help suggest the long-term consequences of the current horrendous military misadventure. In particular, little to no information is available as to the injuries suffered by U.S. military personnel associated with male external genitalia. (Even less is provided about the true scale of suffering of the Afghani and Iraqi people.)

Since Homer’s "Iliad," war has been an incubator of patriarchal masculinity. Many have commented on how erotic is the savagery of battle. However, from the most personal hand-to-hand combat to the use of the most impersonal improvised explosive device (IED), the male genitals have been a zone of conflict with both physical and symbolic significance. Nothing seems to have changed with Afghanistan and Iraq.

* * *

Each war introduces a new era of slaughter and suffering. Not surprising, each war also brings forth new technologies of healing, especially new classes of drugs, medical procedures and prosthetic devices to cope with a war’s carnage.

Accounts by soldiers and other witnesses to the Civil War or World War I make one wonder how any soldier could have fought, let alone survived, without suffering irreparable, life-long harm. Yet, Civil War line formations and "The War to End All Wars" trenches seem so quaint, somehow more primitive, whereas compared to the concentration camps, Dresden bombings and atomic destruction that defined World War II or the Agent Orange, tiger cages and napalm of Vietnam.

The evolving technologies of war are measured by how increasingly more effective and efficient they are at inflicting pain, destruction and death on both military and civilian populations. Each war significantly raises the bar as to the barbarism inflected.

The wars in Afghanistan and Iraq differ from earlier calamities. For the U.S., far fewer soldiers are actively involved, thus leading to numerically far less casualties. The U.S. military mortality rate for Iraq is pegged at 10 percent, down significantly from Vietnam (24%) and WWII (30%). [Raja Mishra, Boston Globe, December 9, 2004]

Technology helps account for this development. According to Cmdr. James Amsberry, M.D., chairman of plastic surgery at the Navy Regional Medical Center, San Diego, CA: "What we believe is happening is that because of the central body armor that soldiers are wearing, they’re surviving what in the past could have been fatal events. We’re seeing some pretty devastating extremity injuries, and some head and neck injuries." [Cosmetic Surgery Times, May 2006]

Improved body armor and aggressive in-field emergency care have reduced the death rate among Americans wounded in Afghanistan and Iraq to a historically low level. As the Harvard surgeon, Dr. Atul Gawande, wrote in the "New England Journal of Medicine": "The nation’s military surgical teams are under tremendous pressure, but they have performed remarkably in this war. They have transformed the strategy for the treatment of war casualties." [NEJM, December 9, 2004] Nevertheless, the downside is a cautionary tale.

Soldiers who survive suffer much more grievous injuries. Bulletproof Kevlar vests protect soldiers’ bodies, but not their limbs, groin and genitals. The amputation rate is double the rate of past wars. One-fifth of casualties have suffered head and neck injuries that may require a lifetime of care. More than half of those injured sustain wounds so serious that they cannot return to duty.

The Defense Manpower Data Center reports in "Global War on Terrorism by Reason" that for the period of October 7, 2001 to April 14, 2007, there were a total of 29,613 U.S. military casualties. These casualties include both deaths from hostile and non-hostile sources (3,672) and injuries (25,941). Of these casualties, only 5 percent are attributed to the Afghan conflict.

A host of casualty factors are identified, including cancer and drug overdose, stoke and electrocution, aircraft and vehicle crashes, gunshot and grenade explosion, and laceration and loss of limb(s). However, no data is provided as to bodily injuries suffered.

Another insight into the nature of American military casualties is suggested by military evacuations rates. The Congressional Research Service (CRS) has attempted to make sense of Department of Defense (DoD) data. For example, in a 2005 defense appropriations bill for increased funding for the care of amputees at Walter Reed, the DoD revealed that 6 percent of those wounded in Iraq have required amputations, compared with a rate of 3 percent for past wars.

In a series of separate reports, CRS detailed the two fronts of the alleged "war on terror" in terms of military evacuations. During Operation Enduring Freedom in Afghanistan, from October 27, 2001 to February 27, 2006, there were 4,619 casualties. Of these, only 9 percent were due to battle injuries and another 18 percent were due to non-battle injuries; however, nearly three-fourths (73%) were due to disease.

However, Operation Iraqi Freedom, from March 19, 2003 to May 18, 2006, has resulted in a significance higher level of injury – with battle injuries more than double (20%) that in Afghanistan, those due to non-battle injuries about the same (17%) and those due to disease less (63%). In both war-fronts, the Army has taken the brunt of casualties. [CRS Report to Congress, April 26, 2005 (RS22126) and June 8, 2006 (RA22452)]

Robert Hartwig, writing in the "National Underwriter," assessed the insurance and associated costs borne by employers for in-service National Guard soldiers, warns the insurance industry: "The actual number of military personnel injured in Iraq is actually much higher than official Pentagon figures suggest. That is because the military releases figures only for those wounded in ‘hostile incidents.’" [National Underwriter, December 2005]

* * *

Aaron Glantz recently pointed out that "the Veterans Administration [is] reporting that more than 150,000 veterans of the Iraq war are receiving disability benefits." Drawing upon documents obtained by the National Security Archive at George Washington University, he reports that 25 percent of veterans of the "global war on terror" have filed with the VA for disability compensation and pension benefit claims. He noted that the VA had granted more than 100,000 claims and at least 1,502 veterans are being compensated as 100 percent disabled.

Glantz got a lucky interview with Dr. Col. Vito Imbascini, an urologist and state surgeon with the California Army National Guard, who recently returned from a four-month deployment to Germany. He treated the worst of the U.S. war wounded. (Dr. Imbascini, after realizing that he had revealed too much of the truth, subsequently repudiated the interview.)

Dr. Imbascini said that an extremely high number of wounded soldiers are coming home with their arms or legs amputated. His admission reveals just how bad conditions are for the U.S. soldiers who survive attacks but are likely to remain severely disabled for life.

"If you lost an arm or a leg in Vietnam, you were also tremendously injured in your chest and abdomen, which were not protected by the armor plates back then," Dr. Imbascini said. "Now, your heart and chest and lungs are protected by armor, leaving only your extremities exposed."

Dr. Imbascini said he amputated the genitals of one or two men every day. "I walk into the operating room and the general surgeons are doing their work and there is the body of this Navy SEAL, which is a physical specimen to behold." He added: "And his abdomen is open, they’re exploring both intestines. He’s missing both legs below the knee, one arm is blown off, he’s got incisions on his thighs to relieve the pressure on the parts of the legs that are hopefully gonna survive and there’s genital injuries, and you just want to cry." [Glantz, ipsnews.net]

* * *

Prosthetic devices recreate the history of technology evolution. Sigmund Freud saw technical innovation as a power that helped extend or augment "natural" human capabilities. As he explains in "Civilization & Its Discontents," "With every tool man is perfecting his own organs, whether motor or sensory, or is removing the limits of their functioning." For Freud, "Man has, as it were, become a kind of prosthetic God." [Freud, pp. 37-39]

Having become a "prosthetic God," the forces of mechanization that Freud identified as directed at the "organs" of communication, of sight, sound and (more than he could ever image!) memory, have also been extended to nearly every other organ and function of the body. This process has increasingly transformed the living body into a prosthetic artifact.

Eyeglasses, false teeth, hearing aids and heart valves, let alone arms, hips, legs and vital organs modify the body’s appearance and functionality. By extension, they are likely to affect the sexual life of those who benefit from them. Equally critical, genital reconstruction, breast augmentation, penal enlargement and other more explicitly sexual prostheses (along with innumerable contraceptive devices) have been introduced to alter either physical or sexual performance or both. These devices conceal their own hidden history, a history rooted in the social struggle to disengage sensuous, sexual pleasure from biologically determined procreation.

According to Donald G. Shurr and Thomas M. Cook, "[e]arly prosthetists were blacksmiths, armor makers, other skilled artisans, and the patients themselves." ["Prosthetics & Orthotics," p. 1] By the 19th century, the modern era of prosthetic medicine and genital reconstructive surgery began to take shape. A.A. Marks is considering the first, in 1860, to have replaced a wooden foot prosthesis with a rubber one.

The authors note that "[p]rosthetics grew tremendously during the Civil War, as over 30,000 amputations were performed on the Union side alone." As historical irony would have it, a Confederate army amputee, J.E. Hanger, was the first to "place rubber bumpers in solid feet and then produce the first articulated prosthetic foot." [Shurr & Cook, p. 1]

Almost at the same time, the first surgeon to report a successful genital reconstruction was R.W. Gibb who published, in 1855 in the "Charleston Medical Journal," an article entitled: "A case where the entire scrotum and perineum together with one testicle and its cord attached and nearly all the integument of the penis were torn off. Recovery is with preservation of sexual powers." [Arneri, p. 3919n10].

During the late-19th and early-20th century, both the nature and number of serious bodily injuries (particularly affecting male genitalia) increased significantly. During WWI, plastic surgery began to be used to deal with facial injuries resulting from trench warfare. The war also witnessed the introduction of a new type of landmine, one that, when stepped upon, blew directly up and thus destroyed not only the victim’s legs but genitals as well.

Wilfred Lynch, in "Implants: Reconstructing the Human Body," observes that the "development of dependable surgical implants [during the interwar period] proceeded at a snail’s pace until the emergence of ‘exotic’ new materials in answer to the needs of the military in World War II." [Lynch, p. 1] Hoag Levins, in "American Sex Machines," seconds this observation: "After World War II, new chemicals, new metals, new manufacturing techniques, and new consumer marketing possibilities came together … " to develop a new-generation of prosthetic technologies. [Levins, p. 123]

The new materials introduced during and after WWII for medical prosthetics fall into three broad categories — polymers, metals and ceramics. Among the polymers are plastics, rubber, gels and fluids (including silicones and polyurethane); among the new metals are titanium, stainless steel and cobalt-chromium alloys; and a limited use of ceramics. The material elements of the prosthetic God were thus constituted.

The Vietnam War witnessed the introduction of a still newer generation of weaponry that inflicted major physical calamities, including a significant increase in injuries to external male genitalia. The major military-medical effort was directed at what Shurr and Cook identify as "myoelectrical controlled upper-extremity prostheses and endoskeletal, modular prosthesis." [Shurr & Cook, p. 2]

Nevertheless, as another observer notes, "because of frequent use of land mines [in Vietnam], such [genital] injuries accounted for 41.6 percent of all urogenital trauma." [Arneri, p. 3902] Looking at one brief period of the war, March 1966 to July 1967, the total number of hospitalized soldiers was 17,726, of which those who suffered external genitalia wounds were 594 or 3.4 percent.

Historical trends in external genitalia urological injuries reveal one of the most grievest costs suffered in the name of patriotism. During both World War Two and Vietnam, nearly two-thirds of all genital injuries in involved scrotal testis, penis and urethra. One can only wonder whether the "war on terror" will have comparable results. [Borden Institute, Walter Reed Medical Center, "Urology in the Vietnam War."]

Looking back over the evolution of injuries to male external genitalia since WWI, the Borden Institute at Walter Reed reports, in "Urology in the Vietnam War": "The high frequency of wounds of the external genitalia in World War II and the Vietnam War reflects the increase in the mobile combat activity of the soldier and the increased use of mines, grenades, booby traps, and the other high-velocity explosive surface missile devices, which detonated immediately beneath or besides the soldier." The radical guerrilla or insurgency wars in Afghanistan and Iraq have made "mobile combat" the operational norm.

* * *

It is difficult to fully anticipate the long-term consequences for the returning America military casualties from the "war on terror." Thousands, if not tens of thousands, of men and women will spend the rest of their lives suffering from the injuries inflicted in this immoral, if not illegal, military misadventure.

In war, technology plays a double-edged game. It significantly raises the casualty count and, in particular, injuries associated with the bodily extremities, particularly the genitals. Simultaneously, it increases the effectiveness of medical procedures (especially amputations) and prosthetic devices to save and sustain soldiers’ lives.

Prostheses serve physiological, psychological and symbolic purposes. These purposes define a unique set of issues involving a person’s (particularly a male’s) relation to another person as much as to him/her-self, to one’s own body, to how one physically experiences oneself, and, thus how one experience "nature," the profound sense or feeling of being alive.

Prosthetic devices reflect the conjunction of medicine, technology and social life. Their inherent goal is to help the "disabled" person feel that she/he is a fuller, more capable human being dwelling in a less-then-fully-functional body. By compensating for limitations to physical functionality through the use of prostheses, a more physically complete or functional human being can have a fuller life.

For men reared under the tyranny of patriarchal masculinity, nothing is so shameful as the loss or severe injury to one’s genital, to a man’s ability to sexually perform. Many men experience it as castration. The loss of an eye, hand, leg or other body part doesn’t make a man any less of a man; each organ can be replaced, thus sometime even strengthening, empowering the man. However, the lose of the ability to sexually perform, to fuck, is for (some?, few?, many?, most?) men in America experienced as a lose of masculinity, a challenge to self-hood.

The "war on terror" has been accompanied with many dubious expressions of masculinity. It opens with "shock and awe" pulverizing a weakened adversary. It grew with a pathetic president parading on an aircraft carrier in an Air Force flight suit declaring "Mission Accomplished". It reached its nightmare apex with the torture chambers at Abu Ghraib, eroticized with dog leashes and collars around naked Iraqi men’s necks along with fetishistically-garbed U.S. servicemen and women inflicting S&M punishment while smiling into the camera.

Today, the bravado of masculinity, of patriotism, is deflating with the growing number of military casualties.

America culture is horribly patriarchal and militaristic. It glorifies war, promising young men (and an increasing number of women) a path to individual self-realization through patriotic struggle. The unstated premise is that glory, honor, sacrifice and heroism (self-hood itself!) can be realized through military barbarism. And that these values are somehow inexorably bound to a man’s genitals, his dick.

Under the tyranny of America’s particular version of patriarchal masculinity, it is nearly impossible to envision an alternative vision of masculinity (let alone femininity). While many can debate the meaning of "masculinity" in terms of traditional virtues such as "courage," "strength," "honor" and "sacrifice," such values have nothing to do with a man’s genitals, his sexual ability. Overcoming this contradiction can come only with the end of patriarchy.

DAVID ROSEN can be reached at drosen@ix.netcom.com