Condet

Jeffrey Sellers, MD

• Department of Obstetrics and Gynecology
• Abington Memorial Hospital

The British had no qualitative technological advantage over their French or American opponents in North America in the eighteenth century breast cancer marathon cheap estrace 1 mg mastercard. In India womens health 7 day eating plan estrace 1mg mastercard, the native opposition matched channel 9 menopause diet discount 2mg estrace amex, and often bested womens health retreats estrace 1 mg online, the British in small arms. The French in Algeria discovered in the 1830s that their short-range 98 Imperial Wars muskets offered only a marginal defence against longer-range Arab jezails. Small-arm superiority was seldom a decisive factor in the Russian invasion of the Caucasus. The situation began to change in the 1860s as European organizational ability, combined with technology, began to give the imperial invaders an edge. However, the change was not a sudden one, and, indeed, organization and technology often cut both ways. On the surface, at least, the introduction in the 1860s of breech-loading rifles and in the 1880s of machine-guns changed the equation of colonial battles. No shortage of merchants of death existed to sell modern rifles to indigenous peoples-it is reckoned that over 16 million firearms were imported by Africans in the course of the nineteenth century. Colonial officials, eager to introduce a fatal touch of chaos to African empires which dwelt in conditions of scarcely stifled unrest, might supply weapons to minor chieftains or pretenders to thrones as a means to undermine the position of a local ruler. The French discovered that both the Dahomians in 1892 and the Malagasies in 1895 possessed modern rifles, although they used them badly, when they used them at all. The advent of machine-guns did give Europeans firepower advantages in defensive situations. It appears that the Russians and Imperial Wars 99 Americans were the first to add them to the inventories of armed expeditions in central Asia and the West. However, their general use in imperial warfare was impeded by both technical and tactical factors. Most commanders realized that a weapon which jammed at critical moments posed a distinct danger, which was why Custer left his Gatling behind when he departed for the Little Bighorn. Chelmsford carried them into action against the Zulus in 1879, but the Africans learned to work around them and attack on the flank. Conventional wisdom in the early days also assigned these weapons to the artillery to be used in batteries, rather than distributed to infantry and cavalry units. The lighter, more reliable Maxim gun began to appear on colonial battlefields in the 1890s, to be used by the British on the North-West Frontier, and to best effect in the Matabele War of 1893, when armed police of the Chartered Company and volunteers simply laagered their wagons and mowed down the Africans, who charged with reckless courage. First, they were not well suited for warfare in mountains or jungles where the enemy fought dispersed or was invisible. Pushed too far forward, they might become isolated and their crews be overwhelmed. Second, they remained too few to decide the outcome of a campaign-the British possessed only six Maxims at Omdurman. Maxims were not free of mechanical problems, as the French discovered during the Moroccan attack at Menabba in eastern Morocco in April 1908, when sand jammed the mechanisms of their machine-guns. And even then, the machine-gun remained a relatively scarce item in military inventories well into the Great War. Wellington found artillery useful especially in attacking 100 Imperial Wars Indian fortifications, which were often primitive, as were those of central Asia attacked by Russians. It required a considerable siege-train to storm Constantine in 1837, although the defenders inexplicably mined their own curtain wall, thus allowing the French to storm through the breach. But battles were seldom decided on the basis of superior European firepower-Mahrattan and Sikh forces were well supplied with artillery, although heterogeneous and eccentrically organized, and employed European instructors to train their gunners in the latest European techniques.

In 1914 this fateful combination of technologies turned the whole battlefront in western Europe into a colossal fortification breast cancer vaccine order estrace 1mg without prescription. Its obsession with annihilating the enemy by encirclement on a huge scale menstrual induced migraines buy 1mg estrace visa, the Vernichtungsstrategie women's health center encinitas generic estrace 1 mg, was rooted in Clausewitzian ideas pregnancy non stress test generic 1mg estrace fast delivery, but was carried to an extreme that Clausewitz might well have condemned. It was this readiness to see war in grand historical terms that made the Great War an absolute war from the start, even before its technical demands forced the belligerent states to organize their economic and social resources to an unprecedented degree. Propaganda, mostly a spontaneous surge of hostility amongst the patriotic middle class rather than deliberate governmental action, instantly branded the enemy as the enemy of civilization. But in general the outbreak of war in 1914 produced a sense of national unity that would have seemed almost impossible a few years earlier. Total war in the twentieth century was different from French revolutionary war in scope rather than in spirit. It was not only the traditionally unprepared states like Britain that had to make big adjustments and try new expedients to provide both the man- Introduction 15 power (a distinctively modern concept) and the material for the war of attrition. The extremism that shaped the Schlieffen Plan, and thus the geopolitics of the whole war, was repeated throughout its course. Hence the British imposed a naval blockade on Germany-a traditional British mode of operation, but now more crushing than ever in the past through a mixture of geographical accident and technical development. Within a year Germany was visibly beginning to starve to death, and in the last winter of the war nearly three-quarters of a million Germans were to die of hunger. Possessed of a wholly new technology in the form of the submarine, Germany was unable to exploit it without breaking international law (a law which, as John Hattendorf shows, had been substantially defined by Britain). In rational terms, it was probably an impossible decision to make, because the statistical calculations on which it had to be based were more or less hypothetical. Germany gambled not just to avoid defeat, but to win a decisive victory which would enable it to dictate the terms of peace. In the First World War, the paralysis of strategy by the technological stalemate was answered by the vast expansion of national organization to find ever more manpower and war material. A compromise peace was ruled out by the tremendous fears and ambitions generated 16 Introduction by nationalism. In the Second World War, still more destructive technology was put at the service of a still more ambitious nationalism. The development of tanks and aircraft made possible rapid movement which might dislocate defensive forces and prevent the establishment of fixed front lines. Such was the argument of the British military writer Basil Liddell Hart in the 1920s, and such became the basis of German strategy in the 1930s. Such colossal objectives could not be achieved without war, yet another war like that of 1914 would be suicidal. The defeat of France in 1940, a stunning reversal of First World War experience, was not due to technical imbalances as such. As has often been noted, the impact of blitzkrieg was not so much a matter of having more, or necessarily better, tanks and aircraft, as of using them in greater concentration. The disorienting pace of the German advance was an act of faith which tested the nerve of the German generals almost to breaking point. Only in Russia in 1941 did the technical limits of mechanization become significant. The result was a hardening of civilian hostility towards the invaders, and the intensification of partisan resistance which steadily consumed German military strength. In the Second World War, technology and ideology conspired to accelerate this process. More effective submarines made possible a more formidable blockade of food supplies; the development of long-range aircraft made possible the area bombing of cities in an attempt to undermine civilian morale as well as to destroy productive capacity. Bombloads and bomb sizes increased steadily until the devastating leap into nuclear weaponry in August 1945 dwarfed even the greatest mass attacks of the war. These attacks were, of course, carried out by the liberal democratic states of the West rather than their militaristic opponents. Perversely, the ferocity of modern war has been exacerbated at crucial times by the international law of war.

Infections (viral) Past treatment of viral conditions such as condyloma breast cancer biopsy generic 2mg estrace free shipping, herpes zoster womens health 60 plus buy estrace 2mg on-line, and warts is mentioned for historical perspective and completeness breast cancer lanyard order estrace 2 mg without prescription. Inflammatory (Acute/chronic) disorders not responsive to antibiotics (furuncles breast cancer 2 day atlanta 2mg estrace mastercard, carbuncles, sweat gland abscesses). Variations exist worldwide as to the appropriateness of using ionizing radiation for these disorders. The German review of 2002 lists them as potential indications, however elsewhere this opinion is not supported. Inverted papilloma the treatment of choice is surgical resection of these usually benign lesions of the nasal cavity and paranasal sinuses. However, a malignant component is found in a small percentage of cases, and radiation therapy is then indicated. In cases of incomplete resection or suspected malignant component, radiation therapy is considered medically necessary. Keloid Scar Data is abundant that a few fractions of a relatively small amount of radiation will reduce the chance of recurrence after a keloid is resected. This is medically necessary when other means are less appropriate or have proven ineffective. Typical radiation treatment utilizes superficial x-ray, electron beam, or complex photon beam therapy in four or fewer fractions. Keratitis (bullous and filamentary) Bullous and filamentary keratitis were listed in the 1977 U. Department of Health, Education and Welfare as entities for which radiation therapy was sometimes appropriate. Current literature does not support the use of radiation for either form of keratitis. Langerhans cell histiocytosis the literature has consistently supported the use of radiation therapy for treatment of this disorder over the time period studied. Chemotherapy is commonly utilized when treatment is necessary, with radiation more commonly used to treat localized growths. Lymphangiomas There are four types: capillary; cavernous; cystic hygromas; and lymphangeal hemangiomas. In rare instances, radiation therapy may be appropriate for refractory lesions with repeated recurrence after resection. These may cause a chylous effusion if there is pleural involvement, in which case radiation therapy may be useful in managing chylothorax. Lethal Midline Granuloma this is a progressive, destructive process which involves the mid-facial structures. It has been considered a benign entity, may mimic other lymphoproliferative processes, requires caution in diagnosis, and may be a malignant T-cell disorder. Alternative therapy may be more appropriate, but radiation therapy is considered appropriate for management of localized presentations or in conjunction with systemic therapy. Department of Health, Education and Welfare as an entity for which radiation therapy was sometimes appropriate. Macular degeneration There was great optimism that age related wet macular degeneration could be controlled by the use of radiation therapy to arrest the progression of choroidal neovascularization. Newer approaches to the use of radiation therapy, such as epimacular brachytherapy and stereotactic radiosurgery are being investigated as alternatives or as complementary methods so as to reduce the frequency of intraocular injections. Until the results of these studies are known, the appropriateness of using radiation is unproven. However, when surgery is technically not possible or is medically contraindicated, radiation therapy is regarded as an appropriate treatment for primary or recurrent lesions. Other indications include postoperative treatment of high grade lesions and for incompletely resected ones. Mikulicz Syndrome (salivary lymphoepithelial lesion) Once other etiologies are ruled out, such as malignant lymphoma and infection, the use of low doses of radiation to treat this lymphoepithelial growth in salivary tissue has been reported as effective in older literature. Policy: Cases will require medical review and documentation that no other reasonable alternative exists. Symptomatic lesions may benefit from treatment with relatively high doses of radiation if not amenable to resection. Ocular trichiasis (epilation) Of historical interest, on occasion, to cause epilation of eyelashes, radiation has been used in dermatology or ophthalmology practices to aid in the clearance of trachoma or ocular pemphigoid.

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Diseases

• SCARF syndrome
• Annuloaortic ectasia
• Adrenal hypoplasia
• Heart block
• Chromosome 3, monosomy 3p25
• Amelogenesis imperfecta
• Deafness goiter stippled epiphyses
• Vocal cord dysfunction familial
• Esthesioneuroblastoma

References

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