Artigos de revistas sobre o tema "Nervous system – wounds and injuries – fiction"

The injured central nervous system (CNS) can hardly regenerate. In vitro engineering of brain tissue hits technical bottlenecks. Also, the compaction and complexity of anatomical structure defy the accurate positioning for lesion sites in intracranial injuries. Therefore, repairing injured CNS remains a significant clinical challenge. Various recent in vivo and in vitro experiments have demonstrated the excellent effect of tissue engineering on repairing central nerve cells and tissues through implanting new materials and engineered cells. Except for porous three-dimensional structures able to pad lesions in various shapes and simulate the natural extracellular matrix with nutrients for cell proliferation, hydrogels incorporate high biocompatibility. Injectable hydrogels with the merits of avoiding complex surgery on large wounds, filling irregular gaps, delivering drugs, and others, are of growing interest. This review focuses on the experimental studies regarding injectable hydrogels, especially applying various injectable hydrogels to repair brain damage.

Background: Terrestrial animal bites wounds are injuries caused by terrestrial animals' mouths and teeth. Aerobic and nonaerobic bacteria cause 30–60% of the secondary bacterial infections due to animal bites. Rabies is an infectious disease and it is the most dangerous viral infection caused by animal bites. Also, venomous animal bites can be fatal and cause death if not treated well. Purpose: To identify the clinical manifestation, first aid, and management of terrestrial animal bites to reduce morbidity and mortality. Review: Wounds and crush injuries caused by animal bites are prone to infection. Aerobic bacteria, such as Pasteurella multocida, Staphylococcus spp. (including methicillin–resistant Staphylococcus aureus (MRSA)), Capnocytophaga canimorsus, and Bartonella henselae, and anaerobic bacteria, such as Porphyromonas spp. are commonly found pathogens in animal bite wounds. Rabies, the most dangerous viral infection, occurs in wounds infected by the rabies virus. The virus enters the nerve tissue, multiplies, and spreads to the central nervous system. This can cause disability, and it is life-threatening. In snakebites, management of basic life support, transportation to the hospital, clinical assessment, and immediate resuscitation are the most important procedures. Conclusion: Animal bite wounds are injuries caused by animals' mouths and teeth. Dogs, cats, and snakes are terrestrial animals that most likely attack humans. Proper diagnosis, first aid, and comprehensive management are needed to reduce morbidity and mortality.

This brief review presents Razi’s concepts of bone and joint disorders. Razi differentiated between ligaments, tendons, and nerves and recognized the role of the brain, spinal cord, and peripheral nervous system in the perception of senses and voluntary movements. He described paralysis and loss of sensation following brain, spinal cord, and peripheral nervous system injuries. Razi presented an early concept of compartment syndrome. Razi’s approach to fracture management is very similar to the current concept of functional bracing for some fractures. Razi mentioned suturing the wounds and ligation of bleeding large vessels. He cautioned about phlebotomy in the antecubital fossa as it may become complicated by the adjacent arterial and nerve injuries. Razi treated osteomyelitis by removing the infected and necrotic bone by sawing, cutting, and rasping. He also documented arthralgia, painful hip, and sciatic pain and made a sharp distinction between arthralgia and gout. He indicated the gout origin as the production of a waste substance that the body fails to expel. Razi’s basic concepts on the bone and joint disorders established a foundation for modern orthopedic science.

The aim: Improving the effectiveness of patients' treatment with combat injuries of the peripheral nervous system, which consists in the application and development of new methods of reconstructive interventions, optimizing a set of therapeutic and diagnostic measures for the most effective management of this category of patients with peripheral nerve injury. Materials and methods: The research is based on the results of surgical treatment of 138 patients with combat injuries of peripheral nerves for the period from 2014 to 2020. The mean age was 33.5 ± 2.1 years. Patients were treated for 1 to 11 months after injury (median – 8 months). Damage to the sciatic nerve was observed in 26.1%, ulnar – in 20.3%, median – in 18.8%, radial – in 15.9%, tibial – in 10.9%, common peroneal nerve – in 8% of cases. Results: It was shown that in all patients was significantly improved the recovery of all nerves. In the period from 9 to 12 months, the degree of recovery of motor function to M0-M2 was observed in 40.6%, to M3 – in 35.5%, to M4 – in 16.7%, to M5 – in 7,2%. The degree of recovery of sensitivity to S0-S2 was observed in 36.2%, to S3 – in 42.8%, to S4 – in 17.4%, to S5 – in 3.6%. Regression of pain syndrome after surgery was observed in 81.2% of patients. Conclusions: The results of surgical treatment of peripheral nerves gunshot injury are generally worse than other types of nerve injuries. The best results of surgical treatment of combat trauma of peripheral nerves are obtained in patients with sciatic nerve damage.

Introduction. Identification of microorganisms that colonize combat wounds and cause wound infection is of primary importance for the subsequent successful treatment of the patient. The resistance of microorganisms to antimicrobial drugs makes the efforts of modern medicine in the fight against infectious agents ineffective. The problem of infertility is closely related to combat injuries, their infection, stress, and neurotic disorders. Aim. Obtaining and summarizing data on microbial colonization of mine-blast wounds of pelvic organs and the microbiome of the genitourinary system of combatants. Materials and methods. 84 smears were taken from 56 wounds of 36 patients with injuries of the pelvic organs who were being treated. 73 patients with injuries were examined for the presence of mycoflora in the urogenital tract. Isolation of pure bacterial cultures was carried out by inoculating the studied material using meat-peptone agar, blood agar, chromogenic agars. For the diagnosis of urogenital or other infections by the PCR method, a scraping from the back wall of the urethra was taken from the patients. Results. Predominant microorganisms in positive cultures of smears were non-fermenting gram-negative rods, which in 28% of cultures belonged to the genus Acinetobacter, in 26% to the genus Pseudomonas. As for associated infections, 20% of them consisted of the genus Acinetobacter, 32% – Enterobacter, 4% – Klebsiella and 29% – Pseudomonas. Gram-positive cocci were isolated in 37% of positive smear cultures. The frequency of isolation of the genus Streptococcus in monoinfection was 2.5%, followed by the genus Clostridium – 2%, Bacillus – 3%, Enterococcus – 4% and Actynomycceas – 4%. In associated infections, the frequency of isolation of the genus Streptococcus was 4%, followed by the genus Clostridium – 2%, Bacillus – 4%, Enterococcus – 3% and Actynomycceas – 5%. When analyzing the microflora of the genitourinary system, it was found that the priority role belongs to the combined infection, when there are associations of specific pathogens such as Ureaplasma spp., Mycoplasma spp., Chlamidia spp., Neisseria gonorrhoeae, Trichomonas vaginalis, Streptococcus spp., Enterococcus faecalis, which is 80% of the entire microbiome. Conclusions. Acinetobacter baumanii and Klebsiella pneumoniae are the dominant microflora complicating the course of combat wounds during almost two years of Russia's full-scale war against Ukraine. Probably, the duration of hostilities, the large number of wounded, and the forced mass unsystematic use of various antibiotics lead to rapid changes in the spectrum of pathogens of combat wounds. Combat wounds and their infection, stress, and nervous disorders lead to an imbalance of microflora, in particular microflora of the genitourinary system, which can be one of the causes of infertility. Chlamydia and Ureaplasma are the most common microorganisms that colonize the urogenital tract of men injured as a result of hostilities.

Muscles are the most important executive organs - effectors. Both according to morphological and functional characteristics, muscles are divided into two types - striated and smooth. Striated muscles, in turn, are usually divided into skeletal and cardiac. Striated muscles form the motor apparatus of the skeleton, oculomotor, chewing and other motor systems in animals. The striated muscles, with the exception of the heart muscle, are completely controlled by the central nervous system, they are devoid of automatism.The problem of damage to skeletal muscles is very relevant and widespread. These injuries disrupt the musculoskeletal function of animals, up to its complete loss. To search for methods for restoring the structure and function of muscles, experiments are being carried out on laboratory animals. This article is devoted to the selection of the optimal model of skeletal muscle injury, performed on laboratory rats. The study was conducted on Wistar rats. The choice of the muscle on which the models will be worked out, as well as the surgical access to it, is substantiated. Three options for inflicting damage to muscle tissue (cut wounds directed parallel to muscle fibers; cut wounds directed across muscle fibers; crushed wounds of muscle tissue) and the timing of healing of these injuries are proposed. The result of the study showed that the gastrocnemius muscle is the most suitable for modeling damage to muscle tissue in rats, and a crushed wound has the longest healing time.

Relevance. According to the modern realities of hostilities in the East of Ukraine, the medical community has grown a request for information about the nature of the most dangerous defeats of the participants of the Joint Forces Operation (JFO) in Donbass. Objective: analysis and generalization of the nature of heart injuries received during the hostilities in the East of Ukraine, the stages of medical support of such wounded. Materials and methods. Analysis of scientific publications in scientific journals of Ukraine by keywords for the period 2014-2018. Results. The nature of injuries among participants in the JFO has been analyzed. The first place is occupied by injuries of blood vessels with bleeding (60%), 2 - pneumothorax (34%), and 3 - airway obstruction (6%). All this can be combined and supplemented by damage to the nervous system and other organs. In the conditions of the modern war in Donbass, shrapnel injuries (50.5%), bullet wounds (25.3%), and closed injury (20.3%) are considered frequent types of injuries. The classification of heart injuries, clinical symptoms, the levels of support for such a wounded are described: first aid at the prehospital stage ("golden minutes") on the battlefield, qualified medical assistance ("golden hour"), specialized medical care in a hospital. Post-traumatic stress disorders have been described that last from one to 6 months and require complex treatment. Conclusion. According to NATO's new military medical doctrine, "an effective and reliable medical support system contributes to maintaining the trust of the military and the general public in the army and its political leadership".

Analysis of servicemen participation in hostilities on the territory of the state has led to a significant increase in the number of personnel who have combat wounds, mutilations or injuries. Almost all participants in hostilities have health impairments, namely PCS, the prevalence of which is more than 70 % of the total number of injuries. This contingent of servicemen is important for the Ukrainian army, as their combat experience is a basis for the development and improvement of training of military specialists` training. However, their state of health can be an obstacle to the successful performance of their functional duties. The Purpose of the Study – to comprehensively investigate the functional state of the nervous system of servicemen who had PCS, using a battery of tests aimed at studying the psycho-emotional state. Research Stuff and Methods – 36 servicemen (average age 32,22±1,26 years) who had a history of concussion took part in the study. A set of tests included: tapping test, the Romberg test, finger-nose test, “Walking in a straight line with open and closed eyes” test, and the Yarotsky`s test. Findings. The tests used meet the basic requirements for screening, it means, they are simple, visual, economically feasible and allow obtaining sufficiently informative information about the health state of the participants. The absence of deep lesions of the nervous system was confirmed, that is, the testing proves the conclusions made regarding the pre-nozological nature of health disorders again.

Sea turtles are considered endangered species, largely due to anthropogenic activities. Much of the trauma in these species involves the carapace and skull, resulting in several degrees of damage to the pulmonary and nervous systems. Among traumatic injuries, those involving the skull can be complicated by brain exposure, and turtles with severe skull injuries that have nervous system impairment, emaciation, and dehydration can often die. Between July 2014 and February 2022, a total of 1877 loggerhead sea turtles (Caretta caretta) were referred for clinical evaluation at the Sea Turtle Clinic (STC) of the Department of Veterinary Medicine of the University of Bari. A retrospective study of 29 consecutive cases of loggerhead sea turtles (Caretta caretta) with skull lesions of different degrees of severity is reported. On admission, physical and neurological evaluations were performed to assess and grade the lesions and neurological deficits. In 20 of the 29 sea turtles with more serious head trauma, computed tomography (CT) findings in combination with physical and neurological assessment enabled the evaluation of the potential correlation between deficits and the extent of head injuries. All sea turtles underwent curettage of the skull wounds, and the treatment protocol included the use of the plant-derived dressing 1 Primary Wound Dressing® (Phytoceutical AG, Endospin Italia) applied on the wound surface as a primary dressing. Out of 29 sea turtles, 21 were released after a time ranging from a few days to 8 months. To the best of our knowledge, the literature lacks specific data on the incidence, correlations with neurological deficits, complications, and survival rate of loggerhead sea turtles with traumatic head injuries.

The number of traumatic injuries to nerve stems and plexuses is steadily increasing in peacetime during armed conflicts and terrorist acts. In wartime, peripheral nerve injuries are much more common, and a great deal of the knowledge about peripheral nerve damage and repair is based on combat experience. The study of the clinical course of post−traumatic neuropathies and plexopathies contributes to the development of clinical and neurological criteria and compensatory−restorative responses in traumatic lesions of the peripheral nervous system, helps to assess the functional significance of various parts of the nervous system when compensating a damaged functional unit. To study the features of clinical manifestations of post−traumatic gunshot and non−gunshot neuropathies and plexopathies, 63 patients underwent clinical and neurological examination with topical and clinical diagnoses, collection of detailed anamnesis and complaints, electroneuromyography and ultrasound examination. Movement disorders, characterized by peripheral paresis or plegia of the corresponding muscle group and accompanied with a reduced or lost tendon and periosteal reflexes, were common. Sensitivity disorders were a combination of prolapse (anesthesia, hypoesthesia) and irritation (paresthesia, hyperpathy, hyperesthesia). Autonomic disorders (vascular, secretory and trophic) in traumatic neuropathies differ depending on the clinical individuality of peripheral nerves. Vascular disorders were more often detected with partial damage to nerve structures and were accompanied by local edema. Of the secretory disorders, the most constant sign of impaired nerve conduction was sweating disorder. In the clinical picture of the pain syndrome, i.e. causalgia, the pain sensations by type of burning dominated. The intensity of the pain syndrome in severe cases was very high, in some cases the pain was exacerbated by irritation of the senses. The clinical picture of causalgia is characterized by an increased pain when warming the injured limb and it reduced when cooled, that is a "symptom of a wet rag." Knowledge of clinical features allows the detection of the peripheral nervous system lesions at the early stages of pathology, performance of dynamic clinical and neurological observation and treatment, timely use of modern additional research methods to address further treatment tactics that restore limb function, improve quality of life. Key words: post−traumatic neuropathy and plexopathy, peripheral nervous system, gunshot wounds of nerves and plexuses.

Viral Nervous Necrosis (VNN) and Vibriosis are contagious diseases that can affect grouper fish from the larval to adult stages and cause significant economic losses for farmers. The owner brought the sunuk grouper to BKIPM Mataram to determine the fish's health. Since the grouper arrived at the floating net cage, the owner reports it has sustained bodily injuries. The grouper is separated from the healthy fish and placed in the area where the sick fish are. During maintenance, the fish exhibits a decrease in appetite, wounds on the mouth, operculum, and body from the head to the tail, low mobility, and swimming upside-down. The physical examination revealed that the fish was swimming limply in an inverted position and had lesions on various body parts. According to virological and bacteriological laboratory tests, the sunuk grouper infected with Vibriosis and VNN can be affected by the condition of fish that have been sick since they first arrived. Also, stress, contact with infected fish, and a decreased appetite result in sunuk grouper contracting the disease. Due to a disease, a fish's immune system does not function optimally. This condition makes sunuk susceptible to several infectious diseases.

During the 1536 siege of Turin in northern Italy, a young French barber-surgeon abandoned the conventional treatment of battle-inflicted wounds, launching a revolution in military medicine and surgical techniques. Ambroise Paré (1510–1590) was born into a working-class Huguenot family in Laval, France, during an era when surgery was not considered a respectable profession. He rose from humble origins as a barber-surgeon, a low-ranked occupation in the French medical hierarchy, to become a royal surgeon (chirurgien ordinaire du Roi) serving 4 consecutive French monarchs. His innovative ideas and surgical practice were a response to the environment created by new military technology on 16th-century European battlefields. Gunpowder weapons caused unfamiliar, complicated injuries that challenged Paré to develop new techniques and surgical instruments. Although Paré’s contributions to the treatment of wounds and functional prosthetics are documented, a deeper appreciation of his role in military neurosurgery is needed. This paper examines archives, primary texts, and written accounts by Paré that reveal specific patient cases highlighting his innovative contributions to neurotrauma and neurosurgery during demanding and harrowing circumstances, on and off the battlefield, in 16th-century France. Notably, trepanation indications increased because of battlefield head injuries, and Paré frequently described this technique and improved the design of the trepan tool. His contribution to neurologically related topics is extensive; there are more chapters devoted to the nervous system than to any other organ system in his compendium, Oeuvres. Regarding anatomical knowledge as fundamentally important and admiring the contemporary contributions of Andreas Vesalius, Paré reproduced many images from Vesalius’ works at his own great expense. The manner in which Paré’s participation in military expeditions enabled collaboration with multidisciplinary artisans on devices, including surgical tools and prosthetics, to restore neurologically associated functionality is also discussed. Deeply religious, in a life filled with adventure, and serving in often horrendous conditions during a time when Galenic dogma still dominated medical practice, Paré developed a reputation for logic, empiricism, technology, and careful treatment. "I have [had] the opportunity to praise God, for what he called me to do in medical operation, which is commonly called surgery, which could not be bought with gold or silver, but by only virtue and great experimentation."

• Background For any given traumatic injury, older adults experience a longer hospitalization, more complications, and higher mortality than do younger patients. • Objectives To prospectively identify problems in designing follow-up studies in seriously injured older adults without head injury and to examine outcomes after serious trauma in older adults who were sent to a level I trauma center. • Methods A short-term descriptive follow-up design was used in which each patient served as his or her baseline. Eligible patients had injuries that required admission to an intensive care unit, a hospital length of stay longer than 72 hours, or surgery. Patients with isolated hip fractures, central nervous system injuries, and burn injuries were excluded. Data were collected by using standardized instruments during the acute hospital stay and 3 months after discharge from the hospital. • ResultsDuring a representative 2-month period, 21% of a potential 77 subjects died in the hospital, 44% had cognitive impairment that precluded participation, and 17% declined to participate. Twenty older adults (mean age 73.5 years) who were injured in motor vehicle crashes (45%), falls (35%), or pedestrian accidents (15%) or who had gunshot wounds (5%) were enrolled. Ten percent died after discharge. Levels of physical disability at 3 months after discharge were higher than those before the injury (score on Sickness Impact Profile physical subscale 24.5 vs 10.9, P = .02), and psychological distress (Impact of Event Scale score 20.9) remained elevated. • Conclusion Mortality, disability, and posttraumatic psychological distress after discharge are problems in seriously injured older adults.

January 19, 2021 marks the 75th anniversary of the birth of one of the leading Russian neurosurgeons, Academician of the Russian Academy of Sciences Boris Vsevolodovich Gaidar. Eight years at the head of the Department and Clinic of Neurosurgery at the Military Medical Academy and 7 years at the head of Military Medical Academy, when his talent as a teacher and leader was most clearly revealed. Academician B.V. Gaidar is one of the countrys leading scientists in the field of treatment of combat injuries of the central nervous system (craniocerebral trauma and mine-explosive wounds of the central nervous system), vascular neurosurgery, and neurooncology. He made a major contribution to solving the issues of organizing specialized neurosurgical care in the Armed Forces in peacetime and in wartime. He personally took part in providing medical assistance to the wounded during the armed conflict in the North Caucasus. B.V. Gaidar represented Russian science at international forums in Austria, Germany and the United States of America, in 2005 he led the organization of the World Congress on Military Medicine for the only time in our country. During the years of leadership of the S.M. Kirov Military Medical Academy B.V. Gaidar carried out a large-scale reconstruction and re-equipment of a number of leading surgical clinics, which contributed to the progressive development of the academys scientific schools. B.V. Gaidar created a scientific school of neurosurgeons, prepared a rich legacy of articles, textbooks and monographs, his merits were recognized by the scientific community and the state. Celebrating the anniversary, Boris Vsevolodovich continues to actively engage in scientific work, training, counseling critical patients, passionately defending the interests of the Military Medical Academy.

Lightning injuries can cause multi-organ damage such as burns, ear damage, and nervous system damage. The type of Burns in this trauma consists of linear or flash burns, punctate burns, thermal injuries, Lichtenburg figures, and combination wounds which are generally superficial and heal faster. Lightning strikes also cause ear damage in the form of perforation of the tympanic membrane, bleeding, and micro fractures in the cochlea. The sequelae in lightning injury survivors consist of permanent brain injury, chronic pain syndrome, peripheral neuropathy, and blindness. This case is a man, 20 years old, working as a farmer, referred to the hospital because he was struck by lightning while working in the middle of the rice fields during heavy rain. There were complaints of pain, heat throughout the body, and decreased hearing in both ears in the anamnesis. Physical examination showed a general condition within normal limits. Local status examination found burns as large as 31.5% of the body area, with 2a degree burns (partial thickness) on the chest, back, upper and lower limbs. Examination of the outer and middle ear revealed no abnormalities. The principle of the treatment refers to the electric burns treatment with initial therapy in fluid resuscitation, evaluation of ECG, adequate analgesia, and wound care. The advanced phase of the treatment focuses on treating the burns and evaluating the hearing loss. Adequate care for nine days showed that the wound was epithelialized by 60% of the total wound area and without any other complaints. This case is essential to be studied considering that Indonesia's natural conditions allow for lightning strikes, especially during the rainy season, so lightning is a threat to farmers as a part of the agro-industrial community. Keywords: Lightning injuries, burns, agroindustrial

White phosphorus (WP) has been used in hand grenades, mortar and artillery shells, and aerial bombs since World War I. Recently it has been used in combat operations in Iraq, Syria, Afghanistan, Yemen, Nagorno-Karabakh and is used during the Palestinian-Israeli conflict in Gaza. Burns caused by WP usually result in death or disability. The purpose of the work is to analyze and summarize the data of the scientific literature on the medical consequences and treatment of lesions caused using ammunition with WP. Materials and methods. For the analysis, we used available scientific publications describing the consequences of WP burns received during hostilities. The method of analysis is descriptive. The following tasks were solved: the properties of WP as a damaging agent were studied; materials on the medical consequences of WP lesions and methods of treatment of such lesions were summarized. Discussion of the results. WP is highly reactive, highly toxic and ignites in air as early as 35°C. The severity of WP lesions is the result of both the thermal and chemical effects of combustion. Fatalities among humans from WP burns have occurred involving less than 10% of the total body surface area. Burns caused by WP heal more slowly than thermal burns. WP penetrates deeply through the fatty subcutaneous tissue. Therefore, the burns are full-thick, necrotic. The absorbed WP acts as a cellular poison and causes damage to the central nervous system, liver, kidneys, myocardium, and other organs. Any WP particles trapped in the wound may re-ignite. Conclusion. At the pre-hospital stage, the first thing to do is to wash off the wounds with cool water and remove the pieces of WP that have fallen into the skin with forceps. The light from the UV lamp can help to visualize the small particles of WP. Cleaning exfoliated skin and removing visible WP particles from the skin are critical methods for limiting wound severity and systemic WP absorption. It is advisable to excise the burned area within an hour after the lesion and repeat surgical procedures until all phosphorus particles have been removed; to control during the first 48 hours for the content of calcium and phosphorus in the blood serum with appropriate correction. In the future, skin grafting and treatment with allogeneic mesenchymal stem cells are advisable.

Traumatic injuries to the nervous system, including the brain and spinal cord, lead to neurological dysfunction depending upon the severity of the injury. Due to the loss of motor (immobility) and sensory function (lack of sensation), spinal cord injury (SCI) and brain injury (TBI) patients may be bed-ridden and immobile for a very long-time. These conditions lead to secondary complications such as bladder/bowel dysfunction, the formation of pressure ulcers (PUs), bacterial infections, etc. PUs are chronic wounds that fail to heal or heal very slowly, may require multiple treatment modalities, and pose a risk to develop further complications, such as sepsis and amputation. This review discusses the role of oxidative stress and reactive oxygen species (ROS) in the formation of PUs in patients with TBI and SCI. Decades of research suggest that ROS may be key players in mediating the formation of PUs. ROS levels are increased due to the accumulation of activated macrophages and neutrophils. Excessive ROS production from these cells overwhelms intrinsic antioxidant mechanisms. While short-term and moderate increases in ROS regulate signal transduction of various bioactive molecules; long-term and excessively elevated ROS can cause secondary tissue damage and further debilitating complications. This review discusses the role of ROS in PU development after SCI and TBI. We also review the completed and ongoing clinical trials in the management of PUs after SCI and TBI using different technologies and treatments, including antioxidants.

The scientific work of the outstanding French surgeon Rene Leriche is analyzed. Little-known facts from his life are noted. Lerish has published more than 1,200 scientific papers, including 21 monographs. Most of his works are devoted to problems of general and private clinical physiology and served as the basis for the establishment and development of the physiological direction in surgery. He investigated the problem of pain, in particular pain syndrome resulting from injuries; studied the possibilities of using surgical techniques for pathogenetic treatment. He was one of the first to propose the use of surgical interventions on the autonomic nervous system for the treatment of mainly peripheral vascular diseases. R. Lerish believed that the disease is not a distortion of normal, but the emergence of new physiological relationships. R. Lerish developed a technique for blockades and surgical interventions in the sympathetic department of the autonomic nervous system, including periarterial sympathectomy. He described the clinic in detail and proposed a method for surgical treatment of chronic occlusion of the terminal abdominal aorta (Lerish syndrome). R. Lerish attached great importance to the individual characteristics of a healthy person and indicated that doctors know little about a person during his illness. He was also worried by the fact that doctors know little why the disease takes one form or another, why the infection is virulent in one and benign in the other, while the contagiousness is the same. Lerish put forward in medicine the concept of individual pathology. He pointed out that the form of the disease depends on the organic personality of the person and does not depend on the type of infection. Referring to his impressions, Lerish said that he tried to search on this path, but found nothing but banality. For his work on the treatment of infected wounds, R. Lerish was awarded the Lister Medal (1939). He was the founder and first president of the European Society of Cardiovascular Surgeons; He was an honorary doctor of 30 foreign universities, an honorary member of several foreign academies and societies, including the All-Union Society of Surgeons of the Union of Soviet Socialist Republics.

Blood-brain barrier (BBB) is the most important component of central nervous system (CNS) to keep toxins and pathogens from CNS. Although our studies demonstrated that using interleukin-6 antibodies (IL-6-AB) reversed the increased permeability of BBB, IL-6-AB is limited in their application that only could be used a few hours before surgery and seemed delayed the surgical wounds healing process, which urges us to find another more effective method. In this study, we employed the C57BL/6J female mice to investigate the potential effects of umbilical cord-derived mesenchymal stem cells (UC-MSCs) transplantation on BBB dysfunction induced by surgical wound. Compared to IL-6-AB, the transplantation of UC-MSCs more effectively decreased the BBB permeability after surgical wound evaluated by dextran tracer (immunofluorescence imaging and luorescence quantification). In addition, UC-MSCs can largely decrease the ratio of proinflammatory cytokine IL-6 to the anti-inflammatory cytokine IL-10 in both serum and brain tissue after surgical wound. Moreover, UC-MSCs successfully increased the levels of tight junction proteins (TJs) in BBB such as ZO-1, Occludin, and Claudin-5 and extremely decreased the level of matrix metalloproteinase-9 (MMP-9). Interestingly, UC-MSCs treatment also had positive effects on wound healing while protecting the BBB dysfunction induced by surgical wound compared to IL-6-AB treatment. These findings suggest that UC-MSCs transplantation is a highly efficient and promising approach on protecting the integrity of BBB which caused by peripheral traumatic injuries.

The article deals with certain medico-legal aspects of trauma in the salon of bus as one of the types of road traffic accidents with a large number of dead and injured. Are shown the typical causes of such incidents and the nature of the victims injury. Was developed and proposed a modern approach to optimization of expert research in case of appearance a large number of victims in the bus. Circumstances of injury in case of personal injury people in the bus are very diverse:− rollover of the bus when transporting a large number of people while driving;− bus falling from height;− a massive collision with a fixed roadside objects; − collision with other vehicles; among the latter is the most fatal bus collision with a moving train.Naturally, in these cases, the massive injuries have affected depends on the intensity of injury to passengers in the bus, and the mechanism of damage is determined by the specific form of an accident involving a bus. In such cases, the experts faced, usually with mechanical trauma inside the cabin, and mixed types of injuries passengers (e.g. in case of fire). For in-car trauma characterized by formation damage from the following mechanisms:− shock bodies on the inner part of the interior (interior);− injuries from the shards of broken glass.Basically, the nature of injury is determined by the structural features of the bus, the presence of foreign objects, the location of the victims. If the vehicle rolls over, the occupants people are numerous additional impact. Formed characteristic for the driver damage to the hands, fractures of the sternum fractures of the hips, legs and feet. For passengers is characteristic fractures of the lower limbs, bruised head wounds, fractures and dislocations of the cervical spine when using the seat belts − stripe-like bruises and abrasions ofthe chest and abdomen, broken ribs, collarbone, sternum, in the projection of the belts. Shards of broken glass caused by the multiple linear abrasions and (or) surface or deep cut wounds mainly in the face and upper extremities. In the case of deformation of the bus body can be compression of the bodies are formed by damage to several areas, primarily the chest, abdomen, extremities, accompanied by multiple bilateral rib fractures, ruptures of internal organs. If in the future there is a fire or explosion of the vehicle, the nature of thedamage detected on the bodies will correspond to the combined injury.In cases of injuries in the bus to work with the bodies of the victims begins at the scene. Thus, the Protocol of inspection of the scene and of the corpse in the first place should reflect the data about the mutual position of bodies and (or) their fragments relative to the vehicle and other parts, the distance between them; the condition of clothing, odors from it, the presence of different overlays, damage; contamination of the skin; localization and nature of the injuries on the bodies, the presence of deformations of its individualparts; the presence of traces of biological origin on the vehicle in comparison with the nature of the deformation (damage) of the body.Be sure to note the results of the inspection of the road where there was a traffic accident, a bus traces of blood, and fragments of various things, etc. Despite the small percentage of bus injured in world General statistics of fatal injuries, it presents certain difficulties in planning, organization, execution and coordination of forensic work on multi-step liquidation of medical consequences of the accident, usually associated with a large number of victims, gross impact of factors affecting on the bodies of the victims, the need to quickly address some specific issues: establishing at autopsy pathological symptoms that indicate the status of the health of drivers in the period priorto the tragic event; the existence of facts pointing to the use of intoxicating and medicinal substances that depress the nervous system and many others), early identification of all victims. According to the results of the analysis made it impossible to offer modern, optimal, evidence-informed, and until only itremains to be reliable in practice the system approach to the organizational model of forensic activities, while ensuring the interests of the investigation of an accident involving a bus and a large number of victims:1. The preliminary stage of organization expert services. It can conditionally enough be divided into 2 phases:− advance (pre-) phase;− the immediate phase.To the basic questions of the early phases include: early development, coordination and approval of the optimal legislative and other regulatory framework; preliminary methodological, administrative and organizational, theoretical-practical, logistical, software and applied training; exercise reasonable estimates of projected short and long term needs and costs with regard to the peculiarities specified by the tragic events; creation, storage, use and replenishment of the trust reserves, logistical and financial resources areinviolable, is intended solely for use in such emergencies. It also includes the creation, maintenance and continuous improvement of a Single centralized situation center on a temporary or permanent basis, with a good system of departmental and interdepartmental cooperation, primarily containing a - operational information-Supervisory and analytical center for the collection, processing, storage, information exchange and joint action with the threat, occurrence and prevention of emergencies with a large number of victims.Immediately with the receipt of the news of the accident involving a bus and a large number of victims for forensic services begin immediate phase, the main elements of which include:− prompt notification and collection of employees and expert institutions;− an emergency conference call to discuss the organizational, theoretical and practical questions and short specialized trainingon occupational safety, including use of personal protective equipment depending on the nature of the accident and actions are potentially dangerous to health and life of employees and expert institutions factors.All plans of measures are necessarily coordinated and agreed with appropriate representatives of structures of fast reaction, especially when conducting urgent investigative actions in the emergency areas, primarily the inspection of the scene. 2. The inspection of the crime scene it is advisable to start with a preliminary review («intelligence»), which finally determined the necessity of application of those or other technical means, and the number of specialists who will participate in the inspection.The static phase of scene examination with the participation of forensic doctors is accompanied by clear mapping; mapping, photo - and video fixing of vehicle, various objects; it is noted the exact relative positions of the bus (its parts) and discovered the corpses, fragments of human remains and other biological material. During dynamic examination of the scene produce a detailed external examination of the human remains, their fragments, biological material, perform primary medical sorting, their careful packaging,clear detailed marking. Then performed the proper loading, transportation and unloading. In case of need in a temporary Deposit of biological material, can be used in railway wagons refrigerators, refrigerated trailers, mobile camera with a refrigeration unit, and in the absence or lack of volume for the total number of remains and the biomaterial deploys heat-resistant boxes, fit the space with the use of outdoor mobile air conditioning systems, large amounts of ice obtained from specialized industrial ice makers, etc., which is especially important for braking processes of rotting corpses, their fragments and biomaterial in the warm season.3. After the initial registration and a secondary sort examine corpses, their fragments and biological material collection for postmortem identification of significant information, determine the cause of death, nature, mechanism and prescription of formation damage and address other special issues. At this stage also produce the identification of fragmented body parts and (or) tissues that or another body. In expert identification work on the fragments of human remains or biological material, preference is given to genetic research providing highly accurate results. Depending on the extent of influence of damaging factors on the bodies of the victims and their degree of preservation, only after the completion of the necessary is judicial-medical research with a full range of fence material for additional research, producing restoration of the exterior, embalming, sanitary and cosmetic processing of human remains and give them to relatives (relatives, authorized representatives, etc.) for burial. 4. Issued the final results of examinations; establishes data that may be useful for later investigative and judicial actions aimed at gathering and verification of evidence in a criminal case.5. The penultimate stage consists of conducting sanitary-and-hygienic, treatment-and-prophylactic, rehabilitation (including a full psychological) of interventions for physical and mental health of employees and expert institutions involved in this work.6. After the conclusion of the criminal proceedings in general, with the official opening of data access, it is advisable to analyze the material, and publish the relevant data in the scientific literature, with the goal of widespread study and use of gained experience.CONCLUSIONS.1. Research platform forensic activities in cases of accidents involving buses and a large number of victims to date have not been developed.2. The effectiveness of forensic medical groups in this situation is in direct proportion to the degree of readiness for quick response and timely quality completion of tasks.3. Based on this, very urgent is the development of modern optimal evidence-based systemic approach to the organizational model of forensic activities in the presence of a large number of injured persons in the bus; the solution to this problem and sent the above recommendations.4. The recommendations, in principle, can be applied not only in cases of injuries in the bus, but also to similar situations in which there is a massive injury and loss of life.5. It is necessary to continue scientific and practical research aimed at improving this algorithm works experts.

ABSTRACT Introduction Genitourinary (GU) trauma resulting from combat and the treatment of these injuries is an inadequately explored subject. While historically accounting for 2 to 5% of combat-related injuries, GU-related injuries escalated considerably during U.S. involvements in Iraq and Afghanistan due to improvised explosive devices (IEDs). Advanced body armor increased survivability while altering injury patterns, with a shift toward bladder and external genitalia injuries. Forward-deployed surgeons and military medics manage treatment, with Role 2 facilities addressing damage control resuscitation and surgery, including GU-specific procedures. The review aims to provide an overview of GU trauma and enhance medical readiness for battlefield scenarios. Materials and Methods This review examined urologic trauma management in combat, searching PubMed, Cochrane Central, Scopus, and Web of Science databases with search terms “wounds” OR “injuries” OR “hemorrhage” AND “trauma” AND “penile” OR “genital” AND “combat.” Records were then screened for inclusion of combat-related urologic trauma in conflicts after 2001 and which were English-based publications. No limits based on year of publication, study design, or additional patient-specific demographics were implemented in this review. Results Ultimately, 33 articles that met the inclusion criteria were included. Included texts were narrowed to focus on the management of renal injuries, ureteral trauma, bladder injuries, penile amputations, urethral injuries, testicular trauma, Central nervous system (CNS) injuries, and female GU injuries. Conclusions In modern conflicts, treatment of GU trauma at the point of injury should be secondary to Advanced Trauma Life Support (ATLS) care in addition to competing non-medical priorities. This review highlights the increasing severity of GU trauma due to explosive use, especially dismounted IEDs. Concealed morbidity and fertility issues underscore the importance of protection measures. Military medics play a crucial role in evaluating and managing GU injuries. Adherence to tactical guidelines and trained personnel is vital for effective management, and GU trauma’s integration into broader polytrauma care is essential. Adequate preparation should address challenges for deploying health care providers, prioritizing lifesaving and quality-of-life care for casualties affected by GU injuries.

In the last months of his life, 86-year-old Albert Facey became a best-selling author and revered cultural figure following the publication of his autobiography, A Fortunate Life. Released on Anzac Day 1981, it was praised for its “plain, unembellished, utterly sincere and un-self-pitying account of the privations of childhood and youth” (Semmler) and “extremely powerful description of Gallipoli” (Dutton 16). Within weeks, critic Nancy Keesing declared it an “Enduring Classic.” Within six months, it was announced as the winner of two prestigious non-fiction awards, with judges acknowledging Facey’s “extraordinary memory” and “ability to describe scenes and characters with great precision” (“NBC” 4). A Fortunate Life also transformed the fortunes of its publisher. Founded in 1976 as an independent, not-for-profit publishing house, Fremantle Arts Centre Press (FACP) might have been expected, given the Australian average, to survive for just a few years. Former managing editor Ray Coffey attributes the Press’s ongoing viability, in no small measure, to Facey’s success (King 29). Along with Wendy Jenkins, Coffey edited Facey’s manuscript through to publication; only five months after its release, with demand outstripping the capabilities, FACP licensed Penguin to take over the book’s production and distribution. Adaptations soon followed. In 1984, Kerry Packer’s PBL launched a prospectus for a mini-series, which raised a record $6.3 million (PBL 7–8). Aired in 1986 with a high-rating documentary called The Facey Phenomenon, the series became the most watched television event of the year (Lucas). Syndication of chapters to national and regional newspapers, stage and radio productions, audio- and e-books, abridged editions for young readers, and inclusion on secondary school curricula extended the range and influence of Facey’s life writing. Recently, an option was taken out for a new television series (Fraser).A hundred reprints and two million readers on from initial publication, A Fortunate Life continues to rate among the most appreciated Australian books of all time. Commenting on a reader survey in 2012, writer and critic Marieke Hardy enthused, “I really loved it [. . .] I felt like I was seeing a part of my country and my country’s history through a very human voice . . .” (First Tuesday Book Club). Registering a transformed reading, Hardy’s reference to Australian “history” is unproblematically juxtaposed with amused delight in an autobiography that invents and embellishes: not believing “half” of what Facey wrote, she insists he was foremost a yarn spinner. While the work’s status as a witness account has become less authoritative over time, it seems appreciation of the author’s imagination and literary skill has increased (Williamson). A Fortunate Life has been read more commonly as an uncomplicated, first-hand account, such that editor Wendy Jenkins felt it necessary to refute as an “utter mirage” that memoir is “transferred to the page by an act of perfect dictation.” Sidonie Smith and Julia Watson argue of life narratives that some “autobiographical claims [. . .] can be verified or discounted by recourse to documentation outside the text. But autobiographical truth is a different matter” (16). With increased access to archives, especially digitised personnel records, historians have asserted that key elements of Facey’s autobiography are incorrect or “fabricated” (Roberts), including his enlistment in 1914 and participation in the Gallipoli Landing on 25 April 1915. We have researched various sources relevant to Facey’s early years and war service, including hard-copy medical and repatriation records released in 2012, and find A Fortunate Life in a range of ways deviates from “documentation outside of the text,” revealing intriguing, layered storytelling. We agree with Smith and Watson that “autobiographical acts” are “anything but simple or transparent” (63). As “symbolic interactions in the world,” they are “culturally and historically specific” and “engaged in an argument about identity” (63). Inevitably, they are also “fractured by the play of meaning” (63). Our approach, therefore, includes textual analysis of Facey’s drafts alongside the published narrative and his medical records. We do not privilege institutional records as impartial but rather interpret them in terms of their hierarchies and organisation of knowledge. This leads us to speculate on alternative readings of A Fortunate Life as an illness narrative that variously resists and subscribes to dominant cultural plots, tropes, and attitudes. Facey set about writing in earnest in the 1970s and generated (at least) three handwritten drafts, along with a typescript based on the third draft. FACP produced its own working copy from the typescript. Our comparison of the drafts offers insights into the production of Facey’s final text and the otherwise “hidden” roles of editors as transformers and enablers (Munro 1). The notion that a working man with basic literacy could produce a highly readable book in part explains Facey’s enduring appeal. His grandson and literary executor, John Rose, observed in early interviews that Facey was a “natural storyteller” who had related details of his life at every opportunity over a period of more than six decades (McLeod). Jenkins points out that Facey belonged to a vivid oral culture within which he “told and retold stories to himself and others,” so that they eventually “rubbed down into the lines and shapes that would so memorably underpin the extended memoir that became A Fortunate Life.” A mystique was thereby established that “time” was Albert Facey’s “first editor” (Jenkins). The publisher expressly aimed to retain Facey’s voice, content, and meaning, though editing included much correcting of grammar and punctuation, eradication of internal inconsistencies and anomalies, and structural reorganisation into six sections and 68 chapters. We find across Facey’s drafts a broadly similar chronology detailing childhood abandonment, life-threatening incidents, youthful resourcefulness, physical prowess, and participation in the Gallipoli Landing. However, there are also shifts and changed details, including varying descriptions of childhood abuse at a place called Cave Rock; the introduction of (incompatible accounts of) interstate boxing tours in drafts two and three which replace shearing activities in Draft One; divergent tales of Facey as a world-standard athlete, league footballer, expert marksman, and powerful swimmer; and changing stories of enlistment and war service (see Murphy and Nile, “Wounded”; “Naked”).Jenkins edited those sections concerned with childhood and youth, while Coffey attended to Facey’s war and post-war life. Drawing on C.E.W. Bean’s official war history, Coffey introduced specificity to the draft’s otherwise vague descriptions of battle and amended errors, such as Facey’s claim to have witnessed Lord Kitchener on the beach at Gallipoli. Importantly, Coffey suggested the now famous title, “A Fortunate Life,” and encouraged the author to alter the ending. When asked to suggest a title, Facey offered “Cave Rock” (Interview)—the site of his violent abuse and humiliation as a boy. Draft One concluded with Facey’s repatriation from the war and marriage in 1916 (106); Draft Two with a brief account of continuing post-war illness and ultimate defeat: “My war injuries caught up with me again” (107). The submitted typescript concludes: “I have often thought that going to War has caused my life to be wasted” (Typescript 206). This ending differs dramatically from the redemptive vision of the published narrative: “I have lived a very good life, it has been very rich and full. I have been very fortunate and I am thrilled by it when I look back” (412).In The Wounded Storyteller, Arthur Frank argues that literary markets exist for stories of “narrative wreckage” (196) that are redeemed by reconciliation, resistance, recovery, or rehabilitation, which is precisely the shape of Facey’s published life story and a source of its popularity. Musing on his post-war experiences in A Fortunate Life, Facey focuses on his ability to transform the material world around him: “I liked the challenge of building up a place from nothing and making a success where another fellow had failed” (409). If Facey’s challenge was building up something from nothing, something he could set to work on and improve, his life-writing might reasonably be regarded as a part of this broader project and desire for transformation, so that editorial interventions helped him realise this purpose. Facey’s narrative was produced within a specific zeitgeist, which historian Joy Damousi notes was signalled by publication in 1974 of Bill Gammage’s influential, multiply-reprinted study of front-line soldiers, The Broken Years, which drew on the letters and diaries of a thousand Great War veterans, and also the release in 1981 of Peter Weir’s film Gallipoli, for which Gammage was the historical advisor. The story of Australia’s war now conceptualised fallen soldiers as “innocent victims” (Damousi 101), while survivors were left to “compose” memories consistent with their sacrifice (Thomson 237–54). Viewing Facey’s drafts reminds us that life narratives are works of imagination, that the past is not fixed and memory is created in the present. Facey’s autobiographical efforts and those of his publisher to improve the work’s intelligibility and relevance together constitute an attempt to “objectify the self—to present it as a knowable object—through a narrative that re-structures [. . .] the self as history and conclusions” (Foster 10). Yet, such histories almost invariably leave “a crucial gap” or “censored chapter.” Dennis Foster argues that conceiving of narration as confession, rather than expression, “allows us to see the pathos of the simultaneous pursuit and evasion of meaning” (10); we believe a significant lacuna in Facey’s life writing is intimated by its various transformations.In a defining episode, A Fortunate Life proposes that Facey was taken from Gallipoli on 19 August 1915 due to wounding that day from a shell blast that caused sandbags to fall on him, crush his leg, and hurt him “badly inside,” and a bullet to the shoulder (348). The typescript, however, includes an additional but narratively irreconcilable date of 28 June for the same wounding. The later date, 19 August, was settled on for publication despite the author’s compelling claim for the earlier one: “I had been blown up by a shell and some 7 or 8 sandbags had fallen on top of me, the day was the 28th of June 1915, how I remembered this date, it was the day my brother Roy had been killed by a shell burst.” He adds: “I was very ill for about six weeks after the incident but never reported it to our Battalion doctor because I was afraid he would send me away” (Typescript 205). This account accords with Facey’s first draft and his medical records but is inconsistent with other parts of the typescript that depict an uninjured Facey taking a leading role in fierce fighting throughout July and August. It appears, furthermore, that Facey was not badly wounded at any time. His war service record indicates that he was removed from Gallipoli due to “heart troubles” (Repatriation), which he also claims in his first draft. Facey’s editors did not have ready access to military files in Canberra, while medical files were not released until 2012. There existed, therefore, virtually no opportunity to corroborate the author’s version of events, while the official war history and the records of the State Library of Western Australia, which were consulted, contain no reference to Facey or his war service (Interview). As a consequence, the editors were almost entirely dependent on narrative logic and clarifications by an author whose eyesight and memory had deteriorated to such an extent he was unable to read his amended text. A Fortunate Life depicts men with “nerve sickness” who were not permitted to “stay at the Front because they would be upsetting to the others, especially those who were inclined that way themselves” (350). By cross referencing the draft manuscripts against medical records, we can now perceive that Facey was regarded as one of those nerve cases. According to Facey’s published account, his wounds “baffled” doctors in Egypt and Fremantle (353). His medical records reveal that in September 1915, while hospitalised in Egypt, his “palpitations” were diagnosed as “Tachycardia” triggered by war-induced neuroses that began on 28 June. This suggests that Facey endured seven weeks in the field in this condition, with the implication being that his debility worsened, resulting in his hospitalisation. A diagnosis of “debility,” “nerves,” and “strain” placed Facey in a medical category of “Special Invalids” (Butler 541). Major A.W. Campbell noted in the Medical Journal of Australia in 1916 that the war was creating “many cases of little understood nervous and mental affections, not only where a definite wound has been received, but in many cases where nothing of the sort appears” (323). Enlisted doctors were either physicians or surgeons and sometimes both. None had any experience of trauma on the scale of the First World War. In 1915, Campbell was one of only two Australian doctors with any pre-war experience of “mental diseases” (Lindstrom 30). On staff at the Australian Base Hospital at Heliopolis throughout the Gallipoli campaign, he claimed that at times nerve cases “almost monopolised” the wards under his charge (319). Bearing out Facey’s description, Campbell also reported that affected men “received no sympathy” and, as “carriers of psychic contagion,” were treated as a “source of danger” to themselves and others (323). Credentialed by royal colleges in London and coming under British command, Australian medical teams followed the practice of classifying men presenting “nervous or mental symptoms” as “battle casualties” only if they had also been wounded by “enemy action” (Loughran 106). By contrast, functional disability, with no accompanying physical wounds, was treated as unmanly and a “hysterical” reaction to the pressures of war. Mental debility was something to be feared in the trenches and diagnosis almost invariably invoked charges of predisposition or malingering (Tyquin 148–49). This shifted responsibility (and blame) from the war to the individual. Even as late as the 1950s, medical notes referred to Facey’s condition as being “constitutional” (Repatriation).Facey’s narrative demonstrates awareness of how harshly sufferers were treated. We believe that he defended himself against this with stories of physical injury that his doctors never fully accepted and that he may have experienced conversion disorder, where irreconcilable experience finds somatic expression. His medical diagnosis in 1915 and later life writing establish a causal link with the explosion and his partial burial on 28 June, consistent with opinion at the time that linked concussive blasts with destabilisation of the nervous system (Eager 422). Facey was also badly shaken by exposure to the violence and abjection of war, including hand-to-hand combat and retrieving for burial shattered and often decomposed bodies, and, in particular, by the death of his brother Roy, whose body was blown to pieces on 28 June. (A second brother, Joseph, was killed by multiple bayonet wounds while Facey was convalescing in Egypt.) Such experiences cast a different light on Facey’s observation of men suffering nerves on board the hospital ship: “I have seen men doze off into a light sleep and suddenly jump up shouting, ‘Here they come! Quick! Thousands of them. We’re doomed!’” (350). Facey had escaped the danger of death by explosion or bayonet but at a cost, and the war haunted him for the rest of his days. On disembarkation at Fremantle on 20 November 1915, he was admitted to hospital where he remained on and off for several months. Forty-one other sick and wounded disembarked with him (HMAT). Around one third, experiencing nerve-related illness, had been sent home for rest; while none returned to the war, some of the physically wounded did (War Service Records). During this time, Facey continued to present with “frequent attacks of palpitation and giddiness,” was often “short winded,” and had “heart trouble” (Repatriation). He was discharged from the army in June 1916 but, his drafts suggest, his war never really ended. He began a new life as a wounded Anzac. His dependent and often fractious relationship with the Repatriation Department ended only with his death 66 years later. Historian Marina Larsson persuasively argues that repatriated sick and wounded servicemen from the First World War represented a displaced presence at home. Many led liminal lives of “disenfranchised grief” (80). Stephen Garton observes a distinctive Australian use of repatriation to describe “all policies involved in returning, discharging, pensioning, assisting and training returned men and women, and continuing to assist them throughout their lives” (74). Its primary definition invokes coming home but to repatriate also implies banishment from a place that is not home, so that Facey was in this sense expelled from Gallipoli and, by extension, excluded from the myth of Anzac. Unlike his two brothers, he would not join history as one of the glorious dead; his name would appear on no roll of honour. Return home is not equivalent to restoration of his prior state and identity, for baggage from the other place perpetually weighs. Furthermore, failure to regain health and independence strains hospitality and gratitude for the soldier’s service to King and country. This might be exacerbated where there is no evident or visible injury, creating suspicion of resistance, cowardice, or malingering. Over 26 assessments between 1916 and 1958, when Facey was granted a full war pension, the Repatriation Department observed him as a “neuropathic personality” exhibiting “paroxysmal tachycardia” and “neurocirculatory asthenia.” In 1954, doctors wrote, “We consider the condition is a real handicap and hindrance to his getting employment.” They noted that after “attacks,” Facey had a “busted depressed feeling,” but continued to find “no underlying myocardial disease” (Repatriation) and no validity in Facey’s claims that he had been seriously physically wounded in the war (though A Fortunate Life suggests a happier outcome, where an independent medical panel finally locates the cause of his ongoing illness—rupture of his spleen in the war—which results in an increased war pension). Facey’s condition was, at times, a source of frustration for the doctors and, we suspect, disappointment and shame to him, though this appeared to reduce on both sides when the Repatriation Department began easing proof of disability from the 1950s (Thomson 287), and the Department of Veteran’s Affairs was created in 1976. This had the effect of shifting public and media scrutiny back onto a system that had until then deprived some “innocent victims of the compensation that was their due” (Garton 249). Such changes anticipated the introduction of Post-Traumatic Shock Disorder (PTSD) to the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. Revisions to the DSM established a “genealogy of trauma” and “panic disorders” (100, 33), so that diagnoses such as “neuropathic personality” (Echterling, Field, and Stewart 192) and “soldier’s heart,” that is, disorders considered “neurotic,” were “retrospectively reinterpreted” as a form of PTSD. However, Alberti points out that, despite such developments, war-related trauma continues to be contested (80). We propose that Albert Facey spent his adult life troubled by a sense of regret and failure because of his removal from Gallipoli and that he attempted to compensate through storytelling, which included his being an original Anzac and seriously wounded in action. By writing, Facey could shore up his rectitude, work ethic, and sense of loyalty to other servicemen, which became necessary, we believe, because repatriation doctors (and probably others) had doubted him. In 1927 and again in 1933, an examining doctor concluded: “The existence of a disability depends entirely on his own unsupported statements” (Repatriation). We argue that Facey’s Gallipoli experiences transformed his life. By his own account, he enlisted for war as a physically robust and supremely athletic young man and returned nine months later to life-long anxiety and ill-health. Publication transformed him into a national sage, earning him, in his final months, the credibility, empathy, and affirmation he had long sought. Exploring different accounts of Facey, in the shape of his drafts and institutional records, gives rise to new interpretations. In this context, we believe it is time for a new edition of A Fortunate Life that recognises it as a complex testimonial narrative and theorises Facey’s deployment of national legends and motifs in relation to his “wounded storytelling” as well as to shifting cultural and medical conceptualisations and treatments of shame and trauma. ReferencesAlberti, Fay Bound. Matters of the Heart: History, Medicine, and Emotions. Oxford: Oxford UP, 2010. Butler, A.G. Official History of the Australian Medical Services 1814-1918: Vol I Gallipoli, Palestine and New Guinea. Canberra: Australian War Memorial, 1930.Campbell, A.W. “Remarks on Some Neuroses and Psychoses in War.” Medical Journal of Australia 15 April (1916): 319–23.Damousi, Joy. “Why Do We Get So Emotional about Anzac.” What’s Wrong with Anzac. Ed. Marilyn Lake and Henry Reynolds. Sydney: UNSWP, 2015. 94–109.Dutton, Geoffrey. “Fremantle Arts Centre Press Publicity.” Australian Book Review May (1981): 16.Eager, R. “War Neuroses Occurring in Cases with a Definitive History of Shell Shock.” British Medical Journal 13 Apr. 1918): 422–25.Echterling, L.G., Thomas A. Field, and Anne L. Stewart. “Evolution of PTSD in the DSM.” Future Directions in Post-Traumatic Stress Disorder: Prevention, Diagnosis, and Treatment. Ed. Marilyn P. Safir and Helene S. Wallach. New York: Springer, 2015. 189–212.Facey, A.B. A Fortunate Life. 1981. Ringwood: Penguin, 2005.———. Drafts 1–3. University of Western Australia, Special Collections.———. Transcript. University of Western Australia, Special Collections.First Tuesday Book Club. ABC Splash. 4 Dec. 2012. <http://splash.abc.net.au/home#!/media/1454096/http&>.Foster, Dennis. Confession and Complicity in Narrative. Cambridge: Cambridge UP, 1987.Frank, Arthur. The Wounded Storyteller. London: U of Chicago P, 1995.Fraser, Jane. “CEO Says.” Fremantle Press. 7 July 2015. <https://www.fremantlepress.com.au/c/news/3747-ceo-says-9>.Garton, Stephen. The Cost of War: Australians Return. Melbourne: Oxford UP, 1994.HMAT Aeneas. “Report of Passengers for the Port of Fremantle from Ports Beyond the Commonwealth.” 20 Nov. 1915. <http://recordsearch.naa.gov.au/SearchNRetrieve/Interface/ViewImage.aspx?B=9870708&S=1>.“Interview with Ray Coffey.” Personal interview. 6 May 2016. Follow-up correspondence. 12 May 2016.Jenkins, Wendy. “Tales from the Backlist: A Fortunate Life Turns 30.” Fremantle Press, 14 April 2011. <https://www.fremantlepress.com.au/c/bookclubs/574-tales-from-the-backlist-a-fortunate-life-turns-30>.Keesing, Nancy. ‘An Enduring Classic.’ Australian Book Review (May 1981). FACP Press Clippings. Fremantle. n. pag.King, Noel. “‘I Can’t Go On … I’ll Go On’: Interview with Ray Coffey, Fremantle Arts Centre Press, 22 Dec. 2004; 24 May 2006.” Westerly 51 (2006): 31–54.Larsson, Marina. “A Disenfranchised Grief: Post War Death and Memorialisation in Australia after the First World War.” Australian Historical Studies 40.1 (2009): 79–95.Lindstrom, Richard. “The Australian Experience of Psychological Casualties in War: 1915-1939.” PhD dissertation. Victoria University, Feb. 1997.Loughran, Tracey. “Shell Shock, Trauma, and the First World War: The Making of a Diagnosis and its Histories.” Journal of the History of Medical and Allied Sciences 67.1 (2012): 99–119.Lucas, Anne. “Curator’s Notes.” A Fortunate Life. Australian Screen. <http://aso.gov.au/titles/tv/a-fortunate-life/notes/>.McLeod, Steve. “My Fortunate Life with Grandad.” Western Magazine Dec. (1983): 8.Munro, Craig. Under Cover: Adventures in the Art of Editing. Brunswick: Scribe, 2015.Murphy, Ffion, and Richard Nile. “The Naked Anzac: Exposure and Concealment in A.B. Facey’s A Fortunate Life.” Southerly 75.3 (2015): 219–37.———. “Wounded Storyteller: Revisiting Albert Facey’s Fortunate Life.” Westerly 60.2 (2015): 87–100.“NBC Book Awards.” Australian Book Review Oct. (1981): 1–4.PBL. Prospectus: A Fortunate Life, the Extraordinary Life of an Ordinary Bloke. 1–8.Repatriation Records. Albert Facey. National Archives of Australia.Roberts, Chris. “Turkish Machine Guns at the Landing.” Wartime: Official Magazine of the Australian War Memorial 50 (2010). <https://www.awm.gov.au/wartime/50/roberts_machinegun/>.Semmler, Clement. “The Way We Were before the Good Life.” Courier Mail 10 Oct. 1981. FACP Press Clippings. Fremantle. n. pag.Smith, Sidonie, and Julia Watson. Reading Autobiography: A Guide for Interpreting Life Narratives. 2001. 2nd ed. U of Minnesota P, 2010.Thomson, Alistair. Anzac Memories: Living with the Legend. 1994. 2nd ed. Melbourne: Monash UP, 2013. Tyquin, Michael. Gallipoli, the Medical War: The Australian Army Services in the Dardanelles Campaign of 1915. Kensington: UNSWP, 1993.War Service Records. National Archives of Australia. <http://recordsearch.naa.gov.au/NameSearch/Interface/NameSearchForm.aspx>.Williamson, Geordie. “A Fortunate Life.” Copyright Agency. <http://readingaustralia.com.au/essays/a-fortunate-life/>.

Susanne Bier and David Farr’s 2016 television adaptation of John le Carré’s novel The Night Manager (“Manager”) indexes the resilience of traditional Christian misogyny in contemporary British-American media. In the first episode of the series, Sophie (Aure Atika)’s partner Freddie Hamid (David Avery) brutally beats her. In the subsequent scene, despite her scars, Sophie has a sex scene with the eponymous night manager Pine (Tom Hiddlestone). Sophie’s eye socket and the left side of her face bear fresh bruises and wounds throughout the sex scene. And in the sixth and final episode, Pine and Jed (Elizabeth Debicki) have sex after she has been tortured at length by her partner Roper’s (Hugh Laurie) henchman, at Roper’s request. Jed’s neck, face, and arms bear bruises from the torture.These sex scenes function as a space of revelation. I interpret the women’s wounds and injuries alongside a feminist-critical tradition of reading noir on screen. Inaugurated by Ann Kaplan’s 1978 Women in Film Noir, many feminist commentators have since made the claim that women in noir achieve a peculiar significance, and their key scenes a subversive meaning; “in excess of” their punitive treatment within the narrative (Kaplan 5; Harvey 31; Tasker Working Girls 117). My reading emphasizes a tension between Manager’s patriarchal narrative framing and these two sex scenes that I argue disrupt and subvert the former.That Sophie and Jed are brutalised by their partners does not tell us much: it is a routine expectation in British-American film and television that “bad guys” are tough on “their” chicks. It is only after these violent encounters with their partners, when the women share “romantic” moments with Pine, that the text’s patriarchal entitlement is laid bare (“revelation” stems from Late Latin revelare to “lay bare”). Forgetting about their cuts, injuries and bruises, they desire Pine, remove their clothes, and are stimulated, stimulating, pleasuring, and pleasured. Director Bier and writer Farr assume that a 2016 British and American audience will (i) find these encounters between Sophie and Pine, and Pine and Jed, to be romantic and tender; and also (ii) find Pine’s behavior consistent with that of a “savior”. These expectations regarding audience complicity are truly revelatory.Sophie and Jed’s wounds constitute a space of revelation: the wounds are in excess of, and spill over, the patriarchal narrative framing. Their wounds indicate that the narrative has approached a moment of excessive patriarchal entitlement—emphasising extreme power imbalances between Pine and the women—and break through the narrative framing and encourage feminist enquiry. I use feminist legal theorist Catharine MacKinnon’s theory of consent to argue that, given this blatant power inequity, it could be interpreted the characters have different perspectives of the sexual act and it is questionable whether the women are in fact consenting (182).Critical ReceptionAcademic engagement with John le Carré’s well-respected espionage novels continues to emerge, including the books of Myron Aronoff, Tony Barley, Matthew Bruccoli and Judith Baughman, John Cobbs, David Monaghan, Peter Lewis and Peter Wolfe. There are a small number of academic commentaries exploring the screen adaptations of his novels, including Eric Morgan’s “Whores and Angels” and Geraint D’Arcy’s “Essentially, Another Man’s Woman”. Unfortunately, there are almost no academic commentaries on Manager, with the exception of Gunhild Agger’s “Geopolitical Location and Plot in The Night Manager”, and none that focus on the handling of gender themes within it.However, there are abundant mainstream media articles and reviews of Manager. I randomly selected seven of these articles and reviews in order to gauge the response to these sex scenes within a 2016 British-American media community. I looked at articles and reviews by Hal Boedeker, Caitlin Flynn, Tim Goodman, Jeff Jensen, Tom Lamont, Jasper Rees, and Claire Webb. None of the articles mention the theme of “gender” or note the gendered violence in the series. The reviews are complicit with the patriarchal narrative framing, and introduce Sophie and Jed in terms of their physical appearances and in their relation to principal male characters. “Beautiful and pale” Jed is “girlfriend of Bogeyman arms dealer” (Jensen), and is also referred to as “Roper’s long-legged trophy girlfriend” (Rees). Sophie, in a “sultry brunette corner” is a “tempting, tragic damsel-in-distress” (Rees) and “arouses Pine” (Jensen). However, reviewers describe the character Burr (who is male in the novel but played by Olivia Colman in the series) with greater dignity and detail. Introducing the character Sophie (Aure Atika), reviewer Tom Goodman does not refer to her by character or actress name despite the fact he introduces male characters by both. Instead, Sophie is a “beautiful connected woman” and is subsequently referred to as “the woman” (Goodman). This anonymity of Sophie as character, and Atika as actor, indexes the Christian misogyny in operation here: in Genesis, Adam only names Eve after the fall of man (New International Version, Gen. 3:20). Goodman’s textual erasure supports Sophie’s vulnerability and expendability within the narrative logic. Indeed, the reviews recapitulate stock noir themes, suggesting that the women are seductively manipulative: Goodman implies that both Bier and Debicki both deploy beauty so as to distract or beguile (Goodman), and Jensen notes that the women are “sultry with danger” (Jensen).Commentators and reviewers have likened Manager, with good reason, to screen adaptations of Ian Fleming’s James Bond novels. This is a useful comparison for the purposes of clarifying my own analytical approach. Lisa Funnell and Klaus Dodds’s Geographies, Genders and Geopolitics of James Bond, endorse a feminist geopolitical sensibility that audits which bodies are vulnerable, and which are disposable (14). Bond, like Manager’s Pine, is fundamentally privileged and invulnerable (14). Their account of Bond also describes Pine: “white, cis-gender, middle-class, heterosexual, able-bodied… British, attended Cambridge… he can move, act, and perform; gain access to places, spaces and resources” (1). Sophie’s vulnerability counterpoints Pine’s privilege. Against Pine’s athletic form and blond features stands the “foreign” Sophie, iterated through an emphasis on her dark features, silk dresses (that reference kaftans), and accented language (she delivers English language lines with a strong accent and discloses to Pine that she has tried to “Anglicise” her identity and has changed name). Sophie’s social and financial precarity seems behind her decision to become the mistress of violent gangster Freddie Hamid (in “Episode One” Sophie explains that Hamid “owns her”). By the end of this episode Hamid has violently beaten her then later murdered her. And even though the character Jed is white and American, it is implied that financial necessity is behind her choice of Richard Roper as partner. Jed is violently tortured and beaten in “Episode Six”.Funnell and Dodds also note Bond’s capacity to sexually satisfy women as a key dimension of his hegemonic masculinity (1). In Manager, the spectator is presumed complicit with the narrative framing and is expected to uncritically accept Pine’s extreme desirability to women. The assumption of Pine’s sexiness and sexual competency together constitute his entitlement, made clear in sex scenes between him and Sophie, and him and Jed. These sex scenes follow events of gendered violence and I raise the possibility that they also constitute instances of gendered violence.Noir Feminine ArchetypesReviewers have pointed out that Manager engages with the noir tradition (Jensen). Sophie and Jed are both “fallen” women, reflecting the Christian heritage of the noir tradition, though incarnate different noir archetypes (Allen 6). Mysterious and seductive Sophie emerges as a femme fatale in the first episode: the dark and seductive girlfriend of gangster Freddie Hamid, Sophie entrusts Pine with delicate and dangerous information, leading him into a dark world. In Milton’s Paradise Lost, the snake convinces Eve that the fruit does not bring death but instead knowledge. Eve wishes to share this knowledge with her partner “but keep the odds of knowledge in my power / without co-partner?” ultimately precipitating the fall of Adam and mankind (Milton 818). Sophie shares information regarding Hamid and Roper’s illegal arms deal with Pine. There are two transgressions on her part: she shares her partner’s confidential information with Pine and then has an affair with him. Hamid murders Sophie for the betrayals. However, Sophie’s murder does not erase her narrative significance: the event motivates protagonist Pine in his chief quest to ‘bring Roper down’, and as Boedeker concurs, the narrative’s action is “driven by this event”. Indeed, Yvonne Tasker notes the dual function of the femme fatale: she is both “an archetype which suggests an equation between female sexuality, death and danger” and also “functions as the vibrant centre of the narrative” (Tasker 117).Pine’s later love interest Jed is an example of the more complicated “good-bad girl” noir type, as Andrew Spicer has usefully coined it (92). The “good-bad girl” occupies a morally ambiguous space between the (dangerously sexy) femme fatale and (fundamentally decent) “girl-next-door” (Spicer 92). Both “good” and “bad”, Jed is unmarried but living with villain Roper, whom she has presumably selected out of economic necessity; she is a mother, but this does not bestow her with maternal legitimacy as she keeps her son a secret and is physically remote from him. Jed finds “real love” with Pine and betrays Roper in assisting Pine’s espionage plot. Roper’s henchman punishes Jed for the betrayal (in the torture scene Roper laments “I saw how you looked at him last night”; “Episode 6”).Despite the routine sexism and punitive thrust of the noir narrative, the women’s “romantic” sex scenes with Pine are laden with subversive significance. In her analysis of women in noir, Sylvia Harvey argues:Despite the ritual punishment of acts of transgression, the vitality with which these acts are endowed produces an excess of meaning which cannot finally be contained. Narrative resolutions cannot recuperate their subversive significance. (31)The visibility of Sophie and Jed’s wounds throughout their respective sex scenes with Pine signals an excessive patriarchal entitlement that disrupts the narrative logic and invites us to question the women’s perspectives. My analysis of the scenes is informed by feminist legal theorist Catharine MacKinnon’s argument that under unequal power relations consent is fraught, if not impossible (180). MacKinnon argues that women’s beliefs and reactions are shaped by power inequality, including the threat of male violence, economic dependence, and need (175).Analysis of Sophie and Pine’s InteractionsI first analyse Sophie’s dialogue because I seek to demonstrate that there is a communication breakdown in play: Sophie is asking Pine for help and safety while Pine thinks she is seducing him. Sophie’s verbal exchanges with Pine can be read in two different ways: (i) according to the patriarchal narrative framing (the spectator is positioned alongside Pine, seeing Sophie as scopophilic object); or (ii) from a feminist perspective that takes Sophie’s situation and perspective into account (Mulvey 835-36). Sophie’s language is legible as flirtation. If we are uncritically complicit with the narrative framing, Sophie is usually trying to arrange time alone with Pine because she desires him. However, if we emphasise Sophie’s perspective, she is asking for privacy, discretion, and help to stay alive (and to save the lives of others too, given that she is foiling an arms deal). Catharine MacKinnon’s observation that “men are systematically conditioned not even to notice what women want” plays out elegantly in the scenes between Pine and Sophie (181). Pine manages to discern that Sophie needs some sort of help, but shows no regard for her perspective or the significant power inequality between the two of them. From their earliest interaction in “Episode One” Sophie addresses Pine in a flirtatious way. In an audacious request, although it is ‘below’ his duties as manager she insists he make her a coffee and cheekily demands he sit with her while she drinks it. Their interaction is a standard flirtatious tête-à-tête, entailing the playful query “what do you [Pine] know of me?” Sophie begs Pine to copy some documents for her in his office even though he points out that his colleague performs such duties. Sophie suggestively demands “I would prefer to use your office”. It seems that by insisting on time alone with him, Sophie’s goal is that Pine does the task, rather than the task be done per se. However, it promptly transpires that Sophie sought a private location in order to share classified information with him, having noted at an earlier date Pine’s friendship with a British diplomat. She asks him to “hold onto” the documents “in case something happens to her”.Pine nonetheless passes on these classified documents to this contact.Sophie and Pine’s next interaction follows a similar pattern: she rings him from her hotel room and asks him to bring her a scotch. He suggests alternative ways she can procure a drink, yet she confirms the real object of her desire (“I want you”). Pine smirks as he approaches her room. Sophie’s declaration appears as (i) a desirous statement and invitation to come to her room for sex but it is in fact (ii) a demand that Pine (specifically) comes to her room, because she wants to know with whom he shared the documents and to reveal to him the injuries she received as a punishment for his leak.After realising the danger he has put her in, Pine takes her to a remote house to secure her safety. Once inside, she implores “why do you sit so far away?” which sounds like a request for closeness, perhaps even that he touch her. Yet the extent of her desired proximity, and the nature of the touch she requests, can be interpreted in (at least) two ways. Certainly, Pine believes that she desires sexual intercourse with him. The spectator is meant to interpret this request along those lines by virtue of Atika’s seductive delivery. Pine explains that he sits with distance “out of respect” and Sophie teases “is that why you came all the way here, to respect me?” This remark reveals Sophie’s assumption that Pine’s assistance has been transactional (help in exchange for sex) and the content indicates the kind of sex she assumes he expects (“disrespectful” sex, or at least sex that playfully skirts the boundaries of respect). In a declaration that stands up as a positive affirmation of consent under British and American law, Sophie announces: “I want one of your many selves to sleep with me tonight.”From a freshly bruised eye socket, Sophie lovingly stares at Pine. Extra-diegetic strings instruct us that the moment is romantic. Pine strokes the (unbruised side) side of her face. Could her question “why do you sit so far away?” have been a request that he sit near her, place an arm around her shoulder, hold her hand, stroke her forehead, perhaps even tend to her wounds? Might the request that he “sleep with [her] tonight” have been a request that he sleep in the cottage, albeit on the floor?Sophie and Pine are subsequently displayed naked, limbs entangled. A new shot, a close-up of the right side of her face, displays a scab atop her eyebrow, a deeply bruised eye socket, further bruises down her cheeks, and a split lip. The muscular, broad Pine is atop Sophie and thrusting; Sophie’s split lip smiles in ecstasy and gratitude. A post-coital shot follows: she stares lovingly down at him with her facial injuries on full display, her dark eyes stare into his lucid green. Pine asks Sophie’s “real name”. Samira recounts that she changed her name to Sophie in order to “be more Western”. The power inequality is manifest on gendered, cultural, social, and physical lines: in order to advance her social position, Samira has sought to Anglicise herself and partnered with a violent (though influential) criminal (who has recently brutalised her). Her life is in danger, she is (depicted as) dark and foreign and ostensibly has no social or support network (is isolated enough to appeal to a hotel manager for help). Meanwhile, Pine is Western university-educated, a spectacle of white male athletic privilege, and has elite connections with British intelligence.Catharine MacKinnnon argues that consent is only a meaningful option if the parties are equally powerful (174). Sophie’s extreme vulnerability renders their situations patently unequal. As MacKinnon argues “when perspective is bound up with situation, and [that] situation is unequal, whether or not a contested interaction is authoritatively considered rape comes down to whose meaning wins” (182). I do not argue that Pine rapes Sophie per se. However, the revealing of Sophie’s injuries efficiently articulates the power inequality in their situations and thus problematises a straightforward assumption of her consent. MacKinnon’s argues that rape occurs “somewhere between” the following three factors (182). First, “what the woman actually wanted” (Sophie wanted to save the lives of others (by foiling an arms deal) and not die for the breach). Second, “what she was able to express about what she wanted” (class/gender/race power dynamics may have frustrated Sophie’s ability to articulate her needs and might have motivated her sexually suggestive tenor). Third, “what the man comprehended she wanted” (Pine assumes that Sophie, like all women, sexually desire him).Analysis of Jed and Pine’s InteractionsThe injustice of Pine and Sophie’s sexual encounter finds its counterpart in Pine’s sexual encounter with Jed in the final episode of the series (“Episode Six”). Roper discovers that Jed has given a third party (Pine and his colleagues) access to his private (incriminating) files. Roper instructs his henchman to torture Jed until she identifies this third party. The henchman holds Jed by the back of her neck and dunks her head repeatedly into bathwater. The camera reveals deep bruises on her arms. Jed refuses to identify her beloved (Pine) as the ‘rat’, yet the astute Roper nevertheless surmises “you must care deeply about the person you are protecting”.Alas, the dominant narrative must go on: Roper and Pine attend to an arms deal; the deal fails because Pine has set Roper up to appear as though he has robbed the buyers (and so on). Burr and Pine’s mission to “bring down” Roper has been completed. I keep wondering what Roper’s henchman has been doing to Jed during this “men’s business”. Alas, after Pine has completed the job, we encounter Jed again. She is in bed, her limbs entangled with Pine’s. The camera positioning and shot sequencing are almost identical to the sex scene between Pine and Sophie in “Episode One”. A medium close-up from the left reveals Pine thrusting atop Jed. Through pale moonlight the viewer discerns injures on Jed’s face and chin.The morning after this (brief) sex scene, Pine and Jed discuss her imminent departure (“home” to New York, to be reunited with her son). Debicki’s performance is tremendously tender: her lip trembles, her voice shakes as she swallows tears. Jed is sad because she is bidding Pine farewell, and, as she verbalises to Pine, she is nervous about whether her son will “recognise her”. Does Jed’s torture also give her grounds to weep and tremble? Ever a gentleman, Pine clasps her hand, and while marching her to her taxi, we see more bruises atop her left arm.I am also not arguing that Pine raped Jed. Yet given what Jed had endured earlier that day – torture by drowning, as commissioned and witnessed by her own partner – was sexual intercourse what she desired or needed? The visibility of Jed’s injuries throughout the sex scene marks an apotheosis of patriarchal entitlement. Might a fraternal or (even remedial) touch have been Pine’s first priority? Does Jed need a hug? Does she need ice? Had Pine been educated or socialised in a different tradition, one remotely attuned to what anyone might need after a disastrously traumatic and violent event, he might not have found penetrative sex an appropriate remedy. Pine’s absolute security in his own sexual desirability meant that he found the activity suitable, yet her injuries break my blind faith in his sexiness. I wish to raise the possibility that intercourse after this event might have compounded the violent events Jed endured that day. Contrary to the narrative’s implication, penetrative intercourse (even with Tom Hiddleston) might not heal Sophie or Jed’s wounds.ConclusionI am not a humourless feminist immune to the entertaining (and often entertainingly preposterous) dimensions of the spy and action genre. In fact, I enthusiastically await subsequent screen adaptations of le Carré’s work and the next Bond instalment. This is not a call to “cancel” a genre, text, director or writer. Biblically, a “revelation” has always instructed humans on how to live in this life. These sex scenes do not merely lay bare extreme patriarchal entitlement but might instruct directors and writers working within the genre to keep wounds, and wounded women, out of their sex scenes. I think that is a modest request. ReferencesAgger, Gunhild. “Geopolitical Location and Plot in The Night Manager.” Journal of Scandinavian Cinema 7 (2017): 27-42.Allen, Virginia. The Femme Fatale: Erotic Icon. Troy, New York: The Whitston Publishing Company, 1983.Aronoff, Myron. The Spy Novels of John le Carré: Balancing Ethics and Politics. New York: St. Martin’s, 1999.Barley, Tony. Taking Sides: The Fiction of John le Carré. Philadelphia: Open U, 1986.Boedeker, Hal. “‘Night Manager’: Check in for Tom Hiddleston.” Orlando Sentinel, 16 Apr. 2016. 7 June 2020 <https://www.orlandosentinel.com/entertainment/tv-guy/os-night-manager-check-in-for-tom-hiddleston-20160416-story.html>.Bruccoli, Matthew, and Judith Baughman. Conversations with John le Carré. Oxford: U of Mississippi P, 2004.Cobbs, John. Understanding John le Carré. Columbia: U of South Carolina P, 1998.D’arcy, Geraint. “‘Essentially, Another Man’s Woman’: Information and Gender in the Novel and Adaptations of John le Carré’s Tinker Tailor Soldier Spy.” Adaptation 7.3 (2014): 275-90.Funnell, Lisa, and Klaus Dodds. Geographies, Genders and Geopolitics of James Bond. London: Palgrave Macmillan, 2017.Flynn, Caitlin. “Who Is Sophie on ‘The Night Manager’? Aure Atika’s Character Will Drive the Thriller.” Bustle, 20 Apr. 2016. 7 June 2020 <https://www.bustle.com/articles/155498-who-is-sophie-on-the-night-manager-aure-atikas-character-will-drive-the-thriller>. Goodman, Tim. “Critic's Notebook: 'The Night Manager' Glosses over Its Flaws with Beauty and Talent.” Hollywood Reporter, 28 Apr. 2016. 7 June 2020 <https://www.hollywoodreporter.com/bastard-machine/critics-notebook-night-manager-glosses-888648>.Harvey, Sylvia. “Woman’s Place: The Absent Family of Film Noir.” Women in Film Noir. Ed. E. Ann Kaplan. London: British Film Institute, 1980. 30-38.Jackson, Emily. “Catharine MacKinnon and Feminist Jurisprudence: A Critical Appraisal.” Journal of Law and Society 19.2 (1992): 195-213.Jensen, Jeff. “‘The Night Manager’: EW Review.” Entertainment Weekly, 14 Apr. 2016. 7 June 2020 <https://ew.com/article/2016/04/14/the-night-manager-review/>. Kaplan, E. Ann. “Introduction.” Women in Film Noir. Ed. E. Ann Kaplan. London: British Film Institute, 1980. 1-5.Lamont, Tom. “Elizabeth Debicki: ‘We Fought about How Sexy I Should Be’.” The Guardian, 8 Oct. 2016. 7 June 2020 <https://www.theguardian.com/tv-and-radio/2016/oct/08/elizabeth-debicki-fought-a-lot-how-sexy-should-be-the-night-manager>. Lewis, Peter. John le Carré. New York: Ungar, 1985.MacKinnon, Catharine. Towards a Feminist Theory of the State. Cambridge: Harvard UP, 1989.Milton, John. Paradise Lost. Eds. Mary Waldrep and Susan Rattiner. United States: Dover Publications, 2005.Monaghan, David. The Novels of John le Carré: The Art of Survival. Oxford: Basil Blackwell, 1985.———. Smiley’s Circus: A Guide to the Secret World of John le Carré. New York: St. Martin’s, 1986.Morgan, Eric. “Whores and Angels of Our Striving Selves: The Cold War Films of John le Carré, Then and Now.” Historical Journal of Film, Radio and Television 36.1 (2016): 88-103.Mulvey, Laura. “Visual Pleasure and the Narrative Cinema.” Film Theory and Criticism: Introductory Readings. Eds. Leo Braudy and Marshall Cohen. New York: Oxford UP, 1999. 833-44.The Night Manager. Dir. S. Bier. Screenplay D. Farr. UK/USA: BBC and AMC, 2016.Rees, Jasper. “The Night Manager, Episode 1: Brilliant Event Drama.” The Telegraph, 20 Apr. 2016. 2 June 2020 <http://www.telegraph.co.uk/tv/2016/02/19/the-night-manager-episode-1-event-drama-of-the-highest-calibre/>.Scheppele, Kim. “The Reasonable Woman.” The Responsive Community, Rights and Responsibilities 1.4 (1991): 36–47.Tasker, Yvonne. Working Girls: Gender and Sexuality in Popular Cinema. London: Routledge, 1998.———. “Women in Film Noir.” A Companion to Film Noir. Eds. Andrew Spicer and Helen Hanson. Chichester: Wiley-Blackwell, 2013. 353-68.Sauerberg, Lars Ole. Secret Agents in Fiction. London: Macmillan, 1984.Webb, Claire. “Where to Find the Plush Hotels and Lush Locations in The Night Manager”. Radio Times, 21 Feb. 2016. 2 June 2020 <http://www.radiotimes.com/ news/2016-02-21/where-to-find-the-plush-hotels-and-lush-locations-inthe-night-manager>.Wolfe, Peter. Corridors of Deceit: The World of John le Carré. Madison, WI: Popular P, 1987.

Hundreds of thousands of Australian children were born in the shadow of the Great War, fathered by men who had enlisted between 1914 and 1918. Their lives could be and often were hard and unhappy, as Anzac historian Alistair Thomson observed of his father’s childhood in the 1920s and 1930s. David Thomson was son of a returned serviceman Hector Thomson who spent much of his adult life in and out of repatriation hospitals (257-259) and whose memory was subsequently expunged from Thomson family stories (299-267). These children of trauma fit within a pattern suggested by Marianne Hirsch in her influential essay “The Generation of Postmemory”. According to Hirsch, “postmemory describes the relationship of the second generation to powerful, often traumatic, experiences that preceded their births but that were nevertheless transmitted to them so deeply as to seem to constitute memories in their own right” (n.p.). This article attempts to situate George Johnston’s novel My Brother Jack (1964) within the context of postmemory narratives of violence that were complicated in Australia by the Anzac legend which occluded any too open discussion about the extent of war trauma present within community, including the children of war.“God knows what damage” the war “did to me psychologically” (48), ponders Johnston’s protagonist and alter-ego David Meredith in My Brother Jack. Published to acclaim fifty years after the outbreak of the First World War, My Brother Jack became a widely read text that seemingly spoke to the shared cultural memories of a generation which did not know battlefield violence directly but experienced its effects pervasively and vicariously in the aftermath through family life, storytelling, and the memorabilia of war. For these readers, the novel represented more than a work of fiction; it was a touchstone to and indicative of their own negotiations though often unspoken post-war trauma.Meredith, like his creator, is born in 1912. Strictly speaking, therefore, both are not part of the post-war generation. However, they are representative and therefore indicative of the post-war “hinge generation” which was expected to assume “guardianship” of the Anzac Legend, though often found the narrative logic challenging. They had been “too young for the war to have any direct effect”, and yet “every corner” of their family’s small suburban homes appear to be “impregnated with some gigantic and sombre experience that had taken place thousands of miles away” (17).According to Johnston’s biographer, Garry Kinnane, the “most teasing puzzle” of George Johnston’s “fictional version of his childhood in My Brother Jack is the monstrous impression he creates of his returned serviceman father, John George Johnston, known to everyone as ‘Pop.’ The first sixty pages are dominated by the tyrannical figure of Jack Meredith senior” (1).A large man purported to be six foot three inches (1.9 metres) in height and weighing fifteen stone (95 kilograms), the real-life Pop Johnston reputedly stood head and shoulders above the minimum requirement of five foot and six inches (1.68 metres) at the time of his enlistment for war in 1914 (Kinnane 4). In his fortieth year, Jack Johnston senior was also around twice the age of the average Australian soldier and among one in five who were married.According to Kinnane, Pop Johnston had “survived the ordeal of Gallipoli” in 1915 only to “endure three years of trench warfare in the Somme region”. While the biographer and the Johnston family may well have held this to be true, the claim is a distortion. There are a few intimations throughout My Brother Jack and its sequel Clean Straw for Nothing (1969) to suggest that George Johnston may have suspected that his father’s wartime service stories had been embellished, though the depicted wartime service of Pop Meredith remains firmly within the narrative arc of the Anzac legend. This has the effect of layering the postmemory violence experienced by David Meredith and, by implication, his creator, George Johnston. Both are expected to be keepers of a lie masquerading as inviolable truth which further brutalises them.John George (Pop) Johnston’s First World War military record reveals a different story to the accepted historical account and his fictionalisation in My Brother Jack. He enlisted two and a half months after the landing at Gallipoli on 12 July 1915 and left for overseas service on 23 November. Not quite the imposing six foot three figure of Kinnane’s biography, he was fractionally under five foot eleven (1.8 metres) and weighed thirteen stone (82.5 kilograms). Assigned to the Fifth Field Engineers on account of his experience as an electric tram fitter, he did not see frontline service at Gallipoli (NAA).Rather, according to the Company’s history, the Fifth Engineers were involved in a range of infrastructure and support work on the Western Front, including the digging and maintenance of trenches, laying duckboard, pontoons and tramlines, removing landmines, building huts, showers and latrines, repairing roads, laying drains; they built a cinema at Beaulencourt Piers for “Brigade Swimming Carnival” and baths at Malhove consisting of a large “galvanised iron building” with a “concrete floor” and “setting tanks capable of bathing 2,000 men per day” (AWM). It is likely that members of the company were also involved in burial details.Sapper Johnston was hospitalised twice during his service with influenza and saw out most of his war from October 1917 attached to the Army Cookery School (NAA). He returned to Australia on board the HMAT Kildonian Castle in May 1919 which, according to the Sydney Morning Herald, also carried the official war correspondent and creator of the Anzac legend C.E.W. Bean, national poet Banjo Paterson and “Warrant Officer C G Macartney, the famous Australian cricketer”. The Herald also listed the names of “Returned Officers” and “Decorated Men”, but not Pop Johnston who had occupied the lower decks with other returning men (“Soldiers Return”).Like many of the more than 270,000 returned soldiers, Pop Johnston apparently exhibited observable changes upon his repatriation to Australia: “he was partially deaf” which was attributed to the “constant barrage of explosions”, while “gas” was suspected to have “left him with a legacy of lung disorders”. Yet, if “anyone offered commiserations” on account of this war legacy, he was quick to “dismiss the subject with the comment that ‘there were plenty worse off’” (Kinnane 6). The assumption is that Pop’s silence is stoic; the product of unspeakable horror and perhaps a symptom of survivor guilt.An alternative interpretation, suggested by Alistair Thomson in Anzac Memories, is that the experiences of the vast majority of returned soldiers were expected to fit within the master narrative of the Anzac legend in order to be accepted and believed, and that there was no space available to speak truthfully about alternative war service. Under pressure of Anzac expectations a great many composed stories or remained selectively silent (14).Data gleaned from the official medical history suggest that as many as four out of every five returned servicemen experienced emotional or psychological disturbance related to their war service. However, the two branches of medicine represented by surgeons and physicians in the Repatriation Department—charged with attending to the welfare of returned servicemen—focused on the body rather than the mind and the emotions (Murphy and Nile).The repatriation records of returned Australian soldiers reveal that there were, indeed, plenty physically worse off than Pop Johnston on account of bodily disfigurement or because they had been somatically compromised. An estimated 30,000 returned servicemen died in the decade after the cessation of hostilities to 1928, bringing the actual number of war dead to around 100,000, while a 1927 official report tabled the medical conditions of a further 72,388 veterans: 28,305 were debilitated by gun and shrapnel wounds; 22,261 were rheumatic or had respiratory diseases; 4534 were afflicted with eye, ear, nose, or throat complaints; 9,186 had tuberculosis or heart disease; 3,204 were amputees while only; 2,970 were listed as suffering “war neurosis” (“Enlistment”).Long after the guns had fallen silent and the wounded survivors returned home, the physical effects of war continued to be apparent in homes and hospital wards around the country, while psychological and emotional trauma remained largely undiagnosed and consequently untreated. David Meredith’s attitude towards his able-bodied father is frequently dismissive and openly scathing: “dad, who had been gassed, but not seriously, near Vimy Ridge, went back to his old job at the tramway depot” (9). The narrator-son later considers:what I realise now, although I never did at the time, is that my father, too, was oppressed by intimidating factors of fear and change. By disillusion and ill-health too. As is so often the case with big, strong, athletic men, he was an extreme hypochondriac, and he had convinced himself that the severe bronchitis which plagued him could only be attributed to German gas he had swallowed at Vimy Ridge. He was too afraid to go to a doctor about it, so he lived with a constant fear that his lungs were decaying, and that he might die at any time, without warning. (42-3)During the writing of My Brother Jack, the author-son was in chronically poor health and had been recently diagnosed with the romantic malady and poet’s disease of tuberculosis (Lawler) which plagued him throughout his work on the novel. George Johnston believed (correctly as it turned out) that he was dying on account of the disease, though, he was also an alcoholic and smoker, and had been reluctant to consult a doctor. It is possible and indeed likely that he resentfully viewed his condition as being an extension of his father—vicariously expressed through the depiction of Pop Meredith who exhibits hysterical symptoms which his son finds insufferable. David Meredith remains embittered and unforgiving to the very end. Pop Meredith “lived to seventy-three having died, not of German gas, but of a heart attack” (46).Pop Meredith’s return from the war in 1919 terrifies his seven-year-old son “Davy”, who accompanies the family to the wharf to welcome home a hero. The young boy is unable to recall anything about the father he is about to meet ostensibly for the first time. Davy becomes overwhelmed by the crowds and frightened by the “interminable blaring of horns” of the troopships and the “ceaseless roar of shouting”. Dwarfed by the bodies of much larger men he becomestoo frightened to look up at the hours-long progression of dark, hard faces under wide, turned-up hats seen against bayonets and barrels that are more blue than black ... the really strong image that is preserved now is of the stiff fold and buckle of coarse khaki trousers moving to the rhythm of knees and thighs and the tight spiral curves of puttees and the thick boots hammering, hollowly off the pier planking and thunderous on the asphalt roadway.Depicted as being small for his age, Davy is overwrought “with a huge and numbing terror” (10).In the years that follow, the younger Meredith desires emotional stability but remains denied because of the war’s legacy which manifests in the form of a violent patriarch who is convinced that his son has been rendered effeminate on account of the manly absence during vital stages of development. With the return of the father to the household, Davy grows to fear and ultimately despise a man who remains as alien to him as the formerly absent soldier had been during the war:exactly when, or why, Dad introduced his system of monthly punishments I no longer remember. We always had summary punishment, of course, for offences immediately detected—a cuffing around the ears or a sash with a stick of a strap—but Dad’s new system was to punish for the offences which had escaped his attention. So on the last day of every month Jack and I would be summoned in turn to the bathroom and the door would be locked and each of us would be questioned about the sins which we had committed and which he had not found out about. This interrogation was the merest formality; whether we admitted to crimes or desperately swore our innocence it was just the same; we were punished for the offences which, he said, he knew we must have committed and had to lie about. We then had to take our shirts and singlets off and bend over the enamelled bath-tub while he thrashed us with the razor-strop. In the blind rages of these days he seemed not to care about the strength he possessed nor the injuries he inflicted; more often than not it was the metal end of the strop that was used against our backs. (48)Ironically, the ritualised brutality appears to be a desperate effort by the old man to compensate for his own emasculation in war and unresolved trauma now that the war is ended. This plays out in complicated fashion in the development of David Meredith in Clean Straw for Nothing, Johnston’s sequel to My Brother Jack.The imputation is that Pop Meredith practices violence in an attempt to reassert his failed masculinity and reinstate his status as the head of the household. Older son Jack’s beatings cease when, as a more physically able young man, he is able to threaten the aggressor with violent retaliation. This action does not spare the younger weaker Davy who remains dominated. “My beating continued, more ferociously than ever, … . They ceased only because one day my father went too far; he lambasted me so savagely that I fell unconscious into the bath-tub, and the welts across my back made by the steel end of the razor-strop had to be treated by a doctor” (53).Pop Meredith is persistently reminded that he has no corporeal signifiers of war trauma (only a cough); he is surrounded by physically disabled former soldiers who are presumed to be worse off than he on account of somatic wounding. He becomes “morose, intolerant, bitter and violently bad-tempered”, expressing particular “displeasure and resentment” toward his wife, a trained nurse, who has assumed carer responsibilities for homing the injured men: “he had altogether lost patience with her role of Florence Nightingale to the halt and the lame” (40). Their marriage is loveless: “one can only suppose that he must have been darkly and profoundly disturbed by the years-long procession through our house of Mother’s ‘waifs and strays’—those shattered former comrades-in-arms who would have been a constant and sinister reminder of the price of glory” (43); a price he had failed to adequately pay with his uncompromised body intact.Looking back, a more mature David Meredith attempts to establish order, perspective and understanding to the “mess of memory and impressions” of his war-affected childhood in an effort to wrest control back over his postmemory violation: “Jack and I must have spent a good part of our boyhood in the fixed belief that grown-up men who were complete were pretty rare beings—complete, that is, in that they had their sight or hearing or all of their limbs” (8). While the father is physically complete, his brooding presence sets the tone for the oppressively “dark experience” within the family home where all rooms are “inhabited by the jetsam that the Somme and the Marne and the salient at Ypres and the Gallipoli beaches had thrown up” (18). It is not until Davy explores the contents of the “big deep drawer at the bottom of the cedar wardrobe” in his parents’ bedroom that he begins to “sense a form in the shadow” of the “faraway experience” that had been the war. The drawer contains his father’s service revolver and ammunition, battlefield souvenirs and French postcards but, “most important of all, the full set of the Illustrated War News” (19), with photographs of battlefield carnage. These are the equivalent of Hirsch’s photographs of the Holocaust that establish in Meredith an ontology that links him more realistically to the brutalising past and source of his ongoing traumatistion (Hirsch). From these, Davy begins to discern something of his father’s torment but also good fortune at having survived, and he makes curatorial interventions not by becoming a custodian of abjection like second generation Holocaust survivors but by disposing of the printed material, leaving behind artefacts of heroism: gun, the bullets, the medals and ribbons. The implication is that he has now become complicit in the very narrative that had oppressed him since his father’s return from war.No one apparently notices or at least comments on the removal of the journals, the images of which become linked in the young boys mind to an incident outside a “dilapidated narrow-fronted photographer’s studio which had been deserted and padlocked for as long as I could remember”. A number of sun-damaged photographs are still displayed in the window. Faded to a “ghostly, deathly pallor”, and speckled with fly droppings, years earlier, they had captured young men in uniforms before embarkation for the war. An “agate-eyed” boy from Davy’s school joins in the gazing, saying nothing for a long time until the silence is broken: “all them blokes there is dead, you know” (20).After the unnamed boy departs with a nonchalant “hoo-roo”, young Davy runs “all the way home, trying not to cry”. He cannot adequately explain the reason for his sudden reaction: “I never after that looked in the window of the photographer’s studio or the second hand shop”. From that day on Davy makes a “long detour” to ensure he never passes the shops again (20-1). Having witnessed images of pre-war undamaged young men in the prime of their youth, he has come face-to-face with the consequences of war which he is unable to reconcile in terms of the survival and return of his much older father.The photographs of the young men establishes a causal connection to the physically wrecked remnants that have shaped Davy’s childhood. These are the living remains that might otherwise have been the “corpses sprawled in mud or drowned in flooded shell craters” depicted in the Illustrated News. The photograph of the young men establishes Davy’s connection to the things “propped up our hallway”, of “Bert ‘sobbing’ in the backyard and Gabby Dixon’s face at the dark end of the room”, and only reluctantly the “bronchial cough of my father going off in the dawn light to the tramways depot” (18).That is to say, Davy has begun to piece together sense from senselessness, his father’s complicity and survival—and, by association, his own implicated life and psychological wounding. He has approached the source of his father’s abjection and also his own though he continues to be unable to accept and forgive. Like his father—though at the remove—he has been damaged by the legacies of the war and is also its victim.Ravaged by tuberculosis and alcoholism, George Johnston died in 1970. According to the artist Sidney Nolan he had for years resembled the ghastly photographs of survivors of the Holocaust (Marr 278). George’s forty five year old alcoholic wife Charmian Clift predeceased him by twelve months, having committed suicide in 1969. Four years later, in 1973, George and Charmian’s twenty four year old daughter Shane also took her own life. Their son Martin drank himself to death and died of organ failure at the age of forty three in 1990. They are all “dead, you know”.ReferencesAWM. Fifth Field Company, Australian Engineers. Diaries, AWM4 Sub-class 14/24.“Enlistment Report”. Reveille, 29 Sep. 1928.Hirsch, Marianne. “The Generation of Postmemory.” Poetics Today 29.1 (Spring 2008): 103-128. <https://read.dukeupress.edu/poetics-today/article/29/1/103/20954/The-Generation-of-Postmemory>.Johnston, George. Clean Straw for Nothing. London: Collins, 1969.———. My Brother Jack. London: Collins, 1964.Kinnane, Garry. George Johnston: A Biography. Melbourne: Nelson, 1986.Lawler, Clark. Consumption and Literature: the Making of the Romantic Disease. Basingstoke: Palgrave Macmillan, 2006.Marr, David, ed. Patrick White Letters. Sydney: Random House, 1994.Murphy, Ffion, and Richard Nile. “Gallipoli’s Troubled Hearts: Fear, Nerves and Repatriation.” Studies in Western Australian History 32 (2018): 25-38.NAA. John George Johnston War Service Records. <https://recordsearch.naa.gov.au/SearchNRetrieve/Interface/ViewImage.aspx?B=1830166>.“Soldiers Return by the Kildonan Castle.” Sydney Morning Herald, 10 May 1919: 18.Thomson, Alistair. Anzac Memories: Living with the Legend. Clayton: Monash UP, 2013.