Salient Features of India constitution especially power and functions
Irritable Heart: Smithsonian National Museum of American History Colloquium Slides 8/19/14
1. Soldier’s Heart, Irritable Heart:
The Psychological and Physiological
Origins of Civil War Trauma
Ashley Bowen-Murphy, MA
Doctoral Candidate
American Studies & Public Humanities
Brown University
August 19, 2014
2. Today
• Terminology and theory
• Revisiting the diagnosis “Soldier’s Heart.”
• Dr. Jacob M. Da Costa
• Symptoms and diagnostic techniques
• Chronology
• How did soldiers experience this diagnosis?
• Why does it matter?
• Future directions
• Comments & questions
Aloe’s Illustrated and Priced Catalogue of Superior Surgical Instruments, Physicians Supplies,
and Hospital Furnishings. 6th ed. St. Louis, MO: A.S. Aloe Company, 1893c. Page 584.
3. Terminology
“Soldier’s heart” not used to
refer to the disorder until
roughly World War I.
• irritable heart
• Da Costa Syndrome
• Cardiac muscular exhaustion
• effort syndrome
• soldier’s heart
• neurocirculatory asthenia
… and more.
Da Costa, JM. “On Irritable Heart: A Clinical Study of a Form of Functional
Cardiac Disorder and Its Consequences.”
The American Journal of the Medical Sciences
61, no. 121 (January 1871): 17–52.
5. Theoretical Orientation
Winslow Homer’s “Our Watering Places – The Empty Sleeve at Newport” published in Harper’s Weekly 26 August 1865.
Women’s &
Gender Studies
Disability Studies
6. Dr. Jacob Mendez Da Costa
• Born in 1833 in St. Thomas, West Indies.
• Graduates from Jefferson Medical College
in 1852.
• Student of Dr. T.D. Mütter at Jefferson
Medical College.
• Marries Sarah Brinton, Dr. John Hill
Brinton’s sister.
• Initial reports on exhausted hearts in 1862
and 1864.
• Medical Diagnosis published in 1864, goes
through 9 editions!
• “On Irritable Heart” published in 1871.
• Delivers the Smithsonian Institution’s
Toner Lecture in 1874.
• Referenced in Medical & Surgical History of
the War of the Rebellion.
• Returns to Philadelphia to teach and
manage medical associations/institutions.
Undated portrait of Dr. Da Costa. Image courtesy of the
College of Physicians of Philadelphia.
7. Joseph Henry to Jacob M. Da Costa, May 17, 1876.
Record Unit 7001, Box 4a, Folder 3.
Smithsonian Institution Archives.
8. Da Costa’s Work at Turner’s Lane
US Army Hospital at Turner’s Lane, Philadelphia, c. 1863. Image courtesy of Images from the History of Medicine (NLM).
• Da Costa works as an “acting assistant surgeon”
• Cardiac patients are concentrated in one ward at Turner’s Lane
• Cooperates with S. Weir Mitchell
• 300 (approx) patients form the core of his study
9. Dr. Morse K. Taylor
Letter from Dr. Morse K. Taylor to
Dr. Ira Bartholomew dated Feb. 13, 1886:
“Note, in looking over the foregoing the thought
has struck me that it might seem that I wished to
antagonize Dr. Da Costa. If so I wish to disclaim
any such purpose. We were working
simultaneously in the same direction unknown to
each other ... we stood on equal footing.
To this extent, however, I do claim precedence;
viz; thus I was the first to bring the subject to the
notice of the profession. In proof of this I not only
refer to my letter to the Surgeon General in 1864
but to my paper read before the American
Medical Association…”
HM 80479. The Huntington Library, San Marino, CA.
10. What is Irritable Heart?
Undated portrait of Dr. Da Costa. Image courtesy of
Images from the History of Medicine (NLM)
• Functional disorder of the heart
• Most common heart disorder
• Rarely lethal
• Treatment consisted of
• rest
• mild diet
• sometimes aconite or digitalis
• Lengthy recovery period
• Not unique to Civil War
• Could evolve into hypertrophy (an
organic disease)
11. “There is another form of functional disorder of
the heart, so peculiar as to demand a special
notice. It is the curious cardiac malady of which
we lately saw so many examples in soldiers. Its
main symptoms are…”
• Habitual frequency of the action of the heart
• Attacks of palpitation
• Pain, often nowhere else but the heart
• Headache and dizziness
• Rapid action of the heart (100-140 bpm)
• Irregular heartbeat
Symptoms
12. Diagnosis
Wooden, monauaral stethoscope (302606.003)
“When the hand is applied to the
praecordial region [chest], it may note the
quick impulse happening in a regular
manner, or it takes cognizance of the
irregularity of rhythm of irritable organ.
Further, it may at times perceive the two
sounds of the heart; feel them as it were…
On listening to the heart, the first sound is
found to be lacking in volume, feeble or
short and valvular, and just like the second
sound…
- Dr. J.M. Da Costa
“On Irritable Heart,” p. 26
13. Da Costa’s Autophonic
Stethoscope
• Da Costa proposed the design in winter 1886.
• By 1887 it was on the market.
• Sold for about $3 in 1899.
• Conical insert increases loudness and definition of
sound.
• In October 1887, a “commercial news” item in the
Medical Bulletin praises it as, “the best instrument
in the market.”
Aloe’s Illustrated and Priced Catalogue of Superior Surgical Instruments, Physicians Supplies,
and Hospital Furnishings. 6th ed. St. Louis, MO: A.S. Aloe Company, 1893c. Page 584.
14. Causes
“Irritable heart appears to have
been a result of active field
service. It is true, cases were
attributed to the drills.. Effected
under the full burden of arms and
accouterments… but the greater
number dated from some over
action of the heart during a
particular battle or campaign…
Over action of the heart was due
perhaps as much to nervous
excitement and anticipation of
danger as to overexertion…”
Medical & Surgical History
of the War of the Rebellion
Union soldiers entrenched along the west bank of the
Rappahannock River at Fredericksburg, Virginia. Photographed by
Andrew Russell in April or May 1863.
Image via the Library of Congress Prints and Photographs Division
(LC-DIG-ppmsca-34476).
15. Causes
Contributing factors:
• Fever, typhoid, or diarrhea
• Exposure
• Poor diet
• Excessive marching
• Hard service
• Poor equipment
• Age 16-25
• Pre-war heart troublesUnion soldiers entrenched along the west bank of the
Rappahannock River at Fredericksburg, Virginia. Photographed by
Andrew Russell in April or May 1863.
Image via the Library of Congress Prints and Photographs Division
(LC-DIG-ppmsca-34476).
16. Example Case
"The man, a private in Company B, 187th Pennsylvania Volunteers,
had been an active farmer before enlisting in January, 1864. He never
had had a severe disease, never acute rheumatism... He did hard duty
until the 28th of August, 1864, participating in all the marches south
of the Rapidan, and was in most of the battles and skirmishes which
occurred.
He was found to possess aortic insufficiency marked to a high degree,
and though he attributed the cardiac complaint chiefly to heavy
marching and to the weight of the cartridges, he also mentioned
having had something like an acute seizure... In spite of this, he did
more or less duty for two or three months, until he was sent to the
Cuyler Hospital, and he was thence transferred for special treatment
to my wards in Philadelphia."
- Dr. Da Costa, 1867
18. Psychological Factors
"The heart has important and direct relations to the brain and it
is very likely that just as disturbances of the vagus innervations
are responsible for the raptus melancholicus-- in other words just
as a disordered state of the brain reacts on itself through the
medium of the functional cardiac influence it produces-- so a
valvular lesion may directly influence the emotional states
without pre-existing brain trouble... It is a fact that patients
suffering from cardiac lesions are more likely to develop anxious
and suspicious delusions than those of an opposite nature.”
J.G. Kiernan, “Insanity and Cardiac Disease.”
American Journal of Neurology and Psychiatry 3 (1884): 34.
19. Heart & Mind
Marey type Sphigmograph and tracing (M2382), produced by Breguet, 1866-1900.
“The opinion of those who have
maintained the scientific
importance of pulse-tracings in
mental disorders is more than
justified.”
- Dr. T. Duncan Greenless, 1887
20. Pension Records as Patient Narrative
“The recording of a case in the medical record, a seemingly
innocuous means of description, is in fact a profound, ritual
act of transformation through which illness is made over into
disease, person becomes patient, and professional values are
transferred from the practitioner to the ‘case.’ Through this
act of writing up a patient account, the practitioner turns the
sick person as a subject into an object first of a professional
inquiry and eventually of manipulation. The patient’s record is
an official account, in the language of biomedicine, that has
legal and bureaucratic significance”
Arthur Kleinman, The Illness Narratives: Suffering, Healing, and
the Human Condition (New York: Basic Books, 1988) 130-131.
21. “I enlisted at Springfield Ills. I was examined
thoroughly at enlistment in fact I was
examined twice: the first time I was
examined by a single surgeon; he did not
tell me the result of the examination; a day
or two afterwards I was subjected to a more
through examination by a board of three
surgeons and was pronounced sound and
healthy…”
Deposition of John Murray,
private Co F, 57 Illinois Infantry
August 2, 1888.
22. “He says it feels as though his heart
stopped-- his lips became numb and
he feels as though he should fall...
Last winter during one of his violent
attacks of palpitation his left eye
became almost blind and he has had
trouble with it ever since... He is able
to do only the lightest work and that
only a part of the time. He cannot
sleep on his back - heart dis. We find a
very rapid pulse-- heart's action
irregular, neither sound is distinct, nor
is there a murmur to be detected.
There is a general muscular tremor
from weakness...”
Surgeon Certificate for Leonard Hunt,
Private Co C, 4th RI Infantry
Dated June 6, 1883.
23. "I have a gripping pain around
my heart. a dull ache in my left
side and across the small of my
back, a cold heavy weight across
the upper part of my stomach,
dizzy and fainting spells with a
tired all time feeling, with a
cough and shortness of breath.”
Private James Dennis,
Company K, 2 RI Infantry
6 Feb 1888
24. “Prior to enlistment he was a sound,
hearty man… he worked early and late…
there never was any thing the matter
with him before he enlisted… The first I
noticed anything wrong with him was
the day after he came home from the
army... From that time on he appeared
restless and uneasy more or less every
day and night… [page 1]
I had washed him and shaved him
before the war, but not because he was
unable to do it. The third day after he
came home I shaved him. I was afraid to
have him try it. I do not know who
shaved him before. He did not attempt
to shave himself after coming home. I do
not think he ever did. The second or third
day I noticed his hands tremble eating…
Sophia Fife, wife of private Jacob Fife
of Co B, 1st Ohio Cavalry,
deposition dated December 15, 1885
25. Why does it matter?
Image via the Veterans’ Administration website
“Trauma exposure by itself, even
when PTSD doesn't develop, may
also raise the risk of heart disease.”
- VA Research Currents
28 Feb. 2014
26. Future Directions
• Irritability as a concept
• Freud and anxiety disorders
• Hearts in American life
• Transition from heart to mind
• Emotions history
• Racial disparities
• Sentimentality
• Malingering
• World War I
D.W. Kellogg & Co. A Map of the Fortified Country of Man’s Heart.
Lithograph, 1830-1840. Connecticut Historical Society Museum &
Library.
28. Selected Bibliography
Anderson, David. “Dying of Nostalgia: Homesickness in the Union Army during the Civil War.” Civil War History 56, no. 3 (2010): 247–82.
Anderson, Julie, and Lisa O’Sullivan. “Histories of Disability and Medicine: Reconciling Historical Narratives and Contemporary Values.” In Re-
Presenting Disability: Activism and Agency in the Museum, edited by Richard Sandell, Jocelyn Dodd, and Rosemarie Garland-Thomson, 143–
54. New York: Routledge, 2010.
Berry, Stephen William. “The Historian as Death Investigator.” In Weirding the War : Stories from the Civil War’s Ragged Edges, 176–88.
Uncivil Wars. Athens, GA: University of Georgia Press, 2011.
Dean, Eric T. Shook Over Hell : Post-Traumatic Stress, Vietnam, and the Civil War. Harvard University Press,, 1997.
Dror, Otniel E. “Afterword: A Reflection on Feelings and the History of Science.” Isis 100, no. 4 (December 1, 2009): 848–51.
Jones, Edgar. “Historical Approaches to Post-Combat Disorders.” Philosophical Transactions: Biological Sciences 361, no. 1468 (April 29, 2006):
533–42.
———, and Simon Wessely. “A Paradigm Shift in the Conceptualization of Psychological Trauma in the 20th Century.” Journal of Anxiety
Disorders, Challenges to the PTSD Construct and its Data Base, 21, no. 2 (2007): 164–75.
Klages, Mary. Woeful Afflictions: Disability and Sentimentality in Victorian America. Philadelphia: University of Pennsylvania Press, 1999.
McClurken, Jeffrey W. Take Care of the Living: Reconstructing Confederate Veteran Families in Virginia. Nation Divided. Charlottesville:
University of Virginia Press, 2009.
Mickle, Julius William. On Insanity in Relation to Cardiac and Aortic Disease and Phthisis. Goulstonian Lectures. London: H.K. Lewis, 1888.
Pappert, E. J. “Philadelphia Infirmary for Nervous Diseases: America’s Original Model of Institutional Neurology.” Neurology 50, no. 6 (June
1998): 1847–53.
Travis, Jennifer. Wounded Hearts: Masculinity, Law, and Literature in American Culture. Chapel Hill: University of North Carolina Press, 2005.
Wooley, Charles F. “Where Are the Diseases of Yesteryear? DaCosta’s Syndrome, Soldiers Heart, the Effort Syndrome, Neurocirculatory
Asthenia--and the Mitral Valve Prolapse Syndrome.” Circulation 53, no. 5 (May 1, 1976): 749–51. doi:10.1161/01.CIR.53.5.749.
———. “From Irritable Heart to Mitral Valve Prolapse: The Osler Connection.” The American Journal of Cardiology 53, no. 6 (March 1, 1984):
870–74. doi:10.1016/0002-9149(84)90422-3.
———. “From Irritable Heart to Mitral Valve Prolapse: World War I —The U.S. Experience and the Origin of Neurocirculatory Asthenia.” The
American Journal of Cardiology 59, no. 12 (May 1, 1987): 1183–86. doi:10.1016/0002-9149(87)90872-1.
———. “Jacob Mendez DaCost a: Medical Teacher, Clinician, and Clinical Investigator.” The American Journal of Cardiology 50, no. 5
(November 1982): 1145–48. doi:10.1016/0002-9149(82)90434-9.
———. “The Military Heart Hospitals.” The American Heart Hospital Journal 2, no. 1 (2004): 55–57.
———. The Irritable Heart of Soldiers and the Origins of Anglo-American Cardiology: The US Civil War (1861) to World War I (1918). The
History of Medicine in Context. Burlington, VT: Ashgate, 2002.
Welcome and thanks to the SI for hosting me and funding me for the summer as a pre-doctoral fellow. Today’s talk is going to be both a quick overview of my dissertation project and a more narrow look at the research I did this summer at the SI and in the National Archives.
Unlike many of the talks that folks give during the symposium, I’m going to be a bit more informal. I’ve just started my dissertation process and am still very early in the research phase. This summer, thanks to the generosity of the SI, I’ve been able to see many of the objects used by doctors during this period as well as spend a fair amount of time at the National Archives looking at soldier’s pension records. As a result, today’s talk is going to focus a bit less on firm conclusions and instead posit my initial interpretations of the evidence, documents, and other items I’ve collected in the last three months. I’ll start by revisiting “soldier’s heart,” a diagnosis about which lots has been written by modern historians but which nevertheless fails to capture the essence of the diagnosis. I’ll then talk a bit about the doctor most closely associated with the diagnosis, Jacob Da Costa of Philadelphia, and pivot to a conersation about what, exactly counted as soldier’s heart. In the second portion of the presentation I will talk a bit about how I’m using pension records as a quasi “patient narrative.” Finally, I’ll close by reflecting a bit on why this research is important now– not only its relationship to the 150th anniversary of the war and, eventually, of Reconstruction, but to contemporary debates about veteran’s, PTSD, and medical care. I plan to leave ample time for questions and I hope to get your input on the research I’ve done so far as well as suggestions for future directions for analysis.
A quick note on terminology. There are a lot of different terms used at different times to refer to the disease we now call soldier’s heart. I’m going to use either Da Costa Syndrome or Irritable Heart since those seem to be the terms used most commonly during the mid and late 19th century. The other terms, including effort syndrome, soldier’s heart, etc.
Important to think through irritability– think about the language.
Charity model is a competitor with the social framing model : idea that you’re never going to get better
Before I begin, I’d like to say a few words about my theoretical orientation. Everyone has seen this Winslow Homer, and of course we’ve all seen it because it really does encapsulate a lot of what’s at issue in the new wave of trauma studies of the Civil War era. Like a few other scholars starting to work in this vein, among them Drew Faust, Susan Schweik, and Martha Hodes, I’ll be drawing on insights not only from “traditional” medical history but on the work or (dis)ability studies scholars and scholars of women’s and gender studies– more specifically, on studies of masculinity. In today’s talk, I’ll be focusing a bit more on the research that draws on ability studies insights, mostly about the relationship of the body and mind and the distinction between visible and invisible wounds in the legal system and culturally.
Gender is very different in this era, it’s incredibly complicated. Gender performance is really different from today, it’s very operationalized and it makes it even more difficult to pull these things apart in the period. There weren’t really dualities. Reference the woman who held the farm in trust.
So, with that brief diversion out of the way, I’m going to start by telling you the typical story of “irritable heart” before I problematize it with some of the research I did this summer. Let’s begin with just what exactly soldier’s heart is. To do that, let’s start with the man who identified it– Jacob M. Da Costa. He’s a fascinating character and someone who, sadly, is made all the more fascinating because of the mystery. His papers weren’t kept after his death and he really shied away from publicity during his lifetime. That said, he’s an incredibly important figure in 19th c medicine and he shows up in the background of a lot of the most important meetings, groups, etc. He’s born Jewish in the West Indidies and receives his education in Europe.
Founded the Pathological Society of Philadelphia, original member and eventual president of the Association of American Physicians, chair of Jefferson medical college
Unfortunately, his papers, case notes, letters, etc. have not been collected. Even the SI archives don’t have any information about the Toner lecture beyond simply the transcript printed in the Smithsonian Miscellaneous Collections and this single letter that Joseph Henry wrote to him in 1876. In it, he declines an invitation to stay with the Da Costas when in Philadelphia for the Centennial Exhibition.
His biographer and secretary, Marcy C. Clark, explained that, “"Dr . DaCosta was greatly opposed to the publications of biographical sketches of the living, and invariably refused to give information concerning himself for such projected works”
What we do have are the official records of the military and his published case notes. We also have the commentary from other physicians both that he worked with at Turner’s Lane and that adapted his work in the years after his initial publishing in the 1870s and 1880s. So we’ll just soldier on with that.
Turner’s Lane was officially the U.S. Army Hospital for Injuries and Diseases of the Nervous System. Other physicians there eclipse Da Costa, probably most notable S. Weir Mitchell, but Da Costa’s work is important and under appreciated. His study of functional diseases is described by his peers as “the
Historian and physician Charles Wooley describes Da Costa’s work at Turner’s Lane as, “mature work by a young clinician who made good use of his knowledge of physical diagnosis, recorded and trusted his own carefully documented clinical observations, and filtered the essentials from studies of over 300 cases.”
Da Costa gets all the credit for this diagnosis, but I do want to make sure that it’s clear that other doctors were equally invested in finding out what the cardiac issues were among Civil War soldiers. Dr. Taylor, who had a long career in the US Army’s medical service in the west, claimed that he should be given credit for the identification of irritable heart in a long letter. This is just the final page where he’s clear about
However, the editors of The Medical & Surgical History of the War of the Rebellion, are clear that what he saw in Iowa is different from what Da Costa observed.
Interestingly, Dr. Taylor also has some times to the Smithsonian– he provided meteorological readings before the war. I can’t find evidence (yet) that Da Costa and Taylor ever met each other, though I’m wondering if they crossed paths at meetings or exchanged letters.
Enough of this Da Costa v. Taylor business! That’s immaterial. Let’s get down to business– what is irritable heart?
MSHWR calls it the “most notable product of the war”
Functional disease: which means that it didn’t have a clear pathological agent (I need to confirm this).
I haven’t found a clear case rate. Of the 300 men he treated, about 200 ended up having the disease. 2/3 feels awfully high, though, and he didn’t make any assumptions about the rate in the army at large. Da Costa thought it was probably the most common heart disorder among US troops (and he assumed it existed in Southern troops as well)
Da Costa’s Statistics say that about 38% of men returned to their regiment. He’s clear that he thinks treatment, despite being lengthy, is a worthwile investment. (p. 51 “On Irritable Heart”)
In his 1871 essay, Da Costa says that he doesn’t think it is new– he references very briefly some observations from the Crimean War. However, his work is the first to name it as something unique and distinct.
Hypertrophy = enlargement
p. 343 of Da Costa’s textbook. He actually writes about the disease first in his textbook, Medical Diagnosis, in it’s 1864 edition he then goes on to publish papers/tracts specifically on the disease in 1870s.
p. 343 of Da Costa’s textbook, also in the MSHWR
Diagnosed by evaluating the patient’s heart sounds, pulse rate, and reading symptoms.
Listening to the heart sounds, taking pulse readings, and evaluating symptoms proved to be the most important forms of diagnosis.
Look into if he has diathesis orientation bc if he doesn’t he’d be very unusual.
According to the Medical and Surgical History of the War of the Rebellion, the primary cause is an over action of the heart during a particular battle or campaign.
Look into if he has diathesis orientation bc if he doesn’t he’d be very unusual.
According to the Medical and Surgical History of the War of the Rebellion, the primary cause is an over action of the heart during a particular battle or campaign.
Da Costa acknowledges that knapsacks, belts, and other equipment might put strain on the heart. However, he is wary of assigning full blame to these items. There were more cases of irrtable heart among the infantry but there were also cases among cavalry and artillery. (p. 38 “On Irritable Heart”)
Occupation didn’t have an impact– buther, farmer, and clerk were all represented. General weakness prewar was a factor but that had little to do with temperment
So… Jan to August 1864 and near Rapidan? This guy may have been at the Battle of the Wilderness (in May 5-7 1864)
I’m trying very hard to avoid retroactive diagnosis. Instead, I really want to take the 19th c doctors, patients, and other folks writing about this disorder at their word– they saw this as a functional disorder of the heart that was caused by 1) chronic diarrhea and 2)
Freud is about 40 years away from the identification of Irritable Heart. However, almost as soon as Da Costa starts publishing about the disorder, asylum superintendents AND neurologists start looking at the disorder’s relationship between the heart and mind.
Greenlees, T. Duncan, “Observations with the Sphygmograph on Asylum Patients” Journal of Mental Science 32 (1887): 472-484
Now to turn to methodoloy. I’m drawing heavily from the work of Arthur Kleinman and other medical anthropologists who write about the importance of “illness narratives.”
Read these documents in new ways
Performing respectable disability
Da Costa has a brief note on malingering in his “On Irritable Heart” but basically says that it’s very difficult to fake it (a soldier can put a bandage around his waist and lower chest but once undressed and told to lay down, the pulse returns to normal, see p. 86-87). I’ve also found little evidence the heart disorders were associated with malingering.
Body systems have trends too. We’re now people of the brain.
