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Friday, August 30, 2013

Heart Disease During the Civil War

By Glenna R. Schroeder-Lein


During the Civil War, as in other eras, some people suffered from congenital or early onset heart defects, including heart murmurs, valve malfunctions, enlargement, and other problems, that caused a recruit to be rejected and a soldier to be discharged, if detected.

In the days before electrocardiograms and other modern imaging tests, Civil War doctors relied on the methods of percussion and auscultation. These involved tapping the area of the chest and listening to the resulting sound, such as dullness or shifting fluid, with the ear or with a stethoscope. Although some writers on Civil War medicine have claimed that Civil War surgeons rarely used the stethoscope, recent research demonstrates that some physicians were quite skilled in its use.

During the Civil War soldiers suffered from two main types of heart problems: rheumatic fever and "soldier's heart". Rheumatic fever, frequently called acute rheumatism during the period, was especially prevalent during the winter. Now known to be a streptococcal infection, rheumatic fever begins with a sore throat and progresses to extremely painful swollen joints. More seriously, rheumatic fever can involve inflammation of the sac around the heart and the heart valves, leading to abnormal heart function or even heart failure and death. The illness usually lasted one to two months. Patients were treated with opiates, quinine, baths, and compresses to reduce the pain and inflammation., Many soldiers who survived had to be discharged because of resulting heart problems.

"Soldier's heart" or "irritable heart" was first studied and described during the Civil War by Dr. Jacob Da Costa, a physician who worked with a ward of cardiac patients at Turner's Lane Hospital in Philadelphia. The symptoms of irritable heart included palpitations, rapid heartbeat, and lightheadedness. Evidently the syndrome was related to severe mental or emotional stress. The patients recovered best when given an extended opportunity to rest.

The most notable person who apparently had heart disease during the Civil War was Confederate general Robert E. Lee. However, historians have engaged in considerable controversy about what type of heart disease he had. Some have suggested that he had coronary artery disease, others that he had pericarditis (inflammation of the sac around the heart) since that was what his physicians diagnosed. Yet others suggest angina pectoris, arteriosclerosis (thickening of the artery walls), or rheumatic fever with resulting heart disease. Whatever Lee had seems to have begun with an illness in March and April 1863, from which he never fully recovered and which cannot now be conclusively diagnosed.

From: "The Encyclopedia of Civil War Medicine"

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