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) [Hardcover]

Charles F. Wooley (Author)

Book Description

Publication Date: November 2002 | ISBN-10: 0754605957 | ISBN-13: 978-0754605959

A work written by a practising medical doctor that looks at the phenomenon known as "the irritable heart of soldiers". This condition, characterized by chest pains, palpitations, breathlessness, fatigue, syncope and exercise intolerance, first became an issue in the American Civil War, where it incapacitated thousands of troops. Using his expertise as a doctor, an academic and a former soldier, the author analyses the changing attitudes to this syndrome in the US and British Empire, in both a historical and a medical capacity.

Editorial Reviews

From The New England Journal of Medicine

The American Civil War (1861 to 1865) was the first major conflict of the industrial age, and the progressive industrialization of warfare that occurred over the subsequent 100 years led to unprecedented loss of life. The loss of over 600,000 men in that war was almost more than the fledgling United States could bear, but it was trifling in comparison with what was to come in World War I (1914 to 1918). Of the 65 million men who took up arms during the "war to end all wars," an estimated 10 million were killed and 20 million wounded. French and British men who were between the ages of 19 and 22 years in 1914 saw their numbers reduced by 40 percent during the course of the war. Many deaths were caused by disease, yet ironically, this book is concerned not with a life-threatening disease but with a condition that led instead to substantial disability and was therefore a cause of great alarm to military commanders. Wooley's monograph is a collection of previously published, somewhat disparate, and occasionally repetitive writings that are consolidated into chapters dealing with irritable heart in soldiers. Variously known as disordered action of the heart, effort syndrome, and neurocirculatory asthenia, this condition was the diagnosis given to a large number of men who, after enlistment, were deemed unfit to fight. Wooley, a professor emeritus of medicine at Ohio State University, comprehensively describes the emergence of this condition during the American Civil War, its evolution and scientific study during World War I, and its apparent disappearance during the mid-20th century. The development of efficient killing machines such as machine guns and accurate artillery led to an insatiable appetite on the part of the military for healthy young soldiers. In addition to the enormous logistical challenges resulting from the huge numbers of dead and wounded that overwhelmed existing medical facilities during the American Civil War, there was a major need for clear definitions of health and fitness for service. Wooley discusses the rapid expansion of medical facilities and the establishment of sound medical criteria for the screening of recruits. The summaries of such screening in both wars provide a fascinating snapshot of the general health of the U.S. population in the 19th and early 20th centuries. Symptoms such as shortness of breath, palpitations, dizziness, and inexplicable, profound fatigue were so frequently observed and so frequently required the removal of soldiers from the battlefield that military hospitals were established for further examination of such cases to distinguish malingering from organic or functional cardiovascular disease. Cardiac causes of disability were studied in the first organized center of cardiovascular research in the United States, at Turner's Lane Hospital in Philadelphia, founded in 1862. Responsible for one of the wards at Turner's Lane was Jacob Mendez Da Costa, a remarkable man who later became chairman of medicine at Jefferson Medical College. Reflecting the educational convention of the time, Da Costa had trained at the predominant centers of medicine in Paris, Prague, and Vienna and was fluent in German and French. He elegantly described an unusual functional cardiac disorder that caused substantial disability among young men in military service, and he believed that persistent symptoms would lead to organic heart disease over time. His publications on irritable heart were highly respected in Europe, and Da Costa's original description of this condition serves as Wooley's point of embarkation for a fascinating medical journey back and forth across the Atlantic Ocean over the subsequent century. Military hospitals established in England during World War I were modeled on the Turner's Lane experience, and these hospitals cared for large numbers of men in a fashion that allowed for both effective research and organized medical education. It was at this time that laboratory techniques were beginning to supplement the clinical skills that for almost a century had relied on the stethoscope of Laennec; blood-pressure measurement was becoming routine, Einthoven's electrocardiogram was superseding Mackenzie's polygraph and Ludwig's kymograph, and Roentgen's x-rays were seeing increasingly wide application. World War I military medicine afforded unique opportunities for British and American physicians to work side by side and to use scientific means to develop methods of clinical care that have stood the test of time and that are reflected in much of modern cardiology practice. These productive collaborations were based on individual relationships that were forged in the crucible of war and derived their strong postwar momentum from a shared knowledge of adversity. The description in 1930 by Louis Wolff (Boston), John Parkinson (London), and Paul Dudley White (Boston) of what became their eponymous syndrome may be one of the more concrete examples of these highly fruitful relationships. The introduction of graded physical exercise as a form of therapy also has its origins in wartime experience; prolonged bed rest for the treatment of heart disease had been the norm for many decades, but it was clear that the heavy manpower needs of modern warfare now precluded this luxury. Thomas Lewis and his colleagues at the military hospitals in England dramatically altered the approach to cardiac rehabilitation, inspiring Samuel Levine, when he returned to Boston, to shorten substantially the six-week period of mandatory bed rest after myocardial infarction. This book will interest cardiologists on both sides of the Atlantic who are curious about the roots of current practice and the impressive, if often eccentric, people who were instrumental in laying the foundations of the profession. However, this book may disappoint historians who expect more social, cultural, and political context than the book provides. Indeed, a complete understanding of the historical development of cardiology as a medical specialty requires critical examination of the influence of the dramatic social and technological changes that were under way in early 20th-century Europe and North America. Wooley has provided an excellent framework on which this more comprehensive history may be built. David Martin, M.D.
Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Product Details

• Hardcover: 320 pages
• Publisher: Ashgate Pub Ltd (November 2002)
• Language: English
• ISBN-10: 0754605957
• ISBN-13: 978-0754605959
• Product Dimensions: 9.3 x 6.1 x 1 inches
• Shipping Weight: 1.2 pounds (View shipping rates and policies)
• Average Customer Review: 4.0 out of 5 stars  See all reviews (1 customer review)
• Amazon Best Sellers Rank: #3,226,013 in Books (See Top 100 in Books)

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4.0 out of 5 stars The Irritable Heart of Soldiers, March 28, 2003

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heart doc (Chicago, IL USA) - See all my reviews

This review is from: 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) (Hardcover)

There are at most a few people that could have written a book with the multiple and distinct perspectives required to cover the topics addressed in The Irritable Heart of Soldiers and the Origins of Anglo-American Cardiology: the US Civil War (1861) to World War I (1918). Imagine searching for someone with a record of clinical investigation in cardiovascular disease, particularly the symptom complex and differential diagnoses involved in irritable heart. Require also a military background to understand irritable heart and its implications in determining a given soldier's battle readiness. Finally, this author must have the skills of a medical historian to reveal how evolution in the practice and infrastructure of medicine itself over time influenced the interpretation and management of a particular constellation of symptoms and disease entities. In this book, Dr. Charles F. Wooley draws on his experience in all of these disciplines to lead the reader through a fascinating composite of political, scientific, and personal narratives.

The book begins in the United States with the Civil War perspective. The author aptly quotes T.S. Eliot in surveying the surfeit of statistical analyses generated from Civil War records: "Where is the knowledge we have lost in the information?" [Eliot, `The Rock' 1934] One might argue that this question merits consideration by the clinical researchers of any era. We are led through a lifetime of influences leading to Jacob Mendez da Costa's landmark 1862 War Department communication entitled `On irritable heart' which served as an invaluable reference for successive generations of clinicians in the U.S. and abroad faced with caring for soldiers with similar history and physical examination findings. The author also retraces the mercurial career of William A. Hammond, from assistant surgeon to US Surgeon General to ignominious court marshall and finally to lasting success as an academician with a successful clinical practice; it is no surprise that his combination of insouciance and naivety continues to produce similar trajectories in medical careers today.

Dr. Wooley then takes the reader overseas to understand the 19th and early 20th century British soldier, with a treatise on the importance of the patient history. We learn how Sir Clifford Albutt played a pivotal role in the transition from reliance on pathology to justify a disease entity to a broader understanding of disease in terms of familial, temporal, as well as spatial perspectives. His under-recognized contributions are further highlighted in later chapters, including his observation that irritable heart of soldiers consists of a "group of symptoms [that] is too uniform to be fictitious or fantastic" [Albutt 1917].

We are led through a wonderful illustration of how technology initially developed for research finds its way into the clinical realm. The author deftly establishes how imperfect data coupled with inappropriate confidence in that data can lead to years of misdirected efforts; the French school of auscultatory misclassification of valvular disease "[inhibited] critical thinking about these physical diagnostic phenomena...for the next six decades" (Wooley p.123). Technologies that we now consider routine, the electrocardiogram and chest x-ray, revolutionized the diagnostic process; as the author observes, "cardiology can be divided into two major developmental period: before Einthoven and Roentgen and after Einthoven and Roentgen." Sir James Mackenzie's concerns that technology would erode practitioners' clinical skills have echoes in recent investigations; one hopes that he would find reassurance for his apprehensions in today's cardiovascular practice that still begins and ends at the bedside despite exponentially greater use of technology.

Early 20th century forays into the brain's connection to the cardiovascular system are retraced, including Weir Mitchell's stinging critique of his neurological and psychiatric colleagues of the late 1890s. With advances such as functional and molecular neuroimaging, 21st century practitioners in these fields are just beginning to gain the mechanistic understanding required to implement appropriate diagnostic and therapeutic strategies as Mitchell implored over 100 years ago.

No book covering any aspect of the medical history would be complete without reference to Sir William Osler. He linked what we would today call "lifestyle" changes with control of palpitations in an era that lacked fundamental knowledge of arrhythmias by advising "dietetic management with abstinence from stimulants, moderate exercise and cessation of smoking." (Wooley) Mackenzie resurfaces with the wisdom ensuing from the earliest specialty heart hospitals: "Exercise proved to be the only sound clinical test of the heart's ability to perform its work." [Mackenzie 1924] The book also offers detailed histories of World War I-era giants such as Clifford Albutt, Samuel Levine and Lewis Conner portrayed against the backdrop of unprecedented carnage from both battle and disease in a "pre-therapy war." (Wooley p. 264)

The final chapter brings together a vast array of seemingly disparate individual experiences and historical events in a construct that is surprisingly coherent to even the author: "what emerges is more of a medical continuum than the author expected when initiating the search." (Wooley p. 261) In this book, clinicians and clinical researchers at any stage of their careers will recognize elements of their own explorations in medicine, replete with discovery and confusion, tectonic shifts in practice and the individual practitioner's epiphanies that emerge only from careful analysis of individual patients.