A doctor who shaped military medicine and the understanding of trauma will be discussed at the National Museum of Civil War Medicine in downtown Frederick.
Dr. Ashley Bowen-Murphy wrote her doctoral dissertation on Dr. Jacob Mendes Da Costa, and will share her research on the influential Civil War physician.
Not much is known about Da Costa’s upbringing, which includes being born into a Jewish family in St. Thomas before eventually settling in the U.S., but his pioneering diagnosis of irritable heart is well-known.
“I think as there’s more interest in post-traumatic stress disorder and trauma reaction, my sense is that [Da Costa] is a person whose star is rising, 150 years later,” Bowen-Murphy said.
Irritable heart was a diagnosis Da Costa developed in 1863 while treating Civil War soldiers in Philadelphia, which was then known as the center of American medicine. Da Costa observed heart palpitations, chest pain and exhaustion but was unclear about the cause. He viewed irritable heart as a cardiac problem affected by “hard service,” or the demanding physical labor of Civil War soldiers.
News of this discovery took time to travel, but Da Costa became known as an expert in the 1870s. Irritable heart was even occasionally known as “Da Costa’s syndrome.” In the 1880s, Da Costa rose as a medical educator in his role as the president of the College of Physicians of Philadelphia.
“At the same time, though, there were soldiers, and soldiers that he [treated], who used the language of being broken. They talk about how ‘the war broke me,’ or ‘I’m all broke down,’” Bowen-Murphy explained. “It became very clear to me as I was reading their writing that they were thinking about how they were broken not just in a physical sense, but they were no longer the person they were.”
Through researching at the National Archives in Washington, Bowen-Murphy learned that irritable heart was often an “acceptable defense” for soldiers who were court-martialed for inappropriate behavior.
Da Costa began a medical conversation that pondered whether scars are the only wounds of war.
“He did acknowledge that there was something that happened to soldiers’ bodies that wasn’t necessarily the result of injury or like a sickness,” Bowen-Murphy said. “It was something that happened to the body that was not governed by something external to the body.”
The lack of medical clarity at the time aggravated veterans and their families who were being denied pension support. Bowen-Murphy poured over letters, including from one Civil War veteran she playfully described as an “ornery old man” who was trying to get compensation from the pension office.
“He’s been back and forth with them a bunch and it’s clear he’s just irritated, so he writes this letter where he says, tell me if it’s the law or the doctors or the pension office that I should get angry at so I can cuss with proper distinction.”
By World War I, irritable heart was considered an outdated diagnosis due to medical advancements.
“There’s really only a 50-year period where it’s a diagnosis in use,” Bowen-Murphy said.
Though Da Costa’s work was considered rudimentary, his research was studied by younger physicians discovering a connection between the physical and the psychological. Bowen-Murphy is hesitant to make a direct line from irritable heart to other combat-related stress conditions, but it’s clear that each generation learned from the past.
“There is an easy chronology to see. ... There was irritable heart in the Civil War, there was ‘shell shock’ in World War I, it was ‘battle fatigue’ in World War II, and it was post-traumatic stress disorder in Vietnam.”
This legacy is why Bowen-Murphy feels Da Costa’s work should not be forgotten. In her words, “It opened the door for shell shock and post-traumatic stress disorder. ... He laid a foundation that other physicians were able to build on.”