been but little or no sickness, and but two or
three deaths.”
Similarly, Surgeon John L. Taylor noted
that “kind and sympathizing words—amuse-
ments—seemed to invite a more deplorable
condition.” That approach predominated in
his regiment, whose officers told soldiers that
their disease was merely moral turpitude,
looked upon with contempt, and that “sol-
diers of courage, patriotism and sense should
be superior to the influences that brought
about their condition.” Taylor claimed better
success with his method. “This course incited
resentment, passions were aroused, a new life
was instilled and the patients rapidly recov-
ered,” he said.
In sharp contrast, Gross argued for more
sympathy and less criticism. “The treatment
is moral rather than medical,” he advised,
“agreeable amusements, kindness, gentle but
incessant occupation, and the promise of an
early return to home and friends constituting
the most important means of relief.”
Another surgeon’s view was to give the
troops something to do to pass the dull hours.
“An officer should be detailed as Superinten-
dent of Public Amusements, who should be
manager of theatrical performances, races,
competitive shooting and prize competitions
of all sorts.” Ultimately, such treatments may
say more about the surgeon than about the
patient or disease.
Some surgeons noted heart-related symp-
toms in nostalgia patients early in the war. In
1862, Surgeon A.J. McKelway reported heart
disease caused by “overexertion preceding the
battle and excitement and effort during its
continuance.” With the benefit of two
decades of hindsight, the surgeon general’s
history observed: “Overaction of the heart
during an engagement was due perhaps as
much to nervous excitement and anticipation
of danger as to overexertion. Even soldiers
accustomed to the alarms of battle were not
at all times exempt from the results of men-
tal impressions.” Many cases arrived in hos-
pitals after the continued exertion, anxieties,
and excitement. Some patients experienced
acute chest pain even while asleep.
Most Civil War surgeons did not make the
now obvious connection between heart dis-
ease and stress. In late 1862, Acting AssistantSurgeon Jacob M. Da Costa reported an
uncommon malady, called “Chickahominy
fever,” among soldiers returning from Maj.
Gen. George B. McClellan’s just concluded
Peninsula Campaign. “Both body and mind
remain for a considerable period enfeebled,”
noted Da Costa. Symptoms included mem-
ory loss and “mental wandering.” Another
surgeon listed such symptoms as “indifferen-
tism, wandering and muttering, restlessness,
insomnia, and watchfulness.”
Da Costa described typical cases with
heart-related symptoms, including “palpita-
tion and a feeling of uneasiness in the cardiac
region.” Another patient had palpitations and
sharp chest pains. The patient’s other symp-
toms improved and he regained his strength,
“but any excitement or labor agitates him and
brings on violent beating of the heart,” Da
Costa observed. “The irritable state of the
organ remaining long after the general health
was in every other respect fully reestablished,
all form a clinical combination of very great
interest and frequency.”
In early 1863, Dr. Alfred Stille, who
worked at a large military hospital in
Philadelphia, reported heart palpitations to
be a common disease among the soldiers, ina form he had very rarely observed in civil
practice. Stille associated it with “a state of
extreme exhaustion, especially when occur-
ring after violent and prolonged muscular
efforts.” A few months later, Dr. Henry
Hartshorne noted among his patients, simi-
lar palpitations, which he evocatively called
“trotting heart” or “cardiac muscular
exhaustion.” Hartshorne recognized ner-
vousness as a source of palpitations but
found the soldiers’ palpitations to differ in
character from “ordinary sympathetic or ner-
vous palpitation” in his civilian patients.
Da Costa used the phrase “irritable heart”
in the title of an 1871 journal article in which
he summed up his experience with more than
300 soldiers and continued to define it as a
functional cardiac disorder. Besides palpita-
tions, sometimes violent, Da Costa noted that
his patients suffered from “smothering or suf-
focating sensations at night, a mere feeling of
uneasiness near the heart, shortness of breath,
giddiness, and disturbed sleep, including
dreams of unpleasant character.”
Da Costa attributed a plurality, some 38.5
percent, of the cases to hard field service, par-
ticularly excessive marching. Within this cat-
egory he included constant and heavy dutyThis hand-colored photograph of wounded Union soldiers during the Peninsula Campaign shows the
makeshift nature of medical help. There was little time to deal with soldiers suffering from complex mental
or emotional ailments.CWQ-Sum16 Medicine_Layout 1 4/20/16 6:51 PM Page 96