medical broken heart

so i ran 18 miles thismorning, and i'm wearing heels. so i want lots ofapplause at the end. thank you. [applause] so i'm in the americanstudies department, which is something of a-- it'sa very interdisciplinary field. and i use the kinds of insightsfrom history, from literature, and from medicalscience to think about a particulardiagnosis that

was in use fromroughly the civil war until world war i. it'scalled irritable heart. and the way that i findout about this illness, the way i learn about notjust the way physicians talked about it, but what patientsunderstood about it is by using pension records. these records come fromthe national archives. and they tell incredible storiesabout civil war soldiers, some of whom were at the frontfor only a few weeks, others

who were at the front forthe duration of the war and then went west afterwards. these records include everythingfrom individual medical care to pulses to familystories that can tell us something about what it was liketo be a veteran of the american civil war. after the war, we saw lots ofmen come back to the united states, come back to the north,who had what we might now think of as something ofa panic disorder, right?

so they had things thatwere like high heart rate. they had irregular heart rates. they have incrediblyintense chest pain that they would complain about. and this was something thatwas called irritable heart. it was identified by a mannamed jacob dacosta in 1862 at turner's lane hospitaloutside of philadelphia. what he found amongcivil war soldiers were an incrediblekind of heart disease

that he thought was fairlynew to the american civil war. he sent a letter tothe surgeon general in 1862, explaining that an overexcitement of nervous energy-- and keep in mind thatin the 19th century, nervous energy was not quitethe same thing that we think of today when wethink of nerves. it really was more nerves--combined with exposure to battlefield conditionsand poor nutrition were the kinds of thingsthat would generate

this sort of physicalfeeling in someone. at the same time, weknow that today, soldiers continue to suffer from heartproblems at a higher rate, and earlier thanwe might expect. so just this past year,the va hospital system released a reportin which they found that even men who've been tocombat, even if they don't end up with post traumaticstress disorder or an anxiety disorder that's sort ofclinically recognizable,

they do you have heart problemsat an earlier age than we might imagine, and in highernumbers than we might expect. jacob dacosta totallyknew this, right? my guy, he knew. so what my researchdoes is try and think through the ways in whichmedical history can tell us something about what we'restill seeing in the present. my research also looks athow individual soldiers made sense of their illnesses.

so we'd have soldierswho would say things like, it felt likemy heart stopped. but his heart rate wasmeasured at 104 beats a minute in this case. so this isn't just a questionof how physicians understood illness, but how individualpatients understood that illness as well. so that's one half ofmy work-- patients, physicians, the people whoeither have the illness

or study it. but i'm also interested inall the irritable hearts around these soldiers,the people who ended up caretaking, the peoplewhose lives were impacted because the men intheir lives came home from the war different. so the story i liketo tell on this front is about a womannamed sophia fife. in the years after the war,she told the pension office

that she noticed the changein her husband immediately. when he came back fromthe war, his hands shook so much that hecouldn't hold a coffee cup. it would shake whenevershe handed it to them. she also told thepension officer that she would shavehim before the war, but not because hecouldn't do it himself. so it was common. that was a form of affection.

it was a way to demonstratecare for a male family member. but after the war, she wasafraid to let him do it. keep in mind thisis a man diagnosed with a heart condition. but the shaking of his handswas indicative of so much more. and it changed theirentire family dynamic. eventually, thepension office decided that the fife's weren'teligible for pensions. there were some irregularitiesin his family history.

there were some concernabout him drinking, about loose women. it was the 19th century. so your value as a person thatthe government was going to pay was determined by those things. but after jacob died, sophiadid receive a pension. and in the documents,the pension officers talk about how herlife changed because of his experience in combat.

and that itself wasworth pensioning. so what i think that wecan get from these records is not just the storyof a particular illness, but about the way illnessis experienced and made sense of by all of thepeople around them.