Dr. Da Costa was an incredible doctor during an incredible medical period. Part of the Philadelphia doctors that did research during the war as Assistant Surgeons, he had Dr. Keen as an associate in his office, worked with Dr. Weir at Jefferson Medical College and worked with Dr. Morehouse at Turner’s Lane Hospital where the breakthrough research was done on nerve damage.
At Turner’s Lane Hospital, Dr. Da Costa developed his theories on “soldier’s heart, “irritable heart,” or “Da Costa’s Syndrome.”
He did this through the observation of soldiers with heart problems caused by military service and/or combat.
Dr. Da Costa was born in the Virgin Isles (West Indies) on February 7, 1833. At the age of four, the family left for Europe. He obtained a classical European education.
He could speak French, German, and English. His reading ability included Portuguese, Italian, and Dutch.
In his teens, he originally wanted to go into politics or diplomacy. After his father’s death and his mother’s remarriage, the family settled in Philadelphia.
In 1852, he graduated from Jefferson Medical College. Jefferson Medical College created a clinic in which medical students would provide medical care to the city’s poor for free. This distinguished Jefferson Medical College from all other medical schools in the nation.
He then continued his medical education in Paris, Prague, and Vienna.
Returning to Philadelphia in 1853, he became a physician attached to the Moyamensing House of Industry (a debtor’s prison). Jefferson Medical College recruited him to teach.
Like many of his fellow physicians, Da Costa combined private practice with clinical instruction. He emerged as a leading physician, teacher, and medical researcher.
During the years between his return to the United States and the outbreak of the Civil War, he researched the nature of yellow fever, studied typhoid, and edited/translated a number of medical texts.
In 1860, Dr. Da Costa married Sarah Brinton, the sister of a friend, Dr. John Hill Brinton. Surgeon General William Alexander Hammond made him the first curator of the National Museum of Health and Medicine. Dr. Brinton was also related to Maj. General George Brinton McClellan.
Da Costa spent his entire wartime service in Philadelphia, first at the hospital on 16th and Filbert Streets, then at the giant Satterlee General Hospital, and finally at the Turner’s Lane Hospital. There, heart patients were concentrated in one ward of Turner’s Lane which made it easy for Dr. Da Costa to do his observations and analyze significant patient data.
Others were also writing on this subject during the Civil War. On June 3, 1863, Dr. Henry Hartshorne published his article on patients he had observed after the Battle of Antietam.
In his article, he talks about “muscular exhaustion of the heart” because of prolonged physical efforts on cardiac functioning among combatants. Physicians working in England also identified a similar condition. Da Costa was likely aware of the 1864 work done by W.C. MacLane on British soldiers, whose report used the term “irritable heart” and described similar symptoms.
Da Costa studied more than 300 patients suffering from cardiac complaints who cycled through Turner’s Lane.
He used the phrase “broke down” to describe the soldier’s health before entering the hospital. Soldiers have suffered from chest pain and exhaustion for centuries, a fact Da Costa himself admitted. Many Union soldiers arrived at Turner’s Lane complaining of a wide variety of cardiac symptoms. Da Costa was the first clinician to classify soldiers’ cardiac complaints into a discreet, named disease: irritable heart.
Irritable heart, or what would later be known as the Da Costa Syndrome, consisted of specific observed characteristics in his soldiers.
Men with irritable heart suffered from a stable and common set of symptoms: a rapid heart rate, anywhere from 100-140 beats per minute, with one patient presenting a pulse that measured 192 beats per minute; heart palpitations; chest pain that patients described variously as radiating across the entire chest, passing down the left arm, or concentrating directly over the heart. Some also demonstrated general fatigue and weakness; digestive disorders like chronic diarrhea or constipation; difficulty sleeping or bad dreams; shortness of breath; nervous conditions like excessive sweating or itching; dizziness; and headaches.
Not every patient experienced all of these symptoms but all irritable heart patients would show at least a rapid pulse, heart palpitations, and chest pain, often following some kind of digestive disturbance.
Much of his research at Turner’s Lane Hospital on irritable heart emphasizes the ways in which the disease did and did not resemble well-known diseases familiar to the Civil War physician.
These included tuberculosis, valvular heart disease, and heart murmurs. Efforts to mimic irritable heart could be used by a malingerer as essential to getting away from the front. Soldiers could imitate a rapid heart rate for a time, but true irritable heart proved very difficult to fake based upon the unique and multiple symptoms necessary for a diagnosis by Dr. Da Costa.
Discovering malingerers was done by making the soldier lie down after undressing. This caused the heart to return to its natural beat.
Then upon his resuming the erect position, or walking around quietly, the fakers heart would not (as an irritable heart does) regain its former increased higher frequency of beat or irregular heart rhythm.
Da Costa emphasized the importance of rest laying down to reducing strain on the patient’s heart.
This rest meant, “The hospital treatment is never a short one.” Many of Da Costa’s patients were forced to lay down for several hours a day. He reported on one cavalry soldier who spent two weeks in bed and whose heart rate dropped from 98 beats per minute to just 78 beats per minute after two weeks bed rest. As the heart rate went back to normal upon standing these periods of absolute bed rest, the soldier was given light duty around the hospital. To ensure a complete recovery, he also tested patients while running and performing other exercises to see “how the action of the heart was affected” before releasing a patient to return to their regiment or enter the invalid corps as a soldier.
By the late 1860’s through 1870’s, most doctors referred to these conditions as “Da Costa Syndrome.” Da Costa found that the use of opiates did help reduce the heart rate of these patients. Fearing addiction, he used rest, light exercise, and Tincture of Aconite (Aconite is an alkaloid toxin produced by the Aconitum plant, also known as devil’s helmet or monkshood. Monkshood is notorious for its toxic properties. Although it did not slow the pulse, Aconite did reduce its force and decreased tension on the heart, in turn, preventing hypertrophy (enlargement of the heart). Da Costa also reported finding digitalis less effective in many cases, but did credit the drug with the slow, steady improvement of irritable heart symptoms.
Irritable heart rarely proved fatal to the soldier. In Da Costa’s view, the enlarged heart it caused could eventually contribute to a soldier’s death. This does not suggest that the Da Costa diagnosis was unimportant or inconsequential. Irritable heart did not produce lesions on the heart and did not enlarge the heart until late in the course of the disorder.
Dr. Da Costa wrote in his book on his Turner’s Lane research, On Irritable Heart, in January 1871, stating:
In endeavoring, [sic] to explain the nature of the malady… It seems to me the most likely that the heart has become irritable, from its over-action and frequent excitement, and that disordered innervation keeps it so. But our knowledge of the nerves of the heart, and their special functions, is as yet too incomplete, to say which nerves lie at the root of the disturbance.
Dr. Da Costa medically defined “irritable heart syndrome,” through his cases from the American Civil War. He found the disorder was not confined to the infantry, but affected the cavalry and artillery so the packs were unlikely to be to blamed. Although this was widely regarded as a disorder suffered by soldiers in wartime, Da Costa made the important observation that the same cluster of symptoms could also be seen in civilians.
After the war, he accepted an appointment at Philadelphia Hospital in 1865. He practiced there for the rest of his life and taught clinical medicine at Jefferson Medical College. In 1872, he became Professor of the Theory and Practice of Medicine.
His landmark medical education book was first published in 1864, Medical Diagnosis With Special Reference to Practice Medicine. Many American medical colleges, all the way into the early 20th century, would use this text.
Dr. Da Costa died of heart failure on September 11, 1900 at the age of 77.
Until next Month
Your Obt. Servant
Surgeon T.T. Steinbach
17th Corps Field Hospital, Inc.