Heart problems / Obscure illnesses and diseases

[Neil Clark]

Just found this very interesting website for all non-com specialists - http://www.pubmedcentral.nih.gov/articlere...i?artid=1569621

It would appear that the USA are somewhat more advanced in this area than our own tardy service authorities...

I'm going to get in touch with the author of this work - Edgar Jones*

Institute of Psychiatry, King's Centre for Military Health Research, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, UK. Perhaps he will be interested in our work enough to want to help us out with our difficult cases? It's worth a try, waddya fink?

It's about time that we learned the facts ourselves. That way we can challenge adjudications which are made hastily and without due and proper (expert) consideration. A civil servant sitting behind his desk in Portsmouth is hardly likely to make much effort if he thinks he can easily "pull the wool" over our eyes. The time where a case is thrown out simply because a single civil servant thinks that a heart complaint can't possibly be attributed to a mans war service is OVER. We can prove beyond any doubt that there were thousands of cases where men were awarded war pensions suffering from heart complaints and other obscure illnesses and diseases.

A MUST READ FOR YOU ALL!

I never considered weight of a mans pack - until now!

4. Disordered action of the heart

Also known as irritable heart, soldier's heart, cardiac neurosis, Da Costa's syndrome, neurocirculatory asthenia and effort syndrome, DAH was one of the most common and enduring post-combat disorders (Jones & Wessely 2005a). First recorded by the British in the Crimea, when termed ‘palpitation’, and by the Americans as ‘cardiac muscular exhaustion’ during the Civil War (Hartshorne 1864), it was a consistent feature of military medicine from the late nineteenth century to the Second World War.

Discharges from the British Army for ‘diseases of the circulatory system’ became a serious cause for concern in 1864 following a presentation at the Royal United Services Institute by Maclean (1811–1898), Professor of military medicine at the Army Medical School, Netley (Maclean 1864). Although Britain was not then at war, such soldiers broke down either under the rigours of training or as a result of earlier overseas service in the Crimea and India. To shed light on this problem, Maclean investigated 5500 soldiers admitted to the medical division of the Royal Victoria Hospital, Netley, who had served abroad between 1863 and 1866, and found that 8% had been invalided from the forces with what appeared to be heart disease. At Fort Pitt, where invalids serving in the UK were treated, he estimated that 15% were discharged with heart disease (Maclean 1867). Having excluded rheumatism, excessive alcohol consumption, heavy smoking or over exertion as causes, Maclean considered that the weight and distribution of the soldier's equipment were responsible:

The pack-straps press on important muscles, arteries, veins and nerves to a degree which only those who have carried the loaded pack can appreciate. The weight, especially when the greatcoat… is strapped on, falls, to a great extent, without the line of the centre of gravity… You can well imagine how impossible it must be to make severe exertion under so many disadvantages without suffering (Maclean 1867, p. 162).

He considered that webbing supporting a pack constricted the major blood vessels supplying the heart forcing it to pump excessively hard to maintain circulation. Having reached a similar conclusion, the 1865 War Office inquiry recommended the redesign of equipment affecting the chest (Anonymous 1865). The marked differences in incidence between units, Maclean believed, related to morale: ‘in well-disciplined regiments the practice of falling out at drill or on the line of march is discouraged, and men will bear and suffer much, rather than incur the imputation of being ‘soft’’ (Maclean 1864, p. 111).

A further survey of 1635 cardiac admissions to Netley between 1863 and 1869 by A. B. R. Myers, assistant surgeon to the Coldstream Guards, found that 1322 (80.9%) were discharged from the forces and only 276 (16.9%) returned to duty (Myers 1870, p. 4). Having observed that heart disorders were ‘more prevalent in the army than the civil population’, Myers concluded that three factors accounted for this difference: rheumatic fever, Bright's disease and violent manual labour. He, too, pointed a finger at the soldier's equipment:

His waist-belt adds to the constriction below the chest, and his tunic collar above it… and then, to complete the artificial chest case, the knapsack straps supply all that is requisite, whilst the pouch-belt adds its share to the general compression. The chest, thus fixed as it were in a vice, has little or no power of expansion, and the circulation through the heart, lungs and great vessels is proportionately impeded (Myers 1870, p. 81).

Concern in the UK mounted in 1876 when re-designed equipment failed to prevent new cases of irritable heart. Despite clear evidence that there was an association with combat, Surgeon Arthur Davy suggested that the setting-up drill caused an over expansion the chest, which in turn produced dilatation of the heart thereby inducing ‘irritability’ (Wilson 1916, pp. 119–120). Hence, late-nineteenth century investigations of DAH identified a mechanical pathology, whether hypertrophy, valvular lesion or aortic dilatation and proposed mechanical causes, commonly an obstruction of the heart's outflow (Howell 1998). Because there was no effective treatment of these supposed organic conditions, servicemen were simply discharged, while military physicians sought ways to prevent new cases.

Evidence gathered from the American Civil War failed to clarify the situation. Jacob Da Costa (1833–1900), who had studied the phenomenon during the American Civil War (Wooley 1982), concluded that there was no clear-cut cause, though his analysis of 200 cases (selection criteria were not stated) showed that 38.5% had been subject to ‘hard field service and excessive marching’, and a further 30.5% had previously suffered from diarrhoea (Da Costa 1871, p. 37; Wooley 2002). Since ‘irritable heart’, as Da Costa termed the disorder, was not confined to the infantry but affected the cavalry and artillery, he argued that the webbing and packs, which varied between these arms, could not have been the primary cause. 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.

DAH was a major cause of invalidity during the South African campaign. According to official statistics, 3631 servicemen were hospitalized with DAH, and of these 41% were invalided to the UK, where they were generally discharged (Mitchell & Smith 1931, p. 273). The highest incidence of DAH was reported in orderlies of the Royal Army Medical Corps, explained by the great distances that field units were required to march to support fighting battalions (Wilson 1904). In the latter stages of the war, a large number of small columns were deployed against the Boers so that medical units had long periods of continuous marching to keep up with the widely spread engagements. It was concluded that the prolonged strain of carrying heavy weights and the pressure of straps on the chest had damaged the heart. An official report also argued that ‘cardiac exhaustion cases were much more frequent among men of volunteer companies than the regulars, probably due to the great difference of their usual daily occupation from the life of a soldier on active service’ (Wilson 1904, p. 73)—an observation that would be repeated during the next century. Once a soldier had succumbed to DAH, it was noticed that the symptoms returned if he had to ‘undergo any extra exertion or from the excitement or nervousness of going under fire’. The incidence of such disorders also increased ‘if the physical strength of the men cannot be kept up by good and sufficient food and the necessary amount of sleep and rest’. Thus, the finite resources of soldiers under fire had been observed but their implications not fully understood (Jones & Wessely 2001).

Although shell shock was the quintessential war syndrome of 1914–1918, soldier's heart or DAH was, in fact, equally common. Because of the need to return as many soldiers as possible to some form of duty, much concerted investigation was directed towards the disorder. Traditional explanations of improper drill and faulty equipment were rapidly abandoned in favour of more sophisticated medical hypotheses such as excessive glandular secretions or infectious micro-organisms. Early in 1916, Sir James Mackenzie argued that the privations of trench warfare not only weakened men's constitutions but also provided a suitable habitat for toxic bacteria (Mackenzie 1916). The net result, he believed, was a state of general exhaustion and that heart abnormalities were not cardiac in origin, but the outcome of injury to the central nervous system (Wooley 1986a). This interpretation had parallels in the late-nineteenth century idea that neurasthenia was a consequence of influenza or typhoid infection. Despite the existence of toxic or post-infective explanatory models these did not achieve widespread popularity, in contrast to the latter part of the twentieth century when they were used to account for the effects of Agent Orange and GWS.

Specialist military hospitals were set up at Mount Vernon, Hampstead and Colchester under Thomas Lewis to find more effective treatments (Wooley 1986b). Lewis redefined the disorder as ‘effort syndrome’ in a way that reflected ‘the transformation of the concept of heart disease from static and anatomical to dynamic and physiological’ (Howell 1998, p. 85). This re-evaluation allowed military physicians to think of remedial interventions, such as graduated exercise, rather than discharge to a life of invalidity. Although he was unable to discover the cause of DAH, Lewis ruled out a number of organic factors, including valvular lesions. By the end of the war, he had identified three possible pathological mechanisms: decreased buffer salts in the blood, an increased leucocyte count and abnormalities in urinary constituents (Christophers 1997). However, none of these hypotheses were mentioned in the 1940 edition of Lewis's The Soldier's Heart and the Effort Syndrome, which suggests that further investigation had failed to establish a connection. Nevertheless, Lewis continued to believe that this was a disorder of functional capacity and that the symptoms represented ‘exaggerated manifestations of the healthy responses to effort’ (Lewis 1917, p. 7).

[hillgorilla]

All very interesting, and keep up the good work for remembering those that have fallen.I do wonder however what modern research would say about the subject as the author seems to quote old sources.