The Definitive DAH Thread

[RedCoat]

Hi all,

My Great Grandfather received a war pension for DAH, Disorderly Action of the Heart.

I have read the Long Long Trails piece on DAH, searched the forum and have read some articles online. 

One thing I have noticed is that there are many differing opinions on what DAH is, some say its an organic heart condition, others say its symptomatic of PTSD. I would like to create a definitive thread on all things DAH.

If you have any information to add, be it academic or otherwise I would be fascinated to read it.

Kind regards
Emps

 

Edited 26 December , 2021 by RedCoat

[ss002d6252]

I think you'll have a hard time pinning anything down as, at the time, it was used as quite a wide definition.

You could maybe go back medically now and re-classify each case but as that's not possible I don't think you could ever now begin to try and determine what was DAH and what wasn't, other than a very wide definition. The Medical History of the War alludes to this same situation.

@Dai Bach y Sowldiwr might be able to add something.

Craig

[Dai Bach y Sowldiwr]

8 minutes ago, ss002d6252 said:

I think you'll have a hard time pinning anything down as, at the time, it was used as quite a wide definition.

You could maybe go back medically now and re-classify each case but as that's not possible I don't think you could ever now begin to try and determine what was DAH and what wasn't, other than a very wide definition. The Medical History of the War alludes to this same situation.

@Dai Bach y Sowldiwr might be able to add something.

Craig

I agree wirh everything you say Craig.

[RedCoat]

1 hour ago, ss002d6252 said:

I think you'll have a hard time pinning anything down as, at the time, it was used as quite a wide definition.

You could maybe go back medically now and re-classify each case but as that's not possible I don't think you could ever now begin to try and determine what was DAH and what wasn't, other than a very wide definition. The Medical History of the War alludes to this same situation.

@Dai Bach y Sowldiwr might be able to add something.

Craig

Yes Craig, you have summed up my issue completely. The overwhelming online trend seems to be towards PTSD - I suspect that its due to todays fashionable focus on mental health. My Great Grandfather did in fact die from a heart condition, was it a result from his wartime DAH or a completely unrelated congenital heart defect - we will never know!

It seems that Neurasthenia has the same issues - a catch all term......

Cheers 

[ss002d6252]

20 minutes ago, RedCoat said:

It seems that Neurasthenia has the same issues - a catch all term......

Almost certainly.

Craig

[Interested]

When we were in the heart monitoring business we looked at various arrhythmias  - there are many causes.  I found drinking quantities of grapefruit juice induced occasional ventricular beats; I'm sure Dai Bach will provide explanations if necessary, but I'm trying to  support the expert view - many causes, some not so obvious.

[TEW]

Seems like a good idea to ignore the overwhelming online trend which equates DAH to PTSD. Early use of PTSD stems from the early 1980s, long after DAH had become obsolete.

PTSD does not equate to shell-shock or neurasthenia, although there may be some overlaps in individual cases.

Nobody was diagnosed with PTSD during either World War.

TNA have 408 medical cases in MH106 for Disordered Action of the Heart, not online unfortunately.

It certainly would be interesting to go through DAH cases and try to work out a modern day diagnosis but perhaps you'll end up with a broad range.

Many men no doubt had pre-existing heart conditions they knew nothing about until medical treatment for something else picked that up.

I would also think it likely that pension files and the MH106 files will be trying to nudge DAH out of the caused by and aggravated by the war area to reduce payouts.

TEW

 

[RedCoat]

3 minutes ago, TEW said:

Seems like a good idea to ignore the overwhelming online trend which equates DAH to PTSD. Early use of PTSD stems from the early 1980s, long after DAH had become obsolete.

PTSD does not equate to shell-shock or neurasthenia, although there may be some overlaps in individual cases.

Nobody was diagnosed with PTSD during either World War.

TNA have 408 medical cases in MH106 for Disordered Action of the Heart, not online unfortunately.

It certainly would be interesting to go through DAH cases and try to work out a modern day diagnosis but perhaps you'll end up with a broad range.

Many men no doubt had pre-existing heart conditions they knew nothing about until medical treatment for something else picked that up.

I would also think it likely that pension files and the MH106 files will be trying to nudge DAH out of the caused by and aggravated by the war area to reduce payouts.

TEW

 

Quite right TEW, PTSD is a modern term and shouldn't be used when discussing events that precede it.

Can you post a link to the 408 DAH cases held by TNA please. I may very well enlist the help of a Dr chap I know to see if modern diagnosis's are possible - as you say, it might be interesting.

Cheers

 

 

 

[TEW]

Having trouble copying the TNA link.

If you use the advanced Discovery search and add Disordered Action of the Heart in the Exact word or phrase box. Also add mh106 in the Any of these references box should get you there.

If you wanted to filter the TNA results to those with lots of case sheets or those with an outcome you're going to have to read the full description. Probably better to arm your researcher with ten promising cases rather than those with one sheet and no further details or outcome.

You may be able to use the details from the TNA hits to search online for WO364 records for those Individuals.

I don't know if the WFA records can be searched by ailment but there must be DAH cards/ledgers.

TEW

 

 

[aconnolly]

Hi

DAH was believed to be a "nervous disorder" ; Great War psychiatric stats include the diagnosis, but today it is regarded mainly as an electrical conduction disturbance.  The most common diagnosis made now would be Atrial Fibrillation.  Causes include malnutrition as loss of fat around the heart affects the normal conduction pathways along with  vitamin deficiencies.  Interestingly supremely fit individuals may also have conduction disturbance also likely due to fat loss.  DAH was common on Gallipoli - at least at Anzac - as well as in Palestine campaign but affected soldiers in all Theatres.  

Andrew

Edited 27 December , 2021 by aconnolly

[Guest]

Sorry had a rethink

Edited 27 December , 2021 by stevebecker
rethink

[kenf48]

On 26/12/2021 at 09:37, RedCoat said:

If you have any information to add, be it academic or otherwise I would be fascinated to read it.

The OH Medical Diseases of the War Volume 1 (Macpherson)devotes a whole chapter to cardio vascular disease, including observations on VDH and DAH, noting it was suggested the latter could be more accurately described as 'effort syndrome' but the diagnosis DAH continued to be applied throughout the war.  

It is recorded in the OH that during active warfare it was found that only 5 to 10% of men who complained of referable symptom of the heart could be shown to be suffering from organic disease to the heart.  Another 8 to 10% who referenced their symptoms to the heart were found to be suffering from disease unrelated to the circulatory system.  The most common symptoms of the remaining 80 % were shortness of breath, pain in the chest, palpitation and giddiness but there was no discernible heart disease.The OH observes "It is to this particular class that special attention has been directed." and goes on to describe in considerable detail the incidence of VDH and DAH.  The probable cause and treatment especially in F &F where special centres were set up (in common with 'nervous'diseases)to avoid repatriation and treat men in theatre.  The description includes a statistical breakdown of numbers and the observations made by medical staff when examining patients.

In Volume 2 similar observations are recorded of the cardiac response of those soldiers suffering from nervous disease (Chapter 1).  In addition this volume has indexed references of the incidence of DAH in relation to gas poisoning.

As has been mentioned many times before on here the term PTSD was first coined in the Diagnostic and Statistical Manual of the American Psychiatric Association in 1980 and has little relevance to the Great War period.  It has a much broader definition than that of  'war neurosis' or 'soldier's heart' conditions which were known, although perhaps not fully understood, when the regular army went to war in 1914, becoming more acute on the Western Front as the largely civilian soldiers of the New Armies became fully engaged.

Both volumes of the OH are available online, (archive.org I think I'm quoting from downloads) as is the post war report of the War Office Committee of Enquiry into Shell Shock.  The latter at https://wellcomecollection.org/works/v33yrqma

[Tony Ferguson]

I know this is a highly complex subject, but can someone enlighten me on how they differentiated between DAH and Shell Shock during WW1? What were seen to be the differences?

Thx

[kenf48]

1 hour ago, Tony Ferguson said:

I know this is a highly complex subject, but can someone enlighten me on how they differentiated between DAH and Shell Shock during WW1? What were seen to be the differences?

Thx

I would suggest a good starting point would be the War Office Committee of Enquiry into Shell Shock as linked in my previous post:

essentially the Committee set forward a 'Delimitation of the term Shell Shock', they then set out their reasons for doing so under the heading "Use and Abuse of the Term" (p.4 et seq of their report). They describe the reasons why a "loose and indiscriminate use of the term" had led to problems and the reasons why this occurred.  In other words 'shell shock' a term which was supposed to have been abandoned in 1916 see diary entry of DMS on this thread:-

DAH on the other hand related to a physical diagnosis rather than a mental diagnosis, but again with no discernible cause, or evidence of organic disease save for a minority of cases as previously posted above.

In the main the difference between these two archaic and discredited terms seems to have lain with the empathy of the the medical officers making the initial diagnosis which led to the man being relieved from duty in the front line.  

As previously stated the OH 'Diseases of the War' devotes whole chapters to both 'Neurasthania" and 'Cardio Vascular Disease".