The Civil War, as one of the deadliest wars in American History, resulted in unprecedented casualties at an immense scale. The staggering number of wounded soldiers presented physicians and surgeons with unfamiliar syndromes or conditions, creating an exceptional opportunity for systematic observation and documentation that laid the groundwork for modern diagnoses.
One of the most perplexing and widely observed conditions was irritable heart syndrome, also known as “Soldier's Heart,” a term coined by Dr. Jacob Mendes Da Costa, a civilian contract surgeon in Philadelphia (3). Between 1861 and 1865, Da Costa studied over 300 soldiers presenting with a constellation of baffling symptoms. These men complained of chest pain, a rapid and irregular pulse as well as difficulty breathing, fatigue, weakness, and a host of psychological symptoms, including nightmares and sleep disturbances. He noted that while not every patient experienced all symptoms, all cases of "irritable heart," as he initially called it, included a rapid pulse, palpitations, and chest pain, often following a digestive complaint (3).
Da Costa’s work was groundbreaking for its time, but his conclusions were limited by the era's medical framework. The concept of psychological trauma as a cause of physical ailment was largely nonexistent. While a few physicians of the time suggested the cardiac symptoms were "precipitated by battle trauma," a truly modern understanding of such a condition would not emerge for decades given that Sigmund Freud’s work on the subconscious was still years away. Therefore, Da Costa attributed the condition not to emotional distress, but to an over-taxing of the nervous system (3). He concluded that it was a physiological, rather than a psychological, disorder, and his work was widely published, establishing the condition as “Da Costa Syndrome” in the medical literature (1). Today, the symptoms so carefully documented by Da Costa are recognized as a classic presentation of Post-Traumatic Stress Disorder (PTSD) (3). This shift from viewing the condition as a purely nervous system disorder to a psychological one illustrates the dramatic evolution of medicine in the subsequent century.
Another significant medical discovery to emerge from the war was the phenomenon of phantom limb pain, a term also introduced by a Philadelphia physician, Silas Weir Mitchell, in 1871 (5). Although Mitchell is credited with coining the term and medicalizing the condition, the experience itself was well-known among the thousands of amputee soldiers and military surgeons. However, many physicians at the time dismissed it as soldiers feigning illness because there was no visible physical cause to justify the pain. This dismissal had devastating consequences for the soldiers, who were not only suffering from chronic, agonizing pain but were often stigmatized as malingerers feigning illness to avoid service (4).
Mitchell nonetheless believed that the soldiers’ pain was real and sought to legitimize it in the eyes of both the public and the medical community. He took an unusual approach by publishing a short story anonymously about a fictional amputee named George Dedlow who suffered from this mysterious pain (5). The story resonated powerfully with readers, and many, believing Dedlow to be a real person, even tried to contact the hospital to offer their support (4). This overwhelming public response demonstrated the reality of the soldiers’ suffering and helped Mitchell to fight the pervasive stigma. Following the story's success, Mitchell published clinical articles in medical journals, introducing the concept of pain in an amputated limb as a legitimate injury of the nerves and naming it “phantom limb pain”(2). Today, there is a much more robust understanding of this neurological phenomenon, and a variety of treatments, from physical therapy and medication to mirror therapy, have come about.
The U.S. Civil War, while a period of immense devastation, inadvertently became a pivotal moment for American medicine. The dedicated work of doctors like Da Costa and Mitchell, who meticulously documented the baffling conditions they encountered, led to a deeper understanding of the complex relationship between the mind and body. While their initial conclusions may have been flawed by the limitations of their time, their systematic efforts provided the essential groundwork for modern diagnoses like PTSD and a more compassionate, evidence-based approach to chronic pain. The legacy of these two conditions underscores how an empathetic approach to human suffering can change the course of medical history.
References
Da Costa JM. On irritable heart: a clinical study of some functional cardiac disorders and their diagnosis. Am J Med Sci. 1871;61(1):17-52.
Mitchell SW. Phantom limbs and the ghosts of war. Harper’s New Monthly Magazine. 1871;43(257):697-703.
National Museum of Civil War Medicine. Irritable heart: fictional Dr. Foster and actual Dr. Jacob M. Da Costa. Civil War Medicine. Published January 20, 2016. Accessed September 17, 2025. https://www.civilwarmed.org/irritableheart/.
University of Pennsylvania, Perelman School of Medicine, Department of Neurology. Silas Weir Mitchell (1829-1914). Penn Neurology. Accessed September 17, 2025. https://www.med.upenn.edu/neurology/silas-weir-mitchell.html.
Mitchell SW. The case of George Dedlow. The Atlantic. 1866;18(106):26-48.
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