Historical Implications of a Failing Heart

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Brev. Brig. Gen'l
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Originally published in 2016 in the Surgeon’s Call, Volume 21, No. 1

Robert E. Lee, a well-known historical figure, was born in Virginia, and served in Virginia the majority of his professional career, both as a soldier and university president; his life and career is the subject of public history, as well as a subject of historical scholars. Scholars of the American Civil War are familiar with Lee’s military and personal history. During the past one and a half centuries, thousands of books, essays, and articles have chronicled Lee’s life. The realm of public history contains much about Lee. Writers stylize Lee as a heroic figure, an ideal father and husband, and selfless citizen; the public generally considered Lee to be in good health with a vigorous constitution. The historiography of Lee’s medical condition consists of reports detailing some specific aspects of his health, such as his final illness. The report and interpretation of his final illness varies from a contemporary report by his attending physicians at the time of Lee’s death[1] to a more recent interpretation ascribing his final illness to a stroke.[2] Authors of these previous reports have not written them in the context of the state of medical knowledge, medical practice, medical practitioners; and in the context of the state of medical education in the nineteenth century. Additionally, there has not been a comprehensive report chronologically detailing Lee’s illness.

During Lee’s 63 years (1807-1870), medical education and practice were in significant transition. Early in the nineteenth century, medicine was domestic, family centered, and typically a woman family member provided medical treatment to her own family; the practitioner of medical care at times branched out to other members of the local community. Subsequently, medical care transitioned to lay practitioners who provided care to the community; the role of healer gradually shifted from women to men, and only later in the nineteenth century were women more fully a part of the medical profession. Professionalization of American medicine did not begin to take place until later in the nineteenth century. Medical education in the late eighteenth century and early nineteenth century consisted of apprenticeships under the tutelage of established practitioners; little or no didactic instruction was available. Some early colonial physicians traveled to Europe for formal training, returning to the colonies to provide medical care and tutelage in the form of apprenticeships.

As medicine became professionalized, medical education, licensing, and practice became more structured. Nevertheless, during the Jacksonian period of the nineteenth century, the social and political climate of egalitarianism was unfavorable to the transformation of physicians to elite status, but rather was conducive to the development of medical sects and the existence of “quacks.” Medical sectarianism developed in competition to “regular” or “heroic” medicine, which was characterized by bloodletting, purging with calomel, and the utilization of tartar emetics. The era of scientific advances in the mid to late nineteenth century led to the predominance of “regular” practitioners and the decline of medical sects.

Physicians progressed from just listening to patients give accounts of their symptoms to actual examination of the patient using auscultation and percussion. Medical instruments – stethoscope, thermometer, microscope, among others – began to enter the realm of the practitioner. Medical education became more standardized and scientifically based. Robert E. Lee lived during this transitional period in medical history; he had the opportunity to choose from a broad range of medical practitioners: the lay practitioner, the uneducated regular or sectarian doctor, and the educated/licensed regular physician. As we will see, Lee chose wisely for himself and his army.

Read the rest of the article at: http://www.civilwarmed.org/surgeons...avYMONVNTeTOJDaKDxin-8LEw-L_Z-Pz2Ld6azQJUJrhE
 
Long article but very good. It does leave you wondering how on earth Lee did what he did after 1863. It's always amazed me anyone his age got on a horse and went to war. Keeping it up after what was probably a heart attack? Amazing.
 
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