Tuesday, July 31, 2007

Second Opinions

A patient has a sore throat and goes to a doctor to get treatment for it.
Doctor: Your tonsils gotta come out.
Patient: I wanna second opinion.
Doctor: Okay, you're ugly, too.

When it comes to "second opinions," few Civil War personalities have been poked and prodded as much as Stonewall Jackson, especially as regards conclusions about what really caused his death after his friendly-fire wounding at Chancellorsville.

By turns, several hypotheses have been put forward, including his direct wounding, hemorrhagic shock, chest injury, and pneumonia. Others have raised the possibility of a pulmonary embolism or a pulmonary fat embolism, and other still suggested his death was due to two distinct episodes of pulmonary embolism.

Recently, two more physicians have thrown their hat into the ring with a new hypothesis. In a recent paper, "Chronic gastrointestinal symptoms of Thomas 'Stonewall' Jackson following Mexican-American War exposure: a medical hypothesis," (Military Medicine, Jan 2007, Vol. 172, No. 1, pp. 6-8. 2007 Jan;172(1):6-8), Drs. Timothy R. Koch and Joseph B. Kirsner offer the following explanation:

"In a recent study, a large proportion of veterans seen for chronic heartburn or dyspepsia after the Persian Gulf War had evidence for Helicobacter pylori. Thomas Jackson was bom and raised in an area of West Virginia that has a high prevalence of H. pylori. He suffered chronic dyspeptic symptoms following his service in the Mexican-American War. Therapies that he tried included treatment with a variant of the Sippy diet. Following a bullet wound to the left arm at the battle of Chancellorsville on Saturday, May 2, 1863, Thomas Jackson underwent amputation of the left arm below the left shoulder. He died 1 week later with a diagnosis of pleuropneumonia. The records of the postsurgical course are incomplete. The available clinical information raises the hypothesis that his chronic dyspepsia and his cause of death could have been related to chronic peptic ulcer disease due to gastric H. pylori infection."

It's an interesting hypothesis made even more interesting in that they tie it to their experience in treating veterans of the Persian Gulf War. I'll be contacting the good doctors regarding their research for a future "Medical Department" column in The Civil War News.

If anyone has questions they'd like to ask, let me know, and I'll pass them on.

Best Regards,

Jim Schmidt

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