_:n81324181af074031aba6b6b572b81111xb0
<http://schema.org/articleBody>
"\nNancy Hartevelt Kobrin, Ph.D., L.M.F.T. and Jerry L. Kobrin, M.D. St. Paul, Minnesota This essay presents a Sephardi physician, J. M. da Costa, who described the Civil War equivalent of Posttraumatic Stress Disorder-Irritable Heart. Da Costa's medical contribution is deemed an origin for the contemporary field of traumatic stress studies. Intergenerational transmission of trauma is an important facet of trauma studies; extensive research exists concerning Holocaust survivors, their children and grandchildren. Secondgeneral children routinely choose helping professions such as medicine in order to master their parents' trauma and to fend offfeelings ofpsychological vulnerability which may lead to assimilation and marrying out. Da Costa personifies such findings. It is suggested that the Marrano experience has not been adequately factored into what it means for Jewish identity and continuity. The concept of tinok she-nishbah, the captured infant, is used metaphorically to frame the problematic discontinuity of identity due to trauma. Introduction The answer to the question which this title poses is technically no-J. M. da Costa would not qualify as a tinok she-nishbah (literally a captured infant or child who has been raised in total ignorance of Judaism), but here we will argue that this rabbinic concept may be tremendously helpful in reassessing the emotional discontinuity to Judaism. Such a traumatized sense of self may lead to and perhaps explain in part high rates of assimilation and intermarriage that have plagued Judaism and the Jewish community over the centuries but most especially in post-Holocaust times. The antecedents of traumatic communal experiences have chipped away at a cohesive and productive sense of Jewish identity with shifts away from the traditional value of learning and teaching. By examining the life and works of a brilliant American Civil War physician, Dr. Jacob Mendes da Costa, the authors intend to demonstrate that due to the family legacy ofMarranism, da Costa was psychologically vulnerable to assimilation and marrying out. Psychological trauma dating from the time of the Spanish Inquisition and the family's expulsion from Spain caused the descendents to be set apart, making it quite difficult to reintegrate into a normative Sephardi life free from identification with religions other than Judaism. Jacob Mendes da Costa was an extraordinary physician at the time of the American Civil War, so much so that to this day there exists an eponym, the Da Costa syndrome, J. M. da Costa, M.D.: An American Civil War Converso Physician in medicine, especially psychiatry and cardiology. Da Costa was the first to be credited with describing panic attacks in soldiers associated with cardiac arrhythmia, or irregular heartbeat, which he called Irritable Heart of the Soldier. Da Costa was of Marrano descent with a family history that demonstrated an inability to reintegrate into London Jewry. In many ways he was also a nineteenth-century Converso physician following that important medical tradition, dating from the sixteenth century, of those physicians who were allowed to train in Padua and who were among the first Jews to be allowed to study medicine in Renaissance Europe. Yet da Costa remains largely unknown to a history of Jewish medicine and to the wider Jewish public. This historical repression of his memory serves as a metaphor for the haunting Marrano and Converso experience and the underestimated toll it has taken on Jewish identity and continuity. Like Madeleine Albright's family, Jacob Mendes da Costa's family never settled into a comfortable and cohesive sense of Jewish identity following traumatic social upheaval; and while there is as yet no evidence that he personally converted to Episcopalianism as Albright did, his mother, Ramah Levy Mendes da Costa, did convert after the death ofher husband Yonatan, and within the same time her son Jacob married Sarah Brinton, a prominent Episcopalian. She came from an illustrious colonial white Anglo-Saxon Protestant family. Her first cousin was General George B. McClellan of Civil War fame. Their children, like Albright's, were raised Episcopalian. However, unlike Albright's childhood, da Costa's was outwardly Jewish, in the active Sephardic community ofSt. Thomas, West Indies with sojourns to London and Amsterdam to visit extended family. Yet, the familial chemistry for solidifying a peaceful cohesive sense ofJudaism had not established itself for the previous generations ofthe London Mendes da Costa family, and certainly Jacob followed the ambivalent suit of the English scion, with assimilation and intermarriage being his destiny. Recently Lawrence Schiffman introduced into the English discussion of the Albright affair the rabbinic concept of tinok she-nishbah. 1 He essentially argued that the rabbis would consider Madeleine Albright a tinokshe-nishbah, like the Hidden Children of the Holocaust who were taken against their will and had no opportunity to learn of their Judaism. While the term is generally reserved for those who have grown up in total ignorance of Judaism, a psychological understanding and use of the concept of tinok she-nishbah takes into account the role massive psychological trauma plays in undoing a cohesive Jewish identity. Given the magnitude of the Spanish Inquisition, its subsequent expulsions, and the Holocaust in conjunction with contemporary psychological ILawrence H. Schiffman, \"Responsa: Is Madeleine Albright Jewish?,\" Moment, (April 1997), p. 62. A search of the Bar Han University data base retrieved 79 citations for tinok she-nishbah from Talmud (6), medieval responsa literature (4), 16th c. responsa literature (12), and 17-19th c. responsa (57), with its semantic field expanding in usage over the centuries. knowledge, a more informed reading of Jewish identity could account for the present state of assimilation and intermarriage and the preoccupation with the question of Jewish continuity. This knowledge was something which was not available to the rabbis of the Talmud, who by coining the term tinok she-nishbah indicated that they did have a unique sensitivity to childrearing experiences, though the question of agency and freedom of choice was more complicated for them to account for without an elaborated notion of psychic trauma, most especially for a child, even a child who had apparently been raised in a Jewish home. There was as yet no means of accounting for either the intergenerational transmission of trauma or its implications of traumatic experience in undercutting a cohesive healthy sense of being Jewish. This essay presents a profile of da Costa in light of his life experience and his scientific works. 1. M. da Costa is chosen because he was a brilliant physician who was preocupied theoretically with the effects of combat trauma. He was also of Sephardi descent with ancestors who practiced the crypto-Judaism of the Marrano, an underground experience which indicates an attempt at resiliency and survival. Faur has asserted that the rise of modernity is linked to the Marrano experience. 2 Indeed the Madeleine Albright controversy demonstrates how issues in traumatic experience have yielded a disruption of familial ties to Judaism. The rabbinic concept of tinok shenishbah indicates that the Rabbis had an enlightened sense of trauma and childhood development, though the Greek term trauma itself is not to be found interpolated into the responsa literature, most likely because it was still too early in the history of the west for the term to be used in a psychological sense, something which happened in the late 1800s.3 Nevertheless, the question ofthe status ofthe Marranos and Conversos and who is a Jew was very much under discussion in Sephardi diasporic communities. Thus, the category of tinok she-nishbah may still be potentially helpful in pointing out the arbitrariness of who is included in the category over against the complexity of identity formation processes. Ironically Dr. da Costa is, so to speak, the forgotten father of American Civil War's \"Post-Traumatic Stress Disorder.\" His recognition of this early form of PTSD may have been amplified and facilitated by his own Marrano legacy. PTSD is intimately linked to the transmission of trauma across generations. Da Costa's career choice of medicine, a helping profession, coincides with the high frequency of 2Jos e Faur, In the Shadow ofHistory: Jews and Con versos at the Dawn ofModernity (Albany, New York: State University of New York Press, 1992). 3The Oxford English Dictionary cites the first use of the tenn psychic trauma by Nathan Oppenheim, M.D. in a non-psychoanalytic essay entitled \"Why Children Lie?\" in the Scientific Monthly, 1895. Used in scientific poster fonn at the International Society for Traumatic Stress Studies in San Antonio in 1993 by these authors. J. M da Costa, MD.: An American Civil War Coiwerso Physician Holocaust survivors' children also choosing similarly. Moreover, after the Expulsion from Spain, it may be understood psychologically that many Conversos continued the tradition of medicine in order to master the trauma of their parents. The only discipline today in which da Costa's contribution is genuinely acknowledged is in the interdisciplinary field of Traumatic Stress Studies. There one can hear his name invoked whenever the history of the field is given. Most contemporary American psychiatrists remain unaware that da Costa is generally credited as the first physician to identify and describe panic attacks, and even fewer know him as the Civil War father of a concept like PTSD called Irritable Heart of the Soldier. 4 This is to say nothing ofJewish physicians knowing about his family history or medical contributions as a nascent cardiologist. Few physicians are familiar with his opus Medical Diagnosis (1859), radical for its time, in which he proposed a semiotic approach to the diagnosis, treatment, and teaching ofpathology.5 The text was hailed by The Medical Record of 1867 as having no equal in any language. 6 Da Costa was often referred to as the physician's physician, with an uncanny ability to diagnose. Only one Jewish medical biographer, Solomon R. Kagan, in his 1930 text provided an entry for da Costa, specifically noting his Sephardi heritage, while not one reference can be found for him in the Encyclopedia Judaica. 7 Lost to history, da Costa's person and his writings serve as a reminder of the enormous contribution the American Sephardi community made to American life in the nineteenth century. 8 J. M. da Costa's Childhood Born into the Sephardi community of Charlotte Amalie, St. Thomas, West Indies in 1833 like another Sephardi, Pizarro ofImpressionism, Jacob Mendes da Costa came 4 B. P. R. Gersons, \"Post-traumatic Stress Disorder: The History of a Recent Concept,\" British Journal ofPsychiatry, Vol. 161 (Dec. 1992), pp. 742-748; and Wolfgang Maier, Raimund Buller, Hubert Rieger, and Otto Benkert, \"The Cardiac Anxiety Syndrome-A Subtype of Panic Attacks,\" European Archives ofPsychiatry and Neurological Sciences, Vol. 235, No.3 (1985), pp. 146-152. 5J . M. DaCosta, M.D., LL.D. Medical Diagnosis with Special Reference to Practical Medicine: Guide to the Knowledge and Discrimination ofDiseases, sixth ed., revised (London: J. B. Lippincott & Co., 1884). 6The Medical Record of 1867 (New York: W. Wood). 7Solomon R. Kagan, M.D., Jewish Contributions to Medicine in America (1656-1934), (Boston: Boston Medical Publishing Company, 1934), p. 442. 8Edouard Roditi noted that\" it would seem that America's Sephardi elite failed to produce, throughout the whole of the 19th century, a single scholar, writer, or artist of note, with the exception of the minor poet Emma Lazarus ... and Jacob Hart Lazarus in, 'The Real Grandees,'\" Commentary (October 1971), p. 95. from a family of merchants and bankers. The year of his birth was the same year in which their synagogue, B'racha V'shalom U'gemilat Hasadim, was rededicated after a fire had devastated it and the entire city.9 Biographical material for da Costa essentially has been limited to the memories of his colleague 1. C. Wilson, M.D. and da Costa's secretary Mary Clarke. Both of these non-Jewish biographers present him as being of Spanish and Portuguese descent. Neither biographer can be considered informed about Sephardi history, nor do other entries in medical biographies note his Sephardi heritage, save for Kagan's profile. lo Equally striking is that da Costa's obituaries and death certificate offer no clue ofhis religious affiliation. II While da Costa is buried in a family plot at the Woodlands Cemetery in Philadelphia under an Episcopal cross-most likely because ofhis marriage to Sarah Brinton-it remains unclear under what circumstances this took place. However, it should be noted that the Woodlands Cemetery is the \"Arlington\" of Philadelphia, the final resting place for other notables, especially from the field of medicine such as S. Weir Mitchell, Samuel Gross, John Hill Brinton, John Ashhurst, Frank Fontaine Maury, James Aitkin Meigs, William Williams Keen, Jr., and John Conrad OttO. 12 Thus, to describe da Costa as deriving from a prominent Spanish and Portuguese family strains out and submerges in a Marrano manner the significance ofthe Sephardi tradition from which he came-the importance of its strong family ties, the significance 9phyllis Ellen Funke, \"The Jewish Traveler: The Virgin Islands,\" Hadassah Magazine (December 1994), p. 27; this citation demonstrates how only recently da Costa has begun to be rehabilitated as a Jewish figure of medicine. Funke writes: \"Jacob Mendes da Costa, who upon emigration to the mainland authored five widely circulated medical texts, was born on St. Thomas in 1833\" (p. 29). IOMary A. Clarke, \"Memoir of J. M. da Costa,\" The American Journal ofthe Medical Sciences, Vol. CXXV, No.2 (February 1903), pp. 318-329. See also J. C. Wilson, M.D., \"Memoir of J. M. Da Costa, M.D\" (read November 5, 1902) in the Transactions of the College of Physicians of Philadelphia, Series 3, Vol. 24 (1902), pp. lxxxi-xcii; \"Da Costa, Jacob M.\" in Who Was Who in America, Vol. I, 1897-1942 (Chicago: Marquis, 1968), p. 290; \"Da Costa, Jacob Mendez,\" Dictionary ofAmerican Biography, Allen Johnson & Dumas Malone, eds. (New York: Charles Scribner\"s Sons, 1983), Vol. III, pp. 24-25; Ralph Hermon Major, A History ofMedicine (Thomas, 1954), Vol. 2, p. 897; \"Da Costa, Jacob Mendez,\" The Oxford Companion to Medicine, ed. John Walton, Paul B. Beeson, Ronald Bodley Scott (New York: Oxford University Press, 1986), p. n. c.; John H. Talbott. \"Jacob Mendez Da Costa,\" in Biographical History of Medicine (Grune and Stratton, 1970), pp. 1123-1125; and Solomon R. Kagan, M.D., \"Jacob Mendes da Costa, M.D.,\" in Jewish Contributions to Medicine in America (1656-1934) (Boston: Boston Medical Publishing Company, 1934), p. 442. II Philadelphia Public Ledger (September 12, 1900). 12Personal communication and printed materials, Michael Hardy, Executive Director of The Woodlands: A National Historic Landmark and Active Rural Cemetery since 1840, Philadelphia. See also, Margolinsky, \"299 Epitaphs on the Jewish Cemetery in St. Thomas, W. I. 1837-1916: Compiled from Records in the Archives of the Jewish Community in Copenhagen, 1965.\" of Inquisitional persecutions, the expulsions, the legacy of the subsequent exiled enclave of Converso physicians, the implications of tracing direct descendance to medieval Iberia, and the fact of being a nineteenth-century Early American Sephardi Jew with instances in his family of intermarriage and troubles in reaffiliating with the Sephardi community in England. Indeed the term \"Portuguese\" had lost its Elizabethean meaning signifying Jew. 13 By the end of the nineteenth century, a reader of medical biography probably could not decode this hidden meaning ofcoming from a Portuguese family. Da Costa's family was identifiably Jewish through other sources. His father Jonathan was a prominent banker and his mother Ramah Levy was the daughter of Moses Elias Levy, who was born in Mogador, Morocco, in 1781. His grandfather Moses attemped to establish a Jewish colony in a large grant ofland in Spanish Florida. Moses advocated a pre-Herzl Zionism. Ramah's brother, David Levy (1810-1886), changed his name to Yulee and became Florida's first U.S. senator, the first person of Jewish birth elected to the Senate. Likewise he married out and raised his children Christian. Dr. da Costa was the first born of possibly four children-Jacob, Rebecca, Moses, and Charles. There is some discrepancy as to the number of siblings, in that his two biographers mention only his youngest brother Charles, while the eminent American Jewish geneologist Rabbi Malcom Stern cited only Rebecca and Moses.' 4 Since Sephardi naming patterns are almost invariable, with the oldest son being named for the paternal grandfather, living or dead, and the oldest daughter for the paternal grandmother, we can assume that Jacob was named after his paternal grandfather, Jacob Mendes da Costa, who was the son ofIsaac Mendes da Costa married to Ribca (variant of Rebecca) de Elias Lindo, another very prominent Anglo-Jewish family: 15 I recall that when I first came across your Dr. JACOB, I did some research on him and realized that with his marriage to a Christian he separated himself from the Jewish community. But as the above shows, he was a Sephardi Jew by birth, Rabbi Stern died shortly after writing this, making it impossible to gain clarification of what he meant by \"separating from the Jewish community.\" There were other Sephardim like Spinoza or Uriel Acosta (an ancestor of da Costa), known heretics, yet 13N. Kobrin, \"Moses on the Margin: A Critical Transcription and Semiotic Analysis of Eight Aljamiado Legends of the Morisco Figure of Muuyaa\" (Doctoral Dissertation, University of Minnesota, 1983), Vol. 2, pp. 438--440. See also, \"Portuguese\", The Compact Edition ofthe Oxford English Dictionary (Oxford: Oxford University Press, 1984), Vol. 2, p. 2247. 14Personal communication, Rabbi Malcom H. Stem, letter of Dec. 23, 1993. 15Stem, letter of Dec. 23, 1993. See also Bevis Marks Records, Part II. their memory is retained within Jewish history, albeit ambivalently. Even da Costa's uncle, David Yulee, is cited in the Encyclopedia Judaica. 16 This conflicted scholastic attitude toward Sephardim ofa Marrano or Converso legacy harbors relevant communal emotional ambivalence that happened to resurface with the Albright affair. This is an indicator ofthe residue oftrauma; this kind ofinquiry into one's \"true\" identity reenacts the tone of the Spanish Inquisitors. The repetitive uprooting-traveling back and forth, not being able to settle down-is a constant theme in Jacob's early life, mirroring the experience of expulsion. The Young da Costa's Wanderings Young Jacob made his first trip to Europe at the age offour, leaving St. Thomas with his parents, who wanted him to have a European education. It is unclear as to where in Europe the family went, presumably to the extended family in London. After several years the family relocated back to the New World, this time to Philadelphia, where again there existed a well-established affluent Sephardi community and synagogue Mikveh Israel. 17 The family continued to reside in Philadelphia until Jacob and his brother Charles were ready to enter the Gymnasium. It was then decided that the two boys were to be sent to live with family friends in Dresden. By his early teens Jacob had been to Europe several times and had acquired several languages. On the positive side, these foreign studies deepened da Costa's facility with language and his understanding of culture. Upon finishing high school and returning to Philadelphia Jacob had acquired a series of languages, among them Greek, Latin, French, Italian, Dutch, German, Spanish, and Portuguese. This was a most unusual background for a young gentleman. His mother wanted him to become a physician and urged him to apply to Jefferson 16\"Spinoza,\" Encyclopedia Judaica, Vol. 15, p. 275-284; \"Costa, Uriel da,\" Encyclopedia Judaica, Vol. 5, p. 987; and \"Yulee, David Levy,\" Encyclopedia Judaica, Vol. 16, pp. 894-895. Consider Judah Touro's Jewishness: Judah was the son of Isaac Touro, the famous Cantor of the Rhode Island Synagogue Yeshuat Israel, New Port; upon his death in 1854 he bequeathed $500,000 for Catholic, Protestant and Jewish charities. This gift does not mean that he converted to Episcopalianism as Stephen Birmingham had indicated in The Grandees. It may indicate more correctly the Sephardi and Marrano experience of religious intolerance and the need for dialogue. 17 Abraham J. Karp ed., The Jewish Experience in America: In the Early Republic (New York: KTAV Publishing, 1969). Karp offers statistics on the Jewish community of Philadelphia: It was the only American city that had two synagogues by 1795. By 1820 there were 58 households, with a population of 402. \"Philadelphia,\" Encyclopedia Judaica, Vol. 13, pp. 368-370 notes that services were held earlier at Mikveh Israel by at least 1761 and Gershon Mendes Seixas was the community'S hazzan in 1780, returning to New York after 1782. See Migration and Settlement: Proceedings ofthe Anglo-American Jewish Historical Conference, rapporteur, Dr. Aubrey Newman (London: The Jewish Historical Society of England, 1971). J. M da Costa. MD.: An American Civil War Converso Physician Medical College in Philadelphia. 18 At the time ofhis application Medical School was only a two- or three-year course of study with no standardized application process. Long before Boston and New York were considered the medical capitals of America, Philadelphia boasted the fIrst strongly developed medical tradition with six medical schools, which was considered to be on the cutting edge. Da Costa began his medical studies in 1849 under the direction of Professor Mutter, a world renowned physiciaA and diagnostician. He fInished the course of studies with honors in 1852 and was already recognized as a future scholar. Post-Medical Studies in France-1852 Again da Costa returned to Europe, repeating the old pattern of wandering. It was now a decade before the outbreak of the American Civil War; da Costa wanted postgraduate training in Paris, Prague, and Vienna. Paris was in its heyday as the pinnacle of European medicine and not yet surpassed by Vienna. Da Costa sought out only the best to study with-Trousseau, Orf11a, N61aton, and Ricord. He attended rounds at I'Hotel Dieu, la Charit6, I'Hopital des Cliniques, la Salpetriere and 1'Hopital du Midi. At the end of the year he went on to Prague and Vienna, where he studied with August Klaatsch, an exceptional physician and writer who was himself trained by Hyrtl. Klaatsch had a unique collection ofmicroscopic specimens especially made as a gift for da Costa. 19 This collection was ultimately bequeathed by his brother Charles, a prominent New York lawyer, to the Department of Biology, Columbia University, at the time of his death. 20 The time spent in France left an indelible mark on da Costa's training; it brought into focus the difference between the theory and practice of medicine. This was an area in which few American physicians had yet been trained, since so much of New World medicine was geared to immediate clinical intervention. Da Costa fell into the classic role of the Sephardi physician as cultural translator transmitting knowledge about science and medicine from the East to the West, only this time it was across the Atlantic Ocean and not \"the golden age\" of the school of Toledo. 18The authors wish to thank Frederick B. Wagner, Jr., M.D. professor emeritus, history of medicine at Thomas Jefferson University, for inviting them to preview his essay on Da Costa (at press). 19J. C. Wilson, M.D., \"Memoire of J. M. Da Costa, M.D.,\" Transactions of the College of Physicians ofPhiladelphia (1875), Series 3, Vol. 24 (1902), pp. 81-92. 20That Col~mbia was chosen is not surprising given the fact that the American Sephardi community had longstanding ties with Gershon Mendes Seixas, one of its first Trustees. Cf. \"Seixas,\" Encyclopedia Judaica, Vol. 14,pp. 1116-1117. r' SHOFAR Falll999 Vol. 18, No. I In 1853 da Costa returned to Philadelphia to start a private practice, only to be immediately recruited to teach physical diagnosis. His uncanny ability to listen to a patient's history and draw an accurate diagnostic conclusion earned him the reputation as the city's best diagnostician. Da Costa was a rarity for his day-so young, a Renaissance polyglot. His commitment to the highest level of pedagogy remained a lifelong concern, attested to by the numerous honorary degrees he was granted by University of Pennsylvania and Harvard. Da Costa was repeatedly invited to deliver keynote and commencement speeches on medical school education, ethics, and values. Da Costa's Marriage to Sarah F. Brinton-1860 Once established in private practice da Costa could turn his thoughts to marrying Sarah Brinton, the sister of his good friend and medical school classmate John Brinton. John Brinton went on to become Major and Surgeon of the United States Army during the Civil War. Brinton acquired expertise on gunshot wounds, writing the authoritative text on that subject; he also founded the United States Army Medical Museum. He was a major contributor to The Medical and Surgical History of the War of the Rebellion (1861-65). After the war Brinton became a distinguished surgeon and professor at Jefferson Medical College. Their first cousin was General George B. (as in Brinton) McClellan. Ironically, the extraordinarily high casualties of McClellan's famous military fiasco, the Peninsular Campaign of 1862, would provide the critical mass of case study data for what would become da Costa's systematic study ofthe Irritable Heart ofthe Soldier. McClellan had the reputation of being a little Napoleon, a man obsessed with combat strategies to the point of perseverating paralysis; his narcissism and paranoia were clearly commented upon by colleagues. 21 But family matters do not end here either, since General McClellan's own father, Dr. George McClellan, was not only a renowned professor of medicine at Jefferson Medical College but also taught da Costa, Brinton, and S. Weir Mitchell. Civil War Philadelphia was a place where everyone knew everyone, most especially in the field of medicine. It was through this friendship that da Costa met his future wife Sarah Frederica Brinton in 1860 and thereby married into one ofthe most prominent white Anglo-Saxon Protestant families in America. What is striking about this union is that while on the surface it is an intermarriage, one can easily ascertain many similarities which da Costa shared with the Brintons, such as colonial ties to America with respective extended 21Joseph T. Glatthaar, Partners in Command: The Relationships between Leaders in the Civil War (New York: The Free Press, 1994), pp. 51-94; cf. S. W. Sears, G. B. McClellan: The Young Napoleon (New York: Ticknor and Fields, 1988). J. M. da Costa. M.D.: An American Civil War Converso Physician families in England. The American Brintons were descended from William Brinton, who had emigrated from England to Chester County, Pennsylvania in 1684. 22 Both families had an interest in medicine. Both Jacob and Sarah bore biblical names, etc. Recent sociological empirical studies show that descendents of Early American Sephardi Jews like 1. M. da Costa tend to see themselves as colonial equals to Gentile colonial Americans, especially Episcopalians. This identification seems to have been realized by da Costa through his marriage to Sarah Frederica Brinton, precisely at a time in American Jewish history when an influx of other Jewish immigrants, non-Sephardi, began to appear on the East Coast in greater numbers. 23 The time frame of their courtship coincided with an interesting shift in American Jewish demographics. Prior to 1848 almost all of America's Jews settling during colonial times were Sephardi Jews. They were a distinct homogeneous group. Da Costa's settling in Philadelphia coincides with the end of an era for the Early Americans with an upsurge ofimmigration ofGerman and Eastern European Jews. The \"Grandees\" or Early American Sephardic Jews who had come during the seventeenth century did not identify readily with their Ashkenazi coreligionists who were now coming in significant numbers to America, the majority ofwhom were financially not well-offand certainly did not have comparable elaborate familial/business networks in place as would a family like the Mendes da Costa's. John Brinton unknowingly captured in his diary this shift in demographics and the ambivalence he experienced between feeling close to a Sephardi Jew like da Costa and repulsed by the Jews he encountered in St. Louis whom he drew in a stereotypically antisemitic way. While bidding farewell to his future brother-in-law as he went off to war, Brinton wrote: But I am not yet quite out of Philadelphia. Dr. da Costa and my cousin Brinton Coxe, accompanied me to the railroad station and saw me off, by the night train, which left at II o'clock. Sleeping berths of a very inferior pattern had just been introduced, and I considered myself very fortunate to procure an upper single berth. But I confess, that grown man as I was, and twenty-nine years of age, I felt very lonely upon departing, although anxious to join the army.24 22 Janetta Wright Schoonover, ed. and Gilbert Cope, data collector, A History ofWilliam Brinton: Who Camefrom England to Chester County. Pennsylvania in 1684 and ofhis Descendants with Some Records ofthe English Brintons (Baltimore: Gateway Press, 1992). Research efforts thus far have not located any formal documentation of Brinton's conversion to Episcopalianism. 23J. Mizrahi. 703 American Sephardim: Diversity within Cohesiveness (New York: Gemini Books, 1995), p. 4. 24JoOO H. Brinton, Personal Memoirs ofJohn H. Brinton. Major and Surgeon (New York: Neale Publishing Co., 1914), p. 32. u.s. V. 1861-1865 Brinton recorded the difficulty he had with these noncolonial American Jews: I left Philadelphia, as early as I can remember, on the night of Monday, the ninth of September, 1861. After a considerable delay, I reached St. Louis very tired early on the morning of the 12th, and went to the Planters House, at that time the fashionable hotel of the city. The hotel swarmed with officers, contractors, and others busied with military affairs. I found St. Louis in a strange state; it was, I believe, under martial law, and preparations for war were being carried forward on all sides. The streets swarmed with soldiers, mostly Germans, and the hotels were crowded with money-making people, not a few of whom were Jews. A large number of the inhabitants, they said some fifty or sixty thousand, had already left the city, and I did not wonder, for there was everywhere a feeling of insecurity. 25 This passage retains ambivalence about Jews and reconfmns how the Early American Sephardim such as da Costa's family were held in higher esteem. This split between the known, i.e., his future brother-in-law Jacob da Costa, as \"acceptable\" and the unknown Ashkenazi Jew as \"unacceptable,\" verifies persistence of a virulent Civil War antisemitism. By 1861 St. Louis, as the easternmost point ofthe Santa Fe Trail, had quickly become the center of commerce for the entry point into the developing southwest. 26 Brinton encountered non-Sephardi Jews who were active in this venture. Regrettably access to possible extant correspondence between Brinton and da Costa in which they might have discussed issues of religious affiliation or da Costa's Sephardi heritage has not been obtained. Yet a tie to Sephardic culture, Iberia, and da Costa's medical works can be constructed by hypothesizing a link in the transmission and notion of an ill heart-Irritable Heart may have been the recycling ofa medieval Spanish concept-mal de coraz6n, or malady of the heart. J. M. da Costa's Irritable Heart of the Soldier-1861 It would be one year following his marriage to Sarah Brinton that da Costa would describe this heart condition for the medical community; for the science of medicine and the nascent field of cardiology, this would be a kind of medical breakthrough. Part of the lore surrounding the history of the field of PTSD is that Weir Mitchell, a prominent neurologist (1827-1914) is to be considered the father of PTSD, not da Costa, since legend has it that Mitchell founded the first psychiatric hospital during the Civil War. This claim and attribution are incorrect. General Hammond created a series ofspecialty hospitals including Turner's Lane Military Hospital, where S. Weir Mitchell 25Brinton, Personal Memoirs, p. 32. 26See M. L. Marks, Jews Among the Indians: Tales ofAdventure and Conflict in the Old West (Chicago: Benison Books, 1992); cf. Harriet and Fred Rochlin, Pioneer Jews: A New Life in the Far West (Boston: Houghton Mifflin Company, 1984). J M dacCosta, MD.: An American Civil War Converso Physician studied injuries to the nerves. Located on the outskirts ofPhiladelphia, Turner's Lane was also where 1. M. da Costa worked. S. Weir Mitchell oversaw the wards that were dedicated to neurological injuries due to gunshot wounds, amputations, and acute exhaustion, while da Costa's ward dealt with cardiac problems at times called exhausted heart as well as irritable heart. The theme of exhaustion commonly permeated the subject of illess. At Turner's Lane Mitchell founded a treatment known as the Rest Cure which went on to become a very fashionable treatment for female hysterics in post-war America, even though his first patients were actually wounded Civil War soldiers. His [mdings were ultimately published as The Treatment of Fat and Blood and How to Make Them in post-war years. 27 Sigmund Freud refers to Mitchell's work in his early studies on hysteria as well as to da Costa's cardiac studies. 28 S. Weir Mitchell and 1. M. da Costa were paradigmatic partners in the study of psychological trauma; they shared many interests and attributes in common, though generally they have been thought to be radically distinct theoreticians, one in neurology and the other in cardiology.29 However, upon closer consideration they essentially elaborated the nineteenth-century concept of exhaustion commonly called neurasthenia-nervous exhaustion and exhausted heart. Despite this similarity, it is really da Costa's work on Irritable Heart of the Soldier which provides a semantic missing link for an understanding of the terminology of psychic trauma that is in use today. Furthermore, it is da Costa's work which serves as a reminder as to why to this day the Diagnostic and Statistical Manual places PTSD in the category of an anxiety disorder. 3D Yet neither one was the first to describe the psychic trauma. Da Costa and Mitchell found themselves viewing similar combat phenomena through their different theoretical lenses even though they were both trained at the same medical school at about the same time, but this was precisely a time when the disciplines themselves were nascent, and 27S. Weir Mitchell, Treatment of Fat and Blood and How to Make Them (Philadelphia: Lippincott, 1874). 28Sigmund Freud, The Standard Edition ofthe Complete Psychological Works ofSigmund Freud, trans. James Strachey (London: The Hogarth Press, 1981 [1966]), Vol. I, 36. Freud writes: Two Short Reviews, Review ofWeir Mitchell's Die Behandlung Gewisser Formen von Neurasthenie und Hysterie. 2~. Kobrin, \"Paradigmatic Partners in Trauma: J. M. da Costa and S. Weir Mitchell,\" presented at the symposium on \"The Limiting Effects of Paradigms on Trauma\" of the Second World Congress of Traumatic Stress Studies, Jerusalem, June 5, 1996. From the unpublished presented text: \"Oddly, both had ties to the Spanish Inquisition, an institution obsessed with blood. Mitchell's first cousin, the noted Harvard historian H. C. Lea, wrote the first authoritative text on the Inquisition, preceding Benzion Netanyahu's The Origins ofthe Inquisition by some ninety years.\" 3D Diagnostic and Statistical Manual III (Washington, D.C.: American Psychiatric Association, 1980). discrete disciplinary boundaries between cardiology, neurology, physiology, and psychiatry had not yet been tightly drawn. 3 \\ The psychic battle scars which they diagnosed and treated were very much informed by the language available to them. It is misleading to think, based on extant materials, that S. Weir Mitchell did not focus on the problems of battle fatigue and delayed stress.\"32 The experience of war and family life was bound up in their work and wore on the physicians as well. S. Weir Mitchell, so traumatized by the death of his first wife that he wrote to his sister Elizabeth desiring to take a rest cure for himself, remarked that he thought da Costa would be the best companion to accompany him to Europe because he was so empathic!33 \"If I could get Dr. da Costa to go along, he would be an understanding companion for a grief-stricken man. \"34 This trip did not materialize, and compounding his grief, shortly thereafter he was sent on to the battlefield at Gettysburg. Mitchell broke down under the strain and obtained a two-month leave of absence to sail to Europe. Of all his war experiences, it was the battlefield at Gettysburg which haunted him the most. On his deathbed he was said to have hallucinated the battle one last time. Da Costa's pattern for combating trauma was different, and he saw in the Civil War experience earlier historical descriptions of war: He claimed no priority for the observation, noting that a similar condition was observed among the troops in the British Army during the Crimean War and in Havelock's troops in India. Nor was the malady confined to military medicine; it also appeared in civilian practice. 35 3\\The first author is indebted to Harold Kudler, M.D., Duke University, for asking the question concerning their theoretical differences. 32Eric T. Dean, Jr., \"'We Will All Be Lost and Destroyed': Post-Traumatic Stress Disorder and the Civil War,\" in Civil War History, Vol. XXXVII, No. 2 (June 1991), p. 153. Part of the difficulty with Dean's assertion is that S. Weir Mitchell had taken elaborate case notes on the diagnostic entity of 'acute exhaustion' of Civil War soldiers. These notes were to be published, but a house fire destroyed them, thereby leaving readers with this false impression. See S. Weir Mitchell, \"The Medical Department in the Civil War,\" The Journal ofthe American Medical Association, Vol. LXII, No. 19 (May 9,1914), p. 1449. 33Jean Goodwin, M.D., University of Texas, Galveston, Dept. of Psychiatry, who was the first to point out the unconscious act whereby Mitchell applied his yet-to-be therapy to himself. 34Richard D. Walter, S. W. Mitchell, M.D.-Neurologist (Springfield: Charles C. Thomas, 1970), p. 54; Anna Robeson Burr, Weir Mitchell: His Life and Letters (New York: Duffield, 1929), p. 56: At age 84 he remembered: \"that strange complex odour which rises from a battlefield ... as horrible and as unlike any other unpleasant smell\"; and some 30 years later the winds ofa forest fire reminded him of \"dead Confederates lying below Round Top the day after the fight, with arms and legs in rigid extension-a most horrible memory.\" 35J. Talbott, Biographical History ofMedicine, pp. 1123-1125. J. M. da Costa. M.D.: An American Civil War Converso Physician In an odd kind of way the military physicians drafted to treat the soldiers drew upon the history of medicine and its oral tradition as to the effects of combat on its men, yet the average Joe in the field had no language to fall back on adequate to describe the trauma he was experiencing. For the Union army had no label like shell shock, battle fatigue or post-traumatic stress disorder to help explain and legitimise a mysterious condition, no category short oflunacy to account for peculiar behavior. 36 In addition to this pragmatic problematic the history of Civil War medicine and its writing has generally overlooked neurology and cardiology, tending to describe surgery and its preferred course of treatment-amputation; since antibiotics had not been developed yet, this was the only way to contain infection. In a later communication, da Costa pointed out that even the Irritable Heart condition was not limited solely to war and that the civilian population also suffered from it. This observation concurs with the contemporary understanding of PTSD as pertaining to a series of populations including civilians. In the Toner Lecture of 1874 to the Smithsonian, da Costa gave a brief, less technical description of Irritable Heart in order to reach a larger audience, though he had first described the phenomenon as early as 1862: [Irritable Heart] consists chiefly in extremely rapid action of the heart, attended with pain in the chest, dizziness and oppression. The pulse is small, and readily compressible; its frequency is greatly lessened by the recumbent posture. The impulse of the heart is extended abrupt; the first sound is short, the second very distinct. Occasionally the first sound is replaced by an inconsistant murmur; the respiration is not hurried or frequent in proportion to the pulse. The general health often appears good, or at least it may be fully restored while the cardiac malady remains. Hard field service, particularly excessive marching and diarrhoea act as the predominant cause. Digitalis and rest are, on the whole the most successful remedies. 37 3610hn Talbott, \"Combat Trauma in the American Civil War,\" History Today (March 1996), pp. 41-47. 371. M. da Costa, \"On Strain and Over-action of the Heart,\" Toner Lectures 3, Vol. IS, Art. 4 of Smithsonian Miscellanious Collections; also delivered at the Smithsonian on May 14, 1874. SHOFAR Fa1l1999 Vol. 18, No. I Excerpts from the essay \"On Irritable Heart; a Clinical Study of a Form of Functional Cardiac Disorder and its Consequences,\" Amer. 1. o/the Med. Sci (January 1871), pp. 2-52. SYMPTOMS.Palpitation.- . .. In some cases (as in Case 208), the attacks lasted several hours, and were attended with increased pain in the cardiac region, and under the left shoulder. They were often accompanied by a great deal of distress, and were really painful. Cardiac Pain. - Pain was an almost constant symptom ... The chief seat of the pain was the lower part of the praecordia, particularly near the apex.... It was spoken of as shooting to the left axilla, as passing down the left arm (case 111), which then felt numb; as being present under the left scapula (Case 239); and as radiating from over the heart in all directions (Case 240) ... Pulse.- The pulse was mostly noted to be very rapid, varying from 100 to 140. In Character it was small, and easily compressible; it might or might not exhibit the abrupt or jerking character, which, as we shall presently see, is one of the chief peculiarities of the cardiac impulse, and this might have a certain amount of force which the pulse would lack ... Respiration.- Shortness of breath, or rather oppressions on exertion, was constantly complained of, and was a prominent symptom during attacks of palpitation ... Nervous Disorders.- These manifested themselves chiefly by headache, giddiness, disturbed sleep and were symptoms which, though common, were not so constant as those already described ... Digestive Disorders.- These are very frequent. All kinds of indigestions, great abdominal distension, and diarrhoea were symptoms constantly encountered ... Urine.- There is nothing in this secretion of special importance; at least not so far as investigated in the usual manner ... PHYSICAL SIGNS.- ...The impulse is almost always extended, yet not correspondingly forcible; rather, it is quick, and abrupt or jerky ... COURSE OF THE DISORDER.- ... This mostly either gradually subsides, or it passes by degrees into cardiac enlargement ... Da Costa's observation intimated that the ascribed source for the cardiac disorder arose from anxiety as made manifest physiologically by the pulse. This was a first for American medicine in that it grounded the fear of war in physical symptoms, but more important, it elaborated the interrelationship between the emotional trauma of the battlefield and the heart through a physiology and cardiology. J. M da Costa, MD.: An American Civil War Converso Physician Irritable Heart, or da Costa's Syndrome, for example, was a condition that achieved prominence in nineteenth-century wars, notably the American Civil War, the FrancoPrussian War, and the Boer War. In 1895 Freud wrote a paper, \"On the Grounds for Detaching a Particular Syndrome from Neurasthenia under the Description of' Anxiety Neurosis,'\" which he attributed symptoms that had been described for irritable heart such as \"spasms of the heart,\" \"difficulty in breathing,\" \"Outbreaks of sweating,\" and the like as basically anxiety attacks. In his words, \"I call this syndrome' anxiety neurosis' because all its components can be grouped around the chief symptoms of anxiety.\" Thus, Freud turned da Costas' Syndrome on its head and, in contrast to previous writers who had attributed the symptoms to the disorder of the heart, emphasized that anxiety was a central unifying factor that produced the somatic manifestations. 38 Da Costa's strong ties to military medicine did not end with this discovery or with the end of the Civil War. Late in his career in 1892 he was made a member of the Military Service Institution of the United States, where he delivered a welcoming address to the Association ofMilitary Surgeons in 1896 proving that he had kept current with changes in modem warfare. The photographic image revolutionized the perception and impact ofthe trauma of the battlefield by readily preserving and transmitting the depiction of death, mutilation, and wounding for later generations. The Civil War was the bloodiest American war to date. 39 It heightened a growing awareness of combat trauma and its horrors for the American public in ways different from, say for example, the genre and tradition of military painting. Civil War soldiers were also the first literate American army of volunteers. Literacy proved to be of critical importance for the dissemination of public information about the culture of war with access through correspondence by post and newspaper reporting. Another first was the large-scale use of surgery, most especially amputation, which, while fragmenting the body, was the pre-antibiotic method of curtailing infection and stemming mortality. It would be the use of horsehair for surgical suture which would lead to the revolutionary discovery of the importance of 38Alfred M. Freedman, M.D., in his introduction to F. G. Gosling's Before Freud: Neurasthenia and the American Medical Community 1870-1910 (Chicago: University of Illinois Press, 1994), p. 4-5. Cf. Jarcho's comment on a comparison between Morse Taylor and da Costa: \"Taylor's work was an effort to analyze large groups of miscellaneous cases, characterized mainly by arrhythmia or weakness or sudden death... This was done, in soldiers of the Civil War, by J. M. da Costa,\" in Saul Jarcho, M.D., \"Morse K. Taylor on Heart Disease in the Civil War (1867),\" Amer. J. ofCardiology, Vol. 4, 1959, pp. 809-817; and see also Dr. Henry Hawthorne, \"On Heart Disease in the Army,\" Amer. J. ofMed. Sciences (1863), Vol. 48, pp. 80-92. His work did not remotely approach the depth and systematic study undertaken by da Costa, though he too resorted to a notion of exhaustion, particularly \"muscular exhaustion of the heart.\" 39Charles Phillips & Alan Axelrod, My Brother's Face: Portraits of the Civil War in Photographs, Diaries and Letters (San Francisco: Chronicle Books, 1993). sterilization of medical equipment and instruments for the successful treatment of injuries. In order to make the horsehair supple enough to be used as suture, it had to be boiled, which in tum made it sterile, thereby decreasing postsurgical infections. The Civil War was also the first systematic attempt to organize field hospitals and establish a system of medical evacuation through an ambulance corps in the United States. 40 The Civil War drama of surgery literally done on the field would come to overshadow a contribution such as da Costa's. In \"A Short History of PTSD from Thermopylae to Hue\" there is no mention the works of da Costa. 4\\ The biggest killer of the Civil War was not combat but disease: \"Ofthe estimated 623,026 soldiers who died, 388,580 or 62% died because of disease-diarrhea, typhoid, malarial fevers, pneumonia, small pox and measles.\"42 These were also traumata and had a cumulative demoralizing effect on the soldier by surrounding him with the sick and dying, which in tum put him at risk for developing Irritable Heart. With da Costa's depiction of this panic in physiological terms and grounding of it in science, he articulated a new sense of war terror. While he named it Irritable Heart, the complete phrase in his essay was Irritable Heart of the Soldier, which the lay public quickly shortened to Soldier's Heart, thereby retaining a romantic ring. This subtle shift in register from \"Irritable Heart\" to \"Soldier's Heart\" serves as a modeling moment, recording an American self-perception of war's trauma while at the same time submerging the scientific base of da Costa's discovery as well as any attribution to him. Some twenty five years later, in 1895, another psychological notion of trauma would begin to be articulated with the actual first use of the term psychical trauma 40Maris A. Vinovskis, ed., Toward a Social History of the American Civil War: Exploratory Essays (New York: Cambridge, 1990); see also Philip Van Doren Stem, ed., Soldier Life in the Union and Confederate Armies (Greenwich, Conn.: Fawcett Publications, n. d. & n. pl.); Harold Elk Straubing, In Hospital and Camp: The Civil War Through the Eyes of Its Doctors and Nurses (Stackpole Books, 1992); Richard Harrison Shryock, The Development of Modern Medicine: An Interpretation ofthe Social and Scientific Factors Involved (Philadelphia: University ofPennsylvania Press, 1936); George Worthington Adams, Doctors in Blue: The Medical History ofthe Union Army in the Civil War (New York: Henry Schuman, 1952); and finally Albert Deutsch. \"I. Military Psychiatry: The Civil War, 1861-1865,\" in One Hundred Years ofAmerican Psychiatry (New York: American Psychiatric Association, Columbia Press, 1944). 41Steve Bentley, \"A Short History ofPTSD: From Thermopylae to Hue,\" in Veteran [Vietnam Veterans of America, Inc. Washington, D.C.] (January 1991), pp. 13-16. 42Rod Gragg, The Civil War Quiz and Fact Book (New York: Harper and Row, 1985), p. 16. Dean's statistics are the following (pp. 143-144): \"Soldiers of the Civil War clearly were subjected to hardships that threatened their physical as well as mental, health. While at least 110,070 Union soldiers died in combat or from wounds received in battle, an additional 199,720 died from disease. Malaria, typhoid, and dysentery were common; ... (cited by Paul E. Steiner in his Disease in the Civil War: Natural Biological Warfare in 1861-1865 [Springfield, Ill.: Charles C. Thomas, 1968], p. 8). J. M. da Costa, M.D.: An American Civil War Converso Physician recorded by the Oxford English Dictionary. It first occurred in an essay entitled \"Why Children Lie,\" by Nathan Oppenheim, M.D., a forerunner of Dr. Spock. 43 While this psychological trauma is not combat related, the use of the term trauma had begun to creep into linguistic use. Texts and public lectures such as da Costa's at the Smithsonian or Oppenheim's article in Popular Science Monthly were part of the growing geme of books, lectures, and essays for a burgeoning lay public for whom the topic of psychical trauma held significant interest. People were interested in understanding human suffering from a scientific point of view. The Marrano's Panic, or Mal de Coraztin Returning to da Costa's specific word choice for his syndrome, Irritable Heart, it must be realized that this term did not arise de novo. There is a rich history for the idea of the heart in western culture as seat of emotions and the essence of the individual. The Civil War circulated this view; indeed even the Civil War Confederate General George Pickett entitled his memoirs, The Heart ofa Soldier. 44 By the onset of World War II Sir Thomas Lewis chose to call his study of combat trauma Soldier's Heart and the Effort Syndrome. 45 Interestingly enough, in seventeenth-century Spain there was a similar expression, mal de corazon. Between 1643 and 1644 Spanish Catholic troops were sent to conquer the Protestants of Belgium and Holland, where many of the Marranos and Conversos had fled in order to throw off their Catholicism and reembrace Judaism by rejoining the Sephardi community there (and in London where many of da Costa's relatives sought refuge). Combat was so intense that the soldiers' march to the Low Countries was nicknamed the Spanish Road. Many Spanish conscripts died and many went AWOL; descriptions were recorded of instances of combat trauma involving the heart. 46 There is some thought that mal de corazon was in linguistic circulation even at the time of the Inquisition because of the latter's violent practices of state terror. Marranos, or anusim, the Hebrew for forced converts, were essentially traumatized victims of the Inquisition, living an underground existence for fear of being burned 43Nathan Oppenheim, \"Why Children Lie,\" Popular Science Monthly (July 1895), p. 386. See also, \"trauma,\" in The Compact Edition oJthe OxJord English Dictionary, Oxford University Press, 1984, Vol. II, pp. 3387. 44General George Pickett, The Heart oja Soldier (n. d. & n. pl.). 45Sir Thomas Lewis, The Soldier's Heart & the Effort Syndrome, 2nd. ed. (London: Shaw, 1940). 46Geoffrey Parker, The Army ojFlanders and The Spanish Road. 1567-1659: The Logistics oj Spanish Victory and DeJeat in the Low Countries' Wars (Cambridge: Cambridge University Press, 1972); and George Rosen, \"Nostalgia: A 'Forgotten' Psychological Disorder,\" Psychological Medicine (1975), Vol. 5, p. 341. SHOFAR FalI1999 Vol. 18, No. I alive at the stake, which was da Costa's familial legacy. Like generations coming after the Holocaust, da Costa was born into a traumatized legacy. In keeping with an attempt at mastering the devastating aspects of this familial history da Costa did something which was classically Jewish and especially Sephardi, namely choosing the field of medicine in order to become a healer of pain. Da Costa coined a term which had close ties to Spanish medical history, and at the same time he would as a physician be reliving the experience of the Converso physician. He seemed to embody the experience itself. Prior to 1492 the role of transmitter of medicine from East to West had already been established by Jewish physicians who translated critical texts from the Greek into Arabic, preserving the tradition of the Greeks from which the very term \"trauma\" derives, signifying wound. This tum toward medicine may be understood as a classic Jewish response. However, the phenomenon of the Converso physician occurs precisely at a time in European history when Jews were barred from entrance to medical schools. At the same time, the Converso physician formed a subcommunity which continued the tradition of generations of physicians, often from within the same family, who took the Spanish Judeo-Arabic tradition of medicine into the next diaspora. One major training ground for Jewish scientists and doctors was Spain and Portugal, the point of departure of a conspicuous number of Converso physicians who settled in Amsterdam, in Italy, in Germany and even in Eastern Europe, serving as physicians and purveyors of scientific learning throughout the Jewish communities of Europe, while yielding considerable political and economic power. As we have seen, this group of Converso physicians proudly displayed their own sense ofgroup identity which in turn was heightened by those who derided their alleged global presence. [emphasis supplied]47 During the sixteenth and seventeenth centuries, hundreds of Sephardi Jews were permitted to train at the medical school of Padua. The Paduan experience is unique, however, because for the first time a relatively large number ofJews graduated from a major medical school, entered the medical profession and practiced medicine across the entire European continent. Padua also was unique because it afforded the opportunity for intense socialization among Jews from remarkably variegated backgrounds-former conversos from Spain and Portugal, together with Italian, Turkish, German, Polish and Russian Jews. Moreover, Padua's university alIowed its 470avid B. Ruderman, Science, Medicine, andJewish Culture in Early Modern Europe (Tel Aviv University, 1987), p. 22; and S. Muntner, Alli/ot al Rofim Yehudiyim b-Aspaklariya Shel Toledot haRefu 'ah (in Hebrew) (Jerusalem, 1953). J. M. da Costa, M.D.: An American Civil War.Converso Physician Jewish students substantial social and cultural contact with non-Jewish students and faculty:s This rich inheritance would repeat itself specifically with da Costa, for as a Civil War physician ofPTSD he articulated the social experience ofso many soldiers through this medical codification as syndrome. Furthermore within da Costa's extended London Marrano ancestors there were direct ties to medicine. Catherine of Braganza was traveling in Portugal when she came down with the disease erysipelas, a bacterial infection causing a red skin rash which ifuntreated could prove to be fatal. An ancestor of 1. M. da Costa, Dr. Antonio Mendes, successfully treated her and thereby was invited to immigrate to England along with his brothers Andrea and Alvaro, becoming among the first Marranos to settle there. 49 Unlike the story of the Marrano physician Dr. Rodrigo Lopez, who was put to death in 1594 though falsely accused oftrying to poison the Queen, the da Costa tradition of medicine fared better. It is noteworthy that modem clinicians and scholars of PTSD have not been aware of da Costa's background, nor have they bothered to contemplate its potential significance. The clandestine practice of Judaism alters the possibility of maintaining a formerly coherent sense of Jewish identity, layering it with other counteridentifications. Its complexity and the emotional strain of negotiating a series of shifts in identities on a daily basis should not be underestimated. Even religious conversion pursued volitionally has been understood psychologically as an indicator of psychic trauma, signaling an attempt at smoothing over that which is ego dystonic by taking on a new religious identity to bolster a shaky sense of self. 50 For the Marranos conversion 48Rudennan, Science, Medicine, and Jewish Culture, p. 23. See also others cited by Rudennan, such as G. Whitteridge, William Harvey and the Circulation ofthe Blood (London-New York, 1971). Da Costa also wrote his own treatise on Harvey, entitled Harvey and His Discovery (Philadelphia: J. B. Lippincott and Co., 1879). See also D. Carpi, \"Jews Holding the Degree of Doctor of Medicine from the University of Padua in the 16th and Begining of the 17th Centuries\" (Hebrew), in Scritti in Memoria di Nathan Cassuto, ed. D. Cassuto et al. (Jerusalem, 1986), pp. 62-91; C. Roth, Venice (Philadelphia, 1930), pp. 285-93; H. Friedenwald, The Jews and Medicine, 2 vols (Baltimore, 1944), I, pp. 221--40, pp. 253-58; J. Kaplan, \"Jewish Students from Amsterdam at the University of Leiden in the 17th Century\" (Hebrew), in Mehkarim 'al toledot Yahadut Holland (Jerusalem, 1979), pp. 65-75; H. S. Hews, Jewish Physicians in the Netherlands (1600-1940) (Assen, 1980). 49James Picciotto, Sketches ofAnglo-Jewish History (London: Triibner & Co., 1875), p. 103. 50Sigrnund Freud, \"A Religious Experience,\" The Standard Edition of the Complete Psychological Works ofSigmund Freud (London: The Hogarth Press, 1961), Vol. XXI, pp. 169-172; and W. R. D. Fairbairn, \"The Repression and the Return of Bad Objects (with special reference to the 'War Neuroses'),\" British Journal ofMedical Psychology, Vol. XIX, parts 3 & 4 (1943), pp. 327-341. For a review of the literature see Lewis R. Rambo, Understanding Religious Conversion (New Haven: Yale University Press, 1993). was neither desired nor deliberate and resulted. in a violation of the self and the community. Even for Conversos who did not continue to practice a form of cryptoJudaism, it is arguable that the question of freedom of choice under duress during such times cannot be viewed as spontaneous and unmotivated by external stressors like losing one's life, and that the hidden identity, like that of the hidden child, has been compromised in its sense of freedom and authenticity, always struggling in an ambivalence of mixed identities. 51 While Dr. da Costa was many generations removed from the trauma of the Inquisition, still this conflicted and traumatized legacy remains part and parcel of his family history and its complex family fantasies about who the Mendes da Costas were and are now. And while much work has been done on the intergenerational transmission of trauma with regard to the Holocaust, little thought has been given retroactively to the ramifications of applying this concept to the experience of the Inquisition. Assuredly, it is a most delicate matter to speak of the Holocaust in terms of psychological trauma and its continuing aftermath; psychological vulnerability as a significant issue for the Jewish community's discussion of continuity and identity has generally been sidestepped most essentially as a contributing factor for assimilation and intermarriage. In the entire discussion of Madeleine Albright's Jewishness no mention has been made explicitly to the significance offamilial trauma as formative of her identity. The same goes for J. M. da Costa. Recent research on \"The Impact of the Holocaust on the Second Generation: Norwegian Jewish Holocaust Survivors and Their Children\" is worth citing. The author, who undertook the study ofthe entire population ofNorwegian-born Jews who survived the German concentration camps and their children, attempted to look for symptoms described as a \"second generation syndrome.\" What she discovered was not so much the prevalence of serious psychopathology as a certain degree of psychological vulnerability among the children. SlOne does not have to look to the past to understand the notion of acquiring additional identities under duress. See the example of the diagnostic concept of multiple personality according to Dr. Mustafa Masri, a psychiatrist in the Gaza strip: \"A Moslem woman may wake up one day with an additional identity; as a Christian, a Jew or even an Israeli. This kind of splitting occurs in response to severe stress and is a way ofcoping with it, he says. But instead of receiving treatment-especially ifshe is poorly educated and has a passive husband who can't protect her-she will be pushed into becoming a healer herself by a society that sees her as having acquired supernatural powers from the jinn-or demon-that has possessed her.\" Esther Hecht, \"Therapy for Society,\" The Jerusalem Post International Edition (August 10, 1996), p. 19. As adults, they are more often engaged in health/social care professions and organizations and also show signs of greater assimilation to their non-Jewish surroundings than the comparison group.52 Like the tinok she-nishbah, the \"encapturement\" may be psychological in nature and hidden from view; this is the nature of trauma, most especially for a child's identity which in tum leads to a compromised sense of Jewishness and ultimate religious disaffection even in a ritually observant household. This empirical finding strikingly coincides with the lived experience of da Costa, who not only pursued the career of medicine but also married out, a loss for the Jewish people. Victor Perera has written that for his own family\" ... the Inquisition was a holocaust stretched out over centuries. \"53 While Danieli, Kristal, Bergmann, Jucovy, and others have written extensively on the intergenerational transmission of trauma for Holocaust survivors, elsewhere the first author herein has argued that the SOOth anniversary to commemorate the Expulsion of the Jews from Spain points to the fact that contemporary Jewry continues to live in the palpable shadow of a Post-traumatic Quincentennium. 54 Little work has been done on the intergenerational transmission of 52Ellinor F. Major, \"The Impact of the Holocaust on the Second Generation: Norwegian Jewish Holocaust Survivors and Their Children,\" Journal of Traumatic Stress, Vol. 9, No.3 (1996), pp. 441--454: \"The assimilation tendency which our data seemed to reflect may be a coping strategy for reducing unconscious fear of possible renewed antisemitism. This suggestion is supported by the CC (i.e. concentration camp) children reporting less fear and anxiety with regard to antisemitism than the Swedish children. Fewer CC children identified themselves as Norwegian Jews; they were less attached to both the Jewish and the Norwegian communities. This may be interpreted as an attempt to root their identity and security in a more supranational one\" (p. 449). \"One possible interpretation is that the CC children's 'helping role' in the family from childhood and adolescence into adulthood transferred in working life to an interest within the health/social care professions. This may be viewed as a primarily positive consequence of growing up in a survivor family. Even so, one should take into consideration the self-help, as those CC children who were engaged in health care also displayed more symptoms than those who were not engaged\" (p. 451). 53Victor Perera, The Cross and the Pear Tree: A Sephardic Journey (Berkeley: University of California Press, 1996), p. 63. 54Yael Danieli, \"The Treatment and Prevention of Longterm Effects and Intergenerational Transmission of Victimization: A Lesson from Holocaust Survivors and Their Children,\" in C. R. Figley, ed., Trauma and Its Wake (1985), Vol. I, pp. 295-313. Danieli, \"Confronting the Unimaginable: Psychotherapists' Reactions to Victims of the Nazi Holocaust,\" in J. P. Wilson, Z. Hare! & B. Kahana eds., Human Adaptation to Extreme Stress: From the Holocaust to Vietnam, pp. 219-238; and Yael Danieli, ed., International Handbook ofMultigenerational Legacies of Trauma (New York: Plenum, 1997); Martin S. Bermann and Milton E. Jucovy, eds., Generations of the Holocaust (New York: Basic Books, 1982); N. Kobrin, \"Our Sephardi 'Routes/Roots': Commemorating the 1492 Expulsion of the Jews from Spain in 1992.\" Communal address on commemorating the 1492 Expulsion delivered in 1992 at the Adath Jeshurun Synagogue, Minneapolis, SHOFAR Falll999 Vol. 18, No. I trauma with regard to the experience of the Sephardi community, and it is here that J. M. da Costa may serve as a unique example. The da Costa family history repeatedly shows a vacillating between Judaism and Christianity, a struggle to achieve a stability in Jewish identity unencumbered by a Marrano past. A once richly pluralistic society, composed of Christian, Jew, and Moslem, Spain became exclusionary, promoting institutionalized terroristic practices such as the auto-da-fe, a political theatre oftorture and limpieza de la sangre, i.e., ethnic cleansing-all in the name ofprocuring a nationstate. 55 That exclusionary legacy was transmitted to the West and recycled in a number of ways during the Holocaust. Conclusion Jacob Mendes da Costa's work with American Civil War soldiers led him to describe the syndrome Irritable Heart, also called Soldier's Heart by the public, and eponymically Da Costa's Syndrome. A similar pathology ofthe heart was also observed and named mal de corazon among the Spanish and recorded at least by the seventeenth century. Da Costa's own family, generations earlier, had fled to the Netherlands and England in order to escape from the Spanish Inquisition. Reminiscent of Holocaust survivors, some of the Mendes da Costas survived the tortures of the Inquisition, an institutional agency used to create the first modem nation-state in the West-Spain in 1492. Family history and da Costa's career trajectory predisposed him to a sense of· social history and culture unusual for his time. His pioneering efforts, while described as pertaining to the realm of cardiology, offer a good example of how his discovery exceeds the confines of a discipline. He may be considered the father of the American Civil War PTSD equivalent-Irritable Heart-as well as a nineteenth-century Converso physician who carried forward the concept of mal de corazon. His writings and life experience anticipated the need for fully functioning veteran citizens who would be able to live in a democratic society free from trauma, unlike oppressive, autocratic medieval Spain. Da Costa understood only too well what it meant for individuals and communities to be abandoned to the aftermath of trauma. It is ironic Nov. 14, 1992. See N. Kobrin, \"Diplomatically Speaking: A Jewish Language called Ladino,\" in Solomon Goldman Lecture Series, (Chicago: Spertus College, Spring 1990), Vol. 5 pp. 71-83; Kobrin, \"Holocaust Literature in Spanish, Portuguese and Ladino,\" Tradition, Vol .3, No. 18 (Fall 1980),pp.288-294. 55N. Kobrin, \"Aljamia-Lebenstil und Gruppenbindung am Rande des christlichen Europ,\" in StU: Geschichten und Funktionen eines Kulturwissenschaftlichen Diskurselements, ed. Hans Ulrich Gumbrecht (Frankfurt am Main: Suhrkamp, 1986), pp. 463-474; and N. Kobrin, \"Das Sprachproblem: Kreolisdierung, Kulturpluralismus und das Beispiel der Morisken,\" in KultuRRevolution: Zeitscrift fUr angewandte Diskurstheori, 10 fata morgana multikultur, no. 10 (Oktober 1985), pp. 63-65. that this father of trauma has been similarly forgotten by Jewish history. Having the Marrano legacy of his family history, da Costa was in a way a tinok she-nishbah, captured from the experience of a childhood history free from trauma to his sense of whatever it meant to him to be Jewish. Psychologically, then, a tinok she-nishbah ofthe generations born after the cataclysm metaphorically retains social and emotional wounds from being held captive by trauma. Thus, even in the best-intentioned ofJewish homes, a child may already have been stolen away from Judaism by the intergenerationaI transmission of trauma whose scars are often hidden from sight. This essay honors Rabbi Professor Byron Sherwin on his 25th year at the Spertus Institute for Jewish Studies, Ms. Judith Berg, the first author's first Spanish teacher, a '60 alumna of Purdue University, and Professor Emeritus David Romey, Portland State University, the first author's first Ladino professor.\n"
<https://www.deepdyve.com/lp/purdue-university-press/j-m-da-costa-m-d-a-tinok-she-nishbah-an-american-civil-war-converso-i6yS1bbym0?key=projectmuse>