Rheumatic Disease in Wartime
Rheumatic Disease in Wartime
Both generals described in this report were dysfunctional and unable to make critical battle decisions because of acute gouty arthritis. Although few clinical details are available, it is likely that Elphinstone had chronic gouty arthritis involving all extremities and systemic disease, perhaps uremia, which was responsible for weight loss and cognitive impairment. Shafter's disability from acute gout was compounded by morbid obesity and perhaps also by alcohol ingestion. Certainly, both men must have received medications, but we have no information about this. Colchicine was reintroduced in the early 19th century but was often prescribed in suboptimal doses, combined in liquid preparations with other drugs. The disastrous outcome of the Afghan war might have been avoided with strong leadership, and indeed, some of the officers on the scene were capable of providing it, but a rigid command structure provided no mechanism for replacing an incompetent general without orders from far-away Calcutta. In Cuba, the campaign's goals were quite straightforward, and unit commanders simply took charge; the American forces had superiority in numbers, equipment, and morale, and the outcome was never in doubt.
Discussion
Both generals described in this report were dysfunctional and unable to make critical battle decisions because of acute gouty arthritis. Although few clinical details are available, it is likely that Elphinstone had chronic gouty arthritis involving all extremities and systemic disease, perhaps uremia, which was responsible for weight loss and cognitive impairment. Shafter's disability from acute gout was compounded by morbid obesity and perhaps also by alcohol ingestion. Certainly, both men must have received medications, but we have no information about this. Colchicine was reintroduced in the early 19th century but was often prescribed in suboptimal doses, combined in liquid preparations with other drugs. The disastrous outcome of the Afghan war might have been avoided with strong leadership, and indeed, some of the officers on the scene were capable of providing it, but a rigid command structure provided no mechanism for replacing an incompetent general without orders from far-away Calcutta. In Cuba, the campaign's goals were quite straightforward, and unit commanders simply took charge; the American forces had superiority in numbers, equipment, and morale, and the outcome was never in doubt.
