GDG- Lee's illness

Robert G Pielke rpielke at ca.rr.com
Sat Jan 28 12:28:53 CST 2012


I recall reading somewhere that a slight stroke may have been more
likely....but I don't recall the evidence -- [I am a doctor....but not a
"real one"  My specialty is philosophy! Hahahahaha

-----Original Message-----
From: gettysburg-bounces at arthes.com [mailto:gettysburg-bounces at arthes.com]
On Behalf Of Dave Glorioso
Sent: Saturday, January 28, 2012 10:16 AM
To: GDG
Subject: GDG- Lee's illness

Esteemed GDG Member Contributes:
I have just completed reading Lee's Illness Lost Gettysburg.
The article had some interesting facts and insight.
I mean no disrespect to the author but I have multiple criticisms.
I first wish to state that I am a practicing physician.
I graduated from Jefferson, the same school as Lafayette Guild, the ANV
medical director(never met him).
I suspect the author is not a practicing physician as the article exhibits a
lack of knowledge of clinical practice.
The article states he specializes in research.

I will focus on the medical aspect.
He explains angina, pericarditis and the effects of diarrhea quite well.
His extrapolation that these issues caused Lee to be irritable is a stretch.
He then summarizes that Lees illness led to the bad outcome. Really?

My focus of criticism is his explanation that diarrhea leads to low
magnesium which leads to a heart attack.
First, a heart attack is due to a deficiency of blood flow through the
coronary arteries that deliver blood to the heart muscle.
This usually occurs when fat builds up in the arteries. With any physical
stress more blood flow is needed by the heart. If it can't get that blood
you may suffer angina, which is pain. If the deficiency of blood flow is
great enough the tissue may die which is a heart attack.
Physical stressors may include exercise, drop in blood pressure and  a heart
arrhythmia (an irregular electrical pulse which can lead to sudden death due
to the heart not beating or a heart attack due to poor contractions of heart
muscle and subsequent decreased blood flow through coronary arteries.)

Second, the author concludes that diarrhea caused low magnesium which caused
a heart attack.
In twenty years of practice I have seen thousands of heart attacks and only
several times could I say that low magnesium was a cause.
Low magnesium is very common.
In fact, the majority of patients that I take care of every day have low
magnesium and 5-10 of them daily also have heart disease.
I am a Gastroenterologist. My patients all must drink a laxative that leads
to diarrhea to undergo Coloniscopy.
They frequently have low magnesiums.
I know because we often check the magnesium levels.
None have had a heart attack. None.
Twenty years. None. Period.
None exhibit acute confusion, acute poor judgement. None. Period.

In fact, physicians acknowledge that low magnesium may cause confusion or
may effect the electrical rhythm and may cause sudden death but rarely.

In summary, the author makes many broad generalization about Lee's health
leading to the loss at Gettysburg.
Unfortunately, his premise that diarrhea led to low magnesium and thus poor
decisions and possibly worsened his heart is also a stretch.
Although possible, incredibly unlikely.
When viewed with a learned eye one must conclude that his conclusions are
far from acceptable probability.

I suspect that if the magazines editors were physicians the article would
not have been published.

Respectfully
Dave

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