Diseases of Importance
As the clinical specialty of neurology developed in America, the types of disorders cared for by the practicing specialist included a mixture of disorders considered today neurological and psychiatric. Under the direction of SW Mitchell, the Philadelphia Infirmary for Nervous Diseases maintained one of the most detailed sets of case books for the period, showing that in 1871, typical diagnoses included locomotor ataxia, hemiplegia, chorea, local palsies, convulsive disorders, neuralgia and encephalitis. A number of disorders were of particular interest to American neurologists and helped to establish United States neurology in the international arena. Post-traumatic neuropathies and neurological disorders among women were specialties of SW Mitchell, and Hammond was celebrated for his studies of insomnia and athetosis. B. Sachs developed an expertise in pediatric neurology and FX Dercum acquired much of his reputation based on his gait studies.
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Neurological Diseases
The diagnoses contained in case books from the Philadelphia Infirmary for Nervous Diseases included locomotor ataxia, hemiplegia, chorea, local palsies, infantile palsies, adult paralysis, convulsive diseases, neuralgia, epilepsy, and encephalitis. In addition, there are several cases labeled malingering. |
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Neurological Programs
The identification of select diagnoses led to the need for specialty hospital units and services. Closely allied to the development of neurological professorships in the United States, the University of Pennsylvania and Bellevue Medical College established neurological inpatient units or outpatient "Nerve" clinics to deal with neurological diagnosis and therapy. Separate neurological hospitals like the New York State Hospital for Diseases of the Nervous System offered patients and physicians an autonomous treatment center and educational forum for neurological training. The Philadelphia Orthopedic Hospital and Infirmary for Nervous Diseases, likewise, focused a large staff on neurological disabilities and served as the core for several publications. William Osler's seminal monograph, On Chorea and Choreiform Affectations was largely based on children with Sydenham's chorea seen at this hospital. Outside the major cities, neurological asylums were established to remove epileptic patients from almshouses and provide them with special care and neurological expertise. The ANA served as an official body to encourage this movement. Among those established, the Craig Colony in upper state New York was the most sophisticated.
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First US Professors
Whereas the most celebrated of the nineteenth century Professors of Neurology was J-M Charcot, in Paris, his chair was not formed until 1882. Prior to this date, several Professorships were formed in the United States. Though smaller in scope and less powerful, these posts nonetheless showed the clear priority that American medicine afforded neurology in its early years. |
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Neurological Diagnostic Tools and Treatments
American neurologists used instrumentation to distinguish their specialty and to record, diagnose and treat diseases of the nervous system. Hammond's Treatise of Diseases of the Nervous System opened with a full chapter devoted to the various instruments available to neurologists and included the esthesiometer for testing two-point discrimination and the dynomometer for measuring strength. American neurologists readily adopted instruments and techniques developed by their European colleagues and in addition modified these models to create new instruments, that ranged from simple gadgets to complex and highly cumbersome appliances. Electrical equipment was used in a wide variety of applications and a cephalohemometer measured cerebral circulation. The sophistication implied by the use of such instruments afforded greater legitimacy to neurology and helped early American neurologists distinguish themselves from general practitioners.
Electricity was used for treatment as well, as small electric shocks were felt to nourish weakened muscles. Of the various drugs available, bromides were used for epilepsy, and zinc, cathartics, mercury products and arsenic were widely used. Belladonna, with centrally active anticholinergic properties and ergot agents were empirically used for treating Parkinson's disease decades before realization of striatal dopamine/cholinergic balance was considered. During the latter part of the century, tissue extracts were used including cerebrine (sterilized extract of the brain of the ox) for functional brain disturbance and musculine (sterilized extract of the muscular tissue of the ox) for muscular weakness. Non-drug treatments included applications of heat, trephination, hydrotherapy, exercise therapy and rest treatment.
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Neurological Instruments
Popular instruments of the time were used by neurologists to define their specialty and diagnose neurological disorders. |
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Reflex Hammers
A hallmark of neurology, the reflex hammer has taken a
variety of forms. Shown here are those developed by Krauss (c 1904) and
Taylor (c 1888).
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