The Origins of American Neurology

The past! The infinite greatness of the past!

For what is the present, after all, but a growth out of the past?

(As a projectile, formed, impelled, passing a certain line, still keeps on,

So the present, utterly formed, impelled by the past.)

– Walt Whitman, Passage to India (1871)

By understanding where we came from, we can better understand where we are now, and where we may be headed in the future. In our latest episode of BrainWaves, we take you into the past as we talk about the origins of American Neurology.

In 19th century America, at the birth of American neurology, this time period was defined by two major themes: the “Wild West” and the “Gilded Age”. There was a migration from the east coast to the west of adventurers searching after riches, cheap land, new customers, new opportunities, and a new start. This was when the transcontinental railroad was completed in 1869. Rapid industrial growth led to increased wages for skilled workers, the growth of labor unions, and the influx of millions of European immigrants.

In Europe, this time period coincided with the Victorian Era and the Belle Époque. This was a time of period of unprecedented peace, prosperity, and cultural and scientific achievements. It is no shock that medicine was flourishing in this environment. If you were a doctor living in the second half of the 19th century, the cutting edge of medicine wouldn’t have related to genetics or targeted immunotherapy, but rather infectious disease. This period saw the move from “bad humors” to “germs”. In 1854 John Snow tracked a London cholera epidemic to the Broad St pump. In 1867 Lister published his antiseptic surgical technique. Perhaps the most exciting, in 1882 Robert Koch identified the causative agent for consumption, the tuberculum bacillus, for which he was awarded the Nobel Prize in Physiology and Medicine in 1905. Neurology in Europe at this time was mainly in two models: a growth out of psychiatry in Vienna and a growth out of internal medicine in France. In Vienna, you’ll recognize the names Meynert, Chiari, Virchow, Alzheimer, and Karl Wernicke (see prior episode on Wernicke’s encephalopathy). In France, at the famed La Salpetriere hospital, you’ll recognize Charcot and his friends Babinski (whose name is immortalized in med student neurologic exams), Broca, Joffroy (who published seminal work on the pathology of poliomyelitis), Tourette, Duchenne, and Dejerine (whose reflex hammer still bears his name).

h-b-_halls_engraving_of_w-a-_hammond

William Alexander Hammond. Image under public domain.

Here we turn to American neurology. Immediately preceding this grand age of prosperity, peace, industrial, cultural, and scientific growth was something very destructive and dark, the American Civil War. From 1861-1865 hundreds of thousands of Americans were killed, nearly one in 12 of all adult men of the time. Countless more were injured by .58 caliber projectiles fired from rifles causing horrendous injuries to limbs resulting in a gamut of neurological injuries. In the middle of this war, in 1862, Lincoln named William Hammond US Surgeon General, at age 34. Near the beginning of his career, he befriended Silas Weir Mitchell, (not to be confused with the actor who shares his name) who—like Hammond—shared an interest in the nervous system and the two wrote a paper together on poisons affecting the nervous system in 1859. After becoming surgeon general, Hammond instituted many reforms and started focused military hospitals. One of these was Turner’s Lane Hospital in Philadelphia, which would later become the 1st American site for focused neurologic investigation.

While working at Turner’s Lane, Mitchell meticulously studied the breadth of traumatic

silas_weir_mitchell

Silas Weir Mitchell. Image under public domain.

peripheral nerve injuries during the war. In doing so, he described causalgia, erythromelalgia, and phantom limb among other disorders. After the war he published a seminal work on peripheral nerve disorders. As for William Hammond, after the war he moved to New York and worked at Bellevue Medical College and New York State Hospital. In 1871 he wrote “Treatise on Diseases of the Nervous System”, the 1st American neurologic text which is still cited today. Importantly, he was also the key to founding the American Neurological Association (ANA) in 1875. Mitchell was also among the charter members. The first meeting was hosted by Hammond at his Manhattan home over dinner. Like Mitchell, he was also a prolific writer and heavily involved in promoting the public awareness of Neurology as a distinct field of medicine. Following Mitchell and Hammond were other leaders in the field like C.K. Mills in Philadelphia (famous for recognizing the role of the right hemisphere in emotional processing, James Putnam in Boston (who is no longer eponymized for subacute combined degeneration, a.k.a. the Putnam-Dana syndrome), Francis Miles in Maryland, and Bernard Sachs (a private practitioner who is remembered for the original descriptions of Tay-Sachs disease) in New York, who also wrote the first pediatric neurology textbook in 1895.

This combination of publications, text books, organizations, and specialized hospitals and training programs formed American Neurology and gave it recognition on an international level in the grand age at the end of the 19th century. And as a beneficiary of these scientific achievements, I am humbled to play a part in the writing of modern history.

 

[Joshua VanDerWerf]


REFERENCES

Goetz CG, Chmura TA, Lanska D. Part 1: the history of 19th century neurology and the American Neurological Association. Ann Neurol. 2003;53 Suppl 4:S2-S26.

Koehler PJ1, Lanska DJ. Mitchell’s influence on European studies of peripheral nerve injuries during World War I. J Hist Neurosci. 2004 Dec;13(4):326-35.

Lanska DJ1. Characteristics and lasting contributions of 19th-century American neurologists. J Hist Neurosci. 2001 Aug;10(2):202-16.

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