PHILADELPHIA-INFIRMARY-FOR-NERVOUS-DISEASES - AMERICA ORIGINAL MODEL OF INSTITUTIONAL NEUROLOGY

The role and contributions of the Philadelphia Orthopedic Hospital and Infirmary for Nervous Diseases in the development of neurology in 19t h-century America are described. American neurology was largely born d uring the Civil War through the work of S.W. Mitchell at Turner's Lane Hospital. With the closing of this military facility, the United Stat es was left without an institution dedicated to neurologic research an d the treatment of nervous system diseases. Nineteenth century archiva l data, including original Trustees' minutes, annual board of managers reports, patient case books, and published research from the Philadel phia Orthopedic Hospital and Infirmary for Nervous Diseases were studi ed. The Philadelphia Orthopedic Hospital and Infirmary for Nervous Dis eases promoted the development of neurology in the United States throu gh three main activities. First, it offered patients with primary nerv ous system diseases, arthritis, and orthopedic disorders specialized c are that was unavailable at medical universities. Second, its medical staff, especially Mitchell, provided opportunities for advanced neurol ogic education. Postgraduate physicians interested in neurologic disea se attended formal lectures and directly participated in the operation of outpatient clinics and inpatient rounds. Finally, its formalized r ecord system in the form of case books facilitated neurologic research . These records formed the basis of landmark publications by Mitchell, Sinkler, Osler, and others on rest therapy, spastic palsies, chorea, and other topics. As America's first and comprehensive peacetime neuro logic facility, the Philadelphia Orthopedic Hospital and Infirmary for Nervous Diseases fostered the evolution of neurology as a separate, v iable specialty in the post-Civil War period and provided a particular focus for the study of interactions among orthopedic, nutritional, an d neurologic disorders.