Jefferson Medical College - Clinic Yearbook (Philadelphia, PA)

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personality, according to Earnest, that filled neurotic patients with hope and confidence. It also brought him wealth, conceit and absurd adulation, the biographer reports, but despite it all he never became a stuffed shirt. Probably this was so because his mind was too active to be cast in a mold of smugness. He was always eager to seek out a new truth or accept a new challenge. A decade before he evolved his rest cure he contributed major neurological works stemming from his observations during the Civil War. Publication of Gunslfzot Wotrnds and Other Injuries of Nerves in l864 as- sured him a place in medical history. While that work was produced in collaboration with William Williams Keen-who was to become a lifelong friend-and George R. Morehouse, biographers agree that Mitchell was the prime contributor. Keen at the time was a young physician, newly graduated from Jefferson and years away from his world-renowned achieve- ments in brain surgery, and Morehouse never attained the stature of his two fellow researchers. Gunslzot Wmands was such a valuable work that an ex- panded version-written by Mitchell alone-was still in use by the French Army during VVorld War l. That it is a neurological masterpiece is certain. The presence of motor centers in the forebrain controlling muscles on the opposite side of the body was postu- lated for the first time. This was the basis for Mitchell's later work delineat- ing the functions of the cerebellum. This work, along with his research on snake venom-which led to later dis- coveries in toxicology and immunology -is the basis for his reputation as a scientific researcher. During his work on the cerebellum, he experimented on pigeons, rabbits and guinea pigs, rely- ing mainly on three methods-ablation, freezing and irritation. He correctlv determined that the cerebellum plavis a role in influencing the main motor tracts from the brain. His other con- tributions to neurology were his de- scriptions of clinical entities he had observed, including postparalytic cho- rea, disorders of the sensorium and the relationship of seasons to depressive states. As Mitchell grew older and more successful, his mind turned to other pursuits: he entered the world of let- ters, As poet and novelist, according to Fielding Garrison, Mitchell has a place near Goldsmith and Holmes. In literature as in medicine he followed in the footsteps of his father, John Kearsley Mitchell, sometime poet and professor of medicine at JeHerson. liar- nest rates Mitchell as a Hrst-rate writer, but contends that in literature he is less secure in his reputation than as a physician. However, he notes, ln a period when American novels were chiefly designed for hammock reading, Mitchell's have an intellectual quality which is rare among his contemporary writers. The biographer also compares Mitchell to Holmes Canother physi- cian-authorD, as well as Henry James. James is of course the greatest, Ear- nest says, but Mitchell, using a similar social milieu, has a health which James lacks. Mitchell relied for much of his inspiration on his Givil War experi- ence and his knowledge of abnormal psychology. His literary career began in earnest after he passed the age of 50, but thereafter he was prolific. Sev- eral explanations can be found for his late start. According to one story Mit- chell submitted a volume of poems to a Boston publisher when he was only 20. Supposedly, Holmes saw the manu- script and advised the young man to secure his medical practice before at- tempting to dabble in literature. Ac- cording to another version, Mitchell feared that his patients would have little confidence in a physician inter- ested in writing poetry. Nevertheless, he published several works anony- mously before tackling serious writing in middle age. While Mitchell was basically an academic luminary, he never held any academic position of note. Perhaps this was because he was rebuffed early in his career when he applied for chairs in physiology at Jefferson and later at the University of Pennsylvania. When offered a professorship in medicine at Penn years afterward he turned it down, but apparently not out of en- mity, for he served that institution for 35 years as a trustee and was instru- mental in establishing its school of biology. Perhaps he aided this en- deavor because he was alwavs on the alert for promising young men, hoping to point them on the way to sueeess, ln doing so, according to Earnest he n P left mark on three generations of physicians and scientists. gg n the i5 Ill So Merrwif the Yard ceflainlf ness- H1 Olllef pl paSt'Wa teacher' plallded Consider' teaching cordirlgl ical liisti the able: in the Ei Da ence CHS and he skills. Hr tion in tl stimulate througho ical educ he was g 1852 aft talents v was singl strate pa low studl knowledg perience, to study of the ll Vienna. German use of A Americar i0 Enjoy he even Walerfol of great Qf Sketch His sncrans r attend If Mfblecin AmCI'lC3I- Physici he rctu H Career Yea OVQ llCQ flogis X even dl I Ser gre

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:C COIPS W siffptember the blperblil t the Hlooditst :hin 24eld Was yatth h0Llrs. T ew Brady titan- sCtlI61'n-lan feSldQm is in umed that th doubly pleases ll and medical :roving his Sys- r and set up, here W0U11ded 'eld bl' Hmbu- ent. According he SHH16 system th some slight V0 adjust to the lvantage of the gery since the :ess of Letter- the interest of litary observers ctics developed Military men ue of salvaging if whom would ay. Lettermans in the develop- for the worlds another leller- .vstem in direct- s for France in as p1'0lJalJlY the tan system bla ted far beimd the inspiratwtl be the nationS that Ol View York. Df- , devel0Pfd the AITUY 0 -emacs- E the lan- n ermaflellf gen Fran- - s dlfl annamed d died in iff 3 -ears after his 1 3 A new com' C. . it was 7 e last Year' ll 'our s Pflnclpleiing ay, infuffgvery 56IVlfeO f any of the accomplishments of S. Weir Mitchell can be considered paramount, it is that he understood- and successfully treated-neurotic wo- men in an age contemptuous of their complaints. He did so by the sheer force of his personality and will, which were more than equal to the task. At the heart of his method was the con- viction that the best way to heal the mind was to provide it a healthy body. Mitchell's work in this field-only one aspect of his multifaceted career-quali- fies him as one of the early American psychiatrists, though he considered himself a neurologist and physiologist. Ernest Earnest, a critical biographer, classifies Mitchell as probably the leading psychiatrist in America for one or two decades. While his success in psychiatry earned him adulation from his patients and a great deal of money, his contributions in other fields earned him consideration during his lifetime as the most versatile Amer- ican since Franklin. Silas Weir Mitchell was almost a genius, Earnest wrote in 1950. His contemporaries believed that he was Iways eager to seek out a new truth or accept a new challenge one, an opinion Mitchell came to share. The reasons for this belief were impressivef' Mitchell contributed clas- sic works in the Held of neurology, conducted research on brain function and snake venom, wrote novels that won critical acclaim, numbered many of the luminaries of his age among his friends and served in a host of civic, institutional and charitable positions- all in addition to his large medical practice. Earnest notes that others made more important contributions to psy- chiatry but are less well remembered than Mitchell. The reason: If he did nothing else he took psy- chiatry out of the madhouse and brought it into everyday life. It became respectable to be treated for mental illness. He might have added that not only is it respectable but in 20th century America it is considered fashionable in many circles. Une of the ways Mitchell helped in this regard was in using his influence to overcome opposition to Charles K. Mills when he attempted to start a department for nervous dis- orders at Blockley-predecessor of Phil- adelphia General Hospital. Mitchell hoped proper administration of the de- partment would allow Philadelphia to become the American center for neu- rology and psychiatry, but political opposition eventually thwarted the ef- fort. Mitchell's psychiatric methods are now outdated, but shortly after his rest cure for nervous disorders was introduced it was adopted in clinics throughout America and Europe. Fat and Blood, his famous little book out- lining the new method went through eight editions in America and was translated into French. German, Span- ish, italian and Russian. Though it was written for doctors, its style was so straightforward it was easily under- stood by laymen. Unencumbered writ- ing was a Mitchell hallmark. He avoided jargon and frowned on its use by others. COnce after receiving a lengthy, complicated report from an ophthalmologist, he replied, 'iThanks, but what I really wanted to know was if this patient needs glasses.,'D Con- sequently, Fat and Blood has none of the elaborate terminology used by Freud, but is noteworthy for its prag- matism and realism. Mitchell's descrip- tion of a Victorian-era neurotic is classic: Everything wearies her-to sew, to write, to read, to walk-and by and by the sofa or the bed is her only comfort. Every effort is paid for dearly, and she describes herself as aching and sore, as sleeping ill, as needing constant stimulus and end- less tonics. Mitchell ordered such women to bed for a month or six weeks and then began their rehabilitation. His success was no doubt due to his ability to get his patients to follow his instructions. Sometimes, however, he had to resort to extreme measures. The most famous anecdote concerning his handling of patients involved a woman who re- fused to get out of bed following her month of rest. When he found the usual methods of persuasion were not working, Mitchell said, lf you are not out of bed in five minutes Iill get into it with youf' The patient was unmoved as he began removing his clothing but when his pants started to drop she bolted to her feet. It was this force of

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a n the medical profession, usefulness is the measure of greatness. So wrote Dr. C. Wilson in his Memoir of M. Da Costa. If that be the yardstick, Iacob Mendez Da Costa certainly merits the mantle of great- ness. His usefulness-as with so many other prominent men in Iefferson's past-was both as a clinician and a teacher. His clinical skills were ap- plauded by his colleagues and he was considered a doctor's doctor. His teaching skills were equally -fine. Ac- cording to Fielding Garrison, the med- ical historian, Da Costa was perhaps the ablest clinical teacher of his time in the Eastern States. - Da Costa didn't attain this emin- ence casuallyg he was well prepared and he worked hard to perfect his skills. He gained a continental educa- tion in the classics as a youth and was stimulated by language and literature throughout his life. His primary med- ical education came at jefferson, where he was graduated at the age of 20 in 1852 after three years of study. His talents were recognized early, for he was singled out even then to demon- strate pathological anatomy to his fel- low students. His appetite for medical knowledge whet by his Jefferson ex- perience, Da Costa traveled to Europe to study in the leading medical centers of the world at that time-Paris and Vienna. His fluency in French and German allowed him to make better use of his opportunities than other American students. It also allowed him to enjoy the cultural attractions, and he even took the time for lessons in water-color painting. This later proved of great use to him in the preparation of sketches and diagrams for his teach- ing. His acceptance by French phy- sicians made it possible for him to attend meetings of the Academie da Medecine, which were open to few American visitors. After studying under the leading physicians and pathologists of Europe, he returned to Philadelphia and began a career that was to stretch nearly 50 years. His initial successes were as a teacher, for he had to prove himself over several lean years before his prac- tice grew. His classes in physical diag- nosis were particularly popular and even drew graduate physicians. These classes were conducted in his office and added to his growing reputation. He continued to conduct private classes until he began lecturing at jefferson in 1858-a mere six years after his graduation. He remained closely tied to Iefferson for the ensuing decade and in 1872 when only 39 years old he was appointed to the Chair of the Theory and Practice of Medi- cine. Da Costa's greatest contribution came eight years before this, when the first edition of his Medical Diagnosis was published. This volume, revised nine times by Da Costa to stay abreast of new medical discoveries, was the preeminent work in its field for four decades. It was translated into every European language and was found on nearly every physician's bookshelf. Ac- cording to an early Da Costa biogra- pher: It claimed the admiration of the medical world. It was the forerunner of other works of its kind but has held its place during 38 years. New works have appeared, some modelled on its lines, but none has rivalled it in scope, in teaching power or in its matchless grace of composition. Competent critics have pronounced it to be the most elaborate work on diagnosis in the English language. Even in the library of the irregular practitioner it has an exalted place. - 1n his book, as in his lectures, Da Costa taught the method of diagnosis by exclusion, which has carried over to the present. His style of writing and speaking were described as simple, natural, lucid, emphatic. This was his strength. He was able to convey con- cepts in a nutshell to grateful stu- dents. Another great contribution was his emphasis on clinical teaching, which was revolutionary for the time. Most medical teaching at that time, according to Garrison, was a mere pedagogic rubbing in of what had already been heard in routine lectures with hardly any practical clinical ex- periences whatever. W. W. Keen paid tribute to Da Costa's contribution, pointing out that the Philadelphia clinics until Da Costa in the session of 1866-67 took hold of them were about as inane and useless as one could imaginef' Da Costa's style alone was enough to attract students and Ere their imaginations. Some feeling for his presentation can be gained from this description in an obituary in H arvard voiced the uni- versal sentiment of the phy- sicians of America that this is the man whom we delight to honor Medical News shortly after his death in 1900: His language was always well chosen and he never hesitated for the correct word. He was a student of correct diction, and both in his lectures and in his writings showed his familiarity with the English classics. He also showed his wide extent of medical readings by refer- ences to French and German au- thorities.