S. Weir Mitchell Representing "a hell of pain": From Civil War to Rest Cure

NANCY CERVETTI S. Weir Mitchell Representing "a hell of pain": From Civil War to Rest Cure In the fall of 1 866, S. Weir Mitchell stayed up most of one night writing a thirty-five-page short story about a Civil War surgeon , George Dedlow. Dedlow, the son of a doctor, is studying medicine at Jefferson Medical College in Philadelphia when the war begins, and he becomes an assistant surgeon and then a first lieutenant in the U. S. Army. Over the course ofa few years, he loses first an arm, then his legs, and finally his remaining arm, becoming "some strange larval creature" (129). When Mitchell's story first appeared in the Atlantic Monthly, many read it as non-fiction, and a few even collected money and tried to visit Dedlow at the "Stump Hospital" in Philadelphia.1 Like Dedlow, Mitchell also attended Jefferson Medical College, and after a year of travel and study in England and Europe, he returned to Philadelphia in 1851 to begin general practice and pursue his interests in original research. He was twenty-two, and while research and experimentation were rare among his colleagues, Mitchell wanted to establish a reputation in physiology and neurology. He notes experimenting with opossums, muskrats, pikes, pigeons, ftogs, turtles, dogs, rabbits, ducks, and chickens, and his most important work of the period followed the purchase of six rattlesnakes. He published essays and gave numerous presentations to the Academy of Natural Science, and in i860 he published his 145-page monograph, "Researches Upon the Venom of the Rattlesnake." In 1862 this animal experimentation was radically transformed, however, when Mitchell became a contract Arizona Quarterly Volume 59, Number 3, Autumn 2003 Copyright © 2003 by Arizona Board of Regents ISSN 0004- 1 610 70Nancy Cervetti surgeon in the U.S. Army and began to focus on wounded soldiers. In a nightmarish substitution, human beings replaced the animals ofhis earlier experiments—many of them very young men with torn flesh and shattered bones, burning pain, and phantom limbs. Mitchell worked at the Filbert Street Hospital, the U.S. Army Hospital for Diseases of the Nervous System, and finally alongside Drs. W. W. Keen and George R. Morehouse at Turner's Lane Military Hospital , treating nervous cases from the twenty-five thousand army hospital beds in the Philadelphia area. He worked long hours, discussed the cases in great detail, and took endless pages ofnotes, and, shortly before his death, returned to this intense clinical work in a jama article: The cases were of amazing interest. Here at one time were eighty epileptics, every kind of nerve-wound, palsies, singular choreas, and stump disorders. I sometimes wonder how we stood it. If urgent calls took us back into town, we returned to the hospital as if drawn by a magnet. In fact, it was exciting in its constancy of novel interest. . . . The victims of nervewounds were often men worn out from fever, dysentery and long marches; hence some of the symptoms of nerve-wounds we described have never been seen since in like intensity. The statements in regard to causalgia—burning neuralgia—were received in England with critical doubt. That hospital was, as one poor fellow said, a hell of pain. ("Medical Department" 1449) The experience took its toll. Exhausted and depressed, Mitchell suffered a nervous breakdown and resigned in 1864.2 In that same year, he had co-authored Reflex Paralysis, "On Malingering, Especially in Regard to Simulation of Diseases of the Nervous System," and Gunshot Wounds and Other Injuries ofNerves. A year after publishing "The Case of George Dedlow," he published "On the Diseases ofNerves, Resulting from Injuries" in 1867 and Injuries to Nerves and Their Treatment in 1872. Gunshot Wounds soon became the authority on nerve injuries, containing the first distinct descriptions of phantom limbs, ascending neuritis , and burning pain or causalgia and discussing various methods of treatment such as blistering, leeches, cautery, electricity, and hypodermic injections. In 1965 the American Academy ofNeurology reprinted Injuries to Nerves, referring to Mitchell as the father of American neurology and stating that each study "of peripheral nerve injuries incident From Civil War to Rest Cure71 upon major wars since the American Civil War has drawn...