Medical America in the Nineteenth Century: Readings from the Literature

Address before the Fiftieth Annual Meeting of the American Medico-Psychological Association

S. WEIR MITCHELL ADDRESS BEFORE THE FIFTIETH ANNUAL MEETING OF THE AMERICAN MEDICO-PSYCHOLOGICAL ASSOCIATION Editor's Note The eminent Philadelphia neurologist and writer Silas Weir Mitchell (1829-1914) was the son of the famed John Kearsley Mitchell. Weir Mitchell and his colleagues began their study of peripheral nerve injuries during the Civil War. In the postwar decades neurology began to grow as a specialty. Those who devoted themselves to this new field argued that there should be no difference between the study of peripheral nerve diseases and the study of the brain in all its manifestations.l Mitchell's address to the fiftieth anniversary meeting of the American MedicoPsychological Association is one of the frankest and broadest criticisms that any society has invited upon itself. Only two years prior to his appearance the group had finally changed its outmoded name from the Association of Medical Superintendents of American Institutions for the Insane. (The Medico-Psychological Association became the American Psychiatric Association in 1921.) Bibliographical Note Ernest Earnest, S. Weir Mitchell, Novelist and Physician, Philadelphia: University of Pennsylvania Press, 1950. Richard D. Walter, S. Weir Mitchell, M.D.-Neurologist, Springfield: Thomas, 1970. I am here to-day under circumstances so unusual that I may be pardoned if I explain them in order to justify the frank language of this address. When your representative, Dr. Chapin, asked me to be your speaker on this important anniversary, I declined. It is customary on birthdays to say only pleasant things, and this I knew I could not altogether do. I foresaw a struggle between courteous desire to follow a kindly custom and the duty to greatly use Proc. Am. Medico-Psychological Assoc. 50 (1894): 101-21. Charles Rosenberg has discussed this issue in his Trial of the Assassin Guiteau (Chicago: University of Chicago Press, 1968). 222 S. WEIR MITCHELL 223 a great occasion. When Dr. Chapin, after consulting some of you, came back to say it was still your desire that I should speak, I reflected that men who could thus ask the criticism, which they knew must come without mercy, were well worth talking to. I said, at last, that I would address you today, but that it would be boldly and with no regard to persons. That was a momentary insanity; I have been sorry ever since. You are on the dividing year of your first century of life. You look back with just pride as alienists on the merciful changes made for the better in the management of the chronic insane. It is to be feared that you also have cause to recall the fact that as compared with the splendid advance in surgery, in the medicine of the eye, and the steady approach to precision all along our ardent line the alienist has won in proportion little. This is partly due to the nature of the maladies with which you have to deal; but there are many other causes at work to retard the wholesome progress. Just that which is impairing the usefulnessof the lesser specialties in medicine has been more gravely enfeebling your value and retarding your development. I mean the tendency to isolation from the mass of the active profession. At first, as concerned the eye for instance, this separation seemed but too complete—the new terms, the methods, the instruments of the ophthalmologist were for a time absurdly unfamiliar. It is not so at present. The general practitioner has come again into touch with the oculist, and understands his terms and methods. In fact, every sudden advance of a brigade of our great line for a time appears to break our ranks; but soon we get up to it and go on as before. With you it has been different. You were the first of the specialists and you have never come back into line. It is easy to see how this came about. You soon began to live apart, and you still do so. Your hospitals are not our hospitals; your ways are not our ways. You live out of range of critical shot; you are not preceded and followed in your ward work by clever rivals, or watched by able residents fresh with the learning of the school. I am strongly of the opinion that the influence which for years led the general profession to the belief that no one could, or should, treat the insane except the special practitioner have done us and you and many of our patients lasting wrong. Standing here...