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When Mitchell married Mary Cadwalader in 1875, he had just embarked on what was, in terms of fame and fortune, the most successful period of his life. Although he has been best (and sometimes only) known as the creator of the rest cure, when Mitchell began to focus primarily on rest, he was in his forties and midway through his career.While there is the expected overlap, his medical life may be divided into three parts:the animal experimentation of the 1850s, the Civil War work with gunshot wounds and nerve injuries,and the treatment of mental illness beginning in the 1870s. The early and extensive vivisection provided a solid foundation in physiology for the important war work that followed . And Mitchell noted that the first indication of the great value of “rest in disease” began with his treatment of Civil War soldiers.1 The third phase of Mitchell’s career began formally and modestly enough in 1871,when he joined the staff of Philadelphia’s Orthopedic Hospital,a tworoom hospital and outpatient clinic established in 1867 by Thomas G. Morton and located over a surgical instrument shop at 15 South Ninth Street.The hospital was established to treat charity and paying patients suffering from deformities such as curvature of the spine, joint disease, and clubfoot. A few years after the hospital was founded,the staff realized the relationship between some bodily deformity and nervous disease, and the Infirmary for Nervous Diseases was added to the Orthopedic Hospital. Mitchell became the first physician at the infirmary.Wharton Sinkler was the second, and they were the only attending physicians until 1879. Largely due to Mitchell’s efforts,over the next decades the infirmary became a major center for the treatment of nervous disease.William Keen wrote that Mitchell’s first step in bringing about this transformation was to reconfigure 6 pandora’s box e 06 Chapter 6_Cervetti 6/27/2012 1:56 PM Page 104 the hospital’s apathetic board of managers into a group of younger,more active and knowledgeable men.In 1873 the hospital moved to an old residence at the corner of Seventeenth and Summer Streets. In 1886 a separate twelve-month nursing program was established with a focus on neurologic care. In 1887 the old house was replaced by a new building with wards,thirty-six private rooms, and greatly expanded facilities.2 Mitchell remained the driving force at the infirmary,and his extensive clinical work and training there sometimes go unnoticed in accounts of his life. Much of the expansion and development were due to his reputation and his focus on research and publication.Like Turner’s Lane Hospital during the Civil War,the infirmary provided Mitchell with opportunities for the clinical research and collaboration on which he thrived.Like a magnet attracting rare and difficult cases, he saw patients who traveled great distances to seek his help, often as a last resort. He developed a neurological department with residents and assistants like Morris Lewis, Charles K. Mills,Wharton Sinkler, and William Osler. Innovations included the teaching clinic, an expanded outpatient department where a senior physician was always in charge, and a school for massage and remedial exercise.3 Mitchell was one of the first physicians in the United States to introduce the card index for cases,where a detailed case history of each patient was taken,followed by an extensive examination.The case-history form at the infirmary included “family history,”“personal history,”“causes assigned by the patient for the disease,” and “sexual functions.” Then a group of doctors, including the senior physician and usually an ophthalmologist and medical electrician ,met to hear the case history read aloud and to make recommendations. There are record books of the Orthopedic Hospital and Infirmary for Nervous Disease for the years 1867–1942 housed at the College of Physicians of Philadelphia. Although incomplete at times and missing for some years, the records contain a wealth of information,including patient books,casebooks,and admission and discharge books. According to these records, Mitchell began by seeing patients of all ages, from eight months to seventy-seven years, for such things as infantile paralysis, epilepsy, chorea, asthma, Pott’s disease, and meningitis .In 1871,of the 160 patients he saw,two were classified as insane,and there was no diagnostic classification for “hysteria” or “neurasthenia.” This began to change quickly, however, and by 1879 there were twenty-two...

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