Silas Weir Mitchell
- Barraquer-Simons syndrome
- Bernard-Horner syndrome (Claude Bernard)
- Mitchell's rest cure
- Mitchell's syndrome I
Biography of Silas Weir Mitchell
Silas Weir Mitchell was born in Philadelphia to a family of Scottish origin, the seventh physician in three generations. His father was John Kearsley Mitchell (1798-1858), a physician and lecturer at Jefferson Medical College in Philadelphia; his mother was Matilda Henry Mitchell (1800-1872). Weir Mitchell was accustomed to wealth and cultural pursuits, and was deeply religious. As a boy he was required to read a daily bible text and to attend church twice on Sundays where he wiled away his time reading novels such as «Midshipman Easy».When he first joined the University of Pennsylvania at the age of fifteen he had a poor record, preferring to play billiards, write poetry, and play truant rather than to deal with subjects such as mathematics, which he cordially disliked.
His father said to him «you are wanting in nearly all the qualities that go to make a success in medicine.» He enrolled at the Jefferson Medical College in 1848, graduated M.D. in 1851, aged twenty-one, and immediately left for Europe on a clipper ship with his sister, Elizabeth. She stayed with her younger sister in England, while Mitchell settled in Paris to study medicine. There he was most influenced by Claude Bernard who impressed him by saying to him «Why think? Exhaustively experiment then think.» He also attended the lectures of Charles Philippe Robin (1821-1885). Although he did not permit the legendary distractions to encroach of his scholarship, after his Montmartre ramblings he could not help reminisce that the can-can resembled a “witches Sabbath.”
After a year in Paris he travelled with his sister in Italy and Switzerland. At the request of their ailing father they returned to Philadelphia, where he joined his father’s medical practice, a practice that he continued until his death in 1914. Mitchell set out a demanding schedule for himself. He worked with his father during the day and worked in the laboratory in the evenings.
He also commenced work with William Alexander Hammond (1828-1900) on snake venoms, which he later extended with William Williams Keen Jr. (1837-1932) and Simon Flexner (1863-1946). It is said that once a rattlesnake got loose, climbed the back of a chair on which he was sitting and put its swaying head over his shoulder. It was only when the snake touched the hot lamp and drew back that Mitchell could leap to escape. In 1860 he produced cataracts in frogs by feeding them sugar. It was also at this time that he became interested in neurology.
By 1855, John Kearsley Mitchell had retired, and Mitchell became responsible for the support of his parents and siblings. He married Mary Middleton Elwyn in 1858, and the couple had two children, John K. Mitchell (1859-1917) and Langdon Elwyn Mitchell (1862-1935). His wife died of diphteriae in 1862. In 1875 he married Mary Cadwalader and his daughter, Maria Gouverneur, was born in 1876.
The Civil War
With the outbreak of the American Civil War, William Alexander Hammond placed him in charge of Turner’s Lane Hospital in Philadelphia, a 400-bed army hospital for nervous diseases. This was an ideal location for Mitchell to pursue his interest in nerve diseases and wounds of the nerves. He was joined by Keen and George Read Morehouse (1829-1905) in conducting extensive neurological research at the hospital. With Keen he went to Gettysburg and brought back carloads of wounded. The three physicians took careful notes, wrote detailed case studies, and published the results of their findings in numerous articles and books, including Reflex Paralysis (1864). The most important work to result from their studies of these soldiers, however, was Gunshot Wounds and Other Injuries of Nerves, which was published in 1864 and in which the first reference is made to causalgia. This was later more thoroughly described in Injuries of Nerves and Their Consequences, another book written in 1872. One of Mitchell’s observations was that a soldier in continuous pain becomes a coward and the strongest man may become hysterical. In the book he refers to the psychology of amputation and phantom limbs.
The nature of Mitchell’s clinical work was deeply affected by his medical experiences in the Civil War. In 1864, having received some degree of notoriety from his work at Turner’s Lane, Mitchell resigned as a contract surgeon and set up his own practice, which was soon limited to neurology. In the early 1870s Mitchell was appointed to the Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases. Few years after the founding of the Philadelphia policlinic and the College of Graduates in Medicine he became professor there, and also commenced clinical courses at his Infirmary for Nervous Diseases. He was for 35 years a member of the board of the University of Pennsylvania where he particularly engaged himself in the equipment for the teaching of biology and hygiene and the expansion of the university hospital. He was successively president of the College of Physicians of Philadelphia; he established the college’s library and had built the convention hall. He also brought in the money for the new home of the College of Physicians and for the Orthopaedic Hospital and the Infirmary for Nervous Diseases. The new house was completed in 1909.
During his work at the Infirmary for Nervous Diseases Mitchell continued his neurological research and developed innovative treatments for patients with nervous ailments. It was during this period he gave the first description of erythromelalgia,
Perhaps he is best known for the establishment of his rest cure, a method of treatment for patients, especially women, who suffered from hysteria and neurasthenia. The cure became the standard treatment for many decades, particularly in England.
His additional contributions to clinical neurology included papers on posthemiplegic chorea, causalgia and traumatic neuralgia, the effect of weather on painful amputation stumps, and various forms of headache. Mitchell also investigated the physiology of the cerebellum and the cutaneous distribution of nerves, described the cremasteric reflex, and with Morris James Lewis (1852-) gave an early account of the phenomenon of sensory reinforcement of the deep tendon reflexes.
His failure to become professor of physiology at Jefferson Medical College or at the University of Pennsylvania caused Hammond to write, «I am disgusted with everything and can only say that it is an honour to be rejected by such a set of apes!» It is said that one of the reasons for his rejection at Jefferson was that he was a republican and the trustees were democrats.
Weir Mitchell was a legendary character whose portraits show him as a handsome man. His rather gaunt features and bearded face make one readily understand why he was likened by many people at the time to «Uncle Sam». He was a superb conversationalist and his personality and humour gave him a wide range of friends. He actively promoted young people who he thought were outstanding, most notably John Shaw Billings (1838-1913) and Hydeio Noguchi (1876-1928).
Mitchell was famous for his sometimes eccentric approach to patients with functional illnesses. He was asked to see a patient who was thought to be dying, and soon sent all the attendants and assistants from the room, emerging a little later. Asked whether she had any chance of recovery, he said «Yes she will be coming out in a few minutes, I have set her sheets on fire. A clear-cut case of hysteria!»
Another story is that he was confronted with a lady who had a similar problem and having tried all the tricks he knew to induce her to leave her bed, threatened her with rape and commenced to undress. He got to his undergarments when the woman fled the room screaming! These stories may have grown with the years since in many ways he was rather prim, and Freud’s writing shocked him. He is said to have thrown a book on psychoanalysis into his fire, exclaiming, «Where did this filthy thing come from?»
Later in life, from the 1880s onwards, Mitchell devoted his attention to writing novels and poetry. Two of his novels achieved great popular success at the time - Hugh Wynne in 1897 and The Adventures of Francois in 1898. A novel entitled Westways was written after he was 80 and it describes his memory of the horrors of the battle of Gettysburg and its consequences. Mitchell’s war experiences were the basis for The Case of George Deadlow (1866), a story about a quadruple amputee notable for its psychological insights and realistic war scenes.
In his later years his fame as a man of letters equalled his reputation as a physician. His home on Walnut Street was a long-time centre of Philadelphia’s intellectual life. Mitchell’s intimates included Sir William Osler (1849-1919), William Henry Welch (1850-1934), and John Shaw Billinges. He corresponded regularly with Oliver Wendell Holmes (1809-1894), William James (1842-1910), Walt Whitman (1819-1892) and Andrew Carnegie (1835-1919).
Mitchell frequently gave speeches before social clubs and professional organizations, and when a busy schedule allowed, he travelled extensively in the United States, Europe, Japan, and Egypt.
Silas Weir Mitchell was founder and first president of the American Neurological Society and first president of the Philadelphia Neurological Society. He also served presidential terms for the Association of American Physicians and Surgeons, and the College of Physicians of Philadelphia. He was elected to the American Academy of Arts and Sciences and the National Academy of Science, and was also made associate corresponding or honorary member of foreign societies.
On a visit to Paris, Mitchell sought out the great Jean Martin Charcot (1825-1893) for help without revealing his name. Where was he from? “Philadelphia?” Then said Charcot: “You should consult Weir Mitchell; he is the best man in America for your kind of trouble."
Mitchell contracted influenza and during the illness read the proof of his poem Bar Abbas, then lapsed into a delirium in which he is said to have re-enacted operating on the wounded at Gettysburg. So died an extraordinary man who had no experience in neurology when he enlisted in the U. S. Army in 1862, but became the doyen of American neurology.
Between 1852 and 1863 Mitchell published more than thirty papers on a variety of topics ranging from the toxic effects of rattlesnake venom to the crystalline forms of uric acid. The physiological bent of these early papers reflected his Paris experience; and although Mitchell always maintained an interest in toxicology, pharmacology, and physiology, his later writings were generally more clinically oriented. A bibliography of his publications would supply the titles of some 150 medical papers, recounting investigations of high scientific importance.
On Silas Weir Mitchell:
Never have I known so original, suggestive, and fertile mind. I often called him a yeasty man . . . An hour in his office set my own mind in a turmoil so that I could hardly sleep. W. W. Keen.
«He was vain but he had much to be vain about.»
Abner Mcgehee Harvey (1911-)
Quotations by Silas Weir Mitchell
«Keen, Morehouse and I worked on a note-taking often as late as 12 or 1 at night, and when we got through walked home, talking over our cases . . . I have worked with many men since, but never with men who took more delight to repay opportunity with labour . . . the cases were of amazing interest. Here at one time were 80 epileptics, and every kind of nerve wound, palsies, choreas, stump disorders . . . thousands of pages of notes were taken . . . about midway we planned the ultimate essays which were to record our work.»
On his work with Keen and Morehouse in Turner Lane Hospital.
«Nature had not waited for man to supply her anaesthetics, and the disturbed chemistries of failing life were flooding nerve and brain with potent sedatives.»
In War Time. Chapter IV.
«The success of a discovery depends upon the time of its appearance.»
Quoted by F. H. Garrison in Bulletin of the New York Academy of Medicine, 1928, 4: 1002.
«The largest knowledge finds the largest excuses.»
«Ever since the Crimean war, nurses have been getting into novels.»
«While I can understand the patient falling in love with a nurse, I do not as easily comprehend the nurse falling in love with the sick patient.»
«The arctic loneliness of age.»
«As to pain, I am almost ready to say that the physician who has not felt it is imperfectly educated.»
«Do not think too much of the dignity of your profession or what it is beneath you to do. It is a normal disorder of young nurses and, I may add, of young doctors.»
He [John Billings] was asked how many degrees he had received, and when they began to count the L.L.D’s and B.C.L.’s, he laughed and said, «Yes, that is my principal title to be considered a man of letters.»
British Medical Journal, 1913; 2: 686.
«The true rate of advance in medicine is not to be tested by the work of single men, but by the
practical capacity of the mass.»
«The truer test of national medical progress is what the country doctor is.»
«All the vast hygienic, social and moral problems of our restless, energetic labor-saving race are, in some degree, those of the future student of disease in America.»
«It is . . . useless to constantly digging up a person’s symptoms to see if they are better.» Doctor and Patient. Introduction.
«I must have told my story ill if to every physician who hears me its illustrations have not the invigorating force of moral tonics.»
Transaction of the College of Physicians of Philadelphia, 1887, 9: 337.
«The moral world of the sick-bed explains in a measure some of the things that are strange in daily life, and the man who does not know sick women do not know women.»
Doctor and Patient. Introduction.
«I know the night is near at hand.
The mists lie low on hill and bay,
The autumn sheaves are dewless, dry;
But I have had the day.
Yes, I have had, dear Lord, the day;
When at Thy call I have the night,
Brief be the twilight as I pass
From light to Dark, from dark to light.»
«What might forces pledged the dust to life!
What awful will decreed its silent strife!
Till through vast ages rose on hill and the plain,
Life’s saddest voice, the birthright wail of pain . . .
Yet still, forever, he who strove to gain
By swift despatch a shorter lease for pain
Saw the grim theatre, and ‘neath his knife
Felt the keen torture, in the quivering life.»
The Birth and death of Pain.