By: Akanksha
Silas Weir Mitchell (1829-1914) was born, raised, educated, worked, and died in Philadelphia, Pennsylvania. While alive, he was renowned as a pioneering doctor of nervous diseases and a successful author. When he died of influenza in 1914, he was considered one of America’s leading physiologists in his early years, the father of American neurology in his middle years, and among the most popular of American novelists in his later years.
Born the third of nine children toJohn Kearsley Mitchell, MD, and Sarah Matilda Henry Mitchell, Weir Mitchell — he did not use his first name — was the seventh physician in three generations in his family. His father was a graduate of the University of Pennsylvania School of Medicine and professor of the theory and practice of medicine at Jefferson Medical College, who also taught chemistry at the Franklin Institute while maintaining a medical practice. Raised in an electric setting stressing literature and poetry — his father’s favorite avocation — Mitchell published the poem “Verse to a Polar Star” in 1846 at age 17.
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Mitchell entered the University of Pennsylvania at age 15, where he was a distracted, desultory student — writing too much poetry and preferring billiards to studying. After three years, he dropped out of Penn to help his ailing father in his medical practice, resuming his education at Jefferson Medical College in 1848. When he announced his plans to study medicine, his father told him, “you are wanting in nearly all of the qualities that go to make a success in medicine. You have brains, but no industry.”
At Jefferson, Mitchell worked as a student assistant in the laboratory of Robert Dunglison, America's leading physiologist, and graduated in 1850 at the age of 21. He and his sister Elizabeth then traveled to Paris, where he took courses with Claude Bernard in physiology and Charles Robin in microscopy. When Mitchell stated during a discussion that “I think that so and so must be the case,” Bernard replied, “Why think, when you can experiment? Exhaust, experiment and then think.”
Cut short by his father’s illness, Mitchell returned from Europe and was denied a residency at Pennsylvania Hospital, purportedly due to his father’s politics. He joined his father’s practice and assumed it completely after his father died in 1858. Working in the laboratory after office hours, he was elected to the Academy of Natural Sciences in 1853. Collaborating with a physiologist and the U.S. Army assistant surgeon William Alexander Hammond, Mitchell studied mechanism of action and physiological effects of rattlesnake venoms and arrow poisons on animals and at times themselves. He also studied the generation of uric acid, blood crystals of sturgeons, the circulation of snapping turtles, and the emotional and physical effects on himself after ingesting the dried tops of the mescal cactus (mescal buttons), a source of psilocybin.
The Civil War greatly disrupted medical life in Philadelphia. Before the war, 650 of the 1,200 students enrolled in Philadelphia’s medical schools came from below the Mason-Dixon Line. As southern students withdrew, University of Pennsylvania medical graduates went on to make up 25% of Confederate Army surgeons and 6% of the Union Army. By spring 1863, the need for assistant surgeons was so great that Penn rescinded its requirement of a year’s clinical experience, sending students directly from the lecture room to the army four months before the Battle of Gettysburg. Second only to Washington, Philadelphia housed over 14,000 hospital beds and treated 157,000 Union soldiers and sailors by the war’s end.
Conical, hollow “minnie balls” flattened on impact, shattering bone and tearing tissue, forcing surgeons to perfect rapid amputation in under three minutes — removing 30,000 limbs during the war.
To avoid conscription and not leave his mother with the financial responsibility of the large Mitchell family, Mitchell volunteered as a contract surgeon at Philadelphia’s Filbert Street Military Hospital, where he was drawn to peripheral nerve injuries his colleagues rejected as impossible to treat. As patients overflowed to Christian Street Hospital, Mitchell was joined by George Reed Morehouse and William Williams Keen.
In 1862, President Abraham Lincoln appointed Mitchell’s collaborator William Hammond as Surgeon General (before a feud with Secretary of War Stanton later led to Hammond’s court-martial, move to New York, and 1871 publication of the first American neurology textbook, A Treatise on Disease of the Nervous System). In 1863, Hammond arranged for Mitchell, Morehouse, and Keen to transfer to the newly built Turner’s Lane Hospital — known as “Stump Hospital” — to care for “the awful harvest of Gettysburg”. Working until midnight or early morning after their private practice rounds, the team documented their findings in Gunshot Wounds and Other Injuries of Nerves (1864) and Injuries of Nerves and Their Consequences (1872). Their work brought systematic clinical observation to the study of nerve injuries and their consequences, helping shape the development of American neurology. Mitchell’s son, John K. Mitchell later published a follow-up of 20 patients in 1895.
In 1867, Mitchell coined the term causalgia — from the Greek kausos (heat) and algos (pain) — describing it as “the most terrible of all tortures which a nerve wound may inflict,” noting how thinned, shining skin fretted with tiny ulcers failed to shelter nerve ends.
In 1871, he coined the term “phantom limb”. While Paré and Descartes had noted the phenomenon centuries earlier, doctors trained to look for physical lesions often suspected patients of “malingering” (feigning illness). Mitchell believed most Turner’s Lane patients were not faking, writing: “I found that the great mass of men who had undergone amputations, for many months felt the unusual consciousness that they still had the lost limb. It itched or pained, or was cramped, but never felt hot or cold…”
Following up with veterans into the 1890s and 1900s, Mitchell recorded accounts from amputees like Henry A. Kircher (“Of course it hurts”) and Gettysburg veteran Henry S. Huidekoper, whose phantom right hand cramped violently whenever he dreamt of writing. Though Mitchell attempted treatments like electrical stimulation and re-amputation, they were rarely effective.
In July 1866, Mitchell’s short story “The Strange Case of George Dedlow” appeared anonymously in the Atlantic Monthly. Mitchell occasionally used the pseudonym “Edward Kersley” for poetry and had co-authored a children’s book, The Children’s Hour, in 1864, but “Dedlow” was published by chance after he lent the manuscript to Reverend Furness, who passed it to Reverend Hale, who sent it to the magazine without Mitchell’s knowledge.
The story follows Union lieutenant George Dedlow, who loses his right arm after a gunshot wound triggers causalgic burning like a “red hot vise”, both legs after being hit at the Battle of Chickamauga — waking from chloroform insisting his missing left calf is cramping — and his left arm to hospital gangrene in Nashville. At “Stump Hospital”, Dedlow explains pain using a bell-wire analogy and describes neuromas and the “telescoping” sensation of a shortened limb before finding partial relief via shoulder “morphia” injections.
Feeling like “not a happy fraction of a man” and questioning his existence, Dedlow attends a Spiritualist séance on Coates Street with a medium named Blake and Sister Euphemia. Knocking out numbers 3486 and 3487 — his legs’ specimen bottles at the U.S. Army Medical Museum — Dedlow briefly walks on the invisible ghosts of his legs before collapsing. While echoing post-war resection metaphors (like Louisa May Alcott’s 1863 Hospital Sketches) and satirizing Spiritualism, the story was mistaken by readers for a real memoir; donations poured into the hospital and visitors arrived hoping to meet Dedlow.
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After selling his military contracts for $400, Mitchell campaigned for the chair of physiology at Penn in 1863, but the board of trustees rejected both Mitchell and Edouard Brown-Séquard in favor of merchant's son Francis Gurney Smith, Jr., “an honor to be rejected by such a set of apes,” Hammond wrote to Mitchell. Rejected again in 1868 for Robley Dunglison’s chair at Jefferson, Mitchell shifted focus to clinical neurology.
Elected consultant in 1870 to the newly established Philadelphia Orthopedic Hospital — renamed the Philadelphia Orthopedic Hospital and Infirmary for Nervous Disease in 1873 — the only neurological infirmary in America. Mitchell spent 40 years treating indigent and returning patients for chorea, epilepsy, locomotor ataxia, palsies, and neuralgia. There, he also discovered that eyestrain caused headache and identified erythromelalgia (Weir Mitchell’s disease). He first described erythromelalgia in an 1878 paper on a rare vasomotor disorder affecting the extremities. He trained residents under strict preceptorships (allowing only 6 hours of absence per 24 hours), including future Penn neurology leaders Charles K. Mills and Francis X. Dercum (who later attended to President Woodrow Wilson after his 1919 stroke, years after Mitchell had consulted on Wilson in 1912).
Marrying Mart Cadwalader from a prestigious Philadelphia family in 1875 after the deaths of his first wife (1862), mother (1872), and sister (1874), Mitchell became a Penn trustee for 35 years — resigning a professorship after 5 minutes when voted the title while briefly out of the room. As trustee, he vetted and recruited Willian Osler to Penn and the Infirmary in London by testing how Osler disposed of cherry pie stones — which Osler passed by disposing of them gentleey in his spoon.
Known as “Dr. Diet and Dr. Quiet” and praised by Paris neurologist Jean-Martin Charcot as “the best men in America,” Mitchell developed two opposing treatments for neurasthenia — nervous exhaustion, described by George Beard in 1869 as a byproduct of overworked “brain-workers” — and hysteria:
The Rest Cure: Prescribed mostly to women to keep them in the domestic sphere, involving six to eight weeks of best rest, isolation, a meat-rich high-calorie diet, massage, and electrotherapy. Mitchell outlined this approach in his book Fat and Blood: An Essay on the Treatment of Certain Forms of Neurasthenia and Hysteria, first published in 1877. Mitchell told postpartum patient Charlotte Perkins Gilman in 1887 to “live as domestic a life as possible” and “never to touch pen, brush or pencil again” — inspiring her harrowing 1892 story “The Yellow Wallpaper.” Gilman’s experience with the Rest Cure helped inspire her critique of restrictive treatment and women’s limited independence in “The Yellow Wallpaper.” The story is a work of fiction rather than a literal clinical record.
The West Cure: Believing nervous system made a strong man “like the average woman,” Mitchell — a self-diagnosed neurasthenic who camped and fished out West annually — sent men West for a “sturdy contest with Nature” through cattle roping, hunting, roughriding, and writing. Patients included disgraced painter Thomas Eakins (who returned from the Dakota Badlands in 1887 “build up miraculously”), poet Walt Whitman (Specimen Days, 1882), novelist Owen Wister (who wrote the first American Western, The Virginian, in 1902), and future U.S. President Theodore Roosevelt, who overcame asthma and effeminate comparisons to Oscar Wilde in the Dakotas to forge his “speak softly and carry a big stick” ethos.
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Writing during summer vacations to avoid boredom, Mitchell published 13 to 19 novels on Philadelphia society and wartime life, short stories, a biography of George Washington, and 7 poetry books. Tough critics faulted his slow plots and emphasis on genteel society, all applauded his accurate portrayals of psychopathology — noting that “only Oliver Wendell Holmes” came close,
Intimately familiar with bereavement and Civil War loss, Mitchell captured his lifelong reflections in his 1899 poem, “Of Those Remembered”:
There is no moment when our dead lose power;
Unsignaled, unannounced they visit us...
Use well thy dead. They come to ask of thee
What thou hast done with all this buried love,
The seed of purer life?
References:
1. Klekamp, Jörg, and Michael Samii. “Surgery of Spinal Meningiomas: A Review.” Neurosurgical Focus 41, no. 1 (2016): E5. https://thejns.org/focus/view/journals/neurosurg-focus/41/1/article-pE5.xml.
2. Canale, D. J. “Civil War Medicine from the Perspective of S. Weir Mitchell’s ‘The Case of George Dedlow.’” Journal of the History of the Neurosciences 11, no. 1 (2002): 11–18.
https://pubmed.ncbi.nlm.nih.gov/12012570/.
3. American Psychological Association. “Go Rest, Young Man.” Monitor on Psychology 43, no. 1 (January 2012). https://www.apa.org/monitor/2012/01/go-rest.
(OG/APC/MSM)
