ENGLISH medical literature contains no complete treatise on injuries of nerves and the diseases consequent upon them. In fact, few persons have at any time in medical history been so situated as to command the peculiar opportunity which has fallen to the lot of the writer of these pages, and which alone he feels may justify him in adding another to the numerous monographs which to-day claim the attention of the profession.

In May, 1863, Dr. Wm. A. Hammond, then SurgeonGeneral of the U. S. Army, requested me to share with Dr. George Morehouse the medical charge of an army hospital for nervous diseases, the foundation of which I had suggested to the medical bureau, over which at that time Dr. Hammond presided with such ability as has caused his name to be inseparably associated with the medical and surgical history of the late civil war.*

* When this hospital was organized, I urged upon the Surgeon-General the necessity of freeing its medical staff from the usual administrative duties which take up so much of the time of our military hospital surgeons. Arrangements were therefore made which permitted us to devote to our cases all available time, and left the government of the house in charge of a competent surgeon-in-chief. I may be permitted to add, that when Dr. Hammond left office he had established special wards or hospitals for diseases of the eye, for syphilis, for stumps, for

This hospital promised very early to surpass in usefulness the fondest expectations of its founder and of the staff, to which, at my request, Dr. W. W. Keen was added, as resident surgeon.

It was finally enlarged to 400 beds, and removed. from Christian Street, Philadelphia, to Turner's Lane, in the suburbs of the city, where, for the first time, its capacity enabled us to classify in distinct wards the numerous cases which fell under our care. Never has such an opportunity for the study of nerve lesions and their results presented itself. A multitude of cases, representing almost every conceivable type of obscure nervous disease, was sent to us from this department and that of Washington, by surgeons who felt conscious that these forms of disease were rarely amenable to treatment in wards crowded with grave wounds, constantly demanding all the time and care of overworked attendants. The medical inspectors, and especially Dr. John Le Conte, were active in selecting and forwarding such instances of disease as seemed to them suited to our service; so that we received and treated during two years an enormous number of cases of diseases and injuries of the nervous system.

Among these was a vast collection of wounds and contusions of nerves, including all the rarest forms of nerve lesion of almost every great nerve in the human body. Nor was this mass of material neglected in any point of view. New modes of treatment were devised, and gymnastic classes instituted, under the care of intelligent sergeants of the invalid corps; electricity was constantly employed, and hypodermic medication

at

diseases of the heart and lungs, and was maturing a plan for the further extension of this system, with such arrangements as must have resulted in vast advantages to scientific medicine and surgery.

that time somewhat novel-was habitually resorted to, and its effects carefully studied.

The Surgeon-General and the hospital staff equally felt that besides the benefit to the sick soldiers, in thus aggregating cases alike in character, and therefore fitted to produce the special experience so useful in their treatment, this opportunity of study entailed upon us certain obligations to the profession. The responsibility which was involved in the possession of such rare experience we endeavored conscientiously to meet. Careful notes were taken by the surgeon or the resident of every case, and were methodically continued until the time at which the patient left us; while in many instances the utmost care has been taken to collect, in the interval which has elapsed since the war, such details of later history as were needed to clear up or complete the story of symptoms or prognosis.

The experience thus acquired during the war led to the publication of a number of communications on various subjects. One of these was a small volume on gunshot wounds and injuries of nerves,* which has been long out of print. I supplemented it, a year ago, by a paper on "The Diseases of. Nerves resulting from Injury," which was published in the medical volume of the Reports of the U. S. Sanitary Commission; but as this volume is bulky and costly, and as neither it nor the monograph before mentioned at all cover the ground which I propose to occupy in the following pages, I still feel that there is room for my present work.

The study of the natural history of any class of diseases so constantly relates itself to the healthy workings of the

* Gunshot Wounds and other Injuries of Nerves, by S. Weir Mitchell, M.D., Geo. R. Morehouse, M.D., and Wm. W. Keen, M.D. J.B Lippincott, & Co., Philadelphia, 1864, pp. 164.