[From The Medical News, September 3. 1887.] 
Clinics at the Infirmary for Nervous Diseases, 
Philadelphia.-This hospital, which has been well 
known for many years, has been handsomely rebuilt on 
the old site, at the corner of Seventeenth and Summer 
Streets, Philadelphia, and is devoted exclusively to 
nervous diseases and orthopaedics. 
The service for outpatients at the hospital has a quite 
peculiar interest from the mode in which it is managed. 
In the first place, these clinics are held by the physicians 
with the assistance of a large staff of assistants. Three 
rooms on the ground floor, well aired and lighted ; a 
large adjoining room for electrical treatment; a dark 
closet for ophthalmoscopic purposes; and a photo- 
graphic chamber, give ample facilities. 
The three physicians each hold a weekly clinic, and 
lectures are now being given twice a week in the lecture 
room of the hospital. 
The method followed at these clinics may be illus- 
trated by a brief mention of the plan adopted by the 
senior physician, Dr. S. Weir Mitchell. One of his 
assistants, Dr. Hinsdale, obtains in one of the case- 
books the introductory knowledge needed in every 
instance, and endeavors to form a rough diagnosis ; this 
sketch comes before Dr. Mitchell, who questions the 
patient and endeavors, as do all the physicians, to follow 
a printed card which gives the order in which the symp- 
toms shall be noted. This regularity of sequence makes 
the notes taken more easily comparable. If the notes 
need to be elaborate, Dr. Morris Lewis examines thor- 
oughly the heart, the lungs, and abdomen; Dr. de 2 
Schweinitz the eye and ear; Dr. J. M. Taylor the secre- 
tions ; while Dr. Massey makes the electrical tests. Each 
aid has thin slips of paper on which are printed clearly 
the main points of inquiry, and these, when filled out, 
come back to the clinical clerk for insertion with the 
notes of the case. It is rare that all the slips are needed ; 
often a mere negation records absence of heart and 
lung troubles; but, by this plan, when very accurate 
notes are needed, they can be had. 
Often no opinion is given until a case has been ex- 
amined at a second visit and a more extended history 
obtained. It would be difficult to secure more care in 
diagnosis than is thus attained. 
The seven sets of books used in these clinics for 
records are peculiar to the hospital; they are for 
epilepsy, chorea, neuralgias, local paralysis and local 
disease of nerve trunks, paralysis of adults, infantile 
paralysis, and miscellaneous cases. The plan provides 
volumes available for examination or inquiry regarding 
these disorders, and saves the inconvenience of sifting 
out from a miscellaneous collection the special cases 
that may be required. 
The pages of the chorea book are printed with about 
fifty questions regarding family history, the previous 
health of the patient and particularly previous attacks 
of the disease, the exact date of onset of the present 
attack, the order in which the members were affected, 
and very many questions regarding the present condi- 
tion of the patient. The answers to these questions 
have secured full statements and have aided the re- 
searches on Chorea and Weather, by Dr. Mitchell, and 
on Chorea and Rheumatism, by Dr. Morris Lewis, as 
well as Dr. Mitchell's papers on Chorea in the Black 
and on Habit Chorea. At present Prof. Osler is 
using them to call back to the hospital for reexamina- 
tion of the heart all the old cases of chorea, which now 3 
number five hundred at least. Dr. de Schweinitz is 
carefully restudying the eyes of the choreic. 
For palsy of infancy case books have been printed 
with spaces for answers to fifty-eight different items. 
From a vast collection of cases thus studied Dr. 
Sinkler was enabled to draw his conclusions as to 
the relation of the paralyses of childhood to tempera- 
ture. 
The less interesting cases which return frequently, are 
seen by an assistant, and thus these large clinics are 
handled with a speed, and yet with an amount of care, 
which is remarkable. 
Medicines are given at a little above cost-at such a 
rate, in fact, as merely to pay for the drugs and sustain 
the apothecary. 
These clinics are, as a rule, open to all visiting physi- 
ciani ; but we believe Dr. Mitchell, at least, declines to 
lecture clinically to a mixed class of men and women, 
and thinks that opportunity for study is lost by teaching 
at clinics of this kind. 
The electrical service under Dr. Massey is very com- 
plete, abundant facilities being provided for the use of 
galvanic, faradic, and franklinic currents in the elec- 
trical room and throughout the house. By a novel 
arrangement the galvanic current is made available for 
use at the bedside of each patient in the hospital, and 
all may be treated simultaneously without danger of 
exhausting the battery. This is accomplished by using 
the current of the incandescent lighting plant, special 
wires being laid beneath the floors and connected with 
plug receptacles, which are placed in the base-boards 
near each bed in the wards, and beneath the lamps in 
the private rooms. To these receptacles movable tables 
provided with a meter and rheostat may be attached at 
will. 
The use of this strong current in medical work is 4 
made possible by the special form of rheostat, or current 
controller, devised by Dr. Massey, which consists of a 
circular pencil-mark arrangement, permitting any 
gradation of current from a fraction of a milliampere to 
fifty milliamperes, by the simple movement of a lever. 
The current used, both for this work and for the electric 
lighting, is derived from an Edco storage battery of sixty 
volts and slight internal resistance, fed by a dynamo, 
both being situated in the basement. The franklinic 
currents are derived from a four-plate twenty-two-inch 
Toepler-Holtz machine, with a spark capacity of seven 
inches. 
A very interesting and unusual feature of this hospital 
is a room on the ground floor devoted to such research as 
requires instruments of precision. There are, of course, 
apparatus such as thermometers of all kinds, sphygmo- 
graphic instruments, and others for counting blood- 
corpuscles and estimating haemoglobin; mechanical 
arrangements for studying and recording tremors and 
knee-jerks; and devices for the study of clonus, on 
which Dr. Mitchell is now engaged. In the middle of 
the room is a large kymographion, with the usual ar- 
rangements of tuning forks, etc., for the records of small 
fractions of seconds. 
It is the desire of the managers and of the physicians 
that the numerous researches which have found their 
means in these clinics in the past, should in the future 
receive every encouragement. No hospital in America 
has, we believe, in the last ten years so notable a record 
of original work done. 
We propose shortly to speak of some of the methods 
in use here in the treatment of disease.