Rare 19th Century Notebooks Reveal New Lessons in Neurology

The crinkly pages filled with elegant script, a dispatch from the Hospital of the University of Pennsylvania’s Dispensary in the late 19^th century, are a window into medical history.

Geoffrey Aguirre, MD, PhD, an associate professor of Neurology, recently received the notebooks after they were uncovered by a colleague in boxes within the department. Now, they’re getting fresh life as an official Penn historical artifact. With the support of Donald H. Silberberg, MD, emeritus professor of Neurology and the former chair of Neurology, and Frances Jensen, MD, the current chair of Neurology, Aguirre transferred the documents to Penn’s University Archives and Records Center.

Mark Frazier Lloyd, director of Penn’s Archives Center, says the notebooks add depth to the university’s current archive collection, which is somewhat lacking in historical documents that offer insight into 19^th century patient care at Penn.

“This is pretty rare,” Lloyd said. “We’ve had instances where we’ve found one little notebook that was maybe associated with an 18th century physician. But this came directly from the intake area of HUP and we couldn’t have been happier, because this documents HUP in a way that I don’t think our collection does anywhere else.”

The seventeen volumes of notebooks contain hundreds of pages of physician’s notes detailing a broad range of neurological conditions and treatments, providing rare insight into the inner workings of the earliest days of the HUP Dispensary and the study of nervous system disorders.

When the Hospital of the University of Pennsylvania opened in 1875, the Dispensary for Nervous Diseases was one of seven dispensaries in the hospital. Located in the basement, the dispensaries provided clinical care for patients who were not sick enough to be admitted to the hospital or were unwilling to be admitted.

Joseph-James “JJ” Ahern, senior archivist at Penn’s Archives Center, manages the review of items before they’re added to the archive collection. In his review, he first checks the items for condition to see if any of the manuscripts have been damaged by water or insects. The items are then rehoused in archival national standard folders or containers that will prevent further deterioration due to an accumulation of acid. Once the items have been safely stored, Ahern works with Lloyd to organize the collection and write a guide that provides an overall description or summary of what the inventory represents.

In thumbing through the pages of the 20 notebooks, Ahern was particularly intrigued by the many unique descriptions of what were then known as neurological disorders.

“We didn’t have time to read every page but it’s very interesting to see all sorts of ailments listed, from hysteria, to chronic alcoholism, to spermatophobia [a fear of sperm],” Ahern said.

Aguirre was equally fascinated by how much the field of neurology has changed since the 1800s and how much has somehow remained the same.

“There are terms in these notebooks that date back to the earliest days of neurology. We use different medical terms now but these old-fashioned ways of describing particular medical disorders colors the history of the field,” Aguirre said.

According to Aguirre, during the earliest days of neurology, many physicians were primarily treating the effects of syphilis because it causes a number of neurologic disorders and “paging through these notebooks, you can see that there are multiple examples of cases that are related in some way to syphilis, which is now a treatable disease but at the time was incurable.”

While the notebooks reveal a great deal of previously unknown details of 19^th century patient care at HUP, Ahern says there may be more to this particular collection that has yet to be discovered.

The majority of the notebooks reflected a numbering system. Some of the dispensary notebooks were numbered during their creation, others were apparently numbered sometime later in the 20^th century. Gaps in the numbering system indicate additional notebooks may be missing.

“JJ’s careful study of these documents revealed that there are probably some notebooks missing from the collection and we’d love to find them,” Aguirre said.

Lloyd’s advice to Penn employees, who are part of the enterprise that launched both the nation’s first medical school and its first teaching hospital: “Trust us with your old stuff.”

“If you see something old lying around, call us,” he said. “You could be holding a piece of history.”