Department of Neurology
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Neurology at Mount Sinai (Adapted from an article by Morris B. Bender, published in The Spectrum, the journal of the Associated Alumni of Mount Sinai, Number 3, Spring 1973.)
By 1900 the hospital outgrew itself so that in 1904 it moved to its present quarters at 100th Street. In 1922 because of an ever-increasing number of neurologic patients seeking admission, the wards were increased to 36 beds. Besides developing the clinic and hospital services, Sachs displayed leadership in the American Neurological Association, being twice its president in 1894 and 1932, and later in international neurology when he was chosen president of the First International Congress in 1931. In 1920 a Laboratory of Neuropathology was established under the direction of Dr. J.H. Globus. Thereafter, there followed an increasing emphasis on clinicopathologic correlations. In 1925 Dr. Israel Strauss succeeded Sachs as chief of Neurology and a new residency program was established. A few of the 36 service beds were assigned to neurosurgery and four for psychiatry. In the ensuing years the attending staff expanded and among these were Moses Keschner who made notable contributions to the understanding of dyskinesias. The investigative trend was chiefly clinical and the only basic science studies were in neuropathology. Globus continued to make numerous contributions and among them was the founding of the journal Neuro-pathology and Experimental Neurology. However, his most important was on the pathology of brain tumors, especially the malignant glioma. With Israel Strauss, he introduced the term "spongioblastoma," whereas Cushing and Bailey named the same tumor "glioblastoma." This difference in nomenclature created lively discussions at various meetings and ultimately led to the modern classification of brain tumors. As for therapy, it consisted chiefly of the treatment of syphilis of the central nervous system and of the psychoneuroses. During this period, although most neurologists practiced psychotherapy, more psychiatrists were added to the staff, the most famous being Drs. Clarence Oberndorf, Sandor Lorand and Dudley Schoenfeld, each a pioneer in the psychoanalytic field. Most of their activities were in the out-patient clinics. Psychiatry was under the administration of Neurology while Neurosurgery, a division of Surgery, also functioned within Neurology. In 1938 Dr. Israel S. Wechsler succeeded Strauss. By that time his Textbook of Clinical Neurology was widely read and translated into many languages. During the next year Psychiatry was placed under the leadership of Dr. Lawrence Kubie, who was physiologically as well as psychoanalytically oriented. Kubie and his group of well-known psychoanalysts became nationally prominent and greatly influenced modern psychiatry. However, because of some organizational problems there followed a separation from Neurology and in 1946 a new department of Psychiatry was established under the direction of Dr. M. Ralph Kaufman. The next year, Neuro-surgery also became autonomous, with Dr. Ira Cohen as its first chief. Thus, Neurology, shorn of its two off-springs, redirected its efforts to investigation and treatment of diseases of the nervous system. Dr. Richard Brickner's work on "Intellectual Functions of the Frontal Lobe" created much interest and his monograph on this subject is still quoted. Wechsler concentrated on vitamin therapy of peripheral neuropathies and of amyotrophic lateral sclerosis. Before World War II, Bender and Weinstein investigated the physiology of brainstem functions and eye movements, especially on the median longitudinal fasciculus. These researches, conducted in a small animal operating room, ultimately led to the creation of laboratories of neurophysiology. During the war Bender, a Commander in the U.S. Navy, conducted studies on disorders of perception caused by battle injuries of the brain. After the war he continued with these investigations on perception of double simultaneous stimulations in normal man and child as well as in brain damaged subjects. These studies were summarized in the monograph on Disorders of Perception. Weinstein, a Major in the U.S. Army, made investigations in behavioral and emotional disorders associated with brain lesions, culminating in his book Denial of Illness. In the immediate post-war period there was a tendency toward basic research, and with electroencephalography and the intro-duction of neuroradiology in 1946, a clear trend toward laboratory methods in clinical neurology ensued. Psychiatry, while still practiced by some staff members, became gradually extinct within the department. In 1951 Dr. Morris B. Bender succeeded Wechsler as chief of service. Within the next few years there were major changes, with emphasis on research and the train-ing of neurologists. New laboratories in neurophysiology were established. The residency program was expanded with the aid of federal grants. The department grew rapidly in patient care, clinical investigation and graduate teaching. In general there was greater emphasis on medical than surgical care of neurologic patients. Subdural hematomas and malignant cerebral neoplasms were treated with steroids and chemotherapy rather than surgery. Research also accelerated. Between 1952 and 1962, laboratories in visual functions, oculomotor physiology, clinical neurophysiology, neurochemistry, cellular physiology and neuroendocrinology were opened as divisions within the department. Later, laboratories in neuro-virology and chemical neurophysiology were added. Special clinics for Myasthenia Gravis and Neuromuscular Disorders, Headaches, Seizures, Aneurysms, Dyskinesiae and Vestibular Dysfunctions were established. With numerous researches on the oculomotor system and in visual functions as a basis, neuro-ophthalmology was introduced as a subspecialty. Pediatric neurology, first started by Bernard Sachs, became fully developed within the department in 1961. Psychiatric activities were reduced and the only investigations were the mental changes, communications defects and perceptual disorders found in subjects with disease of the brain. By1968, although the neurologic service beds were increased to 45, the changing economic times practically abolished the distinction between ward and semiprivate beds. All were considered as teaching beds. Under those circumstances there were between 80 and 110 patients with neurologic disorders. Upon the creation of the Mount Sinai School of Medicine there was another major change. In 1966, all members of the attending staff joined the faculty. In 1968 the Henry P. and Georgette Goldschmidt chair in Neurology was endowed by Mrs. Lucy Moses and first occupied by Dr. Bender. The staff, which then consisted of 13 full-time and a large number of part-time members, participated in the teaching of neurosciences and clinical neurology to medical students and gave special courses in the newly established Page and William Black Post-Graduate School of Medicine. The Mount Sinai group continued to maintain its tradition of prominence in American neurology and as evidence of this excellence there were 18 members in the American Neurological Association during 1972-1973. Dr. Bender retired in 1973. Melvin D. Yahr was appointed the next year. Yahr's work centered on the study and treatment of Parkinson's Disease. In 1974 the Clinical Center for Parkinson's Disease was established, making Mount Sinai one of the world's major centers for this disease. Dr. Yahr continued with refining the neurology curriculum for the medical and graduate students. In 1986 the Fishberg Center for Neurobiology was opened, which provides continuing interaction with the department of Neurology. At Dr. Yahr's retirement in 1991, Howard Lipton was appointed Chairman and Goldschmidt Professor. After a brief tenure, Lipton was followed by C. Warren Olanow in 1994. In 1996, the Neuroscience and Restorative Care Center was opened in the new Guggenheim Pavilion of the Hospital. |
y the end of the 19th century
neurology was a recognized
specialty at the Mount Sinai Hospital. In June 1890 a new six-story dispensary building for various specialties was opened at 67th and Lexington Avenue and one of them was a new clinic created for neurologic cases. Dr. Bernard Sachs was appointed in 1893 as a "Consultant" Neurologist for the Hospital. In 1887 he had described the syndrome of amaurotic familial idiocy that bears the eponym Tay-Sachs disease. He wrote the first textbook in America on Nervous Disease of Children in 1895. The Mount Sinai clinic became more widely known, and in recognition of the growth of Neurology, six male and six female beds were assigned for an in-patient service under the care of Dr. Sachs. In 1900 those 12 beds constituted the first neurologic wards in New York City. At first there was one assistant, but in time the attending staff expanded and included some who became early members of the American Neurological Association. The neurosurgery work at Mount Sinai was performed by Dr. Charles Elsberg until 1921, when he joined the Neurologic Institute.