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ABSTRACT
In 1868, Jean-Martin Charcot identified multiple sclerosis (MS) as a distinct nosological entity. By 1870, American neurologists became aware of the "new" disease and began to diagnose cases in the United States. For the next 50 years, however, American physicians thought it was a rare condition. From 1920 to 1950, this perception changed dramatically; by 1950, neurologists considered it among the most common neurological diseases in America. The increasing prevalence of MS between 1920 and 1950 can largely be explained as an effect of an increase in the number of trained neurologists, urbanization, a changed ecology of disease, and altered concepts of gender and disease. Physicians recognized MS more frequently because over time there were more neurologists who had the skills necessary to make the difficult diagnosis, and because patients were more likely to be seen by a trained neurologist. Significant numbers of patients with MS had been misdiagnosed with other diseases such as hysteria and neurosyphilis; over time, they were increasingly diagnosed correctly.
WE DO NOT HAVE ACCURATE AND RELIABLE STATISTICS for the prevalence of multiple sclerosis (MS) in the United States until the late 1940s, but the literature clearly expresses a changing perception of the frequency of this disease (Kurland 1994). Jean-Martin Charcot, working in France, identified MS as a distinct nosological entity in 1868. More than two decades later, in 1892, Charles Dana reflected the standard view among neurologists when he wrote that "in America the disease is, in the writer's experience, rare." Analysis of the diagnoses reported in the New York Hospital Annual Reports from 1883 to 1906 shows that physicians diagnosed MS only 10 times for inpatients; between 1892 and 1906, they diagnosed MS five times at the outpatient House of Relief. In the early 20th century, some neurologists began to question the idea that MS was rare in America, because they recognized how difficult it was to diagnose the condition (Dercum and Gordon 1905; Putnam 1903). Nevertheless, the general perception remained through the first decade of the century that MS was rare in America (Crafts 1917).
These statistics and continuing suspicions about misdiagnosed cases led, during the 1920s, to assertions by neurologists that MS was an infrequent disease, but one that was increasing slowly (Taylor 1922). Nonetheless,...