Training opportunities for the nineteenth-century American neurologist: preludes to the modern neurology residency.

During the nineteenth century, two parallel developments, a surge in neuroscience discovery and the advent of medical specialization, resulted in new educational demands for advanced, postgraduate neurologic training in the United States. Archival data, including trustees' reports, school charters, and instructional plans from medical institutions in New York, Boston, Philadelphia, and Chicago, document three comparative models for early postgraduate neurologic training. First, senior physicians with an interest in neurologic disease incorporated postgraduates directly into their practice and as laboratory assistants; second, medical universities, as well as distinct postgraduate schools, organized advanced general medical curricula with optional opportunities for focused neurologic training; and third, separate neurologic hospitals provided physicians with full-time clinical instruction specifically in neurology. As a result, although neurology residencies were not established until the 1900s, postgraduate neurologic training was firmly institutionalized in nineteenth-century America. These programs provided doctors in the United States with advanced neurologic educational opportunities and expertise and fostered the development of a distinct American neurologic school.