My aim is to chronicle the early years of the Neurological Study Unit (NSU) at Yale University (1924–1940): the motivations for establishing the unit, its structure, its challenges and its evolution.

The author identified and studied all documents related to the NSU in Manuscripts & Archives, Yale University Library. Extensive material was identified in six boxes.

The NSU was heralded as a “combined attack on a single problem from many angles”. Clinical-pathological conferences were the centerpiece and binding element of the unit, providing a forum for the exchange of ideas between members of diverse allied disciplines around a common clinical problem. However, careful study of neurological cases, which was to have been a centerpiece of the unit, was made impossible by lack of clerical support at the hospital. There was no neurologist on staff, and it was not for many years that the unit was able to enlist the help of an assistant neurology resident. For a time, the centerpiece of the “neurological” effort was missing.

The NSU was slow in forming, with several important missing pieces. While some of this may have been due to lack of funds, it also represented a failure to conceptualize a neurological unit, and this in part was because neurology as a discipline was only partially-formed. As such, the NSU was emblematic of the slow evolution-into-existence of a nascent medicine discipline.