Eighth annual report to the committee from the medical director : presented 31st December, 1929 / The Cassel Hospital for Functional Nervous Disorders.

  • Cassel Hospital for Functional Nervous Disorders (Richmond, England)
Date:
[1930?]
Catalogue details

Licence: In copyright

Credit: Eighth annual report to the committee from the medical director : presented 31st December, 1929 / The Cassel Hospital for Functional Nervous Disorders. Source: Wellcome Collection.

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    ANNUAL REPORT from the MEDICAL DIRECTOR to the COMMITTEE on Patients who have been discharged from the Hospital up to 31st December, 1928. Presented — 31s/ December, 1929. IN accordance with the resolution of the Committee that a full report on all patients who had been discharged from the hospital should be presented every third year, this report will deal only with those who were under care in 1928. During the year, 179 patients were discharged of whom 143 were new ; the remainder had been in the Hospital previously. Of the new, 94 suffered from psychoneuroses, 28 from psychotic states, three were alcoholic, two were drug addicts, nine were classified under the heading Psychopathic Personality, while six were the subject of organic disease. One patient suffered from migraine. The classification of the psychoneuroses, which has been in use for the last three years has been adhered to ; but as has been pointed out previously, there are many occasions when it is diflicult to decide whether a given case should be grouped under a particular heading ; this difficulty is felt in nearly all categories. For example, the hysteric with indifference, does not seem to be a common patient at Swaylands, and examples are found from time to time where patients, whose symptoms are those of great anxiety, develop a functional paralysis. Thus a patient with attacks of profound anxiety in which he experienced grave apprehension about his health, his career and his sanity, one who was troubled by insomnia and distressing dreams, complained one day of weakness of a foot ; this progressed into complete foot drop which lasted about a week. The symptom occurred during a period when his anxieties had become definitely lessened, and was associated with a proposed expedition to London, which he knew he ought not to take ; it effectually prevented him from doing so. It has been frequently observed, that the removal of an hysterical symptom without further treatment may be followed by the appearance of anxiety; that the mechanisms can work the other way round, is not so commonly appreciated. A similar difficulty exists with respect to the classi¬ fication between obsessional and anxiety states. In a sense, any neuropath is obsessional; he is preoccupied by a small number of troublesome affairs, and it has always seemed to the writer, that those who come across many examples of the obsessional neurosis are probably using the term rather widely. It is probably best to keep the term for those where compulsive acts or compulsive thoughts are a prominent symptom, and where there are no complaints of bodily discomfort. The difficult cases are those where a phobia of disease is so insistent, that the patient may be classed as obsessive ; there can be no doubt however, that such are more easily helped than the truly compulsive patients ; and probably they are affected in a different way psychologically. The phobic patient presents the features of an anxiety neurotic state, while the obsessive shows more marked regressive features. The difficulty of distinguishing between hysterical and schizophrenic patients has been commented on in previous reports.