Tenth annual report to the committee from the medical director : presented 31st December, 1931 / The Cassel Hospital for Functional Nervous Disorders.

  • Cassel Hospital for Functional Nervous Disorders (Richmond, England)
Date:
[1932?]
Catalogue details

Licence: In copyright

Credit: Tenth annual report to the committee from the medical director : presented 31st December, 1931 / The Cassel Hospital for Functional Nervous Disorders. Source: Wellcome Collection.

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    The patients with psychoneuroses have been sub-divided as previously into four groups. Seventy- four were placed in the table “ anxiety states.” All except two showed improvement in hospital. Nine relapsed. One is dead. Only four have not been heard from. Thus fifty-eight out of the seventy-four are well or improved at a date at least a year after they left the hospital. In the group “ hysteria ” nineteen were well or improved. In the Obsessive Compulsive group there were five patients ; one of these is now well, a second much improved. Outlines of their cases are given below. Three suffer still severely from the neurosis. In the group Anorexia Nervosa there were two patients, both of whom are now well. During the past year there has been a recurrence of interest in the subject of anorexia nervosa in the medical press. A report of an elaborate investigation into the physical aspect of the problem was published in the Lancet, and in answer a pamphlet reporting a symposium was issued under the auspices of the Society for the Study of Individual Psychology. In these circumstances it seems opportune to put on record the after results of all the examples we have had since the hospital opened. We have now had thirteen patients suffering from this disorder. From the study of their cases the inference may be drawn that the prognosis of the illness is good, that a comparatively simple treatment is all that is necessary, that there are no primarily physical problems connected with the condition, but that these are wholly psychological. The illness will disappear if proper steps are taken. It tends to drag on till this is done. The term anorexia nervosa has been restricted in these reports to a well-defined clinical syndrome, which is marked by seven characteristics that have been present in all our cases. There have been three positive symptoms, anorexia, loss of weight often carried to the point of emaciation and amen- orrhoea. Three other characteristics have been that the patient is female, unmarried and of an age between puberty and about twenty-four. There has been one constant negative symptom, viz. : that despite her deathly appearance she has stoutly maintained that she is never tired. She has usually said that she feels quite well. Two in the series complained of headache. None complained of dyspepsia—it might be said why should they, seeing that they eat nothing, but there are other thin nervous girls, most of whom, in contrast with those we are now considering, feel tired, who say that they do not eat, because eating causes so much indigestion. The patients in this well-defined group do not say this. They do not eat because they do not want to, and as they feel well it seems clear to them that they do not need to. In patients whose cases have been allowed to run on, exhaustion is found, but this is a late and probably ominous symptom. We have not had an example in the hospital. In the more advanced cases where the patients were greatly emaciated, the nose and finger tips showed the cyanotic tint which has been frequently described. The skin in most instances is dry and harsh. With regard to the question of sex, it has been our experience that young men, sent to the hospital with anorexia and emaciation without physical lesion, have been the subjects of grave mental disease, associated with delusions about food, such as that food will rot the brain and that it is better to starve than to become insane, or that their bowels are completely obstructed and that it is useless to put more food on the top of what is already there, etc. In the discussion on Anorexia Nervosa referred to (Individual Psychology Publications, Medical Pamphlets—No. 2) more than one contributor stated that the disease occurred in males, but as several of these required tube feeding, and others displayed obvious schizophrenic symptoms, such as that when the patient’s father entered the room it felt charged with electricity, and that he (the patient) had then no will of his own, it seems clear that they are in a different category from the young women whom we are considering.