Medical report presented 31st December, 1924 / The Cassel Hospital for Functional Nervous Disorders.

Cassel Hospital for Functional Nervous Disorders (Richmond, England)

Date:: [1925]

Catalogue details

Licence: In copyright

Credit: Medical report presented 31st December, 1924 / The Cassel Hospital for Functional Nervous Disorders. Source: Wellcome Collection.

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a large team of about 15 members, and that at this particular place the operation of partial thyroidectomy was being performed about three times a week on non-goitrous patients. This state of affairs was attributable largely to the enthusiasm of two- members of the team, a physician who found signs of hyperthyroidism in nearly everyone, and a surgeon who was extremely skilled in performing the operation. Fortunately for the differential diagnosis of functional disease it is not necessary that the doctor should be prepared to> recognise every disease to which the body is liable; it will be sufficient that he should be familiar with the signs which show that all the organs are healthy, and this is a matter which is, as a rule, within the capacity of every general practitioner. If all the signs are those of health, if there is no typical history of some specific morbid condition, and if the illness is not of recent duration, the absence of organic disease may be assumed. The important physical signs relating to any one system of the body are not very many : they will be touched on later. The first kind of diagnosis then is reducible to fairly simple terms; the second kind is a matter of special reasoning about the individual case, and an attempt will be made as we discuss individual cases to give illustrative examples which it is hoped may be useful. It is with considerable diffidence that the writer of this report sets out on this task. Indeed, he feels little qualified to undertake it. His excuses for doing so- are these. In books on general medicine, special medicine and psychiatry, there is more or less a general assumption that the differential diagnosis between organic and functional disease is not very difficult. The figures just quoted are in direct opposition to any such facile view, and when the various cases are studied in detail, it will be found that errors of diagnosis have been made by the most experienced. Secondly, the Hospital should be a place not only for the treatment of patients, but also, if possible, for the dissemination of knowledge; and the knowledge at least that the difficulty exists is one that has been brought very forcibly to the minds of the staff. Therefore, such knowledge should be placed on record. It will be convenient at this point to tabulate the organic cases which have been admitted in the course of the three years under review. This series does not, of course, include every patient where organic disease was present. There were many where such a condition was known, but where the symptoms were considered not to be due to the organic condition, but to be independent of it. Such are not included in this list, in which the symptoms presented were due probably entirely to the organic condition. Neither are there to be found those nervous patients who suffered also from visceroptosis. They are not included because the whole subject of the chronic abdomen is too vexed a one to be settled here. Some day it is hoped that we shall have accumulated sufficient evidence to put forward an opinion, but that day is not yet. It was stated above that the differential diagnosis between the psychoses and the psychoneuroses was not dealt with sufficiently in text books on psychiatry. That subject too must be left over for further consideration. 1. Diseases of the Nervous System. Paralysis Agitans with tremor. 4 patients Paralysis Agitans without tremor . 4 patients (One of these died in about 6 months after leaving) Disseminated Sclerosis . 2 patients (One of these died within a month of leaving the Hospital)