Medical and general reports and accounts for the year ended 31st December, 1942 : (from Swaylands, Penshurst, Kent.) Present Address: Ash Hall, Bucknall, Stoke-on-Trent / The Cassel Hospital for Functional Nervous Disorders.

  • Cassel Hospital for Functional Nervous Disorders (Richmond, England)
Date:
[1943?]
Catalogue details

Licence: In copyright

Credit: Medical and general reports and accounts for the year ended 31st December, 1942 : (from Swaylands, Penshurst, Kent.) Present Address: Ash Hall, Bucknall, Stoke-on-Trent / The Cassel Hospital for Functional Nervous Disorders. Source: Wellcome Collection.

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    extensively undertaken. The administrative and nursing personnel need to have much patience and tact in their solution, but the results are often highly beneficial. At Stage 2. It is suggested that after the war, if circumstances permit, the Committee might consider the establish¬ ment of a special Convalescent Institution for psycho¬ neurotic patients requiring a period of readjustment along the lines discussed in this report. Residence in such an establishment would probably have to be limited to (say) six months and periodical medical consultations should be arranged. The cost of maintenance would be low since much of the work could be done by resident patients. The establish¬ ment would have a beneficial effect on the work of the parent hospital by relieving the waiting list and reducing long periods of residence in it. The patient who has to stay more than 12 months in hospital is often unconsciously a bad influence on newcomers who tend to lose their sense of urgency and their ideas as to the possibility of a quick recovery. At Stage 3. After the war the Committee might consider the appointment of a psychiatric social worker who would undertake much of the detailed supervision of late-stage rehabilitation. She would also greatly assist in the study and amelioration of difficult environmental problems in the earlier stages of treatment. The geographical problem is the most difficult one in this connection. MEDICAL WORK OF THE HOSPITAL DURING THE YEAR 1942. The first eight months of 1942 may be regarded as a highly satisfactory period during which the improved efficiency of modern methods of treatment in the neuroses showed a visible effect upon our results. During this period the total discharge rate almost equalled that of the equivalent period in 1938 when double the number of beds and twice the medical staff were available. This is an important point for the future, since one of the most serious problems in the successful treatment of neurosis is the provision of adequate medical staff and sufficient time. Five doctors working in a whole-time capacity were only able to be responsible for a total of 143 discharges during 1938. Each doctor was then able to treat up to 14 patients at one time. The number of patients who can be adequately treated has now increased to about 16 per physician. This figure is very much lower than that accepted for E.M.S. Neurosis Centres, but it is necessary to bear in mind that our patients are carefully selected as being suitable for vigorous treatment ; there are no chronic cases and no mentally-retarded patients who simply require placement. The rate of our turnover during the period under review increased to such an extent that the number of discharges per physician per annum rose from under 30 to over 50. Immediate results, to judge from the tables, are quite as good as in previous years. An important factor in achieving this increased output has been the use of electric shock therapy in the depressive states. Other measures of physical treat¬ ment have also been of value, notably the use of continuous narcosis for certain anxiety neuroses, insulin and glucose for disorders associated with marked physical debility and asthenia, and intra¬ venous barbiturate narcosis to induce a state in which rapid psychological analysis is possible. Other factors also played an important part. Ease of placement in employment after illness was of great assistance, as was also the keenness of patients to get well as quickly as possible in order to contribute their share to the war effort. Finally, it must be admitted that the number of beds available in the hospital—-from January to September the figure was 34—could not be compared very accurately with the number of beds available at Swaylands in peacetine—64 in 1938. A system was adopted of boarding out quite a number of convalescent patients in the neighbourhood and these came to the hospital for treatment from time to time. The system worked well, local residents accepted them as paying guests in some cases, and in others they lived in lodgings or hotels. They were able to do a day’s work or follow some course of training whilst still under the wing of the hospital. Various sheltered employments were arranged for some of them, e.g., work in the local Citizens’ Advice Bureau or at Day Nurseries as voluntary helpers. Others were able to begin to earn a living. The success of this experiment augurs very well for the success of the type of convalescent home outlined in a section of this report. Unfortunately, in September, the Medical Staff was compulsorily reduced and the scheme had largely to be suspended. Since then not only has it been impossible to continue to treat what were in effect out-patients, but the number of in-patients has also had to be reduced slightly. Accordingly the figures for the whole year of 1942 do not reflect accurately the improved rate of turnover. In peacetime if it is possible to establish a suitable convalescent home our annual discharge rate shoidd