MENTAL DISEASE

Evening Star, Issue 19126, 18 December 1925, Page 1

MENTAL DISEASE

PROVISION OF MS AT

HOSPITAL

MEDICAL SUPERINTENDENTS STRONG PLEA EXPERT OPINION CITED IN SUPPORT. In support of his contention that special rooms should bo provided at the Dunedin Hospital for mental patients, Dr A. Falconer (medical .superintendent) submitted to tlie Hospital Loaid last- night a report on the subject. Dr Falconer staled; “Referring to previous corresponde-iiec in regard to the provision ot rooms at the Dunedin Hospital for mental patients awaiting medical examination, and the several phases ot mental medicine in winch a general hospital may be considered to have a responsible place, 1 beg to report having received a letter, dated November (>, 1925, ironi Ur C. Macho Campbell, director ol the Boston Psychopathic Hospital, and professor of psychiatrics, Harvard University, which gives a clear and concise account ol the principles underlying the treatment of mental disease in a general hospital, a psychopathic hospital, and a mental hospital. Dr Campbell writes : ‘Ju my opinion the ideal arrangement is when a hospital with any considerable claim to being complete makes arrangements for dealing with the various types of sick people who conic in it, and has definite departments for the different medical problems—medical, surgical, ophthalmologies.!, dermatological, etc. It is of very great advantage, when a hospital him all these departments in touch with each other, and the patients in one department have easily available the consultants in other departments. It is an excellent thing lor the resident staff, as the internees in the various services see the problems in the departments of each other, and help each other from their special angle; it is a good thing lor the visiting stall, as it does the. specialist a world ol good to he in contact with the, problems of his fellows, and to talk over his cases and get opinions Horn a different angle than his own.’’ EVIL TRADITION CONTINUED. “A. hospital may not claim to be complete—it may not have the- finances lo establish the necessary departments, or there may be already in existence special hospitals, and there, may be hesitation to duplicate the work which these special hospitals can do. A general hospital may not have a children’s department, as there may be a good children's hospital available fur the community. It may not have an obstretrical department -if there is a lyingin hospital; it may not have a department lor infections diseases, as the health authorities may already have instituted a special hospital, and it is as well for such patients lo be at some distance from a, general hospital; it may not have a psychopathic department, as there may be a p.-ychopaihic hospital in the vicinity. i.Tuclku' ".o’"

s-ido rations, therelore, may .stand in the way of any special department in a general hospital, but there is no good medical ground why a patient with a mental disorder should not go to a general hospital, ho examined in the psychiatric om-patient department, and he admitted to Die psychiai ric ward unless his condition is such that it is likely to he disturbing to other patients. Thus, in Du- new University Hospital of t ho_ University of Wisconsin the, psychiatric patients have their own wards, which arc, I believe, on the second lloor ol the building. .For extremely disturbed patients and lor patients who will require protracted care, with opportunities lor varied outdoor activities. an institution at sumo distance from the genera! hospital may well be utilised, To have all mental patients sent, to a hospital at some distance irom the general hospital is to continue an evil tradition, to maintain an artificial division between mental disorders and other tonus ol sickness irom which division ol medieval origin, modern medical thought is trying to (emancipate itself. Tins artificuil separation means that patients do not have quite such good consultation facilities as the patients in a general hospital; it moans that both they themselves and lheir relatives are given the feeling that there is a special stigma attached to mental, disorders; it means that patients with mild and incipient disorders arc not brought (or treatment, but that patients usually come under observation at a more advanced stage or their disorder. The separation also docs harm to Hie general hospital, where the nursing and medical personnel do not learn to become familiar with the problems presenled by those disorders, with ike result that patients are unnccesariiy and somewhat abruptly Iranslorred irom general hospitals be-

cause ol the panicky reaction of the superintendent, and nurses io the fact that a patient, shows mental symptoms. ADVANTAGES OF EARLY TREAT-

MKNT. “Yesterday’s mail brought the October ol number ol liie ‘ British Medical Journal,’ containing an address to the I British Medical Association by Sir Hum- i phrey liolleston, Bart., regius professor ! ol physics in l ho University of Cam- i bridge, and president of the lloval Col- 1 lege of Physicians of Loudon, whose re- | murks on the same subject arc as fol- ; low : —‘ The early treatment in psychi- ; atric clinics attached to general hospi- I luls has many advantages. The educa- j tion of the public to" the recognition! that mental disorder is intimately cou- I nected with bodily disease, and not a 1 distinct and mysterious condition, such ! as possession by devils; from the pa- | tient’s point oi view the avoidance of the stigma attaching in die public mind j to residence in a mental hospital, and ; especially to certification; the euro of i acute cases without certification; the , great facilities of complete pathological, | surgical, and biochemical investigation | of all problems presented by the indi- j vidual_ patients, such as focal infections ' and disorders of metabolism; the advantage to the progress of medicine as a whole, and particularly with regard to the prevention of mental disease, for which object association with pediatric clinics and social service is of special value, by bringing psychiatrists and general physicians into dose and constant touch. Lastly, ami not least, the treatment of menial cases in general hospitals will provide a much more sat- , i.sl'actory means of educating students. ; not only in mental disorders, but also in the understanding of the psychological aspects of everyday practice. in this respect the Anglo-Saxon race has seriously lagged behind the Continental countries. Of course, discretion must be exercised as to the class of ease admitted, and after some two weeks or so it becomes clear whether improve- ; meat from such treatment is probable, or whether the ca:»> should he, transferred to a mental hospital. It is an obvious advantage to have the wards for mental patients in an annexe, and j

not actually in the same building and under the same roof as the general wards. They should be surrounded by gardens, so as to make provision for open-air treatment, and connected by a covered corridor with the main hospital. As in tlie Henry Phipps Psychiatric Clinic, attached in this manner to the Johns Hopkins Hospital, and under the directorship of Professor Adolf Meyer, the wards should be generally Iso arranged as to allow classification and separation of incompatible types of patients.’ ” A WORLD TREND. Dr Falconer proceeded: “There is now a world trend in the direction of providing beds for the treatment of mental disease in the immediate vicinity of a medical school hospital. This movement began first in Germany and Holland, and then spread to America, where I found all medical schools of importance have, or are making, such .provision; and this is now being advocated by the head of the medical profession in Great Britain. In connection with the mental hygiene movement it is considered that an essential factor in raising Iho mental health of the nation is to give the medical profession at, largo a more adequate training in the laws underlying the normal and abnormal phenomena of mind, in order that mental disorder might ho more easily recognised and treated in everyday practice, and particularly in early childhood —the starting-point to whicli the whole mental hygiene movement is .rapidly getting back.” I The paper was referred to the Mospita.l Committee for report, also to the honorary medical staff.

Dr Nowlands said that the Dr Campbell mentioned was a fellow-student ot Ids at Edinburgh, and was a high authority on mental diseases.