Follow-up Study at the National Hospital

Having carried out a follow-up survey of patients diagnosed as suffering from " hysteria " at the Bethlem-Maudsley Hospitals, I thought it would be interesting to do a comparable job at the National Hospital. Historically "hysteria" is more a neurological than a psychiatric diagnosis; and it is neurologists who have developed the clinical acumen and the subtleties of observation by which the condition may be distinguished, if it is possible to distinguish it at all. In 1962 Mr. Eric Glithero and I began the survey, following up patients who had been in Queen Square in 1951, 1953, and 1955 and who had received a diagnosis of "hysteria." There were 112 of these patients; but in five cases no trace could be found of the medical notes, and a further eight cases were excluded at the request of the consultant under whose care the patient had been, or of his family doctor. I would like to say here how very grateful I am to my colleagues for permission to approach their patients in this way. We were left with the records of 99 patients. All effort to trace the patient failed in six cases, and a further eight patients when contacted refused co-operation. We were finally able to get adequate follow-up information, as far as possible by personal contact, about 85 patients-32 men and 53 women. One-quarter of the men and one-third of the women had been diagnosed as "hysterical " by one or other of the hospital's psychiatrists, including myself. The most important and the most surprising findings which resulted from the inquiry were the gravity of the after-history and the frequency of misdiagnoses.