Frequency of Misdiagnosis

These men and women at the time of admission were mainly young or middle-aged; the mean age for men was 42 and for women 37. Yet during a follow-up period which averaged about nine years, 12 died, 14 became totally disabled and 16 partially disabled ; and only 43 (50%) remained independent. Only 19 of these patients were actually symptom-free at the time of follow-up.

    Four of the deaths were by suicide, but in two of them it is noteworthy that organic disease was missed while the patient was in the National Hospital. One of these was a man (38985) with weakness of the legs, thought to be hysterical because of a clear history of psychogenesis, who on a later readmission was rediagnosed as having an atypical myopathy. The other was a man (47531) admitted to the National Hospital at the age of 52 with unsteadiness of gait, pain in the legs, urgency of micturition, and impotence. There were no abnormal physical signs, and both the neurologist, who was the late Dr. Hamilton Paterson, and I agreed in a diagnosis of " hysteria." The patient was subsequently admitted to the Maudsley Hospital on two occasions, both times being diagnosed as suffering from disseminated sclerosis with hysterical elaboration.

    There were eight deaths from natural causes. In three of them (57756, 35530, 28227) death took place from vascular disease unrecognized at the time of admission. One of these was a man of 43 (28227) admitted to hospital after a year of illness with three attacks of right-sided weakness accompanied by vomiting and indistinct speech. During that time he had slowed down mentally, and had had difficulties with recent memory. In hospital there were variable right-sided signs; but the patient's breezy manner told against him, and it was decided he was suffering from "hysteria." He went home to attend a psychiatric clinic, and died 10 months later of gangrene of the caecum, caused by mesenteric artery thrombosis.

    There were three deaths from neoplasms (31797, 42556, 37769)-a glioma, a carcinoma of the kidney, and an angioma. The glioma was recognized at the time of the diagnosis, which was in fact that of "left temporal lobe glioma plus hysteria." In both the other cases the existence of the neoplasm was unsuspected. One of these patients was a woman of 37 (4672) who was in the National Hospital with complaints of severe headache and poor vision. She was diagnosed as suffering from "drug addiction and hysteria," and was transferred to the Maudsley Hospital. She took her discharge from there a fortnight later, and left under a diagnosis of "conversion hysteria." She died two years later of an angioma of the brain stem. One more misdiagnosis in this group is that of a woman of 31 (37769) admitted with pains in the back, unsteady gait, failing vision, headache, thirst, polyuria, and fits. Vision improved strikingly under persuasion, and her walking to some extent also. It was thought that her fits were organic but her disabilities largely hysterical. Her illness was a chronic one, and took her into a mental hospital, where she died five years later. The post-mortem diagnosis was chronic arachnoiditis, traumatic epilepsy, and terminal bronchopneumonia.