Mental diseases: a public health problem. James Vance May
Читать онлайн книгу.
may be prevented and where recoveries may be reasonably expected if the patient is given early treatment. This should be the principal object of the state hospital of the future. "The concept of its beneficent ministration to the mind diseased as any physical part of the human body," as Copp[30] has pointed out, "is just appearing in shadowy outline in public consciousness. The effacement of this barrier to early treatment is slowly but steadily progressing. Its pace will be hastened if every mental hospital continues to become, as speedily as may be, the real hospital in the broadest sense, with emphasis laid upon its treatment function and subordination of its control relation within the reasonable limit of caution. The mental hospital and the general hospital are essentially alike. Mental factors predominate in the former, but are potent influences in the latter. The difference is one of degree only. All the imperative requirements of the one must be met by the other. They are supplementary agencies in curing and alleviating disease and must be, eventually, viewed in the same light and administered in the same spirit on even planes of humaneness and efficiency."
One thing should be made clear at the outset. A comprehensive and progressive program for further development means an expenditure of money. If the state hospitals are to fulfill their obligations to the community which they serve they must have more physicians. Provisions must be made for directors of clinical psychiatry, pathologists, internists, surgeons, dentists, and specialists of various kinds. Experts in hydrotherapy, massage and electrical treatments are necessary, as well as dietitians, industrial instructors, occupational teachers, specialists in reeducational work, psychologists, social workers, etc. Furthermore, they must be provided in sufficient numbers if anything is to be accomplished. As a matter of fact, no very great outlay of funds would be required in making a tremendous increase in efficiency. Although the institutional expenditures have increased enormously of late years, largely as a result of war conditions, increased costs, higher wages, etc., the amount actually invested in this humanitarian movement by the various states is not commensurate in any way with the results which are to be obtained. If we leave out of consideration everything except the saving in dollars and cents to be effected by methods which will in many instances render a protracted hospital residence unnecessary, the outlay involved would be well warranted. It should be brought to the attention of the public that very few states are expending as much as one dollar per day for the maintenance of the individual patient. Modern hospital treatment of the highest type, under these circumstances, is manifestly impossible. The time has come when we should no longer be satisfied with the purely custodial care of mental cases.
CHAPTER V
THE HOSPITAL TREATMENT OF MENTAL DISEASES
The responsibility of the hospital for the future of the patient begins with his arrival at the institution and the ultimate outcome of the case often depends entirely upon the developments of the first few weeks of his residence in the wards. A complete understanding of the patient's mental condition, the prospects of an ultimate recovery and the line of treatment to be followed can only be determined by a thorough and accurate examination on admission. This constitutes the basis for all further procedure. If satisfactory results are to be obtained this task should be delegated to a medical officer who has had an extended psychiatric experience. For purposes of completeness, as well as uniformity, a definite plan should be followed. The form used in writing the initial history and in recording the results of the routine mental and physical examinations at the Boston State Hospital are described in full in the "Medical Staff Manual" which is furnished to all assistant physicians entering the service. This has been found to be of great assistance in the training of new men along proper lines and insures a uniformity of hospital records which is indispensable. In a general way the form of examination employed by Meyer and Kirby [31] for some years has been followed. As this scheme is fairly representative of the method of procedure used by hospitals for mental diseases throughout the country it has been thought worth while to reproduce it in full.
HISTORY
Name of Physician: Date:
Name of Informant, Address, Relation to Patient:
It is often desirable to make a note on the intelligence and apparent reliability of the informant.
Residence and Citizenship of Patient:
Birthplace? Date of birth? Time in Massachusetts? If foreign born, date of arrival in U. S.? Naturalized or alien?
Family History:
It is not sufficient to ask simply the general question: Has any member of the family been insane or nervous? A great many persons will answer in the negative, whereas a detailed inquiry will often bring out a number of instances of nervous or mental troubles.
Specific inquiry must be made concerning the persons of the direct ancestral lines as follows:
(a) Paternal grandparents—nervous or mental disease?
(b) Maternal grandparents—nervous or mental disease?
(c) Father: Age, nervous or mental disease, alcoholism? If dead, age at death and cause of death?
(d) Mother: Age, nervous or mental disease, alcoholism? If dead, age at death and cause of death?
(e) Number of children in family (brothers and sisters of patient). Nervous or mental trouble in any of these besides patient? Psychopathic personality, alcoholism, criminality, etc.?
(f) Collateral branches: mention any known cases of insanity or nervous diseases in uncles, aunts or cousins.
PERSONAL HISTORY OF PATIENT
1. Early Development:
Birthplace and age, unusual incidents attending birth, retardation in talking or walking, infantile convulsions, night terrors, fits of temper, etc.—Severe illness or infectious diseases in infancy or childhood—Sequella? Frights, shocks or injuries?
2. Education, Intellectual and Moral Development:
Educational opportunities, time spent in school, interest in studies, progress, marks, behavior, truancy, etc.?
As an adult, regarded as bright, intelligent or dullminded? Well informed or ignorant? Reading, memory, judgment?
Moral responsibility, reliability, religious interests? Church affiliations?
Criminal traits, tramp life, police record?
3. Sexual Life:
Precocious interests in childhood, masturbation, abnormal practices, assaults or seduction?
Love affairs and disappointments? Age at marriage or reasons for single life. Moderate or excessive sexual desires, irregularities or prostitution.
Miscarriages, number of children, date of birth of youngest? If barren, what explanation; what effect on patient?
Frigidity, loss of power, refusal of partner, infidelity, measures to prevent conception. Treatment of partner, abuse, separation, divorce.
Perversions, abnormal methods of gratification with same or opposite sex.
In women, unusual symptoms at menstrual periods; age at menopause, nervous symptoms accompanying climacterium?
4. Diseases and Injuries:
Any previous nervous affection or symptoms, such as headaches, nervous prostration, chorea, epilepsy, hysterical attacks, etc.?
Mention severe infections diseases and sequella, if any. Inquire concerning tuberculosis, rheumatism, heart disease, nephritis, etc.
Venereal disease, syphilis and gonorrhea, full account, if possible, of how acquired, age, treatment and after affects.
Severe injuries, particularly head traumata, should be described as regards their immediate and subsequent effects.
5. Occupation:
Kinds of work undertaken, ambition, efficiency, wages, etc.