52 The arc de siècle- an examination of attitudes to hysteria in twentieth-century medicine, through the eyes of norman dott and his pupils

Abstract

Objectives Hysteria was once a topic of research for leading neurologists; however this interest faded over the course of the twentieth century. Little has been written about the presentation and management of functional disorders in the post Charcot period, and some have gone so far as to suggest that the patients ‘disappeared’. This project aims to shed light on how Edinburgh neurologists interacted with and managed this cohort during the period from 1930–1970. Methods The Lothian Health Services Archive holds 28 000 case files written by Norman Dott CBE, the first chair of Neurosurgery in Scotland, and the department he built around him, with cases spanning the years between 1930–1970. Cases pertaining to hysteria or hypochondriasis were analysed, recording demographics, symptoms, diagnostic and management processes, and evidence for any attitude or opinion exhibited by the physicians. Retired neurologists from Edinburgh and elsewhere also provided oral histories on how they interacted with this group. Results 209 cases were analysed, of which 178 were relevant, and 100 of which included a diagnosis of hysteria. Of these 100, it is of note that 42 were referred to psychiatry. The majority of the remaining patients were given advice or reassurance (48). Conclusions Hysteria in Dott’s department was both a diagnosis based on positive findings of inconsistency, and a personality trait. Although there is evidence of a negative sentiment towards functional patients, there is equal evidence of sympathetic responses, and it is likely that neurologists of the mid twentieth century were often less cautious and more candid in their remarks. Whilst the management of hysteria was not seen as a neurologist’s job, patients were regularly referred to psychiatry, signifying an acceptance of the legitimacy of the condition. Abstract 51 Table 1