Sunday, 13 October 2013

ECT and Neurosurgery


From the Visitors' Reports 1914 - 1934
April 21st 1922

There is a large number of mental deficients in the institution. These should be removed into Mental Deficiency Homes. Our institution is a Mental Hospital and not established for incurable cases. The act of 1913 should be brought into operation and the attention of the Minister of Health directed to the conditions under which our institution suffers.
The war interfered with the provisions of the Act of 1913 but as we are now returning to normal times we recommend this matter should be again taken up by the Committee.
Addendum.....'Considering some of the distressing cases and pitiable creatures I saw today I am more convinced than ever that the time has now arrived for the county to take into consideration the question of sterilization. There is no reason why our Committee should not take the initiative. In my opinion the present system is a continuation of the policy of "commencing at the wrong end".'
June 26th 1923
I am sorry to find that the hospital is still without the services of a visiting dentist. It is obvious that many patients require skilled attention in this respect and it is possible that some would benefit both mentally and physically from a thorough overhaul. Moreover, the high incidence and mortality from Pneumonia might possibly be reduced materially by the prevention of oral sepsis.
In 1923 X-Ray equipment was installed in a room near the laundry and a Dental surgeon, Mr, Charles Hubbarb, began weekly visits in 1924.

September 26th 1923

The site of the new X- Ray and photographic room so excellently situated for use leads me to hope that the old plunge bathroom will not long be allowed to remain useless, but that it will be converted into " Operating Theatre" for which at a so small cost it could be so easily adapted .

January 4th 1929

I talked to several patients from Angelsey, who were glad to see me and were loud in their praise for all that had been done for them at Christmas and the New Year. I brought with me a gentleman from Angelsey who had never been here before, and after he had been round with me he expressed himself as being astonished with what he had seen and with all that was being done here for the relief of insanity.


Department Of Electro-Encephalography (E.E.G.)

ECT AND NEUROSURGERY

The Mental Treatments Act was passed in 1930 and a significant feature was that patients could now enter hospital voluntarily, therefore the Asylum became a Hospital. As a result of this a major change was the establishment of an Out-Patients Clinic in Bangor, Wrexham and Dolgellau in 1935.

Various treatments were introduced during this period, but many were short lived. However, in the 1930s, an investigation was carried out by Professor Ugo Cerletti at Rome into the application of electricity to give a shock to the brain directly through the skull. A Jewish doctor, fled Germany for Italy in 1933, where he witnessed early experiments with ECT (electroconvulsive therapy, or electric shock therapy). A mild electric current is applied to the brain to produce a seizure similar to an epileptic convulsion
Later, he helped to introduce ECT to France. He then moved to England and gradually worked to promote the use of ECT with the British, including a paper in The Lancet in 1939. ECT treatment was introduced at the Maudsley Hospital in 1940, and was rapidly taken up throughout Britain.

It was adopted in the Denbigh hospital in 1941, when the committee of visitors authorized the purchase of an Ediswan electric convulsion therapy apparatus. The therapeutic principle was the same as that of utilizing shock inducing drugs to produce a bodily convulsion, which appeared to have a healing effect upon the mind.

The medical superintendent’s explanation of the benefits over the ones induced by the use of the drug - cardiazol: ‘First as there is immediate loss of consciousness, it is not unpleasant. Secondly, it is milder so that mishaps are less liable to occur, and its use can be extended to older patients. Thirdly, it is more convenient.’
The change it brought to therapeutic practice was so significant that within a year it was reported by Dr. Roberts that, ‘As a result of these relative advantages, treatment by cardiazol has been to all intents and purposes completely suspended.’

Although ECT was initially advocated for the treatment of schizophrenia, within a year Denbigh’s medical superintendent was reporting that, ‘its chief field of usefulness is amongst the Depressions.’


                                                                        ECT Equipment


                                                                        ECT Treatment

From the Medical Annual 1941: Mental Conditions

Since the E.E.G. is accepted as being in some way connected with the cerebral cortex and its activity, it might be supposed that severe disorders of the mind would be reflected in the brain potentials.
It can be imagined that there are many pitfalls in recording the minute brain potentials through the skull. Not least of these is the presence of several disturbing electrical artefacts, particularly those associated with movements of the eyes.

From the point of view of the patient, the method has great advantages. It is safe and brief and need be neither alarming nor expensive. Its only drawback at present is that considerable skill and experience are needed to build and maintain the equipment and still more to interpret the records. Several points in the construction of the amplifiers and recorders are unfamiliar even to expert electrical engineers, and the records begin to acquire meaning only when several hundred have been attentively studied and analysed. Interpretation is probably no more difficult than in radiology, but of course the appearances are harder to relate to known anatomical or physiological facts.

If the structure seems a little lofty for its foundations, it should be considered as a scaffold giving access to the more remote parts of old established knowledge.

1942 Newspaper Report of Electric Shock Treatment

‘New Apparatus at Mental Hospital
Successful Results at Denbigh'

A valuable addition to the modern methods of treatment employed at the North Wales Counties Mental Hospital in the form of apparatus for the treatment of mental illness by electric shock, has had most satisfactory results during the three months it has been in operation, it was reported at last Monday's meeting of the Committee of Visitors. Seven of the nine patients discharged as recovered that day had received the treatment, it was stated, while another patient, who had been transferred to the hospital after spending four years in another institution, had made a complete recovery after three months of the new treatment.
It was used in cases of schizophrenia, depression and excitement, and had largely replaced Cardiazol, over which its chief advantage was its complete lack of unpleasantness to the patient and its increased safety.
"With this remedy in our hands,” went on the Chairman, "It becomes increasingly important that we should receive our patients early, as much mental suffering can therefore be saved. With each month that passes without treatment, the patient's chances of recovery diminish."

Dr. John Jones, Chairman of the House Committee, said he happened to know that the new treatment by electric shock had 'worked wonders' in the case of a patient from the area he represented. It was pleasing to note that the death rate at the institution was very low, while the recovery rate was one of the highest in institutions of the kind in the whole Kingdom - a very gratifying state of affairs.

It was felt that in North Wales insufficient use was made of the provisions of the Mental Treatment Act, which allowed of the admission of patients on a voluntary basis. Patients so admitted could leave the hospital of their own accord on giving notice in writing.

In all spheres, increased liberty was being granted to patients, went on the Chairman, and the parole system, hitherto confined to men, had been extended to include women, many of whom could now be seen doing their shopping in Denbigh. Voluntary patients could, therefore, be assured that if their condition allowed it, they would be permitted considerable liberty to come and go outside the hospital estate.



Three Kids Gripped By Evil By Polly Mullaney     
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