'As syllable from sound': the sonic dimensions of confinement at the State Hospital for the Insane at Worcester, Massachusetts.

As the first state hospital in the USA, the Worcester State Hospital for the Insane at Worcester, Massachusetts (est. 1833), set a precedent for asylum design and administration that would be replicated across the country. Because the senses were believed to provide a direct conduit into a person's mental state, the intended therapeutic force of the Worcester State Hospital resided in its particular command over sensory experience. In this paper, I examine how aurality was used as an instrument in the moral architecture of the asylum; how the sonic design of the asylum collided with the day-to-day logistics of institutional management; and the way that patients experienced and engaged with the resultant patterns of sound and silence.

Inpatients at the St. John's General Hospital: Morbidity in Late 19th-Century Newfoundland and Labrador.

This research analyzes the role of the St. John's General Hospital in late nineteenth-century Newfoundland and Labrador using extant admission and discharge records from 17 May 1886 to 30 December 1899. Most individuals were discharged from the hospital as "cured" or "convalescent." Trauma, musculoskeletal issues, and respiratory diseases were the most common reasons for admission, with males significantly more likely to seek care for trauma, sexually transmitted infections, and kidney/bladder issues. Female inpatients were significantly more likely to be admitted for tumours/cancers, anemia, digestive issues, and issues concerning the female anatomy. Notable were the short hospital stays for tuberculosis, indicating the General played an important role before the founding of the St. John's Sanatorium. A snapshot of late nineteenth-century morbidity reveals the complex risks facing citizens of St. John's and beyond who sought care at the General, which played a key role in the rapidly modernizing medical ecosystem.

Through a glass darkly: patients of the Illinois State Hospital for the Insane at Jacksonville, USA (1854-80).

The State Hospital for the Insane at Jacksonville, Morgan County, Illinois, was the first public hospital of its kind to be established in the state and among the earliest to be built on the 'Kirkbride Plan'. It opened for patients in 1851. We describe the background to the establishment of the hospital and, so far as is possible from publicly available sources, its catchment area, the nature of the patients held there up to 1880, its mechanisms of discharge, and supposed causes of death. We end with a plea that after over 150 years, the release of hospital casebooks and similar records in digital form would be of considerable benefit to historians of psychology, scientific biographers, genealogists and demographers.

[Chance meeting of psychiatry and art on the "dissecting table"]. / Pszichiátria és müvészet találkozása a boncasztaton.

This paper shows one of many aspects of the history of the Hungarian psychiatry between the two world wars. The data were collected from the "Hungarian Museum of Mind" opened for the public in 1931. It focuses on the collecting policy and the research topics of Hungarian psychiatrists working in the asylums in those days. In 2007 Lipotmezo (the Hungarian Psychiatric and Neurological Institution the biggest Hungarian asylum since its foundations in 1868) was closed. Its art collection was rescued by the Hungarian Academy of Science. From 2007 this collection has been named The Psychiatric Art Collection of the HAS, maintained by The Research Centre for the Humanities of the Hungarian Academy of Science. The artistic objects and documents are properly stored and available for research. Two art historians are in charge of curating the exhibitions and leading the research on the psychiatric art in the context of history, psychiatric history and contemporary culture. This work follows the well established practice of the eighties and nineties when the art historian Edit Plesznivy expert in this subject listed the pieces of this historical collection, and through the context of outsider art and art therapy she channeled it into the field of art institutions. Leaving the hospital environment and having been introduced to the academic world the research is looking toward the collection has been changed and new perspectives have been opened. Beside the art works of the patients living as inmates in mental hospitals, the collecting work and therapeutic practices of the mental physicians became a significant research topic also. Arpad Selig as an assistant physician at the Mental and Neurological Clinic in Lipotmezo started to collect the patients' works of art in the first decade of twentieth century. During the 1920s he was appointed the director of Angyalfold Asylum found in 1883. Selig died in 1929 and the Museum of Mind named after its enthusiastic founder Selig was registered in the official list of museums in 1932. In the 1930s Istvan Zsako the physician director of Angyalfold Asylum took care of the collection. He enriched it with further historical documents on the institution, bibliographies, press cuts, tableaux and photographic albums referring to the institution and the research practiceses of the physicians. After Zsako was appointed the director of Lipotmezo the collections of Lipotmezo and Angyalfold were joined. The collection suffered during the World War II and this period is can be viewed as a caesura in the practice of collecting. Later, from the late fifties, the physician Fekete Janos, head of the nurse training in Lipotmezo was in charge of the collection. He focused on sorting and installation of the remnants and also collected new works of the inpatients. During the seventies the psychotherapy was inaugurated and in the eighties the art therapy exercises began. However, through the reconstruction of the therapeutical and collecting practices show that these evolving art therapy practices partly rooted in the work of psychiatric treatment in the twenties and thirties. Psychiatrists, who lived in the asylums too, supported the so called "noble entertainments" - including artistic drawing, painting, reading and playing musical instruments - and as a part of the daily routines of these mental institutions they formed a locally particular modus operandi of therapy. The inmates of the asylums, the physicians and patients cooperated to enrich the collection which was a venue to represent the life of the institution and to demonstrate the research of the physicians. Despite of the significant differences between the pre- and postwar periods concerning the sociocultural and political structures there is a well defined connection between "curing and curating".

[The daily life of patients at the Hôtel-Dieu in Lyon in the nineteenth century]. / La vie quotidienne des patients à l'hôtel-Dieu de Lyon au XIXème siècle.

In 1802 the Hôtel-Dieu in Lyons was incorporated in the so-called Hospices Civils de Lyon. This allowed the expansion and renovation of buildings, as well as the improvement of the conditions of hygiene and comfort of the patients. This hospital was devoted only to the most severely ill or injured adults. 1100 patients were treated by seven doctors, a main surgeon and his deputy, residents and sisters. Broadly speaking the evolution of surgery can be divided into two periods: that of before anesthesia and septic surgery and that of antiseptic and aseptic surgery. We have to mention Gensoul and the resection of the maxillary before anesthesia, Bonnet and Ollier who were devoted to osteo-articular surgery (Ollier's disease), Poncet who built the first aseptic theater, Jaboulay and the resident Carrel who were transplantation's pioneers, Bouveret (paroxysmal tachycardia and Bouveret syndrome), Destot who did the first medical use of X-rays in 1895.

[Research and treatment of war neuroses at the Clinic for Nervous and Mental Diseases at the Jagiellonian University in Krakow before World War II in the context of psychiatry in Europe]. / Badania i leczenie nerwic wojennych w Klinice Neurologiczno-Psychiatrycznej Uniwersytetu Jagiellonskiego w Krakowie przed II wojna swiatowa na tle psychiatrii europejskiej.

The aim of this article is to offer an overview of the research into diagnosis and treatment of war neuroses at the Clinic for Nervous and Mental Diseases at the Jagiellonian University in Krakow before the outbreak of World War II. It also includes a profile of the work of Prof. Jan Piltz, the then director of the Clinic, and his major scientific achievements. The publications cited in the article date in the main from the period of World War I, and comprise clinical analyses of the consequences of stress suffered at the front as well as a description of the ways in which they were treated. These are presented alongside other major findings related to war neuroses being made in Europe at the time. The article draws attention to the very modern thinking on treatment of war neuroses, far ahead of the average standards of the day, evinced by Prof. Piltz and his team. The most important innovative elements of their treatment of these conditions were the fact that they perceived the cause of the neurosis to lie in previous personality disorders in the patients, their recommendation of psychotherapy as the main method of treatment, and their emphasis on the need for further rehabilitation following the completion of the course of hospital treatment. They also paid significant attention to the importance of drawing up individual therapy plans for each patient.

[A campaign against the law of 1838 governing the status of the mentally ill. Hector Malot, Léopold Turck, Théophile Huc -- a writer, a doctor, a lawyer]. / Une campagne contre la loi de 1838 régissant le statut des aliénés. Hector Malot, Léopold Turck, Théophile Huc, un romancier, un médecin, un juriste.

When Napoleon the 3d's government turned to its liberal phase, dissatisfactions felt free to become visible, among which the problems engendered by the law of 1838 about the situation of mental patients; during the 60s, a novelist, Hector Malot; a doctor, Léopold Turck; a jurist, Théophile Huc, tried to amend it.

Inventing the medical portrait: photography at the 'Benevolent Asylum' of Holloway, c. 1885-1889.

In 1885, Holloway Sanatorium, an asylum for the 'mentally afflicted of the middle classes' opened in Egham, Surrey, 20 miles outside London. Until 1910, photographs of about a third of the patients--both those 'Certified Lunatic by Inquisition' and the 'Voluntary Boarders' who admitted themselves--were pasted into the asylum's case books. This paper analyses the photographs that were included in the very first of these, when there was a great uncertainty as to how to represent these patients, or whether to represent them at all. The photographs are unlike any other institutional images of the period, and raise critical questions about the imagined incompatibility between documentary photography and personal agency.

Genetic and phenotypic diversity of methicillin-resistant Staphylococcus aureus among Japanese inpatients in the early 1980s.

To trace the linkage between Japanese healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) strains in the early 1980s and the 2000s onward, we performed molecular characterizations using mainly whole-genome sequencing. Among the 194 S. aureus strains isolated, 20 mecA-positive MRSA (10.3%), 8 mecA-negative MRSA (4.1%) and 3 mecA-positive methicillin-susceptible S. aureus (MSSA) (1.5%) strains were identified. The most frequent sequence type (ST) was ST30 (n = 11), followed by ST5 (n = 8), ST81 (n = 4), and ST247 (n = 3). Rates of staphylococcal cassette chromosome mec (SCCmec) types I, II, and IV composed 65.2%, 13.0%, and 17.4% of isolates, respectively. Notably, 73.3% of SCCmec type I strains were susceptible to imipenem unlike SCCmec type II strains (0%). ST30-SCCmec I (n = 7) and ST5-SCCmec I (n = 5) predominated, whereas only two strains exhibited imipenem-resistance and were tst-positive ST5-SCCmec II, which is the current Japanese HA-MRSA genotype. All ST30 strains shared the common ancestor strain 55/2053, which caused the global pandemic of Panton-Valentine leukocidin-positive MSSA in Europe and the United States in the 1950s. Conspicuously more heterogeneous, the population of HA-MRSA clones observed in the 1980s, including the ST30-SCCmec I clone, has shifted to the current homogeneous population of imipenem-resistant ST5-SCCmec II clones, probably due to the introduction of new antimicrobials.

Hospital bodies: the genesis of Italian National Health Service.

Hospital public bodies were instituted in Italy in 1968. Their creation represents a fundamental step forward in the evolution of the national healthcare system and has allowed improvements in social equity in hospitals. The lack of independent funding beyond the insurance-type healthcare system existing at the time, hindered its success. The hospital body has however left a trace in the modern national healthcare system with the introduction of the hospital corporation.

[Mortality of psychiatric inpatients in France during World War II: a demographic study]. / La mortalité des malades mentaux hospitalisés en France pendant la deuxième guerre mondiale : étude démographique.

INTRODUCTION: In France, World War II lasted from 1939 to 1945. Under-nourishment was a national problem, and was more severe in mental hospitals. The mortality of psychiatric inpatients in France during World War II has long been a controversial issue in the country. LITERATURE FINDINGS: Some authors wrote of the "soft extermination" of 40 000 mental patients, although this has been proven false. The historical study published in 2007 by Isabelle von Bueltzingsloewen provides in-depth description and analysis of starvation due to food restrictions in French mental hospitals. Although the French official statistic services published detailed data, no demographic study has been published so far. Such studies have been conducted in Norway and in Finland. "The influence of a period of under-nourishment upon mortality in mental hospitals can rarely be seen with a clarity equal to that in this work. The strict rationing was the same for everybody, but, extra muros, there was private initiative and ingenuity to help in alleviating the distress. Naturally, patients in institution had no ability to act on their own. The immense increase during the period of war from 1941 to 1945 appeared both as an increase in the exact death-risk and as an increase in the disproportion with normal mortality. The men reacted more strongly than women; which is readily comprehensible on physiological grounds, as the rations were virtually the same for all." Excess mortality continued after the war. Even though under-nourishment had ceased, death rates from tuberculosis remained high the following year. Both papers state that the poor hygiene and bad living conditions existing in mental hospitals before the war worsened the effects of food restrictions. DEMOGRAPHIC DATA: French data were published by the General Statistics of France (SGF) that became the National Institute of Statistics and Economic Studies (Insee) in 1946. A series of datasets were published each year according to sex, diagnosis and type of psychiatric institution. In 1943, the outdated diagnostic classification was replaced by a more modern one, with reference to ICD. The same year, the age groups also changed (instead of 35-44, it became 30-39). Publication of data by type of institution was discontinued in 1943; from 1945 to 1948, the only available data concerned patients in hospital on 31st December, by age, sex and diagnosis. General population data were published by the National Institute of Demographic Studies (INED). The data referring to civilian population during the war are provided by the Human Mortality Database. This study covers number of people in hospital, mortality rates by sex, age, diagnosis and type of institution, and standardised mortality ratios. These refer to the civilian population which is more relevant since mental patients would not have been allowed to join the armed forces, even if they had not been in hospital. Finally, mortality trends in mental hospitals are compared with those in "hospices for old, disabled or incurable people", in order to ascertain whether all vulnerable populations in institutions suffered to the same extent. The results show that the number of inpatients in 1945 was about half the total recorded in 1940, due to fewer admissions and to a large increase in the number of deaths. However, the number of discharges increased in 1940, even though the number of admissions had begun to slow down: many patients were sent to places offering better food and hygiene. The number of deaths began to rise as from 1939. Mortality rates were high in 1940 and especially in 1941, when almost one man in three and more than one woman in five died. Global rates did not change in 1942. In December that year, a government order stated that mental patients should receive more food. Mortality rates went down in 1943 and 1944, but rates did not return to the prewar values until 1946. In 1939, mortality rates are high but only among patients of 70 years of age or more. In 1940, they were highest above 55; in 1941, rates between ages 15 and 54 were double those of the preceding year. Thus, even though excess mortality affected all ages, its strongest effects were felt from the older patients to the younger ones from 1939 to 1941. Trends according to diagnosis are difficult to interpret because of the change of classification in 1943. The patients suffered greatest hardship in public hospitals, which had no budget of their own and were run by the departments and lowest in private hospitals contributing to the public service, most of which were congregational and received religious funding. In 1941, standardised mortality ratios were more than three times higher than they were before the war. CONCLUSION: Comparison with people living in hospices shows that during the war mortality rates were 50% higher in these institutions, while they almost tripled in mental hospitals. The number of people who died of starvation and infectious diseases in mental hospitals from 1939 to 1945 can be estimated at about 45,500. However, mental patients were made specially vulnerable by circumstances that existed before the war in mental hospitals, in terms of food, hygiene and staffing, as suggested by an official document quoted in the paper.

Development of psychotherapy as a method of mental disorders treatment at the Jagiellonian University and in Kraków before World War I.

This article presents the origins of Polish psychotherapy with a special focus on psychotherapy development in Krakow and at the Jagiellonian University. The history of Krakow psychotherapy starts with the foundation of the Psychiatry and Neuropathology Clinic of the Jagiellonian University in 1905. Doctors working in the Department of psychotherapy developed their skills through contacts with the Zurich University Psychiatric Clinic Burgholzli. At the same time psychotherapy, and psychoanalysis in particular, were raising more and more interest in Poland. The most dynamic development of psychoanalysis reflected in the number of scientific publications, occurs in the years leading to the outbreak of War World I. This article presents brief portraits of the first Polish psychoanalysts ( Ludwik Jekels, Herman Nunberg, Ludwika Karpinska, Stefan Borowiecki, Jan Nelken, Kraol de Beaurain). Many of them worked in Psychiatry and Neuropathology Clinic of the Jagiellonian University. Their scientific achievements and contribution to the development of the international psychoanalytic movement are described, as well as relationships with leading psychoanalysts of this period (Freud, Jung). With the outbreak of World War I the research on and treatment of war neurosis was initiated in the Psychiatry and Neuropathology Clinic. Professor Piltz, the director of the clinic, together with his assistants (Borowiecki, de Beuarain, Artwinski) devised a unique in European psychiatry and highly efficient method of post-traumatic disorders treatment, in which psychotherapy was of key importance.

[Fifty years of psychosomatic inpatient treatment]. / Fünfzig Jahre psychosomatische Krankenhausbehandlung.

This article is a review of the historical development of psychosomatic inpatient treatment form its first roots to present. The major focus of the article is a description of the present situation of psychosomatic hospitals in Germany, the kind of inpatient treatment in psychosomatic medicine, current concepts, data on lengths of stay, comorbidity, and the spectrum of diagnoses concerning psychosomatic inpatients. Furthermore, data on effectiveness of inpatient treatment and a description of a typical patient sample in psychosomatic inpatient treatment are outlined.

A biosketch of William Richard Gowers with a new review of his inpatient case history notes.

William Richard Gowers (1845-1915) spent his career working at the National Hospital for the Relief and Cure for the Paralyzed and Epileptic at Queen Square, in London, United Kingdom, and at the nearby University College Hospital. His "Manual of the Diseases of the Nervous System" and many published lectures were based almost entirely on his own clinical observations meticulously recorded in shorthand. In this paper, we have focused on an analysis of his inpatient case records from 1878 to 1911 preserved in the archives at the National Hospital for Neurology and Neurosurgery, Queen Square. We reviewed all 42 volumes and analyzed 2,478 patients. Between 1897 and 1909, a mean of 129.7 cases per year were admitted to the hospital under Gowers' care. We grouped the diagnoses in 12 different categories. Epilepsy (16.5%), followed by spinal cord diseases (10.3%), cerebrovascular diseases (9.5%), and functional disorders (7.9%) were the most common diagnoses.

Narrative survival: personal and institutional accounts of asylum confinement.

This essay has been conceptually eclectic in that we have integrated concepts from genre theory and discourse analysis. In our interpretation of Merivale and Marshall's narratives, we have also drawn upon Frye's Anatomy of criticism, a canonical text in literary genre theory. Such an eclectic approach seems warranted by both the contextual and textual features of Merivale's and Marshall's narratives, and in particular by Merivale's use of Mennipean satire with its encyclopedic detail. In our discussion of Merivale and Marshall's Admissions Records we have drawn on speech act theory to suggest that the Order (to admit a patient), the two medical certificates that follow, and finally, the notice to admit a patient constitute a constellation of texts, a genre suite, with a powerful illocutionary force. These texts are the prelude to and the means of confinement; they are both act and process. At the heart of our comparison of the asylum records of Merivale and Marshall with their "survivor narratives" is our analytic conclusion that the Ticehurst case histories can be said to constitute a linear "chronicle" of what Hayes Newington, the writer of the two case histories observed and inferred about his two patients. As chronicles, the Ticehurst Asylum case histories are linear representations or realistic accounts. As such, these archival documents provide a genuine insight into the "ways that that reality offers itself to perception". The institutional accounts exist in--and mark a--"flat time," equalized by each dated entry depicting the writer's mechanical act of observing/noting in brief, stereotypical sentences, e.g., "Patient is better [or, conversely, no] better today." We dubbed this metronomic time: beating regularly and evenly, flattening out the individual trajectories of each patient's illness. Metronomic time is normative. Each beat is calculated precisely to be the same as next. The dispassionate nature of clinical observations and the metronymic rhythms of the asylum fit with this flat, regular, uniform view of time. Once metronomic, institutional time is set in motion by the precipitating event of the certificates of insanity, entries are logged with regularity and observations are made in a formulaic, abbreviated, and predictable manner. By contrast, the passage of time recorded in both Merivale's memoir and Marshall's oral account is irregular, unpredictable, marked by acute catastrophes and long anxious periods of waiting for a resolution, by peaks of conflict and turmoil alternating with valleys of dazed stupor or inaction. Time in their accounts is also recursive; events are re-lived, sometimes more than once, as the patients recount their feelings about their confinement. Time for Merivale and Marshall (and presumably other patients as well) acquires a symphonic pattern: recursive, with dramatic highs and lows, unfolding multiple variations of a central theme-in both of these cases, denial of insanity. Both metronome and symphonic time have similar rhythmic "deep structures," but while one is simply a repetitive drumbeat of the quotidian, the other takes off into richer, more elaborate arrangements invested with personal meaning.

Evidências para o uso da avaliação nutricional subjetiva global nos pacientes com doença arterial periférica / Evidence for use of subjective global assessment of the nutritional status of patients with peripheral arterial disease

A desnutrição é uma doença extremamente prevalente em pacientes internados, chegando a acometer 50% deles, 47% dos pacientes cirúrgicos e entre 39 e 73% dos portadores de doença arterial periférica, com grande impacto na morbimortalidade desses pacientes. A desnutrição possui grande relevância no desfecho clínico desses pacientes durante a internação, estando associada a maior incidência de infecções, demora na cicatrização das feridas, diminuição do status de deambulação, maior tempo de internação e mortalidade. Entretanto, o diagnóstico de desnutrição ou risco nutricional desses pacientes tem sido um desafio. A avaliação nutricional subjetiva global revelou-se, até o momento, o padrão ouro como método de triagem de pacientes cirúrgicos internados devido à sua praticidade e acurácia. O objetivo deste trabalho é revisar métodos utilizados na avaliação do estado nutricional e da triagem nutricional de pacientes internados e caracterizar a importância dessa avaliação nos desfechos clínicos dos pacientes com arteriopatias.

Malnutrition is an extremely common disease among hospitalized patients, with prevalence rates as high as 50% overall, 47% among surgical patients and from 39 to 73% among patients with peripheral arterial disease. It has a major impact on morbidity and mortality among these patients. Malnutrition is very relevant to these patients’ clinical outcomes and is associated with a higher incidence of infections, slower wound healing, lower rates of mobility, longer hospital stays and greater mortality. However, diagnosing malnutrition or nutritional risk in these patients has proven to be a challenge. To date, subjective global nutritional assessment remains the gold standard screening method for use with hospitalized surgical patients because of its practicality and accuracy. The objective of this study is to review methods used for assessment of nutritional status and for nutritional screening of hospitalized patients and determine the importance of these assessments to the clinical outcomes of patients with arteriopathies.