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62
neurotic problems requiring not only psychiatric treatment but also vocational
assessment and placement. There would appear to be a real need for a neurosis
centre working in close collaboration with the Ministry of Labour where these casescan
be studied. Such a centre could separate out-patients fit only for sheltered
employment from those who might be capable of rehabilitation. The exact organisation
of such a centre could best be decided when the nature of the case material referred
was known, and the extent of the problem became clear.
Maudsley
hospital
re-opening
The Maudsley hospital, closed at the outbreak of the war, was re-opened for the
reception of in-patients on 8th October, 1945. The pre-war arrangements whereby
the bulk of the accommodation was reserved for Londoners and admission was
restricted to voluntary patients under the Mental Treatment Act, 1930, were continued,
but the definition of a London patient was widened to include not only persons
" settled " in or " irremovable " from London under the rules relating to settlement
and chargeability, but also bona-fide residents in the County of London who have not
acquired a status of irremovability by twelve months' continuous residence in the
county, thus bringing the conditions governing admission into line with those operating
in respect of the admission of voluntary patients to the other London County
mental hospitals. In view of the special nature of the hospital and the desirability of
drawing upon as wide a field as possible for patients, a discretionary power was given
to enable not more than 10 per cent, of the total available beds to be used for outcounty
patients. This discretion was not limited, as before the war, to those outcounty
patients who could pay the full cost of maintenance, but was based on the
needs of the patient, irrespective of means, and the interests of the hospital as a
centre for teaching and research.
A change was also made in the method of assessment and collection of contributions
from rate-aided patients. Instead of being done within the Mental Health
Services, this work was transferred to the Social Welfare department, and dealt with
in the same way as other cases in the hospitals service. Recovery of the full cost of
maintenance of out-county cases is made under No. 17 of the Mental Treatment Rules
from the appropriate out-county authority, and that authority makes its own arrangements
for re-imbursement from the patient or liable relatives.
The cost of maintenance was fixed at £6 13s. a head a week for London cases, and
£7 a head a week for out-county cases.
The administrative arrangements referred to above were designed to facilitate the
execution by the hospital of its special functions.
As a psychiatric teaching centre the Maudsley hospital attracts an exceptional
range of clinical cases from many sources for investigation and treatment. A reorganisation
of the medical staffing has been carried out and the appointment of
physicians, senior physicians in psychotherapy, pediatric physicians supported by
assistant physicians, senior and junior registrars and house physicians, makes up a
competent staff for teaching, research and treatment purposes. Direction of this
work is by the professor of psychiatry in the University of London; the medical
superintendent is responsible for the general administration of the hospital.
A similar reorganisation of the Central Pathological Laboratory has taken place
under the direction of the professor in mental pathology. Appointments are being
made to senior posts in the departments of neuropathology, biochemistry and
neurophysiology. Together the hospital and laboratory form the Maudsley Postgraduate
Medical School. The reconstitution of the School on a peacetime basis
anticipates an effective role in post-graduate medical education along the fines of the
Goodenough report.
Pre-frontal
leucotomy
During the year, a review was made of the patients in the Council s mental
hospitals on whom the operation known as pre-frontal leucotomy had been performed.
The first leucotomy in the Council's mental health services was performed at Bexley
hospital on 13th December, 1941. This method of treatment was extended to other
hospitals, and up to 20th July, 1945, 102 patients had been dealt with in this way.