Death of neurasthenia and its psychological reincarnation: a study of neurasthenia at the National Hospital for the Relief and Cure of the Paralysed and Epileptic, Queen Square, London, 1870-1932.
BACKGROUND
The diagnosis of neurasthenia appeared in 1869 and rapidly became fashionable and highly prevalent. It disappeared almost completely, producing ongoing debates about what happened to the disease, which have not so far been informed by empirical data.


OBJECTIVE
To use empirical historical hospital data from one specific hospital to explore several controversies about neurasthenia, including what happened to the disorder.


METHODS
The annual reports of Queen Square Hospital were examined from 1870 to 1947. The prevalence of neurasthenia diagnoses as a proportion of total discharges was recorded. The possible diagnostic categories into which neurasthenia could have been reclassified were identified. Textbooks and writing by neurologists working at the hospital during this period were examined.


RESULTS
Neurasthenia accounted for 6-11% of total discharges from the late 1890s to 1930, when it virtually disappeared. Men accounted for 33-50% of cases.


CONCLUSIONS
Neurasthenia affected both the upper and working classes and both men and women. Neurologists, not psychiatrists, continued to see the disorder well into the 20th century. Neurasthenia did not disappear, but was reclassified into psychological diagnoses.
Taylor
R E
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Department of Psychiatry, St Bartholomew's and the Royal London School of Medicine and Dentistry, Basic Medical Sciences Building, Queen Mary and Westfield College, Mile End Road, London El 4NS, UK.
D049672:History, 19th Century; D049673:History, 20th Century; D006782:Hospitals, Special / Q000266:history; D006801:Humans; D008131:London / Q000453:epidemiology; D009440:Neurasthenia / Q000145:classification / Q000453:epidemiology / Q000266:history*; D009462:Neurology / Q000266:history; D015995:Prevalence; D017678:Sex Distribution; D012923:Social Class