Post-Encephalitis and Its Problems

Attention to-day is chiefly focussed upon the consequences of encephalitis lethargica; the disabled victims of the disease present many problems, both medical and administrative.The disease has a high case-mortality; though the majority of deaths occur during the primary attack, in many cases death occurs at much longer intervals after onset; the death-rate is estimated at 35 to 40 per cent. From the after-histories of some 3,000 patients in London, Glasgow, Belfast, Manchester, Bristol, Sheffield and other large towns, it appears that about 40 per cent. of notified patients become disabled. Generally speaking, severe sequels are preceded by severe symptoms in the original attack, but the Parkinsonian syndrome is a noteworthy exception to this rule.Broadly classifying the sufferers from post-encephalitis, rather than the sequelae observed in this condition, the author discusses (a) those who suffer mainly from physical sequels; (b) those who chiefly show origin of mental deterioration; (c) those who exhibit demoralizations.The provision of suitable institutional accommodation for those with progressive physical disabilities (often combined with mental failing), the general re-training and education of the youngest victims and the training and control of adolescents with serious character-changes, constitute some of the problems of post-encephalitis.While advocating further research the author considers that for the present the welfare of the passive helpless adult is best secured by ad hoc arrangements under the Poor Law Authorities or Board of Guardians. The youngest patients, with a more hopeful prognosis, need special institutional care and training on some such lines as those of the Encephalitis Unit at Winchmore Hill. It is hoped that the Mental Deficiency Act, 1927, will prove of great help for the management of moral delinquents.