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Encephalitis lethargica and its distressing sequelae, which have been frequently After effects
and fully described in previous annual reports and elsewhere, continue to present of encephali-tis lethargica
medical and social problems which still defy solution. From the medical point of
view it must be frankly stated that patient investigation and research have brought
us no nearer the secret of the cause or cure of the disease. From the social viewpoint
there still remains a long-felt need of making provision for institutional treatment
of those unfortunate adult patients whose mental, moral or physical deterioration,
resulting upon an invasion of this disease has unfitted them for normal domestic
and social life. Suitable cases under the age of 16 years are catered for at the
Metropolitan Asylums Board's Northern Hospital, Winchmore Hill, on which comment
is made in Chapter II, the report of the School Medical Officer. A review of
the work carried out at this institution is contained in the printed report of Dr. G.
A. Borthwick, the Medical Superintendent, which was adopted by the Metropolitan
Asylums Board on the 10th December, 1927, describing the second year's working
of the unit.
It is true that the modification of the Mental Deficiency Act in 1927 may have
some effect in securing the admission to mental hospitals or otherwise bringing under
supervision those patients whose intelligence or moral outlook has so degenerated
as to bring them within the scope of the new Act. This Act widens the definition of
a mental deficient to include those persons whose mental deficiency arises before
the age of eighteen, whether due to inherent causes or induced by disease or injury,
whereas in the previous Act it was necessary to show that mental deficiency had
existed " from birth or an early age." It was thus impossible to certify many cases
of mental deficiency due to encephalitis lethargica.
The recommendations in the report of Dr. G. A. Borthwick on the encephalitis
lethargica unit at Winchmore Hill referred to above (see the report on the subject
in Chapter II.) make it clear that, whilst the experience gained in regard to children
shows that no positive curative results can be expected, many cases show considerable
improvement, and that the unit has justified its existence, if only as a
clearing house and observation station, where patients suffering from the charateristic
physical disabilities, including the paralysed and Parkinsonian cases, may
receive skilled attention and where children, whose mental condition unfits them
for ordinary outside life, may be kept under observation.
The need for making similar provision for adults who are affected applies with
equal force.
For the past three years the Council's public health department has concentrated
upon following-up every known surviving case of the disease, whether notified or
not. Enquiries are made at frequent intervals, as far as possible not less often
than every six months, and in connection with these enquiries very valuable assistance
has been rendered by the medical officers of health of the metropolitan boroughs
in regard to adults and children under school age, as well as by the children's care
organisers and the school medical service in regard to school children. As a result
it has been possible to show the proportion of disability among a very large number
of survivors. A table was given in last year's annual report which reflected the
position as it was in 1926. This year a further table is submitted which, though
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