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tendency to the reversal of the sleep rhythm, in which the patient is restless at
night and sleepy by day, though the total amount of sleep appears adequate to
maintain physical vigour. Children returning to school have frequently been
observed to drop off to sleep in class, though th s tendency to drowsiness is less
noticeable in lessons which attract the greatest interest. This sleep disturbance
is usually more marked during the first year than subsequently, although it is sometimes
observed for two or three years after the original attack. The most serious
sequelae are the physical and mental changes. On the physical side it has been
found that children become progressively paralysed or develop increasingly jerky
movements, tremors and the like, which may pass on to a condition known as
"Parkinsonism," resembling the paralysis agitans of old age. Children thus affected
have been able to attend physically defective schools, but of these some have had
to be invalided on account of the progress of the malady.
On the mental side there are two types :—(i.) Those affected in fairly early
life have lost the power of intellectual development, and have remained in a subnormal
condition, varying from idiocy to feeblemindedness, according to the severity
of the attack, those affected a little later have been severely retarded, whilst others
have slowly returned towards normal mentality. Some cases have exhibited conduct
changes, but for the most part, where the intellect has been severely impaired, there
has been little difficulty in this respect, possibly because the necessary nervous
energy required to stimulate misbehaviour has been lacking, (ii.) In other cases
there has been little intellectual deterioration, but great disturbance of conduct.
The children are much more irritable and less capable of self-control than before
their illness. Whilst some are irritable and impatient, others are excitable, noisy
and restless, or are destructive, spiteful and violent so that they are a danger to other
persons. A marked feature is the frequency with which these children take to
pilfering. The juvenile courts have had to deal with many such cases, and as has
already been pointed out their disposal has been a matter of some difficulty, for even
in the ordinary residential school their bad behaviour, combined with the latitude
necessarily allowed them by reason of their ill-health, has proved detrimental to the
other children. Only two cases of sexual misconduct have been observed.

Five cases prior to 1924 developed a "Parkinson" syndrome, whilst two cases
previously noted had died, and so are excluded from the return. The mortality
rate is variable, but figures for the whole country taken over some years indicate