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circulating in the blood, others are due to organic changes resulting from the
inflammation.
How poisons or toxins can produce the effects can be illustrated by the action
of a simple poison, alcohol. Alcohol in excessive doses produces a loss of control,
a tendency to restlessness and talkativeness, in which gradually the thoughts expressed
become confused and the speech thick, while the loss of control of the muscles of the
face may be shown by dribbling. The gait becomes staggering and movements
inaccurate, and there is also double vision. Drowsiness or even stupor may follow,
but after a sleep the individual recovers, though next day there is often headache,
lassitude and unusual irritability. After the toxic doses of alcohol have been
frequently repeated there may be organic changes shown by fine tremors, slight incoordinations
of movements, pains and tenderness in the limbs, or even wrist or footdrop.
Mentally, there is a defect of memory of an irregular type and especially
applying to recent events. Facts become merged with phantasies, the patient
gets slightly disoriented and may develop hallucinations or delusions. While the
toxic effects pass off rapidly if the dose is not repeated, the organic changes once
established remain permanently. In other forms of encephalitis the poison is not
so quickly eliminated, and the organic changes are more readily set up, but the
essential features are of the same nature. Fortunately, so far as children are concerned,
alcohol is a toxin which has, practically speaking, ceased to be supplied,
though it remains a potent agent for the mental and physical ill-health of those of
riper years. But certain diseases act through toxins in a somewhat similar way,
especially those of rheumatism, diphtheria and certain vague chronic infections. The
cerebral form of rheumatism, known as chorea, produces twitchings and tremors of
the same kind as does epidemic encephalitis, and leads to irritability, mental hebetude,
character changes and even maniacal outbursts which differ only in degree from those
of the more recently recognised disorder. Diphtheria is frequently followed by
various paralyses and also more rarely by other symptoms, such as tremors and
irritability. Chorea, indeed, may be regarded as a true encephalitis, though due
to rheumatism. When the history of the onset is vague it is often impossible to be
quite sure whether a given child, showing twitchings with character changes and
other symptoms, owes its condition to one or the other of these primary
disorders.
Group of
disorders
affecting the
central
nervous
system and
the need for
after care.
On referring to past records, in the light of recent experience it would seem that
a condition of encephalitis may arise from a variety of infections such as give rise,
not only to the epidemic forms under review, but also to such diseases as poliomyelitis,
cerebro-spinal meningitis, scarlet fever, diphtheria, "influenza," rheumatism, etc.
The severity and after-effects of the encephalitis vary with the nature of the infection.
In an extreme case, such as in rabies, the result is always fatal. In mild "influenzal"
cases there are no sequelae at all. Just as local physical rest is necessary in the early
stages of paralysis, so is mental rest essential when the brain has been involved.
The most important factor from the standpoint of mentality is the state of irritation
and lack of concentration exhibited by the patient after the initial illness. At this
stage, sufferers, especially children, seem to have lost all power of weighing up a
situation, and react at once in an indiscriminating manner either to one extreme or
the other. Older persons express themselves as unable to withstand minor worries,
or to overlook events which they formerly took as a matter of course. During this
phase, considerateness is necessary, but measures for control must be uniform and
consistent. No mental conflict would arise were the results of misconduct as inevitable
as those which would follow such an act, for example, as the touching of a
hot object. The difficulty is that this phase is frequently overlooked, especially by
parents, so that the children discover that by rebellious conduct they can gain the
desired objects. Once this discovery is made the convalescing child, like a normal
infant, takes full advantage of its opportunities. Parents often pet and chide a child
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