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discharged, leaving 71 under treatment at the end of 1927. One child died a few
days after discharge during an “access of rage” and another child who was
suffering from severe Parkinsonian rigidity died in the institution from broncho
pneumonia. The duration of stay ranged between a few months to nearly two
years, but in 35 cases the children were withdrawn by their parents against
medical advice.
The procedure in regard to ascertainment is similar to that obtaining in the
case of poliomyelitis. Every notified case is reported by the borough medical
officer of health on a special enquiry card to the Council's medical officer
of health, and, in addition, large numbers of non-notified cases come to light
through various channels of information. The majority ot these latter cases have
not been diagnosed in the acute stage and are only discovered when the later
manifestations appear. A comprehensive system of following-up by the school
medical service in regard to school children, and through the agency of the borough
medical officers in regard to all other cases, has been instituted. Applications for
admission to the Northern Hospital are accepted from the Council's medical officer
of health or the boards of guardians. Usually the children are examined for suitability
for admission by one of the Council's medical officers, and where a child is
considered suitable and the parents consent has been obtained an application form
is sent to the Board. If the Board's neurologist endorses the application the child
is admitted as soon as a vacancy occurs. In considering the outlook with regard
to these difficult cases, both from the mental and physical aspect, and the need for
continuing the institutional treatment, it will be appropriate to quote from the
last report of Dr. G. H. Borthwick, medical superintendent of the Northern Hospital.
He states:—
“The experimental unit has not been productive of any positive curative
results, but it has proved very valuable as an observation station where cases may
be investigated and classified.
“It has even been very valuable as an institution for housing both those
children whose physical disabilities require skilled attention and those whose mental
condition is such that they are unsuited to the ordinary outside life.
“There is very little hope that patients suffering from the many after effects
of encephalitis lethargica will ever, generally speaking, be cured, for evidence shows
that the nerve cells attacked by the virus are irretrievably damaged.
“It may be possible in a minority of cases to educate other cells to function in
the place of the old ones, but this will be a very long task involving months and
may be years of patient endeavour.
“Whilst I cannot whole-heartedly recommend the Board to continue the
section as an experimental unit with the hope of ultimately curing patients suffering
from post encephalitis lethargica, yet the absolute necessity of housing these difficult
and pitiful cases, either from a mental or physical point of view, is perhaps sufficient
justification for carrying it on.”
Again, writing on the subject of the neurological types, Dr. Borthwick states
that the outlook of patients suffering from Parkinsonism is grave, and that, although
under careful treatment many ot them tend to remain stationary, it is impossible
to say that they will not deteriorate. He thinks that the hospital school is best for
these patients and, as their capacity for movement is so reduced, that they should
be dealt with in separate wards away from the naughty and restless children. Severe
and bedridden cases require skilled hospital treatment where provision can be made
for keeping up their interests through the medium of sight and hearing. Dr. Borthwick
also points out that the patients showing paresis only have improved, but
that cases of definite paralysis have not yielded well to treatment. They require
skilled attention along ordinary orthopaedic lines, combined with the provision ot
surgical boots and splints. Operative measures are also indicated in certain cases,