1239PERMANENT CARE OF THE FEEBLE-MINDED.

contact in 18 per cent. and suspicious history in10 per cent., and no history in 16 per cent. Theyconsider the theory of milk infection to be untenablein these cases because in New York City 98 per cent.of the milk-supply is pasteurised. The influence oftenement houses, of diseases such as measles andwhooping-cough, and of sex and of age are all dis-cussed as setiological factors. The fact that about9 per cent. of the cases were preceded by tonsillectomyunassociated with any other disease leads the authorsto the conclusion that further research on this lineis necessary. The greatest number of cases of tuber-culous meningitis in any single age-period was foundin children between 1 and 2 years of age, whilst, interms of absolute numbers only, outside of theAmerican stock there were more cases of tuberculousmeningitis amongst the Italians than in any otherracial groups comprised in the series. One of themost interesting sections of this study is that whichdeals with the investigation of housing conditions as Ian aetiological factor. This lays emphasis on a veryvaluable point. The part played by zymotic diseasesas a predisposing cause is, of course, well recognised,but the connexion with operation for tonsillectomyis an isolated factor in the inquiry which certainlyneeds further investigation.At the moment it would appear to be useless to

speculate on this point without further data, andespecially without controls. That the mortality-ratein tuberculosis in childhood has fallen with suchmarked rapidity during the last quarter of a centuryis a demonstration of the value of the antituber-culosis campaign in New York.

PERMANENT CARE OF THE FEEBLE-MINDED.

IN the history of social progress in the twentiethcentury the Lancashire and Cheshire Society for thePermanent Care of the Feeble-minded occupy anhonourable position. They were pioneers in obtainingrecognition for the fact that inborn mental defect isa permanent condition requiring life-long care, andtheir colony at Sandlebridge was the first of suchestablishments founded in England to meet a needeven now inadequately supplied. On the occasion ofthe opening of a new recreation hall in the earlierpart of this year reference was made to the remarkablebeginnings of a work which is still incomplete.Twenty-eight years ago Miss Mary Dendy, nowpresident of the society, set out to collect evidence Iwhich would induce the School Board for Manchesterto adopt the then tentative experiment of specialschools. First working single-handed, and later withthe help of the late Dr. Henry Ashby, she discovered500 defective children actually in the class-rooms. Afurther series were so grossly afflicted that schoolattendance had been excused. " Most of these caseswere very severe, and many were pitifully neglected.One lad we found tied up in a cellar naked and howling."By the time the survey was completed it was

realised that special schools were not going to solvethe problem. A permanent home was needed andprotective legislation to keep the children safe andso to safeguard society from them. The statement ofthese aims seems obvious to the point of tritenessto-day, but in 1897 the opposition aroused was fierceand almost universal. Even mental specialists con-sidered that it was unjustifiable to put a stigma onany child by saying that he could not become normal,even if this was the obvious truth. From discouragingbeginnings, however, indomitable pluck and hardwork have built up the flourishing colony of to-day.Sandlebridge now shelters 212 inmates over 16 and108 children. Over 200 adults have been there froman early age, some of them over 20 years. As all whohave visited the colony know, they live under admir-able conditions. A large farm and market gardensnot only supply the older men and boys with a healthyand satisfying occupation, but provided produce for

1 See Twenty-sixth Annual Report for 1925 of the Society,72, Bridge-street, Manchester.

the institution to the value of over 22000 in 1924.Both males and females are trained in a variety ofskilled trades which utilise the gifts of all, and makethe colony almost self-contained as regards labour,if not financially self-supporting. The school hasbeen extended during the year, but the pressurein places is very great, and speaks eloquentlyof the need for similar institutions elsewhere.It is disappointing that local authorities shouldstill refuse to exercise their right of maintainingdefectives after the age of 16, even though, as in twocases quoted in this report, the lads are of provedcriminal tendencies. The instinct of the ordinaryman, who revolts against the idea of permanentconfinement and demands that the experts shouldprove their case in every instance, is none the less asound one. The appeal of Sandlebridge and other-colonies will be all the stronger when it is realisedthat they are required for selected cases only out of-the feeble-minded population, and that special schoolsand home supervision will suffice for the majority.In view of the high reputation of this colony and theindispensable work it is doing, a fall in subscriptionsof over 2265 for the current year is regrettable. A

suggestion that the debt of 23000 incurred for a much-needed recreation room and additional beds shouldbe paid off in commemoration of Miss Dendy’s long-years of service is worthy of wide support.

ENCEPHALITIS FOLLOWING VACCINATION.

AT a recent meeting of the Academic de Medecineof Paris Dr. F. S. van Bouwdyk Bastiansee and Dr.Terburgh, of The Hague, in collaboration with Dr;Byl, of Utrecht, and Dr. Levaditi, of Paris, made animportant communication dealing with the occurrencein Holland of encephalitis following vaccination.During the course of 18 months there had been34 cases of which 14 were fatal. The first case

developed in March, 1924, and was followed by thesecond in April, the third in July, and five more inSeptember. The next two occurred in February,1925, the largest number in one month-viz., 16-being notified in March, followed by seven in April,and the last at the end of June. The clinical coursewas as follows. After a period ranging from 9 to 15days after vaccination, the interval in the greatmajority being 10 or 11 days, an acute and violentcerebral condition developed. The first symptomswere vomiting and headache followed by increasingdrowsiness. The following days convulsions appearedaffecting one side or one extremity only. Babinski’ssign was present in all cases in which it could beinvestigated. In only one case which ended fatallywas there any paralysis-viz., hemiparesis accompaniedby paresis of the frontal branch of the facial nerve.In the cases which recovered the acute stage lastedfrom 7 to 15 days. There were no sequelae. Thecondition was obviously one of encephalitis, as

meningitis could be excluded by the normal conditionof the cerebro-spinal fluid, poliomyelitis by theabsence of paralysis, and tetanus by the absence oftrismus, convulsions, and the characteristic facies.The disease differed from epidemic encephalitis andthe ordinary encephalitis of children in the followingrespects. The great uniformity of the symptomsas contrasted with the variable picture of epidemicencephalitis. The shortness of the acute stage, theabsence of paralysis, particularly of the eye muscles,the presence of Babinski’s sign, and the absence ofsequelae were distinctive. In two cases in which thebrain was examined histologically the lesions werechiefly localised in the white substance, whereas inepidemic encephalitis they are mainly situated inthe grey substance with a predilection for themesencephalon. In some cases the vaccinationpustules were very pronounced, but as a generalrule the vaccinal reaction was normal. The lymphemployed in the 34 cases did not come from the samecalf but from ten different animals, and the lymph

1 Bulletin de l’Académie de Médecine, 1925, xciv., 815.