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encephalitis ; PEABODY and DRAPER, among theirown 183 cases, did not find a single typical case ofpolio-encephalitis; and SÖRENSEN, among nearly100 cases in Copenhagen, saw no case which hecould confidently describe as polio-encephalitis. Ithas been common, however, in this country, followingthe lead given by STBUMPELL in Germany in 1885,to ascribe a large proportion of cases of hemiplegiain infants to encephalitis resulting from infection bythe virus of poliomyelitis. These are cases in which,after a short period of malaise and pyrexia, con-

vulsions occur and are followed by hemiplegia. Theillness, like poliomyelitis, usually affects childrenwithin the first three years of life, and it is apt tooccur during or shortly after one of the acute specificfevers. It is to be assumed that most of the casesincluded as

" polio-encephalitis" in the officialreturns are of this nature.

These cases of infantile cerebral palsy, as was

pointed out long ago by G. F. STILL, show neitherthe seasonal incidence nor the epidemic occurrencewhich are features of acute anterior poliomyelitis.Whereas in a very large proportion of the cases ofthe latter disease in this country the onset occursduring the autumn months, infantile hemiplegiaappears to come on with equal frequency at all timesof the year. Many epidemics of poliomyelitis havenow occurred in different parts of the world, but nospecial prevalence of infantile hemiplegia has beendescribed in association with them. A significantfact to which attention was drawn by STILL, andwhich has recently been proved anew by FAIR-BROTHER and HURST, is that, in the experimentalproduction of acute anterior poliomyelitis in monkeys, the intracerebral inoculation of the virus does not result in spastic paralysis of the cerebral type, but in flaccid (i.e., spinal) paralysis of the lower limbs,with the lesions of acute anterior poliomyelitis in thespinal cord. It is evident, therefore, that even inconditions which would seem especially to favour theoccurrence of a cerebral paralysis the virus of polio-myelitis maintains its affinity for the spinal cordand does not produce the spastic paralysis which isseen clinically in infantile hemiplegia. There seemsthus to be no sufficient ground for regarding infantilehemiplegia, coming on in association with a febrileillness, as having any close kinship with the morecommon spinal infantile paralysis.At the present time there is another group of cases

which is likely to swell the number of those groupedunder the heading " polio-encephalitis." These arecases of encephalitis occurring in association withone of the specific fevers, such as measles, or evenwithout any such association. Such cases of acutedisseminated encephalitis seem to have been muchmore common during the last two or three yearsthan formerly. The pathological changes found inthe brain in these cases differ in many importantparticulars from those produced by the virus of

poliomyelitis, and it is therefore certain that thesecases are distinct from polio-encephalitis. It will beapparent that all statistics relating to polio-encephalitismust for various reasons be fallacious, and that theyare likely to remain so as long as we are devoid of anyspecific test for recognising infection by the polio-myelitis virus. Whether any useful purpose is servedby having a separate group for " polio-encephalitis

" inthe official returns seems doubtful. It will also beapparent that the diagnosis of polio-encephalitis isone which should be made at all times with reserve,and which, as applied to disease of the cerebralhemispheres, is hardly plausible except at times whenpoliomyelitis is rife.

PSYCHIATRIC REFORM.Dr. MAPOTHERs impressions of psychiatry in

America, which we published last week, are timelyseeing that the Mental Treatment Bill has not yetpassed through all its stages. They will shock thosewho think we have nothing to learn from othercountries and who are satisfied that the eighteenthand early nineteenth century reforms, in which

England took a large part, so settled the principles oftreatment of the insane that for ever in this countryits abuses and corruptions are removed. In Americaample money has been available for the endowment ofmissionaries on mental hygiene, and the Common-wealth Fund has acted on the principle that privatecharity is best directed towards financing hopefulexperiments, withdrawing its support when theexperiments have proved so successful that the workought to become a part of the national duty. Onthese terms a child-guidance clinic has recently beenstarted in London, and the British psychiatristsappointed to it visited America to study Americanmethods. The International Congress of MentalHygiene to be held in Washington next month willtake many of our own mental specialists across theAtlantic, and there is constant interchange of medicaland lay psychological workers between the twocountries for brief periods of training. The chiefpoint that emerges from Dr. MAPOTHER’s survey isthe remarkable freedom of American psychiatristsfrom legal interference. America has learnt to trusther experts in a way that England has not. She hasalso learnt to subsidise efforts to secure mentalhealth, both from State funds and private munificence.The governor and legislature in most progressiveAmerican States are content to limit their province inthe realm of mental disease to deciding how muchmoney they can afford for new ventures. Procedurevaries from State to State, but the permanentCommissioner, if a psychiatrist with institutionalexperience, may have powers far exceeding those ofour own Board of Control and has direct access tothe legislature without the intervention of any

layman. In the criminal courts the psychiatrist ismore widely consulted and his advice more closelyfollowed than anything dreamt of in this country.Where the court differs from the psychiatrist, theresult is almost invariably a more lenient sentence:this is an answer to those who fear that reference to a

psychologist means " coddling the criminal." Thecommitment regulations vary with different States,and in Maryland a patient can be committed forpermanent detention on the certificate of two medicalpractitioners without judicial intervention. The

system works well ; actions for illegal commitmentare no commoner there than elsewhere and practicallynever successful.Another direction in which advance has been made

in America is in psychiatric education, both of thepublic and of the profession. In contrast to thescanty instruction of students which is still a reproachto medical education in this country, the Americanmedical schools teach medical psychology and psycho-pathology in each of the four years of the course ;the students examine mental and neurotic cases, andthey learn the psychological aspect of the ordinaryhospital case. America has often been accused ofover-specialisation, but she is not unaware of herown risk, as is shown by the recent foundation of theInstitute of Human Relations at Yale. Here thefuture doctor, lawyer, clergyman, and business manare to come together for a common grounding in

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psycho-biology. Dr. MAPoTHER summarises thesituation by saying that American psychiatry ischaracterised by the domination of the medical spiritand the instinct to look rather to the future than atthe present. Nevertheless, there is room for doubtwhether the methods adopted in the United Statesof America are necessarily of value here. The con-ditions vary so greatly ; th attitude of the public isso different ; and more than this, the availableresources are unlike. Conditions exist in Americathat would not be tolerated here, even though thescientific work in certain directions is far in advanceof ours. It would perhaps be unwise to think of anycountry as being pre-eminent in psychiatry. Dr.MAPOTHER himself is sceptical of the Mental TreatmentBill, and, as we have pointed out, certain of itstendencies appear to be unfortunate. Whether he is

justified in speaking of England in this respect as alawyer-ridden country and in extolling the States asbeing comparatively free from this alleged evil is amatter of opinion. Some of his illustrations of

procedure strike us here as odd. The power touse a habeas corpus procedure, which resulted in apatient shooting the lawyer who was instrumentalin gaining him freedom, is a case in point. Somehave wondered whether as a matter of fact there ismore liberty in America than in our own land. Atany rate, judging from what we read, the Englishare naturally a more law-abiding people ; this beingso, our machinery for dealing with mental illness mayrightly differ from that of America.The real value of Dr. MAPOTHER’s survey, as it seems

to us, lies in showing the many and various ways inwhich America has tackled the problem of mentalinfirmity. Research, after-care, the study of socialand individual conditions, occupation therapy, theseare carried to an extent hardly envisaged in this

country. Nevertheless the public institutions are verylarge, often greatly overcrowded, although they have arelatively large and highly trained medical staff. Move-ment of patients is far more free than here ; admissionsand discharges are relatively much greater. But whenall this has been granted there is somehow left inthe mind the query, are the patients better off inAmerica ? Have they really a greater chance of

recovery ? Is their treatment by the State and bythe staff of the hospitals more sympathetic than it isin this "lawyer-ridden" country of ours

A PRESENTATION has been made to Dr. A. BrownRitchie by members of his staff, on his retirement from theposition of school medical officer under Manchester authority.BRITISH EMPIRE CANCER CAMPAIGN.-At a recent

meeting of the Grand Council of this Campaign the followinggrants were approved : £2500 to St. Bartholomew’sHospital for work including the continuance and develop-ment of investigations in the deep X ray treatment ofcancer, and the further study of malignant growths byslow-motion photography ; £950 to St. Mark’s Hospitaltowards its cancer research work; and £200, making atotal grant of £300, to the Yorkshire Council of the Campaigntowards a special statistical inquiry into the incidence ofcancer shown by post-mortem investigations at some of theprincipal Yorkshire, Scottish, and London hospitals. TheCouncil also confirmed a grant of £3900 to the MiddlesexHospital towards its cancer research.The Council decided to convene an informal meeting to

review present activities, and consider what further linesof research might be inaugurated. It will take placeshortly after the Midsummer recess.-The Council approvedthe publication of a popular book on cancer which has beendrafted by the investigation committee. This book hasbeen prepared so that it can be appreciated by the laypublic.-It was reported that the British Dental Associationhad nominated Mr. C. H. Howkins to serve as its representa-tive on the Grand Council, and that, Dr. Powell White havingretired through illness, the Christie Hospital, Manchester,had nominated Prof. John Shaw Dunn to serve in his stead.

Annotations." Ne quid nimis."

ROBERT BRIDGES.

THE death on Monday last of Robert Bridges,physician and poet-laureate, at the age of 85, broughtto an end an interesting career-especially interestingbecause the finest flower of his intellectual achieve-ment did not blossom until his last year. An unin-formed reading of his life would lead to the idea.that he drifted from medicine because he was unfittedfor its pursuit, and that when he discovered hismetier as poet he was too aloof and too severely-artistic to be the interpreter of ideals which would-inspire a work-a-day world. Robert Bridges, as a.

matter of fact, was a successful physician before heallowed the influence of classical studies at Etonand Oxford, and the urge, gradually growing in.intensity, of poetic production, to detach him from ourranks. And although much of his poetry was directedto an audience composed of the highly educated,and even of the severely cultivated, neither itsmelody nor its teaching asked for any extraordinaxyintellectual grasp from the reader. And the fervourand patriotism of his singing was slowly makingappeal to an increasing number of readers when lastyear he published the lovely " Testament of Beauty,"wherein deep religious feeling was blended with thehumanism of medicine and a knowledge of its funda-mentals. In Robert Bridges all medicine had agreat colleague, and its followers may well regret thathis long life is closed.

THE ASTHMATIC REACTION IN CHILDREN.

WORKING in the University Uhildren’s Ulinic in

Berlin, Dr. J. Tuscherer has analysed the records.and made clinical observations on 152 cases of asthmaor allied disorders. The diagnosis in four instances.proved to be wrong, while in 12 other patients theillness was so short as to make the diagnosis doubtful.Tuscherer prefers the term " asthmatic reaction "for the cases he describes, and he would includeunder this heading all examples of true asthma,bronchial asthma, and nervous asthma as occurringin adults, the bronchial asthma and asthmaticbronchitis of children, and the spasmodic bronchitis.of infants. As regards the mechanism of the attackshe follows modern authorities in analysing this into.its nervous and secretory components (spasm plusexcess of mucus in the bronchi), but he does notagree that the underlying nervous predispositionto the disease is necessarily inborn. Nevertheless,.analysis of the family histories of the patients in.this series showed asthma in the father in 12, in themother in 11, in the grandparents in 15, and in otherrelatives in 16 ; 17 of the asthmatic patients had a.family history of nervous trouble. The age ofonset of symptoms varied in the series, but Tuscherershows that first attacks may date back to early life..Three of his patients undoubtedly began to showsigns of the asthmatic reaction during the first fourmonths, and he gives details of one of these casesadmitted with a respiration-rate of 85 per minuteand an acute spasmodic bronchitis, rapidly clearing,.at the age of only nine weeks. Subsequent historyshowed that this early attack was the beginning of’the asthmatic reaction in this child. The associationof asthma in children with the " exudative diathesis "’

of Czerny is emphasised, and the relation of infantileeczema to asthma is also brought out in this series.The alternation of asthma and eczema in the samepatient was well illustrated in some of the cases

analysed. The influence of infectious fevers inbringing out a latent disposition to asthma was seenin many instances. In the whole series of 152 casesthe first asthmatic symptoms followed whooping-

1 Jahrb. f. Kinderh., 1930, cxxvii., 20.