888

being allocated to various Consumption Sanatoriums —£7825, and Convalescent Homes—£2175. The I£190,000 destined for hospitals is £9000 in excessof the sum distributed in 1917, JE27,500 in excess ofthat distributed in 1916, and JE40,500 in excess ofthat distributed in 1913, the year before the war,although the buying power of the total hasdoubtless diminished during the same time. Ofthe total distributed over £160.000 is being appliedin the form of grants to maintenance, leavingJE29,750 as capital grants. Of these capital grants;f10,100 is being employed in reduction of capital liabilities incurred before the war, 15,500 hasbeen ear-marked for schemes of improvement, andthe remainder represents the sums sanctionedfor schemes of extreme urgency during the war.

While the war was proceeding the DistributionCommittee discouraged the issue of public appealsin aid of schemes which were not of extreme

urgency, but in 1917 some capital grants were

sanctioned in aid of deferred schemes, and earlythis year the Committee was announced to be

ready to consider proposals for the immediate issueof appeals for post-war schemes on certain con-

ditions-the main one of which was that in such

appeals it should be clearly stated that the con-tributions received in response might be usedeither for building or for endowment. In this wayhospitals would not be committed in advance toextensions which might later be found inadvisable.As a matter of fact, if all the schemes of extensionwhich have come before the Fund were to materialisethe available accommodation of the voluntary hos-pitals of London would be increased by no less than1750 beds. It is quite clear that if any increaseof this sort is contemplated the whole questionshould be considered from the point of view of thetotal needs of the metropolitan population and thegeographical position of the institutions. The-,value of the work of the Fund is especially shownin its readiness to look at the voluntary hospitals.of London as one public service and not as a

congeries of rival charities.The report of the Distribution Committee

announces also the receipt of proposals for the

_.amalgamation of University College Hospital andthe Royal Ear Hospital, whereby the latter, whichhas been closed during the war, will be reopened as Ia special department of the large general institution.,The Distribution Committee is supporting theworking out of this scheme by grants. This amalga-mation, following on that of the Hospital for Diseasesof the Throat, Golden-square, with the LondonThroat Hospital reduces the number of ear, nose,and throat hospitals applying for a grant from fiveto three, of which only two are now on the booksof the Fund. This is another indication of the

way in which the Fund desires to bring order intohospital service for the vast London populationby preventing overlapping of energies ; but of coursethe process of fusing hospitals, general or special,with each other introduces the question of selectingthe honorary staffs. We trust that those responsiblefor the management of King Edward’s Fund willbear in mind the real difficulty that often underliesthe position.

Annotations.

LETHARGIC ENCEPHALITIS AND POLIOMYELITIS-

" Ne quid nimis."

THE difficulty of calling by an intelligible namesuch diseases as lethargic encephalitis and anteriorpoliomyelitis when the morbid agent is unknownand the morbid lesions are so various must notobscure the fact that a stage of useful knowledgehas been reached in regard to the two diseasesand their relations. In his lecture on lethargicencephalitis delivered before the Medical Societyof London, which appeared in our issue of Dec. 21st,Dr. Farquhar Buzzard drew some general conclu-sions with regard to the recent epidemic. He directedattention to the fact that in the case of the

analogous disease, acute poliomyelitis, the profes-sion as a whole has tended °to take too limited aview. In this it has followed the course of thehistory of the disease, in which our knowledge wasfor a long time based upon late examination of

sporadic cases. It was not until epidemics occurredthat attention was directed sufficiently to the

protean character of the disease, due to the veryvariable localisation of the morbid process. Becausethe most common site was in the spinal cord and themost vulnerable elements the cells of the anteriorhorns the disease received the name " anteriorpoliomyelitis," and this stereotyped our conceptionof it. Dr. Buzzard has rendered a service bywarning against a similar limitation of view in thecase of lethargic encephalitis. This disease presentsmany points of similarity to acute poliomyelitis, butis

"

undoubtedly an entirely different disease." Theform in which it was first observed was character-ised by lethargy, asthenia, and oculo-motor paralysis ;a second group of cases present the features of acuteparalysis agitans. Dr. Buzzard describes a thirdgroup in which "the force of the inflammation wasspent upon the cerebral cortex," with resultantJacksonian movements and consecutive paralysis.In different cases the distribution of the lesionsmay be very various, and no doubt other typesof case will be described later. The numberof cases recorded in the present epidemic hasbeen comparatively small, and they have occurredover a wide area, as shown in the note on thedistribution of the disease by Lieutenant-ColonelS. P. James in the same issue of THE LANCET. Itis probable that many other cases have occurredwhich have not been recognised as such, becausethey did not conform in type with the variety of thedisease which was first described, and that later an"

abortive form of lethargic encephalitis may beestablished, as has been done by Wickmann in thecase of poliomyelitis. Dr. Buzzard suggests thatsome sporadic cases of encephalitis lethargica havepreviously been diagnosed as cerebral thrombosisor haemorrhage; he points out that microscopicalexamination is frequently the only method of

differentiating between the two, the naked eyeappearances being indistinguishable. This wouldexplain those cases of " cerebral thrombosis " inwhich the Wassermann reaction is negative andthe vascular system apparently healthy. Unfor-tunately, our ignorance of the causal agent is socomplete that but little help in treatment is affordedby such a differentiation, beyond confirming ourbelief that the cause is one associated with a pro-found toxæmia against which general measures canbe taken. °