Paul FOLEY
Prince of Wales Medical Research Institute, Randwick (Sydney), New South Wales, Australia
pfoley AT unsw.edu.au

Encephalitis lethargica was an apparently disorder which was widespread in the Western world from about 1916 to the mid-1920s; its cause was never been definitively demonstrated. Some 30% of its victims died during the acute phase of the disorder, but the survivors rarely returned to full health. Best known of the sequelae of this epidemic are the extrapyramidal and other motor symptoms which constituted the so-called ‘post-encephalitic parkinsonian syndrome’. Less well known is the fact that large numbers of victims, especially those under the age of 25 years, exhibited marked personality and other psychological changes which often required involuntary confinement of the ‘patient’. Many of the archived cases are remarkably similar to more recent descriptions of children presenting ‘attention deficit disorders’. This paper will present an overview of the discussions which this phenomenon stimulated, particularly regarding the question of whether such persons required medical care or imprisonment. As an example, the case of Stanley Fletcher, who came to the attention of authorities for petty larceny at the age of 20 years after suffering encephalitis lethargica six years previously, will be discussed. Fletcher’s situation, brought to the attention of the British Parliament by Lord Ammon, ultimately contributed to changes in the British Lunacy Act as well as in the manner in which ‘moral defectives’ were treated.

Pavia, Italy, 2006