In  the  lethargic  type,  one  should  be  governed  largely
by  the  intensity  of  the  somnolence.  This  however,  is  not
the  only  index  which  may  serve  as  a  guide.  Many  of  the
most  severe  cases  of  this  type  make  a  good  recovery  and
they  should  be  considered  as  particularly  grave  only
when  the  cranial  nerves  of  the  bulb  give  evidence  of
involvement.
The  prognosis  in  the  cataleptic  type  is  much  better
than  the  general  impression  which  these  patients  actually
convey  during  tlie  period  of  tluMr  illness.  Their  appear-

63


64  EPIDEMIC    ENCEPHALITIS

ance  seems  to  certify  a  fatal  termination,  and  yet  a  num-
ber of  these  cases  make  a  good  recovery.  In  our  series,
one  case  of  the  cataleptic  type  is  still  living  and  one  of
them  died.
In  the  paralysis  agitans  type  of  the  disease,  it  is  perhaps
too  early  at  this  time  to  state  definitely  what  outcome
may  be  expected  in  every  case.  It  is  quite  certain  that
complete  recovery  from  this  type  of  involvement  is
possible,  but  whether  all  of  the  cases  manifesting  the
Parkinsonian  syndrome  will  eventually  clear  up  is  a
question  to  which  the  material  of  this  study  cannot  as
yet  give  satisfactory  answer.  A  number  of  other  observ-
ers, however,  have  reported  cases  of  the  paralysis  agi-
tans type  in  which  complete  recovery  has  eventually
occurred.
