Page:Acute Poliomyelitis.djvu/50



The General Clinical Aspect of the Disease.—As a rule, Heine-Medin's disease begins quite suddenly, with fever and malaise. Tenderness is a frequent and prominent feature. Pain, headache, stiffness of the neck and spontaneous pains in the limbs appear. In some cases vomiting and diarrhea are present; in others, the disease commences with sore throat, coryza or bronchitis.

These symptoms, which are in no way peculiar to, or distinctive of, the disease, may constitute the whole clinical picture. After a few days the patient may recover without further symptoms: such is the typical course in abortive cases.

In others, again, after the malaise has lasted one or more days, paralysis appears. Paralysis is the only sign which is characteristic of the disease; and it is the only sign which conclusively establishes the diagnosis. Paralysis generally attacks the limbs—most often the legs—but it may also affect the trunk and head. It develops rapidly and within a few days attains its maximum extent and severity. In a number of cases complete recovery of function occurs, but usually in certain areas the paralysis diminishes to some degree and then remains stationary. It shows the characteristics of a flaccid paralysis, diminished reflexes, changes in electrical excitability, and atrophy. Subsequently, in cases in which the paralysis is persistent and extensive, paralytic contractures, faulty positions and deformity develop, and more or less incapacitate the patient.

According to the course of the disease, the seat of the paralysis, the predominance of isolated symptoms, and other features, I have distinguished the following forms of Heine-Medin's disease:

1. The spinal poliomyelitic form.

2. The form resembling Landry's paralysis.

3. The bulbar or pontine.

4. The encephalitic.