Page:Acute Poliomyelitis.djvu/91

Rh paralysis of limb, of abdominal, and — as occurred in a private case — of isolated neck muscles, together with the appearance in them of the reaction of degeneration, and recovery either complete or associated with permanent, more or less diffuse, flaccid paralysis and atrophy of the muscles, permitted no doubt that these were cases of Heine-Medin's disease.

In the epidemic in New York, a case occurred in which convulsions, rigidity of the neck, Babinski's sign and Kernig's sign led a distinguished pediatrist to diagnose meningitis (Schwartz). Hochhaus saw two cases in which post-mortem examination demonstrated conclusively Heine-Medin's disease, although the clinical course had been that of an acute meningitis. Netter called attention to the striking and frequent occurrence of signs of meningeal irritation during the Paris epidemic of Heine-Medin's disease. Kernig's sign was very often noted. One child was sent to the hospital with a diagnosis of cerebrospinal meningitis. Netter observed one case in which the spinal fluid was somewhat cloudy and yielded a fine cobweblike coagulum; but in another, the fluid was clear. Netter further noted that in one third of his cases the disease began with distinct meningeal symptoms. He was able to prove in Paris, synchronous with the epidemic of poliomyelitis, the prevalence of a benign form of meningitis which he considered — correctly, I believe — to belong to the meningitic type of Heine-Medin's disease.

Occasionally the spinal fluid coagulates (Netter and Spieler). Its other characters have already been discussed in dealing with the acute stages (page 29).

How closely Heine-Medin's disease may resemble ordinary meiningitis has just been narrated. The knowledge of this meningitic form helps us to explain the statements of observers such as Caverley and Macphail, and Mackenzie, who reported that cerebrospinal meningitis and poliomyelitis may occur simultaneously. It also bares the foundation of the belief that these two diseases are related. Wickman proved that where exact data were available no such relationship existed and he suggested that in both of the recent American outbreaks numerous and definite cases of the meningitic form of Heine-Medin's disease, alone, occurred.

The Abortive Form. — During the Swedish epidemic of 1905,