Page:Acute Poliomyelitis.djvu/92

80 in the immediate neighborhood of well-defined cases of poliomyelitis, and in distinct etiological connection with them, many patients were discovered who showed only general symptoms of being ill and presented no signs of paralysis. Such cases Wickman designated Abortive Cases. Between the definitely abortive case running a course characterized merely by malaise, or by slight and fleeting palsies, and the completely typical and, even, sometimes, fatal case, the existence of transitional forms was clearly established. Indeed, these various forms were occasionally exemplified among the respective members of one family.

The picture of the abortive type corresponds in general with that of the initial stage of typical infantile paralysis. The attack as a rule is acute and accompanied by fever, headache and general malaise. In some cases these symptoms are associated with others, such as rigidity of the neck; pain in the neck, back, loins, and limbs; and paresthesia; which point to implication of the nervous system. But these symptoms are not followed by paralysis. The patient usually recovers within several days and no trace of the disease remains except prostration which may be protracted. The abortive case thus presents only symptoms of a general infection and no real localizing signs. Even if the disease sets in suddenly, vague, ill-defined prodromal symptoms, such as exhaustion, mark its commencement. But after a few days generally the symptoms become acute. In discussing the initial stage it was mentioned that the height of the fever and the severity of the other signs are not significant of the further course of the disease. In abortive cases simultaneous with the usual complaint of headache is that of pain in the neck. Rigidity of the neck muscles is often then detected. In the abortive case not infrequently symptoms perhaps attributable to meningeal irritation arise. More or less marked opisthotonus even may occur. The disease then closely resembles meningism. Such cases are a link with the definite meningitic type of the disease. Among other signs of irritation pain in the limbs is especially marked. Usually several extremities are tender but sometimes only one. Sometimes the severity of this tenderness is extreme. In such cases, for want of a better, a diagnosis of influenza is often made.

Nausea, vomiting, diarrhea and other gastrointestinal symptoms have frequently been observed in association with the abortive