Page:Acute Poliomyelitis.djvu/96

 CHAPTER VI

Diagnosis and Differential Diagnosis

As a general rule, a diagnosis of Heine-Medin's disease is justifiable if, after a short, acute, febrile, initial stage, paralysis of flaccid type develops. The paralysis attacks usually the leg, trunk or arm muscles ; rarely, the muscles supplied by the cranial nerves. During the initial stage, symptoms such as general ten- derness, rigidity of the neck, sweating and somnolence are to a certain extent characteristic.

As Heine-Medin's disease often presents at the onset only the general characters of an ordinary infectious disease, we must be prepared to distinguish it from similar conditions due to other infections. If well-marked general tenderness be present a sus- picion either of influenza or of a rheumatic affection may arise. The latter, as a rule, is easily excluded; the tenderness in rheu- matic affections is usually localized to joints; whereas, in Heine- Medin's disease such a localization, although it may occur and be associated even with joint swelling, is extremely rare.

To differentiate from influenza is more difficult. Clinically influenza has become as a lumber room in which most hetero- geneous conditions are lodged. Heine-Medin's disease may be separated from a real influenza produced by Pfeiffer's bacillus: in Heine-Medin's disease catarrhal symptoms, although generally present, are less, whereas sensory irritability as a rule is more severe than in influenza. Yet, a bronchitis, a conjunctivitis, or other catarrhal inflammation may appear in the course of infantile paralysis.

If gastrointestinal symptoms are present, or if they predomi- nate, an intestinal catarrh may be suspected. But in such cases, usually, some symptom, such as tenderness, or sweating, suggests that the nervous system is implicated.

What has just been said applies to the abortive forms. These can be diagnosed with certainty only if they appear during an epidemic, or if they are associated with cases either of paralysis, or of indubitable implication of the nervous system. Among the