ACUTE ANTERIOR POLIOMYELITIS 913 



of slight fever, sweating, drowsiness, pain in the neck and head, and 

 weakness. Intestinal symptoms are not uncommon. Again cases 

 may begin without prodromal symptoms with sudden illness, chill 

 and fever. This may be all that occurs in the so-called abortive cases 

 which in Wickman's studies represent from 25 to 56 per cent of all 

 cases. 



During the early periods of the disease the cases may show vari- 

 ous types of development. They may simply show signs of general 

 infection, they may resemble influenza, the gastro-intestinal symp- 

 toms may be predominant, and others may show signs of meningeai 

 irritation. The neck may be stiff, but not with the involuntary stiff- 

 ness of meningitis, showing rather a reflex resistance when the at- 

 tempt is made to move the head forward. Peabody, Draper and 

 Dochez state that the best appreciation of the clinical condition in 

 acute poliomyelitis may be had by considering the cases as (1) the 

 abortive cases which never become paralysed, 3 the cerebral group 

 which is rare and in which involvement of the upper motor neurons 

 with spastic paralysis is the chief characteristic, and (2) the bulbo- 

 spinal group, which is the largest group, and in which motor neuron 

 involvement and flaccid paralysis occur. 



In the pre-paralytic stages the leucocytes are apt to be slightly 

 increased in number and there is a definite increase of the poly- 

 nuclears by 10 or 15 per cent. A leucocytosis of 15,000 to 30,000 

 is stated by the writers mentioned above as distinctly suggestive of 

 the disease, especially if the polynuclears are increased at the ex- 

 pense of the lymphocytes. The study of the spinal fluid is of great 

 value. During the first days of the disease, before the paralysis 

 appears, there is an increase of the cellular contents with a total 

 which may run as high as 500 cells per cubic millimeter, but usually 

 they run about 50 per cubic millimeter. The writers above quoted 

 saw two cases in which there were 999 and 650 cells, respectively. 

 During the second week, of 45 cases seen by them, 8 had over 50, and 

 23 were above normal. In the later stages of the disease the cell 

 counts come back to normal. During this early stage, most of the 

 cells consist of lymphocytes, rarely showing predominant poly- 

 nuclears. The globulin contents during the early stages are prac- 

 tically normal, or slightly increased. This, however, increases later, 

 as the cell counts drop. The fluid reduces Fehling's solution. 



8 For literature, see Landsteiner and Popper, loc. cit. and Wickman, Die Heine- 

 Medinsche Krankheit, Berlin, 1911. 



