. A treatise on the nervous diseases of children : for physicians and students. -times during the first are of the order of generalconvulsions, and in this respectcan be distinguished from theconvulsions which occur duringthe earlier stage of acute cere-bral diseases. In some cases ofpoliomyelitis anterior acuta theconvulsions are entirely is on the whole very muchrarer than convulsions, and, ifpresent, may be taken to indi-cate a tolerably severe form ofthe disease. The coma is not asprofound, and not of as long duration as in many acute cer-ebral diseases. I have drawn
. A treatise on the nervous diseases of children : for physicians and students. -times during the first are of the order of generalconvulsions, and in this respectcan be distinguished from theconvulsions which occur duringthe earlier stage of acute cere-bral diseases. In some cases ofpoliomyelitis anterior acuta theconvulsions are entirely is on the whole very muchrarer than convulsions, and, ifpresent, may be taken to indi-cate a tolerably severe form ofthe disease. The coma is not asprofound, and not of as long duration as in many acute cer-ebral diseases. I have drawn this analogy between the acute cerebral and the acutespinal disease, because as a matter of fact a sharp differentiation betweenthe two is often impossible in the earlier days of the disease; and many acase of incipient acute anterior poliomyelitis has been diagnosticated byskilful physicians as the first stage of a meningitis, of cerebral hemorrhage,and what not. If these symptoms of the initial stage are not well de-veloped it stands to reason that but few physicians would. Fig. 75.—Case of Acute InfantileCerebral Palsy for Comparisonwith Fig. 74. 292 THE NERVOUS DISEASES OF CHILDREN. be willing to make the diagnosis of a spinal infantile palsjwith absolute certainty. The diagnosis becomes positiveonly after the recognition of the form of palsy present. The paral3^sis may possibly be present from the verystart, but it is very often overlooked in the presence of theother symptoms which appear to be so much more have in three different cases recognized the paralysis dur-ing the first ten hours after the onset of the first paralysis is widely distributed at the start. It may in-volve all the four extremities, and may even involve partssupplied by the lower cranial nerves (bulbar paralysis) asobserved by Medin. In some few cases disturbances ofspeech (dysarthria rather than aphasia) have been the initial wide-spread paralysis rapidly diminishe
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