Dr. L. F. Freissell, of Columbia, reports a case of this disease in a Princeton student (J.A.M.A., Mar. 4) that came under his care. The details of the case need not be gone it no, but the conclusion is interesting, bearing as it does on diagnosis.
“To summarize, one is impressed with the difficulty of diagnosis of this disease in its acute stage, in which it may resemble any of the infections, especially typhoid fever, influenza or intestinal toxemia. The very slight rigidity of the neck and the increase in the activity of the reflexes, which at that time we thought might be due to a hypersensitive nervous system, were suggestive, but only the presence of an epidemic put us on our guard as to the possibility of the correct diagnosis.
“The exaggeration of the reflexes, gradually diminishing, and disappearing at the time of paralysis, only to become again exaggerated later, is another point in evidence of the general nature of the disease which cannot be exclusively confined to the anterior horn cells.
“The inestimable value of lumbar puncture cannot be too strongly insisted on. By its means, a diagnosis was established, and the fact that paralysis would probably follow determined twenty-four hours before its onset. Finally, by a second puncture twenty-four hours after the onset of thee paralysis, the fact was determined that the height of the paralysis had passed and that the paralytic stage was nearing an end. As a matter of fact, within eighteen hours we had the last evidence of progression in the lesion. The puncture had, in this case, booth prognostic and diagnostic value.”
But as the paralysis came and went apparently regardless of what was done one can hardly see what advantage the puncture had for the patient. In this respect we quote from another paper on the subject by Dr. Anderson and frost, of the U.S. Marine Hospital service, who, after pointing out the great difficulty of accurate diagnosis save when paralysis occurs, state: “No laboratory diagnostic methods of demonstrated reliability and universal application have been evolved. The early examination of cerebrospinal fluid is the mo soot reliable laboratory method at present known. Lumbar puncture for diagnosis in hardly justifiable, however, unless some consideration of the safety, either of the patient or of the community, makes an accurate diagnosis of special importance.”
To add to the troubles of diagnosis it is now recognized by clinicians “that cases of the disease occur without subsequent paralysis,” according to the editor. Needless to add that no thigh definite in the way of successful treatment has been discovered. The homoeopath will do well to stick closely to his symptomatology if the disease breaks out again this summer, and he is called to treat it.
