A Diagnostic Problem in Poliomyelitis

During the 1931 epidemic of poliomyelitis our colleagues, practicing in the community, spoke of the difficulty encountered in the diagnosis of a large number of acute illnesses appearing among their patients. There seemed to be no certain distinction between the cases which possibly were poliomyelitis and those which probably were not. In the New Haven Hospital, probably owing to the selective factors governing hospital admissions, we had, for a while, little difficulty in making satisfactory diagnoses, provided meningitic or myelitic involvement were regarded as an essential criterion. But before the epidemic was over we saw five patients with the usual features of poliomyelitis, including paralysis, in whom lumbar puncture revealed normal spinal fluid. These findings raised the question of the diagnostic value of spinal fluid examinations in poliomyelitis, and it is the purpose of this communication to elaborate this point. Clinical Material The local epidemic began in June and terminated in November, 1931. During this period 266 patients were seen, in whom the diagnosis of poliomyelitis seemed probable. In 246 of these, paralysis or the presence of alterations in the spinal fluid established the diagnosis. In 20 patients this remained in doubt. Of the total number, 253 were admitted to the hospital and 13 were seen by us only once in the lumbar puncture clinic. The State epidemiologist reported' 296 cases from the townships which may be said to be served by the New Haven Hospital. Accordingly, a generous sampling of the reported cases was available for study.