have not been made upon cases which from the distinctness of the neuritic symptoms definitely belong to this group. Although we can, therefore, say that the existence of a neuritis in Heine-Medin's disease has not been histologically demonstrated, we cannot completely exclude its possibility.
It is, however, quite certain that Heine-Medin's disease is frequently indistinguishable from spontaneous, infective, acute polyneuritis and it cannot be differentiated from the "amyotrophic plexus, neuritis of infancy," described by E. Remak. As in each of these, the paralysis directly follows a febrile initial stage, both stand, in all probability, in direct etiological relation to Heine-Medin's disease. I think it is of practical importance to distinguish a neuritic or pseudo-neuritic type of Heine-Medin's disease.
7. The Meningitic Type. — The signs of meningeal irritation, which can often be observed in Heine-Medin's disease, may, under certain conditions, attain such prominence as convincingly to resemble some form of meningitis. Vomiting, headache, pain and rigidity in the neck and back, opisthotonus, Kernig's sign, tonic and clonic spasms, strabismus, coma, etc. — all the symptoms of an acute meningitis in all degrees and in all possible combinations may be added to the picture of the disease. Only in the chronic stage does the course differ from that of a meningitis. In most cases, the signs of irritation cease and the characteristic palsies of Heine-Medin's disease become evident. In some, the disease, even after it has assumed a most threatening aspect, disappears in a tolerably short time and an astoundingly complete recovery ensues. In others, under a more or less stormy aspect, the malady runs a lethal course.
During the Swedish epidemic, numerous transitions from distinct meningitis to typical poliomyelitis were observed. Upon this clinical basis and upon the epidemic connection of these meningitic cases with proven poliomyelitis, Wickman established a special meningitic form of Heine-Medin's disease. The following are two typical examples of this meningitic form:
The first developed convulsions, marked somnolence, stiffness of the neck, opisthotonus, hyperesthesia, persistent tonic spasm of the limbs, strabismus, inequality of the pupils and retention, with subsequent incontinence, of urine. All these symptoms disappeared within two weeks and left no trace.
