The second, an adult, had fever, headache, vomiting, pain and stiffness in the neck and tonic spasms in some of the muscles of the shoulders and arms. Later, cramps in the legs appeared; then, opisthotonus; and, finally, difficulty in speech and in swallowing developed and death came three days after the illness began. As this patient was pregnant, the physician thought she suffered from eclampsia. He therefore induced premature labor. Post-mortem examination showed in the spinal cord the changes typical of acute poliomyelitis. In connection with this case, some others of a transient nature are mentioned on page 77. Upon epidemic, clinical and pathological grounds, the meningitic type is in established relation to Heine-Medin's disease. This has been confirmed by others. Leegaard in his statistics of the Norwegian epidemic reports cases which he enumerates as cerebrospinal meningitis, but which undoubtedly belong to this group. Zappert states that according to his observations during the Austrian epidemic the existence of this type is beyond doubt. Spieler's statements about similar cases are of such great interest that I shall here quote them literally: In 8 out of 44 cases of Heine-Medin's disease, admitted to the Karolinen-Kinderspital in Vienna, more or less pronounced and typical meningeal symptoms were present. The picture of the disease in four of these eight so resembled a tuberculous meningitis that not until some time had elapsed was its relation to Heine-Medin's disease suspected. For a week or more the well known prodromal symptoms — change in disposition, tiredness, nocturnal restlessness, screaming, occasional vomiting and obstipation — suggestive of commencing basic meningitis were present. This suggestion was reinforced by the sudden appearance of convulsions, which were associated with marked rigidity of the neck, irregularity of the pulse, Kernig's sign, transitory increase of the patellar reflexes, strabismus, general cutaneous hyperesthesia, vasomotor disturbances, and typical cerebral facies. The deception was still further enhanced, for lumbar puncture yielded a clear fluid which was under increased pressure, which formed a distinct diffuse, non-reticular, fibrinous clot; and which, on cytological examination, showed only numerous lymphocytes. At length, the noteworthy retrogression of the signs of irritation, and, later, of the cranial nerve symptoms; the complete disappearance of the fever; the more or less localized, flaccid
