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Wardner D. Ayer, M.D.
JAMA. 1926;86(4):294-295. doi:10.1001/jama.1926.02670300056027.
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To the Editor:  —It seems imperative that sharp exception be made to the report of five cases of poliomyelitis treated with intramuscular injections of convalescent serum by Drs. E. B. Shaw, H. M. Thelander, and E. C. Fleischner of San Francisco (The Journal, Nov. 14, 1925), on the basis that the clinical facts presented are at variance with the usual and definite symptomatology of early poliomyelitis.Poliomyelitis is characterized by a preparalytic period of a fairly uniform duration of three days. This period is in reality the active phase of the disease and is then followed by the appearance of the paralytic sequelae. The manifestations of this early period are remarkably constant. Fever is seldom high, averaging 102 and rarely above 103 F. Headache, rigid neck and tremor constitute an important and almost constant triad of findings. In addition, there may be a peculiar apathy and listlessness but never delirium


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