JAMA. 1932;99(13):1043-1048. doi:10.1001/jama.1932.02740650001001.
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Stated simply and in a homely way, the diagnosis of preparalytic poliomyelitis consists of a healthy clinical suspicion and a lumbar puncture. Three kinds of evidence contribute to the soundness of the clinical suspicion.

Epidemiologic factors offer aid in that the disease is primarily one of early childhood, most cases occurring before the sixth or seventh year of life. The seasonal distribution is largely limited to late summer and early autumn, to such an extent that poliomyelitis at other times of the year, winter and spring, is most uncommon. The geographic distribution directs major attention to the disease in north temperate climates. The symptoms are those of many general infections, including typically a low grade fever, headache and vomiting. Stiffness of the neck, rigidity of the spine and ataxic tremor are three physical signs of outstanding clinical consideration.

Too often the well appreciated advantages of early diagnosis tend toward overemphasis


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