SPINAL PARALYSIS.CEREBRAL PARALYSIS.
Paraplegic or monoplegic (rule).Hemiplegic, (rule). Monoplegic as residuum of hemiplegia or as consequence of solitary tubercle (exception).
Hemiplegic as residuum from paraplegia, or original and involving facial nerve (very exceptional).
Intelligence free (rule).Intelligence depressed (rule).
Intelligence depressed (when spinal paralysis has affected imbecile children).Intelligence free (exception, especially with solitary tubercle).
Disposition lively.Disposition apathetic or cross.
Initial convulsion unique; general symptoms of a few hours' duration (rule).Convulsions repeated; pyrexia prolonged several days or weeks (rule).
Convulsion repeated during two to three weeks before paralysis; fever a month (rare exceptions).
Sensibility intact (rule).Sensibility intact after initial period.
Occasional hyperæsthesia (exception).
Reflexes cutaneous, and tenderness lowered or lost (rule).Reflexes intact.
Reflexes preserved when only single muscles in groups paralyzed.
Associated movements of hand absent (Seeligmüller).Associated movements frequently observed in hand.
No rigid contractions of upper extremity.Extensive and rigid contractions of upper extremity very frequent.
Atrophy of paralyzed muscles and arrested development of limb, very marked.Atrophy very slight.
Faradic contractility diminished or lost; degenerative galvanic reaction.Electrical reactions normal.

Rather singularly, the diagnosis from transverse myelitis is less liable to error than that from cerebral paralysis:

ANTERIOR POLIOMYELITIS.TRANSVERSE MYELITIS.
Fever brief or absent.Persistent fever.
Sensibility intact.Hyperæsthesia, then anæsthesia.
Decubitus absent.Presence decubitus.
Reflexes lost.Reflexes increased.
Atrophy of muscles.Atrophy of muscles sometimes as intense.
Electrical muscular contractility lost.Loss of electrical contractility, but not proportioned to sensory and motor disturbance; less rapidly completed.

The diagnosis from hæmatomyelitis is almost impossible, and practically useless. For if the hemorrhage be severe, the child dies at once, as in Clifford Albutt's case. If less severe, it excites a myelitis, and the history becomes identical with that of the disease we are considering; or if the clot beyond the anterior cornua, it is identified with a vulgar myelitis of traumatic origin.

Progressive muscular atrophy is extremely rare in childhood, but is occasionally seen under hereditary influence (Friedreich's disease). In adult cases confusion is not only easy to make, but often difficult to avoid, especially with the rare, chronic form of poliomyelitis. The basis of distinction is as follows:

ANTERIOR POLIOMYELITIS.PROGRESSIVE MUSCULAR ATROPHY.
Onset sudden; maximum of paralysis at the beginning.March very gradual; maximum of disease not attained for years.
Faradic contractility lost almost at once.Faradic contractility not lost until atrophy complete.
Shortening of limbs and atrophy of limbs (in infantile cases).No arrest of development of limbs.
Functionally associated muscles frequently associated in paralysis: hand rarely affected.Capricious selection of muscles, but frequent wasting of these at eminences.

Paralysis from lesion of a peripheric nerve closely imitates anterior spinal paralysis.154 It is distinguished by closely following the distribution of the injured nerve, and, usually, by concomitant lesions of the sensibility and of cutaneous nutrition.

154 The importance of this fact has been shown in the section on Pathogeny. (See also quotations from Leyden and remarks on lesions of peripheric nerves.)

The pseudo-paralysis sometimes observed in syphilitic children as a consequence of a gummatous infiltration of the bones at the junction of the epiphysis and diaphysis155 might easily be mistaken for a spinal paralysis. But it is an affection peculiar to the new-born; the electrical reactions of the paralyzed muscles are intact; careful examination will show that the movements of the muscles are not impossible, but restrained by pain; often other syphilitic affections are present.