155 Parrot, Wagner.
The diagnosis from diphtheritic paralysis is embarrassed, from the fact that true anterior poliomyelitis may develop in the course of diphtheria as of other infectious diseases. The paralysis of the soft palate, preservation of faradic reaction, absence of atrophy, and the usually rapid recovery must establish the differentiation.
In spinal paralysis there is loss of the reflexes,156 and also of faradic contractility, both of which are preserved in hysteria. In hysterical paralysis, also, there is no wasting of the affected muscles.
156 See Gowers's monograph on “Spinal-Cord Diseases” for an excellent summary of the spinal reflexes.
Various diseases of the bony skeleton or articulations may simulate spinal paralysis. Congenital club-foot, caused by unequal development of the bones and cuticular surfaces, is to be distinguished from the paralytic variety by the date of its appearance,157 by the deformity of the tarsal bones, and by the extreme difficulty of reduction.
157 Though in some cases paralysis of the muscles of the foot seems to take place during fœtal life, and a club-foot result which is both congenital and paralytic.
Caries of the calcaneum, leading the child to walk on the anterior part of the foot to avoid pressure on the heel, may leave after recovery such a retraction of the plantar fascia as to cause a degree of equinus and varus, with apparent paralysis of the peroneal muscles. I have seen one such case.
Congenital luxation of the hip may simulate paralysis; indeed, by Verneuil, it has been attributed to an intra-uterine spinal paralysis. There is, however, no change in the electrical reactions of the muscles surrounding the joint.
In coxitis, however, Newton Shaffer158 has demonstrated a moderate diminution of faradic contractility in such muscles, and a corresponding degree of atrophy; and this fact might complicate the diagnosis of paralysis from arthritis of the hip-joint. Gibney159 has called attention to the facility with which this confusion may arise, and Sayre160 relates cases of infantile paralysis mistaken for coxitis.
158 Archives of Medicine.