Birth-Palsy.

Etiology.—This occurs most frequently in premature births and in difficult labors, especially in instrumental deliveries, and which are attended by meningeal hemorrhage.

Abnormal conditions during intra-uterine life, not readily accounted for, may be responsible for this condition. Syphilis, heredity, shock, and great mental excitement may have some etiological significance.

Pathology.—The most constant lesion is the meningeal hemorrhage, which impairs the cerebral cortex, affecting various brain centers. Thus where the pressure takes place in the third frontal convolution, the speech centers are involved, and when the center controlling the eye movement is involved, the child squints.

Where forces have been at work prior to birth, and therefore are not mechanical, a loss of cerebral substances takes place, porencephalous cysts sometimes replacing the brain-tissue.

Symptoms.—Even at birth, rigidity of the muscles may be noticed, while attempting to dress the infant, or it may not develop for some weeks, when the legs are inclined to cross. In other cases nothing unusual is noticed until the child attempts to walk or use its hands. The intellect is usually feeble, especially when the cause is due to loss of cerebral substances.

When the child attempts to stand, the weight is thrown upon the inner side of the feet, the knees are placed together or even crossed, and if able to walk, only one foot is advanced, the other being dragged after its fellow. Choreiform movements and various grades of spasmodic incoordination are seen, and convulsions are not uncommon. Sensation is generally normal, though the reflexes are increased.

Diagnosis.—The rigidity of the limbs, the choreiform movements and spasmodic incoordination of the muscles, the peculiar position of the feet and limbs on standing, and the unnatural gait on attempting to walk, together with deficient intellectual features, render the diagnosis comparatively easy.

Prognosis.—This depends, to some extent, upon the mental condition and the. degree of paralysis, though the prognosis is grave in all cases.

Treatment.—In addition to hygienic and dietetic measures to improve the general health, massage, and faradization should be given a thorough trial. A careful and systematic course of training should be carried on as long as there is the least encouragement. The medication will be entirely symptomatic.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.