1862-2012 : THE IDENTIFICATION OF CEREBRAL PALSY AS CLINICAL ENTITY

This year (2012) marks the 150th anniversary of the first clear description of “cerebral palsy” by William John Little (1810-1894), and as such provides us with a timely opportunity to remember the historical pathway to identify this condition. The first reports of “muscular stiffness associated to the birth” were made by the French surgeons Nicolas Andry de Bois-Regard (1658-1742) and Jacques Mathieu Delpech (1777-1832), fathers of the modern concept of Orthopedics. In 1840 the German physician Jacob von Heine (1799-1879) described other three cases of cerebral palsy; he named them as “paraplegia spastica cerebralis”. Five years later, Catullo Rogier, author of the first Italian treatise on “Orthopedics”, wrote on “convulsive muscular retractions” due to “alterations of nervous centers” that generated spasticity. Even if these early works had identified the clinical features of cerebral palsy, the total number of cases studied was far too limited. Since 1853, the British surgeon Little, founder of the first “Royal Orthopedic Hospital” in London, had collected quantitative perinatal data in 24 patients for generalized spasticity: he noted associations with varying degrees of prematurity, difficult labor, instrumentation (forceps), asphyxia, and convulsions. On October 1861, Little presented his conclusions before the Obstetrical Society of London: "On the Influence of Abnormal Parturition, Difficult Labours, Premature Birth, and Asphyxia Neonatorum, on the Mental and Physical Condition of the Child, Especially in Relation to Deformities”. In this lecture, published in the following year, Little first argued that asphyxia at birth could occasionally cause permanent central nervous system damage. At the end of the century, Sigmund Freud (1856-1939) conducted several studies on this condition, being the first to write about cerebral palsy as a nosographic category. In conclusion, the history of this condition highlights also the decisive role of non-neurologists, particularly orthopedic surgeons and pediatricians, in the history of neuroscience.