This thesis is the result of an investigation of the
prevalence, clinical findings and aetiology of cerebral
palsy in the childhood population of Edinburgh which was
carried out during 1952 and 1953, whilst the author held a George Guthrie Research Fellowship from the University of
Edinburgh.
The aims of the investigation were, firstly to establish
the prevalence of cerebral palsy in the childhood population
of the city; secondly to study the clinical features of
cerebral palsy and their effects on the patient's way of life;
to define some of the important aetiological factors
in cerebral palsy in a representative group of children in
the community.
During the investigation it became increasingly apparent
that the currently defined categories included in "Cerebral
'Palsy" did not allow for an accurate classification of cases
by neurological findings. Eventually a new classification
on the basis of neurological syndromes was evolved. This
classification will be described and compared to previous
classifications in Section 3.
It was possible to establish figures for the prevalence
of cerebral palsy in the childhood population of Edinburgh,
though a complete ascertainment of all patients was not made.
The clinical features of cerebral palsy in the childhood
;community were studied and are described in Section 4. During
the survey it became increasingly apparent that "Cerebral
Palsy" was no clinical entity. Rather it comprised a number
of neurological disorders in which the only common factor
appeared to be that there was motor dysfunction due to abnormality of the brain which was present in early life. The clinical features varied widely from category to category.
The ways in which patients were handicapped and the extent
to which they were printed from taking part in everyday
activities were very different. A detailed study was made
of the clinical findings and handicaps of patients and they
were compared to those described by previous authors. Thus,
some idea of the importance of cerebral palsy in the community
was obtained, (Section 5).
Aetiological factors which were important in one form
of cerebral palsy were found to be much less important in
others. Many different "causes" of cerebral palsy were found
which varied from developmental malformation to traumatic head
injury, and from abnormal parturition to the complications of
infectious diseases in early life. The multiplicity of
aetiological factors in single categories and even single
patients was impressive. For example, within the category of
"Ataxic Diplegia" patients were found whose disorder appeared
to be genetically determined, and patients who were suffering
from the effects of birth injury, parainfectious encephalomylitis or meningitis. To take account of the multiplicity of
aetiological factors it was necessary to study the heredity
and social backgrounds of patients as well as their individual'
birth and later histories.
The current concept of cerebral palsy as being due predominantly to the effects of birth injury is a misleading simplification of the true position. In the same way as there are many different causes of stillbirth and infant death, !so there are many causes of cerebral palsy in children who
survive. The later sections of this thesis are concerned
with demonstrating that the aetiological factors in cerebral
palsy are as complex as those involved in infant mortality.
Social, genetic, obstetric and many unknown factors play a
.part. An attempt has been made to define the importance of
some of them in Sections 5 and 6
