Against Cerebral Palsy

A Railway Express truck pulled up at a big yellow brick house on Chicago's North Drake Avenue one morning last week, and as the deliveryman handed over a package, he said knowingly, "Here's another one for the doc." Dr. Meyer A. Perlstein took the package out to the garage, set it on his workbench and stripped the wrappings. With a screwdriver, the doctor pried the top off a shiny new quart can. In it, well preserved by wrappings of formaldehyde-soaked gauze, was a human brain.

Like half a dozen others that had recently arrived, this brain came from a child who had just died with cerebral palsy. It gave Dr. Perlstein, pediatrician at both Cook County and Michael Reese Hospitals, one more chance to learn additional details about the grim affliction which is not directly fatal but is severely handicapping, sometimes shortens life by lowering resistance. The specimen was listed in the brain registry of the American Academy of Cerebral Palsy (which Dr. Perlstein helped to found in 1949) and sent on to Pathologist Herman Josephy at Chicago State Hospital. Dr. Josephy may take as long as three months, slicing up to 200 paper-thin sections from the brain, mounting and photographing them, before reporting back to Perlstein on where and how the brain was damaged.

Matched Histories. Cerebral palsy afflicts one child out of 215 born in the U.S. But it is a catchall label for a wide variety of symptoms, and it may have an equal variety of causes. Symptoms range from spasticity (generalized rigidity of the muscles), chorea (sudden and jerky purposeless movements), athetosis (slower and more writhing movements), grimacing and lack of balance.

For both treatment and prevention of palsy, doctors need to know the precise cause of each type of case. One school of medical opinion has held that birth injury (usually from high forceps) is the commonest cause; also, that the nature of symptoms depends on just which part of the brain was damaged. Dr. Perlstein long ago became convinced that these were oversimplifications, set out to pinpoint cause and effect in the only way possible: study the living patients in detail, keeping a minute record of symptoms, then examine their brains after death to see which symptoms go with what type of brain damage. Parents of palsied children who have been studied in this way are asked to permit an autopsy, during which the brain is removed. Either the brain alone or the detailed history alone is useless; doctors must have both for matching.

Tentative Conclusions. From the specimens examined in Chicago and similar registries in Washington and Los Angeles, Dr. Perlstein has already drawn correlations that will require revision of some long-held ideas. Forceps deliveries, he believes, account for less than 3% of cerebral palsy, although a total of 60% of all cases can be traced to some kind of damage at birth--notably brain hemorrhage and contusions during a difficult delivery, and oxygen starvation (which in its turn may have a multiplicity of causes). About 30% of cerebral palsy is caused, Dr. Perlstein believes, by the mother's illnesses during pregnancy (especially German measles, but also anemia and diabetes) and Rh incompatibility--though this last cause has fallen in frequency from 10% to less than 3%, now that doctors are paying closer attention to pregnant women's blood groups. Finally, 10% of cases result from injuries in childhood.

Details of the relationships between the nature and location of brain injury and a victim's symptoms are highly technical, but from a growing mass of such data, Dr. Perlstein and his fellow researchers hope to learn more about the injury mechanisms in each type of palsy case, and eventually to suggest measures for prevention and treatment.

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