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NEW HORIZONS IN THE NEUROLOGY OF CHILDHOOD MARIA Z. SALAM and RAYMOND D. ADAMS* Until comparatively recent times, medicine has been little concerned with the major nervous disorders of infants and children. The mentally retarded, the spastic, and the epileptic were customarily placed in public institutions, allegedly for their own good and that ofsociety, and given custodial care. Only a few members of the medical profession expressed curiosity about the diseases which underlay these clinical states or took the trouble to gain competence in their diagnosis. But now all this is changing, and new attitudes are being formed, prompted in large measure by public demands for help. Slowly it is being realized that these patients suffer from a large variety of nervous diseases, some ofwhich are preventable, rather than a few hopeless congenital anomalies. Clinics and laboratories are being established where none existed before, and medical scientists for the first time are making these diseases the objects of systematic investigation. The large body of factual data concerning normal development, so patiently accumulated by anatomists, physiologists, and psychologists in past decades is being scrutinized to see ifit constitutes a stable base on which the special studies ofthese many obscure diseases may be erected. The first systematic medical incursions into the area of children's neurology and neuropathology have revealed a number of formidable problems. First, there are the rapid changes in nervous structure and function due to normal growth, development, and maturation. One must contend with these whether one tries to appraise the natural development of * From the Departments of Pediatrics and Neurology, American University of Beirut, and the Department of Neurology-Neuropathology, Harvard Medical School, and the Neurology Service (Pediatric Neurology), Massachusetts General Hospital. This study was supported in part by funds from theJoseph P. Kennedy, Jr., Foundation. 384 Maria Z. Salam and Raymond D. Adams · Neurology ofChildhood Perspectives in Biology and Medicine · Spring 1966 infant or child, to diagnose a known disease of his nervous system, to evaluate a method oftherapy, or to delineate a new disease. Second, there is the special difficulty posed by the relative inaccessibility of the infant's nervoussystem to examination, both during the long period ofintrauterine life and immediately after birth, when large portions of the cerebrum have not yet begun to function. Finally, one must reckon with the special problem ofthe nervous diseasehaving its originpotentially in not one, but three organisms: the child, the mother, and the father. Common to all these problems in this relatively new field ofmedicine is the necessity ofdiscerning the influence ofthe time factor, represented in the natural processes of maturation in the age of the patient when the disease arises, and in the natural course ofthe disease itself. Eddington has remarked in his provocative essay on the Nature ofthe Physical World that "time permeates every corner ofphysics." The biologist, geneticist, and psychologist would insist that time is manifest also in everyphase ofhuman and animal development. Every organism grows, and growth involves the "metric ofduration" which is customarily reckoned "by clock and calendar " and expressed in terms of "time-elapse" and "time-consumption," to take phrases from Gesell [?]. To grow takes time, and development in this sense is but a special form ofduration called age. Furthermore it is the authors' contention that the recognition ofthe effects ofthe time factor is also crucial to an understanding ofmany of the major problems of children 's neurology, and that a failure to appreciate this fact has impeded the progress ofmedical science. Age (or time) is admittedly an abstraction, a mere convention for the dating of some event in organized development, but this does not do justice to its true significance. Age confers on any category of development , whether normal or pathologic, an orientational as well as a quantitative dimension. A given age always represents a position in the growth scale. Viewed in this way, the exact determination of true age assumes obvious importance in the methodology ofchild psychology, and, as we shall show, in child neurology, and neuropathology as well. This is especially true in prenatal life and infancy when development proceeds at such a rapid pace that small units oftime weigh heavily. Age also expresses the relationship ofevents within the life...


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