Peripheral Brachial Paralysis in Infants

In 1861 Duchenne noted in four cases of ' subacromial subluxation,' thought to be produced at birth, a true paralysis of the brachial plexus. In 1872 he described in detail obstetrical paralysis, with or without fracture or subluxation, and in older children described subspinous luxation as complicating or producing the paralysis (Duchenne, 1872). Erb, in 1874, localized by faradic stimulation an area in the neck associated with the contraction of the muscles most commonly paralysed in this lesion. This point was later associated with lesions at the junction of the fifth and sixth cervical roots (reviews by Williamson, 1897; Kennedy, 1903). Whereas the earlier observers blamed direct pressure from forceps, the midwife's finger or the subject's clavicle, the work of Fieux and more especially Duval and Guillain towards the end of the last century emphasized traction on and rupture of the upper roots of the plexus from forcible separation of the head and shoulder. Much experimental work on the cadaver has supported this view (Delbet and Cauchoix, 1910; Sever, 1920; Taylor, 1921). Whitman (1905) by his work on reduction of the subluxation sometimes present emphasized this aspect, and several workers have followed T. Turner Thomas (1911) in regarding the subluxation as primary in some cases at least (Ashhurst, 1918; Lange, quoted from Thomas, 1916; and Platt, 1921).