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• The author responds
  Andrew N. Williams
  Published on: 9 January 2022
• Response: A message for the future in a plea from the past
  S Chakrabarti
  Published on: 9 January 2022

• Published on: 9 January 2022

  The author responds

  • Andrew N. Williams, Consultant Paediatrician (Community Child Health)

  Dear Editor

  I'd like to thank Dr Chakrabarti for his useful comments. The painting itself is open to a wide degree of interpretation but essentially shows a disabled child begging for a living, which was the theme of the paper. The fact that the boy is holding a begging note is suggestive of some form of speech disability but clearly we cannot know what that is. The paper itself was an attempt to what indicate wh...

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  Dear Editor

  I'd like to thank Dr Chakrabarti for his useful comments. The painting itself is open to a wide degree of interpretation but essentially shows a disabled child begging for a living, which was the theme of the paper. The fact that the boy is holding a begging note is suggestive of some form of speech disability but clearly we cannot know what that is. The paper itself was an attempt to what indicate what he would say to us today, if he could speak. I'm not disagreeing with Dr Chakrabrti, but I should add that I have seen previously normal children who have had sudden infarcts or haemorrhages in the area of the left middle cerebral artery which have rendered them hemiplegic and aphasic

  Andrew Williams

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  Conflict of Interest:
  None declared.

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• Published on: 9 January 2022

  Response: A message for the future in a plea from the past

  • S Chakrabarti, Senior House Officer

  Dear Editor,

  I am writing in response to a recent report on Ribera's 'The clubfooted boy', in which the authors coments, 'whether his disability was congenital or occurred later, affecting his speech, we can never know'.[1]

  The boy's right-sided spastic hemi paresis with 'mutism' points towards a cerebral cause and a hemiplegic cerebral palsy. He also has right-sided hemi-hypoplasia, as seen by his arm length, folde...

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  Dear Editor,

  I am writing in response to a recent report on Ribera's 'The clubfooted boy', in which the authors coments, 'whether his disability was congenital or occurred later, affecting his speech, we can never know'.[1]

  The boy's right-sided spastic hemi paresis with 'mutism' points towards a cerebral cause and a hemiplegic cerebral palsy. He also has right-sided hemi-hypoplasia, as seen by his arm length, folded arm sleeve and subtly by the girth of the right leg. There is no suspicion of dysmorphism or microcephaly. Please note that he can stand without support, cooperate with an artist by smiling (for prolonged periods of time), has at least grade 3/5 power in the right-sided limbs and is carrying a walking stick, which suggest a good functional capability.

  In a child, significant and prolonged hemiplegia may be accompanied with hemi-hypoplasia and hence, here it is suggestive of a congenital cause or an event soon after birth. A unilateral cerebral event in infancy is unlikely to lead to 'mutism' considering the normal patterns of speech development. A possibilty of congenital deafness is likely and cytomegalovirus and rubella are among the known viruses, which can have associated neurological involvement. However, perinatal asphyxia can very well explain the scenario. Degenerative brain diseases and Rasmussen's encephalitis can also cause similar observations but do not cause cerebral palsy.

  Reference
  (1) Williams, AN (2001). A Message for the future in a plea from the past. Arch Dis Child85:503.

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  Conflict of Interest:
  None declared.

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