Fred Silverman and the" Battered children" syndroùe

FRED SILVERMAN (1914-2006) AND THE "BATTERED CHILDREN" SYNDROME "

André J. Fabre                  1996

 It took a long time for pediatricians to understand the tragedy experienced by those who are least able to defend themselves, children.

The "battered child syndrome" is not new: for centuries, has perpetuated the "massacre of Innocents" in the general indifference

 THE BATTERED CHILD SYNDROME IN ANTIQUITY

 Such practices were common in ancient times already and no one seems to be indignant:

Thus Plato, about the corporal punishment of children "as" children "obey and good, otherwise it will be straightened by threats and blows like a piece of wood", "Of all the animals, the child is the most difficult to teach because the use of reason is not yet clear in him is the most devious, the most stubborn, the smartest animals The child must be clamped tightly and. first when he left his mother and nurses, it must be closely monitored by teachers, whatever their function. It is also a slave can punish every free man if any offense was committed "He's just to say that Plato good dialectician door elsewhere in his work a somewhat contradictory judgment. "free man shall learn nothing slave Corporal work does not harm the body but what is taught force does not remain in mind "," Teach your children to study in game and not by force, and you will see the power of nature "

Aristotle clearly says: "Education is clearly not the aim of entertaining the youth because to learn is not fun and not without pain", "Of course, if the child does not behave as it should, it should be reprimanded and punished. "

Plutarch "(If children Sparta) were caught in the act of theft, they were whipped without thank you for the fact that flying is highly improper and reprehensible. The Spartans take so seriously the consequences of theft of a child who stole a little fox and having hidden in his coat fox let him eat the intestines. them died rather than admit the truth. This story is likely to be true because I saw myself children Spartans flogged to death at the foot of the altar of Dian. ". However, Plutarch knows, too, qualify his thoughts: "I also said that a child will reach good behavior through encouragement and reason and not by Zeus, by blows or maltreatment that are good for slaves, not free men. With this method, it becomes like dazed and horrified to spots for fear of beatings or shame punishment. Encouragement and learning are more effective in forming a free being the punishment. Encouragement encourage them to stand apart from evil. "

Roman philosophs, they are unanimous in encouraging the practice of corporal punishment: and especially Martial. "What we need you, villain schoolmaster cursed head boys and girls The roosters crest erect have not yet broken the silence of the night;? Here and we already hear the thunder your voice gets angry and your blows! "," Leaving aside the huge whips and terrible stick, the scepter of the schoolmaster, they go to sleep until October. "

These texts show the belief of the ancients in an educational "virtue" of corporal punishment associated with ethnic, social and gender discrimination of all kinds. It should be remembered that there was in Roman law yet so explicitly, no legislation on the subject ...

Some dissenting voices were yet high in antiquity:

Cato the Elder: "He said a man who beats his wife or child puts his hand on the most sacred objects", "As soon as the intelligence of the child awoke, Cato undertook himself teach him to read, although he was a slave named Chilo, who was a grammarian of mind fine with many students. He did not admit, as he says himself a slave réprimandât son or pulls his ears for being too slow to learn or that his son was indebted to a slave of a blessing as valuable as education. "

Quintilian famous teacher of the first century clearly Preise his thought "As for hitting high, it is a practice, although it is received and Chrysippus does not disagree, I would not like at all, all of First, because it is shameful and made for slaves, and what grant if it were another age, -. really offensive Furthermore, if a child has as free spirit of nobility a reprimand for not correcting it even harden to blows as the worst of slaves, and finally, there will not even need such a punishment if the child near a regular monitoring Today his studies usually neglect educators that we seem to take,. we do not force children to do well but they have not done well, they are punished Finally, if you force it. child by blows to do with the young man that we can use such intimidation and can not acquire greater knowledge. Add the pupils and strikes are often worn by resentment or fear of nasty actions that will soon be for them a source of confusion. shame breeze soul and shade and invites to flee and hate the big day if the care given to the selection of supervisors and tutors was insufficient in terms of moral, I blush to say what dishonorable actions lend abominable men abusing this detestable right to strike and which sometimes offer opportunities to others as the fear felt by these unfortunate children I can not stress this point by.: hints at what is too much. therefore it suffice to say that this age is low and exposes the contempt we must concede to anyone too much freedom. " At the end of antiquity, Oribasius (324-408), Greek physician of origin and Augustine (354-430), Doctor of the Church of North African origin express their disapproval towards corporal punishment of children even if their testimony is sometimes nuanced

 RECOGNITION OF THE "BATTERED CHILDREN" IN OUR TIMES

 It was not until the nineteenth century, with the work of French clinicians, Ambroise Tardieu and Parisot to see denounced the practice of abuse of children are victims, but the view will remain deaf and blind and that, for one major reason: the doctors had no objective criterion to take legal action. We can mention here that'' the biblical word that "the fault leaves no more trace than a snake on the wall"

The change came in the early '60s with the work of Frederick (Fred) Silverman, MD Children's Hospital of Cincinnati showed that the forensic value of radiological materials.

The retrospective diagnosis of Syndrome "battered child" could say with certainty when radiographs put in evidence the notion of multiple fractures of different ages in the absence of bone fragility associated.

The brilliant personality of Fred Silverman, knowledge in the analysis of radiological materials have enabled it in the early sixties, to achieve public awareness and get very quickly in the United States, all coopératrion administrative and judicial powers.

An awareness of the existence of these problems and the severity of their consequences gradually in all countries. In France, in 1967, A. Fabre and J. Canet were the first to draw public attention to the plight of "beaten child" but In 1970, again, a radio program dedicated to violence inflicted on children exposed that the important thing was not in the reading of radiological materials but in the analysis of relationship problems between parents and children, appreciation, of course, but based incomplete problem.

After the 1970s, the public became aware of the frequency of these problems but also their complexity. A multidisciplinary care involving physicians, judges, social workers and psychologists is required once the diagnosis is confirmed.

Indeed, many different situations can be observed: open parental violence often associated with the most unfavorable psycho-social conditions, as well as the use of alcohol and drugs, more or less pronounced emotional deficiency pouvent take the most unexpected clinical, family rejection situation (children of another, preferences, similarities ...), abuse hidden or disguised (poisoning, defenestration, intentionally harmful care ...), sexual abuse.

Such complex situations face serious misdiagnosis: the child who refuses to denounce his playmate (sometimes a pet ...), false allegations in a divorce case ... and always possible, the dramatic risk of a miscarriage of justice and, in the case of abuse due to the custody of the child ...

Treatment guidelines can be decided, again with multidisciplinary care involving physician, judges, psychologists and social workers working in a fully coordinated: in some cases outstanding, the child must be removed from the family. In most cases will be considered counseling partner, in all cases, careful monitoring and prolonged the child and his family.

What will become, in adulthood, the abused child? The long-term consequences are not easy to predict: it is not unusual for former victims become abusers turn to their parent ... The physical and mental abuse of children is it, as some claim, a "dark area" of human nature embedded in its genetic makeup?

The Syndrome of "battered children" means any natural or legal violence on those who are least able to defend themselves, children. It is in no way a new medical entity: all time, the child has been abused of all kinds. These dramatic events have a long history and a recent study showed Pr Gourevitch, on a very wide range of texts, that the syndrome "battered child" was nothing unusual in the Antiques companies.

First comes an embarrassing question: why has it taken so many centuries to become aware of the seriousness of such acts and their consequences? Any attempt to diagnostic analysis or prognostic evaluation has long been obscured by cultural, religious and psychosocial inciting prejudice to "keep your eyes closed" to such tragedies .... .1 In the first phase,

All began in the XIXth century, with the work of Ambroise Tardieu that is asked the question of the frequency of abuse of children can become victims. In fact, until the middle of next century, medical opinion remains deaf and blind despite some courageous position taken.

EVOLUTION IN MEDICAL LITERATURE

Until the middle of last century, the situation had hardly improved for several reasons:

• limited response made rare items devoted to this topic

• skepticism about the frequency if the facts.

• need for objective criteria to confirm the diagnosis and, therefore, to undertake legal action: according to the biblical word "fault leaves no more traces of a snake on the wall"

Mid-XXth century, pediatricians from Europe and US began to alert the medical community on the gravity of such problems

1929: Parisot and Caussade, "The abuse against children" (Journal of Forensic Medicine 1929.9:. 398-428)

1946: J. Caffey, "Multiple fractures associated with subdural hematoma" (Am. J. Roentgenol. 1946.53:163)

1958: SH Fisher, "Bone manifestations of abuse against infants and children" (Southern Med J. 1958 51:1956-60.).

1967 : Fabre A. Canet and J. "Multiple fractures and "battered child syndrome". Gazette Médicale de France. October 9, 1967: 4481-4492

Under the leadership of Prof. Frederic Silverman, radiologist at Cincinnati Children's Hospital, the medical world is becoming aware of the existence of the "Battered children syndrome "

. milestone: radiological materials acquire a forensic value. The presence of all three criteria together "multiple fractures of different ages without evidence of bone fragility," says the diagnosis so pathognomonic

. the brilliant personality of Fred Silverman, his authority, he had exceptional gifts for the analysis of radiological materials have enabled it in the early sixties, to raise medical opinion and quickly get cooperation all administrative and judicial powers of the United States

. a capital  point was the lack of separation between the various disciplines has enabled early establish an effective management structure coordinated by a pediatrician high level problem, Prof. CH Kempe.

Regarding the Greco-Roman world, several factors seem to be causes and, first, for obvious reasons, the fact that many children were orphaned by their father or their mother. Without going very far, simply refer to the many stories and legends describing the plight of children left helpless brutality of "stepmother" or "stepfather" ...

Aggravating factor was certainly the unlimited power once given to the head of the family: many texts Veterans, especially Biblical, make mention unequivocal.

The most dramatic is the certainty that the elders of that corporal punishment was "normal" part of any education and lived it fully justified. Many texts are explicit on this subject ...

All this joined the facts which, even our time, physicians are frequently confronted: the parents of "battered child" are often themselves former "beaten child" and thus feel "normal" to their children that if they were themselves to undergo ..

Without any cultural or ethical consideration, the doctor may consider such a diagnosis without objective proof that shows the importance of radiological documents showing multiple bone lesions and different age. Well documented is the notion of serious injuries occurring on various parts of the body, at successive periods, a bone showing no signs of abnormal fragility.

This is a bundle of arguments objectives and not accusations or suspicions that will make the decision to bring such facts to the attention of the administrative and judicial authorities involved suites with such a diagnosis.

 Many works have been devoted in recent failures syndrome "battered child" but a new scope could range soon in the field of archaeological science. The results of such investigations need to be interpreters with caution but particularly demonstrative in this respect is the article of G. Blondiaux recently appeared on the skeleton of a child of the pre-medieval period discovered in a grave in Normandy.

It is hoped that new investigative techniques will find answers to many questions that still remain to be elucidated in this area:

1. What was the actual frequency of such events in ancient society and the severity of their consequences.

2. The "battered child syndrome" should be understood as being part of the cultural traditions of the Ancient World?

3. Physical aggression and moral children is it, as some claim, a "dark area" of human nature embedded in its genetic material?

 

a.fabre.fl@gmail.com 

 

BIBLIOGRAPHY

 Silverman F. N. The roentgen manifestations of unreckognised skelettal trauma in infants. The Amer. J. of Roent. Rad. Ther. and Nucl. Med.1953. 69 : 413-327.

 Ambroise Tardieu. Etude médico-légale sur les sévices et mauvais traitements exercés sur des enfants. Annales d'hygiène publique et de médecine légale  1860 (Pages 361-398

Blondiaux G. "Étude du squelette d'un enfant de deux du 4ème siècle, de la nécropole Michelet à Lisieux : rachitisme et maltraitance de l'enfanta dans l'Antiquité" (Thèse pour le diplôme d'État de Docteur en Médecine, Lille III, 26 janvier 1998)

4. Caffey J., "Multiple fractures in long bones of infants suffering from chronic subdural hematoma" (Am. J. Roentgenol. 1946.53:163)

6. Fisher S.H., "Skeletal manifestations of parent-induced trauma in infants and children" (Southern Med. J. 1958. 51:1956-60)

10. Meir Bar-Ilan. "The battered jewish child in antiquity". Bar-Ilan university, Ramat Gan 52900 Israel (http://faculty.biu.ac.il/~barilm/battered.html)

11. Parisot et Caussade, "Les sévices envers les enfants" (Annales de Médecine Légale. 1929.9 : 398-428)

 

 

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