Academic journal article International Journal of Child and Adolescent Health

Child Abuse and Neglect in a Historic Perspective

Academic journal article International Journal of Child and Adolescent Health

Child Abuse and Neglect in a Historic Perspective

Article excerpt

Introduction

Abuse and maltreatment of children has been part of our history for a very long time (1-8). In international medical literature, intentional injuries to a child was mentioned in the year 900 by a Persian physician working in the harems of Baghdad (2). Greek physicians in the early second century also seemed aware of newborn babies at high risk for later abuse and neglect, and even advocated infanticide in some circumstances (2). Throughout the 16th, 17th and 18th centuries, children were raised under the rule of the "Schwarze Paedagogik" (8), with parents as the supreme masters of their children. Parents made all decisions, had complete power and ruled with a firm hand. Tradition and child rearing instructions cautioned parents to begin "breaking in" their children at a very early stage in order to gain complete control over them. This tradition has unfortunately continued to this very day.

During the 18th century, poverty, violence and alcohol abuse were part of daily life in London and indeed in all of Europe. The English artist William Hogarth (1) made the well-known engraving "Gin Lane" in 1751, showing the total disintegration of society, children with the characteristics of fetal alcohol syndrome, neglect and even fatal child abuse.

The 19th century brought more understanding for children's rights, as well as the acknowledgement of child maltreatment. In Paris, Ambrois Tardieu (2, 3, 5, 6), professor of forensic medicine, reported on 32 cases of child abuse in 1860: nine cases of brutality and ill-treatment, five cases of severe injuries and torture and 18 cases of fatal child abuse. In New York in 1871, a church worker discovered that 8 year old Mary-Ellen was beaten and starved by her foster family. Appeals to the police and department of charity were unsuccessful (3, 6). However contact with the American Society for the Prevention of Cruelty to Animals brought the matter before the Court on the grounds that Mary-Ellen was a member of the animal kingdom and she was subsequently removed and replaced in an orphanage.

The New York Society for the Prevention of Cruelty to Children (www.nyspcc.org) was founded in 1875. The first English Society was founded in Liverpool in 1883 and the London chapter the following year. During the first three years, the London Society dealt with 762 cases of assault, starvation, dangerous neglect, desertion, cruel exposure to excite sympathy, other wrongs and 25 deaths (2).

Pediatrics

Known as the founder of American pediatrics, Abraham Jacobi (1830-1919) worked with child welfare advocates to address cases of child labor and cruelty in the late 1800s. In the first half of the 20th century, sometimes called "the century of the child," there were several papers published on subdural hematoma in infants (2), but it was first in 1946 that John Caffey (9), from Babies and Children's Hospital of New York, associated subdural hematoma with multiple fractures. He described six infants born between 1925 and 1942, who had chronic subdural hematoma with 23 fractures and four contusions of the long bones.

After publication of that article, several papers on subdural hematoma associated with fractures and bruises were written in both the United States (10) and France (2). In each case no etiological explanation was offered, because the parents denied trauma. In 1953, Frederic Silverman from the Children's Hospital in Cincinnati was the first to state that caretakers of children "may permit trauma and be unaware of it, may recognize trauma, but forget or be reluctant to admit it, or may deliberately injure the child and deny it" (11).

In 1955, Woolley and Evans (12) from Detroit reviewed cases from 1946-54 at the Children's Hospital and found that "the general environmental factors surrounding infants who suffer osseous discontinuity range from "unavoidable" episodes in stable households through what we have termed an unprotective environment, to a surprisingly large segment characterized by the presence of aggressive, immature or emotionally ill adults. …

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