Geoffrey Wyatt and Marietta Higgs
You will readily admit that it would be a good thing to have a second method of arriving at the aetiology of hysteria, one in which we should feel less dependent on the assertions of the patients themselves. A dermatologist, for instance, is able to recognise a sore as leuetic (ie. syphilitic) from the character of its margins, of the crust on it and of its shape, without being misled by the protestation of his patient, who denies any source of infection for it; and a forensic physician can arrive at the cause of an injury, even if he has to do without any information from the injured person.
In this chapter Geoffrey Wyatt and Marietta Higgs, the two consultant paediatricians at the centre of the child sexual abuse inquiry in Cleveland in 1987, discuss the 157 children whose diagnoses were the subject of dispute and whose details were submitted by them to the judicial Inquiry at that time. They describe the children forming two groups. In Group A, there was concern about sexual abuse before the child saw the paediatrician. In Group B the paediatrician was the first to raise the possibility of sexual abuse in children referred with other health problems. What they describe as 'essential data' is provided in this chapter to show how the medical diagnosis was made for each group. They discuss the grounds for, and the role of, a medical diagnosis of child sexual abuse as a possible explanation for particular and persistent symptomology which has no other determinable or identifiable organic aetiology. The case for doctors making a medical diagnosis of child sexual abuse is considered, together with the factors which influence whether the medical diagnosis is corroborated by a disclosure from the child. They discuss the importance of medical intervention especially for children in Group B, who depend on a doctor to initiate the multi-disciplinary assessment, and the dilemmas that this creates.
Since doctors usually work in a surgery or hospital clinic, the diagnosis will be made following a process of history-taking and examining the child.