Monday, September 24, 2012

Shaken baby syndrome: Dr Norman Guthkelch's "Swan Song." Possibility of natural causes must be thoroughly explored. (Must Read; HL.)

PAPER: "Problems of Infant Retino-subdural Hemorrhage and Cerebral Edema with Minimal External Injury," by A.N. Guthkelch, published by the Medill Innocence Project.

GIST: "This contribution is offered as a final reflection- after 40 years' consideration - on a problem of apparent child abuse which has caused a lot of controversy since it was first described. Time has been wasted by confusing arguments about whether the triad of subdural hematoma, retinal hemorrhage and cerebral edema constitutes a syndrome with questions as to whether, if a syndrome exists, it is always the result of abusive behavior. For me, the triad may legitimately be classified as a syndrome, but it is not necessarily the result of shaking, or of abusive behavior. What I have to say is therefore intended as a Serious Call - I borrow the phrase from the title of a religious treatise by the 18th century Protestant clergyman, William Law - to members of the medical and legal professions to reconsider these problems with restraint.........Society is rightly shocked by any assault on its weakest members, and demands retribution. But there seem to have been instances where both medical science and the law have gone too far in criminalizing alleged acts of violence of which the only evidence has been the changed clinical state of the infant. Rather, there seems to have been inadequate enquiry into the possibility that the picture resulted from natural causes. In reviewing a number of cases where the alleged assailant has continued to proclaim his/her innocence, I have been struck by the high proportion of these in which there was a significant history of previous illness, and of abnormalities of structure and function of the nervous system. Yet these matters were hardly, if at all, considered in the medical reports. Tuerkheimer has pointed out the fallacy of assuming criminal intent, simply because signs of the classic SBS triad have been found or because no one can think of any other explanation of the infant's injuries, an expert medical witness who answers such a question as "Have you any doubt that given the appalling injuries which this unfortunate infant sustained, they were inflicted, in complete disregard of the danger to his/her life?" in the negative, is exceeding his/her authority."

The link to this paper can be found at:


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