Child Abuse: Neuropathology Perspectives JAN E. LEESTMA, MD, MM
Throughout history most societies have exhibited ambivalent and often inconsistent behaviors toward children: on the one hand, espousing the value and sanctity of the child and, on the other, condoning if not codifying various modes of maltreatment. In some countries such as Sweden, rigorous and sweeping laws protect all aspects of the child’s life, whereas in others, maltreatment, slavery, sexual exploitation, infanticide, and mutilation are tolerated. In most advanced societies a well-defined system of law exists for children to grant to them the same degree of protection under the law afforded to adults, but even in ancient times laws existed that proscribed the killing of babies and children, and various punishments were stipulated for individuals found guilty of this activity . However, it was well recognized that it was often not possible to determine if the death of a child was due to natural causes or the actions of another. Autopsies, after a fashion, even in medieval times, were often sought to resolve this issue, and the legal quandaries posed by difficulties in obtaining reliable medical information were well known. The discovery by Swammerdam in 1667 [2-4] that the lungs of infants who had breathed floated in water whereas those of stillborns did not constituted a valuable advance in pathological knowledge that went a long way toward proving infanticide at the time. Further reports corroborated this early observation, but like many historic observations and the conclusions that arose from them, experience and research have developed exceptions. It is now recognized that lungs of stillborn infants can sometimes float, for which there may be several reasons. Among them are bacterial contamination with gas formation, manipulation after stillbirth, attempted resuscitation, possibly elastic expansion of the thorax in precipitous deliveries of the stillborn infant, and probably others .