Expert Witness Journal Dec 24 - Journal - Page 74
In the end, having been schooled by Roy as to the
likely mechanism, when I questioned the mother,
through an interpreter, she, a lady of ‘traditional build’
as Alexander McCall Smith might say, explained that
she had been concerned that her son was not growing
adequately and that she regularly massaged his limbs
by forcefully pulling them in order to stimulate
growth.
I now have come to understand that a society may
pass through a spectrum in its acceptance of categories
of abuse, and do so in stages. Each stage leads on to
greater understanding and to the next stage. The process no doubt never finishes and where we are today,
in 2024, cannot be the end of the journey. But the passage from one stage to the next is not a steady or well
mapped one. With each step, new ground is being
trodden, aided by greater understanding and, often,
with developing technical and scientific support.
The bench accepted this explanation for the fractures
and, whilst her actions had caused significant harm, it
was possible for the social services and medics to give
her advice and monitor the child’s progress at home.
He was not adopted.
From physical abuse in the 1970s, in this country we
moved on to begin to understand issues around sexual abuse in the 1980s. This was by no means a
straightforward or easy journey. By the middle of the
decade there was intense and well reasoned professional debate over a range of matters. For example,
what were the physical signs of past sexual abuse that
might be seen on a child? In particular, whether any
such sign might be thought to be, of itself, diagnostic?
Were the words of a child in response to questioning
more or less reliable depending upon the way in
which the questions were asked and by whom? Separately, if you placed a child in a room with some dolls,
some of which were anatomically correct [if you know
what I mean], did the child’s interest in the genitalia of
a doll indicate, one way or the other, whether they had
been sexually abused?
‘From little acorns’ ….
For me that case, and particularly that contact with the
medical science behind it, stimulated an interest in
child abuse and child protection which has developed
and continued down the ensuing 40 years.
But for paediatric radiology in the UK, I suspect that
the presence of Dr Roy Astley in Birmingham, followed at the very time that I am speaking of, by the arrival of his protégé Dr Stephen Chapman, was also
something of a ‘little acorn’ event.
Thus, in a way, but for me it is a clear way, I feel that I
have a debt to paediatric radiology and to Roy Astley
and Stephen Chapman with whom I developed, over
the course of many cases in Birmingham and elsewhere down the years, a most stimulating professional
relationship.
These and many more similar questions swirled
around and were the subject of intense consideration
in the courts, which relied upon experts in paediatrics,
other fields of medicine, child psychiatry, psychology
and social work for advice.
My reason for burdening you all with this personal
memory is not just to acknowledge publicly my interest in and support for your profession, it is to tee-up a
much wider point about the protection of children
from child abuse and the importance of experts within
the court process.
Matters came to a head in Middlesbrough in 1986/87
when 2 paediatricians came to diagnose child sexual
abuse in no fewer them 125 cases over the course of
just a few months. The report of the ensuing public
inquiry, chaired by Dame Elizabeth Butler-Sloss, as she
then was, provided a watershed moment and purported to give an authoritative view on many of the
subject’s professional debate at that time.
Back in the days of which I was speaking, and before
the Children Act 1989, professional knowledge about,
and indeed understanding of the prevalence of child
abuse in society, was very much in its infancy. I will
offer one or two examples.
Pausing there, I suspect that those in the audience,
like me, had understood that what had happened in
Cleveland arose from misdiagnosis by the two paediatricians. In that regard a recent book by journalist
Beatrix Campbell, ‘Secrets and Silence’ may be of interest. All these years later, with the ability to inspect
previously confidential documents in the National
Archive, the book explains that most of the children
were probably the victims of sexual abuse, and therefore the diagnosis by medical professionals was likely
to be correct. The book reveals a lack of transparency
which has had lasting impacts. As a result, there has
been a continuing false belief that the Cleveland children did not experience sexual abuse and that the crisis was the result of over-zealous and incompetent
practice.
It was only in the 1970’s – yes, the 1970’s – that the
understanding that parents might physically abuse
their children became widely accepted. Before then,
when children were presented at hospital with multiple physical injuries, and the parents denied being the
cause, the medical profession were baffled. Of course,
it was thought, parents would not intentionally harm
their child, so there must be some other cause, but
what was it? These cases were therefore labelled ‘unexplained infant trauma syndrome’. It was only when
two esteemed American paediatricians, Ruth and
Henry Kempe published their seminal work on ‘Child
Abuse’, that physical abuse by parents and the concept
of there being ‘Battered Babies’ came to be accepted.
You will think of this as ancient history now, but it isn’t.
Kempe’s book was published in 1978, a date which
shows just how far we have come in just 50 years.
EXPERT WITNESS JOURNAL
After sexual abuse, professional understanding moved
on to understand something of factitious illness, emotional abuse, domestic abuse leading, only recently, to
72
DECEMBER 2024
