Problems and Challenges with Inflicted Trauma at the Extremes of Life
Moderators: Gregory G. Davis and Roger W. Byard
Section 1 -
The History And Recognition Of Child Abuse
Child maltreatment is now recognized as one of the major public health problems in our society. In
countries where mandatory reporting of cases of abuse has been established, the number of reports
increases from year to year. Yet, 50 years ago, this subject was not even taught to medical students.
Must we conclude that this is a new problem and that it is in constant progression?
The analysis of the situation of children living in past centuries fully demonstrates the contrary.
In this presentation, I will describe some examples of maltreatment based on the history of children in
Western society. I will then present how the medical community became aware of this problem and then in
turn brought about a heightened awareness of society as a whole of the importance of protecting children.
1. History of child maltreatment in Western society
In ancient times, most societies used infanticide to get rid of illegitimate, undesired, or
handicapped children as well as those born of incest. Before the Christian era, in Rome, Athens and
Sparta, it was the fathers or the elders who decided whether the newborns would live. Even though
infanticide was strictly forbidden at the beginning of the Christian era, it was still carried out on a
large scale until the beginning of the 20th century.
Infanticide was used as a method of family planning in times when contraception was forbidden and not
very effective. Abortion was not only prohibited, it was very dangerous and caused the death of a third
of the women who risked having the procedure. For many families living in extreme poverty, infanticide
was a means of avoiding putting their own survival in danger. It also prevented condemning a child to a
life of misery. In the case of illegitimate pregnancies, infanticide allowed the mother to avoid being
socially outcast for having a "bastard" child.
To lower the number of infanticides, religious authorities encouraged mothers who did not want to keep
their babies to leave them on the steps of a church. In the beginning, these babies were taken to
hospitals. Later there were foundling homes specially designated for their care. The number of
abandoned children increased considerably over the years, which caused significant problems for their
Before the discovery of germs and effective methods of conserving cow's milk, the only means of safely
feeding abandoned babies was to place them in the care of wet nurses. As it was difficult to find such
nurses in the city, the children were sent to the country. Feeding problems, poor hygienic conditions
and transportation problems were responsible for an alarming mortality rate of these babies, situated
between 50 and 90%, depending on the place and the period.
In the past, as in today's society, children were beaten by parents who had lost their self-control or
had sadistic tendencies. What was particular to past centuries was that physical abuse was carried out
systematically on the majority of children with the objective of raising them properly, with the consent
of civil and religious authorities, as well as the majority of experts on child rearing.
Testimonies concord to the effect that the favoured method of discipline, from ancient times to the
20th century, was severe physical punishment, with the help of instruments such as cords, whips, sticks,
belts, rods, and ferules. Few children in past centuries escaped brutal physical aggressions at home, at
school, or in their work environment.
In the past, it was imperative that the child submit to the authority of the father or his
representative. Immediate obedience of the child was mandatory and was to be obtained at any cost.
Civil laws, influenced by the ancient roman concept of "patriae potestas", wholly endorsed this attitude.
Religious authorities also supported this way of doing things, due to a literal interpretation of certain
passages of the Old Testament and the concept of original sin, seeing every child as being contaminated
by evil at birth.
In the times of Plato in Greece , pederasty was customary. Later, many factors contributed to the
sexual abuse of children by strangers. Children were easy prey in situations where they were without
protection and in the presence of adults in authority: children who were slaves, abandoned, orphans, or
placed as apprentices or servants. The very young legal age for sexual relations and marriage made abuse
easier from the age of 10 years on. Juvenile prostitutes were in demand by clients wishing to avoid the
risk of contracting sexually transmitted diseases. Many even believed that having sexual relations with
children cured these diseases. Even in their own families, children were not always safe. Sexual abuse
was made easier by overcrowding in dwellings, the habit of sharing beds, and the belief that children
under the age of seven could not be influenced by sexuality.
To teach their children morals in the past, parents brought them to witness very cruel public
punishment of criminals. To make children obey, they were threatened with terrifying imaginary
characters or apocalyptic visions of hell. A popular method of punishment was to confine children to
dark spaces for hours at a time.
In times when life was particularly difficult, misery, often associated with alcoholism, led many
parents to neglect their children. For younger children, neglect often led to early death by disease or
accidents. Older children were often left on their own in the streets of large cities. These children,
called "street Arabs", had to take care of their own subsistence. If they could not find work, they had
to resort to begging, stealing or prostitution.
Before school was legally declared mandatory at the end of the 19th century, children started working
at a very young age to contribute to the subsistence of their families. Since the majority of families
lived in the country, most children were initiated into work on the farm. In the cities, from the age of
seven years old, children were placed as servants for rich families or apprentices with craftsmen or
At the beginning of the 19th century, the industrial revolution created a high demand for children to
work in industries. The use of machine tools completely transformed the work place because industries
could use non-qualified workers for repetitive tasks. It was very advantageous to use children to do
such work because they were docile and, especially, because they could be paid much less than adults for
Work conditions in the industries were horrible: long hours, filthy work environments, and risk of
accidents. The small stature of children was exploited in mines, where the work conditions were even
worse. The consequences were tragic: work-related illness and disease, stunted growth, physical
deformities, work accidents, as well as physical and sexual abuse.
Harmful childcare practices
Many methods of caring for babies used in the past now appear clearly abusive to us, such as giving
them ice baths to toughen them and swaddling them until they were a year old. To calm babies' crying and
to put them to sleep, they were given alcohol or opium, which led to addiction and even death by
From Antiquity until the end of the 19th century, many children were not breastfed by their own
mothers, but rather by a wet nurse. It was believed that breastfeeding weakened the mother and harmed
her appearance. She was forbidden to have sexual relations for fear her breast milk will go bad or that
her menses would return. Mothers with financial means had their babies breastfed by poorer women for a
period of one to two years. The richest women were able to keep a wet nurse in their own homes. In the
majority of cases, babies born in the city were sent to the country to be breastfed. This system led to
much abuse and a high death rate among children fed by wet nurses as well as among the wet nurses' own
Among the aggressive and useless medical interventions practiced in the past, the fight to stop
children from masturbating deserves our attention. Physicians claimed that masturbation could cause
serious physical or mental health problems: alteration of vision, vertigo, apathy, sullenness,
hallucinations, or insanity. They thus recommended several methods for parents to use to prevent their
children from masturbating: hands tied behind the back, genital organs wrapped in bandages, cold baths,
and physical punishment. In the case of failure, some did not hesitate to resort to circumcision,
clitoridectomy, or cauterization of genitalia.
2. Recognition of maltreatment
In 1651, Paulus Zacchias, an Italian, was the first forensic physician to describe the lesions caused
by violence inflicted upon children. James Parkinson, the famous English physician, reported in 1800
that blows to the head were among the causes of hydrocephalus in children and warned parents against
severe and frequent physical punishment of their children.
Ambroise Tardieu, a French forensic physician, was the first to describe all of the characteristics of
the syndrome of the battered child in an article written in 1860. He also described 632 cases of sexual
abuse of girls, of which 70% were younger than 13 years old. Furthermore, he studied and published
articles on infanticide, negligence and the exploitation of children in the workplace. Unfortunately,
his extensive work did not have a significant impact on his contemporaries.
In 1946, John Caffey, an American pediatric radiologist, reported 6 cases of babies presenting
subdural hematomas in association with long bone fractures. He suspected that these lesions were of
traumatic origin, which would be confirmed in subsequent years with the help of fellow radiologists,
including Frederic N. Silverman.
C. Henry Kempe, a pediatrician from Denver, and his colleagues published "The battered child
syndrome" in the JAMA in 1962. This article described their study of 302 cases of physical abuse of
children. It was this classical text that finally led to the wide recognition of child maltreatment as a
public health problem.