Section 1 -

The History And Recognition Of Child Abuse Jean Labbé

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 Infanticide 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. Abandonment 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 survival. 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. Physical abuse 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. Sexual abuse 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. Emotional abuse 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. Negligence 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. Working children 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 tradesmen. 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 identical work. 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 intoxication. 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 children. Medical abuse 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.