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Intracranial sewing needles: Review of 13 cases.

Three new cases of intracranial sewing needles are reported and are reviewed with 10 other published cases. These needles must have been introduced in infancy before the closure of fontanelles. The intention, at least in most cases, has been infanticide. Except in one case which the mother reported and two cases found at necropsy, the others were diagnosed by skull radiography. Headache and epilepsy were the main symptoms and they often appeared when the patient had reached adulthood. Removal of the needles lessened the symptoms.

Adult↗

Homicidal parents.

This paper describes a series of 13 cases of parents who have killed their children. A review of the literature suggests that child murder is infrequent and committed in most instances by the parents. Most attention has been directed to the universal phenomenon of child abuse. The killing of a child in our culture is viewed much more seriously than the killing of a newborn infant, legally defined as infanticide. Only a few authors have reported on the former, and their studies tend to demonstrate that a higher proportion of these crimes are perpetrated by mothers. Homicidal behaviour in parents may also be associated with common forms of psychiatric disorders and may manifest as the extended suicide phenomenon (homicide reported with major depressive illness). Attributes of both parents and the children are also significant factors to be considered. In a retrospective study the relevant demographic and clinical data of a series of 13 cases are reviewed. The diagnostic classification using DSM-III-R is discussed in detail. A higher incidence of maternal perpetrators was found and is consistent with previous studies. Exposure to a variety of psychosocial stresses appears to have been a major factor. Similarly the suicidal history and behaviour of the subjects is significant. Affective disorder appears to be an important diagnostic category. Finally, the role of psychiatric and other social agencies is considered in relation to the murder of children. A better understanding of this phenomenon is indicated in order to help us deal with families at risk.

Adolescent↗

Women who kill their children.

During a 6 year period (1970-75) 89 women charged with the killing or attempted murder of their children were examined in a female remand prison. Six types of maternal filicide were distinguished: battering mothers (36 cases), mentally ill mothers (24 cases), neonaticides (11 cases), retaliating mothers (9 cases), women who killed unwanted children (8 cases) and mercy killing (1 case). Types of filicide were compared on a number of social and psychiatric characteristics and on their offence patterns and court disposals. The operation of the Infanticide Act is discussed in the light of these findings.

Adult↗

Yesterday, today, and tomorrow's pediatric world.

The paper covers the historical evolution of children's health care beginning in antiquity and proceeding into the present. Various themes emerge including the indifference of society to children and the overt acts of infanticide and child abuse. By the 18th century new information in the field of medicine and chemistry led to improvements in the physical care of children. A spirit of humanism and the rise of the health professions joined forces in the late 19th century to institute important changes in the health status of children. Finally, several current national trends are discussed in light of their potential impact on child health care.

Child↗

The comparative constitution of twinship: strategies and paradoxes.

In both traditional and modern societies, twinship, as an unusual mode of reproduction, involves difficulties for social systems in maintaining consistent classification systems. It is proposed that the most prevalent response to twinship involves various 'strategies of normalisation' to defuse and contain the potential disruption. This proposition is illustrated and analysed in relation to ethnographic maternal drawn mainly (but not exclusively) from African communities in the twentieth century. Following a discussion of twin infanticide as the most extreme of the normalising strategies, the article concludes by identifying a number of paradoxes in the social construction of twinship.

Africa↗

Twin death and mourning worldwide: a review of the literature.

Cultural beliefs about the nature of multiples appear in the mourning practices of many civilizations. Ethnographic literature suggests common themes that echo modern concepts. Many societies viewed twins as fragile, likely to die without preferential or meticulously equal treatment. A shared soul between twins is a common tenet, and the death of one is often felt to herald the other's prompt demise. The close relationship between multiples influences funerary rites. Honor, fear and mysticism are often evident in rituals. Twin infanticide was widely practiced, yet mourning customs were still observed. Many peoples recognize the special status of multiples and their families after one, two or more die.

Attitude to Death↗

Homicide in childhood: a public health problem in need of attention.

Homicide is now among the five leading causes of death in childhood, accounting for 1/20 deaths of those less than 18 years of age. Based on childrens' changing developmental vulnerabilities, it is possible to characterize three subtypes of child homicide--infanticide, fatal child abuse and neglect after infancy, and homicide in the community. Specific approaches to primary prevention include measures to strengthen families and their community support systems, and to educate adults and children concerning appropriate behaviors of children at different ages.

Adolescent↗

Abuse and neglect in the surgically ill child.

Child abuse and neglect are a global phenomenon often symptomatic of underlying psychosocial family problems, which may represent a transferred aggression from one or both disturbed parents onto the child. Although the scope has been widely explored in Africa, little has been written on children presenting with surgical lesions. We report 31 children abused by their parents on accounts of frustrations engendered by the children's surgical conditions in Lagos. 26 (83.9%) of these children had major congenital defects while only 5 (16.1%) had acquired lesions. The commonest form of abuse was child abandonment, seen in 9 (29%) of cases. Neglect was recorded in 7 (23%) cases while 2 children were mutilated because of surgical lesions. Three patients were starved, 3 children with colostomy were evicted by landlords while 2 were locked up by parents out of shame. One child died of infanticide. Reasons for abuse included financial constraints, hopelessness and shame associated with grotesque lesions, broken homes and maternal pregnancy. Doctors and nurses engaged in the care of gross congenital anomalies and other major surgical lesions should anticipate this problem and evolve appropriate strategies to deal with it. The social worker should be involved early enough in the management. Provision of adequate social safety nets, affordable medical care and specific legal protection for children will curtail this ugly trend in our society.

Attitude to Health↗

Ethical issues in the application of medical technology to paediatric intensive care: two views of the newborn.

Recent advances in medical technology have led to a marked improvement in the chances of survival of sick or preterm infants, thereby stimulating renewed ethical debate on the status of the newborn. Two contradictory attitudes to the medical care of preterm or congenitally malformed newborn infants can be discerned in our pluralistic society. The two attitudes have their historical roots in the classical Graeco-Roman and Judaeo-Christian ethical traditions respectively. The former views newborn infants as of potential value only whereas the latter emphasises the intrinsic worth and dignity of the individual made in God's image. Recent secular philosophical reflection has provided a rationale for infanticide of the sick or abnormal newborn. A Christian approach to the care of the newborn prohibits intentional killing yet may encompass the withdrawal of treatment that is inappropriate or unduly burdensome. Medical care should be based upon respect for the value of the individual, protection of the defenceless from abuse or exploitation, and wise stewardship of limited health-care resources.

Attitude↗

Separation-survivability--the elusive moral cut-off point?

Act 92 of 1996, the Choice on Termination of Pregnancy Act, seeks to promote female autonomy. The Act makes no reference to the nature of the abortus--implying its moral insignificance. Utilitarian arguments on the value of life strongly support this position. Utilitarians argue that neither belonging to the human species, nor possession of the potential to develop into a person, is a significant intrinsic characteristic in determining the value of life. For them the entrance requirement to any conception of moral significance is sentience--the ability to suffer. Full moral significance is only accorded to 'persons'. A person is someone who has attained a sufficient level of self-awareness to have an interest in the continuance of its existence. This develops some time after birth. 'Conservatives' argue for conception as the moral cut-off point after which termination is morally unacceptable; 'liberals' hold that there is no such prenatal point. Both of these notions are problematic, as is the notion of sentience. We argue that separation-survivability is the only morally acceptable cut-off point, based on four premises, viz. (i) a particular notion of potentiality; (ii) the inextricable, mutual relationship between human beings and their world (without either, the other cannot exist); (iii) the moral correspondence of the viable fetus and the neonate; and (iv) the moral unacceptability of infanticide. We support a graded position on the value of prenatal human life, and a 'moderate' stance on termination--that notwithstanding possessing some moral significance, other arguments may trump this up to the point of separation-survivability. This seriously problematises 'partial birth' abortion, and the utilitarian argument on the value of life.

Abortion, Legal↗

History of son preference and sex selection in India and in the west.

In the history of mankind, there was a time when women dominated the world. In due course of time, as the patriarchal societies evolved, the status of women gradually declined. Sons were preferred to daughters. In India, the Brahmin community promoted such customs and rituals, which gave more and more importance to sons eg. Lighting the funeral pyre of the father was told to be a pre-condition for salvation of his spirit. Similarly, in western civilization also women were considered to be weak. In consonance with such a mind-set man has been trying various techniques for sex-selection since antiquity eg. for acquiring a son choosing a special day, time and posture for sexual intercourse, special diet, charms and amulet and prayers etc. In Vedas also punsavana karma has been described as a technique for acquiring a son. Apart from these techniques, female infanticide has also been used as a way to create a male dominated, son-worshipping society. On development of the technique of ultrasonography as an example of progress of science and technology, man has devised a new way of killing females in womb itself, which has resulted in continuous decline in female: male sex ratio in India. To stop this, Indian Govt. promulgated PNDT Act 1994. But considering the widely prevalent practice of use of various regimen of sex-pre-selection by people as well as unscrupulous medical practitioners, Govt. of India has amended this Act (2002). Still, as authors have found in one of their studies, sex-selection drugs are being used widely by north Indians for getting a son. Here, it should be noted that sex-selection methods are being used in west also. But the perspective is different. There, it is not used for female feticide or for acquiring a son. Rather, it is more an effort towards demonstrating the control of man over the NATURE.

Abortion, Induced↗

Postpartum psychosis: a family's perspective.

One couple's experience of a postpartum mental illness that led to the tragedy of infanticide is described. A case background is presented to highlight significant objective data relevant to a previous pregnancy. Individual recommendations are made to the health care profession on how to better intervene with families experiencing a postpartum psychiatric illness. Nursing implications are discussed.

Counseling↗

Neonaticides following "secret" pregnancies: seven case reports.

Seven neonaticides were reported during a 14-month period in the State of Iowa. This is an alarming number considering that only one such case was reported in the previous year. The majority of cases involved the birth of a live infant to an adolescent who had reportedly kept her pregnancy secret from family and friends. The death of the infants resulted from exposure or drowning. Efforts were made by the mother to hide or dispose of her infant's body. Basic information about each of the reported cases is presented, as well as the sentences given the adult mothers charged with the crime of child endangerment. The dynamics of these cases are reviewed in the context of earlier studies dealing with the phenomenon of neonaticide. Infanticide has deep roots in several cultures. It was practiced in some primitive societies and was decreed a capital offense as early as 1643. Its occurrence recently prompts suggestions for activities by professionals to prevent these tragedies. More research and further attention to this problem is warranted.

Adolescent↗

The psychiatrist's guide to right and wrong: Part III: Postpartum depression and the "appreciation" of wrongfulness.

Whether or not the psychiatrist testifies on the ultimate issue in insanity defense cases, it is critically important that he familiarize himself with the applicable legal standards and interpretations in order properly to relate his clinical findings to the relevant criteria for insanity and thereby enhance the probative value of his testimony. This is the third in a series of articles which attempts to explicate judicial and statutory standards of insanity and correlate them with the psychiatrist's findings of psychopathology. This article analyzes the Model Penal Code formulation of insanity, with special emphasis on the all important distinction between "know" and "appreciate." This formulation permits the defendant possessed of mere surface knowledge or cognition to be exculpated, requiring that he have a deeper affective appreciation of the legal and moral import of the conduct involved if he is to be held criminally responsible. The Model Penal Code approach more readily lends itself to application as a standard of responsibility in cases involving affective disorders. An important disorder within this group, postpartum depression, is discussed in the context of raising the insanity defense in a case of infanticide.

Adult↗

Immunohistochemical demonstration of homicidal insulin injection site.

Deliberate fatal injection of insulin is apparently a rare event. Its investigation generally requires demonstration of an exogenous insulin injection site and high blood or tissue levels. Interpretation of such results in postmortem samples can be difficult, and the demonstration of an insulin injection site has previously usually involved a tedious extraction procedure. We report a case of infanticide in which insulin was demonstrated immunohistochemically at the fatal injection site and discuss some aspects of interpretation of postmortem insulin levels.

Autopsy↗

Five decades of missing females in China.

This paper seeks to explain the dearth of females in the population of China in cohorts born from the late 1930s to the present. We demonstrate that in virtually all cohorts, the shortage of females in comparison with males is revealed when the cohort is first enumerated in a census. Subsequently it barely changes, an indication that female losses occur very early in life. Using the high-quality data from the censuses and fertility surveys in China, we show that many of the births of the girls missing in the censuses were not reported in the surveys because they died very young. The incidence of excess early female mortality (probably infanticide) declined precipitously in the Communist period, but not to zero. The recent escalation in the proportion of young females missing in China has been caused largely by rapidly escalating sex-selective abortion.

Abortion, Legal↗

A killing of Baby Doe.

An anencephalic infant died in the Neonatal Intensive Care unit six hours after birth. Eighteen months later, in a discussion of intrusive federal "Baby Doe" regulations with co-workers at the hospital, a registered nurse mentioned that he had found a way to avoid these provisions, and that he had in fact done so on one occasion by killing this particular infant. A co-worker related his story to police, and the "wheels of justice" were set into motion. I describe the chronology of events and the pathologic findings in this case of infanticide, purportedly committed "with mercyaforethought."

Anencephaly↗