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[Starvation due to child neglect. Case report and aspects of expert testimony].

Case report on 2,5 years old monozygotic twins who died of starvation due to negligence. Different gradings of protein-energy-malnutrition are discussed, among them the Waterlow-classification of PEM. The advantage of the Waterlow-classification is that stunting and wasting can be distinguished. The Waterlow-classification is suitable also for the classification of fatal cases of starvation in childhood. Practical experiences with own cases and cases from the literature are presented.

Adipose Tissue↗

Brutality to twins in south-eastern Nigeria: what is the existing situation?

Following rumors of some persistence of abuse on twins, a survey was conducted from January through June, 1991 in the rural areas of Efik, Ibibio and Annang tribes of South-Eastern Nigeria to determine the current attitude of the people towards twins and their mothers. Of the 619 women interviewed, 56% cherished having twins; 35% would not desire largely because of the economic and other minor difficulties associated with their up-keep but none of these would abandon the infants. The remaining 9% hold a taboo against twins: as babies derived from the devil, non-human and punishment from the gods for sinfulness. Consequently, 2.3% and 2.6% of the mothers would have their twins rejected and killed respectively and 6% of the twin mothers would be cast out but none killed by their husbands' families. The intention to perpetuate this form of abuse was elicited in all the three tribes but seemed relatively to be most pronounced in Annang people. The information generated, though limited to rural population, suggests that the rejection of twin births has actually not yet disappeared from this part of the country. Health workers in South-Eastern Nigeria who encounter twins with failure to thrive should consider rejection as a possible contributing factor. It would need intensive moral education and religious teaching to stem this brutal culture.

Child Abuse↗

SIDS and homicide.

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Diagnosis, Differential↗

[Abortion in Japan].

In Japan, the artificial abortion is a penal offence; only in the presence of certain conditions it is authorized under the provision of the Eugenic Protection Law which was promulgated in 1948. According to the law, the artificial abortion is restricted to the period, in which the fetus is not viable outside of the uterus. This period is prescribed by notification from the Ministry of Public Welfare; up to now it has been shortened twice (1976, 1991). Due to the introduction of economic reasons in the list of conditions and the simplification of the procedure the artificial abortion in Japan was virtually liberalized. Prosecution for illegal abortion is very rare in recent years. The number of reported artificial abortions decreases; in the about last 30 years it reduced by half. However, the increase in the number of abortions in women younger than 20 years of age is a problem. The abortion in teenagers is late compared with that in other age groups. Although the number of neonaticides does not seem to increase, the increase in the number of abortions in teenagers remains a serious problem in Japan.

Abortion, Legal↗

[Hippocrates or Taigetos--ethical dilemmas in neonatal surgery].

As a result of the decrease of the medical authority and the increasing power of the lawyers, the relationship between doctors and patients, patients and society has changed. The situation is more complicated in the case of neonates, infants and children who are unable to articulate their rights and wishes. The problem is complex in connection with the fetus because their interest and that of the mothers are often in conflict. The neonatal surgeon--only together with the geneticist, obstetrician and neonatologist--plays and important role in the evaluation of the mentally or somatically handicapped fetuses and neonates. The neonatal surgeon should suggest the termination of a pregnancy, should give his/her expert opinion about the result of the treatment of a malformation or should propose the withdrawal of the intensive care in the case of a critically ill neonate. Fetuses and neonates with congenital anomalies can be divided into 6 groups. 1. potential for total recovery--2. anomaly enabling a nearly normal life--3. malformations requiring permanent supervision and/or medical care--4. somatic rest defect and subnormal mental development--5. serious somatic and mental damage--6. anomal incompatible with life. In the complex evaluation of a fetus or a neonate with congenital malformation the neonatal surgeon--while not forgetting his/her Hippocratic oath--should take into consideration the quantity and quality of the rescued life, possibilities of a long treatment he/she should act according to the law and fulfil the expectations of the society.

Congenital Abnormalities↗

Recall and repetition of a severe childhood trauma.

This study focuses on a patient who at the age of 3 survived the extended suicide of her parents. The account concentrates on the way in which this woman repeated the experiences of her trauma in the highly emotional therapy process (initially infrequent), and then how she recalled them at different stages and with variations, and it shows the decisive involvement of the analyst in this activity, in parallel processes of defence and reconstruction. The distinction needs to be drawn between the reproduction of the trauma, the form in which the extreme trauma is indelibly tattooed on the memory, and actual recalling. This is to be regarded as a method of analytical understanding, general in its applicability, as an evolving retrospective imposition of sense, by means of which the previously valid construction of knowledge is revised in accordance with the central relationship in the present. What the patient recalled as trauma events in evolving perspectives revealed itself as an overpowering prefiguration (attainable a posteriori) of the vicissitudes of transference. With regard to extreme trauma in childhood, this study develops the following hypotheses: (1) the overwhelming, shattering blow of an external event is met by an equally strong, archaic defence, even in the historical situation itself, as an escape from the unbearable, unspeakable pain; (2) the Janus face of the victim/perpetrator introject is manifest in the masochistic character-structure; (3) these splits can be attenuated in the course of a person's life, with the appropriate help, although they cannot be fully integrated.

Adolescent↗

Reinventing the tale.

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Anthropology, Cultural↗

[Homicides without clues in children].

From 1990 to 1995, 274 deaths of infants (age range 7 days-6 years) were investigated in Münster, where there were no indications of suspicious circumstances. In 167 cases a legal autopsy was carried out and revealed 5 homicides. In 107 cases where an autopsy was not ordered by the prosecutor 3 homicides were discovered. A similar frequency of homicides in both groups indicates that the criteria used to form the basis of a decision by the prosecutor to release the body are insufficient. On average one out of 30 cases was found to be a homicide as the result of the autopsy where the initial assumption was death from natural causes.

Autopsy↗

Childhood homicide, suicide, and firearm deaths: an international comparison.

This article is intended to provide a better understanding of the incidence of violent deaths among children under 15 years of age in highly industrialized countries/areas. We found that rates of violent childhood deaths are not uniform in the industrialized world and that rates in the United States greatly exceed those in the other countries and areas. In fact, total firearm deaths among children are 12 times higher in the United States than in all of the other countries or areas combined; childhood homicide rates are 5 times higher; and childhood suicide rates are twice as high. Five countries or areas, 3 of which are in Asia, reported no firearm deaths among children under 15 years old. These findings suggest the value of conducting further research to explore these cross-national differences.

Adolescent↗

Don't shake the baby.

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Child Abuse↗