Unexplained fractures explained

'Unexplained' fractures explained

12 December 2008
Dr Viera Scheibner PhD,
Scientist/Author Retired Dear Editor,
Blackheath NSW Australia

Send response to Once upon a time, more precisely in 1946, John Caffey,
journal: published an article "Multiple fractures in the long bones of
Re: 'Unexplained' infants sufferring from subdural haematoma" (Am J
fractures explained Roentgenology; 56: 163-173). In this article he considered
fractures in the long bones as a complication of the infantile
subdural haematoma associated with the fractures of the
cranium. Even though his own illustrations (x-ray
photographs) show what is generally considered typical
scurvy fractures, he denied any "roentgen signs of scurvy".
Without much ado, Caffey concluded that "The fractures
appear to be of traumatic origin but the traumatic episodes
and the causal mechanism, remain obscure". Indeed, in 1972
("On the theory and practice of shaking babies" Am J Dis
Child; 124 (2): 161-169), Caffey proceeded to speculate that
"all of these metaphyseal avulsions appeared to result from
indirect traction, stretching, and sheering, acceleration-
deceleration stresses on the periosteum and articular
capsules, rather than direct, impact stresses such as
smashing blows on the bone itself". Then, without a shred of
evidence, he called these findings "traumatic involucra" which
commonly accompany the metaphyseal avulsions and involve
the same terminal segment of the same shaft. He thought that
such injuries develop due to traction-rupture of abundant
normal perforating blood vessels, which are severed at the
junction of the internal edge of the periosteum with the
external edge of the cortex.

It is difficult to understand why such classical scurvy fractures

as shown in Caffey's own photographs were misinterpreted
even in his time; however, Caffey admitted in his 1965 article
"Significance of the history in the diagnosis of traumatic injury
in children" (J Pediatrics; 67 ((5): 1008-1014) that "It is still a
wonder to me that Ross Golden welcomed me, a pediatrician
without either formal of informal training or experience in
radiology, into his department of radiology and highly trained
radiologists." Why, indeed? The fact remains that Caffey
made a mess of things which even the years of supposedly
professional radiology have not rectified. The sooner the
rectification begins the better for not only thousands of victims
of Caffey's (and his followers') obvious ignorance and closed
mind, but also for those formally trained radiologists who
blindly follow misinterpretations of a formally untrained Caffey.

Hiller (1972), a formally trained Australian radiologist,

demonstrated that Caffey's misunderstood bizarre fractures
are in fact caused by scurvy, even though he did not explain
what actually caused scurvy in the affected babies ("Battered
or not - the reappraisal of metaphyseal fragility". Am J
Roentgenol Radiol Therapy & Nuclear Medicine; 114 (2): 241-
245).

According to Hess' far ahead of his time book (1920. Scurvy

past and present. Philadelphia and London J.B. Lippincott
Company: 279pp), one of the symptoms of scurvy are
haemorrhages such as into the gums, frenulum, skin and
bones, into the stomach, intestines (with fatty infiltration of the
liver), into the eye, under the conjunctiva or into the anterior
chamber leading to the destruction of the eyeball. He
described petechial haemorrhages into the lungs, pericardium
and elsewhere, meningeal bleeding, which may give rise to
apoplexy, haemorrhaging into scapula, periosteum and jonts;
infantile scurvy (which may by acute or subtle, sub- acute or
latent), with bizarre fractures of the long bones, ribs
(separation at the costo-chondral junctions resulting in
beading), scapula, cranium, separation of the epiphyses of
the head of the humerus, and partial or complete separation
of the lower ends of the femur, bleeding into muscles or
between the muscle planes, joints, heart characterised by
moderately dilated ventricles, and right hypertrophy, the heart
muscle pale and tough, the cardiorespiratory syndrome,
oedema etc. etc. etc. Scurvy affects all systems of the body.
Scurvy in the twentieth and twenty first century?

These days people generally think that nobody suffers scurvy,

which used to be identified with long sea voyages during
which the sailors were deprived of any fresh fruit and
vegetables. The reality is far from such idealised perceptions.
Most people probably have only marginal reserves of vitamin
C and this applies particularly to babies and small children.
Moreover, administration of vaccines depletes the marginal
vitamin C reserves very quickly and this results in an acute
scurvy. Vaccines of the kind given to babies as early as at
birth (hepB vaccine) and DPT, Polio, Hib and pneumococal
vaccines at 6-8 weeks, 2 and 4 months and other vaccines
later on, contain beside adjuvants and preservatives,
pertussis, diphtheria and tetanus, measles, mumps rubella
toxins which are treated with formaldehyde to lower their
virulence and toxicity. However, all of these treated toxins
(toxoids), bacteria and viruses have the ability to revert back
to their original toxicity and virulence by passage in the
injected individuals, as demonstrated by Samore and Siber
(1992. Effect of pertussis toxin on susceptibility of infant rats
to Haemophilus influenzae Type b. J Infect Dis; 165: 945-948)
and as early as in the sixties by Gerber et al. (1961.
Inactivation of vacuolating virus (SV40) by formaldehyde.
Proc Soc Exp Biol & Med; 108:205-209) and Fenner (1962.
The reactivation of animal viruses. BMJ; July 212: 135-142).
Two Czech researchers, Pekarek and Rezabek,
demonstrated already in 1959 (An endocrinological test for
inocuity of the pertussis vaccine. J Hyg Epidemiol Microbiol
Immunol; 3: 79-84) that when rats are injected with pertussis
vaccine, they develop an acute scurvy. My comment is that
the difference between rats and human species is in that rats
produce their own vitamin C and recover, while human babies
do not produce their own vitamin C and may not recover
unless they are given large doses of vitamin C (sodium
ascorbate). By the way, vitamin C is essential for the
production of collagen which is essential for the bones and
connective tissues.
 Many of those who have been involved in the study of shaken
baby syndrome (according to a California judge, it is a
factitious diagnosis carefully fabricated by medical profession)
have been rather shy or silent about the administered
vaccines, even though those vaccine injections are as a rule
the only documented facts. Without revealing the vaccination
status of the affected babies, the whole issue is not going to
be resolved. In court cases when parents are accused of
injuring their child, it amounts to withholding vital information.
Indeed, more recently some judges in Australia threw out the
accusations of SBS because of insufficient evidence (of the
alleged shaking or whether shaking can actually cause the
observed injuries). One can't convict a person based on an
opinion; medical opinions are subject to errors and changes.
In a normal ordinary murder case people cannot be convicted
on someones' opinion; in cases of SBS the accused parents
are effectively convicted on someone's opinion.

The picture is really crystal clear, at least for people who

really study medical literature right from the first and original
articles. If you set out to study the ancient Rome, you should
read the authors who lived in the ancient Rome and not those
who did not and who, inevitably base their perceptions of the
ancient Rome on second and third hand information.
Everybody is familiar with the school children's game "The
Chinese whispers": the original word totally changes before it
reaches the last person in a line. In medicine, for some
reason which escapes me, many authors think that they not
only don't have to, but they must not study older published
information. Their patients may suffer.

Moreover, due to the known inevitable political interference,

political correctness may delay the truth for centuries. Yes, I
am referring to The Holly Inquisition. However, these days we
have a freedom of speech and the truth is allowed to prevail.
Why not see and reveal it?

Competing interests: None declared

Our tunnel view may miss a child abuse 16 December 2008
Khalid Alkhouly,
General Surgeon, Child abuse has its own proportions as a social and medical
HDSJH, NB, Canada
problem. The number of abused and neglected children in the
Send response to
United States rose from 1.4 million in 1986 to 2.9 million in
journal:
1993.[1] We all may agree that its actual incidence is
Re: Our tunnel view
unknown and many cases are unreported. Unfortunately, the
may miss a child abuse
problem is still identified in retrospect after a history of
repetitive trauma has been established. [2, 3]

Awareness of the skeletal signs of abuse in children is

important