The Natural History of Child Abuse: A Study in Social Problem Definition

Author(s): NIGEL PARTON

Source: The British Journal of Social Work , 1979, Vol. 9, No. 4 (1979), pp. 431-451
Published by: Oxford University Press

Stable URL: https://www.jstor.org/stable/23698160

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 The Natural History of Child Abuse:
A Study in Social Problem Definition

NIGEL PARTON

Nigel Parton qualified as a social worker at Bradford University, and subseque

Essex University. He has worked as a basic grade social worker in a social servi
and is now lecturer in social work at Huddersfield Polytechnic.

SUMMARY

Using a natural history model, this paper attempts to understand and explain
problem of child abuse was recognized in Britain when it was and in the manner i
was. It traces its development from the initial discovery in America. Particular e
given to the work of the NSPCC battered child research unit, Sir Keith Joseph, the T
Wells Study Group and the media in contributing to the social reaction to the cas
Colwell, which established non-accidental injury as a major social problem in Brit
developments have had implications for the changing role of the personal social se
may reflect broader changes in the control culture and the relationship between the
the family.

Non-accidental injury to children is now perceived by numerous authorita

tive sectors of British society as a major social problem.1 However, it is only
in recent years that we have become so conscious of the phenomena. It
seems that health visitors, social workers, doctors, psychiatrists, police,
teachers and others are spending an increasing proportion of their time
trying to control, reduce and monitor the problem. This paper argues that
we cannot understand these developments simply by trying to catalogue
the 'objective' clinical characteristics and dimensions of the problem, for
these have existed in some form throughout history. If we are to try and
explain why recognition of the problem emerged when it did and in the
manner in which it did, we must analyse the social forces that facilitated,
influenced, initiated and reacted to it. Apart from contributing to the
general study of the ways social problems come to be defined, it is hoped
also to illuminate the way social policy2 emerges and develops in relation to
these problems. More specifically I hope to be able to illustrate, and make
explicit, the way in which certain assumptions, conceptions and interests
have contributed to and influenced developments in one specific area of
social policy.

THE NATURAL HISTORY APPROACH

I will suggest that the emergence of a social problem is contingent

Br. J. Social Wk, 9, 4. Printed in Great Britain

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432 NIGEL PARTON

organization of activities that define

and assert the need to 'do somethi
ceived are not static conditions but se
and every social problem has its o
suggested, 'every social problem has a
of stages, each stage reflecting a chan
kind of definition it is given, and th
problem'. In outlining a natural histo
are the critical actors in each stage, h
why their definition seems pre-emine
stake. In doing so I will be primar
sources of the labels non-accidental in
istics, variations and forms.
I shall consider the natural history a
might call the stages of discovery, di
The first stage in this development o
person or group sees a set of condi
important to identify: To whom do
What brings it to their attention as a
the problem has come to someone's at
shared and widespread. Therefore, th
must point it out to others and con
enough to require public attention (di
asking: What kinds of people will the
to convince? What are the best tactics? W
promoting widespread public conce
might be identified when the state, i
welfare/control agencies, is either gi
new agency is created for such a role
Perhaps finally we can identify a s
granted as a natural area for conce
agencies and professions who have a v
(reification).

ALTERNATIVE IDEOLOGIES OF THE

MANAGEMENT OF NON-ACCIDENTAL INJURY

In attempting to outline a natural history of child abuse it is

and establish for each stage how the problem is conceived, wh
is pre-eminent and who are the primary definers. It is thus im
discuss who have been the major interest groups in the hi
suggest how their ideologies, in terms of which social problem
fied, manipulated and controlled, differ. We can then begin to

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 THE NATURAL HISTORY OF CHILD ABUSE 433
why and how conceptualizations of child abuse and its management
vary.
I am using the term ideology simply to refer to the general assertions h
about the nature of human behaviour, its causes and how to change it.
only being used to relate to a shared or collective set of ideas. The ideolo
themselves are of an ideal type and will seldom be found in practice in t
entirety for the operational procedure may differ from abstract ideolog
Stoll6 has argued that the main factor in differentiating such ideologie
the control agents image of man with respect to his belief about the abil
of individuals to control their own destiny. So that

to the extent that individuals believe non-conformity to be conscious defian

rules .. . then they will prefer to restrict and castigate deviants ... and to the ex
that individuals believe non-conformity to be the result of external forces (o
determinists holding 'sickness' assumptions) then they will prefer to treat or
deviants without accompanying approbrium'.

Such an analysis reflects the ideologies of the two major control ins
tions: law and medicine. Put simply, crimes are those deviant act
attributes for which individuals are held responsible, and illnesses are t
for which they are not. Scheff7 suggests that people who work accordin
the medical ideology typically assume it is better to impute disease rath
than risk overlooking it, for they believe that the work they do is all for
good of the client. In contrast the legal ideology assumes that it is better
allow a guilty man to go free than to mistakenly convict an innocent m
Carter8 has identified three broad groups, which differ in their ideo
cal stance, and which have played a significant role in conceptualizing a
managing the problem of child abuse at some time in the natural histor
First there are those who work on the basis of a legal model, in particu
the police and the legal profession. Secondly there is a large group that I
include under the umbrella of the medical model. This is a diverse grou
which includes paediatricians, radiologists, psychiatrists and fore
pathologists. Finally there is a group which I will call social work, pract
ing according to a social welfare model. These have been located a
summarized in Table 1.9

THE DISCOVERY OF THE BATTERED BABY

SYNDROME

While there was an increasing concern for child welfare in

teenth and early twentieth centuries,10 there was little recogni
abuse as a specific social problem. Other problems related to
were pre-eminent during the period, particularly delinquency,
the problem family. However, there is ample evidence to show t

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 434 NIGEL PARTON

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 THE NATURAL HISTORY OF CHILD ABUSE 435
of interaction and behaviour we now call child abuse or non-accidental
injury has existed throughout history—perhaps to a greater degree.11 Cases
that may now be diagnosed or labelled non-accidental injury were often
seen as rickets, brittle bones or the result of enthusiastic discipline or a good
beating. This is well illustrated by a case recorded by an Englishman, Dr.
Samuel West12 in 1888:

A child, aged five weeks, was brought by its mother with the statement that its left
arm had 'dropped'. A swelling occupied the middle third of the shaft of the
humerus. Similar swellings were found on the right humerus and on the left femur.
There was some slight bruises on the ribs. The patient was the fifth child.

The eldest child, along with the third and fourth children of the family, was
similarly affected. He felt that the diagnosis was 'rickets'.
It certainly seems that since the second world war the emphasis in
legislation and theory and practice relating to child care has stressed the
importance of the natural family, and has focussed on the problems of
delinquency and neglect. As a consequence the notions of cruelty to
children and child abuse were not conceptualized in any independent way.
When they were it was usually in one of two ways. Firstly cases were still
brought to court for prosecution by the police, NSPCC or children's
departments, but were defined in the context of a serious criminal offence so
that the legal model was pre-eminent. Or secondly, and perhaps more
commonly, cruelty was seen as a symptom of neglect.
In 1956 even the NSPCC was arguing that 'cases of physical ill-treatment
are less severe than they were', and recorded that of98,277 children helped
by the society in the previous year 64,291 were suffering from neglect.131 do
not wish to imply that prior to the discovery of child abuse, the British legal
tradition failed to punish cruelty to children for there are numerous cases
resulting in the conviction of parents recorded in the official statistics.
However, the socio-legal reactions in this period were sporadic and did not
constitute recognition of a social problem. The discovery of child abuse in
Britain, its definition as a social problem and the socio-legal reaction
against it required the coalition of certain organized interests in the 1960s
and early 1970s.
Many of the articles related to the problem written in Britain during the
1960s14 have registered their debt to the work of numerous American
researchers, and it would seem that the discovery in Britain was not only
influenced by, but was also dependent upon, these developments. It is my
contention that the discovery of the problem in America was closely related
to diagnostic radiology in the field of paediatrics.15
Medical recognition in America began in the mid 1940s with the work of
Dr. John Caffey, a distinguished paediatric radiologist, who demonstrated
a relationship between the two conditions of multiple fractures to the long

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 436 NIGEL PARTON
bones, and chronic subdural haematoma (inf
While he seems to have assumed that both conditions were traumatic in
origin, he made no attempt to define the source of trauma or to provide a
firm label.16 Ample support for Caffey's observations quickly followed.17
However, in 1955 Woolley and Evans18 suggested that the trauma was 'due
to undesirable vectors of force' and made reference to 'parental indiffer
ence, alcoholism, irresponsibility and immaturity manifested by uncon
trollable aggressions' as the cause of child injury.
The major breakthrough in America came in 1962 with the publication
of an article by Kempe et al.19 in the Journal of the American Medical
Association. This provided a firm emotive level and at the same time defined
it in medical terms, i.e. 'the battered child syndrome'.20 The article dis
cussed why it was felt doctors were reluctant to believe the problem existed,
concluded that it was a major cause of death and maiming in children, and
recommended that doctors report all incidents to law enforcement or child
protective agencies. The way the problem was presented can hardly be seen
as passive, for the radiologists and paediatricians involved at this stage
were orientated to seeking out and establishing a new illness. As Friedson
argues21 'medical activity leads to the creation of new rules defining
deviance; medical practice seeks to enforce those rules by attracting and
treating the newly defined deviant sick'.22
However, recognition of the problem in Britain developed much more
slowly. Sometimes the clinical diagnosis of injuries to young children was in
terms of some bone weakness.23 Even though in 1956 Cafley spoke in
London of the importance of early diagnosis if the abused youngsters were
to be removed from their traumatic environment and the wrongdoers
punished, it gave little impetus to the discovery.24
The problem was first discovered in Britain by two orthopaedic sur
geons, Griffiths and Moynihan25 in 1963 in the form of the battered baby
syndrome. Following the developments in America they make their aim
quite explicit, for they hoped 'to give publicity to a syndrome which we
think more common than is usually believed and which would appear often
to be misdiagnosed with possible tragic results'. They were convinced that
many children were being exposed to the hazards of repeated injury
because of erroneous diagnosis, and that the possibility should always be
considered that babies may have been injured by brutal violence with the
culprit almost always the parent. The article was particularly well received
by the British Medical Journal, the main organ of the medical profession in
Britain, and a leader comment in the same issue said that Griffiths and
Moynihan 'deserved the thanks of the medical profession for drawing
attention to the problem'.26 Certainly it seems to have caused a degree of
concern in the medical press, and one letter in response to it is worth
considering as it reflects the way the problem and reactions to it were

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 THE NATURAL HISTORY OF CHILD ABUSE 437

perceived within the medical profession during this period. Dr. E.

wrote in 1964 that he was 'relieved' to see the article as he felt m
were aware of the problem, but that they should not act as la
judges, but should prevent disease. He felt there were two
approaching the problem. First it was important that doctors publi
create an atmosphere in the community which does not overlook
and he argued that 'what is really needed is a cause célèbre with f
treatment in the press'. Secondly it was important to make co
virtually certain and then give an exemplary sentence of many
prison. He concluded by arguing that 'we can start by moving
palpitating British conscience'. While this letter clearly expresses
sion evident through the natural history between stressing the lega
ment of punishing the parents and the medical/welfare one of tr
child and family, it also clearly illustrates that certain individ
sections of the medical profession were involved in a moral crusad
While the initial discovery in Britain can be attributed to tw
paedic surgeons, the main branches of the medical profession t
most active during this early period was paediatricians and forens
logists. In particular we can find a number of articles produced at t
in Medicine, Science and the Law, the official journal of the Assoc
Forensic Pathologists,28 and the crusading of Professor K. Simpson
Dr. F. E. Camps30 seems to have been especially significant. At
time the British Paediatric Association contributed an important e
to the discovery when it published a memorandum,31 The Battere
which discussed the recognition and management of the proble
the memorandum stressed that a purely punitive attitude to th
inflicting the injury is ill advised, it clearly felt that the manageme
problem was the responsibility of the medical and social welfare (c
department) agencies.
We can thus locate the discovery of the battered baby in Britain
the medical profession. Concrete evidence for this is that the Brit
cal Journal index first had a section headed 'Battered Baby Syndro
the period covering January-June 1966, i.e. the period covering th
memorandum. However, unlike America, the impetus was not
from radiologists but forensic pathologists and paediatricians.
surprising that the loci of discoveries in America and Britain w
what different, bearing in mind the fact that the initial disco
American anyway, and simply needed someone to take up the caus
country. Neither is it surprising that members of the legal and socia
agencies did not take up the mantle at this stage, for both would r
such cases, and the latter laid the emphasis on family casework, neg
the problem family at this time.
There were also numerous reasons why doctors themselves did no

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 438 NIGEL PARTON
the problem prior to the 1960s. Firstly it
departments were simply unaware of the pos
psychologically unwilling to believe that p
thirdly they were unwilling to violate the
confidentiality, and finally doctors are reluc
criminal justice process that would forfeit bo
control the outcome of diagnosis.34 However
a position to overcome these problems, partic
allied to the courts and the criminal justice p
role as bridging the gap between medicine an
come into contact with the most extreme
distinctive impression. While it is more diff
cians should become so concerned at this ti
them to be aware of the problem once it was
raison d'être is children. This interest ma
organizational and status factors. For as P
'had attained valued organizational status prio
age characterized by preventive drugs and tr
gerous or deadly diseases, it was again slidi
profession'. This slide may have been furth
birth rate in the late 60s and early 70s. In th
battered baby could be seen to provide an
attracting more resources and status.

DIFFUSION OF THE PROBLEM

While some dissemination of this discovery outside the medic

had begun prior to 196836 we can identify the period from 1
crucial in diffusing the problem. The work of the NSPCC
research unit was central to this process. In order to un
significance of the unit it is important to look at why it was s
was.

It seems that in the post-war period the NSPCC was increas

to change its punitive legalistic image and establish a new pr
for itself. Whereas before 1900 up to 21% of the cases dealt
prosecution, the figure was below 2% in 1964 (Lapping)37 and
(Shearer).38 However, in trying to become a more profession
organization, it seemed that the society was increasingly
work of the fast expanding children's departments.39 The an
the society for 1964-6540 indicated that it dealt with 5% few
and that this was probably due to an increase in local au
workers reducing the NSPCC workload. The report also indic
society was facing a financial problem that was threatening

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 THE NATURAL HISTORY OF CHILD ABUSE 439
Expenditure exceeded income by £261,961 during the year and would h
been worse if inspectors' houses had been included.
It would seem that the society was facing a major crisis which may h
threatened its future. It is within this context that the NSPCC first disco
vered the battered child syndrome and decided to set up the research unit
which became so influential in the next few years in helping to establish a
new-found role for the society.
The planning of the unit was greatly influenced by the work of Dr.
Kempe and his colleagues in Denver. The Rev. Arthur Morton, Director of
the NSPCC, spent some time in Denver in 1964 and 1967, while Miss Joan
Court and Mr. Raymond Castle (first unit director and assistant director
respectively) spent parts of 1968 and 1969 in America. Dr. Kempe himself
spent a sabbatical year with the unit in 1969-70 doing research, lecturing
and generally publicizing the problem.
The NSPCC unit was eventually named Denver House, and was estab
lished in 1968 'to carry through a comprehensive programme of study and
treatment of families where a child has been battered, and to help build up
an informed body of opinion on the battered child syndrome'.41 Its main
function was to publicize the problem and bring it to the attention of the
professions concerned, and between January 1969 and February 1973
members of the unit had seventeen articles published in various profes
sional journals, ten of which were written by Joan Court.42-43
In its work the unit stressed that the problem was primarily a disease
passed on through generations, and symptomatic of family malfunction
ing. As a consequence, it argued that punishment of the parents was
inappropriate. Intervention should be non-punitive and directed at: (i)
identifying potential abusers, and (ii) prevention by a 'consistent trusting,
professional relationship' with the parents, whereby the whole family could
be rehabilitated. Such an approach was clearly influenced by the medical
model of social work. The unit was quickly recognized as the chief agency
specializing in the field and one of its major reports44 prompted central
government to make a formal response.45
While interest and concern continued to grow within certain sections of
the medical profession during this period46 there were no similar develop
ments in social work.47 Similarly, while there is evidence of some publicity
for the problem in the media during this period,48 it is given a fairly low
profile and reflects very much the views and publications of the battered
child research unit. It would thus seem that between 1968 and early 1973
recognition of the problem of child abuse had been slow and confined to a
few specialists working in the field. While the NSPCC unit was the vital
publicizing agency, the problem had not become widely diffused and there
had not been a 'cause célèbre with front-page treatment in the press'. Both
central and local government gave the problem low priority, and in the

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 440 NIGEL PARTON

House of Commons on December 22,1

to a question said that while the DHS
approach was logical and strategic, it ha
local authorities'.

DIFFUSION AND CONSOLIDATION—THE CASE

OF MARIA COLWELL49

This situation quickly changed as reaction to the problem escalated in late

1973 as a direct response to the official enquiry into the death of Mari
Colwell.
This can be seen by the amount of press coverage given to the problem.
Between 1968 and early 1973 The Times carried little coverage of the
problem—the only two entries of note followed the publication of the two
NSPCC reports in 1969 and 197250—but between 10 October and 7
December 1973 it carried over 320 paragraphs on the problem. It is
important to stress that nearly all of this focussed directly on the enquiry
into the death of Maria Colwell. In fact the only reference to the case by The
Times prior to the enquiry was an entry of 11 lines when Sir Keith Joseph
announced he was setting up the enquiry.51 This is not to say that the case
and the trial of the stepfather, Mr. Kepple, had not received some coverage
prior to this, but that the decision to set up an official enquiry was crucial in
establishing this case as a scandal and the issue as a major social problem. It
would thus seem that the decision to set up the enquiry pre-empted the
massive reaction that was to follow—rather than vice versa. It is thus
important to ask why it was set up.
As Minister for Social Services, Sir Keith Joseph made explicit his
analysis of social deprivation in Britain and suggested solutions accord
ingly. He put particular emphasis on his notion of the cycle of depriva
tion,52 which argued that deprived parents pass on to their children the very
habits and behaviour which cause their condition, so that each generation
reproduces the failings of the former. The main cause of social problems
and deprivation was identified as the family, particularly certain 'problem
families'. This notion seems to have had an increasingly pervasive influence
on the DHSS during the period, both in the way problems were conceptua
lized and the way priorities were set.53 As noted above most of the research
and publicity on the problem of child abuse, particularly that by the
NSPCC unit, argued that abusing families could be characterized as suffer
ing from some pathology which was passed from generation to gene
ration.54 Cases of child abuse could thus be seen to epitomize the notion of
social deprivation as defined by Sir Keith Joseph at that time.
It is also my contention that the intervention of the Tunbridge Wells
Study Group on Child Abuse was crucial in attracting Sir Keith's interest

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 THE NATURAL HISTORY OF CHILD ABUSE 44I
to the problem and influencing DHSS policy. The Study Group w
self-appointed ad hoc group55 which saw itself as providing a link bet
the medical profession, the social services, the legal profession an
police. It wanted to share and to discuss with other professions and gr
the views 'which stem from Dr. Kempe in Denver and the NSPCC
Britain'. The group consisted of leading professionals including paed
cians, psychiatrists and social workers and was chaired by Dr. A. W
Franklin, an eminent paediatrician.56-57 Formed in 1972, the gr
organized a conference which was held at Tunbridge Wells on 15-18
1973, attended by Sir Keith Joseph and others from the DHSS, an
which the DHSS gave some organizational and financial assistance.
timing is vital when we realize that the announcement of the enquiry
the death of Maria Colwell was made on 24 May, only a few days after
conference. It would certainly seem that Sir Keith's attendance at
bridge Wells was a crucial factor in explaining why such an enquiry w
up when it was and in the manner in which it was. The DHSS had
under Sir Keith's guidance, set up an internal committee to look a
problem, and later published and circulated the report and resolutions
the Tunbridge Wells conference58 to coincide with the opening of
Maria Colwell enquiry. 'While the timing of Maria Colwell and Tunbrid
Wells was coincidental the combination was explosive'.59
It also seems that the media, apart from simply giving more coverag
the problem, took a far more active, campaigning, crusading role at
time, and in doing so helped to consolidate it. This role was encouraged
other concerns. Firstly there was a growing disquiet about the work an
efficiency of the recently reorganized social services departments. It w
increasingly being suggested that the quality of social work had deteri
ated as a consequence of reorganization, and that child care was receivin
far too low a priority.60 Secondly it was apparent that the media had b
concerned about the rights of foster parents, changing attitudes t
blood tie and the law relating to adoption for some time. In the late 19
number of cases had received publicity as 'tug of love cases' when the m
took the side of the foster or prospective adoptive parent.61 The repor
the Houghton Committee62 had been published in 1972, but no action h
been forthcoming from the government. The enquiry into the dea
Maria Colwell provided an excellent opportunity to campaign on
issues.
The work of The Sunday Times provides a good example of the role of
media at this time, for on 11 November 1973 the paper launch
campaign entitled 'The Battered Baby Scandal' and 128 paragraphs
devoted to it in that issue alone.63 The campaign was continued ove
next three weeks, using a picture of a smiling Maria Colwell as its symb
was claimed that over 700 children died each year in this way, and it c

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442 NIGEL PARTON

for legislative reforms to protect the

of the 'batterers'. The enquiry formed
news programmes, so that by the ti
Colwell was published in September
major social problem requiring formal
Using the conceptual framework sug
we can begin to understand why th
priority in 1973-74. Parker argues t
others the authorities must first believ
feasibility and support. The problem o
as a legitimate and important concer
ment had to respond to in some way
already had an overall responsibility t
(particularly via the recently reorg
Clearly action in this area would be
support with little or no organized
argue that abused children should not
British research suggested that it w
professionally feasible to prevent the
Secondly there were certain factor
significance of the problem in 1973-
into the death of Maria Colwell, which
policy. In particular the issue, as defin
the policy interests of the Secretary of
with other issues, particularly the ine
personal social services and the rights
its significance. At the same time r
gested the numbers of children sufferi
more than could be allowed in an ad
and was yet another example of the
values and discipline. The fact that t
issues should originate with the lon
NSPCC could only further the cause
by such a broadly based professional a
Study Group with such an influential
that the Secretary of State and the
These factors combined in 1973 to pro
audience, so that the case of Maria
consolidate the problem as being of
The timing and details of the enquiry
characteristics of a crisis or scandal
from central government.

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 THE NATURAL HISTORY OF CHILD ABUSE 443

CONSOLIDATION AND REIFICATION

There followed a series of scandals and reports67 which pl

tant role in the development and consolidation of public
concern. While they have been used as political touchstone
administrative and managerial procedures for coping with
few could be considered typical of the vast majority of batte
described in the literature. The chief policy decision that seem
drawn from these enquiries has been the need for much grea
tion and co-operation between the professionals and agenc
and the prime need for better identification of children at ris
Central government responded with a series of circulars
system of child abuse management was effectively inaugurat
publication of the DHSS circular LASSL (74) on 22 April
problem was officially labelled 'Non-Accidental Injury to
lowing the title of the Tunbridge Wells report, and thus establ
by which it is now generally referred to by the professionals
circular was concerned with both the management of individ
the local organization of services involved with the problem.
it emphasized the value of team work and strongly recommend
case conferences and area review committees, for it was t
important that the professionals concerned should share both
bility and decision making involved. The circular also fe
essential to establish a register to aid good communications.69
that the official conceptualization of the problem and its solu
closely that of the NSPCC battered child research unit and th
Wells Study Group. It was primarily seen as a problem for so
social services departments to control.
On 18 November 1976 DHSS released a circular70 which was aimed
primarily at promoting understanding between the police and the other
agencies involved. It stressed the importance of close co-operation, and for
the first time made it clear that a senior police officer should be included on
all area review committees and case conferences. The circular also recom
mended that the police should release relevant confidential information to
case conferences about a family whether the convictions are 'spent' or not.
It would thus seem that the police are increasingly being included in the
management of the problem and that many of the principles of confidentia
lity and due process are being suspended in the best interests of the child.
The problem is now consolidated in social policy and reified in the everyday
work of the professionals concerned.71 While the overall conceptualization
of the problem is still based on medical and social welfare models, there has
been increasing use of intervention that is 'authoritative, intrusive and
insistent' (Smith72).

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 444 NIGEL PARTON

CONCLUSION

In this paper I have attempted to explain why recognition of the

child abuse emerged when it did, and in the manner in which it
argued that the problem has a history which has developed thro
of stages, each of which has reflected a change in who defines t
the kind of definition used and the preferred solution. This is s
in Table 2. It would thus seem that certain moral, organiza

table 2. A taxonomy of the natural history of child abuse in Britain, wh

summarize the dominant definers, definitions of the problem and ideologies
were dominant at each stage

Dominant Dominant Ideologies

Dates Principal Definers Definition of Control

Pre 1963 Age of Children's Officers, Neglect Psycho-dynamic

Pre-discovery FSU Social Welfare Model
NSPCC, Police Cruelty Legalistic
1963-68 Age of Paediatricians Battered Medical/Social
Discovery Baby Syndrome Welfare Model
Forensic Pathologists Battered Medical/Legalistic
Orthopaedic Surgeons Baby Syndrome Model
1968-72 NSPCC Battered Child Battered Child Medical/Social
Diffusion Research Unit Syndrome Welfare Model
1972-74 Diffusion Sir Keith Joseph, Child Abuse Medical/Social
and Consolidation Tunbridge Wells Study Welfare Model
Group, DHSS, Media
1974- DHSS, Social Service Non-accidental Social Welfare Model
Consolidations and Depts. (and increasingly Injury (but emphasis placed
Reification the Police) Child Abuse on authority and
co-ordination)

professional interests combined at crucial stages to reinforce, leg

and publicize the problem. While these interests may have diffe
siderably, sufficient common ground was available to further the issu
is not to argue that the problem of child abuse was either myth
misrepresented, but to suggest that the increased recognition did not
depend on objective or neutral characteristics.
In utilizing the natural history framework I do not want to exagge
the consistency and neatness of the developments, for as I hope
illustrated, there is a complicated relationship between the recogniti
conceptualization of the problem and the solutions deemed most

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 THE NATURAL HISTORY OF CHILD ABUSE 445

priate to overcome it. As Parker73 has pointed out 'logically the ide
tion and analysis of a problem precedes proposals for a remedy,
reality the sequence is less tidy'. Similarly it would appear that wha
been consolidation and reified is a quite different phenomenon
which had been discovered and initially diffused.74 The term 'child
now includes a wide range of behaviours, clinical features and assum
which were never part of the much more narrowly defined 'batter
syndrome'. This is well illustrated by Heifer and Kempe:75

The term 'battered child' has been dropped. When coined fifteen year
purpose was to gain the attention of both physicians and the public. We
that enough progress has been made to move on to a more inclusive phra
abuse and neglect. The problem is clearly not just one of physical battering.
the children who are killed or endure permanent brain damage (and these
prime concern), the most devastating aspect of abuse and neglect is the p
adverse effects on the developmental process and the child's emotional we

It is quite apparent that the definitional boundaries of the proble

now very fluid and inconsistent, for the crux of the matter is that
dental injury is a socially defined phenomenon and therefore its bo
cannot be stated as if they were fixed and permanent.76 Even s
become a category which is symbolically very powerful.
It is clear the problem of non-accidental injury is now given the
priority by social services departments so that whatever else is cut
rationed or overlooked, this type of case must always take preceden
has had important implications for the way resources are alloca
priority given to other client groups and social work practice.
Director of Social Services told the Parliamentary Select Comm
(Q373) in evidence77 'we, as managers have had to withdraw resourc
other client groups, particularly those that in our view and in the
our councils, required to be positively discriminated in favour of, s
the mentally handicapped and physically handicapped'. The Dire
Birmingham Social Services commented78 after the report on the d
Neil Howlett: 'we are becoming a big children's department, an
groups are suffering because of the concentration on child care
Stevenson79 has identified the anxiety about non-accidental injury as
the most important developments affecting social work practice in
years. She has written that
the anxiety is not only on behalf of the child. There is also fear among
workers, and others, similarly involved, of censure and widespread p
Vitally important as is the protection of such children, it is arguable that the
hectic climate may be resulting in excessive concentration upon one g
families and to the detriment of many others in need ... furthermore, w
tightrope between the protection of children and unwarrantable intru
family life.

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 446 NIGEL PARTON
In this context it is hardly surprising t
inadequate and badly trained when faced wi
and non-accidental injury as the whole a
inconsistencies and half expressed assum
beginning to recognize. However it is my
ments have had significant effects on the r
resources to children and families by the
of the concern attributed to the problem, c
register are given top priority when vacanc
minders, in children's homes, with foster p
As there is a disproportionate number of po
potential or actual abusers, these developm
cations for the rationale of the department
the general public. Increasingly, with gre
public expenditure cuts, a family may only
children are at risk. The development of ser
child abuse seem to have reinforced the per
of regulating the poor and providing a stigm
If this is the case such changes may be r
structure, the control culture and the role o
considerable analysis and research before th

ACKNOWLEDGEMENTS

I would like to thank the Rev. A. Morton, Miss S. Creighton, Ken

Plummer, Joan Court, Helen Masson, Ralph Firth, Judith Milner, Roger
Bacon, John Clarke and Chris Parton for their useful comments on earlier
drafts of this paper.

NOTES AND REFERENCES

1. The First Report from the Select Committee on Violence in the

Children ( 1977) HMSO, est imates that ( 1 ) for each 10,000 children under
England and Wales 10 will be severely injured each year; (2) one of the
die as a result of the severity of the injury; (3) in England and Wales
children will be injured each year, and six of them will die each week; (4
children in every 10,000 will be slightly injured, i.e. 40,000 children in E
'The Court Report' (1970) HMSO, para. 2.11 states that non-acciden
fourth commonest cause of death in the first five years of life (two to t
100 children dying caused by non-accidental injury).
2. Following Townsend, P. (1975) Sociology and Social Policy, Allen L
taken to mean 'the rationale by which societies are steered towards s
rationale according to which different ends are combined together an
3. Becker, H. (ed.) (1966) Introduction, Social Problems, New York, W
history approach was first used by Fuller, R. C. and Myers, R. D.
History of a Social Problem', Amer. Sociological Rev. 6. Also see B
'Social Problems as Collective Behaviour', Social Problems, Winter,

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 THE NATURAL HISTORY OF CHILD ABUSE 447
and Kitsuse, J. I. (1973) 'Towards a Sociology of Social Problems: Social Conditi
Value Judgments and Social Problems', Social Problems, Spring, 20, 4.
4. Becker, op. cit.
5. See Smith, G. and Harris, R. (1972) 'Ideologies of Need and the Organisation of
Work Departments', Br. J. Social Wk, 2,1, pp. 27-45. See also Hardiker, P. (1977) 'S
Work Ideologies in the Probation Service', Br. J. Social Wk, 2, 2, pp. 121-154.
6. Stoll, C. S. (1968) 'Images of Man and Social Control', Social Forces, 47 (2), pp. 11
7. Scheff, T. (1966) Being Menially III: A Sociological Theory, Chicago, Aldine Press.
8. Carter, J. (ed.) (1974) The Maltreated Child, Priory Press.
9. This framework closely relates to that suggested by Carter, ibid.
10. See Pinchbeck, I. and Hewitt, M. (1969,1973) Children in English Society, Vol. 1 and
2, Routledge and Kegan Paul; Piatt, A. (1969) The Child Savers: The Inventio
Delinquency, Chicago, University of Chicago Press; Thomas, M. P. (1972) 'Child A
and Neglect: Historical Overview, Legal Matrix and Social Perspectives', North Caro
Law Review, 50, February, pp. 293-349; May, M. (1978) 'Violence in the Family
Historical Perspective in Violence and the Family (ed. Martin, J. P.), Chichester, Wil
11. See Garrison, F. H. (1965) 'Abt-Garrison History of Paediatrics' reprinted from Pa
trics by various authors, Vol. 1 (ed. Abt, J. A.), Philadelphia and London, W
Saunders; Bakan, D. (1971) Slaughter of the Innocents: A Study of the Battered
Phenomenon, San Francisco, Jassey-Bass; Pinchbeck and Hewitt (1969, 1973), op
Radbill S. X. (1968) 'A History of Child Abuse and Infanticide' in The Battered Child
Heifer, R. E. and Kempe, C. H.), Chicago, University of Chicago Press; Resnick,
(1972) 'Infanticide' in Modern Perspectives in Psycho-Obstetrics (ed. Howells, J
Edinburgh, Oliver and Boyd; Smith, S. (1975) The Battered Child Syndrome, Butterwor
12. West, S. (1888) 'Acute Periosteal Swellings in Several Young Infants of the Same Fam
Probably Rickets in Nature', Br. Med. J., 1, pp. 856-857.
13. NSPCC Annual Report (1956) 31 May.
14. See for example, Griffiths, D. L. and Moynihan, F. J. (1963) 'Multiple Epiphyseal In
in Babies ("Battered Baby Syndrome")', Br. Med. J., 11, pp. 1558-61; Okel!, C. (1
'The Battered Child—Tragic Breakdown in Parental Care', Midwife and Health Visit
June, pp. 235-40.
15. It is interesting that the diagnosis of Dr. S. West (op. cit) pre-dated the invention o
X-ray in 1895, and its introduction into the medical profession in the twentieth centu
Without the X-ray it is unlikely the battered baby syndrome could have been discover
the way it was in the early 1960s.
16. Caffey, J. and Silverman, W. A. (1945) 'Infantile Cortical Hyperostosis: Prelim
Report on a New Syndrome', Am. J. Roentgen. Rad. Ther. 54, pp. 1-16; Caffey, J. (1
'Multiple Fractures in the Long Bones of Infants Suffering from Chronic Subd
Hematoma', Am. J. Roentgen. Rad. Ther., 56, pp. 163-173; Caffey, J. (1946b) 'Infan
Hyperostosis', J. Paediat., 29, pp. 541-49.
17. See for example, Bakwin, H. (1952) 'Roentgenographs Changes in Homes Follow
Trauma', J. Paediat., 49, pp. 7-15; Barmeyer, G. H., Alderson, L. R. and Cox, W
(1951) 'Traumatic Periostitis in Young Children', J. Paediat. 38, pp. 184—90; Lis,
and Frauenberger, G. S. (1950) 'Multiple Fractures Associated with Subdural Hemat
in Infancy', Paediatrics, 6, pp. 890-92; Smith, M. J. (1950) 'Subdural Hematoma
Multiple Fractures', Am J. Roentgen. Rad. Ther., 6, pp. 343-44.
18. Woolley, P. V. Jr. and Evans, W. A. Jr (1955) 'Significance of Skeletal Lesions in In
Resembling those of Traumatic Origin', J. Am. Med. Ass., 158, pp. 538-43.
19. Kempe, C. H., Silverman, F. N., Steele, B. F., Droegemueller, W. and Silver, H. K. (
'The Battered Child Syndrome', J. Am. Med. Assoc., 181, pp. 17-24.
20. Kempe et al., ibid., wrote that 'the Battered Child Syndrome is a term used by
characterise a clinical condition in young children, who have received physical
generally from a parent or guardian'. The parents were seen as 'immature, impuls
self-centred, hypersensitive and quick to react with poorly controlled aggression . .
chiatric factors are probably of prime importance in the pathogenesis of the disorder,
our knowledge of these factors is limited'.

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448 NIGEL PARTON
21. Friedson, E. (1970) Profession of Medicine: A Stu
ledge, New York, Dodd, Mead and Co.
22. Pfohl, S. (1977) 'The Discovery of Child Abuse', S
argued that the major element in the discovery by
professional self interest. He argues that paediatric
within organized medicine. By linking themselves to
could become involved in the crucial clinical task of
became a direct source of input concerning a risky 'life
an advance in status and a new basis for recognition
23. See for example Astley, R. ( 1953) 'Multiple Metaph
J.Radiol.. 26, pp. 577-83.
24. See Caffey, J. (1957) 'Some Traumatic Lesions in
and Dislocations: Clinical and Radiological Features
25. Griffiths and Moynihan, op. cit.
26. A personal discussion with Miss Joan Court su
responsible for coining the title 'battered baby'. It se
the problem at a meeting of the SE Metropolitan O
Hospital. Baby twins under a year old who had a fai
were shown as a problem of diagnosis. This prompted
came across Caffey's work. This fostered Dr. Moyniha
afterwards he came across three or four similar cases
Kent. Whilst in Manchester he met Dr. Griffiths who
typical of the injuries, and it was from this encounter
27. Dr. E. Turner (1964) Correspondence, Br. Med. J.
28. See Fairburn, A. C. and Hunt, A. C. (1964) 'Caf
Evaluation ("The Battered Baby")', Med. Sei. and
(1965) 'The Battered Child Syndrome', Med. Sei. and
Johnson, H. R. M. and Camps, F. E. (1966) 'The Ba
and Law, 6, pp. 2-21.
29. Professor Simpson had been Professor of Forensic
since 1962 and was a member of the Home Office Sc
interesting that he was Head of the Department of F
the same hospital as Dr. Moynihan.
30. See Simpson, K. (1965) 'Battered Babies: Convicti
Cameron et al., op. cit.
31. British Paediatric Association (1966) 'The Battered B
Standing Committee on Accidents', Br. Med. J., 1, 6
32. See Bain, K. (1963) 'The Physically Abused Child
(1962) 'A Project to Rescue Children from Inflicted I
33. See Elmer, E. (1960) 'Abused Young Children see
98-102; Fontana, V. J. et al. (1963) 'The Maltreated Sy
Med., 269, pp. 1389-94; Kempeet ai., op. cit.
34. See Friedson (1970) op. cit.
35. Pfohl (1977) op. cit. I would like to thank Dr. Roge
36. Hughes, A. (1967) 'The Battered Baby Syndrome—
Con., 14, 8; Kahan, B. (1968) 'Battered Babies', Hosp
January; Walton, C. ( 1966) 'The Battered Baby Syndr
37. Lapping, A. (1965) 'What Use is the "Cruelty Man
38. Shearer, A. (1968) 'The NSPCC—In Search of a Ne
39. See Lapping and Shearer, op. cit. Evidence that the
professional social work image includes (i) the appoin
(ii) the institution of a one year training course for n
given option in 1965 to decide whether or not, in any
uniform and withdrawn altogether in 1968-9 (iv) gre
rather than 'cruelty'.
40. NSPCC Annual Report 1965.
41. NSPCC Annual Report 1969.

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 THE NATURAL HISTORY OF CHILD ABUSE 449

42. Articles by Joan Court included the following: (1969) 'Battering Parents', S
January; (1969) 'The Battered Child: (1) Historical and Diagnostic Reflection (2)
tion on Treatment', Med. Social Wk, 22, pp. 11-20; (1969) 'The Battered Child R
project', Child Care News. July; (1969) 'An Historical Review of the America
Abuse Laws' Child Care News, November; (1969) 'Battered Babies', Health
December; (1971) 'The Need for a Multi-Disciplinary Approach', Nursing Times,
(1970) 'Psychosocial Factors in Child Battering', J. Med. Women's Fed., April; wi
C. (1970) 'An Emergent Programme to Protect the Battered Child and his F
Intervention (Assoc. of Professional Social Workers). Quebec, Spring; with Robi
(1970) 'The Battered Child Syndrome', Midwives Chronicle and Nursing Notes, Ju
Kerr, A. (1971) 'The Battered Child Syndrome—A Preventable Disease', Nursing
June.
43. Articles written by other members of the unit included Okell, C. (1969) op. cit
Okell, C. and Butcher, C. H. H. (1969) 'The Battered Child Syndrome', Law S
Gazette, 66, 9; Okell, C. (1971) 'Childhood Accidents and Child Abuse', Com. Med
126, 8; Kerr, A. and Court, J. (1972) 'Battered Babies', London Doctor, 3, 2; Jone
(1972) 'Parental Anguish and Child Abuse', Practice Team, 11, April, pp. 22-4; O
(1972) 'The Battered Child Syndrome—Recent Research and Implications fo
ment' (excerpt from papers read before the Health Congress of the Royal So
Health, Eastbourne, 24-28 April) Royal Society of Health; Jones, R. A. (1973) 'B
Families', Health and Soc. Serv. J., 83, 4321, pp. 313-14.
44. Skinner, A. E. and Castle, R. L. (1969) 78 Battered Children: A Retrospecti
NSPCC. See also Castle, R. L. and Kerr, A. M. (1972) A Study of Suspected Child
NSPCC, which concluded there had been an increase in recognition of the
between 1969 and 1972 -'the authors would suggest from these findings that the co
able increase in publicity and education on the subject of battered children has
increased awareness of the syndrome. It would seem unlikely that there has been a
increase in incidence ... the authors would also hypothesize, from a consideratio
great increase in moderately injured children and the similarity in age distribution
parents and children, that there has been a growth in awareness of the need for in
tion in less serious cases of child abuse.'
45. DHSS circular (1970) 'The Battered Baby' which followed very closely the recommenda
tions of Skinner and Castle, op. cit: 'co-ordination of information' was seen as essential
while 'there is value in the setting up of a registry of injuries to children which are not
satisfactorily explained'. Also DHSS (1972) Battered Babies, LASSL 26/72.
46. See Br. Med. J. (1969) Leading article 'Battered Babies', 20 September; Cameron, J. M.
(1970) 'The Battered Baby', Br. J. Hosp. Med., 4, pp. 769-77; Diggle, G. and Jackson, G.
(1972) 'Child Injury Intensive Monitoring System', Br. Med. J., 3, pp. 334-6; Guthkelch,
A. N. (1971) 'Infantile Subdural Haematoma and its Relationship to Whiplash Injuries',
Br. Med. J., 7,430; Harcourt, B. and Hopkens, D. (1971) 'Ophthalmic Manifestations of
the Battered Baby Syndrome', Br. Med. J.; Jackson, G. (1972) 'Child Abuse Syndrome:
The Cases We Miss', Br. Med. J.; Lukianowicz, N. (1968) 'Parental Maltreatment of
Children', Br. J. Soc. Psych., 3, pp. 189-95; Mushin, A. S. (1971) 'Ocular Damage in the
Battered Baby Syndrome', Br. Med. J., 3, pp. 402-4; Parry, W. H. and Seymour, M. W.
(1971) 'Epidemiology of Battered Babies in Nottingham', Com. Med., 126, 8, pp. 121-23;
Smith, S., Honigsberger, L., Smith, C. A. (1973) 'EEG and Personality Factors in Baby
Batterers', Br. Med. J. 11, pp. 20-22.
47. For example Social Work Today, the main organ of the British Association of Social
Workers, carried no articles or items on the problem between 1970 and 1973, apart from
news related to Miss Court's departure from the NSPCC battered child research unit.
48. The 'British Humanities Index' lists only nine articles under either 'Children, battered' or
'Infants, battered' between 1968 and 1972.
49. Maria Colwell died on 7 January 1973 at the age of seven, being one of nine children that
her mother had borne by that time. She spent over five years in the foster care of her aunt
but was returned to her mother and stepfather, Mr. Kepple, at the age of six years and
eight months, being placed on a supervision order to the local authority from that date.
The family was visited by a variety of social workers, and concern about Maria was

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 45° NIGEL PARTON

expressed by her schoolteacher and by nei

by her stepfather on the night of 6/7 Janua
quarter of the average seven year old. M
sentenced to eight years imprisonment. H
been convicted of relatively minor offence
State set up an official enquiry, the report
50. Skinner and Castle (1969) and Castle an
51. The Times (1973) 'In Brief, 25 May.
52. See, for example, Sir Keith Joseph (1972
29 June.
53. See Hall, P., Land, H., Parker, R. and W
Social Policy, Heinemann, pp. 68-69.
54. This was perhaps made most clear by Wa
abused child', Children, 14, pp. 175-79.
55. White Franklin, A. (ed.) (1975) 'Introduct
56. Dr. A. White Franklin has had a long a
1906, he is at present honorary consulting p
Bartholomew's Hospital; honorary consul
nity Hospital; was formerly chairman o
founder and treasurer of the Osier Club; p
ation; president of the British Society for
57. See'Personal View' (1971) Br. Med. J., 16
two things were needed: (i) free discussion
of the problem'; (ii) a change in public opin
child abuse is regarded as 'the result of m
emotionally deprived if not abused in their
Keith's 'cycle of deprivation'.
58. Tunbridge Wells Study Group on Non-A
Resolutions (compiled by A. White Frankli
of the Spastics Society, DHSS.
59. Personal communication with Dr. White Franklin.
60. New Society Leading Article (1973) 'Caring for Children', 7 June.
61. See Adamson, G. (1972) The Care-Takers, Bookstall Publications.
62. Report of the Departmental Committee on the Adoption of Children (1972) Houghton,
Cmnd 5107., HMSO.
63. The Sunday Times ( 1973) 'Let Us End the Killings', 'The Omissions that Cost Maria Her
Life', pp. 16-17, 11 November.
64. Report of the Committee of Inquiry into the Care and Supervision Provided in Relation to
Maria Colwell ( 1974) DHSS, HMSO.
65. Hall et al (1975) op. cit. Ch. 15.
66. Hall, M. H. (1972) 'Non-accidental injuries in children' in Royal Society of Health 79th
Annual Congress, April. Using figures from Preston Emergency Department, Hall
estimated 757 annual deaths from child abuse across the country.
67. Other child abuse scandals at this time included Graham Bagnall, report published by
Salop County Council, with Supplementary Report by Shrewsbury Group Hospital
Management Committee, March 1973; Max Piazzani, report published jointly by Essex
Area Health Authority and Essex County Council, 1974; Lisa Godfrey, report published
by the London Borough of Lambeth et al, 1975; Susan Aukland, report published by
DHSS, 1975; Steven Meurs, report published by Norfolk Area Health Authority, 1975;
Wayne Brewer, report published by Somerset County Council, 1977.
68. DHSS (1974) Non-Accidental Injury to Children, Circular LASSL (74) (13), HMSO.
69. According to the White Paper (1976) Social Services for Children in England and Wales
1973-5', HMSO, Area Review Committees had been established for each area in England
and Wales by the end of 1974. By the end of 1975 nearly all the Area Review Committees
had set up a central register of information on non-accidental injury in their areas, and
registers were under consideration in the remaining areas.

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 THE NATURAL HISTORY OF CHILD ABUSE 451
70. DHSS (1976) Non-Accidental Injury to Children: The Police and Case Confere
Circular LASSL (76) (26), HMSO.
71 Further evidence of this process is provided by First Report from the Select Committee
Violence in the Family: Violence to Children, op. cit, and the White Paper (1978) ' Violen
to Children', HMSO, March.
72. Smith, S. (1974) Correspondence, Br. Med. J., 25 May.
73. Parker in Hall et al. (1975) op. cit.
74. For this point I am indebted to Dr. Roger Bacon.
75. Heifer, R. E. and Kempe, C. H. (1976) Child Abuse and Neglect: The Family and
Community, Cambridge, Mass., Ballinger Introduction.
76. NSPCC (1976) Registers of Suspected Non-Accidental Injury. Battered Child Rese
Department., NSPCC.
77. DHSS (1977) Evidence submitted to the Select Committee on Violence in the Fam
HMSO. Also see Fry, A. (1976) 'NAI: Danger of Over-reaction?', Com. Care, 14 Ju
p. 9.
78. The Guardian (1976) 26 November.
79. Stevenson, O. (1976) 'Some Dilemmas in Social Work Education', Oxford Review of
Education, 2, 2.
80. See Jordan, W. J. O. (1974) Poor Parents: Social Policy and the Cycle of Deprivation,
Routledge and Kegan Paul; and (1974) and (1976) Freedom and the Welfare Slate,
Routledge and Kegan Paul.
81. For some discussions related to changes in the control culture and the fiscal crisis of the
state see Scull, A. (1977) Decarceration Community Treatment and the Deviant—A Radical
Review, New Jersey, Prentice Hall; Gough, I. (1975) 'State of Expenditure in Advanced
Capitalism', New Left Review, 92, July/August; O'Connor, J. (1973) The Fiscal Crisis of
the State New York, St. Martins Press; Hall, S., Critcher, C., Jefferson, T., Clarke, J. and
Roberts, B. (1978) Policing the Crisis: Mugging, the State, and Law and Order, Mac
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