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Abstract
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In 1971, Guthkelch hypothesized that subdural hematomas could be caused by manually shaking an infant, without the head impacting any surface. One year later, Caffey alluded, in a paper describing parent-infant traumatic stress syndrome (PITS), to manual shaking causing intracranial injury in the form of subdural hematoma and cerebral contusions in infants. Two further papers by Caffey over the next two years emphasized shaking as a means of inflicting intracranial bleeding in children.
After publication of these papers, shaken baby syndrome became widely accepted as a clinical diagnosis for inflicted head injury in infants. However, in 1987 and again in 2003, careful laboratory investigations based on the known biomechanics of head injuries showed that human beings cannot achieve the necessary accelerations for causing intracranial injury in infants by manual shaking alone, but that impact is required. Moreover, after more than 33 years, despite numerous reports of series of case studies, an actual witnessed incident in which an infant sustained an intracranial injury as a result of shaking alone has yet to be documented.
As is true in other scientific disciplines, knowledge of medicine should, and generally does, advance in two distinct ways. The first is clinical observation of various physical and physiologic manifestations of disease processes, with an attempt to verify underlying etiologic, anatomic, and physiologic principles. The second is laboratory investigation of both normal and abnormal (or disease) processes, in an attempt to arrive at underlying mechanisms. Ideally, both should aim to discover treatment principles. |