Although child abuse and neglect (physical abuse, emotional or psychological abuse, neglect and sexual abuse) have attracted attention over the past thirty years, violence towards infants and children has unfortunately always been part of our history (1-8). In international medical literature, intentional injuries to a child was mentioned in the year 900 by a Persian physician working in the harems of Baghdad (2). Greek physicians in the early second century also seemed aware of newborn babies at high risk for later abuse and neglect, and even advocated infanticide in some circumstances (2).

Throughout the 16th, 17th and 18th centuries, children were raised under the rule of the “Schwarze Paedagogik” (8), with parents as the supreme masters of their children. Parents made all decisions, had complete power and ruled with a firm hand. Tradition and child rearing instructions cautioned parents to begin "“breaking in “ their children at a very early stage in order to gain complete control over them. This tradition has unfortunately continued to this very day.

During the 18th century, poverty, violence and alcohol abuse were part of daily life in London and indeed in all of Europe. The English artist William Hogarth (1) made the well-known engraving “Gin Lane” in 1751, showing the total disintegration of society, children with the characteristics of fetal alcohol syndrome, neglect and even fatal child abuse.

The 19th century brought more understanding for children’s rights, as well as the acknowledgement of child maltreatment. In Paris, Ambrois Tardieu (2,3,5,6), professor of forensic medicine, reported on 32 cases of child abuse in 1860: nine cases of brutality and ill-treatment, five cases of severe injuries and torture and 18 cases of fatal child abuse. In New York in 1871, a church worker discovered that 8 year old Mary-Ellen was beaten and starved by her foster family. Appeals to the police and department of charity were unsuccessful (3,6). However contact with the American Society for Prevention of Cruelty to Animals brought the matter before the Court on the grounds that Mary-Ellen was a member of the animal kingdom and she was subsequently removed and replaced in an orphanage.

The American Society for Prevention of Cruelty to Children was founded in 1875. The first English Society was founded in Liverpool in 1883 and the London chapter the following year. During the first three years, the London Society dealt with 762 cases of assault, starvation, dangerous neglect, desertion, cruel exposure to excite sympathy, other wrongs and 25 deaths (2). In Israel the Association for Child Protection (ELI) was established in 1979.

In the first half of the 20th century, sometimes called “the century of the child”, there were several papers published on subdural hematoma in infants (2), but it was first in 1946 that John Caffey (9), from Babies and Children's Hospital of New York, associated subdural hematoma with multiple fractures. He described six infants born between 1925 and 1942, who had chronic subdural hematoma with 23 fractures and four contusions of the long bones.

After publication of that article, several papers on subdural hematoma associated with fractures and bruises were written in both the United States (10) and France (2). In each case no etiological explanation was offered, because the parents denied trauma.

In 1953, Frederic Silverman from the Children’s Hospital in Cincinnati was the first to state that caretakers of children “may permit trauma and be unaware of it, may recognize trauma, but forget or be reluctant to admit it, or may deliberately injure the child and deny it” (11).

In 1955, Woolley and Evans (12) from Detroit reviewed cases from 1946-54 at the Children’s Hospital and found that “the general environmental factors surrounding infants who suffer osseous discontinuity range from “unavoidable” episodes in stable households through what we have termed an unprotective environment, to a surprisingly large segment characterized by the presence of aggressive, immature or emotionally ill adults”.

Subsequently, articles and books on maltreatment appeared by pediatricians, radiologists, orthopedic surgeons, medical examiners and social workers around the world, but the response of the medical world and the media was rather reserved at first.

Charles Henry Kempe (1922-84) became chairman of the Department of Pediatrics at the University of Colorado Medical School in Denver in 1956. In 1959, Kempe, together with a medical student, William Droegemueller, tried to determine the extent of the phenomenon of inflicted injuries in childhood in the United States. They surveyed 71 hospitals and 77 district attorneys across the country and found 749 cases of maltreated children; 78 had died and 114 suffered permanent brain damage. When Droegemueller graduated in 1960, he left the data in two shoeboxes for Kempe to retrieve and collate. Together with the pediatric radiologist Frederic Silverman, the psychiatrist Brandt Steele and the pediatrician Henry Silver, they published the landmark article “The battered –child syndrome” in 1962 (13). Soon popular press, radio and television presented case-histories and scientific papers appeared from all over the world. From 1965, the Cumulated Index Medicus featured a heading on child abuse and today several hundred articles are published each year.

The National Center for the Prevention and Treatment of Child Abuse and Neglect (today the Kempe Center) in Denver was established in 1972, the International Society for the Prevention of Child Abuse and Neglect in 1976 and the International Journal “Child Abuse and Neglect” published its first issue in 1977.

Helen Keye (1849-1926), a Swedish author and educator devoted to the welfare of children, wrote a book in 1900 entitled “The Century of the Child” claiming that in the twentieth century the nations of the world would finally begin to understand that the life of a nation, indeed the life of the world, depends upon the breath of children. We believe that the 20th century discovered family violence, child abuse and neglect. Let us make sure that the next century will really be “the century of the child”.

Child abuse and neglect must be seen as a major public health problem, but it seems that the lay and professional community have not been able to view this problem with the same seriousness as cancer, heart disease and AIDS.

A coordinated effort must be sought world wide to increase the level of funding for prevention, treatment, education and research in this important field of child health and development. We hope this book will give a small window of what is happening around the world and the issues that each country struggles with.  Somehow it is not so different from country to country as one might think.


Joav Merrick, MD, MMedSci, DMSc
National Institute of Child Health and Human Development, Office of the Medical Director, Health Services, Division for Mental Retardation, Ministry of Social Affairs, Jerusalem and Kentucky Children’s Hospital, Department of Pediatrics, University of Kentucky College of Medicine, Lexington, United States.


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