Probably the most insidiously traumatic aspect of my career has been dealing with Non-Accidental Injury to children, particularly Shaken Baby Syndrome (SBS). In one appointment approximately 50 suspected cases were seen each year. Not all were positive, but many required a legal report be provided to Social Services, the police, and the courts. Court attendance to give evidence as professional or expert witness resulted ten to 15 times a year.
I was reading X-rays showing dreadful injuries perpetrated upon infants, sometimes only a few weeks old. Then in court, coped with lawyers whose sole task was to throw doubt upon the evidence, alleging prejudice, lies, error, stupidity, or worse. It took years to learn to deflect personal attacks whilst remaining objective. An expert witness must explain to the jury what they see, and objectively interpret evidence without favour. So evidence may help either prosecution or defendant irrespective of who has called the witness to court.
At that time much scientific evidence to support what seemed self-evident was being discovered, it was absolutely essential to keep up to date. But some aspects of SBS cannot be verified by experiment (it’s impossible, not to mention unethical, to shake a baby just to see what happens). Forensic interpretation from an X-ray of the kind of forces that might have caused injury, such as multiple rib fractures, derives from deduction, analysis of damage from observed (and measureable) accidental situations, and occasionally from confessions of perpetrators themselves – though not always reliable! Lawyers are quick to exploit those aspects that can’t be tested!
Although multiple fractures are heart-breaking to see, most heal and disappear in time. A more tragic aspect was to follow a shaken baby through the years and watch the little brain fail to develop normally knowing that the child will be disabled for life.
In this picture I’ve included the chest X-ray of a child with fractured ribs; a collar-bone fracture is easily seen. The layers were hand-painted and filtered to give a jagged rather violent effect. There is only one photograph – a candle – symbolising my hope that the realisation of harm that shaking does to an infant brain, through dissemination of information and carer education, will help prevent these horrendous injuries to infants.