THE FIRST ANNUAL NEUHAUSER PRESIDENTIAL ADDRESS OF THE SOCIETY FOR PEDIATRIC RADIOLOGY

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Abstract
Although the syndrome has been known for 25 years, its true incidence is unknown. Clinical experience suggests that 15,000 to 25,000 infants are significantly injured in the United States annually. The number of reported cases manifestly represents but a fraction of the total number. The cause of the trauma is wilful assault by mothers principally (90 per cent), but in less frequency by fathers, siblings, other relatives, parent-substitutes and others of several kinds (baby sitters, "boy friends" of mother, cleaning women, infant nurses, delivery boys, etc.). Perpetrators of the assault are characteristically of normal intelligence and represent all races, creeds, in all cultural, economic, social and educational levels and are distributed proportionately in all parts of the country. As a group, with a few exceptions, they suffer from the same neuroses, the same emotional and character problems in the same range and degree as any randomly selected group of the same milieu and size.7b Less than 10 per cent are psychopaths. Victims are normal infants usually, but the incidence of abuse is higher in provocative, deformed, premature, multiple-birth, adopted, foster and step children. They are characteristically not neglected or deprived of material needs; they are almost always clean, well fed and well clothed. The prime causal mechanisms of assault are the unremitting excessive stresses, both social and economic, in hopeless mothers unprepared for motherhood who succumb to "combat fatigue" in their struggle with poverty stricken environment against material, spiritual, and social inadequacies, which they cannot cope with successfully, alone. Prevention and cure of this infantile scourge require liberation of child-bearing, child-rearing mothers from current and traditional injustices of their environment and a generous recognition of the valuable service they render to the community. They need social and economic support adequate for a good life for their children and themselves; no less, no more. It is possible that some, perhaps much of the now unexplained juvenile mental retardation, cerebral palsy, hydrocephalus, and subdural hematoma are residuals of unrecognized cerebral injuries in the PITS syndrome. Perhaps more important are the undetected repeated cerebral injuries induced during infancy by unrecognized repeated milder acceleration-deceleration shaking, and the whiplash injuries to the brain, inflicted unintentionally during ordinary punishment, and even during care of and play with infants. Guthkelch’s9 surgical studies on infantile subdural hematoma, and its causal relation to shakings fit very well with my own conclusions based on long studies of the clinical and radiographic findings.

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