Editorials

The evidence base for shaken baby syndrome

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7442.719 (Published 25 March 2004) Cite this as: BMJ 2004;328:719

Errors in the diagnosis of child abuse

Reply to Geddes and Plunkett, The evidence base for shaken baby
syndrome. bmj.com 2004:328(7442):719-720, March 27, 2004.

Reading legal depositions and a medical conference summary on “shaken
baby syndrome” has led me to believe that many physicians are under the
impression that a haematologist’s report showing no abnormality in the
blood coagulation mechanism, can be used to rule out a diagnosis of
Barlow’s disease, or infantile scurvy.

If this misguided belief prevails, it explains why so many detailed
hospital reports of deaths from “shaken baby syndrome” omit the necessary
plasma ascorbic acid and whole-blood histamine analyses to diagnose or
discount the presence of infantile scurvy.

FIGURE 1: HISTAMINE & ASCORBIC ACID

Legend for Figure 1. Results of plasma ascorbic acid (reduced form)
and whole blood histamine concentrations in the same blood samples from
437 human volunteers in Brooklyn, NY, 1980. A highly significant increase
in the blood histamine level was evident when the plasma ascorbic acid
level fell below 0.7 mg/100 mL. This comprised 150 of the 437 (34%) men
and women. From Clemetson CAB, Volume III, Vitamin C (1989), page 6.
Reproduced with permission from CRC Press.

There is no abnormality in the blood coagulation system in scurvy.
The bleeding of scurvy results from capillary fragility due to a toxic
histaminaemia, which opens the tight junctions between the vascular
endothelial cells (1, 2). There is, as we know, a collagen deficiency in
scurvy. This deficiency cannot be the cause of the bleeding, for there is
very little fibrous tissue surrounding the capillaries and venules from
which the bleeding occurs.

The swollen, spongy, bleeding gums of classical scurvy are never seen
before the eruption of the teeth, so infantile scurvy is not obvious on
initial physical examination. Subdural haemorrhages and retinal petechiae
may appear alone, or may be accompanied by fractures of the ribs at the
costo-chondral junctions, subperiosteal haemorrhages in the long bones,
epiphyseal separations, skin bruises, and sores that will not heal. One is
bound to consider physical abuse. However, all of these signs are also
characteristic of Barlow’s disease, so blood chemistry analyses are
essential in order to make a proper diagnosis.

In adults, vitamin C depletion alone can cause a four- or five-fold
increase in the blood histamine levels of apparently healthy, ambulant men
and women (3), as shown in Figure 1. Complete deficiency of this vitamin
leads to even greater histaminaemia, which causes capillary fragility and
bleeding. The presence of ascorbic acid is necessary for the removal of
histamine from the blood. Vitamin C acts like a catalyst or a co-enzyme
and is essential for the conversion of histamine to hydantoin-5-acetic
acid, and on to aspartic acid in vivo.

Histaminaemia from other causes, such as the bacterial and viral
toxins accompanying infection or following the injection of the foreign
proteins of vaccines, add to the histaminaemia of vitamin C depletion.
This hyper-histaminaemic state can cause retinal petechiae and bleeding
from the capillaries and in the walls of the bridging veins between the
brain and the dura mater, leading to subdural haemorrhage.

Barlow’s disease, or infantile scurvy, was a well-recognized disease
in bottle-fed infants in the first 75 years of the 20th century, but that
diagnosis is falling into disuse and shaken-baby accusations have largely
replaced it. Today we are seeing a Barlow’s disease variant -- a form of
infantile scurvy which occurs earlier and may be due to a concatenation of
factors, including the increased number of vaccines given all at once to
infants at eight weeks of age.

Child-abuse laws require immediate reporting to the proper
authorities by anyone who even suspects the mishandling of a child. Such
cases soon involve the police and the members of the news media, who, to
be dramatic, sometimes refer to sores that will not heal as “cigarette
burns.”

The laws should be changed, so that none of these accusatory people
would be called until plasma ascorbic acid and blood histamine analyses
have been determined, and the details assessed by a physician. We cannot
allow an alarmist, public hysteria to precede and even supplant the full
evaluation of the appropriate data by unbiased physicians.

There is every reason to believe that infant deaths following
vaccinations could be prevented or markedly reduced by the administration
of vitamin C before inoculations, instead of the more usual paracetamol
(4, 5). Not only will there be a decrease in the infant death rate; but
also an important reduction in the incidence of cerebral palsy, epilepsy,
cognitive and behavioural problems, and intellectual impairment, can be
expected.

Suggestions

A. Vaccinations should be deferred when an infant has an infection or
other illness, even the common cold.

B. Centers for Disease Control and Prevention should consider
reducing the number of vaccinations administered all at one time.

C. Five hundred milligrams of vitamin C powder (or crystals) should
be dissolved in fruit juice and given to the infant to drink within a day
or two before any vaccination.

D. A study of plasma vitamin C and blood histamine levels, at various
intervals following single and multiple inoculations, could be carried out
on adults. Such a study would ascertain which vaccines cause the greatest
histaminaemia, and when the histaminaemia peaks.

References

1) Clemetson, CAB. Is it “shaken baby”, or Barlow’s disease variant?
J Amer Phys Surg 2004; 9:78-80.

2) Clemetson CAB. Elevated blood histamine caused by vaccinations and
vitamin C deficiency may mimic the shaken baby syndrome. Medical
Hypotheses 2004; 62:533-536.

3) Clemetson CAB. Histamine and ascorbic acid in human blood. J Nutr
1980; 110:662-668.

4) Kalokerinos A. Every Second Child: Thomas Nelson Australia Ltd,
1974. Also in Pivot Health Books. Every Second Child: Keats Publishing,
Inc., New Canaan, CT, 1981.

5) Clemetson CAB. Vaccinations, inoculations and ascorbic acid. J
Orthomolecular Med 1999; 14:137-142.

C. Alan B. Clemetson, M.D., Professor Emeritus, Tulane University
School of Medicine, New Orleans, Louisiana, U.S.A. Email:
megcc2000@yahoo.com. Tele: 504-866-1525

CABC/mgc

Competing interests:
None declared

Competing interests: No competing interests

21 December 2004
C. Alan B. Clemetson, M.D.
Professor Emeritus, Tulane University School of Medicine
c/o 5844 Fontainebleau Drive, New Orleans, Louisiana 70125, U.S.A.