e
By JAN DANFORD
A happy, healthy Shelton
baby, on a February evening in
1966, was put to bed in the usual
manner. In the morning the
six-weeks-old child was found
dead.
Prosecuting Attorney Byron
McClanahan, as coroner, then for
the first time came into direct
contact with the intangible horror
that hovers over the households
of small infants; the elusive killer
that defies medical science; the
spectre that haunts the lives of
those involved - crib death.
At least 10,000 and often as
many as 15,000 babies, most of
them between the ages of two and
four months, succumb suddenly
and unexpectedly each year in
this country alone.
"'What did 1 do? What did I
fail to do? What tiny action did 1
ignore, or what feeble sound did I
not hear? Why is my baby not
alive today?"
To the anguished heart-cries
of the bereaved parents,
physicians can say but this:
"Don't blame yourselves."
The pain encompasses also the
doctors, who are unable to
predict or to prevent the problem.
The only symptom is death itself.
In the case handled by Byron
McClanahan an autopsy was
performed at the University of
Washington. Findings made it
possible to assure the parents that
they had been in no way
negligent.
Although previously well
aware of the threat of crib death,
child.
First sought are the
identifiable childhood killers -
heart defect, brain damage,
poison. If no cause of death can
be determined they are actively
dealing with sudden unexplained
infant death. SUID.
In less than three hours the
team will have taken tissue
samples and viral swabs, which are
packed in ice and removed swiftly
to Children's Hospital for
immediate culturing in the
virology lab. All is accomplished
in utmost haste in the hope of
catching viruses before they may
escape undetected.
Cooperative members of the
child's family contribute their
own blood samples and swabs,
and the search for an SUID virus
has begun. If it exists it will be
recognized when it provokes a
reaction from a particular tissue
culture.
It is believed that a virus is
associated with crib death because
SUID occurs most frequently
during months when viruses in
general are prevalent and in
families where minor signs of
infection are present. If such a
virus is at work, it is thought that
certain existing conditions in the
child may make it possible for the
killer to strike.
For the first few months of life
an infant lives in a state of
transition as his immunological
system is developing rapidly to
replace the lessening protection of
his mother's antibodies. As his
nervous system matures, tissues
showed signs of throat
inflammation.
Bergman stated that an
infection most insignificant to an
adult body might act on the
autonomic nervous system of the
immature infant.
A theory advanced by Boston
University School of Medicine
pathologist Dr. Abraham Towbin
proposed that a whiplash injury
to the spinal cord could be the
answer.
In the course of a study
conducted on birth injuries, Dr.
Towbin had made post-mortem
examinations of newborn babies
some of whose spines showed
hemorrhage as though twisted and
strained during delivery. Seven of
eight crib death cases examined
had the same characteristic spinal
hem orrhage.
The doctor noted the
similarity of the damage endured
by these infants to that of adult
victims of whiplash injuries. He
was not, however, able to explain
how the baby might receive the
injury.
Dr. Towbin pointed out that a
newborn baby is very literally
top-heavy, his head weighing
approximately four times as much
as that of an adult in proportion
to total body weight. He
considered it conceiveable that a
baby's heavy head and weak spine
might cause him to be susceptible
to whiplash injury in the course
of sudden twisting and turning
movements in the crib or playpen.
He stated that vital nerve cells in
the spinal cord could thus be
the stricken and shocked families
who have experienced the tragedy
of crib death. The more active
groups include the Washington
Association for Sudden Infant
Death Study, in Seattle; the Mark
Addison Roe Foundation with
headquarters in Greenwich, Conn.
and in Denver, Colo. ; the
California Association for Sudden
Infant Death Study in Fremont,
Cal.; and the Guild For Infant
Survival in Baltimore, Md.
Members of these
organizations strive to alleviate
the punishing self-blame in which
the afflicted families are
entrapped. Charges of neglect by
husband or wife may result in the
breaking up of the family; the
doctor is sometimes blamed for
failure to find a problem during
his routine examination;
baby-sitters and grandparents
have been accused of carelessness;
siblings have been made to feel
unwarranted guilt.
Public misunderstanding has
been a cruelty in the past, many
suffering mothers and fathers
having been suspected of child
abuse; but the worst weapon of
all is the self-denunciation with
which the agonizing parents flay
themselves relentlessly and
indefinitely.
In August of 1962 Jedd and
Louise Roe, then of Greenwich
and later moving to Denver,
established a foundation named
for their six-month-old son, Mark
Addison Roe, who had died in
October, 1958.
Neither the Roes nor their
larynx and windpipe of the dead
infant have been ascertained and
their shapes preserved with a
silicone cast after which detailed
microscopic sections were made.
A sudden allergic reaction to
cow's milk was once proposed
and widely studied, especially by
British doctors. American doctors
did not readily accept this theory,
pointing out that many victims
had never been fed cow's milk.
Crib deaths are more apt to
occur in crowded neighborhoods
where there may be a greater
exposure to germs, thus bolstering
the theory that an overwhelming
infection could be the killer.
Dr. James R. Patrick,
pediatric pathologist at the
Children's Hospital of the District
of Columbia has stated that two
or more viruses are probably
responsible, rather than only one.
Further support for the
infection theory arises from the
fact that the majority of crib
deaths occur at an age when the
infant's immune defenses have
become dangerously low. Dr.
Frederick C. Robbins, professor
of pediatrics at Western Reserve
School of Medicine in Cleveland
and co-winner of the Nobel prize
for his work in culturing polio
viruses, points out that the
protective antibodies received by
the baby at birth from his mother
are constantly declining
throughout the first year of life.
It is known that the polio
antibody is low by three months
of age. Dr. Beckwith hopes that
vaccinating babies against crib
from this day forward and cells undergo changes not as injured with no visible effect, doctor accepted the autopsy death viruses, once they are
McClanahan has been extremely yet fully understood, and any resulting in a later and report of"bronchialpneumonia", identified, might restore
active in the fight to gain failure in the maturing processunexplained death. They considered it merely a label protective levels as does
information, in the efforts to might allow an opening for theThe Seattle research team applied to cover medical vaccination in polio.
educate the public in the beginning of the death-dealingcompletely disproved this theory, uncertainty. A most disturbing question to
recognition of the disease, and in sequence, reassuring grieving mothers who The Roes encountered callous be faced is that of how any germ
the unceasing struggle to trace the Viruses are elusive. It is far feared that failure to support the attitudes toward those losing could kill with such frightening
malady to its source, easier, according to virologists, to s m a I 1 he a d m igh t h a ve children to SUID, and determined speed. None of the infectious
At least as old as the Bible is explain them than to isolate contributed to death, to work toward the banishment diseases such as diphtheria,
crib death, to which, as them. Crib Death seldom occurs of the misunderstanding and thecholera or blood poisoning can
"'overlaying," a reference is made - In the state of Washington, before the age of six weeks ormisconceptions surrounding crib act so swiftly. Only a fatal heart
in i Kings 3 : 1 9. The term progress in the study of crib death after the age of six months. Clues death, attack, a chemical poisoning or
originated at a time when adults was slow until coroner Leo M. to the mystery include an Even more appalling than the the occasional lethal allergic
and infants often shared a bed, Sowers and Fred Dore of the state abnormal metabolic product effect on parents is the shock of reaction to penicillin, which can
and it was thought that the legislature lost children to the which turns to red the alcoholthe tragedy upon little brothers occur within one or two minutes
sudden deaths were due to sudden-death syndrome. They with which it is combined in and sisters. They cannot after injection, can match the
suffocation. Many present-day added to the effort their certain chemical tests. This understand and they cannot speed ofcribdeath.
parents, lending credence to this influence, and in 1963 Dore substance was found in 80% of accept. They are lost in grief for It would therefore appear that
false belief, fear that they may p u s h e d t h r o u gh a b ill the brains of a group of crib death the baby and steeped in fear for involved viruses would necessarily
have smothered their dead child appropriating $20,000 a year tobabies studied in Philadelphia. Of themselves. Death hangs heavy multiply with devastating
through carelessness, finance the infant autopsies to be the infants dying of identifiable over their frightened heads, swiftness or would unerringly
Others wonder if their babyperformed in the University of causes, only 20% produced the Research has been stimulated seek an unusually vulnerable spot
choked on mucus or regurgitated Washington Hospital or the "red substance". The discoverer, by the parents' groups. Pioneers in the infant's body. Several
food; some blame an unsuspected Children's Orthopedic Hospital.
illness occasionally small brothers ~h,e ,Upjversity', .Anedical
or sisters are heart-bre~ ,~school orgamzed in the sameyear
accused. Post mortem findin~T~e international conference on
deny such concepts.
For almost two decades war
has been constantly waged against
SUI D Sudden Unexplained
InfantDeath. In many major
citiesnew techniques and
advanced equipment assist
detailedstudies, among the most
dramatic of which are thos-e that
have been conducted by doctors in
the Children's Hospital in
Washington, D.C.
Backed by a grant from the
National Institutes of Health,
their plan of action has included
the assistance of the district's
homicide department and the
coroner's office.
Homicide detectives and
representatives of the coroner's
office are among the first to know
of crib death cases. The
information is given instantly to
the concerned doctors, and a
group known as an SUID team,
the creation of Dr. James Patrick,
chief of pathology at Children's
Hospital, rushes into action.
The three members, a
pathologist and two assistants,
one of whom is a viral specialist,
are on call 24 hours a day and
seven days a week. If a crib death
occurs during the day, the
message is relayed to an SUID
office in the basement of the
hospital; if at night, team
members are notified in their
homes.
Dressing hurriedly and
grabbing up their equipment,
packed and ready, they hasten to
the District of Columbia Morgue•
An immediate autopsy is
performed on the body of the
A I. TmR FRo/
FROM SANTA CLAUS
SANTA CLAUS, INDIANA
THE PROOF IS IN THE
POSTMARK!
Visit our Santa Post Office and
select a colorful letter FREE!
It's 0ur way of saying Merry
Christmas to children of all ages.
"Causes o{ ~Sudden Death in
Infants•" The published
proceedings are available to every
pediatrician in the United States.
The Washington State
research project received a
three-year grant of approximately
$1 20,000 from the National
Institute of Child Health and
Human Development with which
Pathologist Beckwith and
Pediatrician Bergman financed a
thorough study of all crib deaths
in King County and several from
surrounding areas.
Since 1965 every crib death in
King County has been
investigated by doctors Abraham
B. Bergman, J. Bruce Beckwith
and C. George Ray. Early in the
program a typical pattern
emerged; Most of the victims were
less than four months old; more
deaths occured in winter than in
summer; the death rate was
highest among low-income
families.
Do environmental factors set
the stage for a physiological
explanation of crib deaths? In
each of the cases autopsies
revealed that lungs were
congested and contained many
tiny ruptured blood vessels.
Seattle investigators
attributed the lung damage to
tremendous pressure accumulated
in the chest prior to death. They
believe that the pressure was
caused by the constriction of the
child's vocal cords, whereby the
passage of air was closed in the
windpipe causing death by
internal asphyxiation.
Bergman explained that in an
infant the autonomic nervous
system which controls the vocal
cords is unstable, and evidence
indicates that many of the
stricken children had suffered the
virus infections common in
winter. All autopsied infants
Dr. Frederic Rieders, chief
toxicologist in the office of Dr.
Joseph Spelman, city medicsI
examiller ~r l~atladelphia, ha, yet
to determine the composition of
the substance and he does not
know how or why it is produced
by the body.
Dr. Marie Valdes-Dapena of
St. Christopher's Hospital for
Children in Philadelphia found a
relationship between poverty and
crib death. Dr. Spelman agreed
that environment might play a
role and also suggested
psychological causes as a tentative
idea.
Crib death seldom strikes
twice in the same family.
However, in the years from 1949
until 1966, Arthur and Marie
Nee, Philadelphia low income
parents, lost nine children in
infancy. Suddenly and
unexpectedly, death has
repeatedly occured in a definite
and unchanging pattern with no
discernable reason.
Intensive investigation of the
Nee case has proved beyond a
shadow of a doubt that there was
no neglect, no carelessness, no
faintest suspicion of homicide. No
signs of violence, no trace of
poison, no lethal substance of any
sort was ever found.
The theory of suffocation was
absolutely disproved by Dr. Paul
V. Woolley Jr. of Detroit who has
repeatedly tested and
demonstrated the fact that a baby
between the ages of two and six
months - the period during
which most crib deaths occur -
can easily roll or lift his face from
a mattress surface, and can
wriggle from beneath a blanket.
Crib death has been
christened the "disease of
theories"; but investigators press
on in spite of discouraging forays
in which false leads are followed
down blind alleys.
In the meantime in many
cities parents have banded
together to comfort and to assist
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Page 8 - Shetton-Mason County Journal - Thursday, November 18, 1971
in the field faced resistance to the
very necessary proml~t post
mortem examinations.~ Pressure
for a program requi~'ing ~:g'uch
procedure in each and every crib
death was begun in the state of
Washington in 1956 by Dr.
Sherod M. Billington, a
pediatrician in the Seattle area
and chairman of the Washington
State Medical Society's
committee on maternal and child
welfare.
Upon completion of an
autopsy, parents are now
promptly informed as to whether
or not their baby's death can be
explained. At one time a long
wait was involved before results
were released.
Mrs. Margaret Pomeroy,
graduate nurse and mother of
three children, within two weeks
after the funeral visits the crib
death home for a tape-recorded
interview. Working from an
extensive questionnaire, she
covers such details as the position
in which the baby was found,
when and what the child had last
eaten, the type of bedding used,
whether or not there had been
complications during pregnancy,
and various questions concernittg
the medical history of the
parents.
Mothers often volunteer
suggestions. Several had noted
that deaths occured at exactly the
age when the children w~e
beginning to sleep through the
night.
Although doctors agree that
crib death is death without noise,
they are not certain that it ,is
death without a struggle.
Inflammation of the larynx is
frequently found. In pursuit of
this clue measurements of the
researchers have suggested the
.~. possibility of multiple causes.
'~ According to Dr..Beckwith
there is a chance that a child with
• a certain type of nervous system
or a weakened state of immunity
or both might become infected
with a certain type of virus with
the combination of all factors
leading to death.
Dr. Bergman has likened the
crib death syndrome to an atomic
explosion occurring when the
critical mass has been reached.
"It can be compared,.' the
Seattle team has reported, "with a
nuclear reaction in which a
number of isolated events, each
harmless in itself, must occur
simultaneously to trigger the fatal
explosion."
Much of the mystery of the
silent killer has been dispelled,
although the general public is not
yet fully aware of the true facts
concerning crib death. Many
writers, unable to correctly
interpret medical terminology,
have inadvertantly misquoted the
statements of doctors and
researchers.
In approximately 15% of
sudden infant deaths a standard
medical cause such as pneumonia
or meningitis can be found. The
remaining 85% can be shown in
the course of a skillful autopsy to
follow a single specific pattern,
according to Dr. Bergman.
There are five pathological
signs. In almost every case tiny
hemorrhages are found on the
inner surfaces of the membranes
surrounding the lungs and on
other surfaces within the chest
cavity. Such hemorrhages are not
found elsewhere in the baby's
body and are found but rarely
following death from other
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causes.
Edema fluid is found in the
lungs, and the heart almost always
contains fluid blood rather than
the clotted blood to be found
following death from most other
causes.
The bladder is empty, and a
slight inflammation is apparent
along the airway leading to the
lungs.
Such a pattern of multiple
factors is known as a syndrome,
and therefore the cause of crib
death is called by researchers
"sudden death syndrome", or
SDS.
Autopsy findings and other
evidence have ted the Seattle team
to propose an explanation of how
a crib death occurs. They state
that in a young baby the airway
leading to the lungs is very small
and that the area below the base
of the throat is barely large
enough to admit a pea. Half an
inch lower the two vocal cords
come together in the larynx, and
there the passageway is not much
larger than a grain of rice.
Muscles in and around the
larynx can close it off
involuntarily, as occurs in a
cough. The Seattle team has
concluded that the most likely
mechanism of death in SDS cases
is a sudden involuntary spasm of
the tiny larynx.
Dr. Beckwith reached this
conclusion by following the clues
presented by the hemorrhages
within the chest. Experiments
conducted upon animals
confirmed his view.
"If a laboratory animal is
number one cause of' death in
infants after the first week of life.
It cannot be predicted or
prevented, even by a physician.
The cause is not suffocation,
aspiration or regurgitation,
although sometimes death
certificates use such terms in
error.
A minor illness such as a
common cold may be present, but
many victims are entirely healthy
prior to death.
There is no suffering; death
occurs within seconds, usually
during sleep.
Crib death is not contagious
in the usual sense. Although a
viral infection may be involved, it
is not a "kiUer virus" that
threatens other family members
or neighbors. It rarely occurs after
the age of seven months.
It is not hereditary; there is
no greater chance for it to occur
in one family than in another.
The baby is not the victim of
a ''freakish disease".
Approximately 10,000 to 15,000
babies die in this manner every
year in the United States.
Crib death is at least as old as
the Old Testament and was
apparently at least as frequent in
the 18th and 19th centuries as it
is now, demonstrating that new
environmental agents such as
birth control pills, fluoride in
water Supplies, and smoking are
not to blame. Although the
subject has received increased
attention in recent years, the
incidence of SDS is not rising.
Recent research shows that
Sudden Infant Death
causes over 85%
unexpected death
At the
Washington State
NFSID held in
Children's Orthopedic
Seattle, Doctors
Bergman, Ray and
on the SIDS
Reports included the
cord blood study.
Since August
Seattle hospitals
cord blood from
child. Tests are
baby becomes a crib
Under a new
grant of
National Institutes
three staff members 0!
Orthopedic
the research.
will be Dr. C.
specialist in virus
Co-investigators will
Bruce Beckwith,
director of
Paula Clausen, a
trainee in mt
They will be
agents in the
victims and in the
umbilical cord blooa
the children were born
The Children's
Hospital group
more than 400
the Seattle area.
be obtained by
Washington state
NFSID, 9326
Mercer Island, W"
anesthetized and its airway
clamped shut at the larynx," he
Locol Trovelers Retorn
stated, "Its breathing muscles
promptly contractinaneffortto
From Month Long Tour
draw air into the lungs. The effort
is unsuccessful, but a powerful Mr. and Mrs. Lawrence surrounding plain.
vacuum is produced in the lungs. Carlson and Mr. and Mrs. Herbert not-to-be forgotten
The negative pressure is so great Angle have recently returned was their contact
that small blood vessels burst and from a month's tour that took Aborigines of Austr~
tiny hemorrhages occur, them to the South Seas, New They found tit,
"Later, when the animal is Zealand and Australia. delightful, particur
examined at autopsy, tissue Their itinerary included unspoiled island
surfaces within the chest cavity Honolulu, Tahita, Moorea, Fiji, of their expecta
are found to be mottled with Auckland, Waitoma, Rotorua, lege daryislandpar
hundreds of these hemorrhages Sydney, Melbourne and numerous
- just like the ones found in the side trips to points of interest. W lnn ers N'
same places among babies who Both the Carlsons and the
have died of SDS." Angles were greatly impressed in By Bridge
Although this explanation New Zealand and Australia with Monday night
deals with the "how" of crib the friendliness of the people, the Shelton Bridge
death, it leaves unanswered the
great question of"why", beauty of the scenery, and the B atchelor and
The National Foundation For strength of the economy (which Lynn Rust and
Sudden Infant Death with has virtually no unemployment). Tuey Schumache-r
headquarters in New York City, A highlight of the trip was Mr. Quimby.
has determined certain basic facts Carlson's climb of Ayers Rock, The club meets at
concerning crib death, the largest monolith in the world.
It is a definite disease and the This impressive feature of Central
Australia rises 1,148 feet from the
each Monday :In
building. All bi'idg¢
welcome.
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