http://www.jpands.org/vol11no1/clemetson.pdf

(excerpt) Caffey Revisited: A Commentary on the Origin of  "Shaken Baby Syndrome" by
C. Alan B. Clemetson, M.D., --internationally-known expert on vitamin C deficiency

"Infants with the findings attributed to SBS may be affected by a combination of factors causing generalized capillary fragility, which in turn affects the capillaries of the bridging veins between the brain and the dura mater, predisposing to subdural hematoma, due to inadequate ascorbic acid intake and/or depletion by infections or multiple immunizations.

The defective formation of fibrous tissue, bone, and dentin that is known to occur in scurvy results from proline and lysine hydroxylase deficiencies that affect fibroblasts, chondroblasts, osteoblasts, and ameloblasts. However, the increased capillary and venular fragility causing the bleeding associated with scurvy is due to a many-fold increase in the blood histamine level, as shown by Clemetson. The total blood histamine increases exponentially as the plasma ascorbic acid falls. Majno and Palade have shown that toxic levels of histamine in the blood cause openings in the tight
junctions between the vascular endothelial cells, leading to extravasation of blood. Leakage of blood into the tissue slowly leads to local hemolysis, as evidenced by the yellow color characteristic of the fluid of old subdural hematomas. Hemolysis also leads to local ascorbate depletion.

Chatterjee et al. reported increased blood histamine levels following vaccinations in guinea pigs. This effect would likely be heightened when six vaccinations are given at the same time at 8 weeks of age, such as is now the custom in most English-speaking countries. If vitamin C levels are low at the time of vaccination, a resulting toxic histaminemia may cause further clinical problems.

A relevant finding by Archie Kalokerinos is that the increased death rate following vaccination of Aboriginal infants in Australia was arrested by administering vitamin C at the time of vaccination because ascorbic acid detoxifies histamine. Indeed, Chatterjee et al. demonstrated that ascorbic acid is essential for the detoxification of histamine (in guinea pigs), by converting it to hydantoin-5-acetic acid, and on to aspartic acid in vivo. Illustrations of the physiology and pathology of ascorbic acid and blood histamine have been presented previously.

Other factors that are not given sufficient weight in evaluations for SBS are the presence of chronic subdural hematomas, often occurring during or shortly after birth, and the fact that chronic subdurals are susceptible to rebleeding. Subdural hematomas have been found using fetal ultrasound in utero, before labor, as reported by Gunn, and also following normal, spontaneous delivery, as reported by Chamnavanaki et al. The tendency to rebleed could be
exacerbated by toxic histaminemia through the mechanisms explained above."

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Dr. Clemetson, who wrote a 3-volume work on Vitamin C deficiency which is still a classic in the field, went on in his report to analyze the 6 cases Caffey used as the basis for a 1946 article that was a forerunner to his "whiplash-shaken Infant Syndrome" articles in 1972 and 1974. Clemetson points out that in every case the signs and symptoms pointed to infantile scurvy, even if full-blown disease lacked time to develop, all of which Caffey ignored other than to list scurvy as a Differential Diagnosis (another cause of the same symptoms) but did no testing to eliminate it, and instead made an assumption that bleeding in the head and fractures or callus formation on bones and other symptoms were caused by "shaking", making his "whiplash-shaken" concept nothing more than an unproven hypothesis.

Dr. Clemetson spent the last years of his distinguished career writing about the misdiagnosis of SBS in cases that were more likely nutritional deficiencies causing metabolic disease with the same symptoms attributed to child abuse: subdural hematoma, retinal hemorrhages, hypoxia (low oxygen), brain swelling, bones that fracture spontaneously, with normal handling or falsely appear to be healing fractures due to calcifying subperiosteal hemorrhages on the skin of the bones, bone necrosis, abnormal bruising, anorexia, swallowing difficulties, skin lesions, ecchymosis, pain on movement and many other symptoms, including SUDDEN DEATH. SBS proponents tend to ignore the illnesses seen in cases attributed to SBS, including respiratory infections, ear infections, bacterial infections, anemia, blood disorders, failure to thrive, high-pitched crying, liver problems, heart problems and the many other markers for metabolic conditions and/or adverse reactions to vaccination. Nor do they factor in prior harmful medical treatments and the use of dangerous pharmaceutical drugs, including antibiotics with potentially terrifying side effects in susceptible individuals.

It was noted that "breast-fed infants are notoriously immune from this disorder" (subdural hematoma) without understanding the significance of this finding. Breast milk contains enormous amounts of vitamin C in mothers with a healthy diet, where "artificial" formula lacks enough to address any unusual need for it and heating cow's milk destroys it. When vitamin C is low or absent, many systems of the body are affected, and where there is one deficiency, there are probably several--vitamin D (rickets), vitamin K (hemorrhagic condition) and others. Also, vitamins interact with minerals, compounding deficiency states.

Lack of breast feeding was attributed to a "poor environment" conducive to child abuse. However, in modern times it usually means not so much a bad home but a working mother out of the home and a change in demographics in who happens to be with the infant when a disorder or illness hits a crisis stage, such as on certain key days following the vaccination of a susceptible, formula-fed infant. Fragile health, natural infection, vaccinations, pharmaceutical medicines/drugs and baby formula: a recipe for disaster.

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Subdural Hematoma

Treatment. -- In the postmortem examination of infants dying of cerebral hemorrhage, Rodda [1] found over 50 per cent followed non-instrumental deliveries and many followed normal and easy births. In these cases the blood was found slightly or not at all coagulated. Cerebral hemorrhage was by far the most frequent cause of death in the newborn in his group of cases. In many cases at postmortem, no torn veins were found in the cerebrum or cerebellum to account for the hemorrhage, and multiple hemorrhages were found in portions of the body where it was inconceivable that they could be explained by trauma. Over 25 per cent of all infants dying of cerebral hemorrhage showed this picture of multiple hemorrhages. An analysis of cases reported in the literature deepened the conclusion that these hemorrhages were due to factors other than trauma. Further study led to the conclusion that there was a disturbance in the coagulation time of the blood in the new born. It was found that the average coagulation time in the new born was seven minutes. In icterus, melena, jaundice, syphilis and non-traumatic cerebral hemorrhage, the coagulation time of the blood was prolonged. In melena it might be delayed to ninety minutes. The subcutaneous injection of normal blood was effective in cases in which there was delayed or slow bleeding.

The further treatment in those cases with a diagnosis of intracranial hemorrhage is symptomatic and expectant. There is always the possibility that there may be spontaneous cure. The infant must be kept quiet and warm. For the motor hyperirritability and convulsions narcotics may be employed, before all chloral hydrate (0.12 to 0.5 gm per day per rectum), also bromides (0.25 to 1 gm. per day) or calcium lactate (1 to 2 gm.) or calcium bromide (0.3 to 0.5 gm. per mouth) per day."

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http://www.newscientist.com/article/mg20126931.800-the-
pathologist-challenging-shaken-baby-syndrome.html?full=true

Dr. Irene Scheimberg, Pathologist: (Interview)

Non-Traumatic Subdural Hematoma

"The problem with the shaken baby controversy is that it's very dogmatic. If I don't accept religious dogma (and I don't), I'm not going to accept scientific dogma. If it's there, it can be proven. I do recognise that some adults are capable of doing nasty things to children, but I'm uneasy about people saying: "Oh, if a baby has got subdural haemorrhage (SDH), retinal haemorrhage and brain swelling, it can only be shaken baby syndrome." I'm trying to find out the mechanism of bleeding in the brain in babies who have not been shaken.

Have you any clues as to what the mechanism causing "shaken baby" symptoms might be?

I'm exploring all sorts of theories. My colleague Marta Cohen from Sheffield Children's Hospital and I have just published a paper with observations of our autopsy work on fetuses and babies over the last couple of years. We selected 55 cases - 25 late third trimester fetuses who died shortly before delivery and 30 newborns - who had haemorrhage within the membrane that covers and separates the two halves of the brain, and compared this with the level of brain hypoxia, or oxygen deficiency. We knew that none of these cases could possibly be inflicted trauma. We found that all those with severe brain hypoxia and half of those with moderate brain hypoxia had SDH. This is the same type of SDH that some people describe as specifically indicative of shaken baby syndrome. A similar pattern of haemorrhages has been described in the retinas of newborn babies dying of natural causes. We think that in these cases the haemorrhaging is caused by the hypoxia.

My concern is that by relying on this famous triad of symptoms - brain hypoxia, SDH and retinal haemorrhages - to diagnose shaken baby syndrome, when there's no evidence of inflicted trauma, we may be sending to jail parents who lost their children through no fault of their own. As scientists it's our duty to be cautious when we see the triad, and to take each case on its merits. We owe it to the children and their families."

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http://www.ncbi.nlm.nih.gov/pubmed/7143728?dopt=Abstract
Rinsho Ketsueki. 1982 Aug;23(8):1235-40.
[A case of scurvy with subdural hematoma] (Japanese article)
Miura T, Tanaka H, Yoshinari M, Tokunaga A, Koto S, Saito K, Izumi J, Inagaki M.

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http://tinyurl.com/csxm5y
[Scurvy--a mistakenly forgotten disease]
[Article in German]
Hürlimann R, Salomon F.
Departement für Innere Medizin, Universitätsspital Zürich.

Four cases of scurvy diagnosed within a period of two years are reported. They comprised 2 male patients with heavy nicotine and alcohol abuse, a 35-year-old woman with malnutrition due to food supplements phobia, and a 69-year-old woman with malnutrition due to dementia and social isolation. All four patients were adynamic and anemic. Three patients showed typical dermatologic signs with hemorrhagic hyperceratosis, suffusions or cork-screw hair. Two patients complained of parodontol disorders. Other symptoms were gastrointestinal bleeding, sicca syndrome, retinal bleeding, subdural hematoma, edema and arthralgia. Associated disorders were folic acid and vitamin B12 depletion in two cases, and nephropathy and pneumonia with pneumothorax in one case each. In all cases the serum asorbic acid concentration was below the scorbutic level of 11 mumol/l. Historical data, pathogenesis, incidence, clinical presentation, diagnosis and therapy of scurvy are discussed. We conclude that scurvy can be observed even in a developed country such as Switzerland at the end of the 20th century. The real incidence may be underestimated because symptoms are not well known and disappear rapidly after admission because of sufficient vitamin C content in normal diet. Patients at risk are socially isolated alcoholics, old people, psychiatric patients and diet enthusiasts. Usually scurvy occurs in conjunction with other deficiencies. Smoking and acute illness enhance ascorbic acid depletion. With a knowledge of the symptomatology of scurvy, it is easy to diagnose and treatment is simple and effective.  PMID: 8091164 [PubMed - indexed for MEDLINE]

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Scurvy

http://emedicine.medscape.com/article/413463-overview

* Lethargy, listlessness, mental confusion, and fatigue
* Pale, bloated complexion and dry, rough skin as a result of defective collagen
* Hair follicle enlargement and plugging; perifollicular congestion; proliferation of blood vessels; formation of lumps in hair follicles; fractured, coiled, or bent hairs; and perifollicular hemorrhage caused by defective collagen
* Swollen and purple gums, putrid and bleeding gums, or loosened teeth as a result of defective collagen
* Ecchymoses due to blood-vessel fragility (Purpura may become palpable.)
* Costochondral junction swelling; hemarthrosis; and pain, stiffness, or swelling of the knees or ankles as a result of bleeding
* Arrested skeletal development caused by defective collagen
* Impaired wound healing and breakdown of previously healed ulcers caused by defective collagen
* Dyspnea, chest pain, abruptio placentae, intraocular hemorrhage, diarrhea, and gastrointestinal blood loss caused by fragile blood vessels and defective collagen
* Femoral nerve compression by hematomas
* Normocytic anemia and macrocytic anemia related to osmotic fragility of the red blood cells
* Hypotension due to blood loss and vascular fragility
* Hematuria
* Subdural hemorrhage
* Sudden death