929 as gram-negative and unstainable.2 This is where the Dieterle method has a place even though most human lungs contain confusing debris with the size and morphology of legionnaires’ agent.s Originally devised for staining Treponema pallidum in formalin-fixed paraffin-embedded tissue,6 and later found capable of staining Donovania granulomatis of granuloma inguinale,’ Dieterle’s method celebrated its golden jubilee with this new application. The Center for Disease Control has helpfully issued stained sections and also control treponema-infected tissue to allow departments to practise the staining procedure. Several British cases of legionnaires’ disease have been reportedg-14 and the pathology of the Scottish casesl7 is similar to that of the American ones. There is much more to unravel about this newly-discovered infection. The American reports refer briefly to fatty change in the liver and renal tubular necrosis in some instances. That the organism has been seen interstitially suggests that it is capable of causing bacterasmia or septicaemia. Explanations have still to be offered for the frequent presentation with alimentary symptoms and for the occasional cerebral manifestations. Diagnosis should ideally be made during life, but the pathologist may have to initiate or complete the investigations at necropsy. If effusions are present, a sample of pleural fluid should be taken. One sample of blood should be taken for culture and another for antibody levels. Swabs from involved lung, or blocks of unfixed tissue, can be sent to the bacteriology department though culture and fluorescent-antibody tests may have to be done elsewhere since few laboratories are yet equipped to look for the legionnaires’ disease agent. If the Dieterle stain gives equivocal results, a formalin-fixed paraffin-embedded section can be tested by the fluorescent-antibody technique. Mercurial fixatives should be avoided. When a patient has died of any primary respiratory infection it is well to bear in mind the risks of air-borne dissemination to pathologist and postmortem room staff.

reported

CHILD ABUSE ALTHOUGH children have been physically abused throughout history, it was not until 1961 that Henry Kempe, using for the first time the emotive term, battered-child syndrome, succeeded in evoking widespread interest and concern for the children injured by their parents. In the intervening years, Professor Kempe and his colleagues in Denver have continued to work with such 5. Chandler, F. W., Hicklin, M. D., Blackmon, J. A. New

Engl. J. Med. 1977, 297, 1218. 6. Dieterle, R. R. Archs Neurol. Psychiat. 1927, 18, 73. Van Orden, A. E., Greer, P. W. J.Histotechnol. 1977, 1, 51. 7. Torpin, R., Greenblatt, R. B., Pund, E. R. Am. J. Surg. 1939, 44, 551. 8. Ashford, R. F. U., Edmonds, M. E., Shanson, D. C. Lancet, 1977, ii, 1364. 9. Lees, A. W., Tyrrell, W.F., Boyd, J.F. ibid. p. 1187. 10. Macrae, A. D., Lewis, M. J. ibid. p. 1225. 11. Lawson, J. H. Scott.med. J. 1978, 23, 121. 12. Kerr, D. N. S., Brewis, R. A. L., Macrae, A. D. Br. med. J. 1978, ii, 538. 13. Boyd, J. F., Buchanan, W. M., MacLeod, T. I. F., Shaw Dunn, R. I., Weir, W.P.J.clin.Path 1978, 31, 809. 14. Reid, D., Grist, N. R., Nájera, R.Bull. Wld Hlth Org. 1978, 56, 117.

children and their families. Over 3000 families have been known to the centre at the University of Colorado School of Medicine. Drawing on this unequalled experience, Ruth and Henry Kempe have written a book1 aimed this time not at fellow experts but at the much wider audience of "all those people who in the course of their professional or private lives may be called on to recognise and cope with cases of child abuse". They provide a useful overview of the Denver group’s current ideas on the nature of child abuse and the ways they and others have evolved for dealing with it (and possibly preventing it). We are not allowed to forget that the battered child is likely to have long-term problems (physical and psychological) that will not be solved by "crisis intervention programmes". One chapter is devoted to sexual abuse of children-a recent concern of the Denver team. In Britain this problem is only just being openly acknowledged and the children get next to no help. Preventing recurrent physical injury is relatively simple ; 80% of the Denver children return safely home. Getting parents to understand and enjoy their children is much harder. One mother said "I don’t beat Johnny any more but I hate the son-of-a-bitch like I always did". The Kempes remain optimistic about the future; they are hopeful that prevention will be possible and that communities will respond and protect the rights of children. The main criticism of their book must be that its last rewrite was obviously sacrificed to allow the launch during the Second International Congress on Child Abuse and Neglect held in London last month-the most ambitious conference on the subject yet staged.* Around a thousand participants from 25 countries attended. The usual disciplines of social work, medicine, psychology, and law were joined by sociologists, anthropologists, teachers, lay helpers, a handful of self-confessed baby batterers, Erin Pizzey, and, for one afternoon, Princess Margaret. The faithful anticipated a "meaningful exchange of ideas", the more sceptical, chaos. The reality was a mixture, leaving organisers and participants about equally dazed. Research papers on prediction confirmed that it is possible to identify families at increased risk of abusing a child. What the response to such predictions should be was less clear. One scheme of drawing up a list of at-risk families, who without their knowledge are subjected to extra surveillance, met with some hostility. The solution offered by David Gil (a sociologist) was more radical-the complete restructuring of society and abolition of exploitation. One function the conference did serve well was to highlight some of the issues that must be faced by both policy makers and those responsible for the day-to-day care of abused and neglected children. Christopher Ounsted provoked much-needed debate on the fate of children born to psychotic parents. Harold Martin once more drew attention to the long-term problems of the abused child; the prognosis for many, whether left at home or removed, is grim. The child who should not return home needs firm early decisions on permanent care.

*Many of the Neglect.

papers will appear in the

International Journal of Child Abuse and

1. Child Abuse. RUTH S. KEMPE and C. HENRY KEMPE. London. Books. 1978. Pp.160. £1.25, paperback; £6.95, hardback.

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