Excerpts from a speech made by Alumni President, Dr Kevin Collins on April 27th 2017
In 1966, Dr Robert Gregory Birrell, senior assistant physician to medical outpatients at RCH was 33 years old. A 33-year-old paediatrician at the Royal Children’s Hospital then and now would surely be seen as a very junior member of the consultant staff.
This very junior person, together with his older and better-known brother, the late Dr John Birrell, police surgeon, had the temerity to write an article in 1966 in the Medical Journal of Australia entitled The Maltreatment Syndrome in Children. As they noted, this was the second such article in Australia, with a similar paper on the Battered Child Syndrome published from the Adelaide Children’s Hospital the previous year. The landmark article from the United States by Kempe, Silverman and others first reporting the Battered Child Syndrome had appeared in 1962.
The Birrells documented eight cases of physically abused children who had come to the notice of the police, some of whom had been treated at the Royal Children’s Hospital. The text was accompanied by eloquent photographs of children with bruising, lacerations, frostbite, scalds and fractured limbs. They recommended that there should be legislation along the American lines so that suspected cases of child abuse be notified to a central social agency. Almost prophetically, they wrote “We realised very early one of the main reasons why the maltreatment syndrome is not well-recognised, and this is the general attitude of disbelief and incredulity that people would or could do such things to little children. This attitude is widespread, extending to housewife, doctor, lawyer and even policeman. The hospital staff, orientated in attitude of necessity towards treatment rather than prevention, tends often not to think of violence, particularly when faced by neatly dressed and plausible husband or wife”.
The second article by Bob and his brother, published in 1968, was entitled The Maltreatment Syndrome in Children: a Hospital Survey, and began with a quotation from the interesting psychiatrist RD Laing: “Husbands and wives can drive each other mad but they can get a divorce. Children are stuck with their parents”.
Using a range of methods of ascertainment, they summarised the clinical, radiological and social pathology findings in 42 children who had presented to the Royal Children’s Hospital over a 31-month period – that is, more than one a month that they knew of.
They suggested guidelines for increased clinical suspicion of child maltreatment, insisted that rehabilitating the family should not be undertaken at the risk of further harm to the child and again recommended the guidelines of the American Academy of Paediatrics which included immediate reporting of suspected cases to a legally responsible agency, the keeping of central records and immunity from prosecution of reporting doctors or hospitals.
So, Bob Birrell and his brother John were pioneers, recommending that our esteemed hospital come up to speed and adopt the best practice as determined by our overseas paediatric colleagues.
It could also be argued that they were akin to whistle-blowers – not in the strict sense of revealing corruption or malpractice within an organisation, but certainly in the sense of bringing an unpleasant truth to light. Regrettably they received similar treatment to whistle-blowers.
Incredible as it may seem to us today, their findings were generally not accepted by Bob’s medical peers and relevant administrators at the time. Attitudes varied from acknowledging that their work was well-intentioned but that its importance had been exaggerated, through to active obstruction of further investigation, of involvement of police or of setting up in-house teams to manage such cases.
Eventually, the first and most consistent support came from the social work profession, particularly Miss Kath Dawe, chief social worker at the time, and it is probably fair to say that it is out of her support that later child protection teams came into being.
So, for some 50 years, Bob Birrell has effectively been a prophet without honour in his own medical community. Garry Warne and I, together with our alumni colleagues thought it was time to right this wrong and for Bob to enjoy this recognition. I feel very honoured to be part of this celebration, and again thank Anne Smith and Matt Sabin for helping to make this possible.