Expert opinion in child abuse has received considerable bad press and currently public confidence in this area of medical practice is low. Media interest has focused most on the diagnosis of factitious illness. However doctors who examine children in respect of proceedings arising from suspected sexual abuse should be mindful this area is potentially just as problematic. Widely different rates of abnormal findings have been reported. At least in part this has reflected inconsistency in interpretation.
Paolo Zacchia (1584-1659) was the personal physician of the popes Innocent X and Alexander VII, legal advisor to the Rota Romana and head of the health system in the Papal States. His most important work, written in Latin, is entitled "Quaestiones Medico-Legales" and was published in 9 volumes between 1621 and 1651. Even after Zacchia's death comprehensive reprints were published at several places up to the late 18th century. Zacchia covered all the medicolegal issues of his time including the problem of "malpractice" and medical ethics.
Individuals can carry out complex activity while in a state of impaired consciousness, a condition termed "automatism". Consciousness must be considered from both an organic and a psychological aspect, because impairment of consciousness may occur in both ways. Automatism may be classified as normal (hypnosis), organic (temporal lobe epilepsy), psychogenic (dissociative fugue) or feigned. Often painstaking clinical investigation is necessary to clarify the diagnosis. There is legal precedent for assuming that all crimes must embody both consciousness and will.
