In late March, 1996, I went to court in another state to help a working-class family which had contacted me through this home page. A 2-1/2 year old girl had obvious nonspecific vulvovaginitis, with a mix of flora on gram stain which included some gram-negative diplococci, mostly extracellular. The child was just getting over chickenpox, which might have triggered the vulvovaginitis. The pediatrician, a self-styled expert on child sexual abuse, found an "apparent healed laceration" at the 2-3 o'clock position in the hymen, no further description. Cultures and DNA probes were negative for gonorrhea. Cultures of all family members, including the grandfather, a former chief flight mechanic on a Navy ship, were negative for gonorrhea. The child denied any sexual stuff during the medical exams. The child struggled and cried a lot during the child abuse exams and cultures. A smear of the "purulent" exudate showed no white cells, only a lot of epithelial cells. Afterwards, she talked about "monster(s)" and "doctor monsters", and said, "The monster(s) put a bone in my mouth and the hair choked me" (the cotton-tipped swabs, dummies) and said "the monster had a mask" (duh).

On the strength of this evidence, the Department of Human Services told the court, "The perpetrator has been identified" as the grandfather, the evidence being that he owned a Hallowe'en mask. They told him that if he admitted his crime and got counselling, the child would be restored to the mother. The entire family refused. I was the sole medical witness for the defense, which I took for free.

I poked around the medical library, confirmed and improved on what I already knew, and was able to testify that

(1) 3% of girls had a little nick in the hymen at the 2-3 o'clock position, just naturally, and around 20-30% of three-year-old girls have such innocent nicks ("apparent healed lacerations", I thought), which are no more indicative of trauma than is a double-chin;

(2) relying on a gram stain in this situation was totally unacceptable as a means of diagnosing gonorrhea, and the bugs were probably Neisseria sicca or one of it kin, common commensals, which tend to be extracellular while gonorrhea bacteria are usually mostly intracellular;

(3) the CDC guidelines specifically direct physicians NOT to rely on a gram stain in this situation;

(4) if this were gonorrhea, there would have been white cells in the exudate, and the abundance of epithelial cells suggested "resolving chickenpox" to me;

(5) the negative culture and DNA probes satisfied me that this was almost certainly not gonorrhea;

(6) there are published, empirical criteria for the physical examination of a girl suspected of having been sexually abused, and the "expert" had utterly failed to address or meet these;

We won.

From working in this area, I've reached the conclusion that most doctors don't want to go against the local prosecutors, or defend somebody accused of a vile crime, no matter how silly the charges. Since I'm not a family or political man, I can do this more freely than others, and enjoy the challenge.

Some of Dr. Friedlander's Stories of False Accusations

* A teenaged boy apparently had common jock itch, which was mistaken by a paraprofessional for herpes, and an adult was charged with causing this by sodomizing the boy; I wrote a letter and have heard no more since.

* A young teenaged girl made assorted accusations, some clearly untrue, against her natural father, who was in a custody battle with the mother. The local child-protection doctor evidently mistook the white line that sometimes runs from from the posterior aspect of the vulva to the anus as a healed laceration. The case is pending.

* Not child abuse, but similar. . . . A man died of a heart attack while smoking in his chair, and burned after he died. His wife was wrongfully convicted of a torch murder. My letter written in an attempt to obtain her release got me a paragraph in the Wall Street Journal.  I would rather have seen her released.

Except for one case which went through a referral agency, I've handled these pro bono.