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I have a question about a word mentioned in the "Boy in the Box" mystery: What is hemophilia?

Hemophilia is a hereditary blood disorder, transmitted through the female line, but principally affecting males. Essentially, hemophilia is a disease in which the blood clotting factor is severely impaired.

Persons afflicted with this condition must be especially careful to avoid any risk of receiving even a minor physical injury, since uncontrolled bleeding, both internally and externally, may result. Hemophiliacs can also experience spontaneous internal hemorrhaging. Although hemophilia can be controlled through the administration of modern drugs, it can be a life threatening disease.

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When a child was circumcised back in the 50's, was this optional? Did you have to consent or authorize this procedure? There has to be a doctor out there that performed this procedure on this little boy. I would think that back in the 50's most parents didn't have this done unless the father was circumcised, and they usually wanted their son to be the same. How many babies in that State had an operation of that sort around the time this child would have been born?

In the 1950s the great majority of baby boys (more than 80%), from rich and poor families alike, were routinely circumcised. Among most Jewish sects, male circumcision was (and still is) a religious obligation. For non-Jews the rationale for performing a circumcision was often cosmetic or to promote long-term genital health. Despite its general popularity in the United States, the procedure has never been mandatory.

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When I was reading through the theories on your web page, I noticed that it said the boy may have had autism. Children with autism often engage in repetitious activities. In some cases, these movements may be harmful, such as repeated biting of their wrists and banging their head. This could explain the multiple bruises on this boy's head.

If the little boy had autism, it may have gone (medically) unrecognized and the parent/parents may have 'hidden' the child from almost everyone so that they wouldn't be branded 'bad' parents (while everyone else had children like 'Beaver')... because of the 'bad' behaviors that he may have had. That could explain why the little guy could have been so badly beaten ... parents/caregivers didn't know how to get him to 'mind' and just assumed it was intentional on his part...then they went way too far. A lot of children with autism don't like to have their hair cut. It seems to frighten them and they fight it a lot. It seems that a very frustrated person cut that little guy's hair. Another characteristic is an inability to verbalize properly. If someone got mad at the child to try to get him to talk, or to be quiet, could they have grabbed his little arms so tight that he bruised? Also was there any evidence that the boy still wore diapers? It's something that is harder to train. What I'm suggesting is that someone may have done such a good job 'hiding' the boy that even a baby-sitter may not have been aware of his existence. Did the baby-sitter go into every part of the house while there? We have a little boy with ASD 'features' and this story really frightened me... That little boy may indeed have really been a little angel...whoever was taking care of him just didn't know...or care.

Autism is a developmental disability that typically appears during the first three years of life. It is the result of a neurological disorder that affects the functioning of the brain. Autism is four times more prevalent in boys than girls and knows no racial, ethnic, or social boundaries. Autism impacts the normal development of the brain in the areas of social interaction and communication skills. Autistic children typically have difficulties in verbal and non-verbal communication, social interactions, and leisure or play activities. The disorder makes it hard for them to communicate with others and relate to the outside world. In some cases, aggressive and/or self-injurious behavior may be present. Persons with autism may exhibit repeated body movements, unusual responses to people or attachments to objects and resistance to changes in routines. On the surface, the autism theory has a lot of merit but it would be foolish for anyone to make a medical diagnosis based upon the known facts in this case.

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I was wondering while reading about all the 'surgical' scars the boy had if he could have been the victim of some kind of torture. Like perhaps being deliberately cut and sewn in those various places. That would explain no hospital records and it has been known that some people did their own home doctoring ... as in Dolly Parton's book she wrote of how she'd cut her foot and her mother sewed it up herself. In hearing of cases of child abuse on shows like Oprah, the abusers have kooky ways to torture a child. Was this taken into consideration by investigators?

All of the unknown boy's scars and injuries were carefully examined during a two-hour autopsy. If the scars had been the result of "amateur" surgeries or "torture", that fact would have been easily observed and noted by the city medical examiner. There was no such finding.

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This boy was considered unvaccinated. I only find that odd as I have been vaccinated twice, once as an adult, and have no mark from either. Interesting reading though.

Small pox was one of the most terrible diseases ever to afflict mankind. In the mid-twentieth century, vaccination against small pox was universally required of all children prior to their admission to public school. The live vaccine that was used was made from the vaccinia, a virus that was similar to cow pox. Just one dose of the small pox vaccine produced life-long immunity to both vaccinia and small pox in almost all recipients. Subsequent shots or boosters were rarely needed. There were few potential side effects, and the risk of complications from vaccination was much smaller than the risk of infection without vaccination. Inoculation with vaccinia caused a single pock at the site of injection, which gradually dried up and scabbed after about ten days, leaving a permanent vaccination scar. In most individuals, this scar was fairly large and easily detectable, but in a small minority of cases it was hardly visible at all. Also, whenever possible, doctors would inject the vaccine at the site of a mole or birthmark in order to conceal the scar. Through universal vaccination programs, surveillance and containment, the deadly disease was eventually eradicated worldwide. The last case of small pox was reported in Bangladesh in 1975, and it was declared to be totally eradicated by the World Health Organization in 1977. Since then, vaccinations against the disease are no longer required or even available to the general population.

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I know this case has been researched over and over again. What I noticed when I looked at the pictures on the bottom of the home page, (the left and right side view and full face view) was that this child appears to have been premature. I have 2 premature children who have the long narrow face with ears flat to the head and especially the long almost unnatural slope to the back of the head. My daughter's head looked that way and she had hydrocephalus due to a brain hemorrhage at birth. Being a preemie may also explain the hernia surgery. I didn't see it mentioned though what kind of hernia it was. My son had a hernia where his bowel/intestines had descended into his scrotum. My son got the hernia due to pressure from the ventilation and needed corrective surgery. I think ventilation can also cause umbilical hernia. So maybe instead of checking out full term births, they need to look to premature births. Also was the brain examined at the time of autopsy? Were there any post hemorrhagic cysts or areas of leukomalacia?

The unknown boy's brain and other internal organs were carefully examined during the autopsy. Unfortunately, we cannot tell you what the medical examiner's specific findings were because the autopsy records are classified. The only autopsy information currently available to the general public is limited to generalized statements reported in various newspaper and magazine articles.

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The following message was received from an Assistant Professor of Forensic Medicine:

I have gone through the "Boy in the Box Mystery" many times, and the conclusions that I have drawn are listed here with explanation. My assessment is completely objective and based on the information provided on the Internet. I shall divide my observations into three distinct categories.

(1) Possibility, (2) Probability, and (3) Absolute certainty

(1) POSSIBILITY:

The possibility of the child having died of internal hemorrhage is quite strong. Unfortunately, I do not have the full post-mortem record, otherwise I could be more consistent in my attempt to explain the traumatic sequence. However one thing is quite certain; severe trauma to the chest or abdomen would invariably lead to internal bleeding. If the autopsy surgeon is not keen in his observation he may miss the point of mutual association, i.e., the reciprocity of trauma to internal visceral damage. To emphasize my point, I'll relate an oft-repeated example that I give to my students. Spleen rupture occurs quite easily if sufficient force is directed at the left hypochondrium externally, particularly if the spleen happens to be enlarged. The person's death becomes a certainty unless surgical aid is provided rapidly. On superficial examination only an external bruise will be apparent which can never satisfactorily explain the havoc that has been caused inside by the seemingly trivial trauma. This fact has been co-opted by torturers particularly when they are intent on killing the victim. (And when would they be intent? Generally after the interrogation is over and they feel that a dead victim is better than a live one). In my country, they used to kick the victim on that side of the abdomen. But there was a basic flaw in that method in the sense that kicking produces shoe patterned bruises. So they have devised an indigenous method. Now they force the victim to lie supine. Then they put a moistened jute bag covering the abdomen, and finally they use a stick to cause trauma. The spleen gets ruptured. In autopsy we would encounter a lot of blood in the abdominal cavity as well as in the peritoneal cavity. Our question should be, "From where did the blood come?" This should ultimately lead us to the root cause. I do not know whether internal examination of the boy revealed rupture of any organ, say spleen, liver, mesenteries, or any major blood vessel like the abdominal aorta. Therefore, in the absence of a detailed post-mortem report, I would prefer to keep this possibility open.

(2) PROBABILITY:

(a) A boy of 5-6 years of age can never die because of cerebral hemorrhage induced by pressure on the temples, and that, too, while holding the boy firmly for a hair cut. Cerebral hemorrhage is in the majority of cases caused by rupture of the middle meningeal artery consequent to a severe trauma to the head. Merely applying pressure will not cause cerebral hemorrhage. This probability is discounted outright.

(b) Similarly, bruises across the forehead would not precipitate profuse bleeding so as to cause death. The reason is anatomical. The scalp has five layers, one of which is the tough aponeurotic layer. All the blood vessels supplying the scalp lie underneath it. In case of injury to these vessels, the tougher aponeurotic layer holds the bleeding vessels tight and thus prevents profuse bleeding. Those doctors who deal in head injuries remember the cardinal principle: Never associate the severity of trauma with bleeding of the scalp because the bleeding is always less and is not a reliable indicator of damage. The probability that the child may have died because of these bruises is dismissed.

(c) The report says that the child did not die of drowning. I can only say that immersion deaths are not difficult to find out at autopsy. In any case, drowning wouldn't explain the external injuries. The thickening of skin discerned in the child is known as cutis anserina, and it is not an antemortem phenomenon exclusively. If a body is thrown into water after death, cutis anserina (i.e., washerwoman's skin) would develop roughly 48 hours post-immersion.

(1) ABSOLUTE CERTAINTY:

Here I am on firmer ground. I can say with absolute certainty that the child had been abused, and this inference is based on the pattern of injuries. The physical manifestation of injuries is wide, meaning thereby, that whoever resorted to the abuse did not select any specific site. This indicates that either the child was maneuvering to save himself, or else the abuser just wanted to inflict the punishment in a non-specific frame of mind. This type of generalized beating comes out of a sudden uncontrollable rage of frustration upon failure to discipline the child. Again a tricky situation comes into play. The child had multiple bruises spread all over (unfortunately I do not have clear photographs, only those downloaded from the Internet). In children, bruises are formed much more readily as compared to adults, and this is because of the vessels' fragility. In fair skinned persons, the bruises are quickly apparent and sometimes misleading. However as a general rule, if the bruise is big enough, we must think in terms of haematoma (i.e., collection of blood subcutaneously). A big haematoma could contain up to 100 ml of blood. In a child it may hold up to 50-60 ml of blood. If there are 10 such haematomas, it would mean the loss of 500 ml of blood approximately. In a child of 6 years the average blood volume is 3-4 L. A rapid loss of 500 ml of blood from out of circulation would precipitate instantaneous hypovolaemic shock and the child would die.

A reminder: I do not know whether the autopsy surgeon focussed his attention on such an eventuality. Normally the bruises, if they are multiple, are cut longitudinal to the muscle fibers to assess the amount of accumulated blood.

I may add here that child abuse was an infrequent occurrence as far as the medical statistics are concerned. It is only after the 1960s that child abuse has come to play a significant role in the physician's diagnosis. Therefore in all probability the doctors may have missed this point, otherwise how can we explain seven healed surgical scars on his body (details about surgery not available). These scars remind me of "Proxy Munchausen's Syndrome". If one of the parents/guardians was really suffering from such syndrome, then from my side the mystery is solved. Patients suffering from Munchausen's Syndrome are highly unstable emotionally, and proxy MS is even worse. Unfortunately it is the third party, on whom the proxy is experimented, who suffers. The doctors wouldn't know because these patients keep on shifting their area of residence in a bid to avoid detection. However, too many scars on the body should raise suspicion.

Sexual abuse. No. Murder for ransom. No. Kidnapping for the purpose of removing movable property from the child. No. Neglected child. No. Impoverished child. No. Injuries in different stages of healing, say fractures. No. Fall from a height. No. Injured while playing. No. What the hell is this? All No's. Yes, there is one possibility which I suppose is more likely than others: child abuse which was inflicted by someone who was directly responsible for the care of the child and who was possibly suffering from Proxy MS. Who knows? The child may have refused to undergo another surgery.

Finally I leave 3 questions uncovered:

A) Whether the child was poisoned to death, and the injuries have nothing to do with his death.

B) Whether the child's death was caused unintentionally, and

C) Why there has been such a deadly silence from people who presumably have a conscience. After all, the crime has gone time barred. To me, the most puzzling question is why no one came forward to claim the body. Even though this question may be puzzling, the answer is straight-forward. It is because the child's caretakers were the abusers/killers, and this clinches the diagnosis of CHILD ABUSE WITH ..................INCOMPATIBLE WITH LIFE (the blanks are to be filled-in by the autopsy surgeon).

Thank you for your medical observations. Your message was immediately forwarded to the investigative team at the Vidocq Society. They found your comments and your review of the information on the web site to be most insightful, especially in view of the fact that you had not seen the official autopsy report. The investigators subsequently forwarded your message to one of the Vidocq Society's top forensic experts for further review and analysis. It may also be reviewed by the Philadelphia homicide detective in charge of this case.

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As best determinable, was the boy, although malnourished, healthy? I am a forensic pathologist, and live in an area comprised almost exclusively of American-Norwegians, Germans, Swedes, and Danes; call it a hunch, but I am trying to get a feel of how this child's caretakers felt about him, and compare this with what I know about this population here.

Your inquiry to the America's Unknown Child website was referred to me for a response. I am a member of the current investigative team continuing to pursue the identity of the unknown boy. No determination was made at autopsy regarding the overall general health of this boy during his brief life. Unless a condition of the type that would indicate obvious physical problems (i.e., a congenital heart problem, or some type of existing & easily identifiable disease or disorder) was present, there would be no way of making that kind of definitive determination short of documenting overt starvation, etc. Thank you for your interest and input in regards to this tragic long-term mystery.

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Is there any way to determine if the child was blind? Perhaps he was not adept at getting around, hence the many bruises on his legs, etc., and he could have fallen somehow and caused the trauma to his head. I don't know why, but the photos to me look as if he could have been blind.

At autopsy, unless there is clear evidence of disease (e.g., cataracts, glaucoma, retinal detachment, trachoma, tumors, etc.) or severe physical injury to the visual pathway (i.e., the eye itself, and/or the optic nerve), there really is no way of ascertaining whether or not a deceased person was "blind" when alive. We've placed the word "blind" within quotes because it is actually a relative, rather than an absolute term. There are literally dozens of types, and varying degrees of visual impairment, some of which do not originate in the eye itself. In other words, the eye can be perfectly normal, and yet the person cannot "see". For example, the brain may be unable to properly analyze and interpret the visual signals that are transmitted to it via the optic nerves. This condition, and similar neurological defects affecting the perception and processing of sensory information, cannot be detected at autopsy. As for the unknown boy, his autopsy records are classified, so we cannot comment about the medical examiner's specific findings in this case.

Since the unknown boy was born during the height of the Polio Epidemic, has the following ever been explored:

1) Known treatments involved immersion in water for extended periods. Also, initial treatment by Elizabeth Kenny involved cutting blankets, and immersing them in hot water, then wrapping them around the arms/legs (a practice begun by Sister Elizabeth Kenny.)

2) Some surgeries for braces involved insertion of rods, etc. through the foot/ankle area. (also Thorasic surgery.)

3) If you look at pictures of braces from this era, you will note that there are a series of bolts (?) in a line, particulary in the area of the foot/ankle, which may be consistent with the size of the markings on the child's forehead.

4) There is a web page (http://www.cloudnet.com/~edrbsass/polionarratives.htm#brace) which details the cutting of blankets, etc. and why/how this was done. On the same page, Edmund Sass' story refers to the wearing of a "Milwaukee Brace" (body brace), which could relate to other injuries of the unknown boy (e.g., chin area.)

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Is there a chance that this boy had epilepsy? I know a man who had a grand mal seizure at 7 that turned a normal boy with a normal life into a person who would be seen as 'retarded'. His IQ and reasoning skills basically stopped where he was. He never has stopped having seizures.

My thought is that perhaps this boy was in the tub unwatched for a period, and had a seizure knocking himself out with the left arm out of the water. He could have banged his body all over during a grand mal. Perhaps his mother / father pulled him out by the left arm causing the bruising there. From my understanding of the time period, had he suffered from these seizures, he probably would have been hidden away. The parents, not wanting to be identified, put him where he was hidden but not too well. That way he could be found and buried.

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I think the "Proxy Munchausen's Syndrome" theory is a good one, but it does make one wonder why no one has stepped forward to claim the body. I am not an expert on the illness, so I don't know.

The thing about this case that has grabbed my attention is the diagnostic dye in the left eye. From what I have been told by local optometrists, diagnostic dye, in 1957, could not be administered by optometrists, only ophthalmologists. Diagnostic dye is not something that can be confused with a prescription eye drop or something bought OTC. Also, diagnostic dye will naturally wash away (i.e. it cannot be detected in ultraviolet light) from a person's eye within 4- 8 hours after being administered (depending on cuts and abrasions).

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I have followed this case for some time. I came upon the story some years back. I have been a medical professional for over 15 years. I have seen all stages of traumas to the body and all stages of post mortem. I only have the body/head pictures of this young man from the Internet, but have noticed that there are no noticeable signs of "livor mortis", which is the pooling of the blood caused by gravity in the lowest parts of the deceased. There are chemical changes that occur in blood that start at the time of death, and lividity or livor mortis is noticeable within 2-4 hours post mortem and completed within 8-12 hours post mortem. From the picture of the body still within the cardboard box, the boy was found lying on his back. There should have been signs of lividity on the boy's back. Also, in the photo showing the bruising of the back of the neck, lividity is not visible. The young gentleman with the muskrat traps found the body days before it was turned in to the police. Even in cold temps the lividity process should have been completed.

As for the bruising of the little guy, it is very difficult to produce a bruise in a dead person, because it is very much a 'vital reaction' to injury. It may be possible to produce a bruise following very severe trauma in an area of post-mortem lividity (where blood has drained to dependant parts of the body under the influence of gravity), and if there is any doubt, the pathologist should examine the 'bruise' histologically. However, in the absence of an organising haematoma, histology may only show the presence of haemosiderin, and even then only after approximately 48 hours. So from the color darkness from the pictures which are black and white and the absence of lividity on the back, I do not agree with the Medical Examiner's statement that the TOD could have been as long as weeks.

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The marks on this child's legs have been nagging at me. Is it possible the patterned area of bruises was made by leg braces? As well as a disability associated with the surgical scar on his ankle? Perhaps Polio, considering the epidemic of the virus in that time period. (As I later explain, there were corrective surgeries being performed.) His eye ailment could have been conjunctivitis, also associated with polio. Moist heat was also used for treatment of spasms and/or muscle pain. Maybe why feet and hand were wrinkled? (That could be a stretch.) If death was by respiratory failure, that could also be consistent with the effects of polio. Polio associated respiratory difficulty could possibly be determined by the autopsy report if there were legions on the upper spinal cord or brain. A respiratory problem may also explain the scar on his chest, if I'm seeing the scar correctly, it's in the same area a chest tube insertion would be placed. It's difficult to see details on the photos, though.

The section above the knee, which is clear of bruising, would be consistent with the open section of a brace, and the four pattern marks on the legs could be consistent with brace straps. I'm also curious if the marking on the upper left arm could have been made by a walking apparatus strap. In trying to discover the results of the bruise patterns, I've been researching the history of the Hospital of the University of Pennsylvania, mainly their Orthopedic department of that time. In that time period, the orthopedic department was doing a great amount of tendon surgeries that may have left a mark which has been described on the child's ankle. In addition, the bruising on the inner ankle may have even been made by the other leg's brace. Also, it appears as if the right leg is shorter than the left which would signify a problem which needed corrected, even if another disability was present...maybe even cerebral palsy. If braces were used, perhaps the straps were placed on too tightly for sake of frustration of the caretaker, struggling with the child while placing them on him. The child may have been prone to bruising. The thing is, if he had corrective surgery on his ankle, his hospital stay in that time would have been a great length. From what I've read, it could be up to eighteen months. There were only two children's wards for this type of surgery in that area, and I wonder if the markings were consistent to a surgical procedure of this nature. Perhaps detectives would be able to match the child to one of the patients during that time period for that type of surgery. From what I've read, extensive records were kept at that time on the patients, at least at the PA hospital I earlier mentioned. The hernia operation, which commonly happens within months after birth and probably would have been treated at such time, would more than likely show as a prior surgery on records and may narrow the search. This may be nothing, but I thought I'd pass it along. One never knows, I guess.

I have one more question regarding the scar on the child's chest...the pictures aren't very clear, but I think I had mistaken the area of the scar. Is the scar near his arm on the left side of the chest? I wasn't sure if it's shadowing or the scar. If it is the scar, that could also coincide with surgical procedures being done at that time to help mobility of the arm/shoulder after an incident of polio. I also found records of the surgery being done on the ankle for mobility in that time period, and in fact, they used a cut-down incision for that procedure.

I'm also now questioning the bruised markings on the head. Although my initial thought was that they were the result of fingers, I'm now considering the thought of a non-evasive head restraint/halo brace, also used for polio patients. This theory is due to the vertical lines of bruising on both sides of the forehead, which could be consistent with the support bars used in head support braces. Also, due to the lack of extreme bruising to the chest area, head braces usually had a very protective chest covering. I've been researching the types of contraptions they offered at that time, and there had been a great amount of styles used in the 40's and 50's, but some are consistent with the marking surrounding his head and neck. A fall with braces could have contributed to such bruising of the head and entire body if my theory of braces being utilized is correct.

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