Chronic inflammation does not necessarily imply
inflammation of long duration, and may follow a transient or prolonged acute inflammatory stage (Vernon-Roberts 1988). Essentially there are two forms of chronic inflammation : either the chronic reaction supervenes on the acute reaction or may in fact develop slowly with no initial acute phase (ab initio) (Hurley 1985). Chronic inflammation ab initio can have many causes including local irritants, poor circulation, some micro-organisms or immune disturbances. Chronic inflammation is usually more productive than exudative - it produces more fibrous material than inflammatory exudate. Frequently there is some tissue destruction, inflammation and attempted healing occurring simultaneously (Hurly 1985, Walters and Israel 1987).
http://electrotherapy.org/modalities/tissuerepair.htm
Its clear from this that there is no way to rationally infer chronic parental abuse from the autopsy report expression 'chronic inflammation' that people found and quickly latched onto.
From what I can tell, the chronic reaction can supervene on the acute reaction in a day or two.
I want to expand on that, as I believe some might misinterpret.
It means the
chronic inflammation condition is not necessarily caused by prolonged
inflammation in and of itself, but that the
chronic inflammation condition could result from other underlying or external influences, "including local irritants, poor circulation, some micro-organisms or immune disturbances."
Sexual abuse is not ruled out since multiple transient or prolonged rubbing episodes could be categorized as "irritant". If JB did not have "poor circulation" in her genital area and / or "micro-organisms or immune disturbances" then sexual abuse or other local physical intrusion of a sort would be logical
assumptions.
Without knowledge of a more complete medical diagnosis of JBR immediately before or at the TOD we may not reach definitive conclusion as to whether or not JBR was sexually molested during a prolonged period prior to the DOD....
... but we may assume to other logical conclusions within context:
We know there was an abnormal condition existing at the TOD, a chronic inflammation.
We know JBR was taken numerous times to a doctor for vaginitis, common causes of which in pre-pubescent girls are (different than those for reproductive-age women):
I doubt Strep. as a primary cause in this case. I'd focus more on bacteria or other irritants from JBR's anal region, given that it's been reported JBR needed help with "wiping". I suspect this to be the cause of the chronic inflammation.
We know there was vaginal bleeding at or near the TOD. This indicates sexual abuse / insertion at or near TOD, nothing more, nothing less. It is not known if it was for pure sexual satisfaction or for sadistic pleasure but given the state in which the body was found we might assume a sadistic nature.
JBR was wearing at least one piece of unusual, outsized clothing typically worn by a larger person. I suspect there might be other unusual aspects to JBR's appearance or surroundings at the TOD that are being withheld.
Possible (electrical or other) burn marks were discovered on JBR's face and other areas.
Unattributed DNA material was discovered on particular areas of the clothing.
Unattributed DNA material was discovered under JBR's fingernail(s).
I do not trust the DNA reports in this case. I believe the "reports" to be an LE tactic to elicit response from POI(s). The DNA means nothing in this case.
Some conditions of the scene and of JBR might be unrelated (chronic inflammation and sexual abuse and burns and sadistic tendency of the perp and posing) but within the context of the crime, to many they might appear related.
We might assume a "kidnapper(s)" most likely would not perform extended abusive actions on the child victim within the home, that s/he would attempt to quietly and immediately arrive to the victim's location within the dwelling and spirit her/him away from the dwelling just as quietly and immediately, i.e.: Jessica Lundsford.
I believe the R family had an enemy. That enemy wanted revenge. That enemy most likely is someone very close to the family, in fact might be outwardly friendly and helpful. It could be an extended family member.
There was no reported footprint evidence in the snow cover surrounding the basement window areas. We know perhaps each of 15 (more? less?) individuals possessed a key to the R dwelling.
We also must assume those individuals have family, friends and acquaintances that might have had inadvertent or clandestine access to those keys.
Which of all those individuals knew of a "safe in the Ramsey house"?
Was JBR aware of the safe / location?
Was JBR asked, and she obliged then the perp became enraged upon discovery of an empty or inaccessible safe?
How else to steal money from a family that you hate? A ransom?
After drudging away on writing a ransom note the perp modeled after PR's writings found in the house, the perp ultimately decides the mechanics of demanding and receiving a ransom is too risky so s/he decides to destroy whom s/he believes to be the family's most prized member?
What triggered the hate? What triggered the revenge?
... just throwing thought-threads to up in the air ...