NORTHEAST WILTSHIRE HAS A POPULATION OF 200,000, INCLUDING APPROXIMATELY 18,500 CHILDREN UNDER AGE 5. APPROXIMATELY 40 PERCENT OF THE POPULATION IS URBAN. THE STUDY ENCOMPASSES CHILDREN AGE 4 OR YOUNGER WHO HAVE SUFFERED VERY SEVERE, ACTIVE PHYSICAL ABUSE. DATA WERE OBTAINED RETROSPECTIVELY FROM CHILD ABUSE REPORTS FOR 1965-71. AN INDEPTH STUDY WAS MADE OF THE 38 CHILDREN AND 34 FAMILIES IDENTIFIED FOR THIS PERIOD. IN 1971, AN INTENSIVE EDUCATION PROGRAM WAS UNDERTAKEN TO IMPROVE CASE RECOGNITION AMONG MEDICAL PERSONNEL AND SOCIAL WORKERS. DATA FOR AN 18-MONTH PERIOD AFTER THE PROGRAM WERE GATHERED FOR PURPOSES OF COMPARISON BUT WERE NOT STUDIED IN DETAIL. FOLLOWING THE EDUCATION PROGRAM, THE RATE OF REPORTED SEVERE ABUSE WAS 1 PER 1,000 CHILDREN, AND THE DEATH RATE WAS 0.1 PER 1,000. THE ABUSE RATE FOR THE POSTEDUCATION PERIOD WAS APPROXIMATELY 2.5 TIMES GREATER THAN THE RATE FOR 1965-71. ANALYSIS OF THE CASES IN THE RETROSPECTIVE SAMPLE REVEALED THAT THE FOLLOWING FAMILY CHARACTERISTICS ARE ASSOCIATED WITH ABUSE: LARGE FAMILY SIZE; YOUTHFULNESS; LOW SOCIAL CLASS; INSTABILITY; AND GROSS PSYCHIATRIC, MEDICAL, AND SOCIAL PATHOLOGY. THE FINDINGS ARE DISCUSSED IN RELATION TO DATA FROM OTHER STUDIES. THE NEED FOR A SYSTEM OF LINKED MEDICAL RECORDS TO STUDY IN DETAIL THE APPARENT CLUSTERING OF DISORDERS WITHIN FAMILIES IS NOTED. SUPPORTING DATA AND A LIST OF REFERENCES ARE INCLUDED. (AUTHOR ABSTRACT MODIFIED--LKM)