The Emergency Room doctor who examined six-month-old Cassidy Ann Salahuddin told a Supreme Court jury yesterday that the baby appeared to be dead when she arrived at the hospital.

The baby?s father, Karim Shaheed Salahuddin, 25, is charged with murder in her death but has claimed that her fatal injuries were the result of a fall while he was carrying her in a baby carrier. The baby was rushed to the hospital on May 5, 2003 and died in the early hours the next morning.

The Crown alleges that Salahuddin killed the baby by shaking and hitting her with sufficient force to cause shaken baby syndrome.

Salahuddin, of Serpentine Road, Pembroke, is represented by Queen?s Counsel John Perry and defence lawyer Elizabeth Christopher.

Yesterday, Dr. Philip Jones ? who treated Cassidy on her arrival at hospital ? said Salahuddin told him he had tripped with the baby in his arms, in a ?pumpkin seat?, and she had rolled 30 feet downhill.

Dr. Jones said he was shocked to the see the child in such a condition. ?She was mottled and pale and she looked very ill,? he said. ?There was clear discharge coming from her nose. When I first saw her, initially, she was dead ? meaning that there was no pulse, no heart beat, and she wasn?t breathing.?

Dr. Jones said the discharge coming out of Cassidy?s nose was spinal fluid, which indicates the baby may have suffered from a skull fracture, although none showed up on a CAT scan performed after medical personnel attempted to get her to breathe.

Doctors performed CPR as part of what is known as the Advanced Paediatrics Life Support System on Cassidy in an effort to save her life.

Mr. Perry asked Dr. Jones if the CPR given was vigourous and if, in the struggle to save the baby?s life, her ribs may have been broken. Dr. Jones admitted the CPR was intense and went on for 45 minutes.

?Rib fractures are more common in adults who have ridged ribcages whereas children?s ribs are elastic and require a great deal of force to break,? Dr. Jones said.

Continuing the cross examination, Mr. Perry asked Dr. Jones to look at the pumpkin seat ? a white and navy coloured baby carrier. Dr. Jones admitted there were visible scuff marks on the seat although he had said in earlier testimony that he had examined the pumpkin seat for signs of the fall Salahuddin had told him of, but had not found any scuff marks.

Paediatrician Dr. Peter Perinchief also testified yesterday telling the court Cassidy had massive haemorrhages in both eyes, all the signs of severe brain damage and was in an unresponsive state when he saw her.

An eye exam revealed that Cassidy?s pupils were fixed and dilated, he said, a sign in infants which indicates severe brain damage. ?The pupils were non-responsive which indicates that something was going on with the central nervous system,? said Dr. Perinchief.

He also examined the retinas. ?All I could see was blood, there were massive haemorrhages in both eyes with the surface of the retinas almost impossible to see due to the amount of bleeding.?

He said this is a benchmark in infants which indicates some form of abuse and is ?suspicious? particularly since Cassidy did not have abrasions on her body, consistent with the fall Salahuddin had described.

Dr. Perinchief discovered bruises on both her left and right shoulder and one on her leg.

Apart from those markings there were no abrasions on the baby?s skin. There were also pools of blood in the tissue in the infant?s brain consistent with her head being shaken in a back and forth motion, he said.

?This is a hallmark sign of shaken baby syndrome as there are few signs of the body and massive haemorrhaging in the eyes,? said Dr. Perinchief. ?The prognosis was extremely grim.?

During cross examination by Mr. Perry, Dr. Perinchief was asked about an article in the which points out that shaken baby syndrome is a controversial topic in the medical field.

The March 2004 article cited by Mr. Perry said that shaken baby syndrome can occur as a result of minor trauma or minor falls. According to that article, 37 percent of shaken baby cases are the result of minor trauma.

?There is a substantial body of medical literature in England and the US which supports conclusions based on experience that sub-dural and retinal haemorrhaging consistent with shaken baby syndrome are not necessarily a product of shaken baby syndrome?? Mr. Perry asked.

Dr. Perinchief said he disputed some of the facts in the study and that the author?s methods were criticised by the wider medical community.

However, he did agree that medicine could not always be 100 percent accurate. During further questioning he admitted bruising on the baby could have been the result of a fall. The court also heard that on May 7, Salahuddin was brought to the hospital by Police officers for allegedly refusing to eat ? a concern as he is a Type II diabetic.

Although Salahuddin told Police he had not eaten for two days, Dr. Jones said ketones, a sign of low blood sugar were not present in his urine ? a compound which indicates low blood sugar and would indicate someone has not eaten for two days.

Salahuddin, according to Dr. Jones had high blood sugar.

The trial continues today before Chief Justice Richard Ground.