2. Violent

(a) Mechanical.—Under this head may be mentioned the passage of certain instruments into the cavity of the womb, and the rupture by violence of the membranes which surround the fœtus; also the injection of fluids into the uterus. A medical man practising in Yorkshire informed Husband that so great was the dread of large families, that he knew of several ladies who, if they went a day over their monthly period, passed a catheter into the uterus, with the desired result. “It was wonderful,” he added, “how clever they were.” In India a twig of the Euphorbium nivulia, anointed with assafœtida, is used for the same purpose. “The fœtus is never delivered alive, but there is said to be no great danger to the woman” (Chevers). Women may use hairpins, knitting-needles, and the idea is to pass the instrument “until blood comes,” which is accepted as a sign that abortion will be sure to follow. In some cases it is by no means easy to procure abortion, and women have been known to undergo a considerable amount of violence without abortion taking place. In some women, however, on the other hand, the slightest violence—such, for instance, as slipping from a step or low chair—will cause them to abort.

(b) Medicinal.—Certain drugs, among which may be mentioned ergot, savin, pennyroyal, rue, tansy, saffron, perchloride of iron, diachylon which contains lead, and others, have been used for the induction of abortion. In India unripe pineapple has a great reputation as an abortive (Medical Jurisprudence for India, Chevers). It is scarcely necessary to mention each drug individually, but it must be remembered that there is not one single internal medicament of which it can be consistently with experience asserted that, even when an abortion has followed its use, it must have produced this abortion, and that cause and effect are in such a case “indirect and necessary connection.” All the so-called abortives are most uncertain in their action, and their use is attended with considerable risk to the woman. In the case of diachylon profound lead poisoning may be the result. Be this as it may, they are more frequently used to induce abortion than mechanical procedure, from the fact that the latter requires some amount of anatomical knowledge and manipulative skill.

The dangers of abortion from any cause are hæmorrhage, sepsis, and peritonitis. In mechanical interference, especially where proper precautions have not been taken to prevent them, sepsis and peritonitis from local injury and perforation are prone to occur.

A medical man may be required to—(1) Examine into the nature and characters of the substances expelled from the womb; (2) Examine the woman stated to have aborted.

1. Examination of the Substances expelled from the Womb.—The substances expelled from the womb often become the subject of judicial inquiry, and the medical man may be required to give his opinion as to their probable nature.

Dr. Gallard has called attention to the following:

1. During the last six months of pregnancy, abortion, even when it occurs spontaneously, goes through the two stages as at full time, i.e. the expulsion of the products of conception is, as a rule, preceded by rupture of the membranes, followed after a time by the expulsion of the placenta.

2. In the first three months this order of things is absent, for it is the rule to see the fœtus expelled entire en bloc without rupture of the membranes.

3. If, then, we find during the first three months of pregnancy the products of an abortion in which the membranes have been ruptured and the embryo expelled alone, we must look for a pathological cause for this infraction of a general rule; and if no disease of the embryo or of the mother is found, we are justified in attributing the abortion to mechanical means used directly against the products of conception. Charpentier has shown that this rupture of the membranes is not an absolute proof of criminal abortion; but in eighteen cases of spontaneous abortion M. Leblond only found rupture of the membranes in one, and in this the membranes presented an abnormal friability.

The questions may be asked—(1) Is it a fœtus?—(2) Is it a mole? If so, is a mole also a fœtus?—(3) Is it merely the coats of the uterus, and unconnected with pregnancy?

1. Is it a Fœtus?—The development of the fœtus is given on pp. 35, 36 et seq.

2. Is it a Mole?—This question gives rise to another: Is a mole a fœtus? To this the answer must be in the affirmative. Moles, being the diseased appendages of the fœtus, vary in character, and have been described by obstetrical writers under the following heads: (a) Hydatiginous; (b) Carneous; (c) Fatty Moles.

(a) Hydatiginous Moles are a result of a diseased condition of the villi of the chorion. The villi become dropsical, and hang in masses like a bunch of grapes.

(b) Carneous Moles.—These are the result of hæmorrhage into the chorion. The blood becomes organised, and a fleshy mass is formed, to which in some cases a withered fœtus is attached.

(c) Fatty Moles.—Death of the fœtus and fatty degeneration of the placenta, or fatty degeneration of the placenta and death of the fœtus, produces this variety of mole. A withered fœtus with a mass of fatty placenta are expelled.

3. Is it merely the Coats of the Uterus, and unconnected with Pregnancy?—Fleshy masses may be expelled from the womb, which may not be the result of sexual intercourse. The description just given of true moles will, it is hoped, assist in forming a correct diagnosis. Considerable care will be required, for the honour of the woman accused depends upon the opinion given as to the nature of the substances submitted for examination. It must also not be forgotten that moles may be retained for many months in the uterus and be then expelled. The knowledge of this fact may rebut an accusation of infidelity against a wife. Polypi may be discharged from the womb; the presence of a pedicle will point to their true character. All substances expelled from the uterus should be carefully washed in water, and all clots removed. The examination of the woman may also help in the formation of the diagnosis. The absence of the signs of defloration or of recent delivery will be in her favour.

2. Examination of a Woman stated to have aborted.—This subject may be divided under two heads—(1) Has the woman been recently delivered? (2) What were the means used to procure the abortion?

It is by no means easy to answer the question whether an alleged abortion has really taken place or not. The signs of recent delivery are in most cases absent, for the woman can better hide her condition during the earlier than during the later months of utero-gestation; consequently suspicion may not have been aroused against her for some weeks or months after the event. The history of the case, with other attendant circumstances—milk in the breasts, change in the colour of the areola round the nipples, severe flooding, absence of the hymen, injuries to the os uteri, transverse condition of the os uteri in contradistinction to its circular form after delivery, &c.—will, in most cases, assist in forming a correct diagnosis; but it must be again repeated that few of the signs applicable to delivery at the full time are here available.

In all doubtful cases—

1. Examine into the general and present state of the health of the woman.

2. Find out if there are any reasons which would occasion a pretext to use drugs which are not usually given to women during pregnancy.

3. Learn if menstruation is regular and easy, or if the woman is in the habitual use of emmenagogues, for, if so accustomed, she may have used them ignorant of pregnancy.

4. If a woman ascribes her abortion to a fall, to an accident, or to violence used against her, carefully examine into the nature of these.

5. Examine into the general causes of abortion, and also inspect the expelled substances.

Where death is supposed to have followed the use of abortives, the alimentary canal must be examined for the signs of the action of irritants, or the presence of disease in the internal organs; but when death has resulted from an attempt to procure abortion by instrumental means, the neck of the womb is most frequently found covered by a number of small more or less irregular wounds, which may penetrate into the womb or lose themselves in the walls of the organ. Their course is indicated by infiltration, or a small extravasation of coagulated blood, the exact condition of which must, if possible, be ascertained, so as to decide when the wound was inflicted.

The examiner must not forget that the wounds may extend to the fundus of the uterus, and in this case the autopsy shows that a blunt instrument, as a catheter or uterine sound, introduced through the os uteri into the retroverted uterus, glides by its own weight into the rent. The seat of the tear leads one to think that pregnancy was not far advanced when the attempt was made, and in fact the accident most frequently occurs in cases of suspected pregnancy. It must be remembered that the uterus is often punctured by the injudicious use of the uterine sound, but without any immediate dangerous symptoms. Wounds in the walls of the vagina indicate the use of instruments by an inexperienced hand; in the fundus of the uterus, to one at least accustomed to the introduction of instruments. Spontaneous rupture of the uterus is impossible during the early periods of pregnancy, just when the attempts at abortion are usually made. Rupture due to external violence is, as a rule, accompanied with outward signs of the violence used.

In all cases a careful examination of the structure of the uterus should be made. An examination of the ovaries for false or true corpora lutea should be made. The opinions on the character and differences of these bodies are so discordant as to destroy all confidence in their value as proof of conception or the reverse.

Taylor says: “The discovery of the ovum in the uterus in process of development could alone, in the present state of our knowledge, warrant an affirmative opinion on this point in a Court of Law, and this I believe to be the safest view at present of this much-contested question. On the other hand, the absence of a corpus luteum from the ovary would not in all cases warrant an opinion that conception had not taken place.”

Examine carefully for local sepsis and signs of inflammation of the uterus and its surrounding structures.

Recapitulation

In Medicine, Abortion occurs before the sixth month of pregnancy—premature labour after that period.

In Law, Abortion may take place any time before the full period of utero-gestation.

Abortion may be due to—

CHAPTER XIV
INFANTICIDE

According to the present state of English law, infanticide—murder of a new-born child—is not regarded as a specific crime, but is treated and tried by those rules of evidence which are applicable in cases of felonious homicide, but with this difference, that the law requires proof that the child was born alive. An old Statute (21 Jac. I. c. 27) made the concealment of the birth of a bastard child conclusive evidence of murder. As far as the legal estimation of the crime is concerned, it matters not whether the child was killed immediately on its entrance into the world, or within a few days afterwards. A fœtus not bigger than a man‘s finger, but having the shape of a child, is a child within the Statute (R. v. Colmer, 9 Cox, 506; R. v. Hewitt, 4 F. & F. 1101). An English judge, at a late trial, stated that if the jury were of the opinion that the prisoner had strangled her child before being wholly born, she must be acquitted of murder. The law also, on the score of humanity, presumes that every child is born dead until direct evidence to the contrary, from medical or other sources, is given. The onus of the proof of live birth, therefore, devolves on the prosecution. It may also be difficult to decide as to the maternity, and the woman accused will have to be examined as to the possibility of her recent delivery.

Here let me repeat the advice given on page 148 as to the examination of a woman. Your duty is to request the woman to allow of the necessary examination, giving her the warning which every magistrate or coroner is bound to give to any person charged with a crime, before requiring an answer to a question which may be used in evidence against her at the subsequent trial. The innocent and the guilty may alike object to an examination, but the presumption is against the party declining, if several have voluntarily submitted. A young lady committed suicide rather than submit to an examination by two medical men under an order from the coroner. The medical men were guilty of a grave indiscretion, and both they and the coroner were acting ultra vires in attempting to force a woman to obtain evidence against herself (Taylor, vol. ii. p. 431).

The decision as to recent delivery will, to a great extent, rest on the condition of the mother, and the apparent age of the child found dead. The discovery of the body of the child is not necessary to conviction, but the medical evidence as to the signs of respiration, of course, depends on the body being found and examined. In most cases of alleged infanticide tried in England, juries appear more inclined to fall back on the minor offence—concealment of birth—than to convict of the capital offence; and this appears to be the only alternative if the body cannot be found, for, as we have just said, in law every child is held to be born dead. It must of course be shown that the woman has been recently delivered. In case of failure to prove the murder of the child, the Act (24 and 25 Vict. c. 100, sec. 60) enacts that “if any woman shall be delivered of a child, every person who shall, by any secret disposition of the dead body of the said child, whether such child died before, at, or after its birth, endeavour to conceal the birth thereof, shall be guilty of a misdemeanour.” The mere avowal of the birth is not sufficient to convict her; she must be proved to have done some act of disposal of the body after the child was dead (R. v. Turner, 8 C. & P. 755).

In Scotland, concealment of pregnancy is a statutory crime, chargeable when the child born is found dead or is not found at all, and there is no proof of its having been murdered. Pregnancy, up to a period when a child might be born alive, must be proved, and the words “during the whole period of her pregnancy” do not imply that the pregnancy must have continued for the full period of nine months. All that is necessary is that there should be such proof of duration of pregnancy as made a living birth possible. If the accused can bring forward a witness to whom she communicated her pregnancy, or called for assistance at the birth, or (it is believed) can prove that the child was born dead, she is entitled to an acquittal.

It has also been said that a woman ought not to be convicted of “concealment of pregnancy,” if at the time of delivery the fœtus do not appear to have reached the seventh month of intra-uterine existence. The birth of a “child,” whether dead or alive, is essential; therefore, if the woman accused “can prove that that which she brought forth was not a ‘child,’ but an abortion, or a fœtus, which, from some accident, was in such a condition that, though there had been assistance, it could not have been in a condition to be called ‘a child,’ then the case is out of the Statute.” The Scotch Statute differs from the English on the “concealment of birth” in this, that so long as the woman makes known her pregnancy, the motive for doing so is not considered. Thus, if she make arrangements with anyone to conceal the birth, “the Statute is eluded by that very circumstance” (Alison). The Statute applies to married as well as to single women; but, in the former case, the penalty is seldom enforced unless foul play is suspected.

DEFINITION OF THE TERM “LIVE BIRTH”
IN CRIMINAL CASES

“The entire delivery of a child.” There must be an independent circulation in the child before it can be accounted alive (R. v. Enoch, 5 C. & P. 539). The entire child must be actually born into the world in a living state (R. v. Poulton, 5 C. & P. 329). But the fact of the child being still connected with the mother by the umbilical cord will not prevent the killing from being murder (R. v. Reeves, 9 C. & P. 25). To kill a child in its mother‘s womb is no murder, because the person killed must be “a reasonable creature in being, and under the King‘s peace.” But if the child be injured in the womb, and yet be born alive, and then die as a result of such injuries, it may be murder in the person who inflicted them (R. v. Senior, 1 Mood. C. C. 346).

A distinction must be drawn between medical or physiological life and legal life. A child may have breathed, as it not infrequently does, before it is completely born into the world; and this might, in a medical point of view, be considered as a live child, but it is not one legally. The entire delivery of the child is necessary in law; and “it must also be proved that the entire child has actually been born into the world in a living state, and the fact of its having breathed is not a conclusive proof thereof.” The inference unfortunately follows from this ruling, that a mother may kill her child without fear of punishment, if she do so before the entire body has slipped from her.

DEFINITION OF THE TERM “LIVE BIRTH”
IN CIVIL CASES

The evidence of live birth in civil is somewhat different from that required in criminal cases. The viability of the child is determined in Scotland by its crying; in France, by its respiration; in Germany, “the LIVE BIRTH of a child is to be held proven when it has been heard to cry by witnesses of unimpeachable veracity present at its birth”; but in England, the pulsation of the child‘s heart, or any tremulous motion of the muscles, however slight, has been considered as satisfactory proof of live birth.[15]

According to Blackstone, “crying, indeed, is the strongest evidence, but it is not the only evidence”; and Coke remarks, “If it be born alive, it is sufficient though it be not heard to cry, for peradventure it may be born dumb.”

Signs of Live Birth prior to Respiration, and independent of it.—(1) Negative.—Signs of intra-uterine death, i.e. putrefaction, or “intra-uterine maceration,” or of such imperfect development that it could not have been born alive. (2) Positive.—Injuries to the child showing that it must have been born alive.

1. Negative.—Intra-uterine Putrefaction.—This condition differs in some remarkable points from putrefaction in air.

The body is extremely flaccid and flattened, the bones of the cranium moving easily on one another. The skin of the hands and other parts of the body bear the evidence of prolonged soaking in fluid. In parts, the skin is whitish, or of a reddish-brown or coppery-red colour, without any trace of green, which is always present when putrefaction takes place in the air. The cuticle may be raised in blisters, and be easily detached from the true skin. The denuded patches are moist and greasy, and exude a stinking, reddish-coloured serous fluid. The face is flattened, and the features distorted. In one case that Husband attended of intra-uterine death of the fœtus in a primipara, and where putrefaction was far advanced, the scalp burst during delivery, and the brain was poured out. Should, however, the child be exposed to the air, it may soon acquire the appearances proper to putrefaction in that medium. If the child, immediately after birth, be thrown into water, the putrefactive changes would be like those of intra-uterine decomposition. In this case the lungs must be examined for the evidence of death by drowning.

2. Positive.—Evidence that injuries found on the body could not have been inflicted during birth, or accidentally after birth. On this subject it is scarcely possible to give an opinion one way or the other. All the medical witness can fairly state is, that, from the condition of the lungs, respiration has or has not taken place; that, in the former case, it is not easy to state whether the injuries were the cause of death or inflicted after death.

Appearances showing that a New-Born Child has breathed.—1. Walls of the Chest.—“The vaulting of the thorax is not of the slightest diagnostic value.” Casper quotes from Elsässer the following remarks: “It is irrefutable that the variations in the circumference of the thorax (and, of course, in its diameters) are so considerable that no certain normal mean for a thorax that has breathed, and for one that has not breathed, can be laid down. In most cases the measurements of the thorax are incapable of determining whether the lungs contain air or not. The reasons for these variations is, without doubt, to be referred to the congenital differences in the volume of the osseous thorax; partly, also, to the thickness of the soft parts, particularly of the subcutaneous fat and the thoracic muscles; partly, also, to the differences in the degree and amount of the dilatation of the thorax by respiration, with which the distension of the lungs also corresponds,” &c.

2. Diaphragm.—The position of the diaphragm may be considered as a good diagnostic sign; for it is found that, in children born dead, the highest point of the concavity is between the fourth and fifth ribs, whereas in those born alive it is between the fifth and sixth. The position of the diaphragm may be affected by the gases produced during putrefaction, and also, in children who have breathed, from distension of the stomach and intestines with gas.

3. Stomach and Intestines.—With regard to the stomach, Tardieu has suggested that the presence of air-bubbles in the glairy mucus usually found in that organ is a sign of live birth, as it can only have arisen from the swallowing of saliva and mucus, aerated by repeated attempts at respiration, probably lasting from five to fifteen minutes. Air in the duodenum is strong evidence of live birth. Breslau of Prague, who has further investigated this subject, states that, in children born dead, or who have undergone prolonged intra-uterine putrefaction, there is never any accumulation of gas in the stomach or intestines, and that the presence of gas in these organs is contemporaneous with respiration, and is independent of the ingestion of food. The intestines of newly-born children do not float in water, but rapidly sink in that fluid. As respiration proceeds, the coils of the intestines become distended with gas.

4. Kidneys and Bladder.—The presence of crystals of uric acid in the pelvis of the kidneys and even in the bladder has been suggested as a sign of live birth. Uric acid infarction, as it has been called, usually occurs in from two to ten days after birth, at a period when there are more important signs of live birth than this, even if infarction did not occur, as it does, in still-born infants.

5. Lungs.

(a) Size.—In the fœtus, prior to respiration, the lungs do not fill the cavity of the chest, and the left lung is never found even partially covering the heart.

After respiration they fill the thorax more or less completely, the amount of distension depending, of course, upon the completeness of the respiratory acts on the part of the child.

(b) Consistence.—Before respiration has taken place, the lungs feel firm, compact, and resistant, and are of the consistency of liver.

After respiration they are spongy, crepitant, and yielding when pressed between the fingers. They also present a marbled appearance. These signs of respiration are more or less modified by disease, and the atelectasis pulmonum of Jörg, jun.

Casper denies the existence of atelectasis pulmonum as a distinct disease of newly-born children, and considers that “it is nothing else than the original fœtal condition, from which it differs in no anatomical respect”—an opinion supported by Meigs, who says “it, in fact, resembles exactly the fœtal lung.” It is simply the result of the child dying from some cause before respiration has had time to become fully established, and has possibly been confounded with hepatisation. It must also be remembered that cases are on record of infants having lived for some hours, and then died, yet the lungs sank as a whole, and when cut in pieces.

(c) Colour.—The colour of the fœtal lungs is “exceedingly various,” and it is by no means easy to convey the idea of colour by words. Speaking in general terms, the lungs of children who have not breathed are of a reddish-brown liver colour, this colour changing to a brighter red at their margins. In children who have breathed, the lungs are of a slaty-blue colour, more or less mottled with circumscribed red patches. This circumscribed mottling is never found in perfectly fœtal lungs. When the lungs are inflated artificially, they swell up and present a uniform cinnabar-red colour, destitute of insular marbling. The insular marbling of the lungs is characteristic of lungs that have breathed, and is due to the presence of blood in the arteries and veins surrounding the inflated lung tissue.

(d) Buoyancy in Water.—Lungs which have respired float in water.

But the objection may be raised that lungs that have not respired may yet float from—

The value of these objections will be discussed in the following pages.

The following table is given by Tidy:

Lungs that have not Breathed.Lungs that have Breathed.
1. Dark in colour (black-blue,1. Light in colour (rose-pink,
maroon, or purple), resemblingpale pink, light red, or crimson),
liver. No mottling.mottled.
2. Air-vesicles not visible 2. Air-vesicles distinctly
to the naked eye.visible to the naked eye, or a
lens of low power (say a two-inch,
or even a common reading-glass).
3. When squeezed or cut, do not3. Crepitate or crackle freely.
crepitate or crackle.
4. Contain but little blood,4. Contain a good deal of blood,
therefore little escapes on section.which escapes freely on section.
5. The blood present is not5. The blood present is freely
frothy, unless there bemixed with air, and therefore
putrefaction.appears frothy.
6. Sink in water, unless putrid,6. Float in water; or, at all
and often not then.events, the parts which have been
events, the parts which have been
expanded, or have breathed, float.
If fully expanded, they will buoy
up the heart.
7. Bubbles of gas arising7. The air cannot be squeezed
from putrefaction may beout by pressure.
squeezed out, and as they
escape are usually noted to
be of large size.

Hydrostatic Lung Test

(Docimasia pulmonum hydrostatica)

The value of this test, which is a test of respiration and not of live birth, is founded on the supposition that a lung in which respiration has taken place will float if placed in water, and that when this has not occurred it will sink. Admitting that a lung floats as a result of respiration, it has been objected that this is no proof of live birth, for respiration may take place in:

With regard to the two first objections, it will be sufficient to say that, in all the cases of so-called intra-uterine respiration, the respiratory acts have occurred in difficult or instrumental labours, where it is justifiable to suppose that, in the endeavour to remove the child, a certain amount of air may have been unavoidably admitted into the maternal passages. But the cases with which the medical jurist has to deal cannot be classed with these, for in all those brought under his notice delivery has been more or less rapid and unassisted.

To the last objection the same reply may be given, that rapid delivery in doubtful cases must be considered as the rule, and that the time which elapses between the birth of the head of the child and its complete delivery is so short as not to lead to any great error in diagnosis. It is true that the woman may faint with the child half born, and that respiration may thus take place; and it has not yet been decided how many inspirations a child must make to entirely inflate its lungs, or the length of time required to do so.

N.B.—Any pressure exerted on the umbilical cord during the process of delivery gives rise to respiratory acts on the part of the fœtus. The presence of what Casper calls petechial ecchymoses beneath the pleuræ, upon the aorta, and even on the heart, are, as a rule, a proof that attempts at respiration have been made. These petechial ecchymoses are sometimes found on the same parts in the drowned. (See “[Drowning].”)

How is the Hydrostatic Lung Test performed?
and What are the Objections to its Use?

As this test was first used, it consisted in placing the lungs, with or without the heart, in water, and then noting whether they sank or floated. A glass vessel, eighteen inches high and twelve in diameter, half filled with distilled water at 60° F., should be used. In summer, water at the ordinary temperature of the room will answer the purpose. To this rough test pressure is now added; the lung, or portions of it, are greatly compressed in a linen cloth, and then thrown into water as before. If the lungs thus compressed float, respiration is held to have taken place; should they sink, the contrary is presumed.

Pressure is used for the following reason: The air generated by putrefaction, and which may cause the lungs to float, is removed by pressure, but no amount of pressure, short of entirely destroying the lung tissue, will remove that which is the result of respiration or inflation; and between these the medical expert must decide from collateral evidence.

In performing the test: (1) Try if the lungs will float with the heart and thymus gland attached to them. (2) If they will float without the heart, &c. (3) Try if portions will float with or without pressure.

The following are the Objections to this Test:

1. That in consequence of disease the entire lungs, or portions of them, may sink, and yet respiration may have taken place. Disease of the lung may occur previously to birth or soon afterwards, but it is scarcely probable that the disease would attack every portion of the lung. Parts, doubtless, small in proportion to the diseased part, may yet have been sufficiently inflated to float. The presence of disease is also not difficult of detection.

2. That respiration, even in healthy lungs, may be so imperfect that they may sink. This objection can scarcely be considered valid against the general application of the test, for in these cases there is no known test by which respiration or its absence can be determined. They are, therefore, out of the pale of the test, as they are out of every other mode of investigation.

3. Emphysema pulmonum neonatorum.—Emphysema is generally the result of excessive dilatation of the air cells of the lung, rupture of the cell walls, and infiltration of the intra-lobular areola tissue. This condition may be brought about by:

(a) Respiration. (b) Inflation.

The fact of the matter is simply this, that the so-called emphysema pulmonum neonatorum, or emphysema of new-born children, is nothing more or less than incipient putrefaction, induced by certain unascertained conditions.

Casper sums up his conclusions on this subject in the following words:

“That not one single well-observed and incontestable case of emphysema, developing itself spontaneously within the lungs of a fœtus born without artificial assistance, is known; and it is not, therefore, permissible in forensic practice to ascribe the buoyancy of the lungs of new-born children, brought forth in secrecy and without artificial assistance, to this cause.”

4. Putrefaction.—It must be admitted as proved that the lungs of new-born children in a state of decomposition will float in water. But this admission does not render the test valueless, for it must be remembered:

(a) That air generated by putrefaction is found in bubbles under the pleuræ, or in the fissures between the lobuli of the lungs, and not in the air cells of the lungs.

(b) That gas as a result of putrefaction can easily be removed by compressing the lungs, or portions of them.

(c) That crepitation in putrefied lungs is absent, owing to the fact stated under (a).

(d) That the lungs are among those organs which putrefy late.

(e) That negative evidence may be obtained, if the lungs, in a highly putrescent body, sink in water. The tendency of putrefaction, as above stated, is to cause them to float.

5. Inflation.—In the first place, it is to be remarked that to inflate the lungs is by no means an easy task. Elsässer states “that in forty-five experiments performed on children born dead, without opening their thorax and abdomen, only one was attended with complete success, thirty-four with partial success, and ten with none whatever; and it must also be remembered that these experiments were conducted without disturbance, and with the greatest care.” Professor Gross states his opinion on this subject thus: “We are decidedly of opinion that artificial inflation of the lungs is a very difficult matter; and we believe that the complete distension of these organs can only be effected where a tube is introduced into the mouth of the larynx.” In the cases that come before the medical expert, the question naturally arises, Who would inflate the lungs? Surely not the mother. If not the mother, who else? It has been suggested that some malicious person might inflate them to sustain a charge of infanticide. Is this probable?

The following points may be noticed on this subject:

(a) Known difficulty in inflating the lungs.

(b) Absence on the part of the mother of any preparation to save the life of her child.

(c) Presence of air in the stomach and intestines, the result of attempted inflation.

(d) Bright cinnabar-red colour of the lungs, without trace of mottling.

(e) Absence of frothy blood when the lungs are cut into.

(f) When, therefore, we observe the following phenomena, a sound of crepitation without any escape of blood-froth on incision, laceration of the pulmonary cells with hyperæmia, bright cinnabar-red colour of the lungs without any marbling, and perhaps air in the (artificially inflated) stomach and intestines, we may with certainty conclude that the lungs have been artificially inflated.

It may be further noted that natural respiration is accompanied with, first, the distension of the air cells of the lungs with air; and, second, with an increased flow of blood into the organs, beyond that necessary for their nourishment and growth. They thus increase in absolute weight, while their specific gravity is lessened.

The objections just mentioned apply to the hydrostatic test as originally employed. It will now be necessary to notice those against the same test when modified by pressure. These are two in number:

1. That no amount of pressure, short of entirely destroying the lung tissue, can expel the air from a lung that has been inflated, or from one in which respiration has taken place.

2. Pressure is, therefore, no test of natural respiration or of artificial inflation.

In answer to the above, it will only be necessary to refer to what has been already said with regard to the difficulty of inflation, and the more probable event of the condition of the lungs being the result of respiration.

Casper thus sums up the result of his views with regard to the probative value of the docimasia pulmonaris:

“That a child has certainly lived
during and after its birth—

“1. When the diaphragm stands between the fifth and sixth ribs.

“2. When the lungs more or less completely occupy the thorax, or at least do not require to be sought for by artificial separation of the walls when cut through.

“3. When the ground colour of the lungs is broken by insular marblings.

“4. When the lungs are found by careful experiment to be capable of floating.

“5. When a bloody froth flows from the cut surface of the lung on slight pressure.”

The Lung Test is unnecessary when—

1. The umbilical cord has dropped off, and cicatrisation has followed.

2. Where food is found in the stomach.

3. Where there are evident signs of putrefaction in utero.

4. Also in the case of the birth of monsters, or where, from congenital malformation, the possibility of live birth is excluded.

Besides the hydrostatic test, the following have been proposed:

Ploucquet‘s Test.—This test is based on the relative weight of the lungs, before and after respiration, to that of the entire body of the child. The variations found in practice between the relative weights render the test worse than useless.

Absolute Weight of the Lungs.—This test consists in a comparison of the weight of the lungs before and after respiration, and it may be stated here that the lungs, prior to respiration, vary in weight from about 400 to 650 grains; but so much depends on the maturity or immaturity of the child, and degree of respiration, that, like the last, the test is unworthy of confidence.

Wredin‘s Test.—Dr. Wredin, of Petrograd, states that the gelatinous substance found in the middle ear of infants before birth, gradually disappears, to be replaced by air on the subsequent establishment of respiration. Wendt, of Leipzig, from an examination of 300 cases, declares that the gelatinous substance can only be expelled by the establishment of full respiration. The value of this test has been questioned, as some observers have found that in different cases intervals of from a few hours to five weeks have occurred, before the replacement of the gelatinous material by air.

Table Showing the Signs of
Maturity of Child At Birth

As regards:

1. Average Length of Body.—Nineteen inches.

2. Average Weight of Body.—About seven pounds.

3. Eyes.—The pupillary membrane is not found in the mature child.

4. Navel.—Said to be exactly midway between the pubes and the ensiform cartilage.

5. External Genitals.—Testicles found in the scrotum, and the labia majora cover the vagina and clitoris.

6. Os Femoris.—Ossification of the inferior femoral epiphysis. The osseous nucleus measures from three-quarters of a line to three lines in diameter.