Text-book of forensic medicine and toxicology

by R. J. M. Buchanan

II. Necessary Implements

14. Besides the ordinary instruments used in common dissections, the inspector should be provided with a foot-rule for measuring distances, and a glass measure graduated to drachms, for measuring the quantities of fluids, two or three stoneware jars of medium size, or when these cannot be had, a few clean bladders, for carrying away any parts of the body which it may be necessary to preserve for future examination, and in cases of possible poisoning, three or four bottles of eight, twelve, and sixteen ounces, with glass stoppers or clean corks, for preserving fluids to be analysed. The common square green glass pickle bottles are very suitable, and can generally be obtained. No bottle or jar should be used until it has been thoroughly washed under the supervision of one of the inspectors. In cases of infanticide a balance, having a flat scale-pan with a foot-rule painted on it, is of great use; on it the infant may be stretched, weighed, and measured at one operation. Paper, pens, ink, and sealing-wax should also be provided.

15. All distances, lengths, surfaces, and the like, whose extent may require to be described, ought to be accurately measured; and the same rule ought to be followed in ascertaining the volume of fluids. When large quantities of fluids are to be measured, any convenient vessel may be used, whose capacity is previously ascertained by the inspectors. Conjectural estimates and comparisons, however common, even in medico-legal inspections, are quite inadmissible.

III. External Aspect, and
Examination of the Body

16. The importance of the external examination, and the particulars to be chiefly attended to in performing it, will vary in different cases with the probable cause of death. It comprehends an examination—(1) Of the position of the body when found, as well as of all external injuries or marks presented by it. (2) Of the vicinity of the body, with a view to discover the objects on which it rested, or from or upon which it may have fallen, marks of a struggle, signs of the presence of a second party about the time of death or after it, weapons or other objects the property or not the property of the deceased, the remains of poisons, marks of vomiting; and where marks of blood are of importance, and doubts may arise as to their really being blood, the articles presenting them must be preserved for further examination. (3) Of the dress, its nature and condition, stains on it of mud, sand, and the like, of blood, of vomit, of acids, or other corrosive substances, marks of injuries, such as rents or incisions; where injuries have been inflicted on the body, care should be taken to compare the relative position of those on the body and those on the clothes; and where stains, apparently from poison, are seen, the stained parts are to be preserved for analysis. (4) Ligatures, their material and kind, as throwing light on the trade of the person who applied them; the possibility, or impossibility, of the deceased having applied them himself; their sufficiency for accomplishing their apparent purpose, &c.

17. The inspectors will commence the examination of the body itself by surveying the external surface and openings. Before cleaning it they will examine it on all sides, not neglecting the back, as is often done, and look for marks of mud, blood, ligatures, injuries, stains from acids, and the like; foreign bodies, or injuries within the natural openings of the body, viz. the mouth, nostrils, ears, anus, vagina, and urethra. If there are impressions of finger marks, they will consider which hand produced them. If there be any doubt about stains being blood, the skin presenting them must be preserved for analysis. If there be acid stains, or other probable remains of poison, or any foreign matter, the nature of which may require to be determined by analysis, these must also be preserved. The ordinary places for the impressions of ligatures are the neck, the wrists, the ankles, and the waist. The degree of warmth of the trunk and extremities, the presence or absence of cadaveric rigidity, and whether it exists equally in the upper or the lower extremities, should be noted in this stage of the proceedings; in other cases the progress of putrefaction, as indicated by the odour of the body, the looseness of the cuticle, the colour of the skin, and formation of dark vesicles on it, the evolution of air in the cellular tissue, the alteration of the features, the softness of the muscles, the shrivelling of the eyes, the looseness of the hair and nails.

18. In this part of the examination it will sometimes be necessary to observe the particulars by which the body may be identified. These are numerous. But the most important are the stature, the age and sex, the degree of plumpness, the size and form of the nose and mouth, the colour of the eyes and hair, the state of the teeth, warts, nævi, deformities, scars of old abscesses, ulcers, and wounds, and, if a woman, marks of her having had one or more children.

19. The body is next to be washed, if necessary, and the hair of the head shaved, or at least closely cut; and a thorough examination of the whole integuments is to be made. At this stage the inspectors will look particularly for the appearance of lividity, noting its chief seat and its relation to the posture in which the body was found—for impressions on the skin of objects on which it had rested—for marks of injuries, more especially contusions, taking care to ascertain their real nature by making incisions through the skin—for marks of disease, such as eruptions, ulcers, and the like—for marks of burning—for marks of concealed punctures in the nostrils, mouth, external openings of the ears, the eyes, the nape of the neck, the arm-pits, the anus, the vagina, and beneath the mammæ or scrotum; in infants, also in the fontanelles and the whole course of the spine. At this stage, wounds and other injuries should be carefully examined according to the directions given in Division V. (infra). Where the injury may have caused loss of blood, the presence or absence of pallor of the skin, lining membrane of the mouth, and the gums ought to be noted.

IV. Dissection, or Internal
Examination of the Body

20. In commencing the dissection of the body, it must be laid down as an invariable rule that all the great cavities should be examined, and also every important organ in each, however distinctly the cause of death may seem to be indicated in one of them. It is right to examine the cavity of the spine, and at all events its upper portion, in any case where an unequivocal cause of death has not been discovered elsewhere.

21. In examining the organs situated in the several cavities of the body the inspectors must be guided in a great measure by their ordinary anatomical and pathological knowledge.

22. The inspectors should begin with that cavity over which there is a wound or other mark of injury. Or, if there be an injury on the extremities, the dissection ought to commence there. In the absence of any such guide, that cavity should be taken first where the circumstances of death, so far as they are ascertained, may lead the inspectors to expect unusual appearances. In other cases, the abdomen should be first opened but not dissected, and a general survey made of the parts exposed, without disturbing them materially, the position of the diaphragm being determined by examining it with the hand; then the thorax is immediately to be examined, unless there is good reason for doing otherwise. The reasons for this method of procedure are as follow: If the abdominal organs are removed, and the veins cut, the blood in the heart may drain away through the venæ cavæ, and error result. If, on the other hand, the thorax be first opened, the relation of the abdominal organs to each other cannot be clearly made, owing to the relaxation of the diaphragm, due to the severing of its thoracic connections. Again, if the thorax be first opened, the position of the diaphragm cannot be determined. The inspectors may begin with the head, which may be examined thoroughly in the first instance, afterwards the chest and belly, as above described; the spine being reserved till the conclusion. Wherever unusual appearances are discovered in the first cursory survey, the anatomical examination ought in general to be begun there.

23. In examining the several regions of the body it is to be observed that wherever a wound, or other obvious injury of the external parts, lies in the way of the ordinary incisions, that part must be avoided, so as to leave the external injury unaltered.

24. The most approved mode of opening the head in medico-legal cases is, after dividing the integuments from ear to ear, and reflecting the scalp over the forehead and occiput, to make the usual circular incision through the skull, about an inch above the orbits in front, and over the occipital protuberance behind, using the saw lightly and carefully after the outer table of the skull has been divided, so as to avoid injuring the membranes of the brain; and to raise the skull-cap from before backwards, taking care to detach the dura mater from the skull with the handle of the scalpel or a spatula where it adheres firmly. The chisel and mallet should never be used where there is any chance of finding a fracture of the skull; for how could it be distinguished from a fracture made with the mallet? Should the dura mater be firmly adherent to the skull-cap, the better practice is to divide it carefully, so as to remove both at the same time. Tearing the membrane and crushing the brain substance are thus avoided. In infants and young children this mode of procedure is most necessary, as in them the dura mater is, as a rule, adherent.

25. The ordinary mode of examining the membranes of the brain, and the brain itself, answers well in medico-legal dissections. Effusions of fluid within the skull should always be measured. After the brain is removed, the dura mater ought to be stripped from the base of the skull to facilitate the search for fractures there, which will, of course, indicate external violence. After the removal of the brain, the upper part of the spinal canal should be examined through the foramen magnum before any part of its course be laid open; and search should be particularly made for dislocation or other injury in the region of the atlas and dentata. In cases of fatal fractures of the head, the strength of the bones should be attended to. In cases of extravasation within the head, the state of the coats of the cerebral arteries should be examined.

26. The best mode of opening the spine is, after having finished the examination of the brain, to cut through the integuments from the occiput to the coccyx—to lay the vertebræ thoroughly bare on each side by cutting away the muscles—to make an incision with the saw on each side of the skull, from the postero-inferior angle of the parietal bones into the lateral edge of the occipital hole—to remove the triangular portion of the occipital bone thus detached, and then to cut the rings of the vertebræ on each side with the bone-nippers or spine-knife, beginning with the atlas. In these cases preference should be given to the saw, by which the operation is not only more easily accomplished, but there is no risk of confounding previous fracture with that made in dissecting. Where there is reason to think that the bones are injured, the laying open of the canal should stop at the distance of two or three vertebræ from the injury, and the injured bones, with two or three adjacent vertebræ on each side, should be removed entire before the examination is extended farther down the spine.

27. The organs of the throat may be examined, either by dividing the lower jaw-bone at the chin, cutting the soft parts close to the inner surface of each half of the bone backwards, and then turning the two segments outwards; or by freely reflecting the skin of the throat, separating the soft parts from the inside of the lower jaw, the knife being carried parallel with and close to the bone, drawing the tongue out below the chin, and then continuing the dissection backwards.

28. The best mode of examining the organs situated in the throat is, after detaching the soft parts from the lower jaw, as advised in Sect. 27, to dissect the soft palate from the bone, and proceeding backwards, to detach the whole soft parts from the base of the skull and vertebræ down to the sternum, leaving them connected with the organs in the chest. Besides the ordinary points to be attended to in this part of the examination, the presence of venereal or other ulcerations is a matter requiring attention in some cases.

29. It is necessary to examine the pharynx and gullet, the larynx, trachea, and its greater ramifications, the lungs, the heart, and the great vessels with particular care, because here are most frequently found the causes of sudden natural death. In examining the heart each auricle and each ventricle ought to be laid open by an independent incision of its parietes; and this should not intersect any of the valvular openings or the septum cordis.

30. For laying open the chest and abdomen, the most convenient method is to make an incision down the fore part of the neck, chest, and abdomen to the pubes; then cutting from the peritoneum upwards, to dissect back the integuments and muscles of the chest, and examine the abdomen, as in Sect. 22; next, divide the cartilages of the ribs, and, cutting upwards, close under them, to raise the cartilages along with the sternum. In separating the sternum from the clavicles, care must be taken not to wound the subjacent vessels; and this may be avoided by the dissector moving each shoulder so as to show the exact position of the sterno-clavicular joints, and then dividing both joints cautiously. In dividing the cartilages of the ribs, the saw is sometimes necessary. The cartilages should be cut as far from the sternum as possible, to give free space for the subsequent examination.

31. In inspecting the organs in the chest, a cursory examination should be first made by turning them over, ascertaining the nature and measuring the quantity of effused fluids, feeling for fractures of the ribs, tumours, or other diseases, and opening the pericardium to obtain a view of the heart. The most convenient course to pursue next is, without moving the heart from its place, to lay open its several cavities, in order to judge of the quantity and state of the blood in both sides of that organ. For this purpose the following incisions should be made: The first, beginning close to the base, is carried along the right border of the heart directly into the right ventricle towards the apex, care being taken not to cut the septum. This lays open the right ventricle. The second incision, opening up the right auricle, begins midway between the entrances of the venæ cavæ, ending just in front of the base. The third, for exposing the left auricle, commences at the left superior pulmonary vein, and ends just in front of the base, close to the coronary vein, care being taken not to wound it. The fourth, displaying the left ventricle, commences behind the base, and ends close to the apex. If the blood is in a fluid state, the quantity contained in the right auricle may be materially affected by the head being examined previously, as the blood may have escaped from the heart by the jugular veins. The whole of the organs in the chest—the lungs, heart, and gullet—together with the parts dissected downwards from the throat, should now be removed in one mass, in order to examine them in detail on a table. But previously two ligatures should be applied on the gullet, just above the cardiac orifice of the stomach, and the division made between them.

32. The organs in the abdomen ought to be turned over, like those of the chest, before any one of them is minutely examined, but before the thorax is opened, for the reasons given in Sect. 22. In the subsequent examination, that organ is to be first proceeded with in which there may appear to be disease.

V. Examination in Cases of
Wounds and Contusions

33. In a post-mortem examination, the most approved mode of examining these injuries is, if they be situated over great cavities, to expose the successive structures in the manner of an ordinary dissection, observing carefully what injuries have been sustained by the parts successively exposed before they are divided. Wounds ought not to be probed, especially if situated over any of the great cavities. The depth of a wound is best ascertained by careful dissection and exposure of the parts involved; but after this is done, the thickness of the tissues penetrated may be measured by the probe.

34. The seat of the wounds must be described by actual measurement from known points, their figure and nature also carefully noted, and their direction ascertained with exactness.

35. Before altering by incisions the external appearances of injuries, which should never, if possible, be done, care must be taken to consider what weapon might have produced them, and if a particular weapon be suspected, it should be compared with them. The wounded parts should be cut out entire, and carefully preserved.

36. Apparent contusions must be examined by making incisions through them; and the inspectors will note whether there is a swelling or puckering of the skin; whether the substance of the true skin be black through a part or the whole of its thickness; whether there be extravasation below the skin or in the deeper textures, and whether the blood be fluid or coagulated, generally or partially; whether the soft parts below be lacerated, or subjacent bones injured; and whether there be blood in contact with the lacerated surfaces. By these means the question may be settled whether the contusions were inflicted before or after death.

37. In the cases of wounds, too, the signs of vital action must be attended to, especially the retraction of the edges, adhesion of blood to their surfaces, or the injection of blood into the cellular tissue around, or the presence of the signs or sequelæ of inflammation. Hypostasis must not be mistaken for vascular injection.

38. When large arteries or veins are found divided, care must be taken to corroborate the presumption thus arising by ascertaining, in the subsequent dissection, whether the great vessels, lungs, liver, and membranous viscera of the abdomen be unusually free of blood.

39. In the course of the dissection of wounds, a careful search must be made for foreign bodies in them. When firearms have occasioned them, the examination should not be ended before discovering the bullet, wadding, or other article, if any, lodged in the body; and whatever is found must be preserved. When the article discharged from firearms, or when any other weapon had passed through and through a part of the body, the two wounds must be carefully distinguished by their respective characters, especially as regards their comparative size, inversion or eversion, smoothness or laceration, of their edges, their roundness or angularity, and the comparative amount of bleeding from each. In gunshot injuries, the presence or absence of marks of gunpowder should be noted.

40. When wounds are situated over any of the great cavities, they ought not to be particularly examined until the cavity is laid open; and in laying open the cavity, the external incisions should be kept clear of the wounds.

41. When the discoloured state of a portion of the skin is such as to render it doubtful whether it is due to injury or to changes after death, an incision should be made to ascertain whether there is blood effused into the textures, constituting true ecchymosis, or merely gorging of the vessels of the skin, or discoloration from infiltration of the colouring matter of the blood, which takes place in depending parts of a dead body. The term suggillation should be avoided, as it has been used in opposite senses by Continental and British authors. The respective expressions, “discoloration from extravasated blood,” and “lividity after death,” are preferable.

VI. Examination in Cases
of Poisoning

42. In examining a body in a case of suspected poisoning, the inspectors should begin with the alimentary canal, first tying two ligatures round the gullet, above the cardiac orifice of the stomach, two round its pyloric end, and a third at the sigmoid flexure of the colon, then removing the stomach and entire intestines; next dissecting out the parts in the mouth, throat, neck, and chest in one mass; and, finally, dissecting the gullet, with the parts about the throat, from the other organs of the chest. The several portions of the alimentary canal may then be examined in succession.

43. Previous to commencing the dissection in cases of supposed poisoning, the inspectors should make such inquiries as may enable them to form an opinion as to the class of poison to which the death may be traceable, and thus to guide them as to the conclusions to be come to from the presence, or it may be the complete absence, of any marked appearance explaining the cause of death.

44. The medical inspectors may afford most important aid to the law officers in investigating the history of cases of supposed poisoning. For this purpose minute inquiry should be made into the symptoms during life their nature, their precise date, especially in relation to meals or the taking of any suspicious article, their progressive development, and the treatment pursued. It is impossible to be too cautious in collecting such information, and, in particular, great care must be taken to fix the precise date of the first invasion of the symptoms, and the hours of the previous meals. The same care is required in tracing the early history of the case, where the inspector happens to visit the individual before death; and if suspicions should not arise till his attendance has been going on for some time, he ought, subsequently to such suspicions, to review and correct the information gathered at first, especially as to dates. All facts thus obtained should be immediately committed to writing.

45. Besides inspecting the body and ascertaining the history of the case, the inspectors may afford valuable assistance to the law officers in searching for suspicious articles in the house of the deceased. These are—suspected articles of food, drink, or medicine; the vessels in which they have been prepared or afterwards contained; the family stores of the articles with which suspected food, &c., appears to have been made. All such articles must be secured, according to the [rules in Sect. 13], for preserving their identity. In this examination the body-clothes, bed-clothes, floor, and hearth should not be neglected, as they may present traces of vomited matter, acids spurted out or spilled, and the like.

46. When a medical man is called to a case during life, where poisoning is suspected, he ought as soon as possible to follow the instructions laid down for securing articles in which poison may have been administered.

47. In the same circumstances, it is his duty to observe the conduct of any suspected individual, were it for no other reason than to prevent the remains of poisoned articles from being put out of the way, and to protect his patient against further attempts.

48. The whole organs of the abdomen must be surveyed, and particularly the stomach and whole tract of the intestines, the liver, spleen, and kidneys, the bladder; and in the female, the uterus and its appendages. The intestines should in general be split up throughout their whole length; and it should be remembered that the most frequent seat of natural disease of their mucous membrane is in the neighbourhood of the ileo-cæcal valve, and that, next to the stomach, the parts most generally presenting appearances in cases of poisoning are the duodenum, upper part of jejunum, lower part of ileum, and rectum.

49. In cases where the possibility of poisoning must be kept in view, and where matters may require to be procured for chemical analysis, it is essential to be sure that all instruments, vessels, and bladders used are scrupulously clean.

50. When any unusual odour is perceived, either in the blood in the course of making the dissection, or in the stomach when opened, it ought to be carefully observed, and if possible identified by all the medical men present. In this way alcohol, opium, prussic acid, oil of bitter almonds, and other odorous poisons may be recognised. The smell of the contents of the stomach ought always to be noted whenever it is opened, as the smell often alters rapidly.

51. The stomach and intestines should be taken out entire, and their contents emptied into separate bottles. If the stomach or part of the intestines present any remarkable appearance, examination may be reserved, if convenient, till a future opportunity; but in every circumstance it must be preserved and carried away, as it may itself be an important article for analysis. The throat and gullet may be examined at once, and preserved with their contents, which, if abundant, may be kept apart in a bottle. In addition to the alimentary canal and its various contents, portions of the solid organs of the body ought to be secured for analysis. The most important are the liver, spleen, and kidneys. A part of the liver, at least a fourth part, should be secured in every case of supposed poisoning; and in cases where the fatal illness has been of long duration, and therefore only traces of the poison may remain in the body, the whole of the liver, the spleen, and both kidneys should be secured. A portion of the blood, especially when the odour of any volatile poison is perceived, should be at once put into a bottle, closed by a good cork or stopper.

52. No person ought to undertake an analysis in a case of suspected poisoning unless he be either familiar with chemical researches, or have previously analysed with success a mixture of organic substances, containing a small proportion of the poison suspected.

53. All persons undertaking an analysis should bear in mind that the opinion of some other person practised in toxicological researches may be required; and they should therefore take care, when practicable, to use only a portion of the several articles preserved for analysis. The identity of the subjects for analysis must be secured by the [rules in Sect. 13].

VII. Examination in Cases
of Suffocation

54. In cases of suspected drowning, the inspectors will observe particularly whether grass, mud, or other objects be clutched by the hands, or contained under the nails; whether the tongue be protruded or not between the teeth; state of the penis; whether any fluid, froth, or foreign substances be contained in the mouth, nostrils, trachea, or bronchial ramifications; whether the stomach contains much water; whether the blood in the great vessels be fluid. Careful pressure should be made upon the lungs; any fluid contained in them in thus forced into the bronchial tubes and trachea, and its nature observed. When water with particles of vegetable matter or mud is found within the body, these must be compared with what may exist in the water in which the body was discovered, and should be preserved for further scientific investigation, if requisite. Marks of injuries must be compared diligently with objects both in the water and on the banks near it, and especial attention given to the question—whether any observed injuries had been sustained by the body before or after death.

55. In cases of suspected death by hanging, strangling, or smothering, it is important to attend particularly to the state of the face as to lividity, compared with the rest of the body; the state of the conjunctiva of the eyes as to vascularity; of the tongue as to position; of the throat, chin, and lips as to marks of the nails, scratches, ruffling of the scarf-skin, or small contusions; the state of the blood as to colour and fluidity; the state of the heart as regards the amount of blood in its several cavities; the state of the trunk and branches of the vena cava in the abdomen as regards distension with blood; and the state of the lungs as regards congestion, rupture of any of the air cells, and small ecchymoses under the pleura, or the pericardium. The mark of a cord or other ligature round the neck must be attentively examined; and here it requires to be mentioned that the mark is often not distinct till seven or eight hours after death, and that it is seldom a dark livid mark, as is very commonly supposed, but a pale greenish-brown streak, presenting no ecchymosis, but the thinnest possible line of bright redness at each edge, where it is conterminous with the sound skin. Nevertheless, effusions of blood and lacerations should be also looked for under and around the mark, in the skin, cellular tissue, muscles, cartilages, and lining membrane of the larynx and trachea. Accessory injuries on other parts of the body, more especially on the chest, back, and arms, must also be looked for, as likewise the appearance of blood having flowed from the nostrils or ears, and the discharge of fæces, urine or semen. In cases where death may be due to the emanations from burning fuel or other poisonous vapours, a small phial should be filled with the fresh blood, and securely corked for further investigation, if requisite.

VIII. Examination in Cases
of Burning

56. In supposed death by burning, the skin at the edge of the burns should be carefully examined for redness, or the appearance of vesicles containing fluids.

IX. Examination in Cases of
Criminal Abortion

57. In suspected criminal abortion, when the woman survives, the chief points for inquiry are: The proofs of recent delivery, the ascertaining of facts tending to show that she has been subjected to manœuvres with instruments, and the occurrence of symptoms traceable to the action of any of the drugs reputed as capable of causing abortion.

When the woman has died, the points requiring special attention at the dissection are: The state of the womb, as regards its size and the condition of its lining membrane, in reference to the probable period of delivery; the condition of the intestinal canal, in reference to the action of irritant drugs; of the mucous membrane of the bladder, in reference to the action of cantharides; close inspection of the womb and vagina, in reference to mechanical injuries, especially punctured wounds; and any appearances that the death may have been caused by inflammation in the organs of the pelvis, or by bleeding from the wound.

X. Examination in Cases of
Infanticide

58. In cases of suspected infanticide, certain specialities must be borne in mind. The cavity of the head should be laid open with a pair of scissors. In opening the abdomen, the navel should be avoided, so that the state of the vessels of the navel-string may be examined correctly. This is done by carrying two incisions from the ensiform cartilage to each of the anterior superior spines of the ilia, and by deflecting downwards the triangular flap thus formed.

59. The inquiry in cases of infanticide should be conducted with reference to the five following distinct questions: (1) The probable degree of maturity of the child? (2) How long it has been dead? (3) Whether it died before, during, or after delivery, and how long after? (4) Whether death arose from natural causes, neglect, or violence? and (5) Whether a suspected female be the mother of the child?

60. The points to be attended to for ascertaining the probable degree of maturity of the child are: The general appearance and development, the state of the skin, its secretions, and its appendages; the hair and nails; the presence or absence of the pupillary membrane; the length and weight of the whole body; whether the navel corresponds or not with the middle of the length of the body; the situation of the meconium in the intestines; the size of the testicles in the case of males, and in either sex the size of the point of ossification in the lower epiphysis of the thigh-bone. This is easily observed by making an incision across the front of the knee into the joint, pushing the end of the thigh-bone through the cut, slicing off the cartilaginous texture carefully until a coloured point is observed in the section, and then, by successive very fine slices, ascertaining the greatest diameter of the bony nucleus. This does not exist previous to the thirty-sixth week of gestation, and in a mature child is about one-fourth of an inch in diameter. Has the infant been washed? Absence or presence of vernix caseosa. Nature and character of the wrappings, if any, found on the child.

61. The points of chief importance in reference to the period which has elapsed after death are those specified in the last clause of Sect. 17—it being borne in mind that the bodies of infants are often concealed in ash-pits and dunghills, and that in these circumstances putrefaction is very rapid.

Plate.—Section through the epiphysis
of the lower end of the femur showing
ossification centre, in a full-term fœtus.

62. The circumstances which indicate whether the child died before, during, or after parturition, and how long after it, are the signs of its having undergone putrefaction within the womb; the marks on the crown, feet, buttocks, shoulders, &c., indicating presumptively the kind of labour, and whether it was likely to have proved fatal to the child; the state of the lungs, heart, and great vessels, showing whether or not it had breathed; the nature of the contents of the stomach and of the intestines; the presence of foreign matters in the windpipe; the state of the umbilical cord, or of the navel itself, if the cord be detached.

63. In order to examine properly the state of the lungs, heart, and great vessels, with a view to determine whether or not the child had breathed, the inspection should be made in the following order: Attend, first, to the situation of the lungs; how far they rise along the sides of the heart; to their colour and texture; whether they crepitate or not. Then secure a ligature round the great vessels at the root of the neck, and another round the vena cava above the diaphragm. Cut both sets of vessels beyond the ligatures, and remove the heart and lungs in one mass, which must be weighed and put into water, to ascertain whether the lungs, with the heart attached, sink or swim. In the next place, put a ligature round the pulmonary vessels, close to the lungs, and cut away the heart by an incision between it and the ligature. Lastly, ascertain the weight of the lungs; whether they sink or swim in water; whether blood issues freely or sparingly when they are cut into; whether any fragments swim in the instances where the entire lungs sink; and in every instance of buoyancy whether fragments of them continue to swim after being well squeezed in a cloth.

64. The general question to be considered in relation to the cause of death is, whether the appearances are such as to be traceable to the act of parturition, or whether they indicate some form of violent death. The directions given in Divisions V., VI., and VII. apply to infants as well as adults; but the following points are specially to be noticed in cases of supposed infanticide:

In relation to wounds and contusions, the possibility of minute punctured wounds of the brain or other vital organs; in reference to injuries of the head, the effusion of blood under the scalp, not in the situation where it could have been produced during labour, or fracture of the bones not producible by compression of the head during labour, and not connected with defective ossification of the skull; in reference to the allegation that the head was injured by the child suddenly dropping from the mother, when not recumbent, the presence of sand or other foreign matters on the contused scalp, and the existence of more than one injury of the head; in relation to suffocation, the external and internal signs of this form of death—marks of compression of the mouth, and nose, and throat, and the presence of foreign matters in the mouth and throat, air-passages, gullet, or stomach, especially if the body be found in contact with similar substances; in reference to bleeding from the navel-string, a bloodless state of the body, without any wound to account for it; in reference to poisons, most commonly narcotics, the absence of any of the above appearances, with an otherwise healthy state of the body; in reference to starvation and exposure, emaciation of the body, absence of food from the stomach, and an empty, contracted condition of the intestines; in reference to the possibility of the child having been suddenly expelled, and having fallen on the floor or into privies, &c., the state of the navel-string is to be noted—whether long or short, whether remaining attached to the child and connected with the after-birth, indicating rapid labour, or, if divided, whether it had been cut or torn across. Nature of the ligature used, if any.

65. The circumstances noticed in Sects. 60, 61, 62, 63, 64, compared with the signs of recent delivery in the female, will lead to the decision of the question whether the suspected female be the mother of the child. These circumstances may be shortly recapitulated as being the signs of the degree of maturity of the child—the signs on the body of the kind of labour, the signs which indicate the date of its death, and the interval which elapsed both between its birth and death, and between its death and the inspection.