The appearance of wounds inflicted during life will vary according to the length of time the subject has survived. If death takes place immediately, they will present red and bloody surfaces, with ecchymosis. Should life have lingered for some hours, their edges will be somewhat tumid and retracted, and the surrounding skin will display a reddish appearance; clots of blood may also exist in them, and these will be found to adhere to their surfaces. In those cases in which several days elapse before death, they may appear bedewed with purulent matter. Dr. Hutchinson very justly remarks that wounds, made when the circulation has ceased, and the body become cold; and when the blood has coagulated in the vessels, and the muscles have become rigid, may be known to have been inflicted after death by the pallid appearance of their surfaces, and by the total absence of tumefaction and retraction; such wounds, moreover, never contain any adherent clots of blood, and there is no surrounding ecchymosis. These characters may not perhaps be quite so distinct, where the violence has been effected immediately after death, while the body is still warm, the blood fluid, and the muscles endowed with contractility; yet in this latter case there will neither appear tumefaction, nor ecchymosis; and the blood, which may have oozed from the divided surfaces, will remain fluid, or form clots not adherent to them.
Contusions, effected during life, are always accompanied with more or less of ecchymosis; and, if produced by severe external violence, the skin will necessarily be involved in the injury. When ecchymosis is superficial, and the subject outlives its course, its progress and decline present highly characteristic phenomena; at first the injured surface presents a spot of a red, or bluish colour; this spot which is formed by the blood infiltrated into the cellular tissue, soon assumes a deep livid, or leaden hue; it then after a few days becomes, successively, violet, yellowish, and terminates by a pale citron colour. It is generally seven or eight days before it disappears. These characters will always enable the anatomist to distinguish contusions made during life, from those occurring after death.
The state of the cervical vertebræ should also be carefully examined, for the death of the infant may have been occasioned by a fatal luxation, produced perhaps by some sudden contortion of the neck. Any marks of pressure, or violence about this part should therefore be carefully noted; and it will be obviously more convenient to examine the spine, before the large cavities of the bodies are exposed; and which may be accomplished in the following manner. After dissecting the soft parts from the vertebræ, the dorsal parts may be readily removed by scissars, while the apophyses of the true vertebræ can be very easily cut through. The practitioner will thus be enabled to estimate the nature and extent of any wound, or laceration, or effusion of blood, that may be discovered in connection with the spinal marrow. The appearance and condition of the umbilical cord should also be examined before any of the great cavities are laid open; for it is obvious where a ligature has not been properly applied to it, death may have arisen as the result of hemorrhage from this part. Other reasons also exist which render such an inspection of the greatest importance.
Phœnomena displayed on the dissection of the internal parts.
The ample directions which have been already offered upon this subject, (vol. iii, p. [45]) will in a great degree supersede the necessity of very minute details on the present occasion. There are, however, some few phenomena that exclusively relate to the evidence of infanticide, and must accordingly receive a due share of our attention. Certain peculiarities, moreover, exist in the mode of conducting the dissection of an infant, which demand some explanation.
Cavities of the mouth, œsophagus, larynx, and trachea.
It will be adviseable to commence our incision through the integuments, from the under lip to the top of the sternum, passing quite through the former part; another incision is to follow the inferior margin of the lower jaw; then the triangular portions thus marked out are to be separated from the parts beneath; the head should be bent back in order to put the soft parts that are to come under the knife upon the stretch. The jaw may now be divided at its symphysis, so as to separate it into two lateral portions, which may be turned aside by dividing with a scalpel all the parts which adhere to its internal surface. The object of this arrangement is to bring into view the cavities of the mouth, œsophagus, larynx, and trachea, the condition of which is so frequently connected with the death of the child that they ought never to escape examination. The position of the tongue should be noticed, and the contents of the mouth, if any, ought to be recorded, for cases have occurred in which extraneous matters, such as mud, sand, feathers, &c. have been accidentally, or criminally introduced. It will at the same time be extremely proper to ascertain the state of the nasal cavities, and to observe the quantity and consistence of the mucus in these parts, as well as in the fauces. The tongue may now be gradually pulled downwards, until the isthmus of the fauces is stretched, when, by cutting through the arch of the palate, the whole of the pharynx will be exposed; the dissection should then be extended in order to bring the commencement of the œsophagus into view, which should be carefully examined. The position of the epiglottis is the next object of inspection; and lastly, the interior of the larynx and trachea may be disclosed by making an incision through the thyroid, crycoid, and tracheal cartilages, at their anterior parts. Ligatures should be placed on the lower parts of the œsophagus and trachea.
Thoracic cavity. Having accomplished the examination above described, we may proceed to expose the cavities of the thorax and abdomen, in the manner already explained, (vol. iii, p. [52]) remembering always that, by carelessly wounding the thoracic viscera, we shall, in a great degree, defeat the objects of the dissection; on this account it will be advisable to make the division of the ribs with scissars, instead of a scalpel. From the examination of these cavities we shall, in the first place, derive a confirmation, or refutation, of the opinion respecting the maturity, or viabilité of the subject, which the external view of the body had suggested. Previous to the end of the seventh month the heart will be found exceeding in size its just proportions, and without much difference of capacity between the auricles and ventricles. The lungs will appear small, solid, and retracted from the anterior part of the cavity. In the abdomen we shall find the liver very considerable in size, and situated near the umbilicus, from which it afterwards gradually recedes as the fœtus advances. The gall-bladder will be found to contain a nearly colourless serous fluid, which during the eighth month gradually becomes yellowish, and acquires a bitter taste. If the appearances above described be compared with those which are displayed on the dissection of a full grown fœtus, we shall be able to form a very just estimate of the value of an anatomical investigation, in discovering the term of its intra-uterine or fœtal life. But, by the inspection of the thoracic organs, we endeavour to derive an inference still more important; the state of the lungs is supposed to be capable of indicating whether respiration have ever been performed; and, consequently, whether the child was born alive. It is affirmed that the lungs of the fœtus are small, not filling the cavities of the chest, or covering the pericardium; dense; compact; of a deep-red, or chocolate colour, not unlike that of the liver; carrying but little blood, and having a specific gravity exceeding that of fresh water, and, consequently, sinking in that fluid. Upon cutting into them no air will be emitted, nor will any blood follow the incision. When, however, respiration has been established, these organs become more voluminous, present a yielding elastic texture, and assume a florid-red colour; they, moreover, contain and transmit a larger quantity of blood, and have a specific gravity less than that of fresh water, and accordingly float in it. On cutting into the lungs, under these circumstances, the air contained in their cells will escape, and produce a peculiar crackling noise, which has been well expressed by the term crepitating; a bloody fluid will at the same time exude.
That a change in the character of the pulmonary structure so important as that just described should have attracted the notice of the physiologist, and been eagerly seized, as evidence in proof of the infant having respired, and therefore been born alive, cannot be a matter of surprise; and we accordingly find that the hydrostatic test long enjoyed the unreserved confidence of the profession and the public. Whenever an infant was found dead, under circumstances of doubt and suspicion, its lungs were removed from the body, and immersed in water; if they sank, the subject of the experiment was immediately declared to have been still-born. If, on the contrary, they floated, it was concluded without farther enquiry, that the infant had lived after its birth. The aphorism of Baglivi may be received as an expression of the general feeling so long entertained upon this subject. “Pulmones fœtus mortui in utero matris, si extrahantur, et in aqua ponantur, petunt fundum; mortui vero extra uterum et aqua injecti innatent in ea. Quod signum ad infanticidia detegenda est evidentissimum.”[[72]] The number of innocent females who may have been thus sacrificed through a physiological conceit, is a circumstance that must excite the most awful reflection.[[73]] It is now well ascertained, and as generally admitted, that the validity of the hydrostatic test, as usually applied, must afford very unquestionable indications. Bohn,[[74]] Hoffman,[[75]] and Heister,[[76]] have shewn that the lungs of a fœtus, born dead, will under some circumstances, to be hereafter explained, float in water; while those of one that has lived after its birth may sink in the same fluid. Dr. Gordon Smith is inclined to attribute some of the uncertainty, by which the minds of medical men have been obscured with regard to the pulmonary tests, to confusion in the method of conducting the experiment, for there is, says he, but one order in which the steps can be taken, and if the anatomist should inadvertently resort to one stage of the process before another that should have preceded, he will baffle his own efforts. In commencing an examination of the thoracic organs, we should, previous to the disturbance of the parts, notice whether any morbid appearances present themselves, such as adhesions between the lungs and the pleura costalis, &c. We should at the same time observe whether the lungs be collapsed, or dilated, and whether they cover the lateral parts of the pericardium. We then proceed to separate the pulmonary organs from the body, in order to submit them to the hydrostatic test, to which we have adverted. For the performance of this dissection, Dr. Hutchinson has given us so many complete and satisfactory directions, that we shall here introduce them for the instruction of the forensic physician. “Ligatures must be placed on the aorta and venæ cavæ, near their attachment to the heart; the trachea is then to be removed close to the bronchiæ; the vessels cut beyond the ligatures; and the heart and lungs, attached together, removed from the cavity of the thorax. If bloody, they should be cleansed with a sponge; and then the colour of the lungs, their consistence and elasticity, and their state with regard to healthy structure, be distinctly noticed, without compressing them forcibly, or lacerating in any way their structure. If the body generally be in a state of putrid decomposition, it should be ascertained whether the lungs are also thus affected, and in what degree. A livid colour from congestion of dark coloured blood in the minute vessels, should not be mistaken for gangrene; an appearance of this kind seems often to have the same origin as the lividness of the surface of dead bodies. The lungs are to be turned with the bronchial trunks downwards, that any fluid which may be contained in these tubes may flow out; and whatever escapes from them should be preserved in a clean vessel. These organs are then to be weighed in conjunction with the heart. A vessel, of a foot or a little more in diameter, and of at least a foot and a half in depth, is to be filled to the height of not less than a foot with pure fresh, and if possible, river water, the temperature of which should be nearly equal to that of the air, unless this be very cold or very hot. The lungs and heart, still attached together, are to be placed in a gentle manner in this water. It must then be remarked, whether they float near the surface, or sink to the bottom; whether they fall suddenly, or descend slowly; whether the lungs turn uppermost, and float near the surface of the water, or about the middle of the fluid.
The heart is now to be separated from the lungs, having previously applied a ligature to the pulmonary vessels, to prevent the escape of the blood they may contain; and the weight of the heart alone then determined, that it may be subtracted from that of the heart and lungs together, as previously ascertained. The lungs are now to be placed alone in the water, and great attention must be paid to the position they assume in it; that is, whether they sink rapidly or slowly, or float near the surface; whether, by reversing their vertical situation in the water, they sink more readily or with more difficulty; and, if any part constantly rises and is drawn under water by the rest, this part should be particularly marked.