I. Immaturity on the part of Fœtus.-From some cause or another, the child may die immediately after birth, in spite of every attempt to save it. In many of these cases no disease adequate to account for death can be detected.
II. Complications occurring during or immediately after Birth.—(1) Unavoidable or inherent in the process of parturition. (2) Induced with criminal intent, constituting “infanticide by commission.”
1. Unavoidable or Inherent in the Process of Parturition.—The immediate cause of death may be either maternal or fœtal. In the former, the presence of tumours in the pelvic passages, or disease of the bones, causing a narrowing of the canal, may lead to fatal compression of the head of the child. Death may also be due to protracted labour from debility on the part of the mother, or she may suddenly faint after delivery. A congested state of the brain may be present in these cases. In the latter (fœtal), pressure on the umbilical cord from malposition of the child during labour, or an abnormal increase in the size of the head, may cause death. There is also a greater mortality, both during and after delivery, among male than female children. The child may be also accidentally suffocated in the fæces of the mother, or in the fold of her dress; or it may be born while the woman is straining at stool, and be drowned in the contents of the pan. Husband once met with a case of accidental death of a child from suffocation in the drawers of the mother, who persisted, from motives of delicacy, in wearing those articles of dress during her confinement. Death may also result from strangulation, occasioned by the pressure of the funis round the child‘s neck. The death in this case can scarcely be considered as due to strangulation, as the child had never breathed, but it is probably the result of the arrest of the flow of blood along the cord, from the tightness of the folds round the neck. Some congestion of the brain may, however, be found resulting from the pressure on the vessels of the neck. Lastly, death may ensue from a fall on the floor in cases of sudden and quick labours, especially if the woman be in the erect posture at the time of delivery.
2. Induced with Criminal Intent.—Infanticide by commission: was the death due to violence? The answer to this question is by no means easy. In all doubtful cases the attendant circumstances must be taken into consideration. A woman may unintentionally injure her child in her efforts to drag it from her. The presence of respiration, more or less complete, is strongly presumptive against the death being the result of accident. But even here considerable caution is necessary, for the injury may not be immediately fatal, although accidentally inflicted, sufficient time elapsing between its infliction and the death of the child to allow of respiration. Foreign bodies found in the mouth and fauces are also corroborative of death by violence. A case is recorded in which the child‘s fauces, upper portion of the œsophagus, the larynx, and the trachea were closely packed with a coarse green sand, and yet the lungs sank when the hydrostatic test was applied to them. There was nothing to show when the packing of the fauces was effected.
Strangulation may be produced by the constriction of the umbilical cord round the neck, and for this reason marks round the child‘s neck cannot always be ascribed to intentional violence. Of 327 cases collected by Elsässer, in which the cord was from one to four times round the children‘s necks, there was not in a single instance any mark of the cord perceptible, even though in some cases the cord had to be cut to permit the completion of labour. With regard to marks round the neck of a new-born child, Casper remarks that it is possible “to mistake the folds of the skin, produced by the movements of the head, and which remain strongly marked in the solidified fat, and are very prominent, particularly in short necks, for the marks of the cord.” The mark left by the funis is broad, corresponds with the breadth of the cord, runs without interruption round the neck, and is everywhere quite soft, and never excoriated. Ecchymoses may be present, irregularly following the line made by the cord. On the other hand, “a mummified, parchment-like, unecchymosed depression points in every case to strangulation by a hard, rough body,” and this more especially if there be any abrasion of the cuticle or laceration of the skin. Death, sometimes ascribed to strangulation, is probably the result of suffocation, and happens thus: any pressure exerted on the cord cuts off the blood from the placenta to the fœtus, and gives rise to respiratory attempts on the part of the child, the child dying from suffocation, or from the engorgement of the lungs with liquor amnii drawn into them at every effort to breathe. An infant may be poisoned. This cause of death is very rare, but deaths have resulted from the use of poisonous gases. While on this subject it may be advisable to state here that ulcerations have been found in the stomach and intestines more or less accompanied with a collection of dark brown or black bloody fluid, which have given rise to suspicions of poisoning in infants to all outward appearances quite healthy. An infant may be thrown into water and drowned. No traces of this mode of death would be discoverable in the infant unless respiration had taken place prior to its immersion. The plea of accidental drowning in a cesspool or water-closet pan may be put forward; it is therefore well to examine the cord. Has a ligature been placed upon it? Has it been cut by a sharp instrument? The nature and character of the fluid found in the stomach should be noted.
Fractures of the skull may happen—
1. In the Womb.—The parturient female may fall from a considerable height, and thus cause injury to her child. These cases are of no judicial importance, as the presence of intra-uterine putrefaction or an examination of the lungs will at once show that the child has not breathed. It must be borne in mind, however, that dislocations may take place in the womb, and this fact may be brought forward in defence. The history of the case, and the absence of any other signs of violence, will decide the truth or falsity of the plea.
2. During Labour.—Fracture of the cranial bones during labour generally occurs in difficult and protracted labours, which, from this very cause, seldom become the subject of judicial inquiry. In some cases the defective ossification of the bones of the skull may give rise to fractures, which may lead to dangerous mistakes. This deficiency, in the process of ossification is thus described by Casper: “If the bone in question is held up to the light, this is seen to shine through the opening, which is closed only by the pericranium. When the periosteal membrane is removed, the deficiency in the ossification is seen in the form of a round or irregularly circular opening, not often more than three lines in diameter, though frequently less; its edges are irregular and serrated: these edges are never depressed, as is the case in fractures; and neither they nor the parts in their neighbourhood are ever observed to be ecchymosed.” The child in these cases may breathe for a short time, and then die without any apparent cause.
Fig. 26.—Photo-micrograph
of human milk, × 250.
(R. J. M. Buchanan.)