Text-book of forensic medicine and toxicology

by R. J. M. Buchanan

Has the Infant bled to Death?—Fatal hæmorrhage from the cord may occur, especially if it be divided by a sharp instrument close to the body of the child. As a rule, hæmorrhage does not occur from a ruptured cord. (The signs of death from hæmorrhage have been noticed, page 81.)

How Long did the Child survive its Birth?—The answer to this question is by no means easy, and the data on which a decision can be based are not very reliable. The presence or absence of the vernix caseosa should be noticed. In still-born children the closed eyelids, when raised, do not remain open; in the live-born, on the other hand, the eyes remain half open even after repeated attempts to close them. Another guide to the determination of the length of time the child survived its birth may be found in the absence or presence of the meconium in the intestines. The meconium—so-called from its resemblance to inspissated poppy juice—is found in the large intestine as a dark-greenish pasty mass, more or less filling that portion of the bowel. In the upper portions of the intestines it varies from a light-yellowish or greyish to a greenish-brown colour, till in the large intestine it assumes the colour and consistence above mentioned. It is generally discharged by the infant in from four or five to forty-eight hours after birth. In breech presentations it may be passed during the process of delivery, although the child be still-born; but its entire absence from the intestines is presumptive of existence for some days after birth.

Fig. 27.—Photo-micrograph of
starch granules, × 250 (potato).
(R. J. M. Buchanan.)

The following are some of the points to be considered in forming a diagnosis: (1) Changes in the skin. (2) Changes in the umbilical cord. (3) Changes in the circulatory system.

Table showing how long a
New-born Child has Lived.

	At Birth, but before Respiration.	From 1 to 24 Hours.	From 2 to 3 Days.
Skin.	As a rule, very red, soft,	The skin is firmer and rosy,	The skin assumes a yellowish
	smooth, and covered with	and the vernix caseosa not	tint. Sometimes on the
	a whitish, fatty, sticky coat	so white.	abdomen and base of the chest,
	(vernix caseosa).		the epidermis shows signs of
			approaching exfoliation
Head.	Presence of caput		The caput succedaneum has
	succedaneum.		disappeared, leaving only a
			slight ecchymosis.
Umbilical	Is fresh, firm, bluish, roundish,	The umbilical cord is	The cord is brown from its
Cord.	more or less spongy. The	withering, and the calibre of	extremity to its base, is less
	ductus arteriosusis is four to six	the arteries is beginning to	moist, and already shows signs of
	long. Its lines diameter	diminish from the thickening	mummification. The vessels are not
	is double that of each of	of their walls.	easily made out, being flattened,
	the branches of the pulmonory		and contain a fine clot more or
	artery.		less contracted.
The	The large intestine contains	The meconium is discharged,	The green mucus which covered the
Large	meconium.	but the large intestine still	intestine is detached in places.
Intestine.		contains thick greenish mucus.
	From 3 to 4 Days.	From 4 to 6 Days.	From 6 to 12 Days.
Skin.	The icteric colour of the	The exfoliation of the skin	The exfoliation of the skin has
	skin is more marked. Exfoliation	extends from the groins to the	extended to the extremities.
	of the skin has begun over	axillæ and between he shoulders.
	belly and base of the chest.	The epidermis is detached in
		strips, in scales, or as a firm
		powder.
Head.
Umbilical	The cord is of a brownish-red	The cord is detached from	If the cord was thin, cicatrisation
Cord.	colour, flattened and distorted.	the abdomen, the membranes first,	is complete before the
	The vessels are twisted like a	then the arteries, and last, the	tenth day. The arteries, the vein,
	gimlet. The arteries are in great	vein. The arteries and the vein are	and other fœtal canals are
	part obliterated, the calibre of the	quite obliterated. The ductus	obliterated. If the cord was thick,
	vein and ductus venosus is	arteriosus and foramen ovale	a sero-purulent discharge may
	diminished, but they and the	diminished in size are still open.	continue to the twenty-fifth or
	foramen ovale are still open. The		thirtieth day.
	circumference of the ring is injected
	and begins to show signs of
	inflammation, with the discharge
	of a sero-purulent fluid at the
	base of the cord.
The
Large	The green mucus almost absent.	The green mucus quite absent.
Intestine.

1. Changes in the Skin.—Exfoliation of the cuticle. The time at which this occurs is so variable as to be of little value in a medico-legal inquiry.

2. Changes in the Umbilical Cord.—Mummification of the cord is not of the slightest value as a proof of extra-uterine life; but the separation of the cord which occurs between the fourth and seventh day, especially when cicatrisation has taken place, is a sure sign that the child must have lived four or five days at least. Two other appearances of some value may also be noted, namely:

(a) In fresh bodies, the appearance of a bright red ring about a line in breadth, which surrounds the insertion of the cord, and which is formed within the uterus.