Aids To Forensic Medicine And Toxicology Part 5

5. _Laborde's Method._--This consists in holding the tongue by means of a handkerchief, and rhythmically drawing it out fully at the rate of fifteen times per minute. This excites the respiratory centre, and this method may be employed along with any of the other methods.

XX.--DEATH FROM STARVATION

The post-mortem appearances in death from starvation are as follows: There is marked general emaciation; the skin is dry, shrivelled, and covered with a brown, bad-smelling excretion; the muscles soft, atrophied, and free from fat; the liver is small, but the gall-bladder is distended with bile. The heart, lungs, and internal organs are shrivelled and bloodless. The stomach is sometimes quite healthy; in other cases it may be collapsed, empty, and ulcerated. The intestines are also contracted, empty, and translucent.

In the absence of any disease productive of extreme emaciation (_e.g._, tuberculosis, stricture of oesophagus, diabetes, Addison's disease), such a state of body will furnish a strong presumption of death by starvation.

In the case of children there is not always absolute deprivation of food, but what is supplied is insufficient in quant.i.ty or of improper quality. The defence commonly set up is that the child died either of marasmus or of tuberculosis.

In cases where it is alleged that a child has been starved and ill-used, one must examine the body for signs of neglect--_e.g._, dirtiness of skin and hair, presence of vermin, bruises or skin eruptions. Compare its weight with a normal child of the same age and s.e.x. If the disproportion be great and signs of neglect present, then the probability is great (provided there be no actual disease present) that the child has been starved.

XXI.--DEATH FROM LIGHTNING AND ELECTRICITY

The signs of death from lightning vary greatly. In some cases there are no signs; in others the body may be most curiously marked. Wounds of various characters--contused, lacerated, and punctured--may be produced. There may be burns, vesications, and ecchymoses; arborescent markings are not uncommon. The hair may be singed or burnt and the clothing damaged. Rigor mortis is very rapid in its onset and transient.

Post mortem there are no characteristic signs, but the blood may be dark in colour and fluid. The presence or absence of a storm may a.s.sist the diagnosis.

Injuries by electrical currents of high pressure are not uncommon; speaking generally, 1,000 to 2,000 volts will kill. In America, where electricity is adopted as the official means of destroying criminals, 1,500 volts is regarded as the lethal dose, but there are many instances of persons having been exposed to higher voltages without bad effects.

The alternating current is supposed to be more fatal than the continuous. Much depends on whether the contact is good (perspiring hands or damp clothes). Death has been attributed in these cases to respiratory arrest or sudden cessation of the heart's action. The best treatment is artificial respiration, but the inhalation of nitrite of amyl may prove useful. Rescuers must be careful that they, also, do not receive a shock. The patient should be handled with india-rubber gloves or through a blanket thrown over him.

XXII.--DEATH FROM COLD OR HEAT

=Cold.=--The weak, aged, or infants, readily succ.u.mb to low temperatures. The symptoms are increasing la.s.situde, drowsiness, coma, with sometimes illusions of sight. Post mortem, bright red patches are found on the skin surface, and the blood remains fluid for long.

=Heat.=--Death may result from syncope, the result of exposure to great heat.

=Sunstroke.=--The person loses consciousness and falls down insensible; the body temperature may be 112 F., the pulse is full, and a peculiar pungent odour is given off from the skin. Coma, convulsions with (rarely) delirium, may precede death. _Treatment_ consists in lowering the body temperature by application of cold cloths, stimulants, strychnine or digitalin hypodermically.

XXIII.--PREGNANCY

The signs of the existence of pregnancy are of two kinds, uncertain and certain, or maternal and foetal. Amongst the former cla.s.s are included--Cessation of menstruation (which may occur without pregnancy); morning vomiting; salivation; enlargement of the b.r.e.a.s.t.s and of the abdomen; quickening. It must be borne in mind that every woman with a big abdomen is not necessarily pregnant. The tests which afford conclusive evidence of the existence of a foetus in the uterus are--Ballottement, the uterine souffle, intermittent uterine contractions, foetal movements, and, above all, the pulsation of the foetal heart. The uterine souffle is synchronous with the maternal pulse; the foetal heart is not, being about 120 beats per minute.

Evidence of pregnancy may also be afforded by the discharge from the uterus of an early ovum, of moles, hydatids, etc. Disease of the uterus and ovarian dropsy may be mistaken for pregnancy. Careful examination is necessary to determine the nature of the condition present. Pregnancy may be pleaded in bar of immediate capital punishment, in which case the woman must be shown to be 'quick with child.' A woman may also plead pregnancy to delay her trial in Scotland, and both in England and Scotland, in civil cases, to produce a successor to estates, to increase damages for seduction, in compensation cases where a husband has been killed, to obtain increased damages, etc. A woman may become pregnant within a month of her last delivery.

In cases of rape and suspected pregnancy, it must be borne in mind that a medical man who examines a woman under any circ.u.mstances against her will renders himself liable to heavy damages, and that the law will not support him in so doing. If, on being requested to permit an examination, the woman refuse, such refusal may go against her, but of this she is the best judge. The duty of the medical man ends on making the suggestion.

XXIV.--DELIVERY

The signs of recent delivery are as follows: The face is pale, with dark circles round the eyes; the pulse quickened; the skin soft, warm, and covered with a peculiar sweat; the b.r.e.a.s.t.s full, tense, and knotty; the abdomen distended, its integuments relaxed, with irregular light pink streaks on the lower part. The l.a.b.i.a and v.a.g.i.n.a show signs of distension and injury. For the first three or four days there is a discharge from the uterus more or less sanguineous in character, consisting of blood, mucus, epithelium, and shreds of membrane. During the next four or five days it becomes of a dirty green colour, and in a few days more of a yellowish, milky, mucous character, continuing for two to three weeks.

The change in character of the lochial discharge is due to the quant.i.ty of blood decreasing and its place being taken by fatty granules and leucocytes. The os uteri is soft, patulous, and its edges are torn. The uterus may be felt for two or three hours above the pubis as a hard round ball, regaining its normal size in about eight weeks after delivery. Most of these signs disappear about the tenth day, after which it becomes impossible to fix the date of delivery.

In the dead the external parts have the same appearance as given above.

The uterus will vary in appearance according to the time elapsed since delivery. If death occurred immediately after delivery, the uterus will be wide open, about 9 or 10 inches long, with clots of blood inside, and the inner surface lined by decidua.

The signs of a previous delivery consist in silvery streaks in the skin of the abdomen, which, however, may be due to distension from other causes; similar marks on the breast; circular and jagged condition of the os uteri (the virgin os being oval and smooth); marks of rupture of the perineum or fourchette; absence of the v.a.g.i.n.al rugae; dark-coloured areola round the nipples, etc. The difference between the virgin _corpus luteum_ and that of recent pregnancy is not so marked as to justify a confident use of it for medico-legal purposes.

XXV.--FOETICIDE, OR CRIMINAL ABORTION

This consists in giving to any woman, or causing to be taken by her, with intent to procure her miscarriage, any poison or other noxious thing, or using for the same purpose any instruments or other means whatsoever. It is a felony to procure or attempt to procure the miscarriage of a woman, whether she be pregnant or not, and it is a felony for the woman, if pregnant, to attempt to procure her own miscarriage. It is a misdemeanour for any person or persons to procure drugs or instruments for a like purpose. It is not necessary that the woman be _quick_ with child. The offence is the intent to procure the miscarriage of any woman, _whether she be or be not with child_. When from any causes it is necessary to procure abortion, a medical man should do so only after consultation with a brother pract.i.tioner. Even in these cases there is no exemption legally. Any medical man who gives even the most harmless medicine where he suspects the possibility of pregnancy may render himself liable to grave suspicion should the woman abort.

In medicine, an _abortion_ is said to occur when the foetus is expelled before the sixth month; after that it is _premature birth_. In law, however, any expulsion of the contents of the uterus before the full time is an _abortion_ or _miscarriage_.

In deciding whether any substance expelled from the uterus is really a foetus or a mole, and therefore the result of conception, or the coat of the uterus, and unconnected with pregnancy, the examination of the substances expelled must be carefully made. Moles are blighted foetuses.

An examination of the woman will be necessary, though it is not easy during the early months of pregnancy, and especially in those who have borne children, to say whether abortion has taken place or not. The history must be inquired into; the regular or exceptional use of drugs to promote menstruation is important, for in the former case no criminal intent may exist, although pregnancy be present. The state of the b.r.e.a.s.t.s, the hymen, and the os uteri, should all be carefully examined.

Putting a few apparently unimportant questions as to the frequent use of purgatives, the presence or absence of constipation, will often a.s.sist the diagnosis as showing that the woman has acted in an unusual manner.

Abortion may be procured by the introduction of instruments, by falls, violent exercise, blows on the abdomen, etc. In the hands of ignorant persons the use of instruments (sounds, bougies, skewers, etc.) is attended with great danger. Perforation of the v.a.g.i.n.al walls, bladder, cervix, or uterus, may follow their use. Septic pelvic peritonitis may ensue, and the woman may lose her life. The person who has employed such means for inducing abortion is liable to be charged with the crime of murder. There is no evidence to show that ergot, savin, bitter-apple, pennyroyal, or any other drug administered internally, will cause a woman to abort, except when taken in such large doses that actual poisoning results, with inflammation of the contents of the true pelvis. In such cases reflex uterine contractions may be set up, and abortion may follow. Diachylon pills are largely employed to induce abortion, and very often the woman taking them suffers severely from lead-poisoning.

XXVI.--INFANTICIDE

Infanticide, or the murder of a new-born child, is not treated as a specific crime, but is tried by the same rules as in cases of felonious homicide. The term is applied technically to those cases in which the mother kills her child at, or soon after, its birth. She is often in such a condition of mental anxiety as not to be responsible for her actions. It is usually committed with the object of concealing delivery, and to hide the fact that the girl has, in popular language, 'strayed from the paths of virtue.' The child must have had a separate existence.

To const.i.tute 'live birth,' the child must have been alive after its body was entirely born--that is, entirely outside the maternal pa.s.sages--and it must have had an independent circulation, though this does not imply the severance of the umbilical cord. Every child is held in law to be born dead until it has been shown to have been born alive.

Killing a child in the act of birth and before it is fully born is not infanticide, but if before birth injuries are inflicted which result in death after birth, it is murder. Medical evidence will be called to show that the child was born alive.

The methods of death usually employed are--(1) Suffocation by the hand or a cloth. (2) Strangulation with the hands, by a tape or ribbon, or by the umbilical cord itself. (3) Blows on the head, or dashing the child against the wall. (4) Drowning by putting it in the privy or in a bucket of water. (5) Omission: by neglecting to do what is absolutely necessary for the newly-born child--_e.g._, not separating the cord; allowing it to lie under the bed-clothes and be suffocated.

With regard to the question of the maturity of a child, the differences between a child of six or seven months and one at full term may be stated as follows:

Between the sixth and seventh month, length of child 10 to 14 inches--that is, the length of the child after the fifth month is about double the lunar months--weight 1 to 3 pounds; skin, dusky red, covered with downy hair (lanugo) and sebaceous matter; membrana pupillaris disappearing; nails not reaching to ends of fingers; meconium at upper part of large intestine; testes near kidneys; no appearance of convolutions in brain; points of ossification in four divisions of sternum.

At nine months, length of child 18 to 22 inches; weight, 7 to 8 pounds; skin rosy; lanugo only about shoulders; sebaceous matter on the body; hair on head about an inch long; testes past inguinal ring; c.l.i.toris covered by the l.a.b.i.a; membrana pupillaris disappeared; nails reach to ends of fingers; meconium at termination of large intestine; points of ossification in centre of cartilage at lower end of femur, about 1-1/2 to 2-1/2 lines in diameter; umbilicus midway between the ensiform cartilage and pubis.