Aids To Forensic Medicine And Toxicology Part 6

Owing to the difficulty of proving that the crime of infanticide has been committed, the woman may in England be tried for _concealment of birth_, and in Scotland for _concealment of pregnancy_, if she conceal her pregnancy during the whole time and fail to call for a.s.sistance in the birth. Either of these charges would only be brought against a woman who had obviously been pregnant, and now the child is missing or its dead body has been found. It is expected that every pregnant woman should make provision for the child about to be born, and so should have talked about it or have made clothes, etc., for it. The punishment for concealment is imprisonment for any term not exceeding two years. The charge of concealment is very often alternative to infanticide. To substantiate the charge, however, it must be proved that there had been a _secret disposition of the dead body_ of the infant, as well as an endeavour to conceal its birth.

A woman may be delivered of a child unconsciously, for the contractile power of the womb is independent of volition. Under an anaesthetic the uterus acts as energetically as if the patient were in the full possession of her senses.

Nowadays a woman is rarely hanged for infanticide, and it is a mere travesty of justice to pa.s.s on her the death sentence, well knowing that it will never be executed.

XXVII.--EVIDENCES OF LIVE BIRTH

The signs of live birth prior to respiration are negative and positive.

A negative opinion may be formed when evidence is found of the child having undergone intra-uterine maceration. In this case the body will be flaccid and flattened; the ilia prominent; the head soft and yielding; the cuticle more or less detached, and raised into large bullae; the skin of a red or brownish-red colour; the cavities filled with abundant b.l.o.o.d.y serum; the umbilical cord straight and flaccid.

A positive opinion is justified when such injuries are found on the body as could not have been inflicted during birth, and are attended with such haemorrhage as could only have occurred while the blood was circulating. Fractures of the cranium from accidental falls (precipitate labour) are as a rule stellate, and are situated on the vertex or in the parietal protuberance. The fractures from violence are more extensive, usually depressed, and accompanied by laceration of the scalp.

The evidences of live birth after respiration has taken place are usually deduced from the condition of the lungs, though indications are also found in other organs. The diaphragm is more arched before than after respiration, and rises higher in the thorax in the former case than in the latter. The lungs before respiration are situated in the back of the thorax, and do not fill that cavity; they are of a dark, red-brown colour and of the consistence of liver, without mottling.

After respiration they expand and occupy the whole thorax, and closely surround the heart and thymus gland. The portions containing air are of a light brick-red colour, and crepitate under the finger. The lungs are mottled from the presence of islands of aerated tissue, surrounded by arteries and veins. The weight of the lungs before respiration is about 550 grains, after an hour's respiration 900 grains; but this test is of little value. The ratio of the weight of the lungs to that of the body (Ploucquet's test), which is also unreliable, is, before respiration, about 1 to 70; after, 1 to 35. Lungs in which respiration has taken place float in water; those in which it has not, sink. There are exceptions to this rule, on which, however, is founded the _hydrostatic test_. As originally performed, this test consisted merely in placing the lungs, with or without the heart, in water, and noticing whether they sank or floated. The test is now modified by squeezing, and by cutting the lungs up into pieces.

The objections to the test as originally performed are--(1) That the lungs may sink as the result of disease--_e.g._, double pneumonia. (2) That respiration may have been so limited in extent that the lungs may sink, owing to large portions of lung tissue remaining unexpanded (_atelectasis_). (3) Putrefaction may cause the lungs to float when respiration has not taken place. (4) The lungs may have been inflated artificially. Few of these objections apply, however, when the hydrostatic test, modified by pressure, is employed. To take these objections in detail, it may be stated: (1) If the lungs sink from disease, the question of live birth is answered. (2) This objection is too refined for practical use. The lungs sink, there is an absence of any of the signs of suffocation, and the matter ends. The examiner has only to describe the conditions which he finds, and is not required to indulge in conjectures as to the amount of respiration which may or may not have taken place. (3) Gas due to putrefaction collects under the pleural membrane, and can be expelled by pressure, and is not found in the air cells. The lungs decompose late, hence in a fresh body putrefaction of the lungs is absent; in a putrefied child, if the lungs sink, it must have been stillborn. The so-called _emphysema pulmonum neonatorum_ is simply incipient putrefaction.

The lung test simply shows that the child has breathed, but affords no proof that the child has been born alive. The child may have breathed as soon as its head protruded, the rest of the body being in the maternal pa.s.sages. The child is not born alive until it has been completely expelled, although it is not necessary that the umbilical cord should have been cut.

In addition to these tests, live birth may be suspected from the following conditions: The _stomach_ may contain milk or food, recognized by the microscope and by Trommer's test for sugar; the _large intestines_ in stillborn children are filled with meconium, in those born alive they are usually empty; the _bladder_ is generally emptied soon after birth; the _skin_ is in a condition of exfoliation soon after birth. The _organs of circulation_ undergo the following changes after birth, and the extent to which these changes have advanced will give an idea of how long the child has lived: The _ductus arteriosus_ begins to contract within a few seconds of birth; at the end of a week it is about the size of a crow quill, and about the tenth day is obliterated. The _umbilical arteries and vein_: the arteries are remarkably diminished in calibre at the end of twenty-four hours, and obliterated almost up to the iliacs in three days; the umbilical vein and the ductus venosus are generally completely contracted by the fifth day. The _foramen ovale_ becomes obliterated at extremely variable periods, and may continue open even in the adult.

Importance of late has been attached to the _stomach-bowel test_. If the stomach and duodenum contain air, and consequently float in water, the chances are that the child did not die immediately after birth; this is known as Breslau's second life test, and the lower the air in the intestinal ca.n.a.l, the greater is the probability that the child survived birth.

The umbilical cord in a new-born child is fresh, firm, round, and bluish in colour; blood is contained in its vessels. The cord may be ruptured by the child falling from the maternal parts in a precipitate labour, and the ruptured parts present ragged ends. It is seldom that a child bleeds to death from an untied or cut umbilical cord, and the chances in a torn cord are still more remote. The changes in the cord are as follows: First it shrinks from the ligature towards the navel; this change may begin early, and is rarely delayed beyond thirty hours; the cord becomes flabby, and there is a distinct inflammatory circle round its insertion. The next change is that of desiccation or mummification; the cord becomes reddish-brown, then flattened and shrivelled, then translucent and of the colour of parchment, and falls off about the fifth day. The third stage, that of cicatrization, then ensues about the tenth to the twelfth day. The bright red rim round the insertion of the cord, with inflammatory thickening and slight purulent secretion, may be considered as evidence of live birth, and the stage at which the separation of the cord by ulcerative process has arrived will point to the probable duration of time the child has existed after birth.

There are many fallacies in the application of any of these tests, and the whole subject bristles with difficulties. The medical witness would do well to exhibit a cautious reserve, for if the child dies immediately after birth it is almost impossible to prove that it was born alive.

XXVIII.--CAUSE OF DEATH IN THE FOETUS

The death of the foetus may be due to--(1) Immaturity or intra-uterine malnutrition, or simply from deficient vitality; (2) complications occurring during or immediately after birth, which may either be unavoidable or inherent in the process of parturition, or may be induced with criminal intent.

In the latter category come such accidents as the pressure of tumours in the pelvic pa.s.sages, or disease of the bones in the mother, or pressure on the cord from malposition of the child during labour, asphyxiation from the funis being twisted tightly round the neck or limbs, or from injuries due to falls on the floor in sudden labours. Where the death of the foetus has been induced with criminal intent, it may be due to punctured wounds of the fontanelles, orbits, heart, or spinal marrow; dislocation of the neck; separation of the head from the body; fracture of the bones of the head and face; strangulation; suffocation; drowning in the closet pan or privy, or from being thrown into water.

Under the head of infanticide by _commission_, we have injuries of all kinds; under infanticide by _omission_, neglecting to tie the cord, allowing it to be suffocated by discharges in the bed, neglect to provide food, clothes, and warmth, for the new-born child.

XXIX.--DURATION OF PREGNANCY

The natural period of gestation is considered as forty weeks, ten lunar months, or 280 days. A medical witness would have to admit the possibility of gestation being prolonged to 300 days, and if this time were not very materially exceeded it would be well to give the woman the benefit of the doubt. It may be mentioned that 300 days is the extreme limit fixed by the French and Scottish law. No fixed period is a.s.signed in English or American law to the duration of pregnancy, though it is allowed that utero-gestation may be greatly prolonged. In a recent case decided, the Lord Chancellor accepted a case where it was alleged pregnancy had extended to 331 days. A child only five months old may live, for a short time at all events. There is considerable difficulty in many cases in fixing the date of conception. The data from which it is calculated are the following: (1) _Peculiar sensations attending conception_, which are not sufficiently defined to be recognized by those conceiving for the first time. (2) _Cessation of the catamenia._ Other causes may, however, cause this; and, on the other hand, a woman may menstruate during the whole period of her pregnancy. This datum also gives a variable period, and may involve an error of several days or a month, for the menses may be arrested by cold, etc., at one monthly period, and the woman become pregnant before the next. (3) _The period of quickening._ This, when perceived (which is not always the case), also occurs at variable periods from the tenth to the twenty-sixth week.

(4) _A single coitus._ This does not, however, correspond to the time of fertilization. Several days may elapse before the spermatozoa meet with an ovum and fertilize it.

In Scotland a child born six months after marriage is legitimate, which is allowing an ample margin.

x.x.x.--VIABILITY OF CHILDREN

A child may be born alive, but may not be viable, by which is meant that it is not endowed with a capacity of maintaining its life. Speaking generally, 180 days represents the lowest limit at which a child is viable, but prolonged survival under these circ.u.mstances is the exception. Many cases, however, have been recorded in which children born at six months have been reared. The signs of immaturity and maturity may be thus tabulated:

IMMATURITY. MATURITY.

Centre of body high; head Strong movements and cries as soon disproportionate in size; membrana as born; body clear, red colour, pupillaris present; t.e.s.t.i.c.l.es coated with sebaceous matter; mouth, undescended; deep red colour of nostrils, eyelids, and ears, open; parts of generation; intense red skull somewhat firm, and fontanelles colour, mottled appearance, and not far apart; hair, eyebrows, and downy covering, of skin; nails not nails, perfectly developed; formed; feeble movements; t.e.s.t.i.c.l.es descended; free discharge inability to suck; necessity for of urine and meconium; power of artificial heat; almost unbroken suction, indicated by seizure on the sleep; rare and imperfect nipple or a finger placed in the discharges of urine and meconium; mouth.

closed state of mouth, eyelids, and nostrils.

x.x.xI.--LEGITIMACY

A child born in wedlock is presumed to have the mother's husband for its father. This may, however, be open to question upon the following grounds: Absence or death of the reputed father; impotence or disease in the husband preventing matrimonial intercourse; premature delivery in a newly-married woman; want of access; and the marriage of the woman again immediately on the death of her husband. In the last case, where either husband might have been the father, the child at the age of twenty-one is at liberty to select its father from the possible pair.

A child born of parents before marriage is in Scotland rendered legitimate by their subsequent marriage, but in England the offspring remains illegitimate whether the parents marry or not after its birth.

The offspring of voidable or invalid marriages may be made legitimate by application to the courts.

There is a difference between being legitimate and lawfully begotten. A child born in wedlock is legitimate, but if the parents were married only a week previously it could not have been lawfully begotten.

The Acts and rulings relating to Marriage and Legitimacy are extremely complicated. It is not putting it too strongly to say that a very large number of people in this country who believe themselves to be legally married are not married at all, and that thousands of children who have not the slightest doubt as to their legitimacy are in the eyes of the law b.a.s.t.a.r.ds.

x.x.xII.--SUPERFOETATION

By superfoetation is meant the conception, by a woman already pregnant, of a second embryo, resulting in the birth of two children at the same time, differing much in their degree of maturity, or in two separate births, with a considerable interval between. The possibility of the occurrence of superfoetation has been doubted, but there are well-authenticated cases which countenance the theory of a double conception. It has been shown that the os uteri is not closed, as was once supposed, immediately _on conception_. Should an ovum escape into the uterus, it may become impregnated a month or so after a previous conception. The most probable explanation is that the case has been one of twins, one being born prematurely; or, on the other hand, the uterus may have been double, and conception may have taken place in one cornu at a later period than in the other cornu.

x.x.xIII.--INHERITANCE

In order to inherit, the child must be born alive, must be born during the lifetime of the mother, and must be born capable of inheriting--that is to say, monsters are incapable of inheriting. There is a mode of inheritance called 'tenancy by courtesy.' When a man marries a woman possessed of an estate or inheritance, and has, by her, issue born alive in her lifetime capable of inheriting her estate, in this case he shall, on the death of his wife, hold the lands for his life as tenant by the courtesy of England. The meaning of the words 'born alive' in this instance is not the same as in cases of infanticide. In Civil law any motion of the child's body, however slight, or the fact of it having been heard to cry by witnesses, is held to be sufficient proof of the child having been born alive. It may die immediately afterwards, and it is not necessary that the child be viable.