CHAPTER XIV

INFANTICIDE

According to the present state of English law, infanticide--murder of a _new-born_ child--is not regarded as a specific crime, but is treated and tried by those rules of evidence which are applicable in cases of felonious homicide, but with this difference, that the law requires proof that the child was born alive. An old Statute (21 Jac. I. c. 27) made the concealment of the birth of a bastard child conclusive evidence of murder. As far as the legal estimation of the crime is concerned, it matters not whether the child was killed immediately on its entrance into the world, or within a few days afterwards. A fœtus not bigger than a man‘s finger, but having the shape of a child, is a child within the Statute (R. _v._ Colmer, 9 Cox, 506; R. _v._ Hewitt, 4 F. & F. 1101). An English judge, at a late trial, stated that if the jury were of the opinion that the prisoner had strangled her child before being wholly born, she must be acquitted of murder. The law also, on the score of humanity, presumes that every child is born dead until direct evidence to the contrary, from medical or other sources, is given. The onus of the proof of live birth, therefore, devolves on the prosecution. It may also be difficult to decide as to the maternity, and the woman accused will have to be examined as to the possibility of her recent delivery.

Here let me repeat the advice given on page 148 as to the examination of a woman. Your duty is to request the woman to allow of the necessary examination, giving her the warning which every magistrate or coroner is bound to give to any person charged with a crime, before requiring an answer to a question which may be used in evidence against her at the subsequent trial. The innocent and the guilty may alike object to an examination, but the presumption is against the party declining, if several have voluntarily submitted. A young lady committed suicide rather than submit to an examination by two medical men under an order from the coroner. The medical men were guilty of a grave indiscretion, and both they and the coroner were acting _ultra vires_ in attempting to force a woman to obtain evidence against herself (Taylor, vol. ii. p. 431).

The decision as to recent delivery will, to a great extent, rest on the condition of the mother, and the apparent age of the child found dead. The discovery of the body of the child is not necessary to conviction, but the medical evidence as to the signs of respiration, of course, depends on the body being found and examined. In most cases of alleged infanticide tried in England, juries appear more inclined to fall back on the minor offence--_concealment of birth_--than to convict of the capital offence; and this appears to be the only alternative if the body cannot be found, for, as we have just said, in law every child is held to be born dead. It must of course be shown that the woman has been recently delivered. In case of failure to prove the murder of the child, the Act (24 and 25 Vict. c. 100, sec. 60) enacts that “if any woman shall be delivered of a child, every person who shall, by any secret disposition of the dead body of the said child, whether such child died before, at, or after its birth, endeavour to conceal the birth thereof, shall be guilty of a misdemeanour.” The mere avowal of the birth is not sufficient to convict her; she must be proved to have done some act of disposal of the body after the child was dead (R. _v._ Turner, 8 C. & P. 755).

In Scotland, _concealment of pregnancy_ is a statutory crime, chargeable when the child born is found dead or is not found at all, and there is no proof of its having been murdered. Pregnancy, up to a period when a child might be born alive, must be proved, and the words “during the whole period of her pregnancy” do not imply that the pregnancy must have continued for the full period of nine months. All that is necessary is that there should be such proof of duration of pregnancy as made a living birth possible. If the accused can bring forward a witness to whom she communicated her pregnancy, or called for assistance at the birth, or (it is believed) can prove that the child was born dead, she is entitled to an acquittal.

It has also been said that a woman ought not to be convicted of “concealment of pregnancy,” if at the time of delivery the fœtus do not appear to have reached the seventh month of intra-uterine existence. The birth of a “child,” whether dead or alive, is essential; therefore, if the woman accused “can prove that that which she brought forth was not a ‘child,’ but an abortion, or a _fœtus_, which, from some accident, was in such a condition that, though there had been assistance, it could not have been in a condition to be called ‘a child,’ then the case is out of the Statute.” The Scotch Statute differs from the English on the “concealment of birth” in this, that so long as the woman makes known her pregnancy, the motive for doing so is not considered. Thus, if she make arrangements with anyone to conceal the birth, “the Statute is eluded by that very circumstance” (Alison). The Statute applies to married as well as to single women; but, in the former case, the penalty is seldom enforced unless foul play is suspected.

DEFINITION OF THE TERM “LIVE BIRTH” IN CRIMINAL CASES

“The entire delivery of a child.” There must be an independent circulation in the child before it can be accounted alive (R. _v._ Enoch, 5 C. & P. 539). The entire child must be actually born into the world in a living state (R. _v._ Poulton, 5 C. & P. 329). But the fact of the child being still connected with the mother by the umbilical cord will not prevent the killing from being murder (R. _v._ Reeves, 9 C. & P. 25). To kill a child in its mother‘s womb is no murder, because the person killed must be “a reasonable creature in being, and under the King‘s peace.” But if the child be injured in the womb, and yet be born alive, and then die as a result of such injuries, it may be murder in the person who inflicted them (R. _v._ Senior, 1 Mood. C. C. 346).

A distinction must be drawn between _medical_ or _physiological life_ and _legal life_. A child may have breathed, as it not infrequently does, _before_ it is completely born into the world; and this might, in a medical point of view, be considered as a live child, but it is not one legally. The entire delivery of the child is necessary in law; and “it must also be proved that the entire child has actually been born into the world in a living state, and the fact of its having breathed is not a conclusive proof thereof.” The inference unfortunately follows from this ruling, that a mother may kill her child without fear of punishment, if she do so before the entire body has slipped from her.

DEFINITION OF THE TERM “LIVE BIRTH” IN CIVIL CASES

The evidence of live birth in civil is somewhat different from that required in criminal cases. The viability of the child is determined in Scotland by its _crying_; in France, by its respiration; in Germany, “the LIVE BIRTH of a child is to be held proven when it has been heard to cry by witnesses of unimpeachable veracity present at its birth”; but in England, the pulsation of the child‘s heart, or any tremulous motion of the muscles, however slight, has been considered as satisfactory proof of live birth.[15]

[15] Fyshe or Fisher _v._ Palmer, in 1806.

According to Blackstone, “crying, indeed, is the strongest evidence, but it is not the _only_ evidence”; and Coke remarks, “If it be born alive, it is sufficient though it be not heard to cry, for peradventure it may be born dumb.”

=Signs of Live Birth prior to Respiration, and independent of it.=--(1) Negative.--Signs of intra-uterine death, _i.e._ putrefaction, or “intra-uterine maceration,” or of such imperfect development that it could not have been born alive. (2) Positive.--Injuries to the child showing that it must have been born alive.

1. Negative.--_Intra-uterine Putrefaction._--This condition differs in some remarkable points from putrefaction in air.

The body is extremely flaccid and flattened, the bones of the cranium moving easily on one another. The skin of the hands and other parts of the body bear the evidence of prolonged soaking in fluid. In parts, the skin is whitish, or of a reddish-brown or coppery-red colour, without any trace of green, which is always present when putrefaction takes place in the air. The cuticle may be raised in blisters, and be easily detached from the true skin. The denuded patches are moist and greasy, and exude a stinking, reddish-coloured serous fluid. The face is flattened, and the features distorted. In one case that Husband attended of intra-uterine death of the fœtus in a primipara, and where putrefaction was far advanced, the scalp burst during delivery, and the brain was poured out. Should, however, the child be exposed to the air, it may soon acquire the appearances proper to putrefaction in that medium. If the child, immediately after birth, be thrown into water, the putrefactive changes would be like those of intra-uterine decomposition. In this case the lungs must be examined for the evidence of death by drowning.

2. Positive.--Evidence that injuries found on the body could not have been inflicted during birth, or accidentally after birth. On this subject it is scarcely possible to give an opinion one way or the other. All the medical witness can fairly state is, that, from the condition of the lungs, respiration has or has not taken place; that, in the former case, it is not easy to state whether the injuries were the cause of death or inflicted after death.

=Appearances showing that a New-Born Child has breathed.=--1. Walls of the Chest.--“The vaulting of the thorax is not of the slightest diagnostic value.” Casper quotes from Elsässer the following remarks: “It is irrefutable that the variations in the circumference of the thorax (and, of course, in its diameters) are so considerable that no certain normal mean for a thorax that has breathed, and for one that has not breathed, can be laid down. In most cases the measurements of the thorax are incapable of determining whether the lungs contain air or not. The reasons for these variations is, without doubt, to be referred to the congenital differences in the volume of the osseous thorax; partly, also, to the thickness of the soft parts, particularly of the subcutaneous fat and the thoracic muscles; partly, also, to the differences in the degree and amount of the dilatation of the thorax by respiration, with which the distension of the lungs also corresponds,” &c.

2. Diaphragm.--The position of the diaphragm may be considered as a good diagnostic sign; for it is found that, in children born dead, the highest point of the concavity is between the fourth and fifth ribs, whereas in those born alive it is between the fifth and sixth. The position of the diaphragm may be affected by the gases produced during putrefaction, and also, in children who have _breathed_, from distension of the stomach and intestines with gas.

3. Stomach and Intestines.--With regard to the stomach, Tardieu has suggested that the presence of air-bubbles in the glairy mucus usually found in that organ is a sign of live birth, as it can only have arisen from the swallowing of saliva and mucus, aerated by repeated attempts at respiration, probably lasting from five to fifteen minutes. Air in the duodenum is strong evidence of live birth. Breslau of Prague, who has further investigated this subject, states that, in children born dead, or who have undergone prolonged intra-uterine putrefaction, there is never any accumulation of gas in the stomach or intestines, and that the presence of gas in these organs is contemporaneous with respiration, and is independent of the ingestion of food. The intestines of newly-born children do not float in water, but rapidly sink in that fluid. As respiration proceeds, the coils of the intestines become distended with gas.

4. Kidneys and Bladder.--The presence of crystals of uric acid in the pelvis of the kidneys and even in the bladder has been suggested as a sign of live birth. Uric acid infarction, as it has been called, usually occurs in from two to ten days after birth, at a period when there are more important signs of live birth than this, even if infarction did not occur, as it does, in still-born infants.

5. Lungs.

(_a_) _Size._--In the fœtus, prior to respiration, the lungs do not fill the cavity of the chest, and the left lung is never found even

## partially covering the heart.

After respiration they fill the thorax more or less completely, the amount of distension depending, of course, upon the completeness of the respiratory acts on the part of the child.

(_b_) _Consistence._--Before respiration has taken place, the lungs feel firm, compact, and resistant, and are of the consistency of liver.

After respiration they are spongy, crepitant, and yielding when pressed between the fingers. They also present a marbled appearance. These signs of respiration are more or less modified by disease, and the _atelectasis pulmonum_ of Jörg, jun.

Casper denies the existence of _atelectasis pulmonum_ as a distinct disease of newly-born children, and considers that “it is nothing else than the original fœtal condition, from which it differs in no anatomical respect”--an opinion supported by Meigs, who says “it, in fact, resembles exactly the fœtal lung.” It is simply the result of the child dying from some cause before respiration has had time to become fully established, and has possibly been confounded with hepatisation. It must also be remembered that cases are on record of infants having lived for some hours, and then died, yet the lungs sank as a whole, and when cut in pieces.

(_c_) _Colour._--The colour of the fœtal lungs is “exceedingly various,” and it is by no means easy to convey the idea of colour by words. Speaking in general terms, the lungs of children who have _not_ breathed are of a reddish-brown liver colour, this colour changing to a brighter red at their margins. In children who _have_ breathed, the lungs are of a slaty-blue colour, more or less mottled with circumscribed red patches. This circumscribed mottling is _never_ found in perfectly fœtal lungs. When the lungs are inflated artificially, they swell up and present a uniform cinnabar-red colour, destitute of insular marbling. The insular marbling of the lungs is characteristic of lungs that have breathed, and is due to the presence of blood in the arteries and veins surrounding the inflated lung tissue.

(_d_) _Buoyancy in Water._--Lungs which have respired float in water.

But the objection may be raised that lungs that have _not_ respired may yet float from--

1. The result of artificial respiration. 2. The result of putrefaction.

The value of these objections will be discussed in the following pages.

The following table is given by Tidy:

--------------------------------+----------------------------------- Lungs that have not Breathed. | Lungs that have Breathed. --------------------------------+----------------------------------- 1. Dark in colour (black-blue,| 1. Light in colour (rose-pink, maroon, or purple), resembling | pale pink, light red, or crimson), liver. No mottling. | mottled. | 2. Air-vesicles not visible | 2. Air-vesicles distinctly to the naked eye. | visible to the naked eye, or a | lens of low power (say a two-inch, | or even a common reading-glass). | 3. When squeezed or cut, do | 3. Crepitate or crackle freely. not crepitate or crackle. | | 4. Contain but little blood, | 4. Contain a good deal of blood, therefore little escapes on | which escapes freely on section. section. | | 5. The blood present is not | 5. The blood present is freely frothy, unless there be | mixed with air, and therefore putrefaction. | appears frothy. | 6. Sink in water, unless | 6. Float in water; or, at all putrid, and often not then. | events, the parts which have been | expanded, or have breathed, float. | If fully expanded, they will buoy | up the heart. | 7. Bubbles of gas arising | 7. The air cannot be squeezed from putrefaction may be | out by pressure. squeezed out, and as they | escape are usually noted to | be of large size. | --------------------------------+-----------------------------------

Hydrostatic Lung Test

(_Docimasia pulmonum hydrostatica_)

The value of this test, which is a test of respiration and not of live birth, is founded on the supposition that a lung in which respiration has taken place will float if placed in water, and that when this has not occurred it will sink. Admitting that a lung floats as a result of respiration, it has been objected that this is no proof of live birth, for respiration may take place in:

1. The womb, _vagitus uterinus_. 2. The maternal passages, _vagitus vaginalis_. 3. Cases when the head protrudes, the body not yet being born.

With regard to the two first objections, it will be sufficient to say that, in all the cases of so-called intra-uterine respiration, the respiratory acts have occurred in difficult or instrumental labours, where it is justifiable to suppose that, in the endeavour to remove the child, a certain amount of air may have been unavoidably admitted into the maternal passages. But the cases with which the medical jurist has to deal cannot be classed with these, for in all those brought under his notice delivery has been more or less rapid and unassisted.

To the last objection the same reply may be given, that rapid delivery in doubtful cases must be considered as the rule, and that the time which elapses between the birth of the head of the child and its complete delivery is so short as not to lead to any great error in diagnosis. It is true that the woman may faint with the child half born, and that respiration may thus take place; and it has not yet been decided how many inspirations a child must make to entirely inflate its lungs, or the length of time required to do so.

_N.B._--Any pressure exerted on the umbilical cord during the process of delivery gives rise to respiratory acts on the part of the fœtus. The presence of what Casper calls _petechial ecchymoses_ beneath the pleuræ, upon the aorta, and even on the heart, are, as a rule, a proof that attempts at respiration have been made. These petechial ecchymoses are sometimes found on the same parts in the drowned. (See “Drowning.”)

How is the Hydrostatic Lung Test performed? and What are the Objections to its Use?

As this test was first used, it consisted in placing the lungs, with or without the heart, in water, and then noting whether they sank or floated. A glass vessel, eighteen inches high and twelve in diameter, half filled with distilled water at 60° F., should be used. In summer, water at the ordinary temperature of the room will answer the purpose. To this rough test pressure is now added; the lung, or portions of it, are greatly compressed in a linen cloth, and then thrown into water as before. If the lungs thus compressed float, respiration is held to have taken place; should they sink, the contrary is presumed.

Pressure is used for the following reason: The air generated by putrefaction, and which may cause the lungs to float, is removed by pressure, but no amount of pressure, short of entirely destroying the lung tissue, will remove that which is the result of respiration or inflation; and between these the medical expert must decide from collateral evidence.

In performing the test: (1) Try if the lungs will float with the heart and thymus gland attached to them. (2) If they will float without the heart, &c. (3) Try if portions will float with or without pressure.

The following are the Objections to this Test:

1. The lungs may sink as a result of disease. 2. Respiration, even in healthy lungs, may be so imperfect that they may sink. 3. Emphysema pulmonum neonatorum. 4. Putrefaction. 5. Artificial inflation.

1. That in consequence of disease the entire lungs, or portions of them, may sink, and yet respiration may have taken place. Disease of the lung may occur previously to birth or soon afterwards, but it is scarcely probable that the disease would attack every portion of the lung. Parts, doubtless, small in proportion to the diseased part, may yet have been sufficiently inflated to float. The presence of disease is also not difficult of detection.

2. That respiration, even in healthy lungs, may be so imperfect that they may sink. This objection can scarcely be considered valid against the general application of the test, for in these cases there is no known test by which respiration or its absence can be determined. They are, therefore, out of the pale of the test, as they are out of every other mode of investigation.

3. _Emphysema pulmonum neonatorum._--Emphysema is generally the result of excessive dilatation of the air cells of the lung, rupture of the cell walls, and infiltration of the intra-lobular areola tissue. This condition may be brought about by:

(_a_) Respiration. (_b_) Inflation.

The fact of the matter is simply this, that the so-called _emphysema pulmonum neonatorum_, or emphysema of new-born children, is nothing more or less than incipient putrefaction, induced by certain unascertained conditions.

Casper sums up his conclusions on this subject in the following words: “That not one single well-observed and incontestable case of emphysema, developing itself spontaneously within the lungs of a fœtus born without artificial assistance, is known; and it is not, therefore, permissible in forensic practice to ascribe the buoyancy of the lungs of new-born children, brought forth in secrecy and without artificial assistance, to this cause.”

4. _Putrefaction._--It must be admitted as proved that the lungs of new-born children in a state of decomposition will float in water. But this admission does not render the test valueless, for it must be remembered:

(_a_) That air generated by putrefaction is found in bubbles _under_ the pleuræ, or in the fissures between the _lobuli_ of the lungs, and _not in the air cells_ of the lungs. (_b_) That gas as a result of putrefaction can easily be removed by compressing the lungs, or portions of them. (_c_) That crepitation in putrefied lungs is absent, owing to the fact stated under (_a_). (_d_) That the lungs are among those organs which putrefy late. (_e_) That negative evidence may be obtained, if the lungs, in a highly putrescent body, sink in water. The tendency of putrefaction, as above stated, is to cause them to float.

5. _Inflation._--In the first place, it is to be remarked that to inflate the lungs is by no means an easy task. Elsässer states “that in forty-five experiments performed on children born dead, without opening their thorax and abdomen, only _one_ was attended with complete success, thirty-four with partial success, and ten with none whatever; and it must also be remembered that these experiments were conducted without disturbance, and with the greatest care.” Professor Gross states his opinion on this subject thus: “We are decidedly of opinion that artificial inflation of the lungs is a very difficult matter; and we believe that the complete distension of these organs can only be effected where a tube is introduced into the mouth of the larynx.” In the cases that come before the medical expert, the question naturally arises, Who would inflate the lungs? Surely not the mother. If not the mother, who else? It has been suggested that some malicious person might inflate them to sustain a charge of infanticide. Is this probable?

The following points may be noticed on this subject:

(_a_) Known difficulty in inflating the lungs. (_b_) Absence on the part of the mother of any preparation to save the life of her child. (_c_) Presence of air in the stomach and intestines, the result of attempted inflation. (_d_) Bright cinnabar-red colour of the lungs, without trace of mottling. (_e_) Absence of frothy blood when the lungs are cut into. (_f_) When, therefore, we observe the following phenomena, a sound of crepitation without any escape of blood-froth on incision, _laceration_ of the pulmonary cells with hyperæmia, bright cinnabar-red colour of the lungs _without any marbling_, and perhaps _air_ in the (artificially inflated) stomach and intestines, we may with certainty conclude that the _lungs have been artificially inflated_.

It may be further noted that natural respiration is accompanied with, first, the distension of the air cells of the lungs with air; and, second, with an increased flow of blood into the organs, beyond that necessary for their nourishment and growth. They thus increase in absolute weight, while their specific gravity is lessened.

The objections just mentioned apply to the hydrostatic test as originally employed. It will now be necessary to notice those against the same test when modified by pressure. These are two in number:

1. That no amount of pressure, short of entirely destroying the lung tissue, can expel the air from a lung that has been inflated, or from one in which respiration has taken place.

2. Pressure is, therefore, no test of natural respiration or of artificial inflation.

In answer to the above, it will only be necessary to refer to what has been already said with regard to the difficulty of inflation, and the more probable event of the condition of the lungs being the result of respiration.

Casper thus sums up the result of his views with regard to the probative value of the _docimasia pulmonaris_:

“=That a child has certainly lived during and after its birth=--

“1. When the diaphragm stands between the fifth and sixth ribs.

“2. When the lungs more or less completely occupy the thorax, or at least do not require to be sought for by artificial separation of the walls when cut through.

“3. When the ground colour of the lungs is broken by insular marblings.

“4. When the lungs are found by careful experiment to be capable of floating.

“5. When a bloody froth flows from the cut surface of the lung on slight pressure.”

=The Lung Test is unnecessary when=--

1. The umbilical cord has dropped off, and cicatrisation has followed.

2. Where food is found in the stomach.

3. Where there are evident signs of putrefaction _in utero_.

4. Also in the case of the birth of monsters, or where, from congenital malformation, the possibility of live birth is excluded.

Besides the hydrostatic test, the following have been proposed:

Ploucquet‘s Test.--This test is based on the relative weight of the lungs, before and after respiration, to that of the entire body of the child. The variations found in practice between the relative weights render the test worse than useless.

Absolute Weight of the Lungs.--This test consists in a comparison of the weight of the lungs before and after respiration, and it may be stated here that the lungs, prior to respiration, vary in weight from about 400 to 650 grains; but so much depends on the maturity or immaturity of the child, and degree of respiration, that, like the last, the test is unworthy of confidence.

Wredin‘s Test.--Dr. Wredin, of Petrograd, states that the gelatinous substance found in the middle ear of infants before birth, gradually disappears, to be replaced by air on the subsequent establishment of respiration. Wendt, of Leipzig, from an examination of 300 cases, declares that the gelatinous substance can only be expelled by the establishment of full respiration. The value of this test has been questioned, as some observers have found that in different cases intervals of from a few hours to five weeks have occurred, before the replacement of the gelatinous material by air.

Table Showing the Signs of Maturity of Child At Birth

As regards:

1. _Average Length of Body._--Nineteen inches. 2. _Average Weight of Body._--About seven pounds. 3. _Eyes._--The pupillary membrane is not found in the mature child. 4. _Navel._--Said to be exactly midway between the pubes and the ensiform cartilage. 5. _External Genitals._--Testicles found in the scrotum, and the labia majora cover the vagina and clitoris. 6. _Os Femoris._--Ossification of the inferior femoral epiphysis. The osseous nucleus measures from three-quarters of a line to three lines in diameter.

CAUSE OF DEATH TO THE FŒTUS

Death may be due to--

I. Immaturity on the part of the fœtus. II. Complications occurring during or immediately after birth. III. Congenital disease in one or more of the fœtal organs. IV. Neglect or exposure, constituting “Infanticide by Omission.”

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.

[Illustration: Fig. 26.--Photo-micrograph of human milk, × 250.

(R. J. M. Buchanan.)]

3. _By Falls._--It is beyond doubt possible for a child to be born so precipitately as to fall on the floor and be severely injured, and that even fatally. In cases of alleged precipitate birth, to account for injuries found on the child, the following points should be remembered, and will assist in forming a diagnosis:

1. In Favour of Precipitate Birth and Accidental Injury

(_a_) Rupture of the umbilical cord. In all cases it would be advisable to measure the length of the cord, and then the distance of the vulva from the ground, allowing of course for the woman not being quite erect at the time of delivery owing to a separation of the legs. A disproportion between the two measurements may or may not account for the rupture of the cord. The following measurements may be taken: usual length of cord, eighteen to twenty inches; distance of vulva from the ground, twenty-six inches, but allowing for stooping, two-thirds of the above. To the length of the cord must be added about nine inches, the distance from the navel to the top of the head of the child. Thus, a fall of about thirty inches will put no strain on the cord. A case is on record of a rupture of the cord taking place while the woman was in a _recumbent_ position, but in that case the labour was precipitate, and the cord very short and small.

(_b_) Placenta not detached from the child.

(_c_) Fracture of the parietal bones; the fracture radiating into the frontal and squamous portion of the temporal bone. In experiments on twenty-five children dropped from a height of thirty inches, one parietal bone was found fractured in sixteen of the cases; both parietals, in six cases. The fractures in most cases occurred about the parietal protuberances. It must be remembered that the children were dead, and that it is easier to fracture the skull of a live infant than that of a dead one.

(_d_) Imperfect ossification of the bones of the skull.

(_e_) Absence of other injuries.

2. In Favour of Criminal Violence

(_a_) The fact of the umbilical cord being divided by some sharp instrument and not torn. A caution must be here inserted, for Taylor mentions a case where rupture of the cord occurred in such a manner that it could not be decided whether it had been intentionally cut or torn.

(_b_) Extensive fracture of one or more of the bones of the cranium.

(_c_) Fracture and dislocation of the neck.

(_d_) Presence of incised wounds, and other evidence of violence.

_N.B._--In all doubtful cases, a guarded opinion should be given, stating simply that the dissection does not reveal anything contrary to the statements offered as to the cause of death.

III. Congenital Disease in one or more of the Fœtal Organs.--In all cases the presence of congenital disease must be sought for.

IV. Neglect or Exposure, constituting “Infanticide by Omission.”--Under this head may be mentioned the following:

(_a_) Neglecting to place the child in such a position that it may breathe freely.

(_b_) Neglecting to protect the child from extremes of cold or heat.

(_c_) Neglecting to feed it with the food appropriate to its age. (See Signs of Death from Starvation, pp. 132 _et seq._)

(_d_) Neglecting to tie the umbilical cord.

To give answers to these questions will in many cases be impossible, and each must be decided by such circumstances as present themselves in each individual case. For instance, if the body be found stiff, blanched, naked or nearly so, lying on the ground, the vessels of the interior gorged with blood, whilst the superficial vessels are contracted and can be seen only with difficulty; at the same time, the hydrostatic test shows that respiration has taken place, and in the absence of all external or internal causes--the probability is in favour of death by cold. In close relation with the present subject is the question--

=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.

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

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.

(_b_) A similar red ring, about two lines broad, around the insertion of the cord, accompanied with “_thickening, inflammatory swelling of the portion of the skin affected, and slight purulent secretion from the umbilical ring itself_.” This latter condition Casper considers as affording “_irrefragable proof of the extra-uterine life of the child_.”

3. _Changes in the Circulatory System._

(_a_) Ductus Arteriosus.--Arterial duct. A contracted condition of this duct is of no value as a proof that a child has survived its birth; for the duct is liable to become contracted, and even obliterated, before the birth of the child.

(_b_) Ductus Venosus.--Nothing certain is known as to the exact time when this duct closes; the condition of the vessel is, therefore, of no assistance in determining the possibility of the child having survived its birth. The duct has been found closed in a still-born child; and in one child, which lived for a quarter of an hour, both the _ductus arteriosus_ and the _foramen ovale_ were found closed. Cases are also on record in which these fœtal channels were found open after thirty days of extra-uterine life.

(_c_) Foramen Ovale.--What has been said of the preceding may be said with regard to the foramen ovale.

_N.B._--To sum up, therefore, in the fewest words, any attempt at forming an opinion on the _docimasia circulationis_ may result in a fatal error on the part of the medical witness, as it is impossible to determine with any accuracy by days the period of their closure. As a general statement, however, the following, according to Bernt and Orfila, is the order in which obliteration of the fœtal vessels takes place: (1) The umbilical arteries. (2) Ductus venosus. (3) Ductus arteriosus. (4) Foramen ovale.

Synopsis

1. Infanticide is not regarded as a specific crime.

2. To be tried by the same rules of evidence as apply to murder.

3. The law presumes that every child is born dead, till proof to the contrary is given.

4. Onus of proving live birth devolves on the prosecution.

5. The body need not be found in order to obtain conviction of the suspected party, if not of infanticide, at least of concealment of birth.

The medical evidence, however, depends on the body being found and examined.

The medical witness may be examined on one or more of the following points:

(1) The recent delivery of the accused. (For “Signs of Recent Delivery,” see page 155 et seq.) (2) Maturity of the child found. (3) Was the child still-born or live-born? (4) Cause of death. (5) Lastly, as to the mental condition of the mother. Puerperal mania, &c.

6. In absence of proof of infanticide, the woman, in England, may be tried for _concealment of birth_, that is, disposing secretly of the body, whether the child be born dead or alive.

7. In Scotland, a woman may be tried for _concealment of pregnancy_ when the child is dead or missing, if she do not call for or make use of help or assistance in the birth; but the case is quashed, if the child be shown alive by the mother to others.

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