self has found this center of ossification in a larger number of cases only 2 to 3 mm. in diameter. In the inferior maxilla the degree of ossification is also significant, but not of as great value as that of the epiphysis of the femur. In the jaw at term four alveolar partitions for the teeth are usually found, sometimes three and sometimes five. It serves well as a means of control of the condition found in the femur. These bony conditions are of great value when only a fragment of the body of the infant can be recovered, or when only the skeleton remains. Soon after birth of the mature infant, and often before the umbilical cord is tied, the child cries and fills its lungs with air, after which it continues to breathe. It passes its urine, and rids the bowel of meconium not long after. The signs of immaturity in the fetus approaching term are the lean body, and delicate, wrinkled skin. The head seems too large for the body, and the skull too large for the face; the bones of the skull are thin, movable, and separated from each other by wide sutures, the hair of the head is scant, short, and silvery; the eyelashes and eyebrows are downy. The pupillary membrane is present, the ears are thin, and their cartilages incompletely developed. In males the scrotum is very red and the testicles not descended; in females the lips of the vulva stand apart and the large clitoris protrudes. The child breathes with difficulty, and cries weakly; it sleeps most of the time, sucks with difficulty, and shows no desire for food. The development of the different organs of the body, as found on autopsy, especially the centers of ossification of the bones, and the dif ferent portions of the central nervous system, are very significant in determining the age of the fetus, but for their sequence the works on embryology must be consulted.40 term. 92. Medical abortion. The production of abortion is recognized as a legitimate medical practice for the purpose of avoiding the risks that in special cases would attend the delivery of the child at full The indication for the induction of labor in such cases is usually a contraction of the mother's pelvis, or some disease of the mother; such as threatened, or present, eclampsia, hyperemesis, placenta prævia, or some other condition threatening the life of the mother. In all such cases the physician should associate with himself, if possible, some other reputable colleague before inducing the Also Letourneau, Quelques Observa- tersbestimmung menschlichen Embrytions sur les Nouveaux-nés, Thèses de onen, Prager med. Wochenschr. 1897, p. Paris, 1858. Also Toldt, Ueber die Al- 121. labor; in this way he will not expose himself to reproach, suspicion, or prosecution. The differentiation between the legal and the illegal induction of labor may depend largely upon the secrecy with which the criminal induction is carried on, and the openness with the physician operates with the evident intent to save the mother. 93. Summary of evidence of criminal abortion.-It may be worth while, at the close of this chapter, to summarize the evidence pointing towards the criminality of an abortion. First, there is the secrecy of the woman in concealing her pregnancy, or the open avowal of her intent to get rid of the fetus; next, there is the want of any evident cause for spontaneous abortion, and no reason for inducing labor for medical purposes. The period of pregnancy is usually the fourth, fifth or sixth month. The means employed are often multiple, beginning with the drugs that have a reputation as abortifacients, including the general methods of overexertion and straining, perhaps abdominal traumatisms, and, where successful, usually ending with uterine manipulations. The fetus may rarely show evidence of the means employed; the mother more often shows the lacerations of the internal genitals or uterus, due to the local procedures. These lacerations of the mother are not infrequently multiple, and are the more characteristic the nearer they approach the size of the instrument causing them; they may be distributed over any part of the uterus, but are more often found in the posterior portion of the uterus, the fundus of the uterus, or in the cervix. The wound is often infected, and the origin of an acute inflammatory process of the uterus or peritoneum, which is perhaps the most frequent cause of death in these cases of criminal abortion. CHAPTER VI INFANTICIDE. 1. IN GENERAL. 94. Definition. II. EVIDENCE OF DEATH IN UTERO. 95. Long before delivery. 96. Just before delivery. III. EVIDENCE OF LIVE BIRTH. 97. General. 98. Respiratory tests. 99. Static tests. 100. Docimasia pulmonum hydrostatica. 101. Objections to docimasia pulmonum hydrostatica on the positive side. 101a. Vagitus uterinus. 101b. Freezing and alcohol hardening. 101c. Emphysema. 101d. Artificial inflation of the lungs. 101e. Putrefaction. 102. Objections to docimasia pulmonum hydrostatica on the negative side; disease. 102a. Atelectasis. 102b. Boiled and water-soaked lungs. 103. Docimasia intestinalis hydrostatica. 104. Circulatory tests, in general. 105. Caput succedaneum. 106. Fetal channels. 107. Blood coagulation. 108. Live birth before respiration. IV. DURATION OF THE CHILD'S LIFE. 109. Evidence from the lungs, stomach, umbilical clots. 110. Condition of the umbilical cord. 111. Skin desquamation. 112. Obliteration of the fetal channels. 113. Centers of ossification. V. CAUSES OF DEATH DURING LABOR. 114. Placental separation. 115. Prolapse of cord. 119. Fracture of skull. 119a. From contracted pelvis. 120. Hemorrhage from rupture of the cord. 121. Breech presentation. VI. DEATH AFTER LABOR. 122. Caused by malformations. 123. Caused by prematurity. 124. Death from avoidable causes in general. 125. Suffocation. 126. Manner of producing suffocation. 126b. Burial alive. 127. General evidence of suffocation. 128. Taches de Tardieu. 129. Strangulation. 130. General signs of strangulation. 131. Submersion in water. 132. Submersion in privy. 133. Fracture of skull. 134. Wounds and mutilation. 135. Combustion. 136. Poisoning. 137. Lack of care; caul. 137a. Cord ligature. 137b. Exposure. 137c. Inanition. VII. TIME SINCE DEATH OF CHILD. 138. Evidence from putrefaction. 139. Evidence from mummification. 140. Date of delivery from evidence of mother. VIII. RESPONSIBILITY OF MOTHER FOR CARE OF INFANT. 141. Ignorance of pregnancy. 142. Unconscious delivery. 143. Physical inability. 144. Mental irresponsibility. IX. GENERAL COMMENTS. 145. In general. I. IN GENERAL. 94. Definition.- The term "infanticide" is used to denote the killing of a newborn child. The term "newborn" has no definite timelimit, but merely implies recent birth. Brouardel considers the term "newborn" best defined as limited to the time during which the birth of the child has not been legally recorded or made public. After that time the child's life could not be taken without its being known to more than one person. In one case the charge of infanticide was allowed thirty-one days after birth;2 but, as a rule, the infanticide 'Brouardel, L'Infanticide, p. 11. Case of fille Demange, Briand et Chaude, I., 345. occurs during the first day or two after birth, and in cases in which there is a question as to whether the child has lived at all. Hence, the first point to be considered must be the proof that the child was born alive. II. EVIDENCE OF DEATH IN UTERO. 95. Long before delivery. If the fetus has died in utero some time before labor, it shows marked changes, such as maceration, mummification, or putrefaction, depending upon the conditions under which it has existed. But in these cases there can be no question as to infanticide. 96. Just before delivery.-A child which is born dead, perishing shortly before its birth, will, in most respects, resemble the liveborn child; the external appearance may show the hair wet and closely agglutinated, the ears compressed against the sides of the head, the eyes closed, and perhaps a bit of watery blood escaping from the nose; but these signs are not of any positive value. The condition of the lungs, on the other hand, is of considerable value. When the thorax is opened the lungs are found in its upper posterior portion, almost covered by the heart and thymus, their surface smooth, showing no signs of lobulation or of the air cells, their color a bluish red, similar to that of the liver or the spleen, and they have the consistency of muscle. Their length is greater than their width, their edges are rounded, and they do not crepitate upon incision. The measurements of the thorax, shape of the chest, position of the diaphragm, and absolute weight of the lungs, all depending upon the expansion of the lungs, are signs of minor importance, and are of slight value, because they cannot be determined within a reasonable limit of error, and because there is no standard of fixed value to which they must come. III. EVIDENCE OF LIVE BIRTH. 97. General. If the child is born alive we have the evidence of life vaguely shown in certain general conditions, and absolutely proved by the conditions of the respiratory and circulatory systems. Of the general signs, the dry, clean hair, the slightly prominent ears, the half-open eyes, the expanded thorax, in which the diaphragm has descended from the fourth or fifth rib level to that of the sixth or seventh, the discharge of meconium and of urine, the weight of the 'Brouardel, L'Infanticide, p. 40. |