liver or of the lungs as compared with that of the entire body,-these have all been described as significant in the determination of live birth, but they are all unreliable. The condition of the middle ear contents, a gelatinous mass before birth, and an air bubble, or any inspired foreign substance, after birth, is indicative of attempts at respiration, and, therefore, of live birth; but the test requires delicate manipulations, and then very slight value can be given to the results obtained. There are also a certain number of changes which take place in the child after birth, and show the development of the infant. These are considered in the section that treats of the age of the fetus at the time of death.5

4

98. Respiratory tests. In the respiratory system are the best recognized and authentic proofs of life. The open, rounded larynx and the distended lungs, with air in the air vesicles, are characteristic of respiration. With the first respiration the lungs expand from their position behind the heart and thymus, and now cover these organs. They become filled with air, and so change in color from the dark, bluish red, to a rosy red, marbled by the fine blood vessels that are filled with blood by this first inspiration. The surface shows the markings of the lobules and air vesicles, the tissue crepitates between the fingers, and floats in water. Under the microscope the character of the tissue has changed from the spongy structure of the lung which has never breathed to that of the characteristic air cell and air vesicle structure of the dilated lung.

On examination with the Roentgen rays the expanded lung is found translucent, while the expanded lung of the stillborn infant does not allow the penetration of the X-rays. Brouardel gives a number of photographs of lungs, both expanded and unexpanded, taken with the X-rays, which show distinctly the difference between the two conditions; but he does not consider the test as reliable as that of the specific gravity.

99. Static tests. The static tests, or comparative weights of the lung before and after respiration, may be considered from two points of view: first, as to the absolute weight, and, second, as proportionate to the entire body weight. There is no question but that the lungs do increase in weight with the first inspiration, due to the inflow of the blood. But the absolute weight of the lungs varies so greatly with the size of the child that no definite weight can be established above which the infant can be said to have breathed, and below which it can be said

Brouardel, L'Infanticide, p. 68. See also 377, post.

'See § 109, infra.

Brouardel, p. 55.

not to have breathed. Secondly, while the weight of the lungs before breathing may, in general, be considered to be about one sixtieth of the entire body weight, and after breathing about one thirtieth of the body weight, still this proportion is too inexact to be admitted as more than suggestive of respiration. And if there is doubt in the cases in which the child has respired fully, these tests are to be relied upon still less where the respiration has been incomplete.

100. Docimasia pulmonum hydrostatica.- The hydrostatic lung test, or docimasia pulmonum hydrostatica, is the test upon which the greatest reliance is placed, and upon which, in the majority of cases, the decision of the court turns. It depends upon the decrease of the specific gravity of the lungs when the air enters them with the first respirations. Brouardel, in describing this test,' says that there are five steps which should always be gone through with, and that if all of them are positive, there is no doubt that the infant breathed. The five steps are as follows:

1. In the autopsy, after opening the thoracic cavity and neck, clamp the upper extremity of the larynx and oesophagus, and cut with the knife just above the clamp, through the pharynx, down to the vertebral column. Follow the vertebral column down to the diaphragm, removing all the thoracic organs together, and then cut out just above the diaphragm. Without letting go of the larynx and œsophagus, put the entire mass in the water with the larynx down, remove the clamp, and then let go. The air passages need not be tied if the work is done carefully, and the larynx put under water first. If the infant has breathed fully the whole mass floats frankly.

2. Remove the heart, thymus, and oesophagus, and put the respiratory tract by itself in the water. Again the lungs will float without question if the infant has breathed. If he has not breathed, they will sink to the bottom, and stay there.

3. Cut the lungs into pieces, hold them under water, with the cut surface up, and compress. Air bubbles and bloody serum are expressed, and these float, making red spots on the surface of the water, if the child has breathed.

4. After compression of the lungs, as in the preceding step, the pieces of lung still float if the child has breathed. If he has not breathed they sink.

5. When the lungs float, take one of the pieces, squeeze it, com

'Brouardel, p. 56.

VOL. III. MED. Jur.—5.

press it, and grind it in a mortar. It will still float if the infant has breathed.

101. Objections to docimasia pulmonum hydrostatica on the positive side.— If the docimasia pulmonum is positive, there is no doubt that the infant breathed; but that does not establish the proof of live birth. For, in the eyes of the law, the breathing must take place after the birth of the child, and there are many cases beyond question in which the infant has begun to breathe before being completely born; that, is, while some part of its body is still inside of the mother. After the birth of the head, and before the birth of the rest of the body, the beginning of respiration is by Ritgen, a German obstetrician of high standing, considered not even exceptional.

101a. Vagitus uterinus.-The more exceptional instances in which the infant has breathed while still completely within the uterus, vagitus uterinus, have also been described in cases beyond dispute;8 but usually in those cases where, during labor, version has been begun, and air introduced into the uterus with the hand of the obstetrician; and always in tedious labors, and after the rupture of the membranes. Moreover, the extreme rarity of the cases is evident from the few authentic cases on record, as well as from the incredulity with which the fact has been received by some authors. Hence the probability of its occurring in any case in which the labor has been concealed is exceedingly slight.

101b. Freezing and alcohol hardening. The objections have been raised that the docimasia pulmonum is a test only of specific gravity, and any process which decreases the specific gravity might give the same results. Such processes may be exemplified by freezing or hardening the lungs in alcohol, or the presence of any gas in the lungs. The frozen lungs would be distinguished without any difficulty by their temperature, firmness, brittleness, and most distinctly by the fact that after thawing out in the water in which they were floating they would return to their previous specific gravity, and sink if the infant had not inspired. Lungs which have been preserved in alcohol would have a characteristic odor, and while they might float at first, if they were unaërated they would sink as soon as the alcohol became diffused into the water in which the lungs were floating. Of the cases where gas or air from other sources have been proposed as

Marc, Dict. des Scien. Méd. (in 30 1850; Constatt's Jahresberich. f. 1853, vol.) art. Infticide; Landsberg, VII., 19; Kristeller, Vrtljschr. f. d. Henke's Zeitschr. Erg. Heft, 38, 1849; prakt. Heilk. No. 88, p. 121. Brit. and For. Med. Chir. Rev., Jan.,

invalidating the docimasia pulmonum, three classes of cases have been suggested: emphysema, inflation, and putrefaction.

101c. Emphysema.- Emphysema is certainly never found in lungs which have not respired, and whether it ever exists before birth is a matter of great doubt. Taylor says that in examining the lungs of a great number of children, he has never met with any appearance resembling what has been described as a state of emphysema, independently of respiration and putrefaction. Toulemouche10 regards the occurrence of emphysema as very rare, and says that when it is present it is never sufficient to give buoyancy to lungs which have never breathed. Casper11 says that "as yet not one single well-observed and incontestable case of emphysema developing within the fetal lungs has been known, and it is, therefore, not permissible in forensic practice to ascribe the buoyancy of the lungs to this cause." Brouardel does not consider the possibility as worthy of mention.

101d. Artificial inflation of the lungs.- Artificial inflation is purely theoretical objection; for, in a case of infanticide, who would make the attempt to have the child appear as live-born by inflating the lungs? But still the differentiation of the two conditions is easily made. In the insufflation cases usually only one lobe, the upper of the right lung, is dilated, it is often associated with an interlobular emphysema due to the violence with which the air was forced into the lungs; and at the same time air is forced into the stomach. Moreover, what is still more characteristic, when air is thus artificially introduced into the lungs no pulmonary blood circulation is started up; hence, the lung remains white and anemic, not the rose color of the lung that has breathed; it does not increase in weight, there is no, or very little, blood to be found in the capillaries of the pulmonary vessels, and consequently no mottling of the lung surface. Moreover, the docimasia fails in its last test, for, on compression, perhaps only to the degree expressed by the fourth step of the docimasia, the lung no longer continues to float, showing that the injected air has been pressed out. Cases of imperfect respiration, however, in which the lungs have been filled only in part, cannot always be distinguished from those inflated artificially.

101e. Putrefaction. That putrefaction may lead to the forination of gases which will float the thoracic viscera is possible. In the first step of the docimasia, the heart, filled with the gases of decomposition,

ed.

'Taylor, Med. Juris. p. 303, 6th Am.

Ann. d'Hyg., XVI., 364, and XVIII.,

"Casper, For. Med., N. Syd. Soc. Tran., Vol. III., p. 72.

might be the cause of the floating, but that would be thrown out by the second step. Putrefaction in the lungs themselves does produce gas, but the gas bubbles are on the surface of the lungs, and are not in the air vesicles, but in the interlobular tissue. These bubbles may be seen with a low magnification, and if each is pricked with a pin, and the gas allowed to escape, the lungs will no longer float. However, the putrefaction of the lungs does not take place till the decomposition of the other organs is very marked. This fact is attested by many writers, and especial stress is laid upon it by Casper.12 In four cases examined by him where the child's body was already greatly decomposed, the lungs retained their firmness and sank in the water. In one case the heart and liver were both covered with putrefactive vesicles, and swam upon the surface of the water, while the lungs, which were firm and brown, sank to the bottom. Hofmann13 cites the case of an infant where the liver, spleen, kidneys, stomach, intestines, and whole body floated, but the lungs did not. Should the buoyancy of the lung be due to putrefaction, then the condition of the rest of the body would give marked evidence of the cause.

Recently, Descoust and Bordas1 have made a number of experiments on the putrefaction of the lungs, and have demonstrated so clearly that Brouardel has no doubt as to the accuracy of their work, that no gangrenous putrefaction takes place in the lungs unless the infant has already breathed; artificial inflation of the lungs not producing the same effect. Hence, even if the lungs do float from putrefactive changes, that very putrefaction is evidence of the breathing. These results have not yet been accepted in the courts, but Brouardel is satisfied that they are beyond question. Hofmann cites Ungar15 on this point, who agrees with Bordas and Descoust for the majority of cases, but he finds exceptional cases where bacteria may be inspired before birth. He cites one case16 with fresh-looking organs, where the lungs, stomach, and intestines floated. The mother died of an infection with a gas-producing bacillus.

Maschka1 relates the very interesting case of a child found in a privy. The heart and lungs floated, apparently from decomposition, for after pricking the bullæ and compressing the lungs they sank;

"Casper, Gerichtl. Leich. Off. 1 and 2 Hunderte, Fälle 67, 68, 65, 66.

18 Hofmann, Gericht. Med., p. 789. 14 Brouardel, L'Infanticide, p. 61. De l'Influence de la Putrefaction sur la Docimasia Pulmonaire Hydrostatique, Annal. d'Hyg. Pub., 1865, XXXIII., p. 547.

15 Ungar, Uber den Einfluss der Fäulniss, Viertljhrsch. f. gericht. Med. III. F. XXI.

16 Hofmann, Gericht. Med., p. 790. 17 Maschka, Viertljrsch. f. gerich Med., 1865, IV. F., Bd. II., p. 87.