The yet feces and sand pervaded the smaller bronchial tubules. decision given by Maschka was that the child had been dropped into the privy while still alive, and had there attempted to breathe. The mother stated that the infant had been expelled from her while she was at stool. 102. Objections to docimasia pulmonum hydrostatica on the negative side; disease.— Another point to be considered is the negative value of the docimasia pulmonum. If the lungs do sink, does that prove that the infant did not breathe? Here we must consider the other causes which would lead to the sinking of the lungs; and of these there are the conditions of disease, such as pneumonia and congestion, atelectasis, and some such extraneous conditions, as boiling. It has been suggested that a very great congestion of the lungs would destroy their buoyancy after they had respired; but this has been disproved. 18 Again, pneumonia may so increase the density of the lung as to cause it to sink. It is exceedingly rare, if ever possible, however, that pneumonia occurs congenitally; and it would not involve the entire lungs; hence, portions might be found to be buoyant. Moreover, the diseased condition, whether congestion or pneumonia, could be identified upon either gross or microscopic examination. 102a. Atelectasis.- Atelectasis is the condition of the imperfect expansion of the lungs. Holt19 says that children may live for several days using only one fourth of their lungs that part being usually the anterior border of the upper lobes. When the child lives for a shorter period still less of the lungs may be expanded. Taylor cites two cases from his own observations: one in which the child lived for six hours, and yet the lungs sank. In the other the child survived twenty-four hours, and after death the lungs were cut into thirty pieces, but not a single piece floated. Brouardel20 cites several instances in which premature infants have lived from six to thirty-six hours, in whom the lungs sank when placed in the water, although the infants had been breathing most of the time. As an illustration of the condition of apparent death in which the infant may lie without making any sign of life he tells the story of a midwife who put an apparently dead child in her basket, and, after caring for the mother, took the child to the police station to report it as a still birth. She told her story to the officer, and then opened the basket to show the dead child; whereupon the youngster cried for the first time. "Schmitt, Neue Versuche und Erfahrungen über die Ploucquestische und 72. hydrostatische Lungenprobe, Wien, 1806. "Holt, Diseases of Children, 1903, p. 20 Brouardel, p. 65. Hence, if the child's lungs sink in water, and no disease can be found to explain the sinking, we can not infer that the child has not lived, nor even that it has not breathed, although its respiration must have been very slight. 102b. Boiled and water-soaked lungs.-Again, if the lungs have been boiled the air has been driven out, and the lungs sink without giving evidence in either direction as to the respiration of the child. But here the abnormal condition of the lungs would be very evident, and lead to no trouble. Hofmann has shown another point which is of importance in connection with cases where bodies are found in the water, and where a wound gives access of the water to the lungs. He cites the authority of Koliker21 for the statement that lungs which float, if allowed to remain in the water, sink after three to eight days, from becoming water logged. 103. Docimasia intestinalis hydrostatica. Besides the docimasia pulmonum and the evidences in the lungs of respiration, we not infrequently find in the stomach a certain amount of air which has entered with respiration, for, in a certain number of cases, the respiration is accompanied by the swallowing of air. If, then, we test the stomach as we did the lungs, placing it in the water, in a certain number of cases we shall find that it also floats. This Brouardel22 speaks of as the docimasia intestinalis hydrostatica; and while it is of very subsidiary value as compared with the condition of the lungs, still, if both lungs and stomach float, the lung test can be considered as corroborated; if they both sink the evidence of still birth is greater than if the lungs alone were observed; and if the lungs sink but the stomach floats, it cannot be affirmed that the child has not breathed. 104. Circulatory tests, in general. The circulatory system must also be considered before the question of live birth can be dismissed, for the child may have a fairly active circulation and distinct muscular movements and still not breathe well, or, what is more to the point in the medico-legal cases, the child's breathing may be cut off before it has begun in the perfectly healthy child, as in the cases of suffocation before the first cry. In these cases we must not consider the negative docimasia as evidence of still birth. 105. Caput succedaneum.- As proof of an active circulation during at least part of labor, the presence of a serous exudate under the scalp or on whatever part of the child presented, called the caput succedaneum, formerly used to be cited. But it has been proved by "Koliker, Viertljhrsch. f. gericht. Med., XIX., 261. "Brouardel, p. 67. Blot23 that even in the fetus that has been dead for some time, a similar caput succedaneum is formed. This exudation, formerly attributed to a constriction of the venous circulation, has been shown to be due rather to decreased pressure on that part, and the pressure would be just the same whether the child were dead or alive. Hence, the caput succedaneum is of no value as a sign of live birth. 106. Fetal channels. The effects of birth and respiration upon the course of the blood through the body, and the closure of the fetal channels, are gradual, and can hardly be enumerated as signs that give evidence of live or still birth. They are considered in the section on the duration of the life of the infant.24 Again, the color of the blood in the two sides of the heart after respiration is too indefinite and too liable to modification by other factors to be of any value as a test of life. 107. Blood coagulation. The coagulation of blood after extravasation around fractures, wounds, and abrasions has received considerable attention and much warm discussion. The primary assumption was that if a wound bled and the blood coagulated around it, the wound had been inflicted during a period of life and active blood circulation. Casper, in his works on legal medicine, differed from this view, and held that blood shed after death could present a similar appearance. Tardieu25 considered that Casper had confounded two distinct conditions, and tried to refute all of Casper's arguments. Tardieu was supported by Devergie, West, and Barduet de Limoges, they all agreeing that the blood clot is evidence of life at the time of the injury. Now Brouardel,26 who has succeeded Tardieu at the University of Paris, upholds the view of Casper that such blood clots cannot be accepted as evidence of life. 108. Live birth before respiration. On the other hand, the circulatory tests of life have been recognized by the courts, and live birth before the beginning of respiration conceded. In Rex v. Brain27 the judge said that a child might be born and not breathe for some time after its birth. IV. DURATION OF THE CHILD'S LIFE. 109. Evidence from the lungs, stomach, umbilical clots. After the "Quoted by Tarnier, L'Infanticide, 2e, 1880, p. 74. Blot, Tumeur Oédemateuse Séro-sanguinolente Develloppée sur le Crâne de Pleusieurs Foetus Mort Nès. Mémoires de la société de biologie, 2e s. t. II., comptes rendus des séance, 1855, P. 63. *See 112, infra. "Tardieu, Etude Méd. Lég. sur les Blessures, etc. 1879, p. 1; reference from Brouardel, L'Infanticide, p. 69. 20 Brouardel, L'Infanticide, p. 69. "Rex v. Brain, 6 C. & P. 349, Archibald, Crim. Plead. 367. See also Rex v. Sellis 7 C. & P. 850. proof of live birth the question arises as to how long the child lived. The lungs containing respired air show that the infant lived at least long enough to take one breath, with the exclusion of the cases of the rare instances of breathing before birth. The examination of the stomach of the stillborn child shows that it is filled in some instances, probably always before respiration, with mucus, and in the first few minutes of life this mucus becomes mixed with air, forming a foamy liquid which disappears in a few hours. If this foamy mass, then, is found in the stomach, the life of the child may be considered as limited to a few hours. Similarly, the introduction of milk or food into the stomach will show that the child has lived at least an appreciable length of time. Coincident with the tying of the umbilical cord, or of the cessation of the placental circulation, there is the formation in the vessels of the cord of obliterating clots of blood, showing also a definite duration of life. On the other hand, if life has been shown, and the cord is still attached to the placenta, it would limit the life to a few hours, and at the same time tend to show the intention of the mother. For if the mother desires the child to live she sees to it that the cord is tied, even though the child may not die if the cord is untied or even uncut. Then, according to Tardieu, there occurs a beginning obliteration of the umbilical arteries, which would indicate life of about six hours. 110. Condition of the umbilical cord.-After the first day there is evidence in the umbilical cord of perhaps the greatest value, not merely as to the duration of the life of the child, but also as to life itself. At birth the cord is of a bluish pearly white color; after birth it loses its polish, and begins to become dry and flaccid during the latter part of the first twenty-four hours. The desiccation continues until the cord is hard and dry and falls off. The desiccation of the cord, formerly considered to be a sign of life, has been shown to occur just the same in the dead infant; depending upon the dryness of the cord, not upon life. Tardieu28 describes the case of an infant that was suffocated promptly after birth, but the cord left long and attached to the umbilicus. One week later the infant was found, and by chance a portion of the cord had lain on the ground beneath the body of the infant. The part of the cord that had been exposed to the air was hard and dry, but the portion which had been protected by the body of the child was moist and putrifying. The fall of the cord seems to be due to a mild inflammation that takes place around the umbilicus, which at the end of the first day "Tardieu, L'Infanticide, p. 89. appears as a slightly reddened area. This inflammation never becomes marked in the cases that receive proper care, but continues until the cord falls off. The cord separates usually on the fourth, fifth, or sixth day. The statistics as to the day all agree very accurately. The following are those given by the New York Lying-in Hospital for the six years preceding April 1st, 1896:29 The cord was detached on the 1st day in 3 cases; 2d day in 61 cases; 3d day in 655 cases; 4th day in 1,799 cases; 5th day in 2,203 cases; 6th day in 1,648 cases; 7th day in 829 cases; 8th day in 413 cases; 9th day in 139 cases; 10th day in 37 cases. Then, after the fall of the cord, cicatrization of the navel takes place, and that is generally complete on the fifteenth day.30 One other point must be considered in connection with the fall of the umbilical cord, and that is the fact that the cord may, by accident or otherwise, have been torn off at the umbilicus. Such a condition would be accompanied by a loss of substance around the attachment of the cord, and there would be a distinct wound, which would be easily distinguished from the normal scar after the fall of the cord. 111. Skin desquamation. The skin of the newborn child begins to desquamate usually on the day after birth, or the next day, taking off the remainder of the vernix caseosa. This desquamation usually lasts from one to five days. Hence, if we note the desquamation as present, we may consider the infant to be two or more days old. 112. Obliteration of the fetal channels.-The obliteration of the fetal blood channels has received considerable notice is connection with the duration of life after birth, but they are exceedingly variable. Elsässer31 showed the obliteration of these channels to be entirely unreliable even as evidence of live birth, for he found the ductus venosus closed in one stillborn child; and the foramen ovale and ductus arteriosus both closed in a child that lived but a quarter of an hour. Moreover, the continued patency of these channels is of still less legal value on this point, as the foramen ovale and ductus arteriosus are found open in certain cases in adult life. Brouardel32 gives them very little weight, saying that they are, as a rule, all completely occluded at the end of two weeks, and Hofmann33 says several weeks. 113. Centers of ossification.-The life of the infant is also deter Med. Report of the Soc. of the Lying-in Hospital of New York City, 1897, P. 75. Brouardel, L'Infanticide, p. 75. "Henke's Zeitschr. 1841-1852. Hofmann, p. 815. |