child presents by the breech, it would not be at all surprising that the child were stillborn. In these cases the woman would probably call for help before the birth of the child was completed. Otherwise, the only evidence of the condition that would remain would be the caput succedaneum on the genitals instead of on the head of the infant. VI. DEATH AFTER LABOR. 122. Caused by malformations. There are a certain number of cases of death soon after birth, from unavoidable causes, such as malformation of some of the essential organs of life, the brain, heart, lungs, and alimentary canal,-by reason of which the persistence of life is impossible. These cases show the defects in their structure, and become of interest legally only when associated with attempts at infanticide. Brouardel53 reports the case of an infant born two weeks before term in which the mother claimed to have been taken suddenly with labor pains which she int rpreted as desire to evacuate the bowels, and the child, according to the statement of the mother, was born into the water-closet, and the placenta thrown down after it. The infant was discovered in time to be rescued, taken to the hospital, and cared for till it died on the fourth day, with symptoms of intestinal obstruction. The autopsy showed scratches on the body not sufficient to account for the death of the child; separation of the bones of the skull, which could have been accounted for by the striking on the seat of the closet at the time of birth. There was also a tight stenosis of the intestine, 11 centimeters long, through which a fine probe could scarcely be passed, so that the child could not have lived under any circumstances. At the trial the woman, who had been charged with infanticide, was let go with a non lieu. It was not proved that the action of the woman had been sufficient to cause the death of the child. 123. Caused by prematurity. Similarly, in the cases of premature infants of the last three months, death not rarely occurs. In view of the statistics of the Charitè Hôpital, Paris, where there has been a mortality of less than 50 per cent in the infants born after six and a half calendar months of intrauterine life, because of the use of the incubator and artificial feeding,54 these mothers might be charged with not giving their infants proper care; but it is needless to say that such opportunities are not accessible to all mothers, and they are but little known to the laity. 124. Death from avoidable causes in general. We may turn now 'Brouardel, pp. 22 and 175. "See § 65, ante. to the cases of death soon after birth, from avoidable causes; that is, to the cases of infanticide. The class of people among whom such crimes occur is of interest in comparison with the class in which criminal abortion is found. Brouardel gives the following tables, as taken from the records of the French courts:55 125. Suffocation.- Brouardel also gives a very instructive table of the frequency with frequency with which death is is due to the various means employed to end the life of the child. He gives the figures of Tardieu and Vibert as well as his own, and explains the marked difference between the figures of Tardieu and the others as due to the fact that Tardieu considers subpleural ecchymoses as absolutely characteristic of death by suffocation, while Brouardel and Vibert do not consider that one sign as sufficient to prove the diagnosis. Tardieu considers that of the 804 cases that he examined, 69 per cent were infanticides, of which 34 per cent were due to suffocation. Brouardel, like Tardieu, considers suffocation the most common cause of death in infanticide, but he has, in his table, separated suffocation and strangulation, although they usually occur together. The following is Brouardel's table:56 may be produced in various ways similar to those in the adult, and also in several ways characteristic of the born infant, who can offer no resistance. The face of the infant may be covered with a cloth, pillow, or mattress, none of which will leave any characteristic mark. Or the infant may be buried alive; when, if the dirt has free access to the mouth and nose, it may be inspired, and found in the mouth, pharynx and larynx. The infant may be suffocated by being put in a bureau drawer or in a box, where the asphyxia will follow gradually, and where the signs will also not be characteristic. Similarly, the child's thorax and abdomen may be compressed, either with the hands, or by leaving the infant as it is born, between the thighs of the mother, and compressing it there with her thighs. Here, too, the evidence as to the manner in which the suffocation was produced is rarely distinctive. Perhaps the most usual way for the mother to suffocate the child is to cover the nose and mouth with her hand in her attempt to keep it from crying and so betraying its birth. If the woman succeeds in stopping the cries, she also kills the child. In these cases the signs of the method used are often distinct. There are the marks of the finger nails of the mother on the face of the child, around the nose and cheeks. These lacerations of the skin are especially likely to occur, as the skin of the child is so slippery from the vernix caseosa, and it is necessary to hold the child fast for five or six minutes to end its attempts at respiration. These superficial lacerations are rarely associated with ecchymosis, and are to be distinguished from accidental excoriations occurring after death by their characteristic size and peculiar angular form as well as by their location around the mouth, nose, and neck. Sometimes the head is held in one hand by the occiput, and the other hand used to cover the nose and mouth. Then there would also be nail marks behind the ears as well as on the face. Owing to the difficulty of holding the child's head, it is not infrequent to have the suffocation supplemented by strangulation, the mother's hand readily grasping the neck of the infant. Here the nail marks are found also on the neck. Philippon57 mentions one case in which the identity of the mother was suggested by the fact that the marks of the fingers were on the right side of the neck, and that of the thumb on the left side, thus pointing rather to a left-handed person than to the usual right-handed grasp. It Philippon, De Infanticide par Stran gulation, Thése, Lyon, 1895, XCII., p. VOL. III. MED. JUB -6. could not be said positively that the deed had not been committed by a right-handed person grasping the neck from behind. To these arguments from the nail marks the mother not infrequently makes the response that the marks are the result of the attempt to help herself in the delivery after the birth of the head, by grasping the head with her hands, and pulling on it. Such a defense may be admitted if the nail marks are transverse on the neck, but not if they lie in the long axis of the neck, as is usually the condition. However, such a maneuver is associated with considerable difficulty, for the force that a woman would be able to apply after putting her arms around the abdomen, enlarged by the pregnancy, would not be of great service in extracting a child that was delayed after the birth of the head. 126a. Pharyngeal tampon.- One other method of suffocation deserves consideration, and that is the packing of some foreign substance into the pharynx, so as to cut off the supply of air. Such a tampon in the throat may leave no trace; or, if less carefully applied, may leave excoriations on the mucous membrane.58 In not a few instances the tampons so applied have been left in place, and found on autopsy. Philippon 59 considers that these bodies, if introduced before death, remain dry or stained with mucus at the lower end and the mucus membrane of the pharynx there is anemic, while the mouth end of the tampon is moist and stained with blood, and the mucous membrane at the upper border of the tampon is distinctly congested. Cases of this kind are not rare, and one is of special interest from the uncertainty as to whether or not the child was living when the outrage was committed.60 A child was found in which the fauces, the upper part of the œsophagus, the larynx, and the trachea were tightly packed with sand. At the same time the child's lungs gave no sign of respiration, and sank to the bottom of the water when subjected to the hydrostatic test. While it is difficult to imagine for what purpose, if the child was already dead, the substance wedged so tightly into the entrance to the respiratory passages and throat should have been forced there, it is no less strange that such an act of violence should have been perpetrated upon a living child without its lungs showing at least signs of imperfect respiration. Unfortunately the case remains without solution. 59 126b. Burial alive.- Burial alive may occur, but more often the "Casper's Viertljahrschr., 1852, H. 2. Brouardel, p. 85. Philippon, De Infanticide par Stran gulation, Thèse, Lyon, 1895, XCII., p. body of the child is buried after death, or in a condition of suspended animation at the time of birth. The signs of live burial would be those of suffocation in general, and in addition the presence of the powdered earth in the pharynx and larynx. One case of burial alive in a pot of ashes, confirmed by the statement of the mother, is given in the Annales d'Hygiene, in which the ashes were found in the nostrils, mouth, fauces, and pharynx, but none in the windpipe. Another case is reported in the Lancet, 2 where the child, with the placenta attached, was buried in the ground, and covered with an inch and a half of earth. At least half an hour had elapsed before it was found, and yet, when it was taken up, respiration was still going on. Brouardel 63 considers that a child may live several hours (four or five) after burial. Hofmann 64 cites two cases from Bohn, of infants buried just after birth, that were dug up alive seven hours later. Another from Bardinet, of an infant that was alive after having been buried under 25 cms. of earth for eight hours; and still another from Mascha, where the infant was dug up alive after having been under a foot of earth for five hours. Here, also, may be mentioned the cases of suffocation by exposing the child to noxious vapors, as those of burning charcoal, or sulphur, the exhalations of privies, et cetera, of which no trace will be found except the odor of the deleterious gases. 127. General evidence of suffocation. The evidence of suffocation, no matter how it is performed, has the same general character as in the adult: the cyanosis of the skin, protrusion of the tongue, fluidity of the blood, congestion of the brain, and ecchymoses under the skin and conjunctiva,—all are suggestive of death by asphyxia, possibly by suffocation. The condition of the lungs, however, is more significant. The color of the lungs, if the child has not breathed, will remain like that of the fetus. If the child has breathed the color will not be the rosy hue, but a dark bluish red. The bronchi will contain blood-stained, frothy mucus, which must be distinguished from the slight exudation of colored serum, due to putrefaction, and the thick, purulent mucus of a capillary bronchitis that may have carried off the child without a sign during life. In the case of a child that has died of bronchitis, compression of the lung after it has been cut across will express from the bronchi little candles of muco-pus, 1 to 2 millimeters long, instead of the blood-stained mucus of a child that has been suffocated. "Ann. d'Hyg. XLVII., p. 460, 1852. "Amer. ed., 1853, p. 513. 63 Brouardel, p. 85. |