Chapter V: Part I: Forensic Medicine (2)

17. =Of the Bladder.=--Dangerous from extravasation of urine. In fracture of the pelvis the bladder is often injured, and extraperitoneal infiltration of urine occurs, with frequently a fatal issue.

18. =Of Genital Organs.=--Incised wounds of penis may produce fatal hæmorrhage. Removal of testicles may prove fatal from shock to nervous system. Wounds of the spermatic cord may be dangerous from hæmorrhage. Wounds to the vulva are dangerous, owing to hæmorrhage from the large plexus of veins without valves.

XV.--DETECTION OF BLOOD-STAINS, ETC.

Stains may require detection on clothing, on cutting instruments, on floors and furniture, etc. The following are the distinctive characters of blood-stains:

(a) =Ocular Inspection.=--Blood-stains on dark-coloured materials, which in daylight might be easily overlooked, may be readily detected by the use of artificial light, as that of a candle, brought near the cloth. Blood-spots when recent are of a bright red colour if arterial, of a purple hue if venous, the latter becoming brighter on exposure to the air. After a few hours blood-stains assume a reddish-brown or chocolate tint, which they maintain for years. This change is due to the conversion of hæmoglobin into methæmoglobin, and finally into hæmatin. The change of colour in warm weather usually occurs in less than twenty-four hours. The colour is determined, not entirely by the age of the stain, but is influenced by the presence or absence of impurities in the air, such as the vapours of sulphurous, sulphuric, and hydrochloric acids. If recent, a jelly-like material may be seen by the aid of a magnifying-glass lying between the fibres. If old, a cinnabar-red streak is seen on drawing a needle across the stain.

(b) =Microscopic Demonstration.=--With the aid of the microscope, blood may be detected by the presence of the characteristic blood-corpuscles. The human blood-corpuscle is a non-nucleated, biconcave disc, having a diameter of about 1/3500 of an inch. All mammalian red corpuscles have the same shape, except those of the camel, which are oval. The corpuscles of birds, fishes, reptiles, and amphibians, are oval and nucleated. The corpuscles of most mammals are smaller than those of man, but the size of a corpuscle is affected by various circumstances, such as drying or moisture, so that the medical witness is rarely justified in going farther than stating whether the stain is that of the blood of a mammal or not. Unfortunately, the corpuscles are usually so dried that little information regarding their size can be given.

(c) =Action of Water.=--Water has a solvent action on blood, fresh stains rapidly dissolving when the material on which they occur is placed in cold distilled water, forming a bright red solution. The hæmatin of old stains dissolves very slowly, so employ a weak solution of ammonia, and this will give a solution of alkaline hæmatin. Rust is not soluble in water.

(d) =Action of Heat.=--Blood-stains on knives may be removed by heating the metal, when the blood will peel off, at once distinguishing it from rust. Should the blood-stain on the metal be long exposed to the air, rust may be mixed with the blood, when the test will fail. The solution obtained in water is coagulated by heat, the colour entirely destroyed, and a flocculent muddy-brown precipitate formed.

(e) =Action of Caustic Potash.=--The solution of blood obtained in water is boiled, when a coagulum is formed soluble in hot caustic potash, the solution formed being greenish by transmitted and red by reflected light.

(f) =Action of Nitric Acid.=--Nitric acid added to a watery solution produces a whitish-grey precipitate.

(g) =Action of Guaiacum.=--Tincture of guaiacum produces in the watery solution a reddish-white precipitate of the resin, but on addition of an aqueous solution of peroxide of hydrogen, or of an ethereal solution of the same substance (known as _ozonic ether_), a blue or bluish-green colour is developed. This test is delicate, and succeeds best in dilute solutions. It is not absolutely indicative of the presence of blood, for tincture of guaiacum is coloured blue by milk, saliva, and pus.

(h) =Hæmin Crystals (Teichman's Crystals).=--These are produced by heating a drop of blood, or a watery solution of it, with a minute crystal of sodium chloride on a glass slide and evaporating to dryness. A cover-glass is placed over this, and a drop of glacial acetic acid allowed to run in. It is again heated until bubbles appear. Crystals of hæmin may now be detected by the microscope. They are dark brown or yellow rhombic prisms.

An improvement on this test is the use of formic acid alone; on slowly evaporating it, numerous very small dark crystals are visible if hæmoglobin has been present (Whitney's test).

(i) =Spectroscopic Appearances.=--If a solution of a recent stain be examined by the spectroscope, we get two absorption bands situated between the lines D and E, the one nearer E being doubly as broad as the other. These bands indicate _oxyhæmoglobin_.

If we now add a little ammonium sulphide to this solution, we get the spectrum of _reduced hæmoglobin_, which is a single broad absorption band situated in the interval between the preceding oxyhæmoglobin bands. By shaking the solution, oxyhæmoglobin is again reproduced, and gives its special absorption bands.

If ammonia be added to the original solution, _alkaline hæmatin_ is produced, or if acetic acid be chosen, _acid hæmatin_ is produced, and each gives its appropriate absorption bands.

_Methæmoglobin_ is formed in stains which have been exposed to the air for a few days, and _hæmatin_ is found in old stains. _Hæmochromogen_ gives a very characteristic spectrum, and is obtained by reducing alkaline hæmatin by ammonium sulphide. _Carbon monoxide hæmoglobin_ gives a spectrum which resembles that of oxyhæmoglobin, but it is not reduced by ammonium sulphide.

(j) =Precipitin Test.=--This allows us to tell whether the blood is from a human being or not. A specific serum must be obtained from a rabbit which is sensitized as follows: 10 c.c. of human blood is injected into its peritoneal cavity at intervals, until from three to five injections have been given. The serum of this animal's blood will then give a white precipitate only when brought into contact with dilute solutions of human blood, but with the blood of no other animal. This is known also as the 'biologic,' or Uhlenhuth's test.

=Rust Stains.=--These are yellowish-red in colour, and do not stiffen the cloth. The iron may be dissolved by placing the stain in a dilute solution of hydrochloric acid, when, on adding ferrocyanide of potassium, Prussian blue is produced.

=Fruit Stains= are seldom so dark as blood-stains. Solutions of these do not change colour or coagulate on boiling; ammonia changes the colour to blue or green; acid brightens the original colour, while chlorine bleaches it.

=Hairs.=--Human hairs must be identified and distinguished from those of the lower mammals. If the hair has been pulled out from the root, the microscope will show that the bulbous root has a concave surface which fitted over the hair papilla, or that the root is encased in a fatty sheath.

=Fibres of Clothing.=--Microscopically, wool fibres are coarse, curly, and striated transversely; cotton fibres appear as flattened bands twisted into spirals; linen fibres are round, jointed at frequent intervals, with small root-like filaments; silk fibres are solid, continuous, and highly glistening.

XVI.--DEATH BY SUFFOCATION

_Signs and Symptoms._--There are usually three stages:

1. Exaggerated respiratory activity; air hunger; anxiety; congested appearance of face; ringing in ears.

2. Loss of consciousness; convulsions; relaxation of sphincters.

3. Respirations feeble and gasping, and soon cease; convulsions of stretching character; heart continues to beat for three to four minutes after breathing ceases.

_Post-Mortem Appearances--External._--Cadaveric lividity well marked; nose, lips, ears, finger-tips almost black in colour; appearance may be placid or, if asphyxia has been sudden, the tongue may be protruded and eyeballs prominent, with much bloody mucus escaping from mouth and nose.

_Internal._--The blood is dark and remains fluid; great engorgement of venous system, right side of heart, great veins of thorax and abdomen, liver, spleen, etc. Lungs dark purple in colour; much bloody froth escapes on squeezing them; mucous lining of trachea and bronchi congested and bright red in colour; air-cells distended or ruptured; many small hæmorrhages on surface of lungs and other organs, as well as in their substance (_Tardieu's spots_), due to rupture of venous capillaries from increased vascular pressure.

XVII.--DEATH BY HANGING

In hanging, death occurs by asphyxia, as in drowning. Sensibility is soon lost, and death takes place in four or five minutes. The eyes in some cases are brilliant and staring, tongue swollen and livid, blood or bloody froth is found about the mouth and nostrils, and the hands are clenched. In other cases the countenance is placid, with an almost entire absence of the signs just given. The mark on the neck, which may be more or less interrupted by the beard, shows the course of the cord, which in hanging is obliquely round the neck following the line of the jaw, but straight round in strangulation. In judicial hanging, death is not due to asphyxiation, but, owing to the long drop, the cervical vertebræ are dislocated, and the spinal cord injured so high up that almost instant death takes place. On dissection the muscles and ligaments of the windpipe may be found stretched, bruised, or torn, and the inner coats of the carotid arteries are sometimes found divided. In ordinary suicidal hanging there may be entire absence of injury to the soft parts about the neck, the length of the drop modifying these appearances. The mark of the cord is not a sign of hanging, is a purely cadaveric phenomenon, and may be produced some hours after death.

XVIII.--DEATH BY STRANGULATION

This differs from hanging in that the body is not suspended. It may be effected by a ligature round the neck, or by direct pressure on the windpipe with the hand, in which case death is said to be caused by _throttling_. Strangulation is frequently suicidal, but may be accidental. When homicidal, much injury is done to the neck, owing to the force with which the ligature is drawn. In throttling, the marks of the finger-nails are found on the neck.

XIX.--DEATH BY DROWNING

Death by drowning occurs when breathing is arrested by watery or semi-fluid substances--blood, urine, etc. The fluid acts mechanically by entering the air-cells of the lung and preventing the due oxidation of the blood. The post-mortem appearances include those usually present in death by asphyxia, together with the following, peculiar to death by drowning: Excoriations of the fingers, with sand or mud under the nails; fragments of plants grasped in the hand; water in the stomach (this is a vital act, and shows that the person fell into the water alive); fine froth at the mouth and nostrils; cutis anserina; retraction of penis and scrotum. On post-mortem examination, the lungs are found to be increased in size ('ballooned'); on section, froth, water mud, sand, in air-tubes. The presence of this fine (often blood-stained) froth is the most characteristic sign of drowning. Froth like that of soap-suds in the trachea is an indication of a vital act, and must not be mistaken for the tenacious mucus of bronchitis. The presence of vomited matters in the trachea and bronchi is a valuable sign of drowning. The blood collects in the venous system, and is dark and fluid. Tardieu's spots are not so frequently met with in cases of drowning as in other forms of asphyxia. The other signs of death by asphyxia are present. Wounds may be present on the body, due to falling on stakes, injuries from passing vessels, etc.

The methods of performing artificial respiration in the case of the apparently drowned are the following (the best and most easily performed is Schäfer's prone pressure method):

1. _Schäfer's._--Place the patient on his face, with a folded coat under the lower part of the chest. Unfasten the collar and neckband. Go to work at once. Kneel over him athwart or on one side facing his head. Place your hands flat over the lower part of his back, and make pressure on his ribs on both sides, and throw the weight of your body on to them so as to squeeze out the air from his chest. Get back into position at once, but leave your hands as they were. Do this every five seconds, and get someone to time you with a watch. Keep this going for half an hour, and when you are tired get someone to relieve you.

Other people may apply hot flannels to the limbs and hot water to the feet. Hypodermic injections of 1/50 grain of atropine, suprarenal or pituitary extracts, may be found useful.

2. _Silvester's._--In this method the capacity of the chest is increased by raising the arms above the head, holding them by the elbows, and thus dragging upon and elevating the ribs, the chest being emptied by lowering the arms against the sides of the chest and exerting lateral pressure on the thorax. The patient is in the supine position--but first the water must have been drained from the mouth and nose by keeping the body in the prone position. The tongue must be kept forward by transfixing with a pin.

3. _Marshall Hall's._--This consists in placing the patient in the prone position, with a folded coat under the chest, and rolling the body alternately into the lateral and prone positions.

4. _Howard's._--This consists in emptying the thorax by forcibly compressing the lower part of the chest; on relaxing the pressure the chest again fills with air. Here the patient is placed in the supine position.

The objections to the supine position are that the tongue falls back, and not only blocks the entrance of air, but prevents the escape of water, mucus, and froth from the air-passages.

5. _Laborde's Method._--This consists in holding the tongue by means of a handkerchief, and rhythmically drawing it out fully at the rate of fifteen times per minute. This excites the respiratory centre, and this method may be employed along with any of the other methods.

XX.--DEATH FROM STARVATION

The post-mortem appearances in death from starvation are as follows: There is marked general emaciation; the skin is dry, shrivelled, and covered with a brown, bad-smelling excretion; the muscles soft, atrophied, and free from fat; the liver is small, but the gall-bladder is distended with bile. The heart, lungs, and internal organs are shrivelled and bloodless. The stomach is sometimes quite healthy; in other cases it may be collapsed, empty, and ulcerated. The intestines are also contracted, empty, and translucent.

In the absence of any disease productive of extreme emaciation (_e.g._, tuberculosis, stricture of oesophagus, diabetes, Addison's disease), such a state of body will furnish a strong presumption of death by starvation.

In the case of children there is not always absolute deprivation of food, but what is supplied is insufficient in quantity or of improper quality. The defence commonly set up is that the child died either of marasmus or of tuberculosis.

In cases where it is alleged that a child has been starved and ill-used, one must examine the body for signs of neglect--_e.g._, dirtiness of skin and hair, presence of vermin, bruises or skin eruptions. Compare its weight with a normal child of the same age and sex. If the disproportion be great and signs of neglect present, then the probability is great (provided there be no actual disease present) that the child has been starved.

XXI.--DEATH FROM LIGHTNING AND ELECTRICITY

The signs of death from lightning vary greatly. In some cases there are no signs; in others the body may be most curiously marked. Wounds of various characters--contused, lacerated, and punctured--may be produced. There may be burns, vesications, and ecchymoses; arborescent markings are not uncommon. The hair may be singed or burnt and the clothing damaged. Rigor mortis is very rapid in its onset and transient. Post mortem there are no characteristic signs, but the blood may be dark in colour and fluid. The presence or absence of a storm may assist the diagnosis.

Injuries by electrical currents of high pressure are not uncommon; speaking generally, 1,000 to 2,000 volts will kill. In America, where electricity is adopted as the official means of destroying criminals, 1,500 volts is regarded as the lethal dose, but there are many instances of persons having been exposed to higher voltages without bad effects. The alternating current is supposed to be more fatal than the continuous. Much depends on whether the contact is good (perspiring hands or damp clothes). Death has been attributed in these cases to respiratory arrest or sudden cessation of the heart's action. The best treatment is artificial respiration, but the inhalation of nitrite of amyl may prove useful. Rescuers must be careful that they, also, do not receive a shock. The patient should be handled with india-rubber gloves or through a blanket thrown over him.

XXII.--DEATH FROM COLD OR HEAT

=Cold.=--The weak, aged, or infants, readily succumb to low temperatures. The symptoms are increasing lassitude, drowsiness, coma, with sometimes illusions of sight. Post mortem, bright red patches are found on the skin surface, and the blood remains fluid for long.

=Heat.=--Death may result from syncope, the result of exposure to great heat.

=Sunstroke.=--The person loses consciousness and falls down insensible; the body temperature may be 112° F., the pulse is full, and a peculiar pungent odour is given off from the skin. Coma, convulsions with (rarely) delirium, may precede death. _Treatment_ consists in lowering the body temperature by application of cold cloths, stimulants, strychnine or digitalin hypodermically.

XXIII.--PREGNANCY

The signs of the existence of pregnancy are of two kinds, uncertain and certain, or maternal and foetal. Amongst the former class are included--Cessation of menstruation (which may occur without pregnancy); morning vomiting; salivation; enlargement of the breasts and of the abdomen; quickening. It must be borne in mind that every woman with a big abdomen is not necessarily pregnant. The tests which afford conclusive evidence of the existence of a foetus in the uterus are--Ballottement, the uterine souffle, intermittent uterine contractions, foetal movements, and, above all, the pulsation of the foetal heart. The uterine souffle is synchronous with the maternal pulse; the foetal heart is not, being about 120 beats per minute.

Evidence of pregnancy may also be afforded by the discharge from the uterus of an early ovum, of moles, hydatids, etc. Disease of the uterus and ovarian dropsy may be mistaken for pregnancy. Careful examination is necessary to determine the nature of the condition present. Pregnancy may be pleaded in bar of immediate capital punishment, in which case the woman must be shown to be 'quick with child.' A woman may also plead pregnancy to delay her trial in Scotland, and both in England and Scotland, in civil cases, to produce a successor to estates, to increase damages for seduction, in compensation cases where a husband has been killed, to obtain increased damages, etc. A woman may become pregnant within a month of her last delivery.

In cases of rape and suspected pregnancy, it must be borne in mind that a medical man who examines a woman under any circumstances against her will renders himself liable to heavy damages, and that the law will not support him in so doing. If, on being requested to permit an examination, the woman refuse, such refusal may go against her, but of this she is the best judge. The duty of the medical man ends on making the suggestion.

XXIV.--DELIVERY

The signs of recent delivery are as follows: The face is pale, with dark circles round the eyes; the pulse quickened; the skin soft, warm, and covered with a peculiar sweat; the breasts full, tense, and knotty; the abdomen distended, its integuments relaxed, with irregular light pink streaks on the lower part. The labia and vagina show signs of distension and injury. For the first three or four days there is a discharge from the uterus more or less sanguineous in character, consisting of blood, mucus, epithelium, and shreds of membrane. During the next four or five days it becomes of a dirty green colour, and in a few days more of a yellowish, milky, mucous character, continuing for two to three weeks. The change in character of the lochial discharge is due to the quantity of blood decreasing and its place being taken by fatty granules and leucocytes. The os uteri is soft, patulous, and its edges are torn. The uterus may be felt for two or three hours above the pubis as a hard round ball, regaining its normal size in about eight weeks after delivery. Most of these signs disappear about the tenth day, after which it becomes impossible to fix the date of delivery.

In the dead the external parts have the same appearance as given above. The uterus will vary in appearance according to the time elapsed since delivery. If death occurred immediately after delivery, the uterus will be wide open, about 9 or 10 inches long, with clots of blood inside, and the inner surface lined by decidua.

The signs of a previous delivery consist in silvery streaks in the skin of the abdomen, which, however, may be due to distension from other causes; similar marks on the breast; circular and jagged condition of the os uteri (the virgin os being oval and smooth); marks of rupture of the perineum or fourchette; absence of the vaginal rugæ; dark-coloured areola round the nipples, etc. The difference between the virgin _corpus luteum_ and that of recent pregnancy is not so marked as to justify a confident use of it for medico-legal purposes.

XXV.--FOETICIDE, OR CRIMINAL ABORTION

This consists in giving to any woman, or causing to be taken by her, with intent to procure her miscarriage, any poison or other noxious thing, or using for the same purpose any instruments or other means whatsoever. It is a felony to procure or attempt to procure the miscarriage of a woman, whether she be pregnant or not, and it is a felony for the woman, if pregnant, to attempt to procure her own miscarriage. It is a misdemeanour for any person or persons to procure drugs or instruments for a like purpose. It is not necessary that the woman be _quick_ with child. The offence is the intent to procure the miscarriage of any woman, _whether she be or be not with child_. When from any causes it is necessary to procure abortion, a medical man should do so only after consultation with a brother practitioner. Even in these cases there is no exemption legally. Any medical man who gives even the most harmless medicine where he suspects the possibility of pregnancy may render himself liable to grave suspicion should the woman abort.

In medicine, an _abortion_ is said to occur when the foetus is expelled before the sixth month; after that it is _premature birth_. In law, however, any expulsion of the contents of the uterus before the full time is an _abortion_ or _miscarriage_.

In deciding whether any substance expelled from the uterus is really a foetus or a mole, and therefore the result of conception, or the coat of the uterus, and unconnected with pregnancy, the examination of the substances expelled must be carefully made. Moles are blighted foetuses. An examination of the woman will be necessary, though it is not easy during the early months of pregnancy, and especially in those who have borne children, to say whether abortion has taken place or not. The history must be inquired into; the regular or exceptional use of drugs to promote menstruation is important, for in the former case no criminal intent may exist, although pregnancy be present. The state of the breasts, the hymen, and the os uteri, should all be carefully examined. Putting a few apparently unimportant questions as to the frequent use of purgatives, the presence or absence of constipation, will often assist the diagnosis as showing that the woman has acted in an unusual manner. Abortion may be procured by the introduction of instruments, by falls, violent exercise, blows on the abdomen, etc. In the hands of ignorant persons the use of instruments (sounds, bougies, skewers, etc.) is attended with great danger. Perforation of the vaginal walls, bladder, cervix, or uterus, may follow their use. Septic pelvic peritonitis may ensue, and the woman may lose her life. The person who has employed such means for inducing abortion is liable to be charged with the crime of murder. There is no evidence to show that ergot, savin, bitter-apple, pennyroyal, or any other drug administered internally, will cause a woman to abort, except when taken in such large doses that actual poisoning results, with inflammation of the contents of the true pelvis. In such cases reflex uterine contractions may be set up, and abortion may follow. Diachylon pills are largely employed to induce abortion, and very often the woman taking them suffers severely from lead-poisoning.

XXVI.--INFANTICIDE

Infanticide, or the murder of a new-born child, is not treated as a specific crime, but is tried by the same rules as in cases of felonious homicide. The term is applied technically to those cases in which the mother kills her child at, or soon after, its birth. She is often in such a condition of mental anxiety as not to be responsible for her actions. It is usually committed with the object of concealing delivery, and to hide the fact that the girl has, in popular language, 'strayed from the paths of virtue.' The child must have had a separate existence. To constitute 'live birth,' the child must have been alive after its body was entirely born--that is, entirely outside the maternal passages--and it must have had an independent circulation, though this does not imply the severance of the umbilical cord. Every child is held in law to be born dead until it has been shown to have been born alive. Killing a child in the act of birth and before it is fully born is not infanticide, but if before birth injuries are inflicted which result in death after birth, it is murder. Medical evidence will be called to show that the child was born alive.

The methods of death usually employed are--(1) Suffocation by the hand or a cloth. (2) Strangulation with the hands, by a tape or ribbon, or by the umbilical cord itself. (3) Blows on the head, or dashing the child against the wall. (4) Drowning by putting it in the privy or in a bucket of water. (5) Omission: by neglecting to do what is absolutely necessary for the newly-born child--_e.g._, not separating the cord; allowing it to lie under the bed-clothes and be suffocated.

With regard to the question of the maturity of a child, the differences between a child of six or seven months and one at full term may be stated as follows:

Between the sixth and seventh month, length of child 10 to 14 inches--that is, the length of the child after the fifth month is about double the lunar months--weight 1 to 3 pounds; skin, dusky red, covered with downy hair (lanugo) and sebaceous matter; membrana pupillaris disappearing; nails not reaching to ends of fingers; meconium at upper part of large intestine; testes near kidneys; no appearance of convolutions in brain; points of ossification in four divisions of sternum.

At nine months, length of child 18 to 22 inches; weight, 7 to 8 pounds; skin rosy; lanugo only about shoulders; sebaceous matter on the body; hair on head about an inch long; testes past inguinal ring; clitoris covered by the labia; membrana pupillaris disappeared; nails reach to ends of fingers; meconium at termination of large intestine; points of ossification in centre of cartilage at lower end of femur, about 1-1/2 to 2-1/2 lines in diameter; umbilicus midway between the ensiform cartilage and pubis.

Owing to the difficulty of proving that the crime of infanticide has been committed, the woman may in England be tried for _concealment of birth_, and in Scotland for _concealment of pregnancy_, if she conceal her pregnancy during the whole time and fail to call for assistance in the birth. Either of these charges would only be brought against a woman who had obviously been pregnant, and now the child is missing or its dead body has been found. It is expected that every pregnant woman should make provision for the child about to be born, and so should have talked about it or have made clothes, etc., for it. The punishment for concealment is imprisonment for any term not exceeding two years. The charge of concealment is very often alternative to infanticide. To substantiate the charge, however, it must be proved that there had been a _secret disposition of the dead body_ of the infant, as well as an endeavour to conceal its birth.

A woman may be delivered of a child unconsciously, for the contractile power of the womb is independent of volition. Under an anæsthetic the uterus acts as energetically as if the patient were in the full possession of her senses.

Nowadays a woman is rarely hanged for infanticide, and it is a mere travesty of justice to pass on her the death sentence, well knowing that it will never be executed.

XXVII.--EVIDENCES OF LIVE BIRTH

The signs of live birth prior to respiration are negative and positive. A negative opinion may be formed when evidence is found of the child having undergone intra-uterine maceration. In this case the body will be flaccid and flattened; the ilia prominent; the head soft and yielding; the cuticle more or less detached, and raised into large bullæ; the skin of a red or brownish-red colour; the cavities filled with abundant bloody serum; the umbilical cord straight and flaccid.

A positive opinion is justified when such injuries are found on the body as could not have been inflicted during birth, and are attended with such hæmorrhage as could only have occurred while the blood was circulating. Fractures of the cranium from accidental falls (precipitate labour) are as a rule stellate, and are situated on the vertex or in the parietal protuberance. The fractures from violence are more extensive, usually depressed, and accompanied by laceration of the scalp.

The evidences of live birth after respiration has taken place are usually deduced from the condition of the lungs, though indications are also found in other organs. The diaphragm is more arched before than after respiration, and rises higher in the thorax in the former case than in the latter. The lungs before respiration are situated in the back of the thorax, and do not fill that cavity; they are of a dark, red-brown colour and of the consistence of liver, without mottling. After respiration they expand and occupy the whole thorax, and closely surround the heart and thymus gland. The portions containing air are of a light brick-red colour, and crepitate under the finger. The lungs are mottled from the presence of islands of aerated tissue, surrounded by arteries and veins. The weight of the lungs before respiration is about 550 grains, after an hour's respiration 900 grains; but this test is of little value. The ratio of the weight of the lungs to that of the body (Ploucquet's test), which is also unreliable, is, before respiration, about 1 to 70; after, 1 to 35. Lungs in which respiration has taken place float in water; those in which it has not, sink. There are exceptions to this rule, on which, however, is founded the _hydrostatic test_. As originally performed, this test consisted merely in placing the lungs, with or without the heart, in water, and noticing whether they sank or floated. The test is now modified by squeezing, and by cutting the lungs up into pieces.

The objections to the test as originally performed are--(1) That the lungs may sink as the result of disease--_e.g._, double pneumonia. (2) That respiration may have been so limited in extent that the lungs may sink, owing to large portions of lung tissue remaining unexpanded (_atelectasis_). (3) Putrefaction may cause the lungs to float when respiration has not taken place. (4) The lungs may have been inflated artificially. Few of these objections apply, however, when the hydrostatic test, modified by pressure, is employed. To take these objections in detail, it may be stated: (1) If the lungs sink from disease, the question of live birth is answered. (2) This objection is too refined for practical use. The lungs sink, there is an absence of any of the signs of suffocation, and the matter ends. The examiner has only to describe the conditions which he finds, and is not required to indulge in conjectures as to the amount of respiration which may or may not have taken place. (3) Gas due to putrefaction collects under the pleural membrane, and can be expelled by pressure, and is not found in the air cells. The lungs decompose late, hence in a fresh body putrefaction of the lungs is absent; in a putrefied child, if the lungs sink, it must have been stillborn. The so-called _emphysema pulmonum neonatorum_ is simply incipient putrefaction.

The lung test simply shows that the child has breathed, but affords no proof that the child has been born alive. The child may have breathed as soon as its head protruded, the rest of the body being in the maternal passages. The child is not born alive until it has been completely expelled, although it is not necessary that the umbilical cord should have been cut.

In addition to these tests, live birth may be suspected from the following conditions: The _stomach_ may contain milk or food, recognized by the microscope and by Trommer's test for sugar; the _large intestines_ in stillborn children are filled with meconium, in those born alive they are usually empty; the _bladder_ is generally emptied soon after birth; the _skin_ is in a condition of exfoliation soon after birth. The _organs of circulation_ undergo the following changes after birth, and the extent to which these changes have advanced will give an idea of how long the child has lived: The _ductus arteriosus_ begins to contract within a few seconds of birth; at the end of a week it is about the size of a crow quill, and about the tenth day is obliterated. The _umbilical arteries and vein_: the arteries are remarkably diminished in calibre at the end of twenty-four hours, and obliterated almost up to the iliacs in three days; the umbilical vein and the ductus venosus are generally completely contracted by the fifth day. The _foramen ovale_ becomes obliterated at extremely variable periods, and may continue open even in the adult.

Importance of late has been attached to the _stomach-bowel test_. If the stomach and duodenum contain air, and consequently float in water, the chances are that the child did not die immediately after birth; this is known as Breslau's second life test, and the lower the air in the intestinal canal, the greater is the probability that the child survived birth.

The umbilical cord in a new-born child is fresh, firm, round, and bluish in colour; blood is contained in its vessels. The cord may be ruptured by the child falling from the maternal parts in a precipitate labour, and the ruptured parts present ragged ends. It is seldom that a child bleeds to death from an untied or cut umbilical cord, and the chances in a torn cord are still more remote. The changes in the cord are as follows: First it shrinks from the ligature towards the navel; this change may begin early, and is rarely delayed beyond thirty hours; the cord becomes flabby, and there is a distinct inflammatory circle round its insertion. The next change is that of desiccation or mummification; the cord becomes reddish-brown, then flattened and shrivelled, then translucent and of the colour of parchment, and falls off about the fifth day. The third stage, that of cicatrization, then ensues about the tenth to the twelfth day. The bright red rim round the insertion of the cord, with inflammatory thickening and slight purulent secretion, may be considered as evidence of live birth, and the stage at which the separation of the cord by ulcerative process has arrived will point to the probable duration of time the child has existed after birth.

There are many fallacies in the application of any of these tests, and the whole subject bristles with difficulties. The medical witness would do well to exhibit a cautious reserve, for if the child dies immediately after birth it is almost impossible to prove that it was born alive.

XXVIII.--CAUSE OF DEATH IN THE FOETUS

The death of the foetus may be due to--(1) Immaturity or intra-uterine malnutrition, or simply from deficient vitality; (2) complications occurring during or immediately after birth, which may either be unavoidable or inherent in the process of parturition, or may be induced with criminal intent.

In the latter category come such accidents as the pressure of tumours in the pelvic passages, or disease of the bones in the mother, or pressure on the cord from malposition of the child during labour, asphyxiation from the funis being twisted tightly round the neck or limbs, or from injuries due to falls on the floor in sudden labours. Where the death of the foetus has been induced with criminal intent, it may be due to punctured wounds of the fontanelles, orbits, heart, or spinal marrow; dislocation of the neck; separation of the head from the body; fracture of the bones of the head and face; strangulation; suffocation; drowning in the closet pan or privy, or from being thrown into water.

Under the head of infanticide by _commission_, we have injuries of all kinds; under infanticide by _omission_, neglecting to tie the cord, allowing it to be suffocated by discharges in the bed, neglect to provide food, clothes, and warmth, for the new-born child.

XXIX.--DURATION OF PREGNANCY

The natural period of gestation is considered as forty weeks, ten lunar months, or 280 days. A medical witness would have to admit the possibility of gestation being prolonged to 300 days, and if this time were not very materially exceeded it would be well to give the woman the benefit of the doubt. It may be mentioned that 300 days is the extreme limit fixed by the French and Scottish law. No fixed period is assigned in English or American law to the duration of pregnancy, though it is allowed that utero-gestation may be greatly prolonged. In a recent case decided, the Lord Chancellor accepted a case where it was alleged pregnancy had extended to 331 days. A child only five months old may live, for a short time at all events. There is considerable difficulty in many cases in fixing the date of conception. The data from which it is calculated are the following: (1) _Peculiar sensations attending conception_, which are not sufficiently defined to be recognized by those conceiving for the first time. (2) _Cessation of the catamenia._ Other causes may, however, cause this; and, on the other hand, a woman may menstruate during the whole period of her pregnancy. This datum also gives a variable period, and may involve an error of several days or a month, for the menses may be arrested by cold, etc., at one monthly period, and the woman become pregnant before the next. (3) _The period of quickening._ This, when perceived (which is not always the case), also occurs at variable periods from the tenth to the twenty-sixth week. (4) _A single coitus._ This does not, however, correspond to the time of fertilization. Several days may elapse before the spermatozoa meet with an ovum and fertilize it.

In Scotland a child born six months after marriage is legitimate, which is allowing an ample margin.

XXX.--VIABILITY OF CHILDREN

A child may be born alive, but may not be viable, by which is meant that it is not endowed with a capacity of maintaining its life. Speaking generally, 180 days represents the lowest limit at which a child is viable, but prolonged survival under these circumstances is the exception. Many cases, however, have been recorded in which children born at six months have been reared. The signs of immaturity and maturity may be thus tabulated:

IMMATURITY. MATURITY.

Centre of body high; head Strong movements and cries as soon disproportionate in size; membrana as born; body clear, red colour, pupillaris present; testicles coated with sebaceous matter; mouth, undescended; deep red colour of nostrils, eyelids, and ears, open; parts of generation; intense red skull somewhat firm, and fontanelles colour, mottled appearance, and not far apart; hair, eyebrows, and downy covering, of skin; nails not nails, perfectly developed; formed; feeble movements; testicles descended; free discharge inability to suck; necessity for of urine and meconium; power of artificial heat; almost unbroken suction, indicated by seizure on the sleep; rare and imperfect nipple or a finger placed in the discharges of urine and meconium; mouth. closed state of mouth, eyelids, and nostrils.

XXXI.--LEGITIMACY

A child born in wedlock is presumed to have the mother's husband for its father. This may, however, be open to question upon the following grounds: Absence or death of the reputed father; impotence or disease in the husband preventing matrimonial intercourse; premature delivery in a newly-married woman; want of access; and the marriage of the woman again immediately on the death of her husband. In the last case, where either husband might have been the father, the child at the age of twenty-one is at liberty to select its father from the possible pair.

A child born of parents before marriage is in Scotland rendered legitimate by their subsequent marriage, but in England the offspring remains illegitimate whether the parents marry or not after its birth. The offspring of voidable or invalid marriages may be made legitimate by application to the courts.

There is a difference between being legitimate and lawfully begotten. A child born in wedlock is legitimate, but if the parents were married only a week previously it could not have been lawfully begotten.

The Acts and rulings relating to Marriage and Legitimacy are extremely complicated. It is not putting it too strongly to say that a very large number of people in this country who believe themselves to be legally married are not married at all, and that thousands of children who have not the slightest doubt as to their legitimacy are in the eyes of the law bastards.

XXXII.--SUPERFOETATION

By superfoetation is meant the conception, by a woman already pregnant, of a second embryo, resulting in the birth of two children at the same time, differing much in their degree of maturity, or in two separate births, with a considerable interval between. The possibility of the occurrence of superfoetation has been doubted, but there are well-authenticated cases which countenance the theory of a double conception. It has been shown that the os uteri is not closed, as was once supposed, immediately _on conception_. Should an ovum escape into the uterus, it may become impregnated a month or so after a previous conception. The most probable explanation is that the case has been one of twins, one being born prematurely; or, on the other hand, the uterus may have been double, and conception may have taken place in one cornu at a later period than in the other cornu.

XXXIII.--INHERITANCE

In order to inherit, the child must be born alive, must be born during the lifetime of the mother, and must be born capable of inheriting--that is to say, monsters are incapable of inheriting. There is a mode of inheritance called 'tenancy by courtesy.' When a man marries a woman possessed of an estate or inheritance, and has, by her, issue born alive in her lifetime capable of inheriting her estate, in this case he shall, on the death of his wife, hold the lands for his life as tenant by the courtesy of England. The meaning of the words 'born alive' in this instance is not the same as in cases of infanticide. In Civil law any motion of the child's body, however slight, or the fact of it having been heard to cry by witnesses, is held to be sufficient proof of the child having been born alive. It may die immediately afterwards, and it is not necessary that the child be viable.

XXXIV.--IMPOTENCE AND STERILITY

In the male, impotence may arise from physical or mental causes. The physical causes may be--too great or too tender an age; malformation of the genital organs; _crypsorchides_, defect or disease in the testicles; constitutional disease (diabetes, neurasthenia, etc.); or debility from acute disease, as mumps. Masturbation, and early and excessive sexual indulgence, are also causes. The mental causes include--passion, timidity, apprehension, aversion, and disgust. The case will be remembered of the man who was impotent unless the lady were attired in a black silk dress and high-heeled French kid boots.

If a man is impotent when he marries, the marriage may be set aside on the ground that it had never been consummated. The law requires that the impotency should have existed _ab initio_--that is, before marriage--and should be of a permanent or incurable nature; marriage, as far as the law goes, being regarded as a contract in which it is presupposed that both the contracting parties are capable of fulfilling all the objects of marriage. In the case of the Earl of Essex the defendant admitted the charge as regards the Countess, but pleaded that he was not impotent with others, as many of her waiting-maids could testify. When a man becomes impotent _after_ marriage, his wife must accept the situation, and has no redress. A man may be _sterile_ without being impotent, but the law will not take cognizance of that. The wife may be practically impotent, but the law will not assist the husband. He must continue to do his best under difficult circumstances. In former times in case of doubt a husband was permitted to demonstrate his competency in open court, but this custom is no longer regarded with favour by the judges.

The removal of the testicles does not of necessity render a man impotent, although it deprives him of his procreative power. Eunuchs are capable of affording illicit pleasure, whilst the male sopranos, or _castrati_, are often utilized for that purpose.

In the female, impotence may be caused by the narrowness of the vagina, adhesion of the vulva, absence of vagina, imperforate hymen, and tumours of the vagina.

Sterility in women may occur from the above-named causes of impotence, together with absence of the uterus and ovaries, or from great debility, syphilis, constant amenorrhoea, dysmenorrhoea, or menorrhagia.

XXXV.--RAPE

Rape is the carnal knowledge of a woman by force and against her will. The resistance of the woman _must be_ to the utmost of her power, but if she yield through fear or duress it is still rape. The woman is a competent witness, but her statements may be impugned on the ground of her previous bad character, and evidence may be called to substantiate the charge. The perpetrator must be above the age of fourteen years.

The definition of rape which we have given is not altogether satisfactory. Take, for example, the case of a woman who goes to bed expecting her husband to return at a certain hour. The lodger, let us say, takes advantage of this fact, and, getting into bed, has connection with her, she not resisting, assuming all the while that it is her husband. This is rape, but it is not 'by force,' and it is not 'against her will,' but it is 'without her consent,' as she has not been fully informed as to all the circumstances of the case.

In all cases of rape in which there is no actual resistance or objection, consent may be assumed. It is not essential that the woman should state in so many words that she does not object. The force used may be moral and not physical--_e.g._, threats, fear, horror, syncope.

By 48 and 49 Vict., c. 49, the carnal knowledge of a girl under thirteen is technically rape. The consent of the girl makes no difference, since she is not of an age to become a consenting party.

An attempt at carnal knowledge of a girl under thirteen is a misdemeanour. Her consent makes no difference, and even the solicitation of the act on the part of the child will not exonerate the accused.

Intercourse with a girl between thirteen and sixteen, even with her consent, is a misdemeanour.

This Act is a favourite with the blackmailer. The child is sent out to solicit, dressed like a woman, but appears in the witness-box in a much more juvenile costume.

To constitute rape there must be _penetration_, but this may be of the slightest. There may be a sufficient degree of penetration to constitute rape without rupturing the hymen. Proof of actual emission is now unnecessary.

The subject of carnal knowledge (C.K.) or its attempt may be summed up as follows:

Under thirteen C.K. Felony. Under thirteen Attempt Misdemeanour.

Consent no defence.

From thirteen to sixteen C.K. Misdemeanour. From thirteen to sixteen Attempt Misdemeanour.

Consent and even solicitation no defence. Reasonable cause to believe the girl over sixteen is a good defence. Charge must be brought within three months.

Over sixteen C.K. with consent Nil.

Subject to civil action for loss of girl's services by father.

Idiot or imbecile C.K. with violence Rape. Idiot or imbecile C.K. without violence Misdemeanour. Personation of husband Rape.

Tacit consent no defence, for obtained by fraud.

Married woman C.K. with consent Adultery. Mother, sister, daughter, C.K. consent immaterial; Incest. grand-daughter born in wedlock or not Females Indecent assaults Misdemeanour.

It is a misdemeanour to give to a woman any drug so as to stupefy her, and so enable any person to have unlawful connection with her.

False charges of rape are very often made. The motive may be to extort blackmail, revenge, or mere delusion. On examining such cases bruises are seldom found, but scratches which the woman has made on the front of her body may be discovered, and the local injuries to the generative organs are slight, if present at all.

_Physical Signs._--In the adult the hymen may be ruptured, the fourchette lacerated, and blood found on the parts, together with scratches and other marks and signs of a struggle. In the child there may be no hæmorrhage, but there will be indications of bruising on the external organs, with probably considerable laceration of the hymen, the laceration in some cases extending into the rectum. Severe hæmorrhage, and even death, may follow the rape of a young child. The patient will have difficulty in walking, and in passing water and fæces. After some hours the parts are very tender and swollen, and a sticky greenish-yellow discharge is present. These signs last longer in children than in adults; but as a rule--in the adult, at least--all signs of rape disappear in three or four days. Young and delicate children may suffer from a vaginal discharge, with swelling of the external genitals, simulating an attempt at rape. Infantile leucorrhoea is common, and many innocent people have been exposed to danger from false charges of rape on children, instituted as a means of levying blackmail. A knowledge of these facts suggests the necessity of giving a guarded opinion when children are brought for examination in suspected cases. Pregnancy may follow rape.

_Seminal stains_ render the clothing stiff and greyish-yellow in colour, with translucent edges. On being moistened they give the characteristic seminal odour.

Semen may be found on the linen of the woman and man, and will be recognized under the microscope by the presence in it of spermatozoa, minute filamentary bodies with a pear-shaped head; but it must not be forgotten that the non-detection of spermatozoa is no proof of absence of sexual intercourse, for these bodies are not always present in the semen of even healthy adult young men. Spermatozoa must not be mistaken for the _Trichomonas vaginæ_ found in the vaginæ of some women. The latter have cilia surrounding the head, which is globular.

_Florence's Micro-Chemical Test for Spermatic Fluid._--If a drop of the fluid obtained by wetting a supposed spermatic stain be mixed with a drop of the following solution (KI, parts 1.65; pure iodine, 2.54; distilled water, 30) in a watch-glass, brownish-red pointed crystals resembling hæmin crystals are obtained.

_Barberio's Test._--Mix a drop of the spermatic stain with a drop of a saturated solution of picric acid, when needle-shaped yellow rhombic crystals are formed.

_Gonorrhoeal Stains._--A cover-glass preparation stained with methylene blue reveals the gonococci lying in pairs within the leucocytes.

XXXVI.--UNNATURAL OFFENCES

Trials for =sodomy= and =bestiality= are common at the assizes, but, as they are rarely reported, they fail to attract attention. Sodomy is a crime both in the active and passive agent, unless the latter is a non-consenting party. The evidence of either associated may be received as against his colleague. If the crime is committed on a boy under fourteen, it is a felony in the active agent only. As in cases of rape, emission is not essential, and penetration, however slight, answers all practical purposes.