Chapter VI: Part III: continued (4)

We should next proceed to a more minute and particular inspection of the external appearances; for which purpose the body should be cleansed from the dirt and impurities with which it may be invested, taking care to notice upon this occasion, whether the surface be covered with that sebaceous matter usually present on the skin of newly-born infants, and whether any mud or other matter, capable of stopping the mouth and nostrils be found about them. The head should also be shaved, in order that the fontanelles and sutures may be carefully examined with a view to ascertain whether any injury had been committed on the brain through these avenues. A midwife was executed at Paris for having introduced fine and sharp wires into these parts, before the heads of the unfortunate infants were expelled from the vagina, and consequently before respiration could have taken place. Every appearance of ecchymosis, or wound, should be inspected with attention, in order that its true character may be verified; and upon this occasion it will be important to bear in mind that on the surface of dead bodies, especially on those parts on which they have lain, superficial livid marks, arising from stagnation of blood in the small vessels of the skin will very generally present themselves, and which have received the name of _sugillations_, in contradistinction to that of _ecchymoses_, which are produced during the life of the individual. As the people, observes _Dr. Hutchinson_, are apt to regard the former of these discolourations as signs of violence, and as such propositions have even been maintained in courts of judicature, it is highly essential to obviate the possibility of litigation on this point, by removing a layer of the skin where such lividness is present, to shew that it is confined to this organ, and is not attended with infiltration of blood in the cellular tissue.

The appearance of wounds inflicted during life will vary according to the length of time the subject has survived. If death takes place immediately, they will present red and bloody surfaces, with ecchymosis. Should life have lingered for some hours, their edges will be somewhat tumid and retracted, and the surrounding skin will display a reddish appearance; clots of blood may also exist in them, and these will be found to adhere to their surfaces. In those cases in which several days elapse before death, they may appear bedewed with purulent matter. _Dr. Hutchinson_ very justly remarks that wounds, made when the circulation has ceased, and the body become cold; and when the blood has coagulated in the vessels, and the muscles have become rigid, may be known to have been inflicted after death by the pallid appearance of their surfaces, and by the total absence of tumefaction and retraction; such wounds, moreover, never contain any adherent clots of blood, and there is no surrounding ecchymosis. These characters may not perhaps be quite so distinct, where the violence has been effected immediately after death, while the body is still warm, the blood fluid, and the muscles endowed with contractility; yet in this latter case there will neither appear tumefaction, nor ecchymosis; and the blood, which may have oozed from the divided surfaces, will remain fluid, or form clots not adherent to them.

_Contusions_, effected during life, are always accompanied with more or less of ecchymosis; and, if produced by severe external violence, the skin will necessarily be involved in the injury. When ecchymosis is superficial, and the subject outlives its course, its progress and decline present highly characteristic phenomena; at first the injured surface presents a spot of a red, or bluish colour; this spot which is formed by the blood infiltrated into the cellular tissue, soon assumes a deep livid, or leaden hue; it then after a few days becomes, successively, violet, yellowish, and terminates by a pale citron colour. It is generally seven or eight days before it disappears. These characters will always enable the anatomist to distinguish contusions made during life, from those occurring after death.

The state of the cervical vertebræ should also be carefully examined, for the death of the infant may have been occasioned by a fatal luxation, produced perhaps by some sudden contortion of the neck. Any marks of pressure, or violence about this part should therefore be carefully noted; and it will be obviously more convenient to examine the spine, before the large cavities of the bodies are exposed; and which may be accomplished in the following manner. After dissecting the soft parts from the vertebræ, the dorsal parts may be readily removed by scissars, while the apophyses of the true vertebræ can be very easily cut through. The practitioner will thus be enabled to estimate the nature and extent of any wound, or laceration, or effusion of blood, that may be discovered in connection with the spinal marrow. The appearance and condition of the umbilical cord should also be examined before any of the great cavities are laid open; for it is obvious where a ligature has not been properly applied to it, death may have arisen as the result of hemorrhage from this part. Other reasons also exist which render such an inspection of the greatest importance.

_Phœnomena displayed on the dissection of the internal parts._

The ample directions which have been already offered upon this subject, (_vol._ iii, _p._ 45) will in a great degree supersede the necessity of very minute details on the present occasion. There are, however, some few phenomena that exclusively relate to the evidence of infanticide, and must accordingly receive a due share of our attention. Certain peculiarities, moreover, exist in the mode of conducting the dissection of an infant, which demand some explanation.

_Cavities of the mouth, œsophagus, larynx, and trachea._

It will be adviseable to commence our incision through the integuments, from the under lip to the top of the sternum, passing quite through the former part; another incision is to follow the inferior margin of the lower jaw; then the triangular portions thus marked out are to be separated from the parts beneath; the head should be bent back in order to put the soft parts that are to come under the knife upon the stretch. The jaw may now be divided at its symphysis, so as to separate it into two lateral portions, which may be turned aside by dividing with a scalpel all the parts which adhere to its internal surface. The object of this arrangement is to bring into view the cavities of the mouth, œsophagus, larynx, and trachea, the condition of which is so frequently connected with the death of the child that they ought never to escape examination. The position of the tongue should be noticed, and the contents of the mouth, if any, ought to be recorded, for cases have occurred in which extraneous matters, such as mud, sand, feathers, &c. have been accidentally, or criminally introduced. It will at the same time be extremely proper to ascertain the state of the nasal cavities, and to observe the quantity and consistence of the mucus in these parts, as well as in the fauces. The tongue may now be gradually pulled downwards, until the isthmus of the fauces is stretched, when, by cutting through the arch of the palate, the whole of the pharynx will be exposed; the dissection should then be extended in order to bring the commencement of the œsophagus into view, which should be carefully examined. The position of the epiglottis is the next object of inspection; and lastly, the interior of the larynx and trachea may be disclosed by making an incision through the thyroid, crycoid, and tracheal cartilages, at their anterior parts. Ligatures should be placed on the lower parts of the œsophagus and trachea.

_Thoracic cavity._ Having accomplished the examination above described, we may proceed to expose the cavities of the thorax and abdomen, in the manner already explained, (_vol._ iii, _p._ 52) remembering always that, by carelessly wounding the thoracic viscera, we shall, in a great degree, defeat the objects of the dissection; on this account it will be advisable to make the division of the ribs with scissars, instead of a scalpel. From the examination of these cavities we shall, in the first place, derive a confirmation, or refutation, of the opinion respecting the maturity, or _viabilité_ of the subject, which the external view of the body had suggested. Previous to the end of the seventh month the heart will be found exceeding in size its just proportions, and without much difference of capacity between the auricles and ventricles. The lungs will appear small, solid, and retracted from the anterior part of the cavity. In the abdomen we shall find the liver very considerable in size, and situated near the umbilicus, from which it afterwards gradually recedes as the fœtus advances. The gall-bladder will be found to contain a nearly colourless serous fluid, which during the eighth month gradually becomes yellowish, and acquires a bitter taste. If the appearances above described be compared with those which are displayed on the dissection of a full grown fœtus, we shall be able to form a very just estimate of the value of an anatomical investigation, in discovering the term of its intra-uterine or fœtal life. But, by the inspection of the thoracic organs, we endeavour to derive an inference still more important; the state of the lungs is supposed to be capable of indicating whether respiration have ever been performed; and, consequently, whether the child was born alive. It is affirmed that the lungs of the fœtus are small, not filling the cavities of the chest, or covering the pericardium; dense; compact; of a deep-red, or chocolate colour, not unlike that of the liver; carrying but little blood, and having a specific gravity exceeding that of fresh water, and, consequently, _sinking_ in that fluid. Upon cutting into them no air will be emitted, nor will any blood follow the incision. When, however, respiration has been established, these organs become more voluminous, present a yielding elastic texture, and assume a florid-red colour; they, moreover, contain and transmit a larger quantity of blood, and have a specific gravity less than that of fresh water, and accordingly _float_ in it. On cutting into the lungs, under these circumstances, the air contained in their cells will escape, and produce a peculiar crackling noise, which has been well expressed by the term _crepitating_; a bloody fluid will at the same time exude.

That a change in the character of the pulmonary structure so important as that just described should have attracted the notice of the physiologist, and been eagerly seized, as evidence in proof of the infant _having respired_, and therefore been _born alive_, cannot be a matter of surprise; and we accordingly find that the _hydrostatic test_ long enjoyed the unreserved confidence of the profession and the public. Whenever an infant was found dead, under circumstances of doubt and suspicion, its lungs were removed from the body, and immersed in water; if they sank, the subject of the experiment was immediately declared to have been still-born. If, on the contrary, they floated, it was concluded without farther enquiry, that the infant had lived after its birth. The aphorism of _Baglivi_ may be received as an expression of the general feeling so long entertained upon this subject. “_Pulmones fœtus mortui in utero matris, si extrahantur, et in aqua ponantur, petunt fundum; mortui vero extra uterum et aqua injecti innatent in ea. Quod signum ad infanticidia detegenda est evidentissimum._”[72] The number of innocent females who may have been thus sacrificed through a physiological conceit, is a circumstance that must excite the most awful reflection.[73] It is now well ascertained, and as generally admitted, that the validity of the _hydrostatic test_, as usually applied, must afford very unquestionable indications. _Bohn_,[74] _Hoffman_,[75] and _Heister_,[76] have shewn that the lungs of a fœtus, born dead, will under some circumstances, to be hereafter explained, float in water; while those of one that has lived after its birth may sink in the same fluid. _Dr. Gordon Smith_ is inclined to attribute _some_ of the uncertainty, by which the minds of medical men have been obscured with regard to the pulmonary tests, to confusion in the method of conducting the experiment, for there is, says he, but one order in which the steps can be taken, and if the anatomist should inadvertently resort to one stage of the process before another that should have preceded, he will baffle his own efforts. In commencing an examination of the thoracic organs, we should, previous to the disturbance of the parts, notice whether any morbid appearances present themselves, such as adhesions between the lungs and the pleura costalis, &c. We should at the same time observe whether the lungs be collapsed, or dilated, and whether they cover the lateral parts of the pericardium. We then proceed to separate the pulmonary organs from the body, in order to submit them to the _hydrostatic test_, to which we have adverted. For the performance of this dissection, _Dr. Hutchinson_ has given us so many complete and satisfactory directions, that we shall here introduce them for the instruction of the forensic physician. “Ligatures must be placed on the aorta and venæ cavæ, near their attachment to the heart; the trachea is then to be removed close to the bronchiæ; the vessels cut beyond the ligatures; and the heart and lungs, attached together, removed from the cavity of the thorax. If bloody, they should be cleansed with a sponge; and then the colour of the lungs, their consistence and elasticity, and their state with regard to healthy structure, be distinctly noticed, without compressing them forcibly, or lacerating in any way their structure. If the body generally be in a state of putrid decomposition, it should be ascertained whether the lungs are also thus affected, and in what degree. A livid colour from congestion of dark coloured blood in the minute vessels, should not be mistaken for gangrene; an appearance of this kind seems often to have the same origin as the lividness of the surface of dead bodies. The lungs are to be turned with the bronchial trunks downwards, that any fluid which may be contained in these tubes may flow out; and whatever escapes from them should be preserved in a clean vessel. These organs are then to be weighed in conjunction with the heart. A vessel, of a foot or a little more in diameter, and of at least a foot and a half in depth, is to be filled to the height of not less than a foot with pure _fresh_, and if possible, _river_ water, the temperature of which should be nearly equal to that of the air, unless this be very cold or very hot. The lungs and heart, still attached together, are to be placed in a gentle manner in this water. It must then be remarked, whether they float near the surface, or sink to the bottom; whether they fall suddenly, or descend slowly; whether the lungs turn uppermost, and float near the surface of the water, or about the middle of the fluid.

The heart is now to be separated from the lungs, having previously applied a ligature to the pulmonary vessels, to prevent the escape of the blood they may contain; and the weight of the heart alone then determined, that it may be subtracted from that of the heart and lungs together, as previously ascertained. The lungs are now to be placed alone in the water, and great attention must be paid to the position they assume in it; that is, whether they sink rapidly or slowly, or float near the surface; whether, by reversing their vertical situation in the water, they sink more readily or with more difficulty; and, if any part constantly rises and is drawn under water by the rest, this part should be particularly marked.

The two lobes must be separated, and the above-mentioned experiment made with each distinctly, and any difference in the results remarked; if one lobe float, and the other sink, it should be noticed whether it is the right or left that floats. Each lobe is then to be cut into several pieces, taking care not to confuse those of the right with those of the left.”

Having examined the physiological principles upon which the _hydrostatic test_ is established, and explained the manner in which it is to be conducted, it remains for us to enumerate the several objections which have been urged against its validity.

1. _A fœtus may breathe as soon as its head is without the vagina, and immediately die._—This is one of the great arguments adduced by _Dr. Hunter_;[77] “a child,” says he, “will very commonly breathe as soon as its mouth is born, or protruded from the mother, and in that case may lose its life before its body be born; especially when there happens to be a considerable interval of time between what we may call the birth of the child’s head, and the protrusion of its body. And, if this may happen when the best assistance is at hand, it is still more likely to happen where there is none; that is, where the woman is delivered by herself;” and he adds, “if a child makes but one gasp, and instantly dies, the lungs will swim in water as readily as if it had breathed longer, and had then been strangled.” This opinion, however, must not be received without qualification. We admit that under such circumstances a portion of the lungs will become inflated, and therefore swim in water; but it would appear from the more precise and comprehensive views of later physiologists, that respiration is not completely performed on the first effort, but that it is a process gradually advancing to perfection; and that it will be more or less protracted according to the degree of vigour of which the infant is possessed. _Portal_ has shewn by experiments[78] that the air enters the _right_ lung sooner than the left, and that the left lobe is very often not at all dilated for several days. The same fact was observed by _Blancardi_.[79] _Dr. Hutchinson_ states that he was informed by a late physician to the Foundling-hospital at Naples, who opened daily, on an average, the bodies of ten or twelve infants, which had generally died within twenty-four hours after birth, that he hardly ever found more than a very small portion of the lungs dilated by air; this portion was frequently not larger than a walnut in its green shell, and but rarely larger than a hen’s egg, and it was commonly situate in the _right_ lung.[80] “I have seen,” continues the author above cited, “a case where the _right_ lobe, when separated from the left, sank in water, though this was the most dilated by respiration, and the infant had lived forty hours, and cried pretty strongly: but it died from suffocation by being _overlaid_, as it is popularly termed, by the mother, which had produced such an engorgement of blood in the lungs, as to counterbalance the influence which the small quantity of air they contained could have exerted on their specific gravity. A piece somewhat more than a cubic inch in volume was the greatest portion that in this case floated in water.”

2. _The lungs may have been artificially inflated._—It is so generally known, observes _Dr. Hunter_, that a child born apparently dead may be brought to life by inflating its lungs, that the mother herself, or some other person, might have tried the experiment. It might even have been done with a most diabolical intention of bringing about the condemnation of the mother. There exists not a doubt but that such an operation would impart buoyancy to the lungs, although the fact has been doubted. _Camper_, _Jager_, _Schmitt_, and _Buttner_ decided the question by numerous experiments.

3. _The lungs may float, in consequence of putrefaction._—We have stated on a former occasion that the buoyancy of the human body is materially influenced by the putrefactive process, (_vol._ ii, _p._ 40.) _Haller_ procured the lungs of a child that died before its birth. They were of a dark red colour, and both when entire, and when cut in pieces, sank in water. A portion being left to putrefy in water, the colour became brighter, it was covered with air bubbles, ascended gradually as the process of putrefaction advanced, and at length reached the surface, where it continued to float. But in answer to the objection which such a fact would seem to oppose to the validity of the _hydrostatic test_, let it be remembered that the lungs are particularly unsusceptible of the putrefactive process, and resist it longer than any of the soft parts. So that the body must be very far advanced in decomposition before the lungs are found to participate in it. _Camper_ instituted a number of experiments upon infants, at Amsterdam, by exposing their bodies to the action of water, as well as to that of air, and his results fully confirm the fact we have just stated. _Ballard_ was called upon to examine a child, the muscles of whose face were reduced to “_boulli_”—were in a state of solution—and in which putrefaction had advanced so far as even to prevent discrimination of the sex, notwithstanding which the lungs immediately sunk. If we make incisions into these organs, when in a state of advanced putrefaction, we shall observe air bubbles of a considerable size, and running in lines along the fissures, between the component _lobuli_ of the lungs; where such phenomena present themselves we may be assured, says _Dr. Hunter_, that the air is emphysematous, and not that which has been introduced by respiration; for, in this latter case, the air bubbles will be hardly visible to the naked eye. But there still remains another mode by which we may determine whether the gas diffused in the texture of the pulmonary organs be the effect of respiration, or decomposition. It consists in pressing portions of the lungs between the fingers, or twisting them in a folded cloth, with all the force we can command; when, should the gas have arisen from putrefaction, the portions thus treated will sink in water; a change which no force, however powerful, will effect in those cases where the gaseous distention has arisen from respiration.

From the view which we have taken of the _hydrostatic_ test, and of the objections which have been urged against its validity, the practitioner will be enabled to appreciate its importance. _Plouquet_, desirous of procuring additional evidence, respecting the existence of respiration, from the condition of the pulmonary organs, proposed a test founded on the _absolute_ weight of the lungs compared with that of the body. Respiration produces two important changes in them—by inflating their texture it _diminishes_ their _specific gravity_; and by promoting a determination of blood to their vessels, it increases their _absolute_ weight; upon the former of these changes, the _hydrostatic test_ is founded, as we have already explained; on the latter, _Professor Plouquet_ endeavoured to found his “_Nova Docimasia Pulmonaris_,” which is now very generally known by the name of _Plouquet’s test_, or _assay_. The blood-vessels, observes this distinguished physiologist, being collapsed and compressed in the lungs of the fœtus, admit only a small portion of blood; but after respiration, being dilated, and extended, and more free in the expanded lungs, they receive a greater quantity; in consequence of which they become still farther expanded, and of greater calibre. As this increased capacity of the vessels is necessarily _permanent_, a greater quantity of blood will remain after death in the arteries and veins, and more especially in the latter, than in the lungs of those infants who have never respired, and consequently the _absolute weight of the lungs must be increased_.

In conformity with these views, _Plouquet_ found on examination, that the body of a male infant, born dead, and which had not respired, weighed 53040 grains, the lungs inclusive; and that these latter organs alone weighed 792 grains; the proportion of the lungs to the body, in weight, was therefore in this case as 1 to 67. In another infant, under similar circumstances, he found the proportion as 1 to 70. On examining an infant, born at the full period, and which had respired, the proportion was found to be as 2 to 70, so that the weight of the lungs was absolutely doubled by the act of respiration.

It would be a loss of time to enumerate the different objections which have been urged against the validity of this test, on various grounds, many of which admit of an easy answer. It is sufficient to state that experiments, subsequent to those of _Plouquet_, by _Haartman_,[81] _Struve_,[82] _Schmitt_, and _Lecieux_,[83] have shewn that no constant relation between the weight of the lungs and that of the body, under the circumstances above mentioned, can be established. The reason of which, as _Dr. Hutchinson_ has justly observed, without considering the influence of variation in the original construction of the body, is sufficiently accounted for, by the great diversity in the manner in which respiration is established in new-born infants. We have already stated that, in a great proportion of them, it is but gradually and slowly effected; and that several days even may elapse before the lungs are fully dilated. _Dr. Gordon Smith_[84] is disposed to believe that data might be obtained for a just conclusion upon this point, if practitioners would institute farther inquiry into the subject; and, with this impression, he has been induced to enter more fully into the history of the test, than we deem necessary, believing as we do, that it can never afford evidence sufficiently decisive for practical application. _Daniel_ has proposed a modification of _Plouquet’s_ test, but which is more objectionable even than that which he professes to improve. The same physiologist considers that an inference may be drawn from the increased circumference of the thorax, and the vaulted appearance it assumes after respiration. The objections urged by _Dr. Hutchinson_ to these latter indications appear to us to be unanswerable; the circumference of the thorax, says he, varies so much in infants of the same age and sex, both absolutely and in proportion to other parts of their body, that it cannot be possible to obtain any decisive evidence from it. The vaulted appearance of the chest is almost equally fallacious in the generality of cases, or else it is devoid of utility; because the figure of the thoracic parietes is not much changed until respiration has been fully established, and then we have other and more certain means of detecting its existence. Besides which, it appears from the experiments of _Schmitt_, that the thoracic parietes were distended outwards by artificial insufflation after death, as much as they are by actual respiration as it occurs in the new-born infant. With these remarks we shall dismiss the subject of _Docimasia Pulmonaris_, and proceed to inquire whether the structure of the heart is capable of affording any useful indications. There can be no doubt but that, some time after birth, we shall find on inspecting the heart, evident marks of the altered course of the circulation. The _foramen ovale_ will be closed, and in extending our examination, we shall find that the _ductus arteriosus_ and _canalis venosus_, have collapsed and assumed the appearance of imperforated ligaments; but it must be remembered that such changes require some time for their completion, and in cases where the child has perished shortly after its birth, we do not believe that the alteration in structure will be sufficiently obvious to afford any information of practical application. The degree of importance which is to be attached to the arched state of the diaphragm has been already appreciated. The empty state of the urinary bladder and intestines has been alluded to by some authors, as affording a degree of presumptive evidence, since the evacuation of the urine from the former, and that of the _meconium_ from the latter, are performed by most living children soon after birth. We are, however, inclined to attach but very little importance to such indications; and with regard to the _meconium_, every practitioner in midwifery knows well that it is frequently evacuated by the pressure of the maternal parts on the child during its passage through the pelvis; especially in breech presentations.

The stomach and intestines ought, in every case, to be considered as important objects of examination. It is possible that the trace of some aliment may be discovered, if so, no further proof can be required as to the child having lived. If any thing more than simple mucous fluid exist in the stomach, it should be examined by chemical tests. This remark, which we owe to _Dr. Hutchinson_, applies especially to the possibility of poison having been exhibited; and on this point the mucous membrane of the stomach will furnish useful evidence. If there should appear any fluid in this viscus, resembling water, it will be necessary to examine its nature, and to ascertain if any vegetable matters be present in it, such as portions of weeds, straw, &c. In our examination we should always keep in mind the possibility of the child having been destroyed by _drowning_, _strangulation_, _poisoning_, and the _infliction of wounds_, subjects which we have already so fully discussed in the second volume of our work, that we do not consider it necessary to dwell upon them in this place.

_The cranial cavity._—For the examination of this part _Dr. Hutchinson_ has given us some very minute and valuable instructions, of which we shall avail ourselves. The cranial cavity, he observes, should be exposed, by making, in the first instance, an incision through the integuments of the skull, penetrating to the bone, from the root of the nose to the spinous process of the second or third cervical vertebra; another incision of the same kind should extend from one ear to the other, passing transversely over the summit of the head. Each of the four triangular portions of integuments thus formed, should then be detached from the cranium, beginning at their apex and terminating at their base. The temporal and occipital muscles should then be separated in a similar manner. After examining the state of the cranium, the bones may be removed by dividing the membranous connection between the parietal, frontal, temporal, and occipital bones, with scissars. This, however, should be done without lesion of the vessels of the brain, or of the venous sinuses; in order to avoid the lateral sinus which always contains fluid blood, and which is situated very near the mastoidean angle of the parietal bone, _Dr. Hutchinson_ directs the anatomist, when the point just indicated is approached, to deviate a little from the membrane, and to cut the parietal bone itself near its margin. In the first place, the view of the brain will afford presumptive evidence of its age; previous to the termination of the sixth month it will appear as a soft mass, equally white throughout its whole extent; in the eighth month the cerebral substance will have acquired more consistence, its interior will present a reddish colour, although its surface still remains white. The _pia mater_, which in the earlier stages seemed only to be over its surface, will now be found adherent to it; and some of those grooves and undulations become apparent, which afterwards constitute the circumvolutions. In pursuing the dissection of the brain, the practitioner must be careful in noting every morbid appearance, such as congestions, extravasations, &c., for the cause of death may have arisen from the injured structure of these parts.

C. _The character of the spot in which the body was found_ will often afford presumptive evidence of considerable weight, but in availing ourselves of its indications, we must cautiously avoid the fallacies to which it may give origin; to some of which we shall have occasion to refer at a future period of the investigation. We next proceed to the consideration of the several problems involved in the second division of our inquiry, viz.

II. _Whether, supposing the child to have been born alive, its death was the result of natural causes, of wilful violence, or of negligence and abandonment?_

If sufficient proof should have been obtained that the child was born alive, we have to inquire into the causes of its death; upon which the anatomical dissection will have thrown some light, and in a great measure, prepared our decision. Medical writers on the subject of infanticide have very judiciously considered the modes of violent death in new-born children, as divisible into two great classes, viz. those of _omission_, and those of _commission_. It will be convenient for us, on the present occasion, to arrange our remarks with reference to such a division.

_Death by omission._—For want of due care the child may perish during, or immediately subsequent to, the labour. It may die from suffocation caused by the viscid mucus naturally existing about the pharynx and glottis in newly-born infants getting into the trachea, especially _if the infant has lain on its back for some time after its delivery_; or suffocation may be occasioned by the discharge of blood from the mother, or by the wet linen over it, collapsing and excluding the air, or by being drawn close to its mouth and nose by the suction of breathing. Children are, moreover, often born with a portion of the membranes over the face, which, if not removed, must impede respiration. In some cases strangulation is produced by the umbilical cord; the livid circle therefore round the neck, which without due consideration, might seem to afford a proof of criminal violence, is to be regarded with reference to the probability of such an occurrence; it is possible, adds _Dr. Hutchinson_, that the navel-string may be twisted round the neck of the infant, but loosely, until the body is nearly expelled; and then, if the placenta be firmly retained in the uterus, it may become tightened, and cause suffocation. These circumstances may happen when there is no person about the woman to render her proper assistance; and, therefore, careful examination is necessary, in order to ascertain, if, with the livid circle round the neck, there are marks of nails, or points of fingers, or excoriation of the skin. The breadth of the mark, also, and whether or not it makes a complete circle, with the ends exactly meeting, and without deviating from this circle, should be carefully noticed; the latter circumstances conjoined cannot arise from a natural twisting of the navel string. The livid part should be carefully dissected, in order to ascertain if there are ruptured blood-vessels corresponding to it, whether the trachea or larynx be flattened, or their cartilaginous rings laterally compressed; for it is asserted that such injuries never can occur from the natural twisting of the navel string. The practitioner will be enabled by the foregoing remarks to appreciate the value of that indication, upon which the vulgar have ever laid much stress,—the swollen and red appearance of the countenance. _Dr. Hunter_ has made the following judicious observation upon the phenomenon: “when the child’s head or face looks swollen, and very red or black, the vulgar, because hanged people look so, are apt to conclude that it must have been strangled. But those who are in the practice of midwifery know that nothing is more common in natural births; and that the swelling and deep colour disappear gradually, if the child lives but a few days. This appearance is particularly observable in those cases where the navel-string happens to gird the child’s neck, and where its head happens to be born some time before its body.”

A woman suffering labour alone may have the fœtus escape from her, and fall to the ground, on its head, and be thus killed; or she may unexpectedly be seized with pains in situations at once destructive to the child. In the case of infants being found in privies, this circumstance ought not to escape our remembrance. A woman was tried at the Old Bailey for the murder of her child, by dropping it into a privy. She declared that while there for a natural purpose, an uncommon pain took her, the child fell, and she sat some time before she was able to stir. On this occasion, we learn from _Dr. Gordon Smith_, that a practitioner was examined on the possibility of such an event; who stated that an instance came within his own knowledge, where, while the midwife was playing at cards in the room, the woman was taken suddenly, and the child dropped on the floor. To this the author just cited adds another illustrative case. It recently happened, says he, in the circle of my own acquaintance, that a lady who had borne many children, and must therefore have been alive to the import of uneasiness in the last hours of pregnancy, was sitting in company at dinner, and perfectly free from any consciousness of approaching labour, when she experienced an irresistible impulse to repair to the water-closet. She had scarcely arrived there when she was delivered: now had the place of retirement been differently constructed, this infant might have perished. It will very properly be urged that a woman, on finding what has happened, ought, if her feelings and intentions were honest, to give immediate alarm. This is true, but says _Dr. Smith_, we must admit, in the first place, the possibility of her not being able to do so, in consequence of the effects of the occurrence on her own person; and, in the next place, it is but just to allow that, although an alarm, after she has fully recovered, might secure her in the case of trial, yet as it can be of no use in restoring the life of the child, the idea of concealment will more naturally arise.

A very remarkable case, in illustration of the subject under discussion, is related by _Burnett_, in his _Treatise on the Criminal Law of Scotland_. “It occurred at Aberdeen in September 1804. The girl had become pregnant in circumstances peculiarly disastrous; actuated by the strongest impulse of shame and remorse, she concealed her situation from every one, and ascribed her appearance to cold she had caught. On the day of her delivery she had been to market, and in returning home accidentally slipt her foot, and fell into a mill-pond, where she would have been drowned had she not obtained immediate assistance. She was carried all wet into an adjoining malt-kiln, where there was a large fire, and left under the charge of another woman. The latter having gone out for a very short time, leaving the girl sitting by the fire, found on her return that she had been delivered of a child. The infant was in life, and lying at the extremity of the ashes near the fire. The girl said that her pains came on unexpectedly while sitting by the fire, and that she became insensible and could give no assistance to her child. No violence appeared on the body of the child, but it appeared to have been scorched by the fire, which occasioned its death a few hours thereafter. The prosecutor consented to a petition for banishment.”

The next circumstance which deserves notice under the consideration of the causes of death, by _omission_, is that of _neglecting to divide the navel-string, and to apply a ligature to the infantine portion of it_.—With regard to the value of the presumptive proof of criminal intention which such neglect may offer, there are several very weighty objections, and which have been enumerated by _Dr. Hutchinson_, in the following order. 1. The infant may perish during its birth from hemorrhage from the placenta, or rupture of the navel string, and the mother may, or may not, have divided the latter. 2. The child may have lived after its birth, and the mother may have torn or cut asunder the navel-string, and finding no hemorrhage ensue she has not been led to put a ligature on the infantine portion, and afterwards hemorrhage has taken place from it, from which the infant has died. 3. The mother may discover the hemorrhage in the last mentioned case, and may apply a ligature to the navel string, but too late to preserve the infant’s life. 4. The blood of the mother may be artfully placed about the child, and the navel string left untied; and the mother may wish to have it appear that the infant perished from hemorrhage occurring unknown to her, and that she was not aware of the necessity of tying the navel-string, even though it be found that she had _cut_ it, not _torn it asunder_ with her hands. In the first three cases we shall find, on dissection, evidence of extensive hemorrhage, as indicated by the emptiness of the heart and blood-vessels, paleness of the viscera, &c. In the last case, the proper fulness of the arterial and venous systems will betray the imposture. It is impossible, as _Dr. Hutchinson_ very candidly admits, to trace any rules of general application respecting the first three cases. The decision must be partially founded on various collateral moral circumstances, which come especially within the province of the jury.

_A new-born child may perish from exposure to cold._ This cause of death will be indicated by the character of the place and circumstances under which its body was found. The appearance of the corpse, upon such an occasion, will also assist our judgment; there will generally be a paleness of the skin, and a vacuity in the superficial vessels. _It may perish for want of nourishment._ But let it be remembered that new-born children are seldom, or never, famished to death, within a few days of their birth; for they require very little nourishment, and it was formerly the custom to keep them some days from the breast; such an omission, however, if suspected, may be ascertained by examining the stomach, and, at the same time, by deducing from the appearance of the umbilicus,[85] the probable period that has elapsed since its birth.

_Death by commission._—We have already pointed out the various means by which the death of the newly-born infant is usually accomplished; such as by wounding, suffocating, strangling, poisoning, &c.; and in the course of our work we have so fully considered the phenomena of violent death, that it cannot be necessary, on the present occasion, to expend farther time on their discussion.

The last object of the inquiry, viz. _the appearance and condition of the woman’s person_, has been also considered under the history of _parturition_, and the various questions to which it has given origin, _vol._ i, _p._ 249.

We have thus then presented to the reader the various avenues of information, which the sciences of anatomy and physiology are capable of disclosing; and it will, we trust, appear evident, that the forensic physician can rarely furnish more than presumptive evidence in the support of cases of imputed child-murder.

With the moral circumstances of the case the medical-jurist can have nothing to do; and yet it is impossible not to inquire whether the deed may not frequently be the result of insanity. Such was the opinion of _Dr. Hunter_; and we cordially agree with _Dr. Smith_, that a verdict to this effect might be returned in many cases of this kind with at least as much truth, as in some of suicide. It must not be urged, continues the last mentioned author, that the insanity here is not real because temporary, as long as _temporary insanity_ is so readily admitted in the other case; and we know well that in many instances of the like state of mind, where suicide is unsuccessfully attempted, the supposed lunacy shortly disappears. This plea, however, rarely avails the child-murderer; and yet if the loss of property, or other misfortunes, are to be taken into account as presumptive causes of insanity where there is real evidence of the fact, (the _feelings_ arising from which being the real goad that stings some men to their fate) are we to give a modest female,—one that has probably erred through excess of confidence and attachment—no credit for despair, and distraction, under the anticipation of the infamy that is approaching her?[86]

It is stated by several authors, that the period at which puerperal mania and phrenitis supervenes is variable, but that it is seldom, if ever, sooner than the third day; often, not for a fortnight; and, in some cases, not for several weeks after delivery. We must be cautious, however, in not applying this general assertion, to the disparagement of particular cases; for several instances are recorded which furnish striking exceptions to the rule. “In the year 1668 at _Aylesbury_, a married woman of good reputation being delivered of a child, and not having slept many nights, fell into a temporary phrenzy, and killed her infant in the absence of any company; but, company coming in, she told them she had killed her infant, and _there_ it lay; she was brought to gaol presently, and after some sleep she recovered her understanding, but marvelled how or why she came thither; she was indicted for murder, and upon her trial the whole matter appearing, it was left to the jury with this direction, that if it did appear that she had any use of reason when she did it, they were to find her guilty; but if they found her under a phrenzy, though by reason of her late delivery and want of sleep, they should acquit her; that had there been any occasion to move her to this fact, as to hide her shame, which is ordinarily the case of such as are delivered of bastard children and destroy them; or if there had been jealousy of the husband that the child had been none of his; or if she had hid the infant, or denied the fact, these had been evidences that the phrenzy was counterfeit; but none of these appearing, and the honesty and virtuous deportment of the woman in her health being known to the jury, and many circumstances of insanity appearing, the jury found her not guilty, to the satisfaction of all that heard it.” _1 H. P. C._ _p._ 36. Had this woman been of doubtful character, though innocent, she might have been executed, for want of medical evidence to prove the nature and frequency of puerperal insanity.

OF CRIMINAL RESPONSIBILITY, AND PLEAS IN BAR OF EXECUTION.

In the preceding pages we have endeavoured to lay down such rules, and to draw attention to such points, as may enable medical witnesses to assist the ends of Justice in detecting the perpetration of crime; another duty remains: having discovered the guilty, questions may yet arise, as to whether the criminal is or is not a proper subject for the severity of the law; 1st, in respect of natural incapacity, as in the case of infants and idiots _a nativitate_; 2d, of accidental incapacities, as in lunacy and temporary derangement of intellect. So also it may be a medical question whether a prisoner stands mute of malice, or by the visitation of God; and 3dly, of temporary unfitness for punishment, as where judgment on a female is to be respited, by reason of her pregnancy; to these we shall add the plea of non-identity, for though we have already stated that personal identity does not appear to us to be a subject peculiarly appropriate to medical jurisprudence,[87] yet as the greater number of writers on this subject have so considered it, we should not be warranted in omiting all notice of the subject.

“It is clear that an infant above fourteen and under twenty-one is equally subject to capital punishments, as well as others of full age; for it is _præsumptio juris_, that after fourteen years they are _doli capaces_, and can discern between good and evil; and if the law should not animadvert upon such offenders by reason of their nonage, the kingdom would come to confusion.[88] Experience makes us know, that every day murders,[89] bloodsheds, burglaries, larcenies, burning of houses,[90] rapes,[91] clipping and counterfeiting of money, are committed by youths above fourteen and under twenty-one; and if they should have impunity by reason of such their minority, no man’s life or estate would be safe. In my remembrance, at _Thetford_, a young lad of sixteen years old was convict for successive wilful burning of three dwelling houses, and in the last of them burning a child to death, and yet had carried the matter so subtilly, that by a false accusation of another person for burning the first house, an innocent person was brought in danger, if it had not been strangely discovered: he had judgment to die, and was executed accordingly.” _1 Hale. P. C._ _p._ 25.

But though above fourteen, criminal incapacity cannot be presumed on the mere pretence of nonage, children considerably under that age may be found _doli capaces_, and be tried, and even executed accordingly, whenever from peculiar evidence it shall appear that by precocity in vice or intellect they can clearly distinguish right from wrong, _malitia supplet ætatem_: thus _John Dean_ was executed under the age of nine for arson and murder; and _William York_, in more modern times, was tried and condemned for murder at ten.[92] Seven years of age, or the period of absolute infancy, is probably the limit within which actual crime or sin cannot be imputed morally or legally; (see _1 H. P. C._ _p._ 19; _1 Hawk. P. C._ _p._ 1; _1 Bl. Com._ _p._ 464); but the law of England does not appear to have fixed any determinate period;[93] _Alfred_ decreed that none should be punished capitally for theft under twelve years of age. _Athelstan_ enlarged the period till fifteen, (see _notes 1 H. P. C._ _p._ 12, 23); but the old standard of twelve appears to have prevailed from the time of _Hen. 1_; thus in the time of _Ed. 1_, _Adam de Arnhale_, æt. 12, was committed to the custody of the marshal for stealing nine shillings at night in the dwelling house; _postea habito respecto ad imprisonamentum, quod prædictus Adam habuit, & etiam ad teneram ætatem ejusdem Adæ, eo quod non nisi ætatis 12 annorum, qui talis ætatis judicium ferre non potest, ideo_ de gratia _regis deliberetur_, _1 P. C._ 24; but he was spared, as _Sir M. Hale_ says, _de gratia regis_, in respect that he was passed the old standard of twelve years.

If an infant clearly under seven years of age be indicted, the case ought not to go to the jury; but the prisoner should be discharged by the court; for “he cannot be guilty of felony, whatever circumstances of discretion may appear; for _ex presumptione juris_ he cannot have discretion, and no averment shall be received against that presumption;” (_1 H. P. C._ p. 28) but if it be not apparent that he is under seven, and he have sufficient discretion, then, as in the case mentioned [_note_ [94]] the issue may go to the jury; and with their verdict they may find, according to the evidence, that he was under seven years of age; and the court may then discharge him, for it was no felony. _1 H. P. C._ 27. Also if the prisoner be above seven, and under twelve years of age, unless there be apparent proof of capacity; but it is safer for the court to discharge him, for his trial can answer no useful purpose; and if he once be a felon convict by the verdict of a jury, though subsequently pardoned, the circumstance will probably give a stamp to his character which is never likely to be effaced. Therefore if the humanity of magistrates and prosecutors does not previously interpose to save children from this peril, and the contamination of a gaol, the discretion of the judge may; and it is fortunate that, in London at least, public munificence, in this as in many other cases, has supplied the want of legislation: the Philanthropic and other similar societies afford a refuge and prospect of amendment for the infant culprit, to them therefore he should be committed.

As the fact of absolute infancy may generally be ascertained by the mere view of the party, and his capacity ascertained by questions propounded by the court, an infant prisoner may, as before stated, be discharged without further trial; not so however in cases of idiotcy, madness, or lunacy, these must be tried by a jury, for they may easily be feigned, and it is therefore by evidence of previous conduct that the question is to be determined, rather than by reference to the prisoner’s demeanor in court, which may probably be counterfeit.