MEDICAL PROOFS REQUIRED.

529

ecessary to prove that she was with child, or that the aboried substance was a foetus or child. It might be a mass of blood, a mole, or a group of ydatids. The crime is frequent, but its perpetration is secret. Applications are frequently made to medical men and druggists by the lower class of people for drugs for this purpose; the applicants appear to have no dea of the criminality of the act. Under the name of "female pills" or drops," medicines are thus dispensed in secrecy, and those who supply, as well as those who receive them, appear to have no idea that they are exposing themselves to a criminal prosecution. In one case a bottle containing a liquid supposed to have been used for the purpose of abortion was sent to the author for examination. It was labelled " Persian Otto of Roses." It contained a strong ethereal tincture of ergot of rye.

On one trial for criminal abortion, the medical evidence went far beyond its customary boundary. It appeared that the prisoners had applied to a lical man to supply them with drugs for procuring abortion. The medical man, mistaking his duty under such circumstances, gave information to the police, and, acting under their advice, supplied some drug which uld do no injury. The prisoners were thus led to the commission of a felony, and at the trial the medical man appeared in the capacity of informer as well as expert-a circumstance which led to some severe observations from the judge. When such an application is made to a professional man, there is no objection to the fact being made known to the police or magisterial authorities, but beyond this he should not go. He hould refuse to supply the applicants with drugs or lend himself in any way as a detective for the purpose of a prosecution. The act was no doubt done with a good intention to protect the public, but under a mis'aken sense of duty.

On inducing Premature Labor. Medical Responsibility. It may be proper to offer here a few remarks upon the common practice of inducing premature labor, as, e.g. in certain cases of disease, of deformity of the pelvis, and in cases of excessive vomiting from pregnancy. This practice has been condemned as immoral and illegal; but it is impossible to admit that there can be any immorality in performing an operation to give a chance of saving the life of a woman, when, by neglecting to perform it, it is almost certain that both herself and the child will perish. (See, on the morality, safety, and utility of the practice, Ramsbotham's Obst. Med., P 325, 5th ed.) Any question respecting its illegality cannot be entertained; for the means are administered or applied with the bona fide hope of benefiting the female, and not with any criminal design. It is true that the law makes no exception in favor of medical men who adopt this practice, nor does it in the Stutute on Wounding make any exceptions in favor of surgical operations; but that which is performed bona fide would not be held to be unlawful. The necessity for the practice ought to be apparent thus, for instance, it should be shown that delivery was not likely to take place naturally without seriously endangering the life of a Woman. It is questionable whether, under any circumstances, it would be justifiable to bring on premature expulsion merely for the purpose of attempting to save the life of a child, since the operation, even when performed with care, is accompanied with risk to the life of the mother. Hence a cautious selection of cases should be made, as the operation is necessarily attended with some risk to both. All that we can say is that, according to the general professional experience, it should place the woman in a better position than she would be if the case were left to itself. fore a practitioner resolves upon performing an operation of this kind, he should hold a consultation with others; and, before it is performed he

Be

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CHEMICAL EVIDENCE.

should feel assured that natural delivery cannot take place without greater risk to the life of the woman than the operation would itself create. These rules may not be observed by obstetric experts in large practice: but the non-observance of them is necessarily attended with some responsibility to a general practitioner. In the event of the death of a woman or child, he exposes himself to a prosecution for a criminal offence, from the imputation of which even an acquittal will not always clear him in the eyes of the public. If the child were born alive and died merely as a result of its immaturity, this might give rise to a charge of manslaughter. Several practitioners have been tried upon charges of criminal abortion -whether justly or unjustly it is not necessary to consider; but they had obviously neglected to adopt those simple measures of prudence, the observance of which would have been at once an answer to a criminal charge. Because one obstetric practitioner of large experience may have frequently and successfully induced premature labor without observing these rules, and without any imputation on his character, this cannot shield another who may be less fortunately situated.

Chemical Evidence. Blood in Abortion. Liquor Amnii —In the event of an abortion having taken place, stains produced by blood or by the waters (liquor amnii) may be found on the linen of a woman, and a practitioner may be required to say whether these stains are of a nature to throw any light upon the perpetration of the crime.

A woman who has aborted may allege that the stains are those of the menstrual discharge. Speaking generally, there is no practical distinction between menstrual and other blood (see ante, p. 284). The menstrual blood contains less fibrin, is commonly acid and watery from admixture with the mucous discharges, and when examined by the microscope it presents epithelial scales or cells derived from the mucous membrane. These scales or cells are columnar. (See Rape, post.) Not much reliance can be placed upon their discovery, since the mucous membrane of the organs of respiration is lined with similar cells. Hence expectorated blood might be mistaken for menstrual. Cells of a similar shape line the whole of the mucous membrane from the stomach to the anus. The blood of piles might thus be confounded with menstrual blood. The blood discharged in abortion will present the usual characters of blood, elsewhere described (ante, p. 271, et. esq.); but it may be diluted with the waters simultaneously discharged. This question received the special attention of the French Academy in reference to the crime of abortion; and the report made was to the effect that, in the present state of science, there was no certain method by which the blood of menstruation could be practically distinguished from the blood discharged from a woman in a case of abortion or from blood in infanticide. (Ann. d'Hyg., 1846, t. 1, 181.) In another recent case, Devergie and Chevallier were required to state whether certain stains on the dress of a woman supposed to have aborted were or were not caused by the waters (liquor amnii). A chemical analysis merely revealed the presence of an albuminous liquid. The most elaborate experiments satisfied the reporters that neither by the odor nor by any other process could the liquor amnii, dried on linen, be identified. (Ann. d'Hyg., 1852. t. 2. 414.) It may, however, be of importance to observe that this liquid slightly discolors and stiffens the fibre of the stuff on which it has been effused, and that it can be readily extracted by cold water. The solution contains albumen. The amount of albumen contained in the liquor amnii decreases as gestation advances. Chevallier's experiments show that the amniotic liquid has all the usual chemical properties of a very dilute solution of albumen, containing also urea. (Ann. d'Hyg., 1856, t.

1, 156.)

INFANTICIDE-NATURE OF THE CRIME.

531

INFANTICIDE.

CHAPTER XLVII.

JATURE OF THE CRIME.-MEDICAL EVIDENCE AT INQUESTS.-UTERINE AGE OR MATURITY OF THE CHILD.-CHARACTERS OF THE CHILD FROM THE SIXTH TO THE NINTH MONTH.SIGNS OF MATURITY.—RULES FOR INSPECTING THE BODY.

By infanticide we are to understand, in medical jurisprudence, the murder of a newborn child. The English law, however, does not regard child-murder as a specific crime; it is treated like any other case of murder, d is tried by those rules of evidence which are admitted in cases of elonious homicide. In stating that "infanticide" is the term applied to The murder of a newborn child, it is not thereby implied that the wilful lling should take place within any particular period after birth. Provided it be proved that the child has actually died from violence, it matters hot whether it has been destroyed within a few minutes or not until several days after its birth. According to a return of the RegistrarGeneral, it appears that out of 202 murders, 120 were perpetrated on hildren under one month. In the greater number of cases of infanticide, however, we find that the murder is commonly perpetrated either at the ime of birth or within a few hours afterwards. Although the law of England treats a case of infanticide as one of ordinary murder, yet there is a difference in the nature of the medical evidence required to establish the murder of a newborn child. It is well known that many children come into the world dead, and that others die from various causes soon after birth; and in the latter, the signs of their having lived are frequently indistinct. Hence, to provide against the danger of erroneous convictions, the law humanely assumes that every newborn child has been born dead, until the contrary appears from the medical or other evidence. The onus of proof that a living child has been destroyed is thereby thrown on the prosecution; and no evidence imputing murder can be received unless it first made certain, by medical or other facts, that the child survived its birth, and was legally a living child when the alleged violence was offered to it. Hence there is a most difficult duty cast upon a medical witness on Vese occasions. In the greater number of cases the woman is delivered in secrecy, and no one is present to give evidence respecting the birth of the child. It is under these circumstances that medical evidence is esperially required. For reasons elsewhere assigned, a medical man should be rautious in putting questions to a woman charged with this crime. Uterine Age or Maturity of the Child. Viability. One of the first questions which a witness has to consider in a case of alleged child-murder is that which relates to the age or probable degree of maturity which the dreased child may have attained in utero. The reason for making this quiry is that the chances of natural death in all newborn children are great in proportion to their immaturity; and that, supposing them to

532

INFANTICIDE-UTERINE AGE.

have survived birth, the signs of their having breathed are commonly obscure It is found that the greater number of children who are the subjects of these investigations have reached the eighth or ninth month of gestation; yet charges of murder might be extended to the wilful destruction of children at the seventh month or under, provided the evidence of life after birth was clear and satisfactory.

The following are the characters whereby we may judge of the uterine age of a child from the sixth to the ninth month of gestation, a period which may be considered to comprise cases of abortion as well as childmurder :

1. Between the sixth and seventh months.-The child measures, from the vertex to the sole of the foot, from ten to twelve inches, and weighs from one to three pounds. The head is large in proportion to the trunk; the eyelids are adherent, and the pupils are closed by membranes (membranæ pupillares). The skin is of a reddish color, and the nails are slightly formed; the hair loses the silvery lustre which it previously possessed, and becomes darker. Ossification proceeds rapidly in the chest-bone and in the bones of the foot; the brain continues smooth on its surface; there is no appearance of convolutions. In the male the testicles will be found in the abdominal cavity, lying upon the psoas muscles, immediately below the kidneys. In March, 1885, a primiparous married woman was delivered in Guy's hospital, after severe puerperal convulsions. The fœtus (male) was dead, but the foetal heart had been heard by Horrocks a week before. The foetus was fifteen inches and a half long, and weighed two pounds only. There were points of ossification in the upper portion of the sternum; none in the astragalus, or in the lower sacral vertebræ. Hence the uterine age of the child was judged to be six months. Nevertheless, both testicles were found in the scrotum.

2. Between the seventh and eighth months.-The child measures between thirteen and fourteen inches in length, and weighs from three to four pounds. The skin is thick, of a more decidedly fibrous structure, and covered with a white unctuous matter which now appears for the first time. Fat is deposited in the cellular tissue, whereby the body becomes round and plump; the skin previously to this is of a reddish color, and commonly more or less shrivelled; the nails which are somewhat firm, do not quite reach to the extremities of the fingers; the hair is long, thick, and colored; ossification advances throughout the skeleton; valvulæ conniventes appear in the small intestines, and meconium is found occupying the cæcum and colon. The testicles in the male about this period commence their descent towards the scrotum. The time at which these organs change their situation is probably subject to variation. According to Hunter, the testicles are situated in the abdomen at the seventh, and in the scrotum at the ninth month. Burns believes that at the eighth month they will commonly be found in the inguinal canals. The observation of the position of these organs in a newborn male child is of considerable importance in relation to maturity, and it may have an influence on questions of legitimacy as well as of child-murder. Curling thus describes their change of position: At different periods between the fifth and six months of foetal existence, or sometimes even later, the testicle begins to move from its situation near the kidney towards the abdominal ring, which it usually reaches about the seventh month. During the eighth month it generally traverses the inguinal canal, and by the end of the ninth arrives at the bottom of the scrotum, in which situation it is commonly found at birth. (Dis. of the Testis, 2d edit., p. 17.) Their absence from the

SIGNS OF MATURITY IN THE CHILD.

533

scrotum does not necessarily indicate that the child is immature, because these organs sometimes do not reach the scrotum until after birth.

3. Between the eighth and ninth months.-The child is from fifteen to sixteen inches in length, and weighs from four to five pounds. The eyeids are no longer adherent, and the membranæ pupillares have disappeared. The quantity of fat deposited beneath the skin is increased, and the hair and nails are well developed. The surface of the brain is grooved or fissured, but presents no regular convolutions: and the gray matter is not yet apparent. The meconium fills almost entirely the large intestines; and the gall-bladder contains some traces of a liquid resembling bile. The testicles in the male may be found occupying some part of the inguinal anal, or they may be in the scrotum. The left testicle is sometimes in the scrotum, while the right is situated about the external ring.

4. Ninth Month. Signs of Maturity.—At the ninth month the average ength of the body is about eighteen to twenty inches, and its weight from six to seven pounds; the male child is generally rather longer, and weighs rather more than the female. Extraordinary deviations in length and weight are occasionally met with. Owens has recorded a case in which a child at delivery measured twenty-four inches in length, and weighed seventeen pounds twelve ounces (Lancet, Dec. 1838), and Meadows has reported another in which a child measured, after death, thirty-two inches, and weighed eighteen pounds two ounces. It survived four hours. (Med. Times and Gaz., 1860, ii. p. 105.) In one case which the author examined, the child, a male, measured twenty-two inches, and weighed twelve pounds and a half. Davies had a case in which a child was born alive, weighing nineteen pounds two ounces, probably the heaviest newborn child on record. (Med. Times and Gaz., 1860, ii. p. 249.) (For some practical remarks on this subject, by Ellsässer, see Henke's Zeitschrift, 1841, Bd. 2, p. 235.) According to Duncan, the length and weight of a child vary according to the age of the mother. They are greatest among children when the mother is from 25 to 29 years of age; but the facts collected do not support this statement; for the child of a woman at 22 weighed seven pounds three ounces, and that of a woman of 30, seven pounds seven ounces. The length varied in a less degree, being for the different ages at or about nineteen inches. (Edin. Month. Jour., 1864, ii. p. 500.)

At the full period, the head of a child is large, and forms nearly onefourth of the whole length of the body. The cellular tissue is filled with fat, so as to give considerable plumpness to the whole form, while the limbs are firm, hard, and rounded; the skin is pale; the hair is thick, long, and somewhat abundant; the nails are fully developed, and reach to the end of the fingers-an appearance, however, which may be sometimes simulated in a premature child by the shrinking of the skin after death. The testicles in the male are generally within the scrotum. Ossification will be found to have advanced considerably throughout the skeleton. The surface of the brain presents convolutions, and the gray matter begins to show itself. The internal organs, principally those of the chest, undergo marked changes if the act of respiration has been performed by the child before, during, or after its birth. The external auricle now measures an inch and a quarter to an inch and a half in length, seven-eighths of an inch to one inch in width, and varies little in children of very varied sizes. Medical jurists place great stress on the presence of a point of ossification in the lower epiphysis of the thigh-bone (femur) in its bearings upon the maturity of the fœtus. This point usually first makes its appearance at the 36-37th week; at the 37-38th week it is commonly the size of the