PROOFS OF LIFE AFTER RESPIRATION. 539 Pontained no air, and there was no evidence of breathing. The conclusions drawn by him were that this child had lived and been destroyed by violence to the head. The injuries were the result of violence applied during Ke, and could not have been produced on the body of the child while in the womb. (Ann. d'Hyg., 1837, t. 1, p. 407.) In order to justify any inference respecting the life of a newborn Child under these circumstances, the wounds or injuries should have those well-marked characters which have been elsewhere assigned to wounds on the living body (p. 241), and they should be of such a nature that they Could not have been produced on the child by any accident when in the wonib. There is a class of cases in which a child is born alive, but its lungs remain in the foetal condition, i. e. they present no appearance of having received air by the act of breathing. These are cases of atelectasis (p. 544). The appearances in the body are the same as in stillborn children. Donders, who met with one of these cases in which he, in ignorance of the facts, pronounced a child to be stillborn when it was distinctly proved that it had lived twelve hours, says: "Where the sign of an extra-uterine life, which does not betray itself by air in the lungs, are to be found, faturity must declare." Proofs of Life after Respiration.-There is no doubt that the proof of the act of respiration furnishes the best and strongest evidence of a child having lived at or about the time it was born. It does not, however, show that a child has been born alive. The physical changes in the body of a child which result from the establishment of this process take place in the lungs immediately, and in the heart and its appendages more slowly. It is, therefore, chiefly to the lungs that a medical witness looks for proofs of respiration. Sometimes, however, these organs are found in their fœtal Condition, or nearly so; for, although a child may have survived its birth many hours, there may be no evidence of the fact from the state of the lings. To such cases the remarks now about to be made cannot, of Course, apply; the proofs of life must then be sought for elsewhere, and, if none can be found, the case is beyond the reach of medical evidence. But it is obvious that the occasional occurrence of cases of this description can present no objection to our still seeking for proofs of life in the state of the lungs, any more than the fact of poison not being always discovered in the body of one who has died from poisoning would be a bar to our seeking for the proofs of poison in any unknown case which presented itself. It is the more necessary to insist upon this point, because some have held that, as we cannot always derive proofs of life from an examination of the lungs of newborn children, we should abandon all evidence of this deseription and leave the case in its original obscurity. The very object of medical jurisprudence is to endeavor to remove these difficulties, and to show in every department of the science the degree to which we may safely trust the medical proofs of crime, however insufficient, inconsistent, or contradictory they may at first sight appear. Eramination of the Lungs.-The cavity of the chest may be conveniently laid open by carrying incisions from below the clavicles downwards on each side from about half the length of the ribs backwards. The diaphragm should be separated from the cartilages without opening the abdomen; the ribs sawn or cut through, and the flap formed by the front of the chest turned upwards-though some prefer to turn the flap downwards. The differences in the relative positions of the organs of the chest before and after respiration may be thus stated: 1. If a child has not breathed, the thymus gland, as large as the heart, will be found occupying the upper 540 CHARACTERS OF THE LUNGS AFTER RESPIRATION. and middle portions of the chest; the heart, within its membrane (pericardium), is situated in the lower and middle portion, and is rather inclined to the left side. The lungs are placed quite in the back part of the chest, so as often to give the impression that they are wanting. In some instances they project slightly forwards by their anterior margins, but in no instance, unless congested, infiltrated, or otherwise diseased, do they cover and conceal the heart. The thymus gland is sometimes of a pale fawn color, at others of a deep livid hue: but there is no perceptible difference in this organ in newborn children before or after the performance of the respiration. 2. On the other hand, when a child has fully breathed, the most striking differences will be observed in the color and prominence of the lungs. They are of a light-red hue, project forwardsappear to fill the entire cavity of the chest, and cover and in great part conceal, by their anterior margins, the heart and its membrane. We may meet with every variety in the appearances between these two extremes; for the process of respiration often requires a considerable time in order that it should be fully established, especially in children which are of a weakly constitution or prematurely born. Hence the lungs will be found to occupy their respective cavities to a greater or less extent, and to cover the pericardium more or less, not according to the length of time which a child has lived, but according to the perfection with which respiration. has been performed. Although, as a general rule, the lungs are more perfectly filled with air in proportion to the time during which a child survives its birth, yet this is open to numerous exceptions. Color. The color of the lungs before respiration is bluish-red or deep violet, but it is subject to variation. Some medical jurists bave compared it to the color of the spleen, others to that of the liver. A short exposure to air will materially brighten the color in the parts exposed, so that it should be observed and recorded immediately on opening the chest. After respiration the lungs acquire a light-red hue in proportion to the degree in which the process has been performed. If imperfectly established, they will be mottled or marbled, generally about the anterior surfaces and margins, the patches of light red being intermixed with the livid foetal hue, and being slightly raised, as if by distention, above the general surface of the organs. The light-red tint changes, after a short exposure to air, to a bright scarlet. Volume. Before respiration, the lungs are in general scarcely visible, unless forcibly drawn forwards in the chest. When it has been perfectly accomplished, the volume is so much increased that the bag of the heart (pericardium) is almost concealed by them. Respiration must, however, have been perfectly performed in order that this condition should exist to the full extent described. Consistency. The lungs, before respiration, feel like the liver, or any other of the soft organs of the body. They are firm under the finger, but their substance may be lacerated by violent compression. After respiration has been fully performed there is a distinct sensation of what is termed crepitation on compressing them, i. e. air is felt within them. If a thin section of the lung be submitted to examination with a low power of the microscope before respiration it will present a solid appearance-after respiration air-cells will be distinctly seen in it. These conditions of the lungs must, of course, depend on the degree to which respiration has been carried. The lungs of children that have lived for a considerable time after birth will sometimes give no feeling of crepitation under the finger. Generally speaking, lungs of this kind present the other fatal characters; ABSOLUTE WEIGHT OF THE LUNGS. 541 thus they are small and of a livid color, and no air-cells may be detected on a microscopical examination. Development of Air-cells. On the right lung, and especially on the eizes and concave surface of its upper lobe, the first appearances of respiration may be visible, even when the rest of the lungs retain their fœtal condition. Here it is that the highly characteristic developed air-cells are first visible. These, if the lungs are fresh and full of blood, take the form of bright vermilion spots; but if the lungs contain less blood, or are examined some days after death, the spots are of a lighter tint. (Guy and Ferrier's For. Med., 5th edit., p. 104.) The form and arrangement of these cells are also characteristic-they are angular, and are not perceptibly raised above the surface of the lung. They may be either irregularly grouped or arranged in sets of four, and their outline is distinctly polygonal. They are best seen with the naked eye, or at most with a lens of low power. Their form, their immobility when the finger is passed over the surface of the lung, their color, and the fact that they are not raised above the surface of the lung, render a mistake of these cells for the minute bullæ of putrefaction, melanotic spots, or minute ecchymoses, impossible, if ordinary care be exercised. The same development of air-cells may be brought about by artificial respiration. Nevertheless, these air-cells are of great value as proving either respiration or artificial respiration. Absolute Weight of the Lungs. The Static Test. The absolute weight of the lungs before respiration is less than that which they have after the establishment of the process. From this an inference has been drawn that the absolute weight of the lungs in an unknown case, compared with certain averages, will aid the inquirer in ascertaining whether respiration has or has not been performed. In order to determine the weight of the lungs, these organs should be carefully separated by dissection from the heart and thymus gland and removed with the windpipe and bronchi attached. Previously to their removal ligatures should be placed on the pulmonary vessels, so that no blood may escape from the lungs. They should now be weighed, and the weight accurately noted. The average weight before respiration, derived from nine cases, was found to be 649 grains. According to Traill, the weight varies from 430 to 600 grains. It is of importance, in taking the weight of these organs, to observe whether the chill is at or near maturity, and whether its body is fully developed, or of about the average size and weight; owing to a neglect of this rule, it is highly probable that comparisons have been made of the absolute weight of the lungs in children of different ages, which a full statement of the facts would not have justified. If it is small and immature, or unusually large, the lungs will weigh either less or more than the average. The average weight of the lungs, after respiration, derived from three cases, was 927 grains; but in making an estimate of this kind, much will depend upon the degree to which respiration has been carried. In three cases, in which the children lived half an hour, six hours, and twenty-four hours respectively, the process had been so imperfectly performed that the lungs varied but little in weight from the average before respiration. (Guy's Hosp. Rep., 1837, ii. p. 318.) The truth is, we cannot compare the lungs of children, as to weight, by the time which they may have surrived birth, but rather by the degree to which the lungs have been penetrated by air. Another circumstance must also be considered in basing an opinion on the absolute weight of the lungs. Although there does not appear to be any strict normal relation between the weights of the body and lungs in newborn children, yet it is certain that, in the bodies of children of unusual weight, the lungs will be found much heavier than 512 SPECIFIC GRAVITY OF THE LUNGS. the average, whether the child has breathed or not. The body may vary from six to eighteen pounds; and the lungs under these circumstances will also differ in weight. The healthy lungs of mature newborn children become heavier after respiration, and according to its degree; and where a deviation from this rule is observed, it may probably be explained by the circumstance that the lungs of an immature have been compared with those of a mature child-the lungs of an undeveloped twin with those of one not a twin, or the lungs of one which has breathed imperfectly with those of another in which respiration has become well established. It is very well known to, and admitted by, all medical jurists, that there are some instances in which the fact of respiration cannot be determined by the application of the static or any other test to the lungs, simply because they contain no air. Increased weight, therefore, is only one among several circumstances to which a medical jurist should attend. Great weight of the lungs can obviously furnish no proof of respiration unless this is accompanied by the other physical changes indicative of the process; as, for example, increase in volume from the presence of air, crepitation, and the detection of air-cells. If the lungs are heavy, and at the same time contain little or no air, the increase of weight must depend upon disease or other abnormal causes, not upon respiration. In one case the lungs were large, and weighed upwards of 1200 grains. They contained no air; when divided into thirty pieces, not one portion floated, nor could any air be seen on the closest examination. It was therefore clearly impossible to ascribe a weight so much above the average to the effects of respiration. On the other hand, in another case, the lungs of a newborn child apparently full-grown, although fully distended with air, weighed only 626 grains. In this case the body of the child weighed only six pounds, and a quantity of blood had, no doubt, escaped from the lungs, owing to the pulmonary vessels not having been tied before their removal from the chest. It must not be forgotten that all the physical characters presented by lungs that have respired are liable to fallacies; but these may be removed, or the force of the objection diminished, by not basing an opinion on one or two conditions only. We should take the whole combined; for it would be as wrong to regard great weight in the lungs taken alone as an absolute proof of respiration, as it would be to draw the same inference from a mere change in the color, volume, or consistency of the organs. Ploucquet proposed to determine whether the act of respiration had taken place or not by a comparison of the absolute weight of the lungs with the weight of the body of a child. This, which has been called the test of Ploucquet, is based on the fallacy that there is an invariable relation between the weights of the lungs and bodies in newborn children. No such relation exists, and this method of arriving at a solution of the question of respiration has been abandoned by all medical jurists. The Specific Gravity of the Lungs.-The specific gravity of the lungs is greater before than after respiration; for although the organs become absolutely heavier by the establishment of the process, this is owing, not to the air, but to the additional quantity of blood received into them. The air thus received so increases the volume of the lungs as more than to counteract the additional weight derived from the blood, and thus apparently to diminish their specific gravity. Under these circumstances they readily float on water. The specific gravity of the lungs before respiration, i.e. in the fœtal condition, varies from 1.04 to 1.05 They are about one-twentieth part heavier than their bulk of water. After respiration, THE HYDROSTATIC TEST. 543 the specific gravity of the lungs, with the air contained in them is 0.94; te. the organs are about one-seventeenth part lighter than their bulk of water. The introduction of a very small quantity of air will render the langs buoyant in water, and an alteration in their volume sufficient for this purpose would not be perceptible to the eye. It will be understood that the specific gravity of the substance of the lungs is unchanged; the organs are rendered only apparently lighter by the air contained in their cells, on the same principle as a bladder filled with air. Hence it follows that the apparent diminution of specific gravity will take place whether the air is derived from respiration, artificial inflation, or putrefaction. It is on this property of the lungs that the application of what is termed the hydrostatic test, or the docimasia pulmonaris, is founded-a subject which may be appropriately considered in another chapter. Conclusions. The general conclusions which may be drawn from the contents of this chapter are: 1. That a child may be born alive and be criminally destroyed before it has breathed. 2. That the presence of any marks indicative of putrefaction while the child was in the womb proves that it must have come into the world dead. 3. That there are no certain medical signs by which a child that has not breathed can be proved to have been living when it was maltreated. 4 That a newborn child may be destroyed by the prevention of respira tion during delivery. 5. That by taking together the color, volume, consistency, absolute weight, and buoyancy of the lungs, and the presence in them of developed air-cells, we may be able to draw an inference whether the child has or has not breathed. 6. That the lungs increase in weight according to the degree to which respiration is established, and not necessarily according to the period which the child has survived birth. 7. That no reliance can be placed upon the test of Ploucquet, or the proportionate weight of the lungs to the body. THE HYDROSTATIC TEST.-SINKING OF THE LUNGS FROM DISEASE OR ATELECTASIS LIFE WITH PERFECT ATELECTASIS OR ENTIRE ABSENCE OF AIR FROM THE LUNGS.-ERRONEOrs MEDICAL INFERENCE FROM SINKING OF THE LUNGS.-FLOATING OF THE LUNGS FROM PUTREFACTION.-EFFECTS OF PUTREFACTION ON THE LUNGS. The Hydrostatic Test.-The mode of employing this test is extremely simple. Having removed the lungs from the chest, they should be placed, till connected with the air-tubes, upon the surface of distilled or river Water. If they sink, it should be noted whether the sinking takes place rapidly or slowly. If they both sink, the two lungs should be tried separately; for it is sometimes found that one, commonly the right, will float, While the other will sink. Supposing that both lungs sink, they should be divided each into twelve or fifteen pieces, and these pieces placed separately on water. If after this they all sink, the inference is that, although the child may have lived and survived its birth, there is no evidence of its |