ARTIFICIAL INFLATION OF THE LUNGS.

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7. That the lungs, as situated in the chest, undergo putrefaction very slowly; that if but slightly putrefied, the gases may be easily forced out by compression, and if much putrefied, either the case must be abandoned or other sources of evidence sought for.

CHAPTER L.

FLOATING OF THE LUNGS FROM ARTIFICIAL INFLATION.-INFLATION NOT DISTINGUISHABLE FROM IMPERFECT RESPIRATION.-RESULTS OF COMPRESSION.-IMPROPER OBJECTIONS TO THE HYDROSTATIC TEST.-RESPIRATION BEFORE BIRTH.-RESPIRATION A SIGN OF LIFE, NOT OF LIVE BIRTH.-GENERAL CONCLUSIONS.

Artificial Inflation. It has been alleged that the lungs of a stillborn child may be made to assume, by artificial inflation, i. e. by blowing air into them, all the characters assigned to those which have undergone respiration. Thus, it is said, a child may not have breathed, and yet the application of the hydrostatic test would in such a case lead to the inference that it had. It will be seen that the force of this objection goes to attack directly the inference derivable from the discovery of air in the langs. There is only one form under which this can be admitted as an objection, namely, as it applies to lungs which have been inflated while lying in the cavity of the chest. Any experiments performed on them after their removal from this cavity can have no practical bearing, since in a case of infanticide we have to consider only the degree to which the langs may be distended with air by a person who is fairly endeavoring to resuscitate a stillborn child. Assuming that the experiment has been successfully performed, and that the lungs have been artificially inflated, they would resemble, in their partial distention with air and other physical characters, those of children which had breathed imperfectly. Like them, they may float on water; but on cutting them into pieces some of these would be found to sink. If the pieces which float are firmly compressed, either by means of a folded cloth or between the fingers, they will lose air and sink. When this pressure is produced under water, it will be seen that bubbles of air escape, but mere pressure with the fingers will not in general suffice to expel the whole. The same result is obtained when the divided portions of lungs which have breathed imperfectly are submitted to pressure. If, however, the act of breathing has been perfectly performed, and the air-cells are well filled, the air cannot be expelled by pressure or by any force short of the destruction of the substance of the lungs. This difference in the effect of pressure has been hitherto regarded as a criterion to distinguish lungs that have fully breathed from those which have been simply inflated; but Braxton Hicks met with a case which shows that pressure will not always effect the expulsion of air artificially introduced into the lungs of a child born dead; hence, by an exclusive reliance on this method, a medical man might be led to infer that a lung artificially inflated had received air by respiration. He delivered a woman of a full-grown child; it was stillborn, and there was no effort at respiration. An attempt was made to resuscitate the child, but unsuccessfully, by blowing air into the lungs through a catheter. On inspection the lungs were observed to be of large size, but they did not

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EVIDENCE FROM THE HYDROSTATIC TEST.

present the usual appearance of lungs which had breathed. Although about three-fourths of the organs had received air by inflation, and they were of a pale-fawn color, like the thymus gland, still, the air was contained in the minute air-cells. They floated on water as well as all the pieces (fifteen or sixteen) into which they were divided. When compressed between the fingers under water, small bubbles of air escaped; but no amount of compression short of destroying their structure caused these pieces to sink. A fact of this kind, although perhaps exceptional, shows that the non-expulsion of air from lungs by compression must not be regarded as an absolute proof of respiration. It must be taken with other circumstances, e. g. absolute weight, color, and presence of developed aircells, as a fact to show that the child has either breathed or has had its lungs perfectly inflated in a bona fide attempt to restore life after birth, either by the mother or by some person present at the birth. In these cases, the only course left open to a medical witness is to state that the evidence derived from experiments on the lungs left it uncertain whether the child in question had breathed or had had its lungs artificially inflated.

In concluding these remarks upon the objections to the hydrostatic test, it may be observed that medical practitioners have differed much at different times in their ideas of what it was fitted to prove. At the beginning of the present century, it would seem that the test was regarded by some as capable of furnishing evidence of murder. Thus we find W. Hunter asking the question, "How far may we conclude that the child was born alive, and probably murdered by its mother, if the lungs swim in water?" From what has already been stated, as well as from the most simple reflection on the circumstances accompanying the birth of a child, it must be evident that the hydrostatic test is no more capable of showing whether a child has been born alive or dead than it is of proving whether it has been murdered or has died from natural causes. The test merely serves to furnish in many cases good proof of life from the state of the lungs; and slight reflection will render it apparent that in no case is it susceptible of doing more. Even their utility is much restricted by numerous counteracting circumstances, a knowledge of which is essential to him who wishes to make a practical application of them.

If asked to state in what cases the pulmonary tests are capable of assisting a medical jurist, the answer would be: First, they will clearly show that a newborn child has lived, when, during its life, it has fully and perfectly breathed. Cases of this description form a certain number of those which come before our courts of assize. To them the most serious objections are not applicable; and the few which might be made to the medical inferences are not difficult to answer. Second, they will allow a witness to say that the lungs must have received air, either by respiration or by artificial inflation. These are the cases in which a child has died soon after birth, and where the respiratory changes are but imperfectly manifested in the lungs. They probably form a large proportion of those which fall under the jurisdiction of the criminal law. It might be considered that the qualification in the inference here drawn would neutralize its force; but it must be remembered that there are few instances of actual and deliberate child-murder wherein artificial inflation could become even a possible defence for an accused person. So unusual is this kind of defence, that among the numerous trials for infanticide which have taken place in this country for many years past, we have not been able to meet with a single instance in which it was alleged, as an objection to the medical evidence derived from the buoyancy of the lungs, that the prisoner

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had inflated them in order to resuscitate her child. The reason is obvious: Had such a defence been attempted, the whole of the circumstantial evidence would at once have set it aside. When, in the suspected murder of sa adult, a medical man swears that a fatal wound was such that the deceased might have inflicted it on himself, or that the prisoner might have produced it, he is placing the jury in a position very similar to that in which he places them in a case of child-murder, when he says that the child might have breathed, or its lungs might have been artificially inflated. It is not for him to speculate on the probabilities of respiration or of artificial inflation; but it is for the jury to consider whether the accused was or was not likely, under the particular circumstances of the case, to have resorted to an experiment of this nature. It has been suggested that some person might inflate the lungs of a dead child in order to raise a charge of murder against its mother; but this suggestion presupposes, on the part of the criminal, a profound knowledge of the difficulties of medical jurisprudence; and even then the question of murder does not depend merely on the presence of air in the lungs. Such a case is very unlikely to present itself. The circumstances of the case will commonly furnish a sufficient answer to such hypothetical views.

The hydrostatic test ought not, therefore, to be lightly condemned or rejected upon a speculative objection, which, in nine-tenths of the cases of child-murder, could not possibly exist. Let it be granted to the fullest extent that a conscientious medical jurist cannot always draw a positive distinction between the effects of respiration and artificial inflation on the ngs; still, a jury may be in a situation to relieve him from this difficilty.

We know of only one instance in which a medical man declined to make an inspection of the body of a newborn child for the purpose of examining the state of the lungs. (Reg. v. Pitt, Dorset Sum. Ass., 1859.) The body was found much mutilated and with such injuries as would fully have accounted for the death of the child, assuming it to have been born alive. At the inquest the coroner suggested that a post-mortem examination should be made; but the chief medical witness declined to make it, as he did not consider it to be necessary. He was then asked by the coroner whether the floating of the lungs would indicate that the child had breathed, to which he replied that that theory was now exploded. It seems that the death of the child was so recent that when the body was found it was quite warm. It also became rigid in the usual time. The medical witness relied upon warmth and rigidity in the body as proofs of the child's having been born alive, when it is obvious that these conditions can prove only that the child has been recently living. The neglect to examine the body led to an acquittal. There was no proof of life as the result of breathing, and no evidence to show whether the injuries were inflicted before or after death.

Respiration before or during Birth.-It has been already stated that the pulmonary tests are fitted to prove whether a child has or has not led to breathe. Neither the hydrostatic nor any other test can positively show that the body of a child was entirely born alive when the act of breathing was performed. As this is a subject that generally gives rise to some discussion in cases of child-murder, a few remarks are here made on it. First, respiration may be performed while the child is in the womb, after the rupture of the membranes-the mouth of the child being at the os uteri. This is what is termed vagitus uterinus; its occurrence, although extremely rare, rests upon undisputed authority. Second, a child may breathe while its head is in the vagina, either during a presen

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RESPIRATION A SIGN OF LIFE.

tation of the head or of the breech. This has been termed vagitus vagi. nalis. It is not very common, but it is a possible occurrence. Third, a child may breathe while its head is protruding from the outlet; in this position respiration may be as completely set up in a few moments by its crying as we find it in some children that have actually been born and have survived their birth for several hours. This is the most usual form of respiration before birth. In the vagitus uterinus or vaginalis the lungs receive but a very small quantity of air; in respiration after protrusion of the head, the lungs may be sometimes found moderately well filled, although never, perhaps, possessing all the characteristics of those which have fully breathed. The well-known occurrence of respiration under either of these three conditions strikingly displays the fallacy of making this process the certain boundary of extra-uterine life. A child may breathe in the womb or vagina, or with its head at the outlet, and die before its body is born; the discovery of its having respired would not, therefore, be any sort of proof of its having enjoyed what has been termed "extra-uterine life." (For a well-marked case of this kind see Lond. Med. Gaz., vol. xxxviii. p. 394; and another in Guy's Hosp. Rep., 1850, p. 231.) The death of a child which has breathed in the womb, or vagina, from natural causes before its entire birth, is a possible occurrence; but its death from natural causes before birth, after it has breathed by the protrusion of its head from the outlet, is an unusual event. All that we can say is it may take place; but death under these circumstances would be the exception to a very general rule. Oberkamp states that, in four successive deliveries of the same woman, the children breathed during delivery, but died before they were born.

Respiration a Sign of Life, not of Live Birth-The hydrostatic test. is only capable of determining that respiration has taken place; it cannot show whether this process was established during birth or afterwards. The fact of a child having the power of breathing before it is entirely. born does not, therefore, constitute the smallest objection to its employment, although upon this ground we find the use of it in any case denounced by some members of the medical and legal professions. It is obvious that most members of the law who have treated this subject have adopted, without sufficient examination, the statements of W. Hunter, who observes: "A child will commonly breathe as soon as its mouth is born or protruded from its mother; and in that case may lose its life before its body be born, especially when there happens to be a considerable interval between what we may call the birth of the child's head and the protusion of its body. And if this may happen where the best assistance is at hand, it is still more likely to happen when there is none-that is, where the woman is delivered by herself." (On the Uncertainty of the Signs of Murder in the Case of Bastard Children, p. 33.) Hunter here exposes in plain language the fallacy of trusting to the signs of res piration alone as evidence of a child having been born alive. The truth of his remarks is in the present day generally admitted; and if among medical and legal writers we find some treating respiration as a certain proof of live birth, it is from their not having sufficiently considered the probability of a child breathing and dying before its body is entirely

extruded.

Although the test can prove no more than that a child has breathed, some medical witnesses in giving evidence in cases of child-murder have fallen into the error of assuming that the hydrostatic test is capable of proving "live birth." Medical jurists of repute have sanctioned this erroneous view, ignoring the fact that the child may breathe and die

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before the entire birth of the body, while the test cannot show whether the act of breathing was performed during birth or afterwards. Among others Casper expressed his opinion that if we find air in the lungs of a newborn child, such a child must have been born alive. The reasoning of Casper is as extraordinary as his conclusion. He says: 1. During a rapid delivery those conditions are wanting which lead to breathing in dero or during birth. 2. All cases of secret delivery are rapid, and it is n these cases only that the hydrostatic test can be applied to the lungs; hence the proof of breathing in a secretly born child must be regarded as breathing after and not in or during birth. (Gerichtl. Med.) It will seen that this medical jurist entirely ignored the facts pointed by W. Hunter more than eighty years ago, and accumulated by numerous obstetric authorities since that time. On a trial for child-murder, a medical witness being asked on what he based his statement that the child had been born alive, said, "The presence of air in the lungs," and quoted Casper as his authority. There may be cases in which the signs of full respiration would justify an opinion of live birth, but the dictum of Casper is quite inadmissible. The floating of the lungs in water may Je owing to air received before or during birth, and it cannot be admitted that all cases of secret delivery are necessarily rapid cases-so rapid that the child has had no time to breathe until after entire birth.

The reader will find a good summary of the mode of applying the hydrostatic test, as well as of the conclusions which may be drawn from proper application, by Devergie, in Ann. d'Hyg., 1872, t. 2, p. 169. See also a paper by Tardieu, Ann. d'Hyg., 1867, t. 2, pp. 217 and 365. Conclusions.-The general conclusions respecting the employment of the hydrostatic test, to be drawn from the contents of this chapter, are1. That the artificial inflation of the lungs of a child born dead will canse them to float in water.

2. That lungs artificially inflated while in the chest resemble those organs in which respiration has been only imperfectly established.

3. That in cases of inflation of the lungs in the chest the air may be Jenerally expelled from the divided portions of lung by firm compression so as to cause them to sink.

That the same result occurs with lungs in which respiration has been imperfectly established.

5. That when lungs have undergone perfect respiration the air cannot be expelled by compression of the divided parts so as to cause them to

6. That the artificial inflation of foetal lungs causes no alteration of weight, and as the weight increases in proportion to the degree of respiFation, so in healthy lungs with great buoyancy, there should be great weight if the air has been derived from respiration.

7. That we should base our judgment of a child having breathed upon great weight and great buoyancy of the lungs combined; that the one adition without the other is open to the objection that the air may not have been derived from respiration.

8. That the floating of the lungs in water proves, cæteris paribus, that a child has breathed either at, during, or after birth; it does not prove that a child was born alive or that it has died a violent death.

9. That the sinking of the lungs as a result of the expulsion of air from them by compression does not necessarily prove that the child was born dead. It merely proves that the air contained in them was derived either from artificial inflation or from the imperfect establishment of the respiratory process.