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EPITHELIAL SCALES IN THE STOMACH.

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have by measurement the following diameters: Maximum, 0.00045 inch; minimum, 0.00006 inch; and medium size, 0.00022 inch. They are distinguished from blood-corpuscles by their shape and lustre, and from starch-granules by the fact that they are not colored or changed by

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jodine-water. Colostrum is the name applied to the milk first secreted after delivery; it contains in addition to oil-glubules numerous spherical granular bodies (Fig. 52, b). When milk is present milk-sugar is generally found in the contents of the stomach by the appropriate sugar-test (p. 558). The casein of milk precipitates sulphate of copper; but on adding an excess of a solution of soda the precipitate is redissolved, forming a purple or violet-colored solution. It is rapidly coagulated by the digestive matter contained in the gastric juice, so that the casein may be found in small soft masses adhering to the lining membrane of the stomach. It should be observed that albumen forms a deep violet-colored solution with sulphate of copper and soda, but the red suboxide of copper is not precipitated on boiling unless sugar is present

4. Epithelial Scales.-The epithelial scales commonly found associated with articles of food in the stomach are of various shapes and sizes; they are flat, oval or rounded, and sometimes polygonal. They are nucleated, and from their pavement-like appearance they are called "tessellated." In Fig. 53, b, an epithelial scale from the mucous membrane of the inside of the mouth is represented magnified 570 diameters. In the long axis it was 0.002 inch, and in the shortest 0.0011 inch in diameter. The central nucleus was 0.00025 inch in diameter, and the small granules around it 0.0001 inch. These epithelial scales are very numerous, much intermixed, and so thin and transparent that they are often only distinctly seen at the edges, which are occasionally folded or slightly turned over.

Besides the substances mentioned, other solids and fluids, such as blood and meconium (the fecal discharges of the fœtus), may be found in the stomach of a newborn child, and a question may arise whether their presence indicates that the child was fully born. It is not impossible that a child might be fed and might exert

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Fig. 53.

a

Tessellated Epithelial Scales: a, from Sharpey; b, from observation.

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LIVE BIRTH-MEDICAL PROOFS.

a power of swallowing when its head had protruded from the outlet, and its body was still within the body of the mother. Children have been known to exert a power of sucking or aspiration under these circumstances, and, with this, a power of swallowing might be exercised. In defending a prisoner on a charge of child-murder counsel would scarcely resort to a defence of this kind. That the starch, sugar, or milk, etc,, found in the stomach should have been given to a child when its body was only halfborn, is so improbable an hypothesis that the most inexperienced lawyer would hardly resort to it to account for the presence of food in this organ. When the substances found in the stomach are not in the form of food, but are fluids connected with the child or the mother, the case is different. These may penetrate into the lungs or stomach during birth, either by aspiration or by the act of swallowing; they thus indicate that the child was living, but they do not necessarily show that its body was entirely in the world when they were swallowed.

5. Blood. An instance is related by Dōring in which a spoonful of coagulated blood was found in the stomach of a newborn child. The inner surfaces of the gullet and windpipe were also covered with blood. Döring inferred from these facts that the child had been born alive; for the blood, in his opinion, could have entered the stomach only by swallowing, after the birth of the child, and while it was probably lying with its face in a pool of blood. Taken alone, however, such an inference would not be justifiable from the facts as stated. Blood might be accidentally drawn into the throat from the discharges of the mother during the passage of the child's head through the outlet, and yet the child may not have been born alive. The power of swallowing may be exerted by a child during birth, either before or after the act of breathing. This power appears to be exerted even by the foetus in utero. Blood may be recognized in the contents of the stomach, not only by the color which it imparts to the mucous liquids present, but by the aid of the microscope.

Robinson finds that the substances which naturally exist in the stomach of a fœtus before birth are of an albuminous and mucous nature. His observations were made on the stomachs of two human fœtuses, and on those of the calf, lamb, and rabbit. The conclusions at which he arrived were that the stomach of the foetus, during the latter period of its uterine existence, contains mucous and albuminous matters derived from the salivary secretion; and that gastric juice is not secreted until after respiration has been established. The medical jurist will perceive, therefore. that the discovery of farinaceous food, milk, or sugar in the stomach will furnish evidence of birth, since substances of this kind are not found naturally in this organ.

6. Meconium.-This name is applied to the excrementitions matter produced and retained in the intestines during foetal life. It may be found in the stomach of a newborn child, and a question will thence arise whether its presence there should be taken as a proof of entire live birth. It may be discharged from the child during delivery, in cases in which there is a difficult or protracted labor. During the act of breathing it may enter the throat with other discharges, and thus be found in the stomach. That a breathing child can thus swallow meconium cannot be disputed, but, assuming that, in the body of a child which has not lived to breathe, this substance is found in the air-passages and stomach, how is the conclusion affected? From a case which occurred to Fleisher, it is probable that as some portion of the meconium may be discharged from the bowels of a child during labor, and as the mouth passes over this liquid a portion may be drawn into the throat by aspiration. When once

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MECONIUM IN THE STOMACH.

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there the instinctive act of swallowing would immediately convey a portion of it into the stomach. (See case in Vierteljahrsschr. für Gerichtl. Med., 1863, Bd. 1, p. 97; also for another case, Med. Times and Gaz., 1861, ii. p. 116.) The same remark applies to the urine.

Fig. 54.

The presence of fluids, therefore-such as blood, meconium, or the watery discharges attending delivery-in the stomach and air-passages of a newborn child, does not prove live birth, but merely indicates the existence of some living actions in the child at or about the time of its birth. A woman was suddenly delivered of a child while sitting over a slop-pail of dirty water. On examining the body, it was obvious that it had not breathed. There was no air in the lungs, but a quantity of dirty water like that in the pail was found in the stomach. This could have entered the organ only by the act of swallowing, and, in Ramsbotham's opinion, the child had swallowed the liquid under some foetal attempt to breathe. The coroner who held the inquest directed the jury that the child was born dead: but most physiologists will consider that the power of swallowing cannot be exerted by a dead child; and as its body must have been entirely delivered in order to have fallen into the liquid, there was proof that it had been born living, and that in this instance it had died after it was entirely born, by the prevention of the act of breathing. The facts connected with the aspiration of liquids by newborn children have been fully examined by Hofmann. (Vierteljahrsschr. für Gerichtl. Med., 1873, Bd. 2, p. 228.)

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Microscopical appearances of Meconium: a, crystals of cholesterin; b, epithelial scales; c, masses of green coloring matter of bile (biliverdin); d, e, granules; magnified 400 diam

eters.

The meconium may be generally recognized by its dirty-green color and general appearance, as well as by the absence of any offensive odor, which it does not acquire until after the third or fourth day from birth, when it becomes mixed with feculent matter. Its microscopical characters are represented in the above engraving (Fig. 54). In the air-passages it is sometimes associated with vernix caseosa, and hairs derived from the skin. (Med. Times and Gaz., 1861, i. p. 591, and 1861, ii. p. 117; see also Ann. d'Hyg., 1855, t. 2, p. 445.)

But little need be said on its chemical properties; still, as the detection of stains of meconium on clothing may occasionally form a part of the medical evidence, a few observations are here required. The stains which it produces are of a brownish-green color, very difficult to remove by washing. They stiffen the stuff, and are usually slightly raised above the surface, without always penetrating below it. Meconium forms with water a greenish-colored liquid, having an acid reaction, and a boiling temperature does not affect the solution. Nitric acid and sulphuric acid with sugar yield with it the green and red-colored compounds which they produce with bile. Cholesterin may be separated from it by hot ether.

Huber has subjected meconium to an elaborate investigation. According to him, the most important substance, medico-legally considered, met with in meconium is a greenish-yellow body which gives it its dark-green color. These bodies are admirably depicted by Tardieu. (Sur l'Infantiride, plate 2.) They are oblong, elliptical, of oval or roundish contour, not unfrequently flaky and with rounded angles, and are very variable in

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DISTINGUISHING CHARACTER OF MECONIUM.

size, some being excessively minute, others as large as the epithelial cells depicted in Fig. 53, p. 559. They are homogeneous in structure, and, being enveloped in mucus, it is difficult to ascertain the action of chemical reagents upon them; but they are unaltered by acetic acid and solution of potash, but soluble in ether. Huber held that the discovery of these bodies in stains is characteristic of the presence of meconium. (Friedreich's Blätter für Gerichtl. Med., 1884, pp. 24, 142.) Huber's memoir contains a complete bibliography of all that relates to meconium.

It may be remarked, in reference to stains produced by the feces of a child which has survived birth, that until the fifth or sixth day they retain a dark-green or greenish-yellow color. On the seventh day after birth they generally acquire a bright-yellow color, like that of the yolk of egg; and, if the child is in health, they will retain this color during all the

time that it is suckled.

7. Ear-test.-Wreden has pointed out that the middle ear of a newborn child is filled with epithelial cells or metamorphosed embryonal connective tissue; and that this becomes absorbed or removed shortly after birth if the child be alive. The presence of a distinct cavity in the middle ear hence becomes an inportant factor in determining that a child has survived its birth. (Lancet, 1877, ii. p. 741.) The editor has found this test useful in several cases.

The slightest consideration will show that the various indications of live birth above described are weak and of purely accidental occurrence. If a child is destroyed either during birth, or within a few minutes afterwards, there will be no medical evidence to indicate the period at which its destruction took place: the external and internal appearances presented by the body will be the same in the two cases. It is most probable that, in the greater number of instances of child-murder, a child is actually destroyed either during birth or immediately afterwards; and, therefore, the characters above described can rarely be available in practice. If any exception is made, it is with respect to the nature, situation, and extent of marks of violence; but the presence of these depends on mere accident. Hence, then, we come to the conclusion that, although medical evidence can generally show, from the state of the lungs, that a child has really lived, it can rarely be in a condition to prove, in a case of infanticide, that its life had certainly continued after its entire birth. We could only venture upon this inference when the signs of breathing were full and complete, or when some article of food was found in the stomach.

Conclusions. The general conclusions which may be drawn from the facts contained in this chapter, on the question whether a child has or has not been born alive, are as follows:

1. That if the lungs are fully and perfectly distended with air by the act of breathing, this affords a strong presumption that the child has been born alive, since breathing during birth is in general only partial and imperfect.

2. That the presence of marks of severe violence on various parts of the body, if possessing vital characters, renders it probable that the child had been born alive when the violence was inflicted.

3 That certain changes in the umbilical vessels, and the separation (by a vital process) and cicatrization of the navel-string, as well as a general peeling or scaling-off of the cuticle, indicate live birth.

4. That the absence of meconium from the intestines, and of urine from the bladder, are not proofs that a child has been born alive, since these liquids may be discharged during the act of birth.

5. That the open or contracted state of the foramen ovale or ductus

CAUSES OF DEATII IN NEWBORN CHILDREN.

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arteriosus furnishes no evidence of a child having been born alive. These parts may become closed and contracted before birth, and therefore be found closed in a child born dead; or they may remain open after birth in a child born living, even subsequently to the establishment of respiration. 6. That the presence of air and of farinaceous or other food in the stomach and bowels proves that a child has been entirely born alive. 7. That the presence in the stomach and air-passages of blood, meconium, vernix caseosa, or the natural discharges, does not prove that a child was born alive.

8. That the presence of an air-cavity in the tympanum, or middle ear, affords additional evidence of live birth.

9. That, irrespective of the above conclusions, there is no certain medical sign which indicates that a child that has died at or about the time of birth-has been born alive.

CHAPTER LII.

CAUSES OF DEATH IN
NATURAL CAUSES OF
LACERATION OF THE NAVEL-STRING.-COMPRESSION OF THE NAVEL-STRING.-MALFOR-
MATION-DESTRUCTION OF MONSTROUS BIRTHS.--DEATH FROM CONGENITAL DISEASE.

NEWBORN CHILDREN.-PROPORTION OF CHILDREN BORN DEAD.-
DEATH.-A PROTRACTED DELIVERY.-DEBILITY. BLEEDING FROM

Causes of Death in Newborn Children.-The next important question in a case of infanticide, and that upon which a charge of murder essentially rests, is-What was the cause of death? 1. It is admitted that a child may die during birth or afterwards. 2. In either of these cases it may die from natural or violent causes. The violent causes may have originated in accident or in criminal design. The last condition only involves the question of child-murder. If death has clearly proceeded from natural causes, it is of no importance to settle whether the cause operated during or after birth. All charge of criminality is henceforth at an end.

It is well known that of children born under ordinary circumstances a great number die from natural causes either during birth or soon afterwards; and in every case of child-murder death will be assumed to have arisen from some cause of this kind, until the contrary appears from the medical evidence. This throws the onus of proof entirely on the prosecution. Many children die before performing the act of respiration, and thus a large number come into the world dead or stillborn The proportion of stillborn among legitimate children, as it is derived from statistical tables extending over a series of years, and embracing not fewer than eight millions of births, varies from one in eighteen to one in twenty of all births. (Brit. and For. Med. Rev., No. 7, p. 235.) In immature and illegitimate children, forming the greater number of those which give tise to charges of child-murder, the proportionate mortality is much greater-probably about one in eight or ten. Stillbirths are much more frequent in first than in after-pregnancies; and children are much more frequently born dead among primiparous than among pluriparous women. Males are more often stillborn than females. According to Lawrence's observations, the proportion of deaths is 1 to 11 among the primiparous, and 1 to 31. 2 among the pluriparous. (Edin. Med. Jour., March, 1863, p. 814.) In most cases of child-murder, the woman is primiparous. These

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