POWER OF EXERTION AFTER DELIVERY.

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bility of this explanation of the accidental origin of such fractures, if he were made acquainted with all the facts connected with the delivery. But the acquisition of this knowledge must be accidental; and it will in general be out of his power to obtain it. When the fractures are accompanied by cuts, punctures, or lacerations of the scalp or face, although their production might be accounted for by an alleged fall during parturition, the cause of these wounds would still remain to be explained. In fractures of the bones of the head in newborn children the presence of effusions of blood on the outside of the skull, or on the membranes within, is one of the most common appearances. Effusions of blood beneath the skin of the scalp are by no means uncommon in newborn children, and are not necessarily indicative of criminal violence. Each case, however, must be decided by the circumstances attending it. Effusions on the membranes and in the substance of the brain are generally the result of great violence to the head. (See Tardieu, L'Enfanticide, p. 133.)

Twisting of the Neck.-Children are sometimes destroyed in the act of birth by the neck being forcibly twisted, whereby a displacement of ths vertebræ of the neck, with injury to the spinal marrow, may occur and destroy life. Such injuries are immediately discovered by an examination of the body. It should be remembered that the neck of a child is very short, and that it always possesses considerable mobility.

Destruction by Fire.-Newborn children are sometimes destroyed by placing their bodies in a fierce fire. The result of this is that only charred flesh with white fragments of burnt bones may be found. In one case the body of a child was found in a saucepan, boiled. It was here a question whether it had been put in living or dead (see p. 368.)

Violence in Self-delivery.—When the marks of violence found on the head, neck, or body of a child cannot be easily referred to uterine action or to an accidental fall, it is common to ascribe them to the efforts made by a woman in her attempts to deliver herself the destruction of the child being an accidental result of these efforts. A medical opinion in such cases must depend upon the nature, situation, and extent of the injuries; and each case must be therefore decided by the circumstances attending it. A medical witness, however, should always be prepared to allow that a woman at the time of her delivery, owing to pain and anxiety, may be deprived of judgment, and may destroy her offspring without being conscious of what she is doing. It is, therefore, a sound principle of law that mere appearances of violence on a child's body are not per se sufficient, unless there is some evidence to show that the violence was knowingly and intentionally inflicted, or the appearances are of such a kind as of themselves to indicate intentional homicide.

Power of Exertion in recently delivered Women.-On these occasions, a witness will often find himself questioned respecting the strength or capability for exertion evinced by the lower class of women shortly after childbirth. Alison remarks that many respectable medical practitioners, judging only from what they have observed among the higher ranks, are liable to be led into an erroneous opinion, which may affect their evidence. He mentions a case in which a woman accused of child-murder walked a distance of twenty-eight miles in a single day, with her child on her back, two or three days after her delivery. (Case of Anderson, Aberdeen Spring Circ., 1829.) Instances have even occurred in which women have walked six and eight miles, on the very day of their delivery, with out sensible inconvenience. In one case (Smith, Avr Spring Circ., 1824), the woman was engaged in reaping; she retired to a little distance, effected her delivery by herself, and went on with her work for the re

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mainder of the day, appearing only a little thinner and paler than usual. In Reg. v. Stowler (Wells Aut. Ass., 1865), two witnesses proved that the prisoner, who was tried for the murder of her child, was at work with them in a field about 800 yards from a pond in which the body was afterwards found. They left the prisoner weeding, returned in about an hour, and she was not then in the field. After a time she returned, sat on a bank, and then resumed her work. The witnesses noticed that, on her return, there was a great difference in her appearance. In this short interval she had been delivered, had disposed of the body of the child, and resumed her work, as if nothing had happened. A firm resolution, with a desire to conceal her shame, may enable a woman, immediately after her delivery, to perform acts connected with the disposal of the body of her child which, from ordinary experience, might appear to be far beyond her strength.

In Reg. v. May (Exch. Ct., May, 1857), for concealment of birth, it was proved that the prisoner, a domestic servant, had been sent to market with some poultry. On her return, she asked the boy who drove the cart to stop. He did so; she got out, went to a recess in the hedge by the side of the road, in five minutes was observed following the cart, and walked home, a distance of a mile and a half. She went about her usual work on that and the following day. The woman had been delivered of a child in the recess, and it was subsequently found there. One witness heard it cry, but it soon died.

Conclusions.-The conclusions to be derived from the contents of this chapter are

1. That a newborn child may die from violent causes of an accidental

nature.

2. That some forms of violent death are not necessarily attended with external signs indicative of violence.

3. That a child may be accidentally suffocated during delivery.

4. That the usual marks of death from suffocation or drowning are not apparent, except in the bodies of children which have breathed.

5. That the state of the navel-string may often furnish important evidence.

6. That a newborn child may speedily die from exposure to cold or from want of food.

7. That slight fractures of the bones of the cranium may arise from the action of the womb on the head of the child during delivery.

8. That women may be unexpectedly delivered while in an erect posture; the cord is under these circumstances sometimes ruptured, and the child may sustain injury by the fall.

9. That the violence found on the body of a child may be sometimes referred to attempts innocently made by a woman to aid her delivery. 10. That some women recently delivered may have sufficient strength to exert themselves and walk great distances.

INFANTICIDE-STRANGULATION.

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CHAPTER LIV.

DEATH OF THE CHILD FROM STRANGULATION.-STRANGULATION BY THE NAVEL-STRING.-ACCIDENTAL MARKS RESEMBLING THOSE OF STRANGULATION.-CONSTRICTION BEFORE AND AFIER DEATH.-BEFORE AND AFTER BREATHING.-BEFORE AND AFTER THE SEVERANCE OF THE NAVEL-STRING.-EXAMINATION OF WOMEN.-MEDICAL RESPONSIBILITY.

AMONG the forms of violent death which are generally attended with appearances indicative of criminal design, are the following:

7. Strangulation.-The destruction of a newborn child by strangulation is not an unfrequent form of child-murder; and here a medical jurist has to encounter the difficulty that the strangulation may have been accidentally produced during delivery, by a twisting of the navel-string round the neck. We must not hastily conclude, from the red and swollen appearance of the head and face of a child when found dead, that it has been destroyed by strangulation. There is no doubt that errors were formerly made with respect to this appearance; for W. Hunter observed, "When a child's head or face looks swollen, and is 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 there is nothing more common in natural births, and that the swelling and deep color go gradually off if the child live but a few days. This appearance is particularly observable in those cases in which the navel-string happens to gird the child's neck, and where its head happens to be born some time before its body."

Strangulation by the navel-string can, of course, refer to those cases only in which it becomes firmly twisted round the neck after the child has breathed. This is rather a rare occurrence, because under these circumstances death more commonly takes place by compression of the cord, and by the consequent arrest of circulation, before the act of breathing is performed. The only internal appearance met with in death from this cause is a congested state of the cerebral vessels, and ecchymoses. The presence of ecchymosis on the scalp, as well as of lividity of the face, is very common in newborn children when the labor has been tedious and difficult; and, therefore, unless there were some distinct marks of pressure about the neck, with a protrusion of the tongue, such appearances would not justify a suspicion of death from strangulation.

It has been supposed that the strangulation produced by the wilful application of any extraneous constricting force to the neck would be known from the accidental strangulation caused by the cord, by the fact that, in the former case, there would be a livid or ecchymosed mark or depression on the neck, while in the latter there would not. Severe violence to the neck of a newborn child may produce in the seat of constriction not only ecchymosis, but a laceration of the skin, muscles, and windpipe; but these appearances are not always present even in homicidal strangulation. Evans communicated to the author the particulars of the case of a newborn child which had been destroyed by strangulation. Great violence had been used, but there was no trace of discoloration in the course of the ligature, or of ecchymosis in the tissues beneath. The muscles compressed were very dark in color. In most cases, when a

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ligature is applied to the neck during life, the skin above and below it becomes much swollen and presents an oedematous character. This indicates an application of violence when there is still some vital power in the body of the child.

The navel-string itself may be the means of constriction, and the mark or depression may sometimes present an appearance of ecchymosis. Among various cases which might be quoted in support of this statement, is the following: In 1846 Foster was summoned to attend a lady in labor with her first child. The labor was a lingering one, owing to the size of the head; and the child came into the world dead. The navel-string was found coiled three times round the neck, passing under the right armpit ; and upon removing it three parallel discolored depressions were distinctly evident. These extended completely round the neck, and corresponded to the course taken by the coils. The child appeared as if it had been strangled (Lond. Med. Gaz., vol. xxxvii. p. 485.) Had this child been born secretly, this state of the neck might have created a strong suspicion of homicidal violence. Strangulation after birth could not, however, have been alleged, because there would have been no proof of respiration. When a blue mark is found on the neck of a child whose lungs retain their fœtal characters, it is fair to presume, cæteris paribus, that it has been accidentally occasioned by the twisting of the navel-string during delivery. Price communicated to the same journal the account of a case in which the cord, which was short, was so tightly twisted around the neck of a child that he was compelled to divide it before delivery could be accomplished. There was in this instance a deep groove formed on the neck, conveying the impression to himself and another medical man that, in the absence of any knowledge of the facts, they would have been prepared to say that the child had been wilfully strangled by a rope. (Lond. Med. Gaz., vol. xxxviii. p. 40.) A diagnosis might have been formed, as in the preceding case, by examining the state of the lungs. Mütter met with a case in which a child was born dead, and the cord was tightly twisted round its neck; when removed, the neck exhibited a livid circle of a finger's breadth, smooth and shining; but on cutting into this mark no ecchymosis was found. (North. Jour. Med., 1845, p. 190.) In Leg. v. Martin (Lewes Lent Ass., 1860), the material question was whether a mark round the neck had been caused accidentally by the navel-string; this was denied by the medical witness. A similar question also arose in another important case, Reg. v. Pyne (Gloucester Winter Ass., 1858).

Williamson has directed attention to an important fact connected with the state of the lungs in a newborn child, and the medical opinions which may be expressed from their condition as furnishing evidence of live birth. Referring to Price's case (supra), in which the cord was tightly twisted round the neck of the child, he states that in similar cases which have occurred to himself, the child has breathed immediately on the birth of the head; but, owing to the shortness of the cord, the child would have been strangled and born dead unless he had divided it. Thus, then, a child might die apparently strangled, and not be born alive, although it might have so breathed during birth that the lungs would present the usual characters of respiration. If the circumstances were not known, a medical man might be led to say that the child had been born alive and had been destroyed by strangulation. (Edin. Med. Jour., 1858, p. 714.) The proof of respiration, as it has been elsewhere stated, is, however, not necessarily a proof of live birth. From these cases it will be perceived that ecchymosis in the depression on the neck furnishes no distinction between constriction produced by criminal means, and that which may result acciden

STRANGULATION BY THE NAVEL-STRING.

583

tally from the navel-string. In the following case (Ann. d'Hyg., 1841, t. 1. p. 127), a woman charged with the murder of her child by strangulation appears to have been unjustly condemned. The child had fully and perfectly breathed; the lungs weighed one thousand grains, and, when divided, every portion floated on water, even after firm compression. There was a circular depression on the neck, which was superficially ecchymosed in some parts. From an investigation of the facts, this appeared to have been a case in which a mark on the neck was accidentally produced by the cord during attempts at self-delivery on the part of the woman; she was, nevertheless, convicted, chiefly from the opinion expressed by two medical witnesses, that a soft and yielding substance like the cord could not produce a depression and ecchymosis on the neck of a child during birth. They attributed the mark to the wilful application of a ligature like a garter; but the experiments of Négrier clearly show that the navel-string has sufficient strength to produce a mark, and with it a fatal constriction.

In the same volume of the Ann. d'Hyg. (at p. 428) will be found the report of another case, suggesting many important reflections in regard to the medical jurisprudence of infanticide. In this instance the navel-string and the membranes were actually used by a woman as a means of strangulation; the child had not breathed, but was by this act of violence prevented from breathing. There was superficial ecchymosis on each side over the muscles of the neck. The defence was that the child was born with the cord around its neck, and that it was from this circumstance accidentally strangled; but the medical evidence tended to show that the cord had been violently stretched and employed as a means of strangulation. The child had not breathed, and the medical witnesses considered that it had been born dead, owing to the violence used by the woman. The cause of death here was certainly not strangulation, but arrested circulation. In the mean time, the case proves that ecchymosis (a blue mark) may be the result of violent constriction produced by the navel-string. A case occurred to M'Cann, in which the navel-string, which was of its full length, had been also used as the means of strangulation. It was twisted once round the neck, passed under the left arm, over the shoulders, and round the neck again, forming a noose or knot, which, pressing upon the throat, must have caused strangulation, as the tongue was protruded, and there were other clear indications of the child having been strangled. The hydrostatic test applied to the lungs proved that respiration had been performed.

When the mark on the neck is deep, broad, much ecchymosed, and there is extravasation of blood beneath, with injury to the muscles or windpipe, and ruffling or laceration of the skin, it is impossible to attribute these appearances to accidental compression by the navel-string. The lividity produced by it in the cases hitherto observed has been only slight and partial, and unaccompanied by laceration of the skin or injury to deep-seated parts. On the other hand, as much more violence is commonly used in homicidal strangulation than is necessary for destroying life, we may expect to find great ecchymosis and extensive injury to the surrounding soft parts. On some occasions all difficulty is removed by the discovery of a ligature tied tightly round the neck; or, if this be not found, the proofs of some ligature having been used will be discovered in the indentations or irregularly ecchymosed spots left on the skin-the depressed portions of skin being generally white and the raised edges livid or oedematous.

It has been doubted whether a child can be born with the navel-string so tightly round the neck as to produce great depression of the skin and