EVIDENCE OF MISCARRIAGE 339 Bisons. If death does not occur, the woman may show signs of chronic fastro-intestinal disturbances, nervous prostration and chronic ill-health. EVIDENCE OF MISCARRIAGE The evidence of miscarriage can be determined by examining the roman alleged to have miscarried and the material alleged to have been 'xpelled from the uterus. Examination of the Woman.—(a) Durmg Life.—The signs of recent lelivery are found. These will depend upon the stage To" which pregnancy ias advanced, and the time that has elapsed since miscarriage at the time of he examination. In the earlier months of pregnancy the signs are likely to lisappear very soon after miscarriage, and the woman should, if possible, >e medically examined within a very few days after its occurrence. If septic infection has occurred at the time of miscarriage, the signs would Dersist for a longer time. The usual sign in such cases is a bloody discharge from the vagina, wrhich is relaxed and dilated. On examining the vagrnaPcanal with a speculum, excoriations, lacerations or wounds of the mucous membrane of the vagina may be discovered. The os and cervix are patulous, with or without fissures, tears or lacerations. The uterus may be found enlarged by bimanual examination or by passing a uterine sound. The enlarged breasts * and other signs of pregnancy are the valuable points for diagnosis. (b) After Death.—In addition to the signs of pregnancy and the lesions caused by general violence, the vaginal canaLshouLd be carefully examined for the presence of punctures or lacerations, and the marks of inflammation and corrosion on its mucous memh^-ne The uterus and its appendages with the vagina attached should then be carefully dissected out, and laid on the table for minute inspection. The con- dition of the os and cervix should be examined as to the presence or absence of fissures, lacerations or the existence of a foreign body. The uterus should then be cut open, and its increased size, the attachment of the placenta and tibe presence of blood clots or of the product of conception should be noted Tne ovaries should be examined for the existence of a corpus luteum. The alimentary and urinary organs should also be examined for evidence of irritant poisoning. In all cases of criminal miscarriage the uterus and its appendages with any foreign matter found in the genital canal, as well as the stomach, etc. should always be preserved for chemical analysis, if there is the least suspicion of a drug having been used locally or internally. Post-mortem Delivery.—The medical man should bear in mind the possibility of expulsion of a foetus by the pressure of putrefactive gases generated in the abdominal cavity some days after the mother's death. 9n March 18, 192*), a Hindu widow, 40 years old, finding that she Jiad Bant jumped into a well to conceal her sbame. Four days later, the body • *" *^~ well with a foetus. At tfcte post-mortem examination held by be body was found to be (feeomposecL The face was bloatec had become loosened and were coming off. The atxlmen Fig. 147.—Uterus showing twins of about 3 months.