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HOW LONG DID THE CHILD SURVIVE THE BIRTH ?                         351

The absence of urine in the bladder is not at all diagnostic of live-birth,
as urine may not be passed for some hours after birth, or it may be passed
mechanically during labour, and the child may subsequently be born dead,

6. Change in the Middle Ear (Wredin's Test).—Dr. Wredin of Petrograd
has observed that the gelatinous embryonic connective tissue, which fills
the middle ear during foetal life, disappears after birth, and is replaced by
air, if respiration has taken place. This is not a valuable sign, since the
gelatinous mass may disappear during foetal life, or may not disappear until
two or three weeks after birth.



It is jaot possible to determine the exact length of time that a child has
BvecTafier its birth, but an approximate idea may be formed from carefully
considering the following changes in the external and internal appearances
of the body : —

1. Changes in. the Sldn.—The skin of a newly-born infant is bright red,
and covered with vernix caseosa chiefly in the axilla, inguinal region and
folds of the neck. The vernix is not easily removed and persists for a day
or two, but it is possible for a child to be born with little or no vernix.
Ag^J>irth the skin changes its colour, and becomes darker on the second
or third day; it then becomes brick red, and finally yellow. It assumes its
normal colour in about a week's time. The exfoliation of theTlsliii, chiefly
on the abdomen, occurs during the first three days after birth. The exfolia-
tion has to be distinguished from the detachment of the cuticle due to
intra-uterine maceration.

_^___ ___^^_     of a Caput Succedanjeum,—A caput succedaneum is a

valuable sign when present. It is a swelling which usually forms in the
scalp tissues over the presenting part of the head during delivery, It
generally contains serum. Occasionally there is effusion of blood with
ecchymoses in the tissues, ^disappears from twenty-four hours to seven
days after birth.

3. Changes in the UmbOical Cord-—The changes in the umbilical cord
begin to appeaflEFSm ffie cut end to its base at the umbilicus soon after birth
when it has been divided. Clotting occurs in the cut end after two hours.
The portion of the cord aflSeEed to the child shrinks, and dries within
twelve to twenty-four hours, and an inflammatory ring of redness forms at
its base from thirty-six to forty-eight hours. This should not be confounded
with a line of redness seen round the umbilicus at the time of birth. This
line is merely red without any sign of a swelling or inflammation. Svt]^
second or third day it shrivels up, mummifies, and falls off on the flftfTor
sixth day leaving a slightly suppurating ulcer, which heals and cicatrizes
witlrn ten to twelve days. In rare cases the cord may drop off as early as
the second day or as late as the tenth day. Hie mere mummification of the
cord is not of any value as a sign of extra-uterine life, as, it occurs in the
dead body of a newly-born child if exposed to the air, but the separation of
the cord with the formation of a cicatrix is a sure sign of survival of the
child after birth.

The mummification of the cord does not occur, if the child is submerged
In water immediately after birth. Similarly, a cord which has already dried
and withered may become soft and supple^ though tough, if the body is,""
fet water or wrapped in wet clothes.

jCimilafinii^'niese occur after birth.   T&f

iuctus venosus, ductus arteriosus and foramen ovale»'"^^iflpp:^
Becessary to carry  out the fo&tal circulation,  are no