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BOSTON CITY HOSPriAL

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THE NEW SYDENHAM
SOCIETY.

INSTITUTED MDCCCLVUL

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VOLUME XXI.

HANDBOOK

OP THE PBACTICB OF

FORENSIC MEDICINE,

BASED UPON PERSONAL EXPERIENCE.

JOHANN LUDWIG CASPER, M.D.,

PKorsasoa or tokimsio xbdicimb xm thb uxitbuitt or bbklim,

rORBMOIC FSXUCIAK TO TBI COURTS OT JCtTIOIAJil OF BBKUK, AMD XB1UB& OB THB KOTAL CBXt&AIi
XBOICAL BOAaO OB PmUSUA, BTC*t BTO., BTC

VOL. III.

INCLUDING THE BIO-THANATOLOGY OF NEW-BORN CHILDREN,
AND THE FIRST PART OF

THE BIOLOGICAL DIVISION.

T&ANSLATED FBOM THE THIBD EDITION OF THE O&IOINAL BT

GEORGE WILLIAM BALFOUR, M.D., St. Andeews,

TBLI.O'W OF TKB BOTAL COLLBOB OF FaTBIClANS, BDIMBOBOH.

-t ^J ''^ --,.

THE NEW SYDENHAM SOCIETY,
LONDON.

MDCCCLXIV.

BOSTON MEDIAL LIBRARY

rRANCIS A. COUNTWAY

^uSSTof MEDICINE

Non hypotheses condo, non opiniones vendito

quod vidi, scripsL

Stoebk.

LONDON t
Printad bj '• W. &o(»b> i, KIrby Street.
HAtton Garden.

CONTENTS.
SPECIAL DIVISION.

PART SECOND.

Bio-thanatology of newborn children . . .1

Statutory reflations . . .1

§ 75. Introduction . .2

CHAPTER I.

Age of the foetus . . . . . • ^

§ 76. Foetus and newborn child . . .5

§ 77. Signs of recent birth . . . .8

$ 78. Immature, yiable, and mature child . . .13
§ 79. Continuation. — ^The development of the foetus according to

months . . . . .15

§ 80. Continuation. — Signs of maturity of the foetus . .18

§ 81. lUustratiye cases . . . . .30

CHAPTER II.
Of the life of a child during and after birth .33

Statutory regulations . . .33

§ 82. Life without respiration . . . .33

§ 83. Respiration before birth, v<igitus uterinas . .37

§ 84. The Docimasia pulmonaris. — a. Vaulting of the chest . 41
§ 85. „ ,> b. The position of the dia-

phragm . . 48

§ 86. „ ,f c. The liver test . . 49

§ 87. ), „ d. Volume of the lungs . 50

§ 88. „ „ e. Colour of the lungs . 51

§ 89. „ ,y /. Consistency of the pulmo-

nary tissue — ^Atelectasis
— Hypersemia — Hepati-
zation . . 53
§ 90. „ » ff' Weight of the lungs and

heart — Ploucquet's test . 56
§ 91, „ „ h. The floating of the lungs

—The hydrostatic test . 62
§ 92. „ „ a. Artificial inflation • 64

§ 93. „ „ i3. Emphysema pulmonum

neonatorum . . 68

„ „ Postscript to § 93 . 72

CONTENTS.

Pace

§ 94. The DocimasU pulmonaris. — y. Putrescence of the lungs . 74
§ 95. ,, ,, Post-respiratory sinking of

lungs . . 76

§ 96. „ „ t. Incisions into the pulmo-

nary substance . 78

§ 97. The centre of ossification in the inferior femoral epiphysis 79
§ 98. Uric acid deposit in the duett of Bellini . • 80

§ 99. The remains of the umbilical cord. — The ring of demarca-
tion. — Mummification. — The separation of the cord . 83
§ 100. Obliteration of the ducts, &c., peculiar to the foetal circu-

lation . . . . . .85

§ 101. Bladder and rectum test . . .86

§ 102. Ecchymoses . . . . .87

§ 103. Conclusions as to the probative value of the Docimasia

pulmonaris • . . . .89

§ 104. When is the institution of the Docimasia pulmonaris su-

perflous? . . . . .90

§ 105. How long has this child lived? And how long is it since

it died? . . . . .92

§ 106. Illustrative cases . . . .94

CHAPTER III.

Kinds of death peculiar to newborn children . . .109

§ 107. General . . . .109

§ 108. Death of the child previous to its birth.-^Fatal injuries in

utero ...... 109

§ 109. Death of the child during labour. — a. Subcutaneous effu-
sion of blood. — Ce-
phalhaematoma .115
S 110. „ >, „ h. Cranial injuries. —

Defective ossification
of the skull-bones .117
§ 111* n )> n Illustrative cases . 120

§ 112. ), „ „ c. Compression ^ and

coiling of the umbilical
cord round the child's
neck. — The mark of
strangulation . 125

5 113. „ „ * „ d. Constriction by the

uterus . .128

§ 114. Death of the child subsequent to birth. — a. By the fall of its

head on the floor 129
5 115* » 9) ,1 Results of precipitate

birth and their
diagnosis. 133

5 116. „ „ „ Illustrative cases . 137

CONTENTS.

§ 117. Death of the child subsequent to birth. — h, H aemorrhage from

the umbilical cord .
§ 118. „ „ „ Diagnosis .

§ 119. ,f „ „ Illustratiye cases

§ 120. Is the mother guilty or not guilty ? .
§ 121. Illustratiye cases . . . . .

Page

147
148
149
154
158

BIOLOGICAL DIVISION.

GENERAL DIVISION,

Introduction ....

§ 1. Nature of the Science
§ 2. Instruction in forensic medicine

175
175
176

CHAPTER I.

The forensic medical officials .

Statutory regulations
§ 3. Germany and other countries
§ 4. Relation of the forensic physician to the judge

Statutory regulations

CHAPTER 11.

The medico-legal investigation
Statutory regulations
§ 5. General.— Of the presence of the judge
§ 6. Inspection of the documentary evidence
§ 7. Place for the examination
§ 8. Object of the examination
« 9. „ „ 1

178
178
178
182
182

184
184
184
187
189
190

§ 10.
§ 11.

§ 12.

§ 13.
§ 14.

§ 15.

Disputed capacity for enduring
imprisonment,— a. Imprison-
ment for debt . . 191
b. Penal imprisonment . 195

2. Disputed ability to appear be-
fore the Court . . 199

3. Disputed ability for making a
livelihood, or for office-bearing 201

Illustrative cases . . 204

4. Injuries. — 5. Sexual relations.

6. Disputed mental condition.

7. Various legal objects . 209
Illustrative cases . .211

TUl

CONTENTS.

CHAPTER III.

Of Uie medieal and medico-lef^ opfauoQ and certificate
SCatntorj re^aUtkma
f 16. General ....
} 17. Of the opbnon giren orallj at the tune of trial
} 18. Of falaeaeientific certificates
} 19. lOnatrattre cases

217
217
290
224
226
227

SPECIAL DIVISION.

PART FIBST.
DISPUTED SEXUAL RELATIONS.

CHAPTER
Dispntad capacity for reproduction
Statutory regulations
1. Impotence

The male
The female

2. „ Examination of both sexes. — 1,

3* 99 >> „ 2.

4. ,f Anormality of the genitals .

6, Capacity for procreation. — Hypospadia and epispadia

6. ff ,f Hermaphroditism

Statutory regalations
i 7. „ „ 1. Incapacity for procreation in

the male
{8. „ „ 2. Barrenness in the female

i 9. Illnstrative cases .....

337
237
238
239
243
245
247
251
251

255
259
263

CHAPTER ir
Disputed loss of virginity

Statutory Regulations
I 10. General .
I 11. Diagnosis of Virginity
f 12. Continuation
f 13. Rape

$ 14. „ Diagnosis, a. The local signs
f 15. „ „ h. The general signs

§ 16. ,, „ c. The examination of the linen

§ 17. ,9 Controversies .
§ 18. Illustrative cases .

276
276
276
278
280
282
285
288
290
296
303

CONTENTS.

CHAPTER III.

Disputed UDnatural lewdness .

Page
. 328

Statutory regulations

. 328

§ 19. General ; . . .

. 328

$ 20. Paederastia

. 330

§ 21. Tribadism . . . .

. 335

§ 22. Sodomy ....

. 335

§ 23. Irrumare — Fellare — Cunnilingus^Coprophagia

. 337

$ 24. Illustrative cases .

. 337

PART SECOND.

Disputed pregnancy ....

. 346

Statutory regulations

. 346

§ 25. General ....

. 349

§ 26. Diagnosis of pregnancy

. 350

§27. „ „ . . .

. 352

§28. „ „ . . .

. 359

§ 29. Duration of pregnancy

. 361

§30. „ „ Protracted gestation

. 363

§ 31. „ „ Duration and diagnosis

of pro-

tracted gestation

. 369

§ 32. Superfoetation

. 371

§ 33. Unconscious and concealed pregnancy .

. 378

PAET THIED.

Disputed delivery . . . . . .381

Statutory regulations . . . .381

§ 34, General . , . . . .381

§ 35. Diagnosis of delivery .... 382

§ 36. „ „ a. Transitory signs of delivery . 384

§ 37. „ „ 6, Persistent signs of delivery . 387

§38. Intentional delivery. — Abortion . . .391

Statutory reg^ulations .... 391

§39. Abortion . . . . . .394

§ 40. Of the substitution of children . .397

Statutory reg^ations .... 397

§ 41. Injuries to the mother and child during delivery . . 400

§ 42. Illustrative cases ..... 402

CASPER

FOEENSIO MEDICINE.

PART SECOND.

THE BIOTHANATOLOGY OF NEW-BORN CHILDREN.
Stattjtoey Regulations.

Upon Viability and Monsters : General Common Law. Paet II.,
Tit. 2, § 2. Civil Code, Art. 312. Statute of 24th Ajpbil,
1854. General Common Law, Part I., Tit. 1, §§ 17 and 18
(Fi^p. 7, Vol. I.)

On the institution of the Docimasia pulmonaris : Criminal Code,
§ 166. Regulations for the performance of the medico-legal
dissection of human bodies, § 16, &c. {Fide pp. 84 and 91,
Vol. I.)

Penal Code of the Prussian States, § 186. — Whoever buries,
or otherioise disposes of a dead body, without the knowledge of the
magistrates y is liable to a fine of two hundred dollars (£30), or to
imprisonment for not more than six months* If a mother bury, or
otherwise disposes of the dead body of her illegitimate child, without
the knowledge of the magistrates, she is liable to imprisonment for not
more than two years.

Ordinance regarding the carrying out op the Penal Code
FOR the Prussian States. Art. XII., § 6. — Whoever has been
Resent a;t a birth, or has found a new-born child, and has not given
due notice thereof, as required by the Civil Code, within the time ap-

VOL. III. B

2 5 75. INTRODUCTION.

pointed, shall be punished by a fine of one hundred dollars (£15), or
by imprisonment for not more than six months.

Penal Code, § 180. — If a mother intentionally kills her illegiti-
mate child, either during, or immediately after, its birth, she shall be
punished for the infanticide, by imprisonment in bridewell for from
five to twenty years. If the child has been intentionally hilled by
any person other than the mother, or if any other person has assisted
in the crime, then the ordinary statutes against murder, homicide, or
participation in such crim^, become applicable,

IbideM; § 181. — Any pregnant woman who, by external or internal
means, produces abortion, or the intra-uterine death of the foetus,
shall be punished by imprisonment in bridewell for not more than five
years. The same punishment shall be inflicted upon whoever gives or
employs such means upon a pregnant woman, even with her own con*
sent,

§ 182. — Whoever intentionally produces abortion, or the death of
the fostus in a pregnant woman, without her knowledge or consent,
shall be punished with imprisonment in bridewell for from five to
twenty years. Should the woman be thereby killed, the punishment is
imprisonment for life.

§ 75. Introduction.

The doctrines regarding the doubtful Ufe or death of new-bom
children, in a greater degree than any others in medico-legal science,
have been from the earliest times, particularly since the end of last
century, and still continue to be, the object of the most diligent
inquiries and the most careful observations. Galen mentions the
colour of the lungs as a criterion of the child having lived, and
the docimasia pulmonaris is almost two hundred years old (Thomas
EarthoUnus, 1663). So careful a cultivation of this field ought to
have ensured its being in a most prosperous condition. But instead
of this we find, that up to this very time, on no other question are
opinions so much divided as upon this one. But here, that particu-
larly holds good which we have so often to complain of in medico-
legal science, that what the dissecting-table has made good the
writing-table has spoiled ! Prom the study such a number of doubts,
considerations, h priori suppositions, and irrelevant judicial contro-
versies have been thrown into the question, that its basis has been
shattered over and over again. To allay these doubts and considera-

§ 75. INTRODUCTION. 3

tions^ new modes of investigation, and new modes of obtaining proof
of respiration have been again and again devised, every one more
complicated than another, and therefore useless in practice, and in
recent times particularly, when the so-called '^ exact ^' system has
commenced to force its way also into judicial medicine, certainly not to
its advantage in its practical application for the purposes of the penal
code, people have gone so far as to demand an amount of mathema-
tical certainty in the proof of Ufe, as if any such certainty could be
required or given in any matters connected with medicine ! Those
unversed in the matter must truly despair when they read the warn-
ings which Henke, so long a great authority in our science, without,
however, the slightest practical forensic experience, that is without
having ever observed nature as she is, has continually thrown out in
repeated attacks against the docimasia pulmonaris ; they will despair
when they read the gloomy colours in which Henke and his nume-
rous followers have depicted in the one case an innocent woman
unrighteously condemned to the severest punishment, in the other a
guilty one just as unrighteously escaping her well-merited chastise-
ment, because the medical jurist has based his decision upon the un-
certain and nothing-proving docimasia pulmonaris ! I will not
adduce the fact, that such warnings have nothing to do either with
science or with its practical application, since the physician must
give his opinion without any concern as to its consequences. I will
not even hint that the supporters of Henke^s scepticism in our day
come with such warnings post /estum, now that the point at fault,
the theory of strict judicial proof, has been everywhere cast aside^
and this has been left to the conscience and judgment of the jury,
who take their own course even in purely professional matters, little,
if at all, disturbed by the deductions of the medical jurist. The only
question to be discussed is, whether these doubts and objections are
confirmed by the observation of nature or not? And that question
I shall endeavour to answer in the following pages.

There are three questions, as is well known, which, in every
forensic case of the kind, are either put by the Judge to the physi-
cian, or spontaneously force themselves upon the attention of the
latter; these are : — ^The age of the foetus, was it viable or mature?
Has it, during or immediately after its birth, possessed an inde-
pendent life ? And if the latter be answered affirmatively, then. How
has it died P All other questions are accidental, and individual cases
often present many such besides those mentioned, specially these for

4 § 75. INTRODUCTION.

instance : — How long has the child been dead ? that is, when, pro-
bably, did the birth occur ? — a point that is often of importance for
the Judge to know when he has to proceed against the mother. Or,
Has the birth been intentionally hastened ? — a question which is of as
frequent occurrence in practice, particularly in the case of the dis-
covery of immature foetuses, as it is in by far the larger proportion of
cases not to be answered even with any probability. Or questions
such as this: — Whether, under the circumstances in which the
birth of the child took place, it might have immediately died inde-
pendent of the injuries found upon it? &c. To answer such
collateral questions, the medical jurist must take his material from
the circumstances of each individual case; but science supplies the
means of answering the three chief questions mentioned above.

CHAPTER I.

AGE OF THE F(ETUS.

§76. F(ETus AND Nbw-boknt Child.

The various stages of man's life are no more sharply divided &om
each other by physical than by mental characteristics, but pass insen-
sibly into each other. This is true collectively as well as individually.
It cannot be determined by scientific criteria where childhood ceases and
passes into youth or manhood, or what are the bounds which separate
manhood from old age. Therefore, in so far as civil rights are con-
nected with these stages, the law has come forward with positive re-
gulations to supply a basis which medical science was unable to give.
The best defined of all the stages of man's development from his
origin onwards is indubitably that between his intra- and his extra-
uterine life, and no subsequent stage is so sharply divided from its
predecessor. And yet it is not easy, even here, successfully to draw
an exact boundary line for the purpose of penal law. Our statutes
make use of three different expressions, which come now to be con-
sidered, their interpretation being as it were tacitly presupposed:
''Births,'' ''Foetuses," and "New-bom Children." The General
Common Law, Part I., Tit. I., §17, speaks of "Births" without
human form or appearance (monsters),— an idea which the penal code
has completely set aside, in which, consequently, malformed and well-
formed and new-bom children, in respect of the general rights of
man, of the right to live, are perfectly identical. The penal code
itself, however, as paragraphs quoted above show, further employs
sometimes the expression " foetus," and at others that of " child."
To distinguish between these two we must in the first place take the
extra-uterine life as our basis, just as it is usual in ordinary medical
speech to term the child still in the womb, in contra-distinction to a
child already bom, a "foetus." This distinction has also been
mentally present with the legislator; since he speaks of secretly dis-
posing of the body of an ahready bom, therefore (extra-uterine), new-

6 § 76. FOSTUS AND NEW-BORN CHILD.

born **cUW^ (Penal code, § 186), of the discovery of a (consequently
once more extra-uterine) ^' cAild^' (Introductory, &c., § 6). On the
other hand, he speaks (j?enal code, § 181), of the intentional produc-
tion of the abortion and death of the ^^/ostwt in its mother's womb,*'
and (§ 182) of the intentional production of the abortion of the
^^f(£tus ^' of a pregnant woman. But the chief and most important
definition, that relating to infanticide, namely in § 180, this dis-
tinction is not preserved ; since the crime is said to consist in the
intentional killing of the illegitimate ''child,*' and that either
'' dimng or '* immediately after its birth, — ^and here, consequently, the
legislator manifestly designates the still intra-uterine "foetus** — for
so long as it is still unborn, it is such — ^by the term '' child.** The
solution of the doubts and difficulties dependant on the use of the
terms ''foetus** and "child*' we may, however, very properly leave
to the lawyers, since they are of no importance to a physician, or in
medico-legal practice, llie physician will never be asked, whether he
considers the birth before him a "foetus" or a "child," and when
he has to decide whether an embryo man has been killed " during,**
or only "immediately after ** his birth, he will know how to deliver
his opinion quite unconcerned as to whether the being should be
called a " foetuif or a " child."

There is stilV another question, however, which may arise, which
was brought before us in a recent case, and of which one is not
likely, h priori^ to think ; it is this : Is a mole also a foetus ? The
medical man of the present day, when it is no longer disputed that
a mole is the consequence of a fruitful connection, would never
hesitate to answer affirmatively.

A servant-girl had accused her master, a physician, of having im-
pregnated her, and of having in the third month of the non-
appearance of her menses introduced into her genitals, first " a long
instrument,*' and subsequently repeatedly "small, three-cornered
pieces of sponge,** the result of these operations being that in a
few days " her courses returned in great quantity, and a large lump
covered with skin passed from her !" The preliminary investigations
in regard to a jorovocatio abortus was instituted, the injured
woman was examined by me, and the results of this were such as to
compel me to give it as my opinion, that the woman had actually been
pregnant, and had aborted. Since, many other suspicious circum-
stances were otherwise ascertained against the accused, the charge
was prosecuted, and he was brought for trial before the jury. Out

S 76. FOETUS AND NEW-BORN CHILD. 7

of the two days' trial I merely extract the following as pertaining to
the present subject. I was asked whether, from the description given
by the accuser (and fellow-prisoner at the bar), it was to be supposed
that what had passed from her was a '^ foetus/' since this was a case
to which the applicability of § 181 of the penal code was doubtful
{Fid. this in extenso, p. 2, Vol. III.). Of course I had never seen
the abortion which had come away more than two years previously,
and nothing in regard to it could be produced but the description
given above. Of course I could not but declare that this abortion
might have been a mole, a degenerated ovum, and of the two
questions put to me, answer the one — ^Does a foetus live in the womb
of its mother? — affirmatively, and the other — Can a mole become a
'' child ?" — negatively. This was the turning-point in the judicial
treatment of the case. The public prosecutor declared, that it was
a great proof of the wisdom of the legislator that he had not made any
mention of a mole in § 181, and that consequently no exception was
made in favour of mole pregnancies, since otherwise, this exception
might have been brought to bear in the case of every charge of
procuring abortion, and the accusation thereby made void; and this
all the more, that as the corpus delicti could seldom or never be
examined, this possibility might be made good in many, if not in
most cases. The advocate for the defence, on the other hand,
addressed the jury very impressively to the eflfect, that the legislator
had made no mention of a mole, because it was no " foetus," which
'^ could afterwards become a man,'' and that, consequently, § 181 did
not apply in this case, since the procuring the abortion of a mole
was not the crime mentioned in this section, which speaks only of
the abortion of a foetus, etc. ! The result of this deduction was the
remarkable verdict ''not guilty !"

The term '^ new-bom child" has also quite as much engaged the
attention of the penal lawyer and legislator, and it may become the
subject .of a medical interpretation, of which Case CCCXXXIV.
affords an example. The Bavarian penal code of 1813, art. 242,
and that of Oldenburg, art. 169, call a child new-born when it is not
yet three days old. On the other hand, according to the Wiirtem-
berg penal regulations of 1839, art. 9, according to the penal codes
of Saxony and its duchies, and of Brunswick, a child is only new-bom
so long as it is not more than twenty-four hours old. The renowned
criminal jurists Tittman and Sttibel, in their outline of a penal code
for Saxony, also limit the term new-bom to the first twenty-four

8 § 77. SIGNS OF RECENT BIRTH.

hours, whilst the Saxon outline of 1812 limits it to the first few
hours after birth only. Gans (on Infanticide, Hannover, 1824) gives
the outline of a statute, in which Art. 8, states " it was new-bom so
long as it was neither fed nor clad, while the mother still laboured
under the immediate consequences of the delivery, and while no one
besides herself, her parents, and its father, knew of its birth'' (!), —
a singular definition, which has, however, been adopted by Werner in
his handbook of Penal Law.

The new Prussian penal code has incontestably got cleverly out of
the diflBlculty when it calls a child new-born only iniplicite " during
or immediately after its birth/' (The Austrian penal code says, " At
its birth"); * the very relative term " immediately after" truly per-
mits of further discussion. For the determination of the punishment
it may be of the greatest importance to decide whether the child has
been killed " immediately," or not for some time after its birth, and
the medical jurist will of course have to decide at what stage of its
short life the child has met its death. Uninfluenced by the various
opinions of jurists and legislators above alluded to, he has to take
the facts on which to base his opinion from the observation of
nature alone.

§ 77. Signs of Recent Birth.

These signs are partly positive, partly negative, and are as
follow : —

1. The skin, — ^When the cuticular surface of the child is no longer
stained with blood, then the child can be no longer regarded as newly-
born, since the mother is not in a situation " immediately after the
birth" of a child to be able thoroughly to wash and cleanse it, since
that requires deliberation, strength, rest, leisure, and apparatus. Of
course it is here presupposed, that no one else has undertaken the
duty of cleansing the child, a supposition which befits the greater
number of all the cases occurring in practice, which are mostly cases
of children bom in secrecy and solitude, which appear unwashed upon
the dissecting-table. This criterion has rightly been highly esti-
mated from the earliest times,t as bearing reference to the state of

♦ The Penal Code of Tuscany, art. 316, says : — " at the time of the birth
or shortly thereafter;*' that of Parma, art. 308; — "just born" {nato di
fresco) ; that of Sardinia, art 571, speaks shortly of a "new-born" child
(un infante di recente nato).

f Lex 2. Cod, de patribus, etc. (IV. 43). Si quia propter nimiam pauper-

§ 77. SIGNS OF RECENT BIRTH. 9

mind of the mother at the time of the possible infanticide. If she
have been so far recruited and rested after her confinement as to have
been able carefully to cleanse her child, and if she have then mur-
dered it, then her state of mind can no longer be supposed by an
equitable Judge (or jury) to be the same as that of a woman in
labour, and as such reckoned in her favour. The same thing is so
far true, with limitations, of the total absence of the vemix caseosa,
particularly from the groins and furrows along the spinal column, as
this cuticular secretion is at least of very frequent occurrence in new-
bom children. We may remark, however, that these criteria are in
many cases lost to observation, particularly in all wholly putrefied
bodies, or in the case of such children as have been thrown dead or
alive into water or other fluids (cesspools, &c.), and been washed
therein. So also the dark-red and subsequent icteric coloration of
the skin of new-born children ceases to be observed from the spread
of the ordinary cadaveric hue, and still more of course from those of
putrescence.

2. Umbilicus and imMlical cord, — ^We shall have to resume the
consideration of both of these, when we come to consider the signs
of live-birth (§ 99) ; it is self-evident that when the umbilical cord
has come away, and the umbilicus is cicatrized — ^the cord not as it were
torn out of the navel — ^then the child can no longer be regarded as a
new-bom one. Not, however, the reverse. The changes which take
place in the umbilical cord, and in the umbilicus itself, the mummifi-
cation or putrefaction of the cord, with the appearance of a shght
inflammatory swelling of the abdominal coverings at its root, with
superflcial ulceration, or also, when the child has been bom alive,
the contraction of the umbilical arteries, do not occur '^ immediately
after'' the birth. The latter, the contraction of the umbilical
arteries in living children occurs indeed, but not sooner than after
eight or ten hours; the mummification after two, three, or even four
days, and the putrefaction, under conditions which are in general but
little favourable to it, is not observable till after the lapse of a much
longer time.

3. The stomach. — In a new-born child, whether bom dead or
alive, and that has in the latter case died " immediately after " its
birth, the stomach is empty, or, more correctly speaking, it contains a

taterriy etc.,JlUum,filiamve sanguinolentos, vendiderit^ etc, (evidently meaning
children jast bom— new-born !). Juvenal also, Sat, VIL, speaks of a new-
bom child a matre rubentem.

10 I 77. SIGNS OF RECENT BIRTH.

trifling quantity^ as mucli as would be taken up on the point of a
knife or half a small teaspoonfol^ of quite white^ transparent^ seldom
somewhat bloody, inodorous mucus, which is very tough, but is
easily removed from the mucous membrane by the handle of a knife.
In an advanced stage of putrescence this is frequently found full of
large air-bubbles. By no means infrequently, there is also found in
the stomach a small quantity of colourless fluid, which must be
acknowledged as liqtuyr amnii, since the fact, that the foetus m ovo
does make movements of deglutition and actually swallows, cannot be
doubted (p. 243, Vol. II.). The mere emptiness of the stomach
forms indeed no irrefragable proof of the" child having died imme-
diately after its birth, because it may possibly have been starved to
death, and may yet have lived for one or two days. But vice versd,
when milk has been found in the child's stomach, and it is clearly
ascertained that no one but the mother has given it, then the child
can no longer be regarded as new-born, since the lonely and help-
less mother would not be in a condition to give the child nourish-
ment '^ immediately after ^' its birth, even if she did intend to bring
it up. All that we have said on this head sub 1 . is also applicable
here.

4. The Lungs. — ^We do not require to state, that when the doci-
masia pulmonaris. proves that the child has not breathed, it must
then be looked upon as new-bom. The same is the case when the
examination of the body reveals that the child's Kfe has been but of
short duration.

In those countries where the legal period of recent birth is ex-
tended by statute till three days after the actual birth, the following
signs will have to be added to those abeady reckoned.

5. In the large mtestmes meconium is still to be found, in its
usual well-known form, two, three, or even four days after the birth.

6. Actiml contraction of the umbilical arteries, which indeed has
advanced so far during the flrst three days of the child's life, that the
vessels only with difficulty permit the passage of a very fine sound.

7. The possession by the centre of ossification of the femoral epi-
physis of a diameter of more than three hues. We shall treat of this
diagnostic mark more in detail iu §§ 80 and 97. Attention must
be paid to this, and it must be used as assistant proof in every case
in which it is desirable to ascertain — whether the child is (has lived
for) " three days old ? '* On the other hand,

8. It is not to be deduced from the presence of the remains of the

§ 77. SIGNS OF RECENT BIRTH. 11

umbilical cord that the child has only lived three days, since, as every-
one knows, these remains do not drop off at the end of seventy-two
hours, but always later,. on the fifth or sixth day. And the same
may be said still more strongly —

9. Of the persistent perviousness of the ductus Botalli, the fora-
men ovale, and the ductus venosus Arawtii. The state of these pas-
sages^^ the foetal circulation is of no value in medico-legal practice
generally (§ 100.), and cannot be used to answer the question : has
this child lived (only) three days ? since they are always open and
pervious to the end of this time, and sometimes for much longer.*

Case CCCXXXIV. — Judicial Question : Has this Child been

NBWLY-BORN ? FaLL OP THE ChILD AT ITS BlBTH ? DROWNING

IN Human Oeduue.

A new-bom child was found in a cesspool on the 18th of October,
and since there was also a cranial injury visible, we had to make a
medico-l^al examination of the body next day. The body was that of
a male child, nineteen inches and a-half long, and about seven potmds
(imp.) in weight. The tongue was not swollen and lay behind the
jaws. The body was still quite fresh and had the usual corpse-
colour. On its back there were much vemix caseosa, and the whole
body was soiled with human ordure (out of the cesspool). The
transverse diameter of the head was three inches and a-half, the lon-
gitudinal one four inches and a-half, the diagonal one five inches,
the diameter of the shoulders was four inches and a-half, the trans-
verse diameter of the chest was three inches and a-half, from back to
front it was three inches and a-quarter, and the diameter of the hips
was three inches and a-half. There was no down upon the skin, the
nails and cartilages were tolerably firm, and both testicles were to be
felt in the scrotum. The part of the umbilical cord still attached was
half-an-inch long, and had irregular, jagged edges. The diaphragm
stood between the fiffch and sixth ribs ; the stomach contained a lit-
tle transparent, inodorous mucus ; neither the liver nor the kidneys

* The more exact times of their gradual and ultimately complete closure
have been determined hy the very numerous and careful investigations of
Billard, and particularly of Elsasser, and to these we refer. Vide Unter-
suchungen liber die Yeranderungen im Korper der Neugebomen, u. s. w.
Stuttgart, 1853, s. 64, &o. ; and also Faber, Anleitung zur geriohtsarztlichen
Unters. neugeb. Kinder, u. s. w. Stuttgart, 1855, s. 102, &o.

12 5 77, SIGNS OF RECENT BIRTH.

were remarkably full of blood; there was a large quantity of meco-
niam; the urinary bladder was empty, the vena cava ascendens was
tolerably congested. The lungs and heart weighed about three
ounces (imp.), the lungs by themselves about one ounce and three-
quarters (imp.), their colour was of a bright cinnabar-red, marbled
with blue. They floated perfectly, both as a whole and in separate
pieces ; on incising them crepitation was heard, bloody froth escaped,
and pearl-like air-bubbles were very distinctly seen to ascend from
them. The trachea and oesophagus were empty, and perfectly nor-
mal. The coronary vessels and the cavities of the heart were almost
empty. On the posterior half of the uninjured scalp there was an
isolated blood coagulum one line thick; the skull bones at the vertex
were unusually thin. Precisely on the vertex there was seen on re-
moving the dura mater a faintly semicircular, ecchymosed stripe,
running transversely, the result of a fracture, which was indeed par-
tially distinctly fissured, and at these points had jagged edges. The
vascular meninges were distended with dark blood, and over the whole
brain there was effused a layer half a line thick of similar thickish,
half-coagulated blood. The brain itself was already so pultaceous,
that it could not be any further examined. The basis cranii was un-
injured and the sinuses were much congested. In accordance with
these appearances we could not hesitate to assume : — 1. That the
child had been mature and viable. 2. That it had lived during and
after its birth. 8. That it had died from haemorrhage on the brain; and
4. That the cranial injury discovered must be regarded as the cause
of this haemorrhage. In regard to the probable origin of this injury
we did not fed warranted in saying more than — "5. That the sup-
position that this injury had been produced by the fall of the child at
its birth upon a hard floor was not improbable ;^^ that, however, also,
6. "The possibility of this injury having been produced by violence
otherwise inflicted could not be denied, though this supposition was
much less probable than the former ;'^ and this opinion we were in-
duced to form by the absence of any considerable external injury
upon the head {Fide § 114). In the first place, the Judge was
anxious to know : 7. If the child was yet alive when it fell into the
cesspool? We denied this, because the cranial injury, which dis-
played signs of vital reaction, could not have arisen by falling into
the soft mass of ordure, and because there was no signs of death from
suffocation (or drowning) present, not even the smallest particle of
ordure in the trachea or stomach. The Judge next inquired if the

S 78. IMMATURE, VIABLE, AND MATURE CHILD. 13

child were new-horn ? Since, according to the penal code, a child is
only to be reckoned as such when it has died during or immediately
after its birth : consequently if this child had lived for a longer time,
it could no longer be reckoned as new-bom, and the more lenient
punishment of infanticide could no longer be applied in favour of the ac-
cused. We decided (for the reasons given in the foregoing §), 8. '^That
the child was to be regarded as newly-born, and that aftci the receipt
of the cranial injury it must have died in a very short period; that,
however, if the cranial injury had not been received during the birth
itself, but had been subsequently inflicted, then the child might per-
haps have lived one day before the receipt of the injury.'^ (It was
not likely to have lived two or more days, as the state of the stomaeh
proved it must have done, wholly without nourishment ; in the case
also of its having continued to live for more than two days, the small
residue of the umbilical cord, which was quite fresh, would already
have displayed the commencement of mummification). Finally, we
were asked in this case also, as in so many other similar ones, how long
a time had probably elapsed since the child was bom ? and judging
from the great freshness of the body, though it had lain in moist and
warm human ordure, we stated : 9. ''That the child had been bom
three or four days previously .'* The mother was never discovered and
the case was therefore not further pursued.

§ 78. Immatuee, Viable, and Matuee Child.

The Pmssian penal code, as we have already shown (§ 76),
recognises only '' foetus ^' and " child,^' but no other subdivisions of
embryonic life. The word "abortus" or any German word correspond-
ing to it, and the word ''viable,'' never occur throughout the whole
penal code. The medico-legal practitioner must not, however, delete
these words from his terminology. For, besides that these designa-
tions have a practical significance in civil cases, complications may
also arise in penal cases, which may necessitate the Judge to inquire
of the physician regarding the age (degree of maturity) of the child;
for instance, when a woimn accused of having murdered a certain
child which appears to be mature and viable, and is supposed to have
been borne by her, denies the latter, and consequently the whole in-
dictment, confessing however, what she cannot deny, that she has
borne a child, but asserting that it was immature, and it now re-
mains to be seen whether the medico-legal examination of the mother

14 § 78. IMMATURE, VIABLE, AND MATURE CHILD.

and cAild supports her statement ( Fide Case COCXXXV) . Further,
it cannot be denied that the answer to the question whether a child
has lived after its birth or no, always more or less depends upon that
to the question, whether it has been capable of living. Finally, it has
already been stated (Gen. Div. § 2. p. 4, vol. I.) that our Eoyal
Ober-Tribunal in interpreting § 186 of the penal code, respecting
the secret disposal of the body of an illegitimate child by its mother,
has laid down the principle that a non-viable foetus is not to be re-
garded as a dead body. Both now, as previously, therefore, the term
viability continues to possess an important practical significance.

This is not so much the case with the terms abortus and imma-
ture foetus, or indeed, with the "premature'' children of many
schools. The tendency of the legislature is to justify the considera-
tion of the first two of these t^ms as identical, since the statutory
regulations in regard to the crime of producing abortion speak only
of the "foetus'' (Penal code, §§181, 182), without giving the
slightest definition of its uterine age, or placing any importance upon
the different stages of the embryo. A new-bom child is, therefore,
either immature in whatever month it may have been born, or ma-
ture (full-grown, "perfect," "folly developed," according to the old
judicial terminology). A mature child, when it is bom without any
malformation which would make it absolutely impossible for it to
continue to live, for instance, with diaphragmatic hemia and prolapse
of the abdominal organs into the thorax, with ectopise, complete spina
bifida^ &c., is at the same time viable.* But the viability of the
human foetus commences before its maturity, and the question is,
what is the terminus a quo viabiUty commences ? In regard to this,
physicians and legislators have from the earliest times diverged from
each other, and have laid down the most opposite opinions.f I have
already pointed out (p. 10, Vol. I.), that these differences of opinion
are of no practical importance wherever the law of the land has ex-
pressed itself categorically as to the time when viability shall com-
mence. In this case, the medical jurist has only to determine,
whether the child has attained this period, or not? In Prussia,
consequently (according to the statutoi]| regulations quoted in § 4,

* Upon the influence of purely foetal diseases, wldch are congenital, upon
the child's viability, and upon viability generally, vide Gen. Div., § 4,
p. 7, VoL I.

t A copious collection of these is to be found in Hubner*s work, die Eiui-
destodtung m gerichtsarztlicher Besiehung. Erlangen, 1846, s. 38, &o.

5 79. DEVELOPMENT OF THE EMBRYO. 15

p. 7, Vol. I.) : — ^whether the child has attained the uterine age of
one hundred and eighty days at least, or two hundred and ten days
respectively? — ^this is to be done by a due consideration of the
stages of development through which the embryo passes in the
different months.*

§ 79. Continuation. — ^Thb Development of the Embeyo ac-
cx)EDiNO to Months.

About the end of the first month (third or fourth week), the
embryo is from four to six lines in length. On the cephalic
extremity the mouth is already recognisable, and the eyes a^^pear as
two points. The extremities resemble wart-like eminences. The
heart is recognisable; the liver is disproportionably large. The um-
bilical vesseb are not yet formed.

Second month (up to the end of the eighth week). — About the end
of this period the embryo is from fifteen to eighteen lines long. The
head is disproportionately large, the nose and lips are abready visible.
The external ear not yet ; the extremities already project a little from
the trunk. The anus is marked by a dark point. After the fifth
week the umbilical vessels commence to form. About the end of
this period the abdomen is closed in. The rudiments of the external
parts of generation are visible, but even with a magnifying-glass the
sex itself can only be distinguished with difficulty, and not certainly.
All the internal organs may now, however, be recognised.

Third month (up to the end of the twelfth week). — The embryo is
from two inches to two inches and a-half long, its weight is about one
ounce (imp.). The eyelids and the lips meet, so that both the eyes
and mouth are closed. The fingers are well separated, and their
nails are already recognisable. The clitoris and penis are very
prominent, and the sex is recognisable particularly with a mag-
nifyiBg.glass. The thymus gland and the supra-renal capsules are
formed. The cerebrum, the cerebellum, and the medulla oblongata,
as well as the cavities of the heart, are plainly distinguishable. The

♦ The question of the viability of the child has been for centuries con-
sidered from the most various points of view, by writers upon criminal law,
civil law, and even on theology (the Church Fathers). We do not require
to enter upon these discussions, as the matter does not belong to the forum
of the medical jurist, as we have already pointed out (Gen. Div., § 4, p. 7
&c. Vol. I.).

16 § 79. DEVELOPMENT OF THE EMBRYO.

humems is three and a-half lines long^ the radios two lines and a-
half, the ulna three lines, the femur from two to three lines, the tibia
from two to three lines, and the fibula two lines and a-half.

About the end of the fourth month (the sixteenth week), the em-
bryo weighs about two ounces and a-half to three ounces (imp.), and
is from five to six inches long. The skin is of a very rosy colour,
and has already a certain amount of consistence. The sex is recog-
nisable without any magnifying-glass, as also a certain peculiar
physiognomy of the countenance, in which the very large mouth
strikes one. The umbilicus is situated near the pubis. There is
meconium in the large intestines, but it is of a light greyish-white
colour. The length of the humerus is eight lines, the radius eight
lines, the ulna eight lines, the femur from four to five lines, the tibia
from four to five lines.

At the end of the fifth month (twenty weeks), the embryo is from
ten to eleven inches long. From this time onwards, the length of
the foetus gives a means of ascertaining its uterine age approxima-
tively, which is very easily remembered, for the length (in inches) of
the foetus (up to maturity) is approximatively exactly double the
number of the {lunar) months it has attained. The weight now com-
mences to vary in individuals, and is, therefore (from this month to
maturity), a less safe guide to the age than the length. The foetus
at five months weighs from about seven to ten ounces (imp.) . The
nails are quite distinct. The hair of the head is visible as a light
down. The head is still disproportionately large ; the Uver, the heart,
and the kidneys are also out of all proportion hgrge compared with
the other organs. The meconium now begins to be of a pale greenish-
yellow colour from the bile, which now begins to be secreted, but it
is still not nearly so viscous and pitchy as it subsequently becomes.
The length of the humerus is from thirteen to fifteen lines, of the
radius twelve lines, of the ulna thirteen lines, of the femur twelve
lines, and the tibia and fibula the same.

About the end of the sixth month (twenty-four weeks), the foetus
measures from twelve to thirteen inches in length, and weighs from
about one pound and a-half to one pound and three-quarters (imp.).
The skin is now well covered with down and sebaceous matter. The
umbilicus is a little further removed from the pubis. The colour of
the fresh body is a dirty cinnabar-red. The meconium is darker and
more viscous. The scrotum is empty, the pupillary membrane is
still present and distinctly visible without a magnifying-glass. The

§ 79. DEVELOPMENT OF THE EMBRYO. 17

length of the humerus is sixteen lines, of the radius sixteen lines, of
the ulna seventeen lines, of the femur seventeen lines, and the tibia
and fibula the same.

The foetus of the seventh month (up to the twenty-eighth week) is
characterized by a length of from fourteen to fifteen inches, and a
weight of from about three pounds to three pounds and a-half (imp.).
The hair is plentiful, and about one-quarter of an inch long. The
large fontanelle is still more than one inch and a-half in longitudinal
diameter, and all the fontanelles are distinctly to be felt. The skin
is of a dirty reddish. The dark olive-green viscous meconium fills
the whole of the large intestine. The liver, still very large, is of a
deep dark brownish-red. The length of the humerus is from twenty
to twenty-two lines, of the radius seventeen lines, of the ulna
eighteen lines, of the femur, tibia, and fibula, each from nineteen to
twenty-one lines.

The eighth month is the most important in all the embryonic life in
a medico-legal point of view, because at the end of the thirtieth
week (two hundred and ten days) the foetus indubitably, and accord-
ing to statutory declaration, commences to be viable. About this
time it is from fifteen to sixteen inches long, and from about three to
five pounds (imp.) heavy. The chief criteria are a brighter fiesh-
colour than formerly, the disappearance of the pupillary membrane
and the descent of the testicles into the scrotum, or at least to the
abdominal rings. The gaping vulva permits the clitoris to be dis-
tinctly visible. The nails have almost grown to the ends of the
fingers. The humerus is from twenty-three to twenty-four lines
long, the radius from eighteen to nineteen lines long, the ulna
twenty-two to twenty-three lines, the femur twenty-four lines, and
the tibia aiid fibula each from twenty-one to twenty-three lines
long.

In the ninth month (up to the end of the thirty-sixth week), the
foetus is from seventeen to eighteen inches long, and already nearly
six pounds (imp.) heavy. The s^otum begins to be corrugated, and
the vulva to close. The head is better covered with hair, whilst
during this month the down begins to disappear.

During the course and at the end of the tenth month (fortieth
week), the foetus becomes mature.

VOL. III.

18 I 80. SIGNS OF FOETAL MATURITY.

§ 80. Continuation. — Signs op Matueity op the Farrus.

A foetus arrived at maturity (come to the full time, perfect, or
fully developed) is easily recognised during life as well as after
death. Even a tolerable amount of putrefaction does not disturb the
diagnosis, which only becomes doubtfnl when considerable destruc-
tion has been caused by putrescence, bursting of the skull-bones for
example, or the loss of individual parts of the body, &c. And even the
bare bones themselves, when exhumed, are still capable of giving the
requisite amount of certainty on which to base an opinion ; wherefore
I have already described the dimensions, at least of the bones of the
extremities, at the various uterine ages of the embryo, and further on
I shall give those of the more important bones of the skeleton of the
mature foetus.*

The fresh body of a mature new-bom child displays at once : 1.
A certain general Aabitus, which an expert who has seen many such
bodies is not apt readily to forget. 2. The firm tense skin, which,
in even a moderately well-nourished child, is no longer wrinkled, but
well stuffed out, is of the usual pale corpse-colour, and not the dirty
brown or cinnabar-red of the earlier months. 3. I^ down has
already disappeared ; though its remains may still be found on the
shoulders of every mature child, and one must take care not to be there-
by induced to caH the child immature. 4. The head is certainly more
or less, but in most cases very distinctly, covered with Aair about
three-quarters of an inch long. 5. The skuU-bones are not remark-
ably moveable, the iBige/ontanelle averages from one inch to three-
quarters of an inch in length. 6. As for tAe weight and length of
the body; and 7. The diameters of the head, the shoulders, and hips,t
the Table hereto annexed, containing the results of two hundred and
forty-seven new investigations, gives the following numerical averages.^

* Vide the accurate colleotion of all the known measurements of the foetal
skeleton, in Eanzler's treatise, quoted at p. 68, Yol. I.

t The diameters of the chest are des^iibed in the Table given further on
(in § 85).

X The first hundred and seventeen cases I have taken from my own
medico-legal cases, and only from perfectly fresh bodies. The measurements
and weights of all the other cases have been taken, at my desire, by two of
the best of my former students, who were subsequently assistant-physicians in
our two Royal Lying-in Institutions, Prof. Hekker, now at Munich, and Dr.
Rabe. There is not the slightest reason for doubting the correctness of their
work.

5 80. SIGNS OF FGETAL MATURITY.

Weights and Measurements op Two Hundred and Forty-Seven
Mature New-born Children.*

Diameter of

No.

Head.

No.

Head.

"8
1"

Ll».

LlM.

Inches.

—

7»

194

—

20i

1|-

—

I9i

—

20i

—

19J

—

20ii

—

20i

—

6]^

—

19J

—

18i

—

19J

. —

2*1

—

—.

—

I8i

—

41 5

—

20i

41 5|

—

19]^

—

41 5

—

4^ 5

31
3|

H 7

—

-■10

—

* The weights are given in Prussian oommeroial pounds and fractions,
the measurements in Rhenish inches. Each Prussian, commercial pound
contains 7217^ grs. imp., 100 lbs. Pr. = 1035 lbs. imp. The Rhenish foot
contains 12.356 British inches. The differences in the weight and measure-
ments of a child are not great enough to be of any importance ; but it is
right to mention that the original figures are adhered to. — Tbansl.

i 80. SIGNS OF FCETAL MATURITY.

Weights and Measurements— Ci>n/mu«rf.

■— ~

Diameter of

Dlwnetwrof

Head.

■

Mo.

Ko.

1 .
t

■a

Lb*.

Inches.

Urn.

Inche*.

115

—

181

I9f

116

—

191

3-1

3i|

117

—

118

—

181

—

119

—

120

—

191

121

—

181

122

—

I9J

123

—

124

—

125

—

191

126

—

201

127

—

128

—

129

—

4»

—

191

130

—

181

—

131

—

191

132

—

133

—

134

—

135

—

136

—

191

137

—

171

—

138

—

4»

—

171

139

—

___

140

—

141

—

142

—

19i

143

—

100

144

—

171

—

101

20i

145

—

102

146

—

191

—

103

—

147

—

104

148

—

105

191

149

—

106

191

150

—

107

151

—

108

—

152

—

101

—

109

20i

153

—

— •

110

—

154

—

111

—

155

—

112

—

156

—

113

157

—

— -

114

—

201

158

"""

§ 80. SIGNS OF FGETAL MATURITY.

Weights and Measurements— Cow^mwee?.

Diameter of

Head.

No.

■i

-a

Lbs.

Inches.

LIM.

Inches.

159

—

204

—

160

—

205

—

161

—

206

—

162

—

207

—

163

—

208

—

17f

—

164

—

209

—

165

—

210

—

18i

—

166

—

211

—

167

—

■ —

212

—

18i

—

168

—

213

—

169

—

214

—

q —

T-

—

^ —

170

1st

—

215*

—

"■^

- —

—

171

8^«

:i8

■3J

—

■ —

216-

—

I8i

—

-—

■ —

172

—

217.

—

_—

—

173

—

218'

'' —

—

174

—

- —

219*

—

— '-

1-L

—

175

—

. —

220-

—

IS-r

■ —

*-.-

, —

—

176

—

221

—

-:r

—

177

—

' —

222*

—

178

—

. —

223*

—

•7

i;-

—

179

—

— ^

224

—

.71

19 ,

' — -'

—

180

—

17i

—

225'

—-

—

181

—

226?

■-^

.Vl8.

—

182

—

227

—

I8i

—

183

—

'-^

228*

—

, —

— ,

—

184

4i.

—

-—'

229

—

20 ^*

^ —

v»

—

185

—

— ;-

230

—

19n;

— :

-*-

—

186

—1

231

—

187

—

232

—

18|

—

188

—

233

—

189

—

234

—

190

—

235

—

191

—

^ —

236

—

192

—

237

—

19i

—

193

—

238

—

194

—

239

^__

_..

—

195

—

240

—

196

—

241

—

197

—

242

—

198

—

243

—

18i

—

199

—

244

—

200

—

245

—

201

___

—

246

—

202

—

247

—

203

—

""""

130

117

S 80. SIGNS OF FCETAL MATURITY.

In 247 mature chfldren tke average length of the body in both sexes
was . - - - 18} inches

The average length of 130 male children

was ... - 19J „

The average length of 117 female chil-
dren was ... 18| „

In 247 matore children the average weight of both sexes

was -

7Albs.

The average weight of 130 male children

was -

7i „

The average weight of 117 female chil-

dren was

6J „

The maximum length attamed

was

in one boy

22 inches

in 38 boys

20 „ and upwards

in 4 girls

21 „

in 23 girls

20 „ and upwards

The minimum length attained

was

in one boy

16 inches

in 8 boys

17 „

in 4 boys

17i „

in 2 girls

16 „

in 13 girls

17 to 17 „

The maximum weight attamed

was

in 4 boys

10 lbs.

in 7 boys

9 to 10 „

in 26 boys

8„

9 «

in 8 girls

9«

10 „

in 16 girls

8„

9 „

The minimum weight attained

was

in one boy

4ilbs.

in 7 boys

under

6 „

in 14 girls

6 «

In 207 mature children the average diameter of the head was

Transversely -

Sj inches

Longitudinally

4i „

Diagonally

4J „

The average diameter across

the shoulders in 117 mature children

was 4tt inches.

§ 80. SIGNS OF FCETAL MATURITY. 23

The average diameter across the hips in 117 mature children was
3^ inches.

8. The naih in mature children feel homy, and not like skin, as
in the ^ earlier months, they reach the tips of the fingers, but never
those of the toes.

9. The cartilages of the ears and nose feel tolerably like cartilage,
and not like mere folds of skin, as previously. The most infalUble
proof, however, of an already advanced condition of ossification is
to be found in the presence of —

10. The centre of ossification of the inferior femoral epiphysis, and for
this, one of the most valuable practical discoveries in forensic medicine,
we have to thank Beclard* chiefly, and also the researches of Ollivierf
and Mildner.J While in the tenth (lunar) month of foetal life, not
one of the epiphyses of the long bones has as yet commenced to
ossify; in the second half of this month the centre of ossification of
the inferior femoral epiphysis commences to form. The easiest way
to find it is to proceed as follows : — a horizontal incision is to be made
through the skin and superficial tissues over the knee-joint down to the
cartilages, the patella is then to be removed, and the end of the femur
made to protrude through the incision. Thin horizontal sections are
then to be removed from the cartilaginous epiphysis, at first more
boldly, but so soon as a coloured point is observed in the last section,
then very carefully, layer by layer, till the greatest diameter of the
osseous nucleus is attained. This appear^ to the naked eye as a
more or less circular bright blood-red spot in the midst of the milk-
white cartilage, in which vascular convolutions can be distinctly
recognised. Figure 24, Plate VIII., gives an unusually correct re-
presentation of such an osseous nucleus, which no one can ever
mistake, if they have once seen it. My own investigations into the
development of this osseous nucleus, which I have to this end
extended over children that have lived some time, comprise as yet but
one hundred and twenty-five cases, and are included in the following
Table.

* Nouveau Joum. de Med. Chir. et Pharm. Paris, 1819, Tom. iv.
p. 107, &o.

f Annales d'Hygi^ne publique, Tom. xxvii. p. 342.

X Prager Vierteljahrsschrift Prag., 1850. Bd. xxviii s. 39, &o.

5 80. SIGNS OF FCETAL MATURITY.

Measurements op the Centre op Ossification in One Hundred

AND TWENTT-PIVE NeW-BORN AND YOUNO CHILDREN.*

Age.

No.

Length.

Wgt.

Diameter of Heftd.

Sex.

RemarkB.

TnuM-

"isr

Inches. 1 Lta.

Inch.

Unee

/Partly stQlbom, partly dead,
\ shortly after birth. ( Vide 2ud
) (German) edition of this work,

—

Var.

\ p. 693.)

In the

—

Stillborn.

seventh

17J

—

Putrid when born.

and

—

Putrid when born.

eighth

Drowned in a cesspool.

solar

15i

—

Stillborn.

month.

( Stillborn ; had lain in the water
( for six weeks.

"~~

~~"

~"~

14J

—

Stillborn.

131

( Taken put of the uterus of the
( drowned mother.

—

Killed by cutting its throat.
Taken putrid out of the water.

—

' —

—

In the

ninth

solar

month.

17f

_«

—

,_1-

Stillborn.

17^^

Stillborn.

X7i

—

— ■

Stillborn.

17i

( Stillborn ; found sewed up in a
1 towel.

—

J Found in the water with a frac-
( tured skull.

, 1

Stillborn.

—

— -'

—

2
21
3
4

Var.

\ Three of these stillborn, four

f killed by suflfocation, and two

I by cranial injuries. ( Vide 2nd

J ((ierman) edition, p. 693.)

19i

—

Stillborn.

Perfectly

—

Stillborn.

mature.

—

Found putrid in a ditch.

Stillborn.
[ Found putrid ; killed by cranial

< injuries (ossification defec-
( tive).

191

Stillborn.

Suffocated.

20i

Killed by a fall at birth.

- * Original weights and measurements retained as in former Table, p. 19,
Vol. III.

§ 80. SIGNS OF FGETAL MATURITY.

M EASUREMEKTS — Continued,

Age.

Len(^.

Wgt.

Diameter of Head.

o»

£ex.

Benurks.

Trans-

"sx-

»jr-

Inches.

Lb*.

Incli.

Inch.

lines

—

-—

—

Stillborn.

,4i

^ F.

Died of cardiac apoplexy.
Drowned; putrid.
Suffocated in a cesspool.

—

( Cranial injuries (defective ossifi-
( cation.

19i

Putrefied.

191

( Drowned in a cesspool (ossifica-
( tion defective).

Died from apoplexy.

—

19i

Drowned in a chamberpot

Found putrid in the water.

I9i

Drowned.

— —

Born alive(ossification defective)
( Stillborn (ossification defective)

19i

1 the large fontanelle 1 1 in. long

PerfecUy

( and 1 in. broad.

mature.

—

Found putrid in the water.

—

Stillborn.

—

{ Stillborn; severe forceps-labour;
( cranial injuries.

Stillborn ; severe labour.

Putrid.

Died from apoplexy.

—

Born alive ; died from apoplexy.

—

Bom alive ; died from apoplexy.

20i

—

Born alive ; died from apoplexy.
i Taken out of a cesspool per-
( fectly putrid.

—

Bom alive ; drowned in broth.

201

( Born alive ; died of cardiac apo-
Born ahve ; drowned m unne.

18i

—

21
21

71
9

31
3

4i
41

5
5i

31
2

—

Bom alive ; died of apoplexy.

( Bom in the ninth month ; died

—

•"""

~~"

next day.

Extra-

Had lived one day (ossification
( defective).

uterine

Lived two days.

life of

(Mature and well -nourished;
( lived three days.

from
one to

—

-~~

■~~

181

Lived four days.

eight
days.

i Bom in the eighth month ; ill-
( nourished ; lived seven days.

Lived eight days.

—

Died atrophied after eight days.

I 80. SIGNS OF FOETAL MATURITY.

Measurements — Continued.

Age.

No.

Lengtk

Wgt.

Diameter of Head.

11
11

Sex.

Aemarfce.

Trane-
Tene

"Sf

^iST

Extra- .
uterine

life of /
from nine *
to fifteen

days.

^ 1
1

Inche*.
18

20
17

Lte.

Inch.

Ineh.

lines

Of
3i

M.
M.

A Stout child ; lived nine days.
Lived fourteen days.
Lived fifteen days ; died syphi-
litic.

Extra-
uterine
life of
from six-
teen days
to one
month.

18
18

—

M.
M.

.Twin brothers; lived nineteen
( days; suffocated in carbonic
< oxide j?as; weakly; atrophied.
f The difference is extremely
^ interesting.

Extra-
uterine
life of

from
one to

three
months.

19
22
19i

20
20

—

5
4

M.
M.
F.

F.
F.

F.
M.

( Well - nourished; lived four

I weeks ; suffocated.

(Very stout; six weeks old;

) drowned.

j Emaciated ; six weeks and four

( days old ; poisoned.

( WeU-nourished (large fontanelle

J only half-an-inch) ; lived ten

\ weeks.

Very stout; eleven weeks old.

Atrophied; ten weeks old.
(Three months old; suffocated
( through carelessness.

Three months old ; atrophied.

Two months old ; atrophied.

Extra- /

uterine

life of

from ^
three to \

six
months. V

—

F.
M.
F.

( Three months and ^ve days old ;
( syphilitic ; atrophied.

Stout child ; six months old.
( Four months and two days old;
( died of sporadic cholera.

Extra-
uterine
life of
from /
seven \
months
to one
year.

—

~~~

—

3
5
4

8
7

F.
F.
M.

M.
F.

Nine months old; much ema-
ciated.

Nine months old ; died atrophied.
(Nine and a-half months old;
\ atrophied and anaemic.

One year old ; much emaciated.
[ One year old ; very fine child ;
) struck dead.

I One year and four days old ;
j died of syphilis and tubercu-
\ losis of the lungs.

S 80. SIGNS OF FGETAL MATURITY.

Measurements — Continued,

Age.

No.

Length.

Wgt.

Diameter of Head.

®S5

Bex.

Bemarks.

Trant-
Ter»e.

"^T

^iar

Extra- (
uterine
life of ]
from one |
to two
years. \

1
1

Inches.

Ltw.

Inch.

lines

F.
M.

( One year and a-quarter old ;
) died phthisical.
1 Rachitic child ; one year and ar
\ half old ; humed to death.

A summary of these observations gives the following results : —

When horn. No. of Children.

In the seventh (solar) month )

In the eighth „ j, j ^^

In the ninth „ 9

Mature 62

8ize of Osseous
Nucleus.

— 2 lines,
f — 4 lines.

From these observations the following conclusions may be drawn: —

a. When there is as yet no visible trace of the centre of ossifica-
tion in the inferior femoral epiphysis, then the foetus can be no more
than from thirly-six to thirty-seven weeks old.

b. The commencement of this osseous nucleus, which is at first
about the size of a hempseed, or of the head of an ordinary fly (half-a-
line), indicates a foetal age of from thirty-seven to thirty-eight weeks,
supposing the child to have been stillborn ; in the opposite case the
child may have been born alive before this time, without any osseous
nucleus, which then becomes developed during its extra-uterine life.
In rare instances of unusually retarded development, a foetus of forty
weeks may exhibit only a trifling commencement of this nucleus,

c. When this osseous nucleus possesses a diameter of from three-
quarters to three lines, it indicates that the foetus must have attained
a uterine age of forty weeks, always supposing of course that the
child has been stillborn. In one instance of unusually retarded de-
velopment, vrith defective ossification of the skull, of a girl born
perfectly mature, we found no osseous nucleus.

d. We may conclude that the child has lived after its birth, when
the osseous nucleus measures more than three lines. Isolated excep-

28 I 80. SIGNS OF FCETAL MATURITY.

tions to this rule in children particularly well developed, will certainly
occur but seldom. But the Table just given proves that the reverse
of this rule does not hold good, that an osseous nucleus of less than
three lines in diameter does not prove that the child has not lived — of
course while duly considering this important symptom, we must not
neglect the other signs of maturity, and we must also take into con-
sideration the individual differences in each child, particularly as to
general nourishment. This symptom has, moreover, the additional
value that it is not obliterated by putrefaction, and we are thereby
placed in a position to determine the age (possible maturity) of a
foetus long after its death by an inspection of the femur alone.*

11. The pupillary membrane is not to be found in a mature child
(indeed not from the end of the twenth-eighth or thirtieth week).

12. The testicles are now found in the scrotum (but they may be
there at the thirtieth week), the scrotum is no longer of such a dirty
brownish-red, or so'smooth as bfcfore the fortieth week, but is corru-
gated and of the usual dirty flesh-oolour.

13. The Mia majora. cover the vagina atid th^ clitoris, whith is no ,
longer prominent. ;

14. The umbilical cord of the mature child is of the average
length of the body, that is from edghteen to twenty-one inchfes^ whilst
it is ia th^ same pi!oportion shorter in immature children. Yet
cords longe(r than from eighteen to twenty-one inches ate very fre-
quent, and, on the other hand, in medico-legal cases entire umbilical
cords are itot generally seen at all, since this usually occurs only in
cases of precipitate birth, where placenta and child are bom together,
and made away with unseparated.

15. Passing by those well-know^ functional differences (not ob-
servable on the dissecting-table) which distinguish a living mature
child from an immature one, I will in conclusion only quote from

• Ollivier relates, op. ciL, p. 346, two cases of this nature. In one, the
remains of a child were found in a cesspool : they were transformed into
adipocire. In the femoral epiphysis, he found an osseous nucleus of a brown
colour, fissured, and like a dried juniper-berry. It measured eight milli-
metres in diameter (3| lines). He concluded from this that the child must
have lived for some weeks. In another case, the skeleton of a child was
found in a chimney. In the femoral epiphysis no osseous nucleus could be
discovered, and 0. held himself justified in concluding from this, that the
child in question had been born before maturity. Vide § 97, for further
information in regard to the state of the osseous nucleus as a proof of the
child having lived.

§ 80. SIGNS OF FCETAL MATURITY.

Giinz, whose careful investigations are worthy of the fullest con-
fidence, the dimermons of the hones of a mature child, which may be
useful in cases of disinterment : — *

Height of the frontal part of the frontal bone .

Breadth of the same ....

Length of the pan orbitalis

Breadth of the same ....

Parietal bone from its anterior superior angle to its in-
ferior posterior one ....

Parietal bone from its anterior inferior angle to its superior
posterior one ....

Height of the pars occipitalis of the os ocdpitis .

Breadth of the same ....

Height of the squamous portion of the temporal bone from
the upper edge of the auditory foramen

Height of the malar bone ....

Breadth of the malar bone ....

Height of the nasal bone . . • •

Breadth of the nasal bone ....

Height of the superior maxillary bone from ike processus
alveolaris to the apex of the processus nasalis

Length of the superior maxillary bone from the spinal,
nasal ant. to the apex of the i^roc. zygamat. .

Length of each half of the lower jaw .

Breadth of the lower jaw

Length of the seven cervical vertebrae

Length of the twelve dorsal vertebrae .

Length of the five lumbar vertebrae

Length of the sacrum and coccyx

Length of the collar-bone .

Length of the shoulder-blade

Breadth of the shoulder-blade

Length of the humerus

Length of the ulna

Length of the radius

Length of the femur

Length of the patella

Breadth of the patella

Length of the tibia

Length of the fibula

All the other supposed signs of maturity, for instance, that the
mouth in mature children is slightly open, the neck full and firm, the
umbilical cord inserted exactly in the middle between the pubis and
♦ Gunz, der Leichnam des Neugeboren. Leipzig, 1827, s. 82.

2 inches 3 lines.

»>

»»

»>

—

>»

—

»>

—

»>

30 S 81. ILLUSTRATIVE CASES.

the ensiform cartilage, we cannot regard as of any value, because of
the extremely numerous exceptions.

§ 81. Illustrative Cases.

Case CCCXXXV. — Judicial Query: Has this Child been

Mature ?

This case was interesting because it occurred under the present
penal code, and yet the circumstances of the case required the matu-
rity of the child to be inquired into, though the law makes no such
distinction. On the 26th of June, 1851, a new-born child was found
in cleaning out a dungpit and was brought to us next day for medico-
legal examination. The unmarried woman W. suspected of having
given birth to the child, confessed that from the middle of November,
1850, to the 20th of April, 1851, she had frequently had carnal con-
nection with N. N. About the new-year her menstruation first
ceased. In the middle of May she suddenly felt herself unwell dur-
ing the night, she went to the pail of dirty water, and there a number
of masses of coagulated blood came out of her sexual parts, in which
however there was no compact mass to be felt. This blood she flung
into the dungheap. The accused consequently confessed to have
given birth, not however to a mature child, but to a five months
foetus. The trifling relaxation of her abdominal coverings, the in-
significant scars on her abdomen, but especially the preservation of
the hymen, all were in favour of her statement and against the sup-
position that she had given birth to a mature child. On the other
hand, the foetus placed before us, which was already much putrefied,
was nineteen inches in length, weighed five pounds, the diameters of
the head were respectively three, three and a-half, and four and a-
quarter inches, the breadth across the shoulders was four inches,
the transverse diameter of the chest was four inches, the longi-
tudinal one three inches, the breadth across the hips was three
inches, the dimensions consequently of a child at the full time and
not of a five months foetus ; the cartilages of the nose and ears were
already firm to feel, as were also the nails, which reached to the tips
of the fingers ; the labia majora covered the vaginal entrance. The
osseus nucleus of femoral epiphysis was two lines and three-quarters
in diameter. The amount of putrefaction present prevented the as-
certaining of any other symptoms, bat these sufliced to prove with

§81. ILLUSTRATIVE CASES. 31

certainty that the child was no five months foetus^ but a mature and
fully-developed child. The appearances found on the mother also,
which corresponded exactly with her statements, were not consonant
with those of the foetus ; here, therefore, we had a case the reverse of
that of a supposititious child, viz., an imputed one ! (The other
appearances, which were not important, are omitted as irrelevant
to the present question.) After the delivery of our opinion the pub-
lic prosecutor did not feel at liberty to go on with the case, since
from the peculiar circumstances of the case there was no objective
corpus delicti existent.

Case CCCXXXVI. — Judicial Query : Has this Child been

MORE THAN MaTURB ?

This case was not a criminal, but a civil one, relative to the dogma
of protracted gestation, and afibrding a scandalous side-piece to the
well-known case of Louis, sur les naissances tardives. Listen, how
far impudence can go ! A man, eighty -two years of age, formerly a
subaltern o£Bcial, had suffered during the latter years of his life
from carcinoma of the bladder and both testicles^ and finally died,
after years of suffering, on the 22nd of August, 18 — , in a state of
general dropsy. He had lived very much alone, for his married
daughter by a former marriage lived abroad (in Russia). From
gratitude for her attentive kindness to him, he had married his cook,
about half-a-year before his death. In January, five months after
the death of her husband, the young widow came forward and de-
clared herself to be six months pregnant (I !), and on the 1st of June,
she gave birth to a female child, the legitimacy of which was, as may
be easily supposed, disputed by the married daughter of the deceased,
who had now returned to Berlin. The weight of the body pro-
duced was seven pounds and a-half, its length twenty inches, the
transverse diameter of the head was three inches and a-qaarter, the
longitudinal four inches, the diagonal five inches, the breadth across
the shoulders was five inches, the transverse diameter of the chest
was four inches, the longitudinal one three inches, the breadth
across the hips was three inches : and in accordance with these
figures, which perfectly represent the normal measurements of a foetus
of forty weeks, we, in the first place, gave a negative answer to the
question put to us : — Is this an eleven months foetus ? Next in
regard to the life and death of the child, only two portions of the

32 § 81. ILLUSTRATIVE CASES.

lower lobe of the right lung were of a bright-red colour and floated^
aU the other criteria were in favour of the child having been dead
when born. We assumed that the child while in the birth had made
an attempt to breathe, but had subsequently died and been stiUbom.
This supposition was subsequently confirmed by the accoucheur, who
stated, that the child had died apoplectic while being turned, and was
dead when bom. — (This case, like that of Louis, gives an instructive
proof how important it is in all cases of doubtful protracted gesta-
tion to ascertain the procreative power of the presumed father at
the nominal period of impregnation. lUis man, as above described,
was said to have been capable of procreating four weeks before his
death ! !.)*

• Vid. Biological Part, Spec. Div., § 31.

CHAPTER II.

OF THE LIFE OF A CHILD DURING AND AFTER BIRTH.

Statutory Regulations.

General Common Law, § 12, Tit. 1, Part I.— Civil rights, tohich
would have been inherited hy a child yet unborn, if it had been a^ctually
born at the time of its conception, are reserved for it conditionally on
its being born alive,

§ 13. In regard to this, it is to be assumed as jfyroved, that a child
has been bom alive when unimpeachable witnesses jpresent at the birth
have distinctly heard it cry.

§ 82. Life without Respiration.

The teclinical language of forensic medicine attaches to many
expressions a sense diflferent from that aflfixed to them in general
medical science, and this must be so, since forensic medicine has
quite specific (judicial) purposes to serve. Thus it speaks of
''Insanity,'^ "Idiocy,'' ''Important injury,'' and the like, in the
sense which the statutes and their makers have assigned to these
words. Thus also the word ' Life ' when spoken of in connection
with a newborn child, is not used in the same general physiological
sense in which all organic beings, even plants, and of course also
the foetus in utero, may be said to live, but in foro the term ' Ufe'
must be regarded as perfectly synonymous with the term 'respiration.'
Life means respiration ; not to have breathed, is not to havh
LIVED. Only that life of a newborn child which is dependant on
respiration, mdependent and unconnected with the mother, can be
proved; every other life is only hypothetical, and the medical jurist
can only base his decision upon proof. Of course it cannot be
doubted that life without respiration is possible, and does occur in the
case of newborn children, Daily experience proves irrefragably that
children are born apparently dead, which do not, therefore, breathe,

VOL. III. D

34 5 82. LIFE WITHOUT RESPIRATION.

and which are yet subsequently roused to respiratory life.* It
cannot be doubted, that a child possessing only this pseudo-life can
be killed, passively as well as actively, by omission as well as by
commission. If no attempt at resuscitation has been made, the
spark of this pseudo-life may have been extinguished thus, and thus
alone. But who would presume to suppose, in any given case, the
subject of an accusation, that this spark would have been kindled to
the full flame of life, had this attempt not been omitted ? It would
probably be easier to prove the murder of this pseudo-living child,
supposing it to have been actively ill-treated. It is possible and
imaginable that the circumstances of a given case might supply more
or less complete proof that a child bom, not dead, but only apparently
so, had been killed immediately after its birth. In regard to this,
Devergie's opinion, which is remarkable as coming from a practical
man, is perfectly erroneous, and deserves to be warned against; he
says, that the appearance of coagulated blood, about the head
or elsewhere, will afford proof of this character in such cases. I
have already (Gen. Div., §11, p. 28, Vol. I.) opposed this er-
roneous doctrine, and I shall return to the subject by and by
(§102). But other appearances may exist on the body, which
may make it probable, and perhaps prove, that violence has been
infficted upon a body apparently dead. For instance, the throat
may be cut, the larynx or cranial bones may be fractured, or there
may be a mark of strangulation, &c., and it is not even impossible
that traces of reaction may be found upon the injured parts, as
happens indeed even in the case of injuries inflicted after death has
actually occurred (Spec. Div., § 33, p. 117, Vol. I.). Nevertheless,
such cases are extremely rare; their peculiarities must, therefore, be
distinctly apprehended, and the matter placed clearly before the
Judge, and left for his decision how far proof of a crime is thereby
afforded. Still more rare are all those cases which have been fabri-
cated and published, or sought for in older records with a diligence
worthy of a better cause, and which are also intended to prove the

* Dr. Masohka has published in the Prager Yierteljahrschrift (1854, 1X1.,
s. 1, &o.)) two oases whioh, in this respeot, may be said to stand alone ; the
one he relates from documentary evidence, the other was observed by him-
self. The first was the case of a child which was bom secretly and buried,
and was roused to life after the lapse of seven hours ; the second was a child
bom apparently dead, in which the sounds of the heart could be faintly
heard after the lapse of twenty-three hours.

§ 82. LIFE WITHOUT RESPIRATION. * 36

possibility of life existing without respiration, and rightly so if only
meant to refer to life of one second's duration, such as birth of the
ovum entire, birth in a bath, &c., cases which are to be looked upon
as curiosities, and to be decided on in accordance with the other
circumstances attendant on the birth, but which are certainly not
fitted to find a general application in the occurrences of daily life,
that is, in regard to the immensely larger proportion of usual births.
Consequently — ^there is, as must be confessed, a short post-partum
life without respiration ; but there are no means of recognizing the
previous existence of such a life, after it has ceased, therefore a life
of this character is not acknowledged in medico-legal practice, which
only acknowledges the existence of a life dependant on respiration,
because that is the only one whose existence can be recognized and
proved. The correctness of this dogma has been recognized from the
earliest times. In Galen's work Be Loc. Aff., libr. VL, Cap. F., we find
the following passage : — In confesso est, respirationem a vita et vitam a
respiratipne separari non posse, adeo ut vivens omnino spiret et spirans
omnino vivat. Short and clear ! As in the Latin dialects the word
'expire' {expirer) is synonymous with mori, so also in the parent
tongue was the similar word exspirare, whilst we (the Germans, who
have no such word as ' expire') use the more figurative expression of
Ho exhale the last breath' as equivalent for 'to die.' And, what is
not without special bearing on our subject, the identity of respiration
with life has even been recognized in the language of lawyers, for in
it exspirare signifies to die, to disannul, to become extinct, to cease
to be; since the Pandects employ the expression, obligatio exspirat.
We can perceive the value placed by the ancient lawgivers upon the
pulmonary function as an evidence of the child's life, both from the
pre-Justinian and the old German statutes, according to which the
well-known "crying within four walls" {vox attdita intra quatuor
parietes domus) was required as necessary to the proof of life. The
quotation from the General Common Law which we have already
given (p. 83, Vol. III.) shows that our Prussian statute book also
requires the " cry" of the child as proof. On the other hand, it has
been objected to our statute book that it actually assumes the possi-
bility of a life without respiration; since its §§ 181 and 182 already
quoted, speak of the death of the " foetus in a pregnant woman," and
only that which has life can be killed. Ergo I But, although, as we
have already hinted, it can never be contested that the foetus in the
womb does " live," yet it must be acl^owledged that the lawgiver

i>2

36 -§ 82. LIFE WITHOUT RESPIRATION.

looks upon the matter from quite another point of view than the
physician, particularly the forensic physician. The former has been
at all times perfectly in the right to threaten foeticide with punishment.
In his position, he is bound to protect the earliest commencement of
human life as carefully as that already developed into man, and a
foetus is in by far the lai^er proportion of cases the first commence-
ment of a human being. And if the future existence as man of this
Aomunculus may be rendered impossible by a criminal procedure,
dare the legislator, in the interest of public safety and morality, ig-
nore this possibility, and leave the crime unpunished ? Certainly not.
But this position and duty of the legislator have no bearing whatever on
those of the (forensic) physician. The latter in such a case has only
to explain to the Judge that the death of the foetus in the womb has
or has not occurred. His task is then fulfilled, and should he be asked,
as I once was, whether the expelled foetus had been alive in tKe
womb ? he may answer the question affirmatively with an unbur-
dened conscience, notwithstanding any further explanation which he
might feel himself bound to give, if called upon to define the nature
of tAis (foetal) life. The Judge will not hesitate one instant in regard
to the views and intentions of the legislator, notwithstanding the
limitations of this definition ! ^ And with suck arguments, as those

* To tMs opinion, it has been judicially objected, that it is a most dan-
gerous view to hold in regard to criminal cases, since it might happen that
actual child-murder (on living but not breathing children) might remain
unpunished, because the forensic physician holding this opinion has de-
clared that the child was not " alive." To this Judicial objection, in itself,
we have no remarks to make, — except that, according to our many years' ex-
perience of criminal life, it has certainly more the air of ^ priori theory than of
a posteriori, practice about it ; that is, in other words, that cases such as those
supposed are of very rare occurrence in real life ; — we have only to repeat,
that the forensic physician must steadily maintain his own mce?eco -scientific
position. And in regard to this, we must still assert there is only one kind
of life — that dependant on respiration — that can be proved. Moreover, even
if it concerned us, we can scarcely believe that actual and evident attempts
at child-murder, such as cutting the throat, smashing the skull, &c., of
children who can be proved never to have breathed, can be so perfectly
ignored and looked upon as non-existent, as seems to be feared in the judicial
opinion just given, provided the medical expert does his duty in properly
estimating all the circumstances of the individual case, and laying it clearly
before the Judge ; for, as we have distinctly laid down in all the foregoing
paragraphs, the case must be decided as a whole, and not in its separate par-
ticulars. Finally, to the fact that our opinions are also held by the highest
Medical Board of the country (J^ide the New Regulations, Vol. I., p. 92),

§ 83. VAGITUS UTERINUS. 37

quoted (p. 34) has it been thought possible to diminish the proba-
tive value of the docimasia pulmonaria ? And is there any one mode
of proof in the whole range of forensic medicine that could stand firm
against such a mode of confutation ? Are the ordinary modes of
chemical investigation in cases of arsenical poisoning useless and un-
certain, because in many cases — and sooth to say, much more often
than in those above referred to — no arsenic can be detected, though
it has been undubitably present ? Is this too the case with the criteria
employed to determine a doubtful case of pregnancy, because, as is
well known, they are not applicable in every instance, nor at every
period of every pregnancy ?

The other objection so often made to the probative value of the
docimasia pulmonaris is apparently of more value than that just
referred to, namely, that though the docimasia pulmonaria may
prove the respiratory hfe of the child, yet this is all, and it cannot
decide that respiration has not occurred b^ore birth, has speedily
ceased, and the child has then been bom dead.

§ 83. Respiration befoee Birth. — Vagitus Uterinus.

The doctrine of the vagitm uterinus has recently been removed
from the domain of the lying-in room, and placed upon the field of
scientific observation by Kohlschiitter, Mayer, Berard, Jaquemier,
Vierordt, Hecker, Schwartz, &c.* I refer, namely, to the discovery
of capillary extravasations beneath the pleura, upon the aorta and on
the heart, which I have ij^ra^^^ ^petechial ecchymoses, to give a proper
idea of them to those unacquainted with them, because they are in-
deed strikingly like petechige. These have been already described in
speaking of the death of newborn children from suffocation (Spec.
Div., § 40, p. 126, Vol. II.), and we have there pointed out how fre-
quently, and by how many observers, this appearance has been noticed.
We have also already shown that the origin of this appearance can be

we will not ascribe more than its due value ; for however honourable this
may be, we willingly confess that in matters of science there is no superior
tribunal.

• It is unnecessary to do more here than refer to the oft-quoted case of
respiration within the ovum, first published by Huter in the " Deutschen
Klinik" of 19th April, 1856, and subsequently in his pamphlet on the occur-
rence of air in the human ovum (Marburg, 1856), and his quite peculiar
statement in regard to the development of air within the human ovum ! !

38 $ 83. VAGITUS UTERINUS.

ascribed to no other cause than to a kind of instinctive and forced
respiration within the uterus, when the natural and necessary pro-
cess of gaseous interchange, afforded by the umbilical cord and
placenta, has been disturbed or interrupted. It certainly deserves to
be called remarkable that forensic medicine up to the latest date has
taken no notice of a physiological doctrine, already adverted to by
Bohn one hundred and fifty years ago, and which has occupied much
of the attention of physiologists and accoucheurs. — Since, therefore,
it can be no longer doubted, that the foetus may make instinctive
attempts to respire, and in certain circumstances necessarily does so,
so also it must, i jpriori — even though it had never been heard '^ to
cry in the womb'^ — ^be acknowledged that it might make more per-
fect and successful respiratory movements. Hecker has observed
and related a case which is too important to be omitted here,*

'^A multipara, aged twenty-eight, on the '20th of May, 1853,
without having felt more than the merest indications of commencing
labour, lost suddenly in bed a large quantity of liqtwr amnii, and on
examination, along loop of the cord, pulsating normally and distinctly,
was found prolapsed beyond the external genitals, and lying along the
posterior wall of the pelvis. Th& os uteri was dilated to the size of
a halfpenny, and the head of the child was felt to be very moveable
and high above the brim of the pelvis. The sounds of the foetal
heart were distinctly heard at the left side of the mother. The attempts
to replace the cords with instruments failed, so it was only pushed into
the vagina, and kept there by a piece of sponge. One hour subse-
quently the OS uteri was completely dilated, but instead of the head of
the child, which had evidently receded to the left, the right elbow
was now found presenting ; the pulsation in the cord remained the
same. The version of the child, performed under chloroform, was by
no means difficult, but in introducing the hand along the posterior
wall of the pelvis, it was found impossible, in endeavouring to keep
the loop of the cord to one side, to avoid making some, though but
slight, pressure upon it, and the repeated deep inspirations made by
the child, and distinctly felt by the hand employ ed^ showed that this
pressure was sufficient to produce an immediate besoin de re-
spirer. The head presented no inconsiderable obstacle to the ex-
traction, though the usual traction was powerfully put in force. The
child, a girl, seven pounds in weight, and ninet^n inches long, was

• Op. cU., p. 127, Yol XL, 8 19.

§ 83. VAGITUS UTERINUS. 39

asphyxiated when born, and could not be resuscitated though arti-
ficial respiration was employed very successfully, as proved by the
dissection. Hypersemise in the thoracic and abdominal organs, and also
subpleural extravasations were not absent in this case. Whether air
had actually got into the organs of respiration during the intra-
uterine attempts at respiration detailed, could not, of course, be
ascertained, because of their artificial inflation.^'

To this we may annex the analogous observations of Hohl,* in
cases of breach presentation, where, with the head still lying in the
pelvis, the uterus has contracted and separated the placenta, without
the head being thereafter speedily delivered. In two such cases Hohl
has seen "the thorax of the child elevated three or four times after
each other J' and the child thereafter bom dead. In the lungs of
both children there was no trace of air. In one case also oi placenta
pravia, this accoucheur observed respirrtory movements. During
the version and extraction of the child, which was immediately per-
formed, Hohl observed "even during the version, lively respiratory
movementSy' which he regarded as '^actual inspirations" The child
was dead and pale. In all these three cases th^e were found peter
ehial ecchymoses, namely, " numerous punctate extravasations on the
surface of the heart and lungs.^^

It cannot, therefore, be doubted, that attempts at respiration are
made by the intra-uterine foetus even before the membranes are rup-
tured, and that the liquor ^nnii may actually be thus inhaled ; nor
that similar attempts may be made cfter the rupture of the mem-
branes, and that the child may still be born dead {Fide p. 128,
Vol. II.). t But what connection have these interesting physiolgi-
cal experiments with the medico-legal docimasia pulmonaris? Th^
lungs of these children sank under water in every case, except in
those few in which the artificial inflation employed in the attempts
to resuscitate them had made the lungs capable of floating. AUthe
children were bom dead; indeed, in several cases related by Elsasser
they were putrid. From another and totally diff^ent point of view,
also, the fact of intra-uterine r^^vcdXion, practically considered, is not
without influence on the solution of the question of the doubtful life
of the extra-uterine foetus — the child after birth. In all these cases in
which children which had made intra-uterine attempts to respire have

• Op, cit, p. 128, Vol. II., s. 837.

t Vide the experiments made by Schwartz on foetal rabbits, related at
p. 128, Vol. II.

40 5 83. VAGITUS UTERINUS.

been assisted into the world by accoucheurs^ the labour has been^ with-
out exception^ assisted and more or less laborious, as indeed is apparent
from a consideration of the conditions necessary for the production of
instinctive respiratory movements. How much greater must the
delay in the birth and the other favouring circumstances be sup-
posed to be, which actually must occur and coincide, in order to
permit the occurrence of not merely a few short, instinctive, and
fruitless respiratory movements, but of actual respiration — ^the
streaming in of atmospheric air into the air-passages ! The liquor
amnii must have escaped, the child, which is not advancing, must
have the face presenting, the os uteri must be fully dilated, and the
vaginal canal kept forcibly open by the hand or otherwise, in order to
favour a true and actual process of respiration. In the few cases of
vagitus uterinus aU these conditions did in fact concur. But do they
also concur in those cases with which the medical jurist is concerned,
or in those newborn children which are found dead, and which give oc-
casion for the employment of the docimasia pulmonaris ? The question
must be answered unconditionally in the negative. Even if it were
not known that concealed births — and only such can give occasion to
the application of the test — are anything but protracted, but that they
are rather in by far the larger proportion of cases very rapid in their
course, or indeed precipitate, because they could not otherwise be
concealed,* such must have been for that very reason, h priori, sup-
posed to be the case. In cases of rapid labour, however, all the con-
ditions necessary, as well as all the exigencies which might necessitate
an attempt to respire in uiero, are wholly wanting. Considering,
therefore, that from the nature of the circumstances, only those new-
bom children are subjected to the dodtnasia pulmonaris whose birth
has been concealed, that concealed births are very rapid, while the
vagitua uterinua cannot take place in such rapid births, but only
where the labour is protracted and requiring the assistance of art,
THAT UESPIBJLTION WHICH IS PEOVED BY THE docimosia pulmonaris

TO HAVE OCCXJREBD IN THE CASE OP A CHILD SECEETLY BORN, IS TO BE
REGARDED AS HAVING TAKEN PLACE NEITHER DURING, NOR BEFORE,
BUT AFTER ITS BIRTH, and the child MUST, THEREFORE, BE REGARDED

* Amongst the medico-legal oases of dissection of newborn children which
come before us, there constantly occur a most disproportionately large
number in which the children have been found still attached to the placenta,
and are thus laid before us: a sufficient proof of the frequency of precipitate
labour in oases of concealed birth.

§ 84. THE DOCIMASIA PULMONARIS. 41

AS HAVING B££N BOSN ALIVE. Cascs in which the chfld with ids
head already bom and lying between the thighs of the mother, ex-
posed to the current of atmospheric air, which excites its respiration,
can be no longer reckoned among instances of vagitus uterintis.*

§ 84. The Docimasia Pulmonaeis. — a. Vaulting of the Chest.

That the thorax of a child which has breathed, particularly when
it has thereby completely distended and filled its lungs with air and

* The yiew here adopted, which is the only one at all answerable to the
case, is not new, but was laid down forty-seven years ago by our superior
Medical Board, the Royal Scientific Commission, in an opinion distinguished
by its brevity, without anything of importance being omitted. It is here
given entire. It is dated 27th Feb., 1816 : — " In accordance with a requi-
sition £rom the Supreme Court of Judicature, the Ministry of the Interior
has requested the Scientific Commission for Medical Afiairs to deliver their
opinion upon the two following questions : 1st. "Whether there are any in-
fallible signs that respiration has taken place in utero materno f 2nd.
What signs shall for the future be reckoned decisive as to the life of a child
subsequent to its extrusion from the maternal genitals ? In regard to the
first question, the only infallible proof is the declaration by trustworthy
persons, that they have distinctly heard the child cry before it was extruded
from the maternal genitals, and when the incidents at the birth agree with
this. When, for instance, a person has been long in labour, so that, from
the entire absence or deficiency in number or power of the pains, after the
escape of the liquor amnii, the hand of the midwife or accoucheur has to be
introduced into the uterus, in a favourable position of the child, the air
entering by the interstices made by the introduced hand may be sufficient
to produce respiration and crying ; this can also more easily happen when
the head has already passed the o8 uteri, and the rest of the body has to be
delivered by the midwife or accoucheur. Consequently, the conditions
necessary for the production of this vagitua uterinua are of rare occurrence,
and, as is particularly to be borne in mind, can only happen in a tedious
labour, in which manual assistance has been given. Therefore this phenomenon
is never to he assumed in cases of concealed birth, which happen rapidly and
without extraneous aid. In these cases the child respires first after it has
been bom, and the Judge can never be placed in any doubt by this pheno-
menon, in regard to whether a child has lived after birth or no."

** The latter part of our opinion has already sufficiently answered the second
question. In every case of rapid and concealed, that is, self-delivery, the
life of the child is to be regarded as a life after birth. Should, however, a
case occur to a Judge, of an assisted birth in which it was requisite to know
whether a vagitus uterinus had taken place, and whether a child previously
breathing and crying had been dead when extruded from the maternal
genitals, this could only be decided by the testimony of witnesses."

42 § 84— a. VAULTING OF THE CHEST.

blood, must be elevated and dilated, and consequently be more
vaulted than previously, is just as certain as that it must, therefore,
appear justifiable, in biostatic experiments, to pay attention to the
degree of vaulting of the osseous thorax. Mere ocular measurement
is, however, not sufficient here, it is indubitable that a mere ocular
estimation cannot be termed an observation, since flat, and vaulted, in
relation to the thorax of a newborn child, are very ambiguous defini-
tions, and are not sufficient to satisfy even the most experienced indi-
vidual who may have had hundreds of such bodies before him.* The
ancient method (Daniel) of measuring the vaulting with a thread is
but little better, since not only may the thread be more or less
stretched in applying it, but its texture may also be more or less ex-
tensile, and differences may be thus introduced which may be
actually greater than those to be measured, which can only amount
to fractions of an inch. The only method of measurement which can
be depended upon, and which is, therefore, now generally employed,
is to take the transverse and longitudinal diameters of the thorax by
means of a pair of callipers. Both of these measurements must be
greater subsequent to the complete commencement of respiratory
life after birth, than they have been in Ikis same child shortly be/ore
its birth. The thesis is incontestably true ; but its practical appUca-
bility is not thereby increased. For who has measured the diameters
of any given child previous to its extrusion from the uterus ? We are,
therefore, obliged to resort to general comparisons, numerical
averages, with which the results obtained in any given case are to be
compared. This method may be perfectly sufficient where the indi-
vidual peculiarities present such unimportant diflferences that the
numerical average of large numbers, say of one hundred observations,
differ but little from the results of each single observation. Such is
the case for instance in regard to the conformation of the head of
mature newborn children, the diameters of which are so constantly
almost the same, that the numerical averages obtained are not merely
the result of a computation of maxima and minima, but may be
always confidently employed as a means of ascertaining the doubtful
maturity of the body of any child which may be brought before us.

• Up to the end of 1853, the number of bodies of illegitimate children either
born dead, or that had died shortly after birth, which had been officially in-
spected by me (for the purpose of filling up the burial certificates), amounted
to 1695 in aU, and all the data capable of being afK)rded by inspection were
carefully attended to, and among these the conformation of the thorax.

$ 84— a. VAULTING OF THE CHEST. 43

And the question is, whether the diameters of the thorax in newborn
children, those bom alive as well as those bom dead, present any
similar or even approximativelj similar constant relative proportions,
in order to enable us to make an analogous use of the numerical
averages obtained from a large number of observations? This
question must be met by an unqualified negative. The following
table comprehends the measurements of the thorax of 238 mature
newborn children, 158 of them bom alive and 80 dead. The first
102 cases were recent bodies and actual medico-legal cases. I have
eliminated all those numerous cases of bodies in an advanced degree
of putrefraction as too uncertain, since the distention of the body
completely alters the measurements ; the other 186 cases have been,
like those detailed at p. 19, Vol. III., measured at my desire in our
two Eoyal Maternity Hospitals. It was to be expected, h priori, that
differences in the manner of applying the measuring instrument,
when performed by different observers, that the longer or shorter
duration of the respiration, that the different degrees of maturity of
the different children, that the varying conditions of the bodies and
other drcumstauces, must eaert some influence upon the results of
the measurements. It has actually happened in our observations, as
well as in those of earlier observers, that real and important differ*-
ences have arisen, which distinctly point out the uncertainty of the
diameters of the thorax as a criterion of the docimasia jmlmonaris.

5 84— a. VAULTING OF THE CHEST.

DiAJIBTEKS OF THE ThOHAX IN 238 MATUKE NeWBOKN ChILDEEK-
158 OF THEM BOKN ALIVE, AND 80 DeAD.

Original Measurements retained as in former Table, p. 1 9, Yol. III.

Diameter

No.

of Thorax.

No.

of Thorax.

alive; drowned

bom dead

„ hemorrhage

—

alive; apoplexy

„ apoplexy

—

" "

it ^

—

„ suffocated

„ drowned

—

born dead

—

alive; drowned

—

„ apoplexy

—

11 It

—

„ suffocated

—

„ apoplexy

—

alive

,) ,)

—

born dead ;

born dead

weighed 10 lbs.

alive?

—

alive

alive; apoplexy

—

It tt

—

ti 11

—

„ drowned

—

bom dead

—

„ apoplexy

—

„ apoplexy

—

11 11

—

11 11

—

11 11

—

11 11

—

alive; weighed

—

born dead

10 lbs.

—

it It

born dead

—

11 it

alive; apoplexy

—

It it

___

,, ?

—

alive; drowned

„ apoplexy

—

„ putrid
„ drowned

9
it *

—

yy suffocated

bom dead

—

11 apoplexy

„ weighed

—

11 ^ 11

10 lbs.

—

„ pulmonary

alive; apoplexy

apoplexy

___

)} 19

—

•. ,.

—

„ cranial m-

— "

„ apoplexy

juries

§ 84 -a. VAULTING OF THE CHEST.

Original Measurements— Continued,

Diameter ,

Diameter

No.

of Ihorax.

No.

«j

of Thorax.

alive ?

106

born alive

born dead

107

))

alive; died atro-

108

—

))

phic

109

—

alive; fall at birth

110

—

born dead

111

—

3§

—

alive; apoplexy,

112

—

pulmonary and

113

—

cerebral

114

—

alive ; cranial in-

115

—

juries

116

—

alive; pulmonary

117

—

apoplexy

118

—

119

—

alive ; cranial in-

120

—

>»

juries

121

—

>»

putrid; born alive

122

—

alive; drowned in

123

—

a cesspool

124

—

alive; suflfocated

125

—

126

—

„ drowned in

127

—

a cesspool

128

—

„ suffocated

129

—

» ft

130

—

born dead

131

—

»»

alive; drowned in

132

—

a cesspool

133

—

alive; drowned

134

—

>»

in pap

135

—

100

alive; cardiac

136

apoplexy

137

—

101

alive; drowned

138

—

in urine

il39

—

102

alive; apoplexy

1140

—

»»

103

born alive *

il41

—

104

142

—

105

—

143

• As were all the following, down to No. 188 inclusive ; these numbers,
inclusive of the four next following children born dead, that is, from No.
103 to 192 inclusive, are the measurements made in the Charit6 Maternity
Hospital.

5 84-a. VAULTING OF THE CHEST.

Original Measurements — Continued.

Diameter

No.

of Thorax.

No.

of Thorax.

181

—

144

bom alive

born alive

145

—

182

—

»)

146

—

183

—

147

—

184

—

))

148

—

>»

185

—

149

—

»>

186

—

150

—

>»

187

—

151

—

>»

188

—

152

—

»>

189

—

born dead

153

—

190

—

))

154

—

191

—

155

—

»»

192

—

>»

156

—

193

—

born alive *

157

—

194

—

))

158

—

))

195

—

})

159

—

196

—

))

160

—

197

—

161

1 1-

198

—

162

>»

199

—

163

200

—

164

—

201

—

165

—

202

—

166

—

»>

203

—

167

—

204

—

3»

168

— 1

205

—

))

169

— 1 1

206

—

)»

170

— ' 1

207

—

171

1 —

208

—

})

172

1 ,-

209

—

3»

))

173

1 ' —

210

—

))

174

1 —

211

—

))

175

—

212

—

)}

176

—

»»

213

—

})

177

—

214

—

178

—

215

—

179

—

216

—

180

"""

217

""~

3«

»>

* As also all those up to No. 236 inclusive ; these and the two following
dead-bom children, consequently from No. 193 to 238 inclusive, were
measured in the Royal University Maternity Hospital.

§ 84— a. VAULTING OF THE CHEST.

Original Measurements— Continued.

Diameter

DiftiTit^ttr

No.

of Thorax.

No.

of Thitriix.

43
5

218

__^

1 \z\

born alive

229

born ftlive

219

—

230

—

220

-|3^

»>

231

—

221

-MM

232

—

222

— 4

j»

233

—

223

- 3J

»»

234

—

311

224

—

235

—

225

—

>»

236

—

226

____

j»

237

—

born deAd

227

238

—

228

"~~

>»

This Table, therefore, supplies the following numerical averages :

Before Respiration.

The transverse diameter of the thorax averaged 3f inches.
The antero-posterior diameter „ „ 3 „

The maximum transverse diameter „ 4f „

The minimum transverse „ „ 3i „

The maximum antero-postrrior diameter „ 3 J „
The minimum antero-posterior „ ,, 2^ ,,

After Respiration.

The transverse diameter of the thorax averaged Z\ inches.
The antero-posterior diameter „ „ ^

^le maximum transverse diameter „ 4|

Iw minimum transverse „ „ 2f

The maximum antero-posterior diameter „ 4J
The minimum antero-posterior „ „ 2J

When from these it is apparent in a most remarkable manner, that
the thorax of those children bom dead had actually in the average a
somewhat longer transverse diameter than that of those born alive,
while the antero-posterior diameter of the latter is in the average
longer than that of the former, though very inconsiderably so, when
we find that the maximum and minimum deviations amount from

48 I 85— ft. POSITION OF THE DIAPHRAGM.

one-half to three-quarters of an inch, when, finally, we find in indi-
vidual but frequent instances that the diameters, both before and after
respiration, are perfectly alike, it is evident that the measurements of
the chest, that is, that the vaulting of the thorax is of not the
slightest diagnostic value. Elsasser has arrived at quite the same
conclusions from the results of his measurements of the circumference
of the thorax ;* from these I quote only the following convincing par-
ticulars, in a series of fifty measurements undertaken on mature
Uving children; the maximum and minimum were 13*5 and 9*9
(Wirtemberg inches) — ^avery considerable difference, in eight mature
stillborn children the maximum circumference of the thorax was 11*3
inches, and the minimum 10*1 inches. E. says, '^it is irrefutable
that the variations in the circumference of the thorax (and of course
in its diameters) are so considerable, that no certain normal mean for
a thorax that has breathed, and for one that has not breathed, can be
laid down. In most cases the measurements of the thorax are
incapable of determining whether the lungs contain air or not. The
reason for these variations is, without doubt, to be referred to the
congenital differences in the volume of the osseous thorax, partly also
to the thickness of the soft parts, particularly of the subcutaneous
fat and the thoracic muscles, partly also in the differences in the
degree and amount of the dilatation of the thorax by respiration, with
which the distention of the lungs also corresponds,'* &c. Founding
upon these recent scientific results, the new Prussian Regulations
(p. 86, Vol. I.) have very properly done away with the measuring
of the thorax, as perfectly superfluous.

§ 85. Continuation. — h. The Position of the Diaphragm.

In considering this criterion as in that just treated of, I for the
present abstain from any consideration of the objection s#frequently
made against the docimasia pulmonaris, that the lungs may be dis-
tended by artificial inflation, I shall recur to this part of the subject
in § 92. This influence being abstracted, it is evident that the foetal
position of the diaphragm must necessarily be higher than after
respiration has taken place, and it is justifiable to take this into
consideration when the diaphragm is found to be depressed. The
position of the diaphragm is most easily ascertained, by making a

♦ Op, cit, p. 11, Vol. III., 8. 6.

§ 86— c. THE LIVER TEST. 49

longitudinal incision through the skin and superficial cellular tissue,
from the chin to the pubis, in the mesial line, dissecting these from
the thorax on both sides, next carefully opening the abdominal
cavity, introducing the finger of one hand into it, and pressing it up
to the highest point of the concavity of the diaphragm, and then
with one finger of the other hand reckoning off the intercostal spaces
from above downwards till both fingers correspond. The rule is,
that the highest point of the concavity of the diaphragm in children
bom dead, is between the fourth and fifth ribs, and in those bom
alive, between the fifth and sixth. Deviations from this rule are
comparatively rare, therefore the position of the diaphragm is a good
diagnostic sign. However, respiration of but a very transitory
nature, which does not distend the lungs much, nor greatly increase
the amount of blood contained in them, may circumscribe the proba-
tive value of this symptom, and this is also the case where the dia-
phragm is forced upwards into the thorax by considerable accumula-
tions of gas in the stomach and intestines, which very readily happens ;
and in this case the diaphragm, in children which have unquestionably
breathed, may occupy a position quite as high as it did previous to
respiration. The reverse of this also sometimes happens, where in
children born dead the diaphragm occupies a lower position than it
ought, from being forced downwards by the distention of the thorax
with the gaseous products of putrefaction.

§ 86. Continuation. — c. The Liver Test.

I do not think it necessary at present to submit to an extended cri-
ticism either the liver test itself, or the experiments of Bemt, Wild-
berg, Tourtual, &c., which are not supported by any large experience,
and which the absence of personal examination does not warrant me
in criticising. All these tests have arisen from an unfounded idea of
the deficiency of the ordinary dodmasia pulmonaris; they are all much
too complicated to be practically useful, and the Prussian " Eegula-
tions,'^ as well as the Austrian, have with great propriety completely
ignored them. As to the liver test in particular, it is quite incom-
prehensible how it should ever be proposed to base a so-called liver
test upon the fact, that the liver commences to decrease in weight
with the commencement of respiratory life, that consequently the
weight of the liver must alter relatively to that of the rest of the
body. If we consider on the one hand, that it is not possible for

VOL. III. B

50 § S7—d. VOLUME OF THE LUNGS.

this alteration in the weight of the liver to be coincident with the
first few breaths drawn^ but that it must at the most commence gra-
dually with the continuance of respiration, and be only then evident and
capable of being proved, when from the long continuance of the
respiration there can be no difficulty in satisfactorily proving it by
the ordinary docimana pulmonaris ; wherefore the liver test is in this
respect superfluous. What, however, is superfluous in regard to the
docimasia pulmonaris, is actually injurious and objectionable, since,
as experience teaches, it only gives occasion to unfounded attacks and
doubts on the part of our opponents. On the other hand, however,
a test founded upon the weight of the liver ought to be banished from
practice as uncertain, because it rests upon a fact, the weight of the
liver, which is in itself extremely variable, and therefore incapable of
affording any conclusions. When such careful observers as Bemt
and Elsasser have found so great variations, the former in one
hundred cases having found in the weight of the liver of those chil-
dren bom dead a difference of from 3 oz. 8 drs. (imp.) to 7 oz. 8
drs. (imp.), and in those that had respired perfectly, from 2 oz. 8
drs. (imp.) to 9 oz. 8 drs. (imp.) ; the latter, in 65 cases of mature
children bom dead, found a variation in the weight of the liver from
2 oz. 12*8 drs. (imp.) to 9 oz. 2*4 drs. (imp.) ! ! and of rela-
tive weight to the rest of the body from 1 : 44*47 to 1 : 34*77 : the
liver test is thereby completely deprived of all confidence. Since the
weights in those born alive and those bom dead resemble each other
in their great variations ; and averages and relative weights do not
improve the matter, for in every medico-legal case the individual
by himself and not collectively is the object of investigation and of
proof: therefore we are justified in stating tAat the liver ted is
unworthy of the slightest consideration.

§ 87. CoNTnajATioN. — d. Volume of the Lungs.

It is well known, that after removal of the anterior wall of the
chest, foetal lungs are found not to fill the cavity of the chest, and in
particular the left lung is never found even partially covering the heart,
whilst after respiration they fill the thorax all the more completely
the more fully respiration has been established ; and in this case the
lower lobes of the left lung cover almost the half of the pericardium.
The foetal lungs are placed quite posteriorly, only occupy about one-
third of tiie concavity of the ribs, and the first glance into the opened

§ 88— c. COLOUR OF THE LUNGS. 51

cavity, even when the divided ribs have only been partially separated,
displays the anterior margins of the lungs projecting. The strong
contrast between the foetal condition of the lungs, and that after
respiration has been fully established, certainly makes the alteration
in the volume of the lungs a very good diagnostic sign, particularly
for an experienced eye ; but the medium condition between these two
extremes, that consequent upon a short and imperfect respiration,
may yet prove deceptive. In such a case, the lungs are frequently
found retracted and deep-seated, and yet the result of the complete
docimasia pulmonaris indubitably proves that the child has breathed.

§ 88. CONTDOJATIGN. C. COLOUR OP THE LxJNGS.

When we consider that the idea of colour is something quite
individual, and how difficult it is to recall by a verbal description the
colour impression received, particularly when it is mere shades of
colour that are in question, we can understand the differences in the
description of the colour of foetal lungs, and of lungs after respira-
tion has been estabUshed, which are to be found in the various
authors from the earliest times. Galen's description cannot be re-
garded as correct, since it was taken from the lungs of animals. But
in later times, and up to the most recent, we find the most manifold
expressions employed, in order to portray the colours of these two
kinds of lungs. I have, therefore, endeavoured to give additional
certainty to the descriptions by drawings taken from nature. But
even the remarkably correct drawings (Plate VI., Pigs. 15-18) are
not nearly sufficient ; since twenty, thirty, or more drawings of each
kind of lung would be required only in some measure to represent
the extraordinary variety of shades of colour which occur in nature.
Orfila and Billard are perfectly correct when they state, that the
colour of the foetal lungs is " exceedingly various,^' and it betrays an
amount of superficiality not usual in him, when Devergie on the
other hand says, that their colour seemed to him always " very much
the same/^ What is true of the foetal lungs, is true also of those
which are no longer foetal. In general it is certainly true to nature
to describe the colour of the lungs of a child born dead as reddish-
brown liver-colour, becoming of a brighter red at the margins,
because there the light acts differently through the thin walls. But
it is by no means rare to find upon the lobes several bright red
streaks or diffuse patches, whereby they come somewhat to Iresemble

E 2

52 { 88— c. COLOUR OF THE LUNGS.

the lungs of those born alive. Moreover, the reddish-brown liver-
colour is sometimes darker, resembling a concentrated water-chocolate,
at others it appears much redder, like a mixture of wine lees and
chocolate. In general it is also true to nature to describe the lungs
of those children which have breathed, and which have not the
slightest resemblance to the well-known slaty-grey marbled colour of
the adult lung, as of a dark bluish-red ground-colour in which
numerous bright red circumscribed patches are seen, while just as
often the bright cinnabar-red prevails and forms the ground-colour in
which the dark bluish-red insular patches are conspicuous. But it is
specially, in lungs no longer foetal, that the greatest variety of
hues occur. K any considerable amount of pulmonary hypersemia
have either caused or accompanied the death, we then find the lungs
to have a dark brownish-red colour resembling that of the liver, but
with bright reddish patches, having even to the accustomed eye of
an expert a most deceptive resemblance to the foetal lungs. TAe
insular marbling described alone affords a certain diagnosis, for this
is never found in perfectly foetal lungs, though it is doubtless only
feebly marked in those cases in which the child has been as it were
bom into fluids (as in a privy), and suffocated at once after one or two
respiratory movements. The colour of the lungs is perfectly different
in those children bom dead, and which have been subsequently
artificially inflated, in those putrid, or anaemic after death from
haemorrhage. I have inflated the foetal lungs a countless number of
times, and of course perfectly successfully, by introducing a pipe into
the trachea and blowing through it. In every case of perfectly suc-
cessful inflation of the lungs, without exception, the lungs imme-
mediately swell up, become spongy, and assume a bright cinnabar- or
bright crab-red colour, which is extended vrnformh/ over all the
pulmonary tissue, by uniformly, I mean without any insular mar-
blings. The representation, Plate VI., Fig. 15, exhibits just such
an inflated foetal lung as one may find exactly reproduced in nature
by experimenting on the first most suitable body of a stillborn child
that may come to hand.* The colour of the lung just commencing

* Maschka (Prager Vierteljahrschr. 54 Bd. 1867, s. 35) asserts that when
the air is blown in very slowly, without the employment of any force, and
in but a small quantity, that then the insular marbling will '< not always*'
be tbund wanting. Certainly in such a mode of experimenting, portions of
the lungs remain of their foetal colour, and this contrasted with the bright
cinnabar-red of the inflated portions, makes the lungs appear mottled. But

§ 89—/ CONSISTENCY OF THE LUNG TISSUE. 53

to putrefy is not materially altered, only somewhat more livid and
dirty-looking ; when the lungs are j^r advanced in putrefaction, their
colour is constantly the same, blackish, or even quite black, not like
ink or charcoal, but like very dark blood that has been long exposed
to the air. - Such a lung cannot, therefore, be confounded with one
in any other condition. In newborn children who have died from
hsemorrhage, the lungs appear pale and of a reddish-grey, with a
few bluish-black marblings scattered through this pale ground-
colour, which is also in itself diagnostically not to be mistaken. I
have endeavoured, without entering into minutiae, which are only apt
to mislead, to describe the colours of the various kinds of lung which
are found in newborn children from my own very numerous observa-
tions. The result obtained is, that it is consistent with experience,
that every insular marhlmg of the lung excludes the idea of a foetal
condition, and entitles us to assume as certain the fact of the child
having lived after its birth; but that we are not entitled to draw this
conclusion in the absence of this insular marbling from the ground-
colour of the lungs alortCy and the other positive and negative means
of evidence supplied by the docimasiajmlmonarismusi be resorted to
as supplementary proof.

§ 89. Continuation.—/. Consistency of the Pulmonaey Tissue.
— Atelectasis. — Hyperemia. — Hepatization.

The difiFerence between the consistence of the foetal lung and the
pulmonary parenchyma after respiration has been established, is so
great, that it is scarcely possible to confound the two extremes in
distinct cases. The one is compact, feels resistent when pressed on
by the finger, which readily slips oflf from the moisture of the organs^
and may be actually termed like the liver in consistence, and not
merely in colour. The other, the tissue of lungs that have respired,
is, on the other hand, crepitant, spongy, and yielding to the pressure
of the finger. But here are also intermediate conditions on the one
hand, and pathological conditions on the other, which cause the
sharply-defined differences of individual cases to disappear. To these,
in the first place, belong those common cases in which respiration

this is not what I have termed, for want of a better expression, " an insular
marbling/* in which the two ooloars are as it were washed into one another.
On the body the difference is at once readily observed, though it is not so
easy to describe it in words.

54 § 89—/. CONSISTENCY OF THE LUNG TISSUE.

has not been completely established, and in which, therefore, there
are portions of the Inngs into which the air has not passed, which
have remained foetal, — a condition which has been named atelectasis
pulnumum by Legendre and Jorg, jnnr.^ The opinion which
would elevate this atelectasis into a peculiar "disease " of the new-bom
child, which kills it by interfering with its respiration, cannot for one
moment be justified. Except where this condition has been, as we shall
by-and-by show, confounded with hepatisation, it is nothing else than
the original foetal condition, from which it differs in no anatomical
respect, and the case is rather the reverse of the above : the child
dies from any given cause, before the whole of the lung has been
able to pass from the foetal to the post-foetal condition, because the
respiration has not had time to become fully established. This so-
called atelectasis, which according to this view is only another name
for the foetal condition of the lung, is therefore not a cause, but
rather as it were an effect of death. From this also it appears, that
it is perfectly absurd to employ this so-called atelectasic condition of
the lungs as an objection to the docimasia pulmonaris. Are the
lungs " atelectasic,^' and therefore brownish-red, compact, sinking in
water, &c. ? the child has just never lived ! Are the lungs only
partially atelectasic (foetal) ? then there has been imperfect respiration,
which will be readily recognised by careftdly carrying out the doci-
masia pulmonaris. For this so-called atelectasis occurs in various
degrees and over a varying extent of the lungs. This cannot be
better described than has been done by Elsasser in the following
words: t — " When the amount of foetal tissue in the lung is lobar in
its nature, that is, when it occupies an entire lobe, or a large con-
tinuous portion extending throughout the entire thickness, or at
least a considerable proportion of the entire thickness of a lobe, then
the separation between it and the tissue containing air is generally
well defined and easily seen. But usually the foetal tissue is only
lobular in its character, that is, there are small patches of foetal
tissue corresponding to one or two lobules scattered in the most
manifold manner throughout the rest of the pulmonary substance,
sometimes running superficially in lines along the posterior surface "
(but also on the anterior surface) " of the lungs, and dipping into
their substance to the extent of from half a line to a whole line, at

* Legendre, Krankheiten des kindlichen Alters. A. d. I*ranz. Berlin, 1847.
Ed. Jorg, Fotuslunge im gebornen Einde. Grimma, 1835.
+ Op. cit.f s. 22.

§ 89—/. CONSISTENCY OF THE LUNG TISSUE. 55

others, strewn irregularly throughout the deeper portions of the
lungs " (which is most commonly the case). ^^ If these foetal insular
patches are very sm^all but present in large numbers, and if the por-
tion of the tissue containing air contains^ any considerable amount of
fluid secretion, and is of a somewhat dark colour, it is often very
difScult, without applying the hydrostatic test to every little portion
of tissue, to decide regarding the presence and extent of the foetal
tissue. The sense of feeling is in such a case not sufScient to decide
the matter, since by the mixture of very small insular patches of
foetal and air-containing tissue, a mixed sensation is imparted, that is,
the part aflfected is somewhat denser than air-containing lung, and
somewhat less dense than foetal pulmonary tissue ; neither does it
distinctly crepitate on pressure, nor upon incision/^

The pathological conditions, which may alter the condition of the
pulmonary tissue, and thus possibly lead to mistakes, are suffocatory
hypersemia and the results of pneumonia. In such a congested con-
dition of the lungs their colour is dark, approaching that of the foetal
lung (p. 51, Vol. III.), and their tissue is also more compact, they
(sometimes only one, the hypersemic one) do not crepitate, but are,
nevertheless, more yielding to pressure than foetal lungs, and ^ene-
rally capable of floating. The red and grey hepatisation (splenisa-
tion), on the other hand, are characterized by a dirty violet-red
colour, by a britileness of tissue, which is easily torn, and finally, by
the presence of fibrinous or albuminous exudation in the pulmonary
cells. On incising the hepatised tissue no bloody froth flows out,
and it is not easy to press any out, but both bloody SOTum and also
a tough albuminous mucus exude in small specks or drops upon the cut
surface. A very little experience will prevent anyone from easily
confounding the different appearances in the lungs here described.
And, yet in many cases, where there was not merely a foetal condition
of the lung present, the actual result of a pneumonia has been declared
to be atelectasis I ^ Moreover, Legendre himself says, he has some-
times (?)'had occasion to observe a foetal condition of the lung
^'combined" with hepatisation, and Jorg supposes that pulmonary

* The more ancient oases are oompletely untrustworthy. They date from
a time when histology, the docrine of the phenomena of putrescence, of
pneumonia and its results, &c., were yet in their infancy. The longer in
any of these cases the children have lived, and it was not merely days, but
even weeks (fifteen days in the case reported by Eemer), so much the more
probable is it that pneumonia has been the cause of death.

56 $ 90-^. PLOUCQUETS TEST.

inflammation ^^ usually'' precedes the death of children born with
atelectasic longs. And now I beg of all practical men to read
Legendre^s prolix description of the differential diagnosis between his
atelectasis and hepatisation {pp. cit. s. 85^ &c.)^ and I am sure they
will agree with me that the condition there described has no exist-
ence^ and that the so-called atelectasis is a mere word without a/ny
real signification, since it has been employed to designate pulmonary
tissue at one time merely in a foetal condition^ and at others in a
state of hepatisation or splenisation.

§90. Continuation. — -g. Weight of the Lungs and Heaet.
— PLOucquET's Test.

There is no more important question in the whole range of
forensic medicine, in which, as I shall point out, more errors, useless
discussions, and, what is of more importance, more serious practical
consequences have followed the customary fashion in our science of
one author quoting another without first submitting his quotation
to the touchstone of his own personal observation and experience, or,
since so few have an opportunity of acquiring the latter, without
even submitting it to a literary criticism. W. G. Ploucquef s rightly-
valued name, and his h, priori^ just as properly recognised as well-
founded supposition, that the lungs of newborn children must
increase in absolute weight from the larger amount of blood which
would flow into them, finally, his '' observation on the bodies of
children'' — What a sentence to employ ! — have, as is well known,
occasioned his proposition to compare the absolute weight of the
lungs (with and without the heart) with the absolute weight of the
whole body, as a means of determining whether the child has lived
or not, to be generally received with great welcome. These circum-
stances have occasioned " Ploucquef s tesf to be added as a new
criterion to the well-known customary docimasia pulmonaria, and
that the numerical relations given by Ploucquet from his " observa-
tions '^ of 1 : 70 for children bom dead, and 2 : 70 for those bom
alive, have been* generally received as at least approximately correct
proportional averages down to the most recent times, till at length
those who observed for themselves, objected to them as incorrect.
Indeed even Ploucquet's hope "that his lung-test would one day
command public attention^' was completely fulfilled, and so it is not
to be wondered that the famous numerical proportions of 1 : 70 and
2:70 have passed from one handbook to another down to the most

§ 90—^. PLOUCQUET'S TEST. 57

recent, and are continually quoted by everybody. I will now pro-
ceed to show what connection these have with Ploucquet'syacfo, and
with his "observations/' and for this purpose I shall go at once to
the fountain-head, and give the exact words of the discoverer
himself,* in his '^ Abhandlung uber die gewalUame Todesarten.
Ah ein BeUrag zur medicinischen Rechtsgelehrtheit*^ or Treatise
upon the various kinds of violent death, A contribution to Forensic
Medicine y second edition, translated from the Latin. Tubingen, 1788,
p. 314. Ploucquet goes on to say : " In this manner (by weighing)
is obtained the true relative proportions of the weight of the body to
that of those lungs which have respired, and also of those which
have not respired. This much at least I have learned from, three
observations^* (mark — ^from thsse observations!), "which I shall
proceed to quote, in which the proportions were the following : the
body of a newborn male chUd, which had exhibited evident signs of
life a few hours before its birth, but which having died in the birth
had certainly never respired, weighed, along with the lungs, 53*040
grs. The dense, collapsed or rather not yet distended lungs weighed
by themselves 792 grs., so that the proportion borne by body, in-
cluding the lungs, to the lungs alone, amounted to almost 67 ; 1.
In another mature, perfect foetus, which however had never breathed,
the proportion of the weight of the body to that of the lungs was as
70 : 1, (S. Jaeger, Diss, de fcetibus recens natis, etc. histor, §12.)
In another foetus, which though not perfect*' (mature) "had yet
breathed, the proportion of the weight of the body to that of the
lungs was 70:2. Prom this it is evident (!), that the weight of the
lungs has been doubled by the amount of blood forced into them by
respiration and remaining in them after death, and that it may be
possible in doubtful cases to decide from this whether the child has
breathed or no. For instance, if we know from experiment that the
proportional weight of the lungs to the entire body is as 1 : 70, then
the child has certainly never breathed; but should the relative pro-
portion be somewhere about 2 : 70 or even as 1 : 36, then we may be
certain {sic! I) that the child has breathed.^'

And has a new " lung-tesf been admitted into science, medicine,
and practice upon a basis like this ! Three cases, of which it is
certain that one of them was not investigated by Ploucquet himself,
while it is very doubtful whether this was not also the case with the

* I quote from the German translation, because I have not the Latin
original at hand.

5 90—^. PLOUCQUET'S TEST.

other two ! Moreover, Ploucquet immediately drops the first case
entirely, and not a word more is said of 1 : 67, the relative proportion
discovered. So that of "Ploucquef s observations'' all that remain
is only two, that is one child bom dead and one bom alive, which are
compared the one with the other, and over and above the comparison
is not made between two equals, for the deadbom child was ^' per-
fect'' (that is> as is well known, mature), but the one bom ailive
was a " not perfect" foetus ! I

It is just as certain that a single case can give no rule, as that it
must have been miraculous had the relative proportion deduced from
it been accidentally coincident with that obtained by an average.
Experience, and the numerous results obtained by more recent and
more exact observers, are far from confirming this miracle. In the
following Table I have given the weights (in Prussian drachms = 2
drs. imp.) of the heart and of the lungs, with the relative proportion
to the weight of the entire body in twenty-six cases of newborn
children, born dead, and in sixty-three of those born alive, all taken
from my official protocols of the various dissections. I regret that
I have not collected the notices of a much larger number from earUer
years : nevertheless the conclusions arrived at in this Table are in-
dependently confirmed in the most conclusive manner by our own
investigations as well as by those of others.

Peopoktion bobne by the Weight op the Lttngs to that op the whole
Body, in Eighty-nine Cases op New-boen Children.

Children horn Dead.

"5 8,

KaUo.

Remarks.

•91

Ratio.

Remarks.

992

1:37

1280

1 :56

768

putrid

480

1:68

putrid

960

—

576

1:64

896

—

768

1 :96

putrid

640

—

1024

1:78

800

—

768

1:55

480

putrid

800

1:73

640

—

672

1:56

1280

—

768

1 : 96

480

8 mo. child

896

1:56

512

768

1 :59

___

480

832

1:69

384

»>

960

1 :69

—

§ 90-^. PLOUCQUETS TEST.

Weights, btc.^ Continued,

Children horn Alive,

•^1

Batto.

Caiue of Death.

Batto.

Cause of Death.

844