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infant found. It may not be discovered in her own possession, as she may have removed it to a distant place, or thrown it into the river or sea, and it may not be found until all traces of her previous confinement may have been obliterated.

The date of the child's birth must also be settled: first, by determining the date of its death, that is, whether it died in the uterus, in the maternal passages, or after birth, and how long afterward; and secondly, by ascertaining what period has elapsed since its death. This last inquiry does not require to extend further than the fifteenth day of extra uterine life, as this is a sufficient period, from the fact that a child which has survived even a few hours, could not be destroyed without leaving sufficient testimony of its previous existence. Certain changes in the child's body furnish sure indications of its having survived birth. These changes are: first, the expulsion of the meconium; second, the fall of the umbilical cord; third, the obliteration of the foetal vessels; fourth, the desquamation of the cuticle.

The fundamental inquiry in all cases of infanticide, and the chief point to be settled by the professional witness, and the most important of all is, Was the child dead or alive at its birth? This question divides itself into two parts, one of which is, the means we possess of determining that the child had been dead born, the other that of the contrary-that it had been live born. The signs which indicate that the child had been still born are those which go to prove, first, that it was immature; second, that it was born with organs in such a state either of congenital malformation, or, third, of intra uterine disease, as prevented the possibility of its surviving birth; or fourth, that it must have died, from causes unknown or otherwise, in the uterus or in the passages, before time had been afforded for respiration being begun, or for the occurrence of any of the other vital changes which take place immediately after birth.

Proof of life in the infant is a physiological question, gathered under two very different circumstances, namely, where the child has not lived to respire, and where it has. The proof that the child has not lived to respire is based upon one or more of the three following changes, namely, those which take place after birth in the respiratory organs, in the organs of circulation, and in the digestive

organs. The points which fall under investigation are, first, the configuration of the chest; and second, the state of the lungs. Respiration cannot take place without the expansion of the chest. To determine this, sight alone is not sufficient; recourse must be had to exact measurement, by determining the circumference, height and depth of the chest by the resulting elevation of the diaphragm, to be ascertained by the opening of the abdomen; second, the state of the lungs and the changes they undergo in respiration. Not only must the whole blood of the body pass through the lungs, but atmospheric air must be introduced in great quantity within their substance, and permeate their remotest cells. The time required for effecting these changes in the lungs of a mature and healthy new born infant is extremely short, not exceeding a few minutes; the reverse is the case when the infant is premature, weakly or diseased, or has sustained any hurt during the progress of labor. Respiration and circulation are essential in establishing viability.

A question arises as to the possibility of introducing air into the cells of the lungs of a dead child, by artificial respiration, and thus an alteration be produced in the shape, volume, specific gravity and color of the lungs. The afflux of blood to the lungs might be the consequence of disease; and putrefaction, by developing gases in organs undergoing decomposition, might change the figure and augment the volume of the lungs. Among the various tests which have been employed for determining viability, the most simple and certain are: first, when the lungs are voluminous, covering the greater part of the pericardium; second, when, on their removal from the chest, they float buoyantly in water; third, when traces of milk, or other alimentary matter, of drugs, or of frothy mucus, air or saliva, are found in the stomach; fourth, when there is no meconium in the intestines; fifth, when the foetal vessels are contracted and altogether, or almost, empty of blood.

The last point to be considered by the medical jurist is, the cause of the child's death. It is a principle of law that "mere appearances of violence on the child's body are not, per se, sufficient, unless some circumstances or evidence exist to indicate that the violence was knowingly and intentionally committed, or that they are of such a kind as themselves to indicate intentional murder."

There is still this one essential difference, however, between the evidence of child murder and of ordinary homicide—that in the former, the fact of murder having been committed is, in general, sufficient to attach strong suspicion of guilt to the mother, since it is highly unlikely that any one else could commit the crime, at least without her acquiescence.

The first question to be determined is, Has the case been one of infanticide in fact? or, in other words, Would the child's death have occurred from natural causes? The solution of this question rests on three kinds of data: first, on the signs which denote that the child has died before delivery; secondly, on those which indicate that the child has died during the labor; and thirdly, on the facts which go to prove that the infant, though born alive, has nevertheless perished after delivery, from causes independent altogether of the will of the mother.

In discussing the criminal causes of the child's death in charges of infanticide, the means of destroying the child during labor, which can properly be classed as acts of commission, can seldom become the subject of criminal procedure, as, for the most part, the assistance of a third person would be necessary to put them into execution; while a woman, especially in her first labor, would rarely be possessed of the strength or presence of mind requisite to enable her to kill her own child while in the passages.

The means known to be resorted to for taking away the life of the infant during labor, are the following, namely: puncture of the fontanel, orbit, or nucha, or even of the chest and the abdomen; twisting of the neck after the delivery of the head; and strangulation. In the Causes Celebres may be found the case of a woman who made a trade of destroying infants, by acupuncture through the top of the spinal column and into the brain. The death of an infant, according to Fodéré, has been caused by puncture of the heart through the walls of the chest. Twisting the head on the vertebral column, on its first emergence, kills the infant at once, and may elude the observation of the medical jurist, unless he be specially on his guard against overlooking it. It may be discovered by the presence of ecchymosis about the upper part of the spine, and laceration of the spinal ligaments.

The medical jurist, when called upon to inspect an infant sus

pected of having been murdered, ought, at the beginning, to make himself acquainted with all the particulars of the case-the place where the child was found, the circumstances attending its removal therefrom, and the facts relative to the suspected party, if suspicion rests on anyone. He should, if possible, visit the place where the infant was found. He should then examine the wrappings of the child, if there be any, the marks upon them, the thread by which they were sewed, the character of the ligature, if any, around the cord, as in this way the mother is discovered sometimes, and brought to trial.

These preliminaries having been attended to, the examiner should proceed to the external inspection of the infant's body: First, its conformation, and especially any defect which might affect its viability; second, its degree of freshness or putridity; third, the color of the skin; fourth, the degree of adhesion of the cuticle and the nails; fifth, the extent of the saponification, if it has commenced, or of the emphysema, if gases are generated under the skin; sixth, the natural openings should be examined as to their being pervious or otherwise with the discharges which may have proceeded from them; seventh, if any punctures, incised wounds, contusions or ecchymosis exist, their situation, extent and depth should be noted; eighth, the body should be weighed and measured; ninth, the state of the navel should be particularly attended to, observing if any part of the cord is attached to the abdomen, and condition generally; tenth, if the placenta is found, the divided points of the cord should be compared to see if they correspond, and the length of the remains of the cord, both placental and foetal, should be measured; eleventh, the sebaceous coating should be looked for in the armpits, groins and hams; twelfth, the hair should be noticed as to color, length and quantity.

The special inspection should begin with the head, including the scalp, skull, brain, medulla oblongata, etc.; the neck, larynx and vertebral column; the cavity of the mouth; the chest, for the purpose of examining the pectoral viscera; the abdomen; the spine should be explored throughout, to ascertain if any ecchymosis exists on the trunk or limbs. Free incisions should be made, and, if necessary, the bones may be examined. The medical jurist will make a full inspection of all the parts enumerated, and will thus be able to render an intelligent opinion on the case presented for his consideration.-From Manual of Medical Jurisprudence.

CASE OF HYDRONEPHROSIS.

BY P. J. MCCOURT, M. D.

November 22, 1878, Mrs. W., at thirty-two, medium height, sanguine temperament, a lady of fine, nervous organization and highly cultured, called on me by request of her physician. The closest inquiry as to the history of her illness elicits only the following: During the past four years, since last parturition, her second, she has suffered from dysmenorrhoea and menorrhagia, also from progressive corpulency and excessive prostration. At no time has there been renal pain or hæmaturia. She now weighs 180 pounds, 40 pounds above her normal standard.

At present we have the following symptoms: Great debility, dry, harsh skin, vertigo and almost constant headache, the pains shooting, in frontal and temporal regions; almost complete blepharoptosis (due not to oedema of the lids, but to partial paralysis of the levator palpebræ superioris): spasmodic cough, with involuntary micturition; a fierce bulimia, which cannot be oppressed by any amount of food; she complains that her load of flesh is crushing her, and that she "feels like a mass of blubber."

Examination reveals a state of general cedema, but no pitting results from pressure; heart normal; liver slightly congested; uterus somewhat prolapsed, and crowded to the left; ovaries apparently healthy. On the right side, involving the hypochondriac, iliac, and, in a lesser degree, the umbilical region, I find a large, bulging tumor; it is soft, almost painless, vibratory and lobulated; percussion yields a dull sound and distinct fluctuation, The left hypochondriac and iliac regions are likewise slightly tumefied, the sound somewhat dull, but fluctuation is not perceptible. Urine scant, albuminous; sp. grav. 1,020, owing, doubtless, to the very small quantity voided; a few tube casts only are present; no blood or pus corpuscles visible; no calculi, nor evidence of their presence at any time.

I think the diagnosis of that extremely rare disease, hydronephrosis (Gr. from hydro, water; and nephros, the kidney), will not be questioned, and it has been caused, presumably, by pressure upon the ureters during pregnancy. The prognosis must, of course, be unfavorable, and the lady is informed that, while

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