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thartics. As a general rule, however, except in the case of very feeble or weakly women, or in those who are predisposed to miscarriage, such measures fail to produce an abortion. The emmenagogues, or the drugs known popularly as abortives, are then next resorted to, on account of the power they are supposed to possess of inducing uterine contractions and of thus causing the expulsion of the fœtus. Among these the most commonly used may be mentioned ergot or spurred rye, cotton-root, savin, or the tops of the juniperus sabina, tansy, pennyroyal, and rue. But large doses may be taken of these drugs without causing uterine contraction, while the oils of savin and tansy have frequently caused death, through gastritis or peritonitis being produced through their irritant properties.
All such means having failed to produce an abortion, instrumental violence, as a last resource, is made use of as the only certain means of inducing uterine contractions and of so insuring the expulsion of the foetus. The rupture of the foetal membranes, however skilfully preformed, is a most dangerous operation, always liable to be followed by the most serious, if not fatal, consequences, death being frequently caused, as already mentioned, by either hemorrhage or peritonitis. peritonitis. When the operation is performed by a professional abortionist, long, narrow, sharp-pointed instruments are made use of, but when self-inflicted, which is not unfrequently the case, the woman uses any articles that may serve her purpose, such as knitting-needles, penholders, long wires, glove-stretchers, etc.
Abortion from Natural Causes.—It should be mentioned, in connection with the subject of foeticide, that abortion very frequently results from natural causes. Indeed, with some
1 Tardieu: Étude Médico-legale sur l'Avortement, troisième edition, Paris, 1868, pp. 28, 99.
women it appears to be habitual, abortion occurring at every pregnancy, especially in the early months of gestation, though every effort has been made to prevent it. As might be expected, the tendency to abortion is most marked at the menstrual periods. Predisposition to abortion appears to be due to causes which affect the mother, such as syphilis, smallpox, albuminuria, etc., or those which affect the child, as death of the ovum, disease of the placenta. Advantage is no doubt often taken of this natural tendency to abort by producing abortion criminally. As natural abortion usually occurs at about the third or fourth month of pregnancy, and as this period is also the one at which a criminal operation is performed, the fact that the fœtus comes away entire would indicate that the abortion was due to natural causes, or at least not to instrumental violence. If, however, the fœtus be expelled first and the ruptured membranes afterwards, the conclusion would be that instruments had been used.
Abortion may sometimes be feigned by women, in order to extort money on the charge of seduction and consequent pregnancy. The examination of the woman will usually be sufficient, under such circumstances, to disprove the charge. The criminality of fœticide is not excused by the fact that the woman was not pregnant, or by the fact that the pregnancy was extra-uterine. Under certain circumstances it may become necessary to perform an abortion, as in cases, for example, where the deformity of the pelvis makes the delivery of a living child at full term a physical impossibility. In all such cases the attending physician should insist upon a consultation being held; and the patient and her family should be fully informed as to the nature of the case before so serious an operation is undertaken.
Infanticide—Live Birth-Appearance of Infant Born at Full Term— Means of Determining whether Child has Breathed-Docimasia Pulmonum-Objections to Hydrostatic Test-Docimasia CirculationisSize of Liver and Contents of Stomach in New-born Child-Examination of Mother-Signs of Recent Delivery-Means by which Infanticide is Committed.
By infanticide is meant, medico-legally, the murder of the new-born child, it being immaterial whether the child is murdered immediately or a few days after its birth. The law assumes, until it is proved to the contrary, that every child is born dead, on account of the fact that so many children are brought into the world who are either dead or die shortly after birth. Inasmuch as this is the law, the prosecution, and not the defendant, must prove that the infant alleged to have been murdered was born alive. For this reason great difficulty is usually experienced in convicting a woman charged with the crime of infanticide. Apart from this difficulty she is often delivered in the absence of witnesses, or the child is concealed or destroyed. The jury also sympathizes to such an extent with a woman accused of this crime that conviction cannot easily be secured. Medico-legally, to be born alive implies complete expulsion of a living child from the mother.1 A child, for example, is not born alive if any portion of it, except the umbilical cord, is retained within the vulva. By this figment of the law, therefore, the destruction of a living child, if only partly born, does not constitute murder.
1 Guy and Ferrier: op. cit., p. 101; Tidy: op. cit., part ii. p. 248; Taylor: op. cit., p. 592.
Appearance of an Infant Born at Full Term.—In infanticide the child is generally born at full term. But, inasmuch as children are frequently brought into the world at an earlier period of gestation, either by natural or artificial means, it is important for the medical examiner, in cases of infanticide as well as of fœticide, to be able to state, from an inspection of the infant, its probable age at birth. The general appearance presented by an infant born alive at full term is as follows: Remains of the vernix caseosa or sebaceous matter are usually found behind the ears and under the arm-pits; the hair is dry and clean; the eyes are half open, and cannot be kept closed; the ears do not lie close to the head; the caput succedaneum, or swelling on the back of the head, is well marked; the thorax is distinctly arched, and the diaphragm much depressed. A dead-born child is usually covered with the vernix caseosa; the hair is agglutinated; the eyes are closed; the ears lie close to the head; the thorax is flattened and unexpanded; the lungs lie in the posterior part of the thorax, are granular, and do not crepitate upon pressure.
In case of the death of the foetus some time before birth, the body will be found flaccid and flattened, as if it had been macerated; the cuticle may be more or less detached, especially upon the abdomen; the head lies flat, howsoever it may be placed, the cranial bones moving readily upon one another; the cellular tissue is infiltrated with bloody serum. The proofs of a child having breathed, and therefore of having lived, though not necessarily of having been born alive in the legal sense, are derived from the condition of the respiratory, circulatory, and abdominal organs.
Means of Determining whether the Child has Breathed.—
While the vaulted character of the thorax, the comparative depression of the diaphragm, the relation of the larynx to the epiglottis, the situation, volume, color, consistence, absolute or relative weight, the specific gravity of the lungs, may all be important under certain circumstances in enabling the examiner to determine whether an infant has breathed, nevertheless the hydrostatic test is the only one that can be relied upon, and even that with certain qualifications, to be presently mentioned. The principle of the hydrostatic test, or the docimasia pulmonum, is based upon the fact that while the lungs of an infant that have been aerated will float when placed in water on account of the inspired air, those of an infant that have not been aerated will sink. To apply the hydrostatic test, the lungs should be removed from the chest of the infant and put in a sufficiently capacious vessel containing distilled water at 60° F. If the lungs float upon the surface of the water, that will prove that they have been aerated. It is desirable also that each lung should be divided into a dozen or more pieces, compressed, and then tested separately in the same manner. If after compression all the pieces float, very complete aeration would be indicated. It must be admitted that the hydrostatic test, while it serves to determine whether the lungs of the infant had or had not been aerated, does not necessarily prove that the child had breathed, still less had been alive in a medico-légal sense, although it may establish a strong presumption of the fact; since the head of the infant may be retained sufficiently long in the uterus or the vagina, as in certain elbow or breech presentations, for the infant to breathe though subsequently born dead, and, though not probable, it is not impossible that the air found in the lungs of the infant may have been artificially introduced, developed through putrefaction,