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be generally cleared up by an examination, as well as by circumstantial evidence. (See case, Lond. Med. Gaz., vol. xix. p. 231; also another by Capuron, Méd. Lég. des Accouchements, p. 110.)

Can a Woman be delivered unconsciously?-Another important question relative to delivery in the living is whether a woman can be delivered without being conscious of it. The signs of delivery may be discovered by a practitioner; the offspring may also be found; the woman may admit the fact of her delivery, but allege that she was totally unconscious of it. The only medico-legal case in which this plea is occasionally raised is in infanticide; and as the possibility of the occurrence may be questioned, the practitioner must be provided with a knowledge of those facts which medico-legal writers have accumulated respecting it. There is no doubt that a woman may be delivered unconsciously during profound sleepwhile laboring under coma, apoplexy, asphyxia, syncope, or when suffering from the effects of narcotic poisons-e. g. the vapors of chloroform and ether, or intoxicating liquors. It is said, also, that delivery has taken place spontaneously while a woman was in the act of dying. This, however, has no bearing on the present question. It is in those cases where, after her recovery, a woman pleads unconsciousness of delivery that medical practitioners are chiefly consulted. Besides the cases enumerated, hysteria, when accompanied by loss of sense and motion, has been mentioned as a state in which parturition is liable to occur unconsciously. We need not be surprised at delivery taking place under these circumstances, when we consider that the contractile power of the womb is altogether independent of volition; but, unless the morbid states already mentioned are accompanied by the most profound lethargy and entire loss of sensation, it can rarely happen that the contractions of this organ in its efforts to expel the child should not at once rouse a woman into consciousness. We ought particularly to expect this in primiparæ, i. e. in those who have never before borne children. At the same time, it must be remembered that parturition in some women, especially when the pelvis is wide and the child small, may take place with such rapidity and ease as scarcely to be accompanied with pain.

It has been observed that when a woman has frequently borne children delivery sometimes takes place without effort, and without any consciousness on her part. On other occasions a woman may lie in a kind of torpor or stupor, or suffer from puerperal convulsions, and have no recollection of her delivery. The following case is possible: a woman may be deliv ered while under the influence of puerperal convulsions, which might have attacked her before labor set in; and after delivery, but before complete recovery, she might become maniacal-a not unfrequent condition_ during which interval she may have killed or injured her child; or the child may have been born dead or suffering from some accidental injury. She would with truth assert her entire ignorance of it. Her statement would be verified by a bitten tongue and a congested conjunctiva or face. Should albumen be found in the urine, this fact would be still more confirmative. Of course, puerperal convulsions occur without these results. The statement might be disproved by finding that her actions had shown care and design in other circumstances at the time she said she was uncon scious. King has described the case of a woman, æt. 36, the mother of nine children. She received his assistance in her tenth labor: when summoned, she was lying calmly and placidly in bed, and was perfectly insensible. He found that the child had been expelled with the placenta. The woman did not recover her consciousness for ten or twelve hours, and then stated that she had no recollection either of the birth of the child or of any

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circumstances connected with this event: she suffered no pain or uneasiness. Another case is mentioned by him in which sensation appeared to be entirely paralyzed during labor. (Med. Times, 1874, i. p. 234.) It is beyond doubt that profound lethargy occasionally makes its appearance about the time of delivery. Schulze met with a case in which a woman remained in a state of sleep for three days, and was delivered while in this unconscious condition: on awaking, she had no recollection of having suffered any pain during delivery. (Ann. d'Hyg., 1842, t. 1, p. 216; Lond. Med. Gaz., vol. xxxvi. p. 40.) Montgomery relates the case of a lady, the mother of several children, who, on one occasion, was unconsciously delivered during sleep. (Cyc. Pr. Med.; see also case in Brit. and For. Med. Rev., No. 9, p. 256.) Palfrey described a case in which labor commenced and progressed in a woman to the second stage during sleep. (Lancet, 1864, vol. i. p. 36.)

The results obtained by the use of the vapors of chloroform and ether show that the expulsive efforts of the womb are often as energetic in the unconscious as in the conscious state. It may appear extraordinary, however, that a primiparous woman, unless rendered unconscious by narcotic substances, should be delivered without suffering pain; nevertheless, a case of this kind is recorded by Wharrie. The woman's age was 21; she had been in labor about six hours; she complained of no pain, and the child was born without effort or consciousness. The child was healthy, but small, weighing rather more than four pounds. (Cormack's Jour., 1846, p. 12.) Notwithstanding this case, it is in the highest degree improbable that any primiparous female should be delivered during ordinary sleep, without being roused and brought to a sense of her condition.

There is another condition in which a woman may state that her delivery took place unconsciously; and this, from its being one of the most common species of defence set up by a female charged with child-murder, must here claim our attention. Thus she will allege that, while suffering from pain, she felt a strong desire to relieve her bowels; that she went to the closet for that purpose, and was there delivered without knowing any thing of the occurrence, until it was too late to save the child. This kind of desire is a very common symptom of the parturient state; and it is often difficult to restrain a woman from yielding to the feeling, when it certainly would be attended with hazard to the child. (Med. Times and Gaz., 1857, i. p. 347.) We must, therefore, admit that an accident of this kind can occur; although here, as in every other instance in which uncon scious delivery is pleaded, a medical witness ought to inform himself, or be informed, of all the particulars which are stated to have attended delivery, before he gives an answer applicable to the case. As a general rule, it cannot be denied that delivery may take place under these circumstances, and a woman not be conscious of it; but before we make this admission in regard to any particular instance, we ought to have a statement of all the facts from the female herself. It is thus that we shall avoid the risk of seeing a premature medical opinion set aside by the subsequent production of circumstantial evidence. Besides, it has been properly observed that, after an accident of this kind, a woman cannot be ignorant of her having been delivered. Women who have raised this plea in cases of child-murder have often been known to maintain that they were unconscious of their pregnancy, and thus have attempted to excuse themselves for not having prepared the articles necessary for childbirth. It is possible that a woman, especially one who is pregnant for the first time, may not be aware of her pregnancy in the earlier stage; but it is rare for one to advance to the full term without being conscious of it.

528

SIGNS OF DELIVERY IN THE DEAD.

Women who have borne children have not unfrequently consulted medical men, and although nearly at full term, they have been unconscious of their state. In the majority of instances, it may be presumed that a woman thus situated must have some reason to suspect her condition; and if only a suspicion existed in the mind of one who did not contemplate the destruction of her offspring, there would be many circumstances forthcoming which would at once establish her innocence. If this remark applies to married women, it applies with still greater force to those who are unmarried, since the fact of illicit connection and the fear of its consequences must render them peculiarly alive to all those changes which, by common repute, take place during pregnancy.

Signs of Delivery in the Dead.-It will not be proper to examine the signs of delivery which are derivable from an examination of the body of a woman after death. Occasionally we may obtain some history of the case during life, by which our labor will be much facilitated; but, on the other hand, every fact may be studiously concealed from us, and then we may be required to prove, not only the delivery, but the previous preg nancy. These investigations relative to pregnancy and delivery in the dead body are almost exclusively confined to cases of criminal abortion, where the contents of the womb have been expelled at the sacrifice of the life of the woman. Death commonly ensues in these cases within two or three days after delivery, and then satisfactory proofs are obtainable by a post-mortem examination; but if the woman has survived three or four weeks, it will be as difficult to determine delivery in the dead as in the living subject. This remark applies to delivery at the full period; for if the womb have expelled its contents in the first months of pregnancy, the traces of this expulsion will have generally disappeared in the course of a few days.

The following may be taken as the chief appearances when the body of a woman is examined soon after delivery at the full period: The womb is like a large flattened pouch from nine to twelve inches long, its mouth being wide open. The cavity contains clots of blood or a bloody fluid; and its surface is covered with the remains of a decidua-the outermost membrane of the embryo or fœtus. In the part to which the placenta has been attached, the substance of the organ appears exposed, presenting several large semilunar or valvular openings. This portion of the womb has been found of a very dark color, which has given rise to a suspicion that the organ was gangrenous. The vessels are extremely large and numerous. The Fallopian tubes, round ligaments, and ovaries are so vascular (full of blood) that they have a purple color. The spot whence the ovum has escaped is more congested than the rest of the ovarian surface. Obstetric writers differ greatly in their statements respecting the size of the womb at different periods after parturition; and these differences may be explained, partly by the fact that the womb contracts more rapidly in some women than in others, and partly perhaps by the circumstance of the birth having been in some instances premature. Toulmouche has reported some instructive cases of delivery at different periods, showing the influence of time on the appearances. (Ann. d'Hyg., 1864, t. 2, p. 349.)

Montgomery states that after delivery at the full period, and under perfect contraction of the womb, if the body be examined within a day or two, the womb will be found seven inches long and four broad. Its substance, on section, will be from an inch to an inch and a half in thickness, and will present the orifices of a great number of large vessels. At the end of a week, the womb is between five and six inches, and at the end of a fortnight about five inches in length; the density of its structure

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has during this period increased, but its substance has considerably diminished. The inner surface is still bloody, and covered partially with a pulpy membrane resembling the decidua. The orbicular direction of the fibres around the internal orifices of the Fallopian tubes is at this time very distinct. In about a month, the womb will have become fully contracted; but the mouth rarely, if ever, closes so completely as in the virgin state. In a case examined by Barnes, in which a primiparous woman, æt. 26, died from puerperal fever on the sixth day after delivery, the following appearances were met with in the womb: The internal surface was blackened and congested, especially in those parts to which the placenta had been attached. There was the appearance of suppurative action in this part. The substance of the womb was healthy; there was no pus in the sinuses. The mouth of the womb showed considerable ecchymosis. The vagina was healthy; the iliac veins contained nothing but loosely coagulated blood. There was in the left ovary a small well-marked corpus luteum, having a central cavity. (Lond. Med. Gaz., vol. xli. p. 294.) This condition of the womb must not be confounded with the appearances which are observed when death takes place during menstruation. Judee found in the body of three women who died during menstruation that the womb was somewhat enlarged-its walls being thickened, and its interior lined by a reddish gelatinous layer about 1-12th of an inch thick, consisting of a capillary network of vessels, enclosed in a mucus-like membrane. When this was removed, the womb below was found to be white and firm. The interior of the neck was of a grayish color; the lips were swollen, of a dull red, bluish, or even black color. On compressing this part, small drops of blood issued. This was not observed either in the neck or body of the vagina. A section of the womb presented only the normal fibrous tissue; but at the level of the mouth (os uteri) there was a mass of tissue resembling a portion of an apoplectic lung. The blood during menstruation, according to him, issues entirely from the highly congested mouth of the womb. (Med. Times and Gaz., 1855, i. p. 632.) An ecchymosed condition of the neck of the womb is very commonly found as the result of even an easy labor, and therefore forms a good guide where present. This point must be borne in mind in reference to criminal abortion, inasmuch as the neck may present an appearance as if violence had been employed.

From the appearances given above, it will be seen that there must be considerable difficulty in determining the period prior to death at which delivery took place. The difficulty is increased when a woman has been prematurely delivered, or when death has not taken place until some time after delivery. A medical opinion may be then in some degree strengthened by searching for those signs which have been described as characteristic of delivery in the living. These, if present, will always furnish strong corroborative evidence, not only of the fact of delivery, but of the period at which it had probably occurred.

Parity and Nulliparity.-The medical question whether a woman has ever borne a child or not may be material in reference to proof of identity. In Reg. v. Wainwright (C. C. C., December, 1875), the charge against the prisoner was that he had murdered Harriet Lane, a woman with whom he had cohabited. She had been missing a whole year, and the remains of a woman were found buried in premises belonging to the prisoner; they had been cut up into various portions, and were so mangled and decomposed that it was necessary to establish the identity of the body as that of the missing woman. One of the medical points raised referred to the condition of the womb-i. e. whether the appearances which this

530

EVIDENCE FROM CORPORA LUTEA.

organ presented were such as to indicate conclusively that the deceased had borne children. The missing Harriet Lane had had two children by the prisoner, the last having been born some time before Christmas, 1873; therefore about nine months previous to her disappearance. From their examination of the womb, Larkin and Bond came to the conclusion that this woman had borne a child. Meadows, who appeared as an obstetric expert for the defence, stated that, in his opinion, the woman of these remains had never borne a child. He qualified this opinion, however, by stating that he believed it to be impossible to decide this question in any case with absolute certainty. If this witness had been able to swear positively that the indications of childbearing were absolutely certain, and could never be mistaken for a virgin or unimpregnated state of the womb, his evidence would have gone far to show that this could not have been the body of Harriet Lane. He felt, however, he could not carry his evidence to such an extent, and the effect of it simply amounted to a difference of opinion on the answer to this question. (Brit. Med. Jour., 1875, ii. p. 744.) The condition of the womb, according to the evidence for the prosecution, was inconsistent with virginity. This organ was in every way enlarged. It was flaccid, and the walls were unusually thin. There were one or two white lines (linea albicantes) in the skin of the lower part of the abdomen, and other marks of a darker color in the inguinal region. The obstetric expert for the defence considered that the shape of the womb and thinness of its walls indicated that the deceased was nulliparous, i. e. that she had never borne a child. The evidence of the medical witnesses for the prosecution was strongly corroborated by a number of facts tending to prove that this was the body of Harriet Lane; and the prisoner was convicted. It would appear from the discussions on this case that took place at the Obstetric Society, that medical science alone cannot at present furnish a certain answer to this question. (Trans. Obst. Soc., 1876, vol. xvii. p. 355, and vol. xviii. p. 69.)

Corpora Lutea. The condition of the ovaries has been considered to furnish strong evidence, not so much of delivery as of previous pregnancy. These organs, as it has been already stated, when examined soon after delivery, are found of a deep purple color, owing to their extreme vascularity. If the woman has really been pregnant, we may expect to find on one of the ovaries the appearance which is denominated a corpus luteum. The accounts given by obstetric writers of the characters of corpora lutea and the evidence which they are capable of furnishing in legal medicine are very conflicting. According to Montgomery, in a true corpus luteum (i. e. of pregnancy) the ovary presents a protuberance with a distinct cicatrix on the part whence the ovum has escaped. The protuberant portion will be found, on section, to have an oval form and to be of a dull yellow color-hence the name corpus luteum. It is full of blood, and in texture resembles the section of a kidney. It is of its greatest size in the early stage of pregnancy, and gradually diminishes as gestation advances. In the centre of this section there may be either a cavity or a radiated white cicatrix (scar), according to the period at which the examination is made. The cavity remains for about three or four months after concep tion, and is surrounded by a dense white cyst; as gestation advances, the opposite sides approximate and a radiated white cicatrix results. The size and vascularity of the corpus luteum are considerably diminished by the time gestation is completed, and in about five or six months afterwards -i. e. fourteen months after its first formation-it disappears altogether from the ovary; so that the corpus luteum of one conception is not found with that of another, unless a premature expulsion of the contents of the