556 SIGNS OF MATURITY IN THE CHILD, scrotum does not necessarily indicate that the child is immature, because these organs sometimes do not reach the scrotum until after birth. 3. Between the eighth and ninth months.-The child is from fifteen to sixteen inches in length, and weighs from four to five pounds. The eyelids are no longer adherent, and the membranæ pupillares have disappeared. The quantity of fat deposited beneath the skin is increased, and the hair and nails are well developed. The surface of the brain is grooved or fissured, but presents no regular convolutions: and the gray matter is not yet apparent. The meconium fills almost entirely the large intestines; and the gall-bladder contains some traces of a liquid resembling bile. The testicles in the male may be found occupying some part of the inguinal canal, or they may be in the scrotum. The left testicle is sometimes in the scrotum, while the right is situated about the external ring. 4. Ninth Month. Signs of Maturity.-At the ninth month the average length of the body is about eighteen to twenty inches, and its weight from six to seven pounds; the male child is generally rather longer, and weighs rather more than the female. Extraordinary deviations in length and weight are occasionally met with. Owens has recorded a case in which a child at delivery measured twenty-four inches in length, and weighed seventeen pounds twelve ounces (Lancet, Dec. 1838), and Meadows has reported another in which a child measured, after death, thirty-two inches, and weighed eighteen pounds two ounces. It survived four hours. (Med. Times and Gaz., 1860, ii. p. 105.) In one case which the author examined, the child, a male, measured twenty-two inches, and weighed twelve pounds and a half. Davies had a case in which a child was born alive, weighing nineteen pounds two ounces, probably the heaviest newborn child on record. (Med. Times and Gaz., 1860, ii. p. 249.) (For some practical remarks on this subject, by Ellsässer, see Henke's Zeitschrift, 1841, Bd. 2, p. 235.) According to Duncan, the length and weight of a child vary according to the age of the mother. They are greatest among children when the mother is from 25 to 29 years of age; but the facts collected do not support this statement; for the child of a woman at 22 weighed seven pounds three ounces, and that of a woman of 30, seven pounds seven ounces. The length varied in a less degree, being for the different ages at or about nineteen inches. (Edin. Month. Jour., 1864, ii. p. 500.) At the full period, the head of a child is large, and forms nearly onefourth of the whole length of the body. The cellular tissue is filled with fat, so as to give considerable plumpness to the whole form, while the limbs are firm, hard, and rounded; the skin is pale; the hair is thick, long, and somewhat abundant; the nails are fully developed, and reach to the end of the fingers-an appearance, however, which may be sometimes simulated in a premature child by the shrinking of the skin after death. The testicles in the male are generally within the scrotum. Ossification will be found to have advanced considerably throughout the skeleton. The surface of the brain presents convolutions, and the gray matter begins to show itself. The internal organs, principally those of the chest, undergo marked changes if the act of respiration has been performed by the child before, during, or after its birth. The external auricle now measures an inch and a quarter to an inch and a half in length, seven-eighths of an inch to one inch in width, and varies little in children of very varied sizes. Medical jurists place great stress on the presence of a point of ossification in the lower epiphysis of the thigh-bone (femur) in its bearings upon the maturity of the foetus. This point usually first makes its appearance at the 36-37th week; at the 37-38th week it is commonly the size of the INFANTICIDE-SUMMARY. 557 head of a house-fly; and at the full period it is of one-fourth to one-third of an inch in diameter. When this point of ossification is one-third of an inch in diameter it may be confidently affirmed that the foetus has reached the full period; but where the point is only one-fourth of an inch in diameter it cannot be positively asserted that the child is mature, though it is probable that such is the case. The characters which have been here described as belonging to a child at the different stages of gestation must be regarded as representing an average statement. They are open to numerous exceptions; for some children at the ninth month are but little more developed than others at the seventh. Twins are generally smaller and less developed than single children; the average weight of a twin child is not more than five pounds, and very often below this. The safest rule to follow in endeavoring to determine the uterine age of a child is to rely upon a majority of the characters which it presents. That child only can be regarded as mature which presents the greater number of the characters described as met with in children at or about the ninth month of gestation. Trötsch has pointed out that the size of the external ear furnishes a good test of the age of the child, and the editor has confirmed his observations. Trötsch measured both the length and breadth of the external auricle, but it usually suffices to take the greatest length only. The following are the usual extreme lengths of the external ear in the fœtus: It is convenient to remember that the length of the child in inches is, during the later stages of pregnancy, double the intra-uterine age in months. If the age of the child has been determined, whether it be under or over the seventh month, the rules for a further investigation will be the same. Should the child be under the seventh month, the medical presumption will be that it was born dead; but if it has arrived at the full period, then the presumption is that it was born alive. Conclusions. The following may be taken as the editor's summary of the principal facts upon which our opinion respecting the uterine age of a child may be based : : 1. At six months.-Length, from eight to twelve inches; weight, one to two pounds; eyelids agglutinated; pupils closed by membranæ pupillares; testicles not apparent externally in the male; ossification in pubes and os calcis. 2. At seven months.-Length, from twelve to fifteen inches; weight, two to four pounds; eyelids not adherent; membranæ pupillares disappearing; nails imperfectly developed; testicles not apparent externally in the male; ossification in four divisions of sternum. 3. At eight months.-Length, from fourteen to eighteen inches; weight, from four to five pounds; membranæ pupillares absent; nails perfectly developed, and reaching to the ends of the fingers; testicles in the inguinal canals; ossification in last sacral vertebra. 4. At nine months.-Length, from sixteen to twenty inches; weight, from five to nine pounds; membranæ pupillares absent; head well covered with fine hair; testicles in the scrotum; skin pale; the finger-nails well 558 INSPECTION OF THE BODY. formed and reaching to the ends of the fingers; the features perfectthese and the body are well developed even when the length and weight of the child are less than those above assigned. The external auricle measures an inch to an inch and an eighth or more in length, and seveneighths of an inch to an inch in breadth. Inspection of the Body.-The questions which a medical jurist has to solve, in examining the body of a newborn child, are: 1. To determine its age, or the stage of uterine life which it has reached. 2. Whether it has lived to breathe. 3. Whether it has been born alive. 4. The period of time which has elapsed since its death. 5. The cause of death, whether violent or natural. Hence, before commencing the inspection, note 1. The length (measured from the summit of the head to the sole of the foot) and weight of the body. 2. The presence or absence of external foetal peculiarities. 3. Any peculiar marks or indications of deformity whereby identity may be sometimes established. 4. All marks of violence, in the shape of wounds, bruises, or lacerations, and the kind of instrument or weapon by which they were probably produced. 5. Whether the navel-string has been cut and tied, or lacerated; the appearance of the divided vessels, and the length of that portion which is still attached to the body of the child. 6. The presence or absence of vernix caseosa about the groins, armpits, or neck-the presence of this substance proving that a child has not been washed or attended to. 7. It will be necessary to state whether there are about the body any marks of putrefaction, indicated by a separation of the cuticle, change of color in the skin, or offensive odor. It is obvious that, unless the circumstances are noticed before the inspection is commenced, they may be entirely lost as evidence. A medical man cannot be too careful in noticing upon the body of the child any special characters which may serve as proofs of identity. He must remember that the defence may be that the child is not that of the woman charged with murder. This observation applies especially to the examination of the bodies of children that may have survived their birth for some days. The body may be found wrapped in paper or in some article of clothing which may help to establish identity. If the child has survived its birth it would be well to form an opinion as to how many days it has lived. The state of the navel-string, or, if separated, whether the part of the abdomen to which it was attached is in the process of healing or already healed,-are facts which may help a medical opinion respecting the date of birth. In addition to these points, the sex of the child and the color of the hair should be noted, as well as any particular marks on the skin, nævi (mother's marks) or moles, and, of course, all wounds or other injuries-their probable cause or mode of production, and their situation. PROOFS OF LIFE BEFORE RESPIRATION. 559 EVIDENCE OF LIFE CHAPTER XLVIII. BEFORE RESPIRATION.-PUTREFACTION IN UTERO.-EVIDENCE of life AFTER RESPIRATION.—COLOR, VOLUME, CONSISTENCY.-PRESENCE OF DEVELOPED AIRCELLS, AND ABSOLUTE WEIGHT OF THE LUNGS.-STATIC TEST.-WEIGHT INCREASED BY RESPIRATION. THE question whether a child was or was not born alive is of great importance in a case of alleged child-murder; and it is unfortunately one which, in respect to the proofs upon which medical evidence is commonly founded, has given rise to considerable controversy. When it is stated that in most cases of alleged infanticide which end in acquittals in spite of the strongest moral presumptions of guilt, the proof fails on this point only, it must be obvious that this question especially claims the attention. of a medical jurist. The medical evidence of a child having been alive, when violence was offered to it at its birth or afterwards, may be divided into two parts: first, that which is obtainable before the act of respiration is performed; and second, that which is obtainable afterwards. At present we shall confine our attention to the question whether the child was legally living when it was maltreated,-the fact of its having been born alive will be a matter for future consideration. These two questions have been frequently but improperly associated, thus rendering the subject confused; but it must be so obvious as scarcely to require stating, that violence of a murderous kind may be offered to a living child before it is entirely born; and that owing to this violence it may come into the world dead. Proofs of Life before Respiration.-It was formerly supposed, if the lungs contained no air, that the child could not have breathed, and must have been born dead; but this is now known to be an error. Children are able to breathe feebly and continue in existence many hours without visibly distending the cells of the lungs with air; the absence of air from the lungs, therefore, furnishes no proof either that respiratien has not been performed, or that the child has not lived after birth. The restoration of many children apparently born dead is in itself a clear proof that many are born living who might be pronounced dead, simply because “breathing" and "life" have been erroneously considered as synonymous terms. That our law authorities will admit evidence of life in a child before the establishment of respiration is clear from the decision in Rex v. Brain, in which the judge said that a child might be born alive, and not breathe for some time after its birth (Archbold, Crim. Plead., 367); as also from the charge of Coltman, J., in the case of Rex v. Sellis (Norfolk Spr. Circ., 1837). In this instance it was alleged that the prisoner had murdered her child by cutting off its head. The judge directed the jury, that if the child was alive at the time of the act it was not necessary, in order to constitute murder, that it should have breathed. In fact, it would appear that respiration is regarded as only one proof of life; and the law will, therefore, receive any other kind of evidence which may satisfactorily show that a child has lived, and make up for the proof commonly derived from the state of the lungs. In these cases it will be first necessary for a medical practitioner to prove that the child under examination has recently died, or, in other 560 EVIDENCE FROM MARKS OF VIOLENCE ON THE BODY. words, that there are good grounds for believing it to have been recently living. Hence, if the body is highly putrefied, either from the child having died in the womb some time before birth or from its having been born and its body not discovered until putrefaction had far advanced both internally and externally, the case is beyond the reach of evidence. A medical witness will in general be compelled to abandon the investigation because the body can furnish no evidence whatever of life after birth. The examination of the thoracic organs would throw no light on the case, for here we are assuming that the lungs are in an unexpanded condition. Evidence from Marks of Violence on the Body.-It has been proposed to seek for evidence of life under these circumstances by observing the characters presented by marks of violence on the body. In general when children are murdered the amount of violence inflicted is considerably greater than that which is required to destroy them, whereby satisfac tory proofs of the crime are occasionally obtained. On the other hand, the body of a stillborn child, dead from natural causes, is often covered with lividities and ecchymoses; and as the blood of the fœtus or child does not coagulate with the same firmness as that of the adult, the evidence derivable from the extent, situation, and characters of marks of violence is often of too vague and uncertain a kind to allow of the expression of a medical opinion that the child was living when the violence was offered to it. The characters which have been already described as peculiar to wounds and contusions inflicted during life (pp. 249, 252) may be met with in the body, whether the child has breathed or died without breathing. So, again, these characters are open to the exceptions there pointed out; for they will be equally present, supposing the wounds to have been inflicted immediately after the cessation of respiration or circulation in the child or after the cessation of circulation only-if the act of respiration has not been performed. But marks of violence on the body of a child that had died in utero twenty-four or forty-eight hours before it was born would not present the characters of injuries inflicted on a living child. There would be no ecchymosis and no effused coagula of blood. These marks when they exist, although they may establish that a child was either living or but recently dead at the time they were inflicted, cannot show that it was born alive. Injuries met with on the bodies of children alleged to have been born dead ought, however, to be of such a nature as to be readily explicable on the supposition of their having arisen from accident. If from their nature, extent, or situation they are such as to evince a wilful or intentional design to injure, it is a fair ground for a jury, not for a medical witness, to inquire why these extensive wounds or other marks of violence were inflicted on a child if, as it is alleged, it was really born dead. It must be confessed that in such a case there would be a strong moral presumption of murder, although medical proof of life or of actual live birth might totally fail. As a summary of these remarks it may be observed that although physiologically a child may live for a certain period after its birth without breathing-and legally its destruction during this period would amount to murder-yet there are at present no satisfactory medical data to enable a witness to express a positive opinion on this point in the majority of cases. If other evidence were adduced of a child having lived and been destroyed under these circumstances as where, for example, a woman causes herself to be delivered in a bath of water, or an accomplice covers the mouth of an infant in the act of birth or immediately after it is borna medical witness would be justified in asserting that the absence of the signs of respiration in the lungs was no proof that the child had been |