Examination of the Body of a Child.-The maturity of the child should first be determined. For this purpose its length and weight should be taken, also the length and condition of the hair on the scalp, the condition and length of the nails, the condition of the eyes with regard to the presence or absence of the membrana pupillaris; finally, the lower epiphysis of the femur is to be inspected with reference to the center of ossification. For this purpose a curved incision is to be made over the lower end of the femur, the patella removed, and the end of the bone protruded through the incision, when thin cross-sections may be made until the greatest diameter of the center is ascertained, which should be measured in millimeters. For the necessary measurements the reader is referred to the article on infanticide. The head must be examined for injuries, but the caput succedaneum formed during labor should not be mistaken for an ante-natal ecchymosis. The fontanelles should be inspected with care. There is a case on record where a midwife was convicted for the destruction of several children, which she accomplished by piercing the fontanelle before birth with a long pin. It is important to examine the neck for the marks of strangulation, but the ecchymosis left by an encircling umbilical cord which has strangled the child must not be mistaken for that which is the result of criminal strangulation. When this has been accomplished by the use of a soft ligature, it will be exceedingly difficult to make the distinction; but if a cord has been used, abrasions and excoriations of the skin will be found, and the mark will be narrower than that produced by the umbilical cord.

The mouth, nose, and pharynx should be inspected for foreign bodies. As it may be sometimes necessary to establish the identity of the corpse, the existence of any peculiarities or malformations should be noticed, also the condition of the skin, more especially as to the presence or absence of the vernix caseosa, for if this be absent, we may infer that the child has been washed, although not necessarily born alive. The condition of the cord should be noted, whether succulent or mummified, also the state of the umbilicus with reference to the healing process. Evidences of an inflammatory process in this locality show that the child. has lived some time after birth. Fractures of the long bones cannot of themselves be considered evidence of criminal violence, as they not infrequently occur as the result of accident in ordinary labors. If the body of the child be found wrapped in a covering of any kind, this should be carefully preserved, as its subsequent inspection may furnish a valuable clue to the identity of the child. Perhaps the most important point connected with the technique of the internal examination of the body is the rule which requires that the abdomen should be opened before the thorax. This is for the purpose of ascertaining the position of the diaphragm with reference to the occurrence of respiration, in which case the convexity of the diaphragm is said to be found at from the fourth to the seventh rib, but if respiration has not taken place it reaches only to the fourth or fifth. Evidently if the position of the diaphragm were the only evidence available in deciding so important a point, in those cases where the diaphragm is found at the fourth or fifth rib, as far as this point is concerned, the child may or may not have breathed, and can only be of value where the diaphragm is found occupying the lowest of the positions possible. In any event, this can be only of value as corroborative evidence.

The technical part of the autopsy is conducted precisely as in the adult. The scalp is reflected in the same manner, when the calvarium may be removed with a pair of stout scissors. It is not uncommon in cases of difficult or instrumental labor to find extravasations of blood, not only on the surface of the dura, but also in the subdural space, and even in the substance of the brain itself, although some writers consider that effusions in the substance of the brain are sure signs of extreme violence. These may exist either as simple ecchymoses or as genuine clots. On this account the medical examiner should be extremely cautious in making the deduction that such appearances are the result of criminal violence. It may be remarked, however, that the more difficult a labor the more difficult will concealment have been; and if instrumental interference has been necessary and concealment practiced, the probable collusion of a practitioner must be inferred.

The brain presents no peculiarity worthy of mention. It is somewhat softer than in the adult, and a little pinker. The thorax is opened as before directed, in the adult. The principal point of difference to be noted here between the infant and adult is the presence of the thymus gland, which in the infant covers the lower part of the trachea and the great vessels. It is about two inches in length, about one inch in breadth, and a quarter of an inch in thickness. It is a light fawn color, and extends upward as far as the thyroid body and downward as far as the cartilages of the fourth rib. The thyroid and thymus glands are connected by two flattened bands of fibrous tissue, which are prolongations of the capsule of the thymus. The weight of this structure at birth is about half an ounce. Immediately on opening the chest, the position of the lungs in the pleural cavities is to be noted, and also their relation to the pericardium. When the child has not breathed they lie shrunken in the posterior part of the chest, whereas when the child has fully respired they fill up the chest and cover the pericardium. They are then, moreover, of a light pink color. It must not be forgotten that if the observation regarding color be deferred until the lungs have been exposed some time, they may acquire a light color from imbibition of oxygen. Previous to the removal of the thoracic viscera, a ligature is to be placed on the trachea and great vessels. After removal the lungs must be weighed separate from the heart in order to obtain the data for the static test, which depends on the fact that the lungs are heavier after respiration has been established than before. As the weight of the lungs must vary with the weight of the child, the data which are often given for purposes of comparison cannot be considered very reliable. Petechial spots are often seen on the surface of the pleura in cases of death from suffocation, but as they may occur in death from other causes, they must be noted with due allowance. As usually directed, the ductus arteriosus, the ductus venosus, and the foramen ovale are to be inspected with reference to patency or closure. They may not be completely closed until a week after birth. The amount of blood contained in the cavities of the heart is to be measured or weighed. The same appearances are to be expected in the internal viscera in death from apnoea occurring in infants as in adults.

The abdomen, previously opened for the determination of the position of the diaphragm, may now be dissected. The stomach and intestines are to be examined with reference to the presence of air, food, and

blood. It has been shown by Breslau that there is no air in the stomach or intestines of new-born children. The stomach and small intestines, if there is suspicion of poisoning, should be removed in the same manner as in the adult. In any case, the contents, if any, should be tested for the presence of starch, and examined microscopically for the oil-globules of milk. Blood may sometimes be found in the stomach. Its presence has not the same significance as that of milk or starch. The liver in the infant is of large size in proportion to the body. It is said to diminish in size after the establishment of respiration, but this fact is of little significance. Large extravasations of blood are sometimes found under the capsule of the liver, without known cause. (Delafield.) The spleen may be abnormal in size. The kidneys are lobulated. The bladder may be full or empty. It is rare that the spinal cord needs examination. If, however, the examiner deems this necessary, the same precautions are to be observed against the production of artefacts as in the case of an adult. The natural and great mobility of the head on the spinal column in the infant should not be forgotten.

In conducting the examination of bodies advanced in putrefaction, we are compelled to modify, not so much our methods, as the conclu sions which we are enabled to draw from the autopsy. The identification of the body in these cases is always important and often difficult. After the features have become undistinguishable the question of sex can always be determined, even when a further identification is impossible. Long after the external parts of generation have become undistinguishable the sex may be determined from the presence of hair on the face or the length of the hair of the scalp. The circle of hair which surrounds the pubes is characteristic of the female, while its prolongation upward in the median line is equally distinctive of the male. In the bodies of children too young for these peculiarities to be available, even although the soft parts have become an undistinguishable mass, the uterus may still be recognized. In the adult it is possible thus to determine the existence or non-existence of pregnancy months after burial. The uterus is not only last in the order of putrefaction, but is still distinguishable long after all the other soft parts have become an undistinguishable mass. Casper gives numerous instances of this fact. In one case, that of a young servant-girl drowned in a privy and discovered nine months subsequent, although all the other soft parts had either been changed into adipocere or were but black and greasy masses, from out this mass of putridity Casper was able to separate the uterus, which was of a bright red color, firm, hard to feel and cut, its form perfectly recognizable, its size that of a virgin uterus, its cavity empty. As it had been charged that the girl was pregnant by her master at the time of her death, Casper was thus enabled to prove that this accusation was unfounded, in spite of the fact that the body had lain in a privy for nine months.

Such a case as this ought to teach us that there is no stage of decomposition in which we may not expect to gain useful information from an autopsy. Frequently the question of sex is the only fact relating to identity that the examination will settle. Here, however, it is sometimes possible to gain additional information from such peculiarities as old or recent fractures, and peculiarities of the teeth. In case a recent fracture is discovered there is a question which may arise, not necessarily connected with that of identity, as to whether the fracture was the result

of violence inflicted before or after death, also its relation, if any, to the death of the person injured. If the fracture be of the skull, an examination of its interior may reveal the presence of extravasated blood or of an inflammatory process, as evidenced by the presence of pus, in which case the answer will not be difficult; but if the progress of decay is too far advanced to admit of this, it will be extremely hazardous to attempt to give a definite reply. If callus be found, it is quite certain that the fracture preceded death at least a week, or, according to the amount and condition of the callus, even longer. Fractures of the base of the skull are not likely to be produced after death, and if extensive fractures of the vault are present, it is most unlikely that they have been produced other than by violence before death. Circumstances may cause us to modify such a declaration as this-as, for instance, where a body is found in the ruins of a fire with the skull crushed and other bones fractured. Here the character of the fracture in the skull will determine whether it was the result of injuries inflicted beforehand, as the sharp incised fracture produced by a cutting instrument, as an ax, can readily be distinguished from the crushed condition resulting from the impact of a mass of debris. The findings which it is possible to make from the soft parts of a body much decomposed, particularly as to the existence of disease, will largely depend on the degree of disorganization of the organs which the inquiry concerns.

Every anatomist is familiar with the rapidity with which the tissue of the brain undergoes putrefactive changes. Therefore, while it may still be possible to harden and make sections of the brain quite late, yet it would be dangerous to draw any conclusions, with regard to pathological processes, based on a microscopic examination of such sections. If it is possible to produce artefacts in the comparatively firm texture of the cord simply by rough handling, how much easier may this happen as the result of the softening produced in a texture so little refractory as that of the brain. After putrefaction has advanced to any extent in the external tissues, we are only justified in making such findings as are based on the grosser lesions-as, for instance, the presence of decomposed blood-clot or the existence of pus. The same remarks apply to the microscopic examination of other structures, as the kidneys and liver, in proportion to their power of resisting putrefactive processes. He is certainly a bold, if not a reckless, pathologist who is willing to make statements based on a microscopical examination of these organs many days after death, unmindful of the cloudy swelling and other progressive changes which so quickly occur in their epithelium. It is quite possible, however, to determine such microscopic changes as an altered relation in the cortical and medullary portions of the kidney, the contracted liver of cirrhosis, or an undue predominance of connective tissue. These facts are, of course, evidence of chronic disease rather than the acute processes so often sought for. Acute changes in the digestive tract, owing to the fact that the stomach and intestines decay relatively early, cannot be discovered with certainty long after death, as the stomach commences to putrefy in about six days thereafter; and the changes in coloration are thenceforward so various, its condition in other respects so changeable, that it is difficult to give a precise opinion with regard to its possible condition in life.

With regard to the detection of metallic poisons, it may be stated

that no degree of decomposition is incompatible with their discovery by appropriate analysis; therefore the stomach and intestines should be removed as carefully as possible, taking the same precautions as directed heretofore. It is usual in such cases, whether the body has been buried or lain exposed, to remove a portion of the adjacent soil in order to exclude by analysis the presence of a metallic poison therein. This precaution should not be neglected. The foregoing remarks apply equally to autopsies performed on bodies advanced in putrefaction, whether before burial or after exhumation. Such autopsies are not attended with unusual risk to the examiner. Post-mortems in fresh subjects are attended with far more risk. Indeed, the only serious consequences which the writer ever saw occurred in recent cases. In an experience of over five years in the dissecting-room of the Long Island College, no cases of poisoned wounds ever came under the author's observation, although he saw many cut fingers and one or two bad lacerated wounds made with the saw in process of removing the calvarium. Late autopsies should always be made in a room through which a draught of air is blowing, and such precautions taken as will readily occur to the reader. Exhumations should be made with care, rather, however, with reference to the dead than to the living. When bodies are buried in the cheap pine coffins of the poorhouse, the thin shell soon decays, and cannot be used to raise the body from the grave. In this instance, a sheet of stout canvas with rope handles on either side may be slipped under the frail coffin, which may then be removed from the grave without accident.

It occasionally happens that the medical examiner is required to make medico-legal inspection so long after death that the bones alone are left. When it becomes necessary to disinter the remnants of the body in such a case, it is best to take the following precautions, in order that all the bones may be recovered: a space much exceeding that of the grave is to be dug over, and the earth in the vicinity of the remains carefully sifted through a moderately fine sieve. In this way the small bones of the carpus and tarsus may all be recovered, and such fragments as the separated bones of the infantile skull. There is one case on record where the identification of the body depended on the fact that the fifth metacarpal bone of the right hand possessed two articular facets, the deceased having had a supernumerary finger to which the second facet corresponded. (Reese.) It would have been impossible in this case to have identified the exhumed bones had it not been for the discovery of so small a bone as the fifth metacarpal.

The main facts to be determined by the inspection of bones are: first, the identity of the remains; second, whether they throw any light on the cause of death. It is evident that the question of identity must depend on the determination of sex, age, and stature. It is easier to speak precisely with regard to the first two points than the last. In mature bones, it will never be difficult to distinguish the peculiarities of the two sexes, where the pelvic bones are entire. In the male, the obturator foramen is oval rather than triangular, as in the female. With regard to the pelvis as a whole, it is to be noted that the bones are more massive and the muscular impressions more prominent in the male than in the female. The subpubic arch is narrow and angular in the male, much wider and more arched in the female, the respective angles being seventy-five and a hundred degrees. The actual size of the pelvis varies in different individ