Fig. 27.—Photo-micrograph of
starch granules, × 250 (potato).
(R. J. M. Buchanan.)

The following are some of the points to be considered in forming a diagnosis: (1) Changes in the skin. (2) Changes in the umbilical cord. (3) Changes in the circulatory system.

Table showing how long a
New-born Child has Lived.

  At Birth,
but before
Respiration.		 From
1 to 24 Hours.		 From
2 to 3 Days.
Skin. As a rule, very red, soft, The skin is firmer and rosy, The skin assumes a yellowish
smooth, and covered with and the vernix caseosa not tint. Sometimes on the
a whitish, fatty, sticky coat so white. abdomen and base of the chest,
(vernix caseosa).   the epidermis shows signs of
    approaching exfoliation
Head. Presence of caput   The caput succedaneum has
succedaneum.   disappeared, leaving only a
    slight ecchymosis.
Umbilical Is fresh, firm, bluish, roundish, The umbilical cord is The cord is brown from its
 Cord. more or less spongy. The withering, and the calibre of extremity to its base, is less
  ductus arteriosusis is four to six the arteries is beginning to moist, and already shows signs of
long. Its lines diameter diminish from the thickening mummification. The vessels are not
is double that of each of of their walls. easily made out, being flattened,
the branches of the pulmonory   and contain a fine clot more or
artery.   less contracted.
The The large intestine contains The meconium is discharged, The green mucus which covered the
Large meconium. but the large intestine still intestine is detached in places.
Intestine.   contains thick greenish mucus.
  From
3 to 4 Days.		 From
4 to 6 Days.		 From
6 to 12 Days.
Skin. The icteric colour of the The exfoliation of the skin The exfoliation of the skin has
skin is more marked. Exfoliation extends from the groins to the extended to the extremities.
of the skin has begun over axillæ and between he shoulders.  
belly and base of the chest. The epidermis is detached in  
  strips, in scales, or as a firm  
  powder.  
Head.      
Umbilical The cord is of a brownish-red The cord is detached from If the cord was thin, cicatrisation
 Cord. colour, flattened and distorted. the abdomen, the membranes first, is complete before the
The vessels are twisted like a then the arteries, and last, the tenth day. The arteries, the vein,
gimlet. The arteries are in great vein. The arteries and the vein are  and other fœtal canals are
part obliterated, the calibre of the quite obliterated. The ductus obliterated. If the cord was thick,
vein and ductus venosus is arteriosus and foramen ovale a sero-purulent discharge may
diminished, but they and the diminished in size are still open. continue to the twenty-fifth or
foramen ovale are still open. The   thirtieth day.
circumference of the ring is injected     
and begins to show signs of    
inflammation, with the discharge    
of a sero-purulent fluid at the    
base of the cord.    
The      
Large The green mucus almost absent. The green mucus quite absent.  
Intestine.      

1. Changes in the Skin.—Exfoliation of the cuticle. The time at which this occurs is so variable as to be of little value in a medico-legal inquiry.

2. Changes in the Umbilical Cord.—Mummification of the cord is not of the slightest value as a proof of extra-uterine life; but the separation of the cord which occurs between the fourth and seventh day, especially when cicatrisation has taken place, is a sure sign that the child must have lived four or five days at least. Two other appearances of some value may also be noted, namely:

(a) In fresh bodies, the appearance of a bright red ring about a line in breadth, which surrounds the insertion of the cord, and which is formed within the uterus.

(b) A similar red ring, about two lines broad, around the insertion of the cord, accompanied with “thickening, inflammatory swelling of the portion of the skin affected, and slight purulent secretion from the umbilical ring itself.” This latter condition Casper considers as affording “irrefragable proof of the extra-uterine life of the child.”

3. Changes in the Circulatory System.

(a) Ductus Arteriosus.—Arterial duct. A contracted condition of this duct is of no value as a proof that a child has survived its birth; for the duct is liable to become contracted, and even obliterated, before the birth of the child.

(b) Ductus Venosus.—Nothing certain is known as to the exact time when this duct closes; the condition of the vessel is, therefore, of no assistance in determining the possibility of the child having survived its birth. The duct has been found closed in a still-born child; and in one child, which lived for a quarter of an hour, both the ductus arteriosus and the foramen ovale were found closed. Cases are also on record in which these fœtal channels were found open after thirty days of extra-uterine life.

(c) Foramen Ovale.—What has been said of the preceding may be said with regard to the foramen ovale.

N.B.—To sum up, therefore, in the fewest words, any attempt at forming an opinion on the docimasia circulationis may result in a fatal error on the part of the medical witness, as it is impossible to determine with any accuracy by days the period of their closure. As a general statement, however, the following, according to Bernt and Orfila, is the order in which obliteration of the fœtal vessels takes place: (1) The umbilical arteries. (2) Ductus venosus. (3) Ductus arteriosus. (4) Foramen ovale.

Synopsis

1. Infanticide is not regarded as a specific crime.

2. To be tried by the same rules of evidence as apply to murder.

3. The law presumes that every child is born dead, till proof to the contrary is given.

4. Onus of proving live birth devolves on the prosecution.

5. The body need not be found in order to obtain conviction of the suspected party, if not of infanticide, at least of concealment of birth.

The medical evidence, however, depends on the body being found and examined.

The medical witness may be examined on one or more of the following points:

6. In absence of proof of infanticide, the woman, in England, may be tried for concealment of birth, that is, disposing secretly of the body, whether the child be born dead or alive.

7. In Scotland, a woman may be tried for concealment of pregnancy when the child is dead or missing, if she do not call for or make use of help or assistance in the birth; but the case is quashed, if the child be shown alive by the mother to others.