a fatal result ensues, it is generally due to ignorance and recklessness on the part of the abortionist, or to impatience on his or the woman's part at the desired result not occurring within a few hours, which consequently induces him to resort to unnecessary violence. An abortion is sometimes procured by fraud on the part of a woman, who consults a medical man with a history of displacement of the womb, at the same time carefully concealing from him, by evasive or untruthful answers, the fact of pregnancy. A medical man is thus very apt to be taken off his guard, and may be led to pass a sound into the uterus with the object of ascertaining the existence of displacement, or of remedying it, and so ultimately producing an abortion. It is possible, however, for a uterine sound to be passed into the cavity of the gravid uterus without causing abortion, provided the sound passes between the uterine wall and the membranes, without rupturing the latter. Abortion may be caused by the injection of some substance into the vagina. Injections of tepid or hot water have been known to induce premature labour in advanced pregnancy. Irritant and corrosive substances have also been injected into the vagina with the object of procuring abortion. A few years ago a man was tried in London for causing the death of a woman by injecting a solution of the acid nitrate of mercury into the vagina, and possibly into the uterus. Death occurred without abortion having been procured. SIGNS OF ABORTION IN THE LIVING AND DEAD These are practically the same as those of delivery. In addition, careful search should be made for indications of the use of instruments or of the employment of violence of any kind. In the living the indications that abortion has taken place vary with the term of gestation at which it happened, and the time that has intervened between the occurrence of the abor tion and the examination. If the abortion occur during the first two months of pregnancy, an early examination will probably show little more disturbance of the parts than is found after a menstrual period; whilst in a few days nothing unusual would probably be seen. As pregnancy advances, the signs of abortion resemble those described as attending delivery at term. The examination for signs of an alleged abortion. should be made within twenty-four hours of the occurrence, or very little useful information will be obtained. In cases of suspected abortion a careful examination of any substances expelled from the uterus should be made. If there be a fœtus, it should be examined in order to determine the stage of intra-uterine life it had reached (see pp. 159 and 189), whether it was born alive, and if so, to what cause its death was probably due. Punctures or wounds upon the fœtus should be searched for, and, if present, an attempt should be made to decide whether such injuries were caused during life or after death, as the defence might be raised that the injuries were caused after birth. If the expelled substances do not contain a fœtus, they should be carefully examined for moles, so-called uterine hydatids, polypi, membranes, and false membranes. The latter may be due to dysmenorrhoea, and not the result of impregnation at all. Post-mortem examination of the female. If death has occurred within three or four days of the attempt to procure abortion, the case can generally be made out satisfactorily; but if the woman has survived for three or four weeks, it may be impossible to determine the fact of abortion, owing to the signs having disappeared, especially if the abortion occurred in the early stages of pregnancy. Careful search should be made for punctures, lacerations, and incisions in the vagina, uterus, and the contiguous organs. These wounds, and especially punctures, may be multiple, as it is not uncommon for an ignorant abortionist to make more than one stab at random with the instrument he is employing. The uterus with the vagina attached should be very carefully removed, so as not to injure it in any way. A measurement of its length (see p. 155) should be made, and if a fœtus be present, its probable age should be determined (see pp. 159 and 189). The appearances of the walls of the uterus, signs of inflammation within its cavity, signs of perimetritis, and the presence or absence of mucous membrane in the cavity are to be noted. The site of the placenta should be searched for, and can probably be made out after the third month of gestation. Care should be taken not to mistake the peculiar appearances of the uterus of a recently delivered. woman—which frequently appears bruised, and as if it had been subjected to violence-for the results of mechanical illusage. The presence or absence of peritonitis, especially in the vicinity of the uterus, should be noted; if the peritonitis be the result of mechanical violence, it is usually more localised than that which occasionally occurs as a complication of puerperal cases at term. The appearances resulting from menstruation a thickened state of the uterus, and a swollen and hyperæmic condition of its mucous membrane-should not be mistaken for those produced by abortion. The stomach, intestines, liver, kidneys, and bladder should always be examined for signs of irritant poisoning. CHAPTER XXXVI Infanticide-Determination of the age of a foetus or infant - Evidences of a child having lived-- Hydrostatic test-Breslau's test-Period of time that an infant has survived its birth-Causes of death of the new-born child - Concealment of birth. INFANTICIDE INFANTICIDE is a term which is restricted to the criminal destruction of a new-born child. In a legal sense it is immaterial whether the child be killed directly it is completely born or soon after. The law of England treats infanticide as ordinary murder; but in such cases juries are not infrequently reluctant to return a verdict of murder, often on account of a feeling of commiseration for the prisoner, owing to her having been seduced and deserted, and therefore convict her only of the minor offence of concealment of birth. In the great majority of cases of alleged infanticide, the establishment of the charge of murder depends upon the medical evidence, as proof is required of the separate existence of the infant from the mother in order that the crime of murder can have been perpetrated. An infant which is partially born, although it may breathe and show other signs of life, has not in the legal sense a separate existence, and until it has a separate existence the crime of infanticide, according to the law, cannot be perpetrated. At a trial for infanticide the medical witness has, therefore, not only to testify to the cause of death as in an ordinary case of murder, but in addition has to give evidence, if possible, as to whether the infant breathed, and whether it was or was not born alive. As many infants are born dead, and may also die from natural causes either during birth or shortly afterwards, and as the signs of an infant having been born alive are frequently indistinct, the law assumes, in order to guard against erroneous convictions, that every new-born child has been born dead unless the contrary is proved by medical evidence, so that the burden of proof that a living child was destroyed is thrown upon the prosecution. The medical questions requiring solution in a case of infanticide relate to both the mother and infant. The question as regards the accused woman is-Has she been delivered of a child recently, or at a period consistent with the time that has apparently elapsed since the birth of the infant? This question has been already fully discussed under the signs of delivery (see pp. 165-170). As regards the infant, the points that require investigation whenever the body of a new-born child is being examined for medico-legal purposes are:- I. To determine the age, or stage of intra-uterine life, which it has reached. II. To determine whether it has lived to breathe. III. To determine whether it has been born alive, and if so, the period of time that has elapsed since its death. IV. To determine the cause of death, whether natural or violent. 1. THE STAGE OF INTRA-UTERINE LIFE, OR THE AGE OF THE CHILD In most cases of infanticide, the child has arrived at the full term of gestation; but as children may be born at an earlier period, the medical witness must be prepared in such cases to give an opinion as to the probable stage of intrauterine life to which the child had attained. Such an opinion must be based upon a knowledge of the size, weight, appearance, and development of the fœtus at the different periods of intra-uterine life. As a case of infanticide is not likely to form the subject of investigation before the completion of the sixth month of gestation, the following tabulation comprises the appearances presented by the foetus from the sixth month |