By the revised statutes of New York, when pregnancy is pleaded in bar of execution, it is enacted that the sheriff shall summon a jury of six physicians, and shall give notice to the district attorney, who shall have power to subpoena witnesses.

In England the jury of matrons is now, for all practical purposes, obsolete; since Courts of law invariably supplement the jury of matrons with a medical man, who acts as assessor and makes on their behalf the medical examination.

These are the only two cases (see p. 146) in which pregnancy has any direct relation to medical jurisprudence; and it is remarkable that, with respect to them, the law of England has expressly provided that they should be left to the decision of non-medical persons. The following conclusions may therefore be drawn:-1. That the cases in which the signs of pregnancy become a subject of legal inquiry in England are rare. 2. That there is no case, in English law, in which a medical man will not have an opportunity of performing an examination per vaginam. 3. That a medical opinion is never required by English law-authorities, until the pregnancy is so far advanced as to render its detection certain. Hence discussions concerning areolæ, the condition of the breasts, &c., are, in a practical point of view, unnecessary to a medical jurist. By these remarks it is not intended to undervalue the importance of an accurate knowledge of the signs of pregnancy to a medical practitioner. Cases which may never come before a Court of law will be referred to him, and the serious moral injury which he may inflict on an innocent woman by inaccuracy should make him scrupulously cautious in expressing an opinion. The case of Lady Flora Hastings furnishes a sad illustration of the effects of such a medical error. (See 'Lancet,' Nov. 22, 1851, p. 485.) On other occasions his own reputation may suffer by a mistake of this kind. A married lady in Scotland, who had not had a child for a long period, thought that she had become pregnant, and consulted the chief physician in the place, a man of skill and experience. He saw her several times, and had every opportunity of examining her condition. He gave a decided opinion that she was not pregnant. The lady, however, made her preparations, and one night, not long after the medical opinion had been formally given, the physician was sent for to aid in the delivery.

Concealment of pregnancy. By the law of Scotland, if a woman conceals her pregnancy during the whole period thereof, and if the child of which she was pregnant be found dead, or is amissing, she is guilty of an offence, and is liable to prosecution. Evidence is sometimes given as to outward appearances indicative of pregnancy; but in the main, proof of a woman having been pregnant and that which is relied on for conviction, is clear and distinct evidence of the actual delivery of a child. This is generally furnished by medical witnesses. The Scotch law, by making the concealment of pregnancy, under the circumstances above mentioned, an offence, proceeds on the principle that every pregnant woman is bound to make preparations for the safe delivery of a child; and it is therefore assumed that if a child is born clandestinely, without preparation, and is found dead or is amissing, its death is owing to the want of such preparation.

Impregnation in a state of unconsciousness. It was formerly a question whether a woman could become pregnant without her knowledge. This may undoubtedly happen, when intercourse has taken place during profound sleep (lethargy, vol. 1, p. 44); or when a woman has been thrown into this state by narcotic drugs or vapours. But it is difficult to admit that any woman should remain pregnant up to the time of her delivery, without being conscious of her condition, if the intercourse took place during the waking state. A woman endowed with ordinary intellect could

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157

not avoid suspecting her condition after the fourth or fifth month: and this alone would be sufficient to induce her to seek advice whereby the fact would become known to her. When a woman is impregnated in a lethargic state, it is unlikely that she should go beyond the sixth month without being fully aware of her pregnancy, and if her motives were innocent she would undoubtedly make some communication to her friends. Capuron mentions a case of this kind, in which the fact of pregnancy was first ascertained at the end of the fourth month, by the woman having complained to one of her sisters of a strange sensation which she experienced in the lower part of her abdomen. ('Méd, Lég. des Accouchemens,' p. 86.) In one case a young woman who had had intercourse knowingly was supposed not to have been aware of her pregnancy until the seventh month; but there is reason to believe that she was guilty of deception. (Med. Gaz.' vol. 39, p. 212.) There are generally, in these cases, strong motives for falsehood; hence such stories require close investigation before they are allowed to influence the opinion of a practitioner. A case occurred in which a woman, æt. 22, described as modest and decorous in her behaviour, then advanced to the sixth month of pregnancy, asserted that she had not consciously had connection with any one, although she specified a date at which she remembered she had lost her consciousness-at which date intercourse might have been had. On being questioned, she denied that she had had at any time any soreness or pain in her private parts. Although there may be unconscious intercourse and pregnancy, it is not probable that in the case of a virgin, there should be such intercourse without the production of pain, soreness, or laceration; and these symptoms, if not perceived at the time, should be felt subsequently and create a suspicion, if not an actual knowledge of what had happened. This rendered the account which the woman gave wholly improbable. The fact that she was able to fix a date for her unconsciousness, with an accuracy in accordance with her condition, was also a suspicious circumstance.

Unconscious pregnancy.--It is quite possible that women who are living in connubial intercourse may become pregnant without being conscious of their state. Rüttel mentions the case of a woman, æt. 41, who had been married upwards of sixteen years, and who, while returning from a neighbouring village, was suddenly delivered of her first child, when she had only a few days before been complaining that she was not likely to have any children. The child was born living and mature. (Henke, 'Zeitschr. der S. A.' 1844, 264.) Long met with a case in which a married woman, æt. 24, subject to irregular menstruation, consulted him for an attack of spasms. On his arrival, he found that she had suddenly given birth to a sevenmonths' child. Neither her husband nor herself had the slightest idea that she was pregnant. She had noticed that she had become somewhat stout, and that her breasts were more full than natural. She attributed her condition to improved health, and the cessation of the menstrual discharge was set down to some accidental cause. ('Med. Times and Gaz.' June 13, 1857, p. 592. See also a case at full term, 'Obst. Trans.' vol. 4, p. 113.) A married lady, who had not had a child for a period of nineteen years, found herself, as she thought, getting unusually stout. She was moving about with her family to different places. At last her size alarmed her, and she thought she was suffering from dropsy; she consulted a physician, who informed her that she was in an advanced state of pregnancy. She treated this opinion with great contempt. In travelling with her daughter, they arrived at a miserable inn: on the night of their arrival, this lady was seized with the pains of labour, and was delivered of a child. She had made no preparation for the birth, and, up to the moment when

she was seized with labour pains, she had not, with all her former expe rience, the slightest belief that she was pregnant. (For other cases, see 'Lancet,' 1860, 1, pp. 643, 909.) Instances of this kind are important in reference to alleged unconscious delivery in the cases of women charged with infanticide. At the same time, many of the cases in which there are motives for pleading unconscious intercourse or pregnancy require close examination: they will frequently be found to be quite unworthy of belief.

Pregnancy in the dead.-There is no special case in law wherein the fact of pregnancy requires to be verified after the death of a woman; but an examination may be necessary in order to determine the identity of a body, or to rescue the reputation of a woman from a charge of unchastity. The discovery of an embryo or foetus with its membranes in the uterus would of course at once solve the question, should the necessity for an examination occur; and the practitioner will remember that, even supposing many years to have elapsed since interment, and the body to have been reduced to a skeleton, still if the foetus had reached the period at which ossification takes place, traces of its bones may be found amidst the bones of the woman. In examining the body of a woman long after death, for the purpose of determining whether she was or was not pregnant at the time of death, it may be borne in mind that the unimpregnated uterus undergoes decomposition much more slowly than other soft organs. In the case of a woman who had been missing for a period of nine months,— whose body was found in the soil of a privy, so decomposed that the bones separated from the soft parts, the uterus was of a reddish colour, hard when felt, and its substance firm when cut. The fact was of importance. It was alleged that the deceased was pregnant by a young man, and that in order to conceal her condition he had murdered her. From the state of the uterus, Casper was able to affirm that this organ was in its virgin condition, and that the deceased was not pregnant at the time of her death. (Ger. Leich.-Oeffn.' vol. 1, p. 93.) In examining bodies many months after interment, while other soft organs are decomposed, the uterus may have scarcely undergone any change: its substance being still firm and hard. It may happen that the appearances in the uterus are sufficient to create a strong suspicion that the woman had been pregnant, but the ovum, embryo, or foetus may have been expelled: in this case several medico-legal questions will arise in reference to delivery.

DELIVERY.

CHAPTER 62.

DELIVERY IN THE LIVING CONCEALED DELIVERY-ABORTION IN THE EARLY STAGES OF PREGNANCY-THE SIGNS SPEEDILY DISAPPEAR-SIGNS OF RECENT DELIVERY IN ADVANCED PREGNANCY-SIGNS OF DELIVERY AT A REMOTE PERIOD-FEIGNED DELIVERY-DELIVERY IN A STATE OF UNCONSCIOUSNESS— CIRCUMSTANCES UNDER WHICH THIS MAY OCCUR-ADMISSION OF THE PLEA IN CASES OF ALLEGED CHILD-MURDER-SIGNS OF DELIVERY IN THE DEAD-TRUE AND FALSE CORPORA LUTEA-FALLACIES TO WHICH THEY GIVE RISE-CHARACTERS OF THE OVUM OR EMBRYO FROM THE FIRST TO THE SIXTH MONTH.

DELIVERY is a subject which much more frequently requires medico-legal intervention than pregnancy. It will be sufficient to state that the concealment of birth, the crimes of abortion and infanticide, with questions

CONCEALED DELIVERY.

RECENT ABORTION.

159

relative to supposititious children, are closely dependent on the proof of parturition. This subject will admit of being considered under two heads-1. As it relates to delivery in the living;-2. As it relates to delivery in the dead. In undertaking the investigation, we ought, if possible, to ascertain, either from the woman herself or from those around her, whether there was reason to suspect that she had been pregnant. If we can acquire any knowledge on this point it will materially facilitate the inquiry; but this is not always possible. It has generally happened, that previous pregnancy has been so concealed that few who saw the woman suspected her condition: then again, as the admission of her delivery may be the strongest proof of her criminality, she will perhaps resolutely deny it; and a medical practitioner has no right to extort this admission from her. From this it will be seen that a medical witness must often be prepared to prove the fact of delivery, against a woman who is criminally charged.

Delivery in the living. Concealed delivery. The signs of delivery in a living woman vary materially according to the time at which this event has taken place. In common language, if the contents of the uterus are expelled before the sixth month, the woman is said to miscarry, or to have an abortion: if after the sixth month, she is said to have a premature labour. The law does not admit any such distinction: the expulsion of the ovum, fœtus, or child by criminal violence, at any period of uterogestation, is regarded as a miscarriage or abortion. It will therefore be proper, in treating this subject, to commence with the earliest period at which the contents of the uterus may be expelled, and to make no artificial distinction between the signs of abortion and delivery. It has been well observed, that the signs of delivery are indistinct in proportion to the immaturity of the ovum. Thus, when it takes place at the second or third month, there are scarcely any proofs which can be derived from an examination of the woman. All the ordinary signs of delivery at the full period will be absent, the development of the embryo not having been sufficient to cause any prominence in the abdomen, or to give rise to those changes in the system which take place previously to the birth of a mature child: e.g. enlargement of the breasts and dilatation of the mouth of the uterus. Abortion at this period (the second or third month) is generally accompanied by loss of blood, which may manifest itself by its effects on the body. This, however, can only give rise to a suspicion. At a later period of gestation there may be a discharge resembling the lochia, and the mouth of the uterus may be found enlarged and soft; but from the small size of the fœtus the outlet will present no positive evidence of delivery. The quantity of blood lost may be greater, and may have a more decided effect on the system. Of course, if the ovum, fœtus, or any of its membranes be found, then the presumption of abortion will be strongly supported: but women who designedly conceal their condition will commonly take effectual means to prevent the examiner from obtaining evidence of this kind.

These remarks relative to the state of the woman apply to an examination made recently after abortion. If any delay has taken place, even the ambiguous signs which have been mentioned will speedily disappear; so that after a period, which is short in proportion to the earliness of the expulsion, no traces whatever will be discovered. Montgomery met with a case in which abortion took place, with a considerable loss of blood, at the close of the second month. Twenty-four hours afterwards, the mouth and neck of the uterus were almost completely restored to their natural state. The vagina and external parts were hardly if at all dilated, and very little relaxed; the breasts exhibited imperfectly the appearances which

accompany pregnancy, the ordinary sympathetic symptoms of which had been almost entirely absent. (Cyc. Pr. Med.' 504; also Devergie, vol. 1, p. 683.) In such a case as this, and for such cases a medical jurist must be prepared,-scarcely a presumption could have been entertained of the fact of delivery. After twenty-four or thirty-six hours, in the greater number of these early cases, we may expect to find, from a personal examination of the woman, no proofs whatever of abortion.

In order to determine the signs of a 'miscarriage,' as it is termed by our law, at an advanced period of gestation, it will be necessary to describe those which are considered to be characteristic of delivery at the full period. In these cases there will be only a difference in degree; the signs being more numerous and more clearly marked in proportion to the lateness of the period at which the contents of the uterus are expelled. The signs of delivery may be enumerated in the following order :

Signs of recent delivery in the living.-The woman is weak, the countenance pale, the eyes are surrounded by dark areolæ, and there is an appearance of general indisposition. Any severe illness may, however, give rise to similar symptoms. Their sudden occurrence, from a state of previously good health, especially when pregnancy is known or suspected, will create a strong suspicion. The breasts are full, especially about the third or fourth day; the nipples are enlarged, and the areola around them present all the characters of advanced pregnancy. If the appearances described are not well marked at the first examination, they may be seen at a later period; and in a doubtful case, when the embryo or fœtus is not forthcoming, a second examination should be made before a final opinion is given.

1. The skin of the abdomen is relaxed, sometimes thrown into folds : the cuticle interrupted by light-coloured broken streaks, passing especially from the groin and pubes towards the navel, which is more or less stretched and altered in appearance. Any disease which has caused enlargement of the abdomen may give rise to a similar appearance in the skin, so that when taken alone much confidence cannot be placed in these lines or streaks as proofs of delivery. The round form of the enlarged and semi-contracted uterus may be felt at the lower part of the abdomen, generally lying towards one or the other side. The size of this organ will depend upon the degree to which it has contracted, and therefore greatly upon the time at which an examination is made. Montgomery has pointed out the existence of a dark line extending from the pubes to the navel, with a dark areola around the latter, in cases of recent delivery; but he has found this line to exist independently of pregnancy and delivery-in one case in a girl aged 10, and in another instance in a lady labouring under an ovarian tumour.

2. The organs of generation will be found externally swollen, contused, or even lacerated, with clots of blood about them. The outlet is much dilated; the mouth of the uterus is considerably open, and its margin considerably relaxed. The body of this organ will be found from two to four times the size of the unimpregnated state. It occasionally happens that the neck of the uterus is lacerated on one side during the passage of the head in a first labour; should this be found, or a cicatrix, it will assist in proving delivery.

3. The presence of the lochia (doxòs, child-birth).—This is a discharge from the vagina, at first of a sero-sanguineous liquid, but it afterwards. appears as a brown or green-coloured serum. It commences soon after delivery, and continues from a week to a fortnight, or even longer: it may be absent after the third day. This discharge has so peculiar an odour that some have regarded this alone as furnishing strong evidence of recent delivery.