IN REFERENCE TO SINKING OF THE LUNGS.

339

of its expounders, that respiration is only one, and not an exclusive proof of life. In order to establish life, or even live-birth, respiration need not always be proved, either in civil or criminal cases (p. 206 ante). A medical jurist would, therefore, be no more justified in asserting that all such children were necessarily born dead, than that they were born living; and it is not possible that his statement can ever be the means of involving an innocent person. It is certain, however, that when the lungs of a child sink in water, it is not safe to consider such a child as having been born dead, for it cannot be too strongly borne in mind, that a woman is not now charged with murder, merely because the lungs of her child float or sink in water, but because there are upon its body marks of violent injuries apparently sufficient to account for the death of a new-born child, or there are strong moral presumptions of her guilt. (See Ann. d'Hyg.' 1836, 2, p. 362.) But there is another aspect in which this question should be viewed. There may be no marks of murderous violence on the body of the child, nor any proofs of ill-treatment, yet a child born under these circumstances may have died through the culpable neglect or reckless indifference of the woman. In reporting two case of atelectasis, in one of which a child had survived its birth twelve hours, Moore remarks that when such a child is deserted or exposed, without the necessary attention required for its helpless condition, the conditions are precisely fulfilled to cause its death within a few hours under a diminution of temperature and a total expulsion of air from the lungs. He has no doubt that many a child so found, which had met with its death through want of care is looked upon as not having lived. (Med. Press,' Nov. 22, 1865, p. 458.) It will be seen hereafter that some of our judges have given a strong exposition of the law, so as to bring all cases of this description within the crime of manslaughter.

FLOATING OF THE LUNGS FROM OTHER CAUSES THAN RESPIRATION.

Another series of objections has been urged to the hydrostatic test, based on the fact that the lungs may receive air and acquire buoyancy from other causes than respiration. These causes are two-putrefaction and artificial inflation. It was supposed that the lungs of a still-born child might receive air, or become emphysematous, from a compression of the sides of the chest during delivery; but it is difficult to understand how in this way air should enter these organs as a result of pressure. The truth probably is, that what has been described as emphysema of the lungs in still-born children was nothing more than partial or imperfect respiration performed during a protracted delivery. In examining the bodies of many still-born children, the author never met with any appearance resembling what has been described as a state of emphysema independently of respiration and putrefaction. However, according to some observers, emphysema of the lungs may be produced under the following circumstances:-the thorax of the child is compressed in passing the outlet; the lungs within are thereby compressed, and if this compressing force be suddenly removed, as by the passage of the thorax, the elasticity of its walls will cause the chest to expand, and air, it is presumed, will then enter as a necessary consequence by aspiration. The simultaneous compression of the abdomen might aid in the entrance of the air. (Lancet,' May 20, 1837; also June 17, 1837.) It is contended that not only may respiration take place during birth, but that even the lungs of a dead foetus may become thus mechanically inflated, and respiration be thereby simulated.

This opinion appears to be founded on an erroneous view of the condition of the thoracic viscera in the chest. The lungs, before air has entered into them, are as dense as the liver. If they are compressed, they may become elongated, but when that pressure is removed, they will, if the

child be dead, simply return to their original foetal condition. To suppose that they would expand and receive air, is to suppose that the reaction of the thoracic walls is greater than the force with which they have been compressed. But what is to carry the thorax of a dead child beyond the point at which equilibrium is restored? Besides, this would not suffice to distend the air-cells, which are yet coiled up, as it were, and condensed. If this theory were correct, scarcely a child would be born without having air in its lungs. In experimenting on this subject, the author never observed the least portion of air to enter: the air-cells of the lungs do not, therefore, appear to be in the condition of compressed spiral strings, which such a theory would represent.

Floating of the lungs from putrefaction. The lungs of a still-born child, when allowed to remain in the thorax, are slow in undergoing putrefaction; but, nevertheless, they sooner or later acquire sufficient air to render them buoyant in water. This form of gaseons putrefaction may even take place in the lungs of a child which has died in the womb. One instance of the kind is recorded by Albert (Henke's 'Zeitschr.' 1837, 2, 179), in which the child was cut out of the uterus in a putrefied state, and its lungs floated when placed on water. It has been also alleged, that the formation of air may take place in the lungs from putrefaction, and not be indicated by change in colour, smell, or other properties of the organs; but, admitting that this may occur, it can create no difficulty in the investigation.

When the lungs are putrefied, this will be determined, in general, by putrefaction having extended throughout to all the soft parts of the body. The organs, according to the degree of putrefaction, will be found soft, of a dark green or brown colour, and of a highly offensive odour; and the serous membrane covering the surface will be raised in large visible bladders, from which the air may be forced out by very moderate compression. It has been remarked that, under the same conditions, gaseous putrefaction takes place as rapidly in the liver, heart, and thymus-gland of a new-born child as in the lungs. We should, therefore, examine the general condition of these organs and the body. The distension of the lungs with gas from putrefaction cannot be easily overlooked or mistaken for the air of respiration. The answer to any objection founded on the putrefied state of these organs must at once suggest itself. It may be that the medical witness cannot obtain satisfactory evidence from experiments on lungs in such a condition. He should then at once abandon the case, and declare that in regard to the question of respiration, medical evidence cannot establish either the affirmative or the negative. The fact of his not being able to give the evidence required, cannot be imputed as a matter of blame to him; because this is due to circumstances over which he has no control. In a case of poisoning, the appearances after death in the viscera may be entirely destroyed by putrefaction; but no practitioner would think of looking for proofs when the circumstances rendered it impossible for him to obtain them.

The possible danger of placing reliance upon the results obtained from lungs which are decomposed is illustrated by a case reported by Douillard, in Nov. 1871. Fajole examined the body of a new-born mature child, which was found on the banks of a river, partly immersed in water. The body was much decomposed; there were many wounds and fractures about it, but it was impossible to say whether these injuries had been produced before or after death. The body of the child had been exposed six weeks. The organs of the chest, including the lungs, floated on water, and each lung floated separately. There was no appearance of air-vesicles, as in putrefaction, and when the structure of the lungs was broken up by compression, there was no crepitation, and the organs (entire) still floated on water. On these grounds, Fajole concluded that the air con

PUTREFACTION ON THE LUNGS.

341

tained in the lungs was not owing to putrefaction, and that the child had breathed. Next day, the lungs were re-examined by Fajole and another physician. To the surprise of both, when the lungs were placed on water they sank. This difference in the results required explanation. From some experiments on the lungs of rabbits, Fajole still concluded that the air in the lungs was not derived from putrefaction. The matter was referred to the Medico-Legal Society of Paris, and they came to the conclusion, 1st, that it was probable, but not certain, that this child had breathed; and, 2nd, that the conflicting results obtained from the hydrostatic test were owing to the structure of the lungs being broken up and the escape of the air, as the result of the imbibition of water between the two trials to which they were submitted. (Ann. d'Hyg.' 1872, 1, pp. 204, 409.) In a case like this, it would have been more prudent to have placed no reliance upon experiments with putrefied lungs. After six weeks' exposure in water, there was a great probability of error accruing from putrefaction of the organs. The floating was probably caused by some small bubbles of air remaining in the lungs, as they were not cut into small pieces before compression. The conclusion drawn was too vague and indefinite for an English court of law. It is not probability, but certainty, which is required for medical evidence in a case of child-murder.

A case may possibly occur wherein the characters presented by the lungs will be such as to create some doubt whether the buoyancy of the organs is due to putrefaction or respiration; or, what is not unusual, whether the putrefied lungs may not also have undergone the changes produced by respiration. The facts may be apparently explicable on either assumption. Other facts, under a proper investigation, may serve to remove any doubt. (See case, Med. Gaz.' vol. 37, p. 460; also Casper's Vierteljahrsschr.' 1864, 2, p. 37.) In some instances, there has been on the part of medical men a disposition to draw the same inferences of respiration from putrefied lungs, as would be correctly drawn from those which are recent. The gases of putrefaction are generally distributed in large and superficial bladders beneath the pleural membrane. The gases themselves have an offensive odour. The air of respiration may be seen in the minute cells of the lungs either by the eye or with the aid of a lens ; but when the lungs are clearly putrefied it is proper not to strain medical evidence too far. These remarks apply only to lungs on which experiments are made in order to determine the fact of breathing. The body may be putrefied, but the lungs may not share in this condition. In this case the results of experi ments might be admissible as evidence.

Conclusions. The general conclusions which may be drawn from the contents of this chapter, respecting the application of the hydrostatic test in cases of infanticide, are the following:

1. That the hydrostatic test can only show whether a child has or has not breathed-it does not enable us to determine whether a child has been born living or dead.

2. That the lungs of children that have lived after birth may sink in water, owing to their not having received air, or to their being in a diseased condition.

3. That a child may live for a considerable period when only a portion of the lungs has been penetrated by air.

4. That a child may survive birth, even for twenty-four hours, when no part of its lungs has been obviously penetrated by air.

5. Hence the sinking of the lungs (whether whole or divided) in water

is not a proof that a child has been born dead.

6. That the lungs of children which have not breathed and have been born dead may float in water from putrefaction, or from artificial inflation.

7. That the lungs as situated in the chest undergo putrefaction very slowly; that, if but slightly putrefied, the air may be easily forced out by compression; and if much putrefied, either the case must be abandoned or other sources of evidence sought for.

CHAPTER 77.

FLOATING OF THE LUNGS FROM ARTIFICIAL INFLATION-INFLATION DISTINGUISHED FROM NATURAL RESPIRATION-NOT DISTINGUISHABLE FROM IMPERFECT RESPIRATION-DOUBTFUL CASES-RESULTS OF COMPRESSION-IMPROPER OBJECTIONS TO THE HYDROSTATIC TEST-SUMMARY-RESPIRATION BEFORE BIRTH-VAGITUS UTERINUS-RESPIRATION A SIGN OF LIFE, NOT OF LIVE-BIRTH—THE KILLING OF CHILDREN WHICH BREATHE DURING BIRTH NOT CHILD-MURDER-GENERAL CONCLUSIONS.

Floating of the lungs from artificial inflation.-It has been alleged that the organs of a still-born child may be made to assume, by artificial inflation, all the characters assigned to those which have undergone respiration. Thus, it is said, a child may not have breathed, and yet the application of the hydrostatic test would in such a case lead to the inference that it had. It will be seen that the force of this objection goes to attack directly the inference derivable from the presence of air in the lungs. There is only one form under which it can be admitted, namely, as it applies to lungs which have been inflated while lying in the cavity of the chest. Any experi ments performed on inflation after their removal from this cavity, can have no practical bearing; since in a case of infanticide we have to consider only the degree to which the lungs may be inflated by a person who is properly endeavouring to resuscitate a still-born child. The difficulty of inflating the lungs of a new-born child is too well known to require to be here adverted to; and the greater the violence used, the less likely is the air to pass into these organs, but it rather finds its way through the gullet into the bowels. Albert denied that the organs, while lying in the chest, can be so filled with air, either by the mouth or by means of a tube, as to be rendered buoyant in water. In performing this experiment several times, he never found a trace of air in the air-cells; and he contended that medical jurists have begun at the wrong end (den Gaul von hinten aufgezäumt), in endeavouring to seek for answers to an objection before they had ascertained that such an objection could have, practically speaking, any valid existence. (Henke's 'Zeitschr.' 1837, 2, 390.) Dépaul also found that it requires great force to inflate the lungs, and that their resiliency was sufficient to expel the greater part of the air thus introduced. ('Med. Gaz.' vol. 39, p. 283.)

The author, having had several opportunities of examining the lungs of children in which inflation had been resorted to, not for the express purpose of creating an objection to the hydrostatic test, but with the bond fide intention of resuscitating them, the results may be here stated. In some of these instances a tube had been used, and in others the mouth. In the first case it was found that only about one-thirteenth part of the structure of the lungs had received air. In the second, no part of the lungs had received a trace of air, although inflation had been repeatedly resorted to; and the air had passed entirely into the abdomen. In a third, attempts were made for upwards of half an hour to inflate the organs, but not a particle of air was found to have penetrated into them. In a fourth, no air had entered the lungs; and in a fifth, although a small

INFANTICIDE.

ARTIFICIAL INFLATION OF THE LUNGS. 343

portion had penetrated into the organs it was readily forced out by compression. In repeatedly performing experiments on dead children, the results have been similar; the lungs, after several attempts, were found to have received only a small quantity of air. Thus, then, it would appear that the lungs of a new-born child may be inflated in situ, although with some difficulty, and that the quantity of air which they receive under these circumstances is generally small. If the efforts at inflation are continued for some time in the dead body, and the tube is violently introduced into the larynx or windpipe, or if the organs are inflated after removal from the chest, with the express intention of causing them to resemble respired lungs, the result is different; but this is not the mode in which the objection can possibly occur in a case of infanticide-a circumstance which appears to have been overlooked by some of those who have examined this alleged objection to the hydrostatic test. It is not likely that a woman, if able to perform the experiment at all, would be capable of doing more than a practised accoucheur; and the probability is, that she would, in general, altogether fail in the attempt. One case is recorded, in which a woman, recently delivered, is stated to have succeeded in artificially inflating the lungs of her child (Meckel, 'Lehrb. der. Gerichtl. Med.' p. 368; see also 'Edin. Med. and Surg. Jour.' vol. 26, p. 374); and another, in which this defence was urged on the part of a woman, is reported by von Siebold (Henke's 'Zeitschr. der S. A.' vol. 3, 1845). The child, in this instance, was found with its head cut off, and the lungs contained air. The inconsistency of the woman's statement as to the mode in which she inflated the lungs was clearly proved, and the examiners did not hesitate to give a decided opinion that the air found in the lungs had been derived from the act of respiration, and not from artificial inflation. This case shows that, when a theoretical objection of this kind comes to be tested practically, it ceases to present any difficulty. It may happen, however, that another person may inflate the lungs, and if the mother has been secretly delivered, she may be wrongly charged with murder. (See case, Casper's 'Vierteljahrsschr.' 1859, 2, p. 38.) A midwife here attempted to revive a child by breathing into its lungs after removal of its body from the soil of a privy; but the circumstances of the case were well known from the statement of the midwife. Other instances of inflation are reported by Dommes, in the same journal, 1860, 2, p. 131.

Fig. 154,

View of the Lungs artificially inflated in situ. a a The thymus gland.

bb The heart in its pericardium.

cc The lungs, the lighter portions of the engraving re

If the lungs have been artificially inflated, in this case they would resemble, by their partial distension with air, and other physical characters, those of children presenting the unequal diffusion of air through the air-cells. which had imperfectly breathed. Like them, they may float on water; but on cutting them into pieces, some of these would be found to sink. If the pieces be firmly compressed, either by means of a folded cloth or between the fingers, they will lose their air and sink; so that in fact