■■* ^ ■S» -'.(V •■ ^ > v.. 1-a 1 V, ty- /ts-<* Surgeon General's Office \\ u rvn crn cr^ofoQ^on.cyacyQ^f- RESEARCHES IN MEDICINE AND MEDICAL JURISPRUDENCE. By JOHN B. BECK, M. D. Professor of Materia Medica and Medical Junsprudence in the College of Physicians and Surgeons of New-York; One of the Physicians to the New-York Hospital; Corresponding Member of the Royal Academy of Medicine of Paris; Corresponding Member of the Medical Society of London, &c. &c. SECOND EDITION. 3/^¥o, PUBLISHED BY E. BLISS, NEW-YORK. ALBANY: PRINTED ON STEAM PRESSES, BY PACKARD AND VAN BENTHUYSEN. 1835. (oOO S3^l v- \S3S TO THEODRIC ROMEYN BECK, M. D. PROFESSOR OP THE INSTITUTES OF MEDICINE, AND LECTURER ON MEDICAL JURISPRUDENCE IN THE COLLEGE OF PHYSICIANS AND SURGEONS OF THE WESTERN DISTBICT OF THE STATE OF NEW-YORK, etc. etc. THIS VOLUME IS MOST AFFECTIONATELY INSCRIBED, BY HIS BROTHER, THE AUTHOR. t NOTICE. All the papers contained in the present volume, have already appeared in print. The flattering noti- ces which have been taken of most of them, both abroad and at home, have induced me to believe, that the republication of them, in their present shape, might not prove unacceptable. It is, perhaps, unne- cessary to state, that the treatise on Infanticide con- stitutes the portion which I contributed to the work on Medical Jurisprudence, published by my brother, Dr. T. R. Beck, and myself. In preparing it for the last edition of that work, it was subjected to a tho- rough revision, greatly extended, and, as I trust, somewhat improved. In its present form, I hope it may not be unworthy of the favor with which it has heretofore been received. New-York, December, 1835. CONTENTS. 1. On Infanticide in its relations to Medical Jurisprudence andMedi. cal Police,........................................ 2. On Acute Laryngitis,...................................... 3. On the Non-contagiousness of Yellow Fever,................. 4. On Onychia maligna,....................................... 5. On Ulceration and Perforation of the Stomach,............... I. ON INFANTICIDE IN ITS RELATIONS TO MEDICAL JURISPRU- DENCE AND MEDICAL POLICE. PART I. Of the history of infanticide as it has prevailed in different nations, ancient and modern. It is a fact no less melancholy than astonishing, that a practice so unnatural as that of infanticide should ever have prevailed to any extent. Its existence might have been sup- posed possible in those unhappy regions of our earth, where untutored passion and brutal sense reign triumphant over reason and morality; but that the fairest portions of society, where genius, science, and refinement had taken up their abode, should have been disgraced by a crime so disgusting, is one of those anomalies in the history of human feeling and conduct, which irresistibly prove how perfectly arbitrary and undefined are the laws of justice and humanity, when unguided by the principles of true religion. The fact, however, is not more astonishing than true. A slight review of its history will show us that this practice prevailed in almost all the an- cient nations, and that it is not even yet blotted from the list of human crimes. 8 INFANTICIDE. The laws of Moses are silent on the subject of infanticide;* and from this circumstance we should be led to conclude that the crime was unknown among the Jews at that period of their history, and therefore that any positive prohibition of it was considered unnecessary. The penal code of the Jews is so very minute on the subject of murder in general—considers it so atrocious a crime, and denounces such terrible punishments against the perpetrators of it, that it is wholly incredible that the murder of infants would have been countenanced by their illustrious legislator. This conclusion is further confirmed by the considerations, that barrenness was esteemed one of the greatest misfortunes which could befall a Jewish woman, and that the Jews were all desirous of a progeny, because each cherished the hope that the Messiah might be numbered among his descendants. These facts would seem to prove that every inducement was held out for the preservation of children, and none to countenance their destruction.! At a subsequent pe- riod, when they became contaminated by their intercourse with the Canaanites, we find the Jews imitating} the example of their king Manasseh, who sacrificed his son to the idol Molech.§ These horrid sacrifices were suppressed by king Josiah, who commanded, " that no man might make his son or his daughter to pass through the fire to Molech."|| And Tacitus, in describing the manners of the Jews of his day, says that they were not allowed to put their children to death.lf The nations surrounding the Jews appear to have been ad- dicted to the sacrifice of children. Of these, the Canaanites are described as "sacrificing their sons and their daughters unto devils, and shedding innocent blood, even the blood of their sons and their daughters, whom they sacrificed unto the idols of Canaan,"** * Commentaries on the Laws of Moses, by J. D. Michaelis, F.R.S. Translated from the German, by Alexander Smith, D.D. vol. 4. t "Abortion and infanticide were not specially forbidden, but unknown among the Jews. Josephus, appealing in honest pride to the practice of his countrymen, re- proaches other nations with these cruelties." (Milman's History of the Jews, vol. 1, p. J07. Harper's edition.) + Jeremiah, vii. 31; and xix. 5. 1| Hist. Lib. v. Cap. 5. § 2 Chronicles, xxxiii. 6. 2 Kings, xxi. 6. ** Psalm cvi. 37, 38. || 2 Kings, xxiii. 10. INFANTICIDE. 9 Among the Egyptians, infants were treated with more hu- manity; yet instances are not wanting of the greatest cruelty towards them. A memorable one is found in the commission of Pharoah to the midwives, to murder all the male offspring of the Jews. Their own children, however, were treated with greater tenderness; and they are, accordingly, on this account, mentioned with honour by some of the writers of other countries. Strabo, in particular, speaks of them as an honorable exception to those nations who exercised the right of life and death over their infants.* Among the ancient Persians, it was a common custom to bury children alive. Herodotus tells us of Amestris, the wife of Xerxes, who, at an advanced age, ordered fourteen Per- sian infants, of illustrious birth, to be interred alive, in honour of one of the deities of the country.! In most of the Grecian states, infanticide was not merely permitted, but actually enforced by law. The Spartan law- giver expressly ordained, that every child that was born should be examined by the ancient men of the tribe; and that, if found weak or deformed, it should be thrown into a deep ca- vern at the foot of Mount Taygetus, called Jlpotheta, " con- cluding that its life could be of no advantage either to itself or to the public, since nature had not given it at first any strength or goodness of constitution."} This practice was not, however, upheld merely by the sanction of law; it was defended by the ablest men of Greece. Aristotle, in his work on government, enjoins the exposure of children that are na- turally feeble and deformed, in order to prevent an excess of population. He adds, " if this idea be repugnant to the cha- racter of the nation, fix at least the number of children in each family; and if the parents transgress the law, let it be ordained, that the mother shall destroy the fruit of her body before it shall have received the principles of life and sensa- tion.'^ The mild Plato also justifies this practice. In his * A History of Inventions and discoveries, by John Beckmann, translated by W. Johnston, vol. 4, p. 435. t Beloe's Herodotus, vol. 4, p. 37. t Plutarch's Lives, translated by Langhorne, vol. 1, p. 142. § Travels of Anacharsis, vol.5, p. 270. 10 INFANTICIDE. Republic, he directs that "children born with any deformity, shall be removed and concealed in some obscure retreat."* Of the existence of infanticide at Athens, we have the tes- timony of the comic poets, who, in describing the manners of that city, frequently allude to the exposure of children.! Thebes, however, exhibited a noble contrast to the rest of Greece. By one of her laws, it was expressly forbidden to imitate the other Grecian cities, who exposed their children at their birth.} Of all the nations of antiquity, the Romans were the most unrelenting in their treatment of infants. The Roman father was vested with an absolute authority over the lives and for- tunes of his children;§ and we have abundance of testimony to show that the right was commonly exercised. This bar- barous prerogative was coeval with the existence of Rome, and continued to triumph over justice and humanity during the lapse of many ages, until Christianity wrested it from her. Romulus authorised the destruction of all children that were deformed. He, however, required the parents to exhibit them to their five nearest neighbours, and to obtain their consent to their death. || The law of the Twelve Tables, enacted in the 301st year of Rome, sanctioned the same barbarous practice.1T After this, even the slight restrictions which Romulus had im- posed upon parents, appear to have been removed, and an un- qualified jurisdiction surrendered to the father over the lives of his children, even after they had arrived to years of matu- rity. Sallust mentions an instance of the latter. " Fuere tamen extra conjurationem complures, qui ad Catalinam initio profecti sunt: in his A. Fulvius, senatoris filius; quem retrac- tum ex itinere, parens jussit necari"—Sallust, Cat. xxxix. * Travels of Anacharsis, vol. 4, p. 342. t Vide Quarterly Review, vol. 2, p. 389, for quotations from Terence and Plautus. t Travels of Anacharsis, vol. 3, p. 277. § The right of parents over their children is thus stated in the Institutes of Justi- nian, Lib. 1, Tit. ix. p. 22, Cooper's edition. Jus autem potestatis, quod in liberos habemus, proprium est civium Romanorum; nuUi enim alii sunt homines, qui talem in liberos habeant potestatem, qualein nos habemus. || Montesquieu's Spirit of Laws, vol. 1, p. 104. London. II Cooper's Justinian, p. 659. INFANTICIDE. II The procuring of abortion, which can be considered no less than murder, was also notoriously prevalent among the Ro- mans. Juvenal thus speaks of that nefarious practice: Hae tamen et partus subeunt discrimen et omnes Nutricis tolerant, fortuna urgente, labores Sed jacet aurato vix ulla puerpera lecto; Tantum artes hujus, tantum medicamina possunt.* Juv. Sat. vi. 476. Minucius Felix thus describes the barbarity of the Romans in this respect: "I see you exposing your infants to wild beasts and birds, or strangling them after the most miserable manner. Nay, some of you will not give them the liberty to be born, but by cruel potions procure abortion, and smother the hopeful beginning of what would come to be a man, in his mother's womb."! Pliny? the Elder, himself defends the right of parents to destroy their children, upon the ground of its being necessary to preserve the increase of population within proper bounds. Such was the practice of ancient Rome from her first ori- gin down to the time of Constantine the Great. During the days of her greatest political grandeur, it was carried to the highest excess; and whilst she was boasting of her refinement, and casting the opprobrious epithet of barbarian on all around her, she was guilty of the basest profligacy, and the most har- dened cruelty. Christianity first opposed a barrier to the de- solations of this crime; her mild and humane spirit could not but discountenance it; and accordingly it animated all who were arrayed under her peaceful banners, to exert their en- ergies in arresting its progress. The christian writers of that day are full on this point. Tertulian, in his Apology, ex- presses himself with heroic boldness on the subject: "How many of you," (addressing himself to the Roman people, and * " Yet these, though poor, the pain of childbed bear, And without nurses their own infants rear. You seldom hear of the rich mantle spread For the babe, born in the great lady's bed. Such is the power of herbs ; such arts they use To make them barren, or their fruit to lose." t Octav. Minucii Felicia, ch. xxxi 12 INFANTICIDE. to the governors of cities and provinces,) "might I deserved- ly charge with infant murder; and not only so, but among the different kinds of death, for choosing some of the crud- est for their own children, such as drowning or starving with cold or hunger, or exposing to the mercy of dogs; dying by the sword being too sweet a death for children, and such as a man would choose to fall by, sooner than by any other ways of violence. But christians now are so far from homicide, that with them it is utterly unlawful to make away a child in the womb, when nature is in deliberation about the man; for to kill a child before it is born, is to commit murder by way of advance; and there is no difference, whether you destroy a child in its formation, or after it is formed and delivered; for we christians look upon him as a man who is one in embryo; for he is a being like the fruit in blossom, and in a little time would have been a perfect man, had nature met with no dis- turbance."* In A. D. 315, Constantine the Great enacted a law, providing for the maintenance and education of those children whose parents were too poor to do the same.! He also ordered a severe punishment to be inflicted on a cruel fa- ther. This was the first time that the authority of the go- vernment had interposed to arrest this crime; and it is not to be supposed, that a custom which had become so familiar to all the habits and feelings of the Roman people would be im- mediately suppressed; and accordingly we find that it still continued to prevail, though in a less degree, until the end of the 4th century, when it was finally exterminated by the em- perors Valentinian, Valens, and Gratian.} • Reeves' Apologies, &c. vol. 2, p. 190. t Ant. Univ. Hist. vol. 15, p. 576. I Mr. Gibbon thus expresses himself in relation to this practice among the Romans: " But the exposition of children was the prevailing and stubborn vice of antiquity; it was sometimes practised, often permitted, almost always practised with impuni- ty, by the nations who never entertained the Roman ideas of parental power; and the dramatic poets, who appeal to the human heart, represent with indifference a po- pular custom which was palliated by the motives of economy and compassion. If the father could subdue his own feelings, he might escape, though not the censure, at least the chastisement of the laws. And the Roman Empire was stained with the blood of infants, till such murders were included by Valentinian and his colleagues, in the letter and spirit of the Cornelian law." (The History oi the Decline and Fall of the Roman Empire—by Edward Gibbon, Esq.—vol. 3, p. 186, Lond. Ed.) INFANTICIDE. 13 The Phenicians and Carthagenians were in the habit of sa- crificing infants to their gods. The latter had a law by which four children of noble birth were regularly immolated upon the altars of Saturn.* History records a melancholy instance of the superstition and cruelty of these deluded people. It is related, that they attributed their defeat by Agathocles, king of Sicily, to an omission of these sacrifices, and in order to atone for their past neglect, they offered up, at one time, two hundred of the sons of their nobility. Silius Italicus notices this custom: " Mos fuit in populis, quos condidit Advena Dido, Poscere caede deos veniam, ac flagrantibus aris (Infandum dictu) parvos imponere natos." Lib. 4. The ancient Germans, although in the habit of sacrificing prisoners taken in battle, do not appear to have been addicted to the cringe of infanticide. Tacitus, in describing their man- ners, mentions a contrary practice as one of the peculiarities distinguishing their character: "Numerum liberorum finire, aut quenquam ex agnatis necare, flagitium habetur."! Among the Visigoths, the murder of infants was a common crime. Chindaswinthus, one of their kings, in his laws, de- scribes the procuring of abortion, as well as the murder of children after they are born, as practices that were prevalent in the provinces, and denounced severe penalties on the per- petrators of those crimes.} But infanticide was not confined to the ancients. It has de- scended to modern nations, and at the present day disgraces Eastern and Southern Asia by its enormities. The Chinese are notorious for their cold indifference in the exposure and murder of their children. According to Mr. Barrow, the number of children exposed inPekin alone amounts to 9000 annually. No law exists to prevent it; on the con- trary, it appears rather to be encouraged, inasmuch as persons are employed by the police of the city to go through the dif- ferent streets every morning in carts, to pick up all the chil- * Ant. Univ. Hist. vol. 17, p. 257. f De Morib. Germ. xix. t On the history of the effects of religion upon mankind. By Rev. Edward Ryan. p. 110. 2 4 14 INFANTICIDE. dren that may have been thrown out during the night. " No inquiries are made; but the bodies are carried to a common pit without the walls of the city, into which all, whether dead or living, are promiscuously thrown."* The practice is not confined to the capital; it prevails also in other parts of the country. It is calculated that the number of infants destroyed in Pekin, is about equal to that of all the rest of the empire.! Almost all those that are exposed are females. The causes assigned for its prevalence, are extreme poverty, arising from an overgrowth of population; frequent and dreadful famines, springing from the same cause; the natural coldness of affec- tion in the Chinese, together with the sanction of custom, and the want of any law forbidding it. Mr. Ellis, who visited China with the British embassy in 1816, expresses some doubts with regard to the frequency of infanticide in China.} Whe- ther the estimate of Barrow be too large or not, it is impos- sible to say. The general prevalence of the crime, however, is unquestionable; and recent travellers speak of it as still existing in all its horrid deformity. "At the beach of Amoy," says Mr. GutzlafF, "we were shocked at the spectacle of a pretty new-born babe, which shortly before had been killed. We asked some of the bystanders what this meant; they an- swered with indifference, ' It is only a girl.'" This same traveller says, "It is a general custom among them to drown a large proportion of the ne.w-born female children. This unnatural crime is so common among them, that it is perpe- trated without any feeling, and even in a laughing mood; and to ask a man of any distinction whether he has daughters, is a mark of great rudeness. Neither the government, nor the moral sayings of their sages, have put a stop to this nefarious custom."§ The same writer, in another work, makes the following statement: "Infanticide, of which the husbands are * Travels in China, &c. by John Barrow, esq., p. 113. (American edition.) t Ibid. p. 114. Also De Pauw's Philosophical Dissertation on the Egyptians and Chinese. (Quarterly Review, vol. 2, p. 255.) \ Journal of the Proceedings of the late Embassy to China, &c. By Henry Ellis, third commissioner of the embassy. Vol. 2, p. 209. London, 1817. § Journal of Three Voyages along the Coast of China, in 1831,1832 and 1833; with Notices of Siam, Corea, and the Loo-Choo Islands. By Rev. Charles Gutzlaff. Page 142. (American edition.) INFANTICIDE. 15 the only perpetrators, is not uncommon; but female children only are murdered, and then immediately after their birth. This horrible crime meets with no punishment from the laws of the country; a father being the sovereign lord of his chil- dren, he may extinguish life whenever he perceives or pre- tends that a prolongation of it would only aggravate the suf- ferings of his offspring."* Another late traveller says, " In some provinces, not one out of three is suffered to live; and in others, as the writer has been informed by the Chinese from those places, the difference between the male and the female population is as ten to one."! Among the Hindoos, infanticide presents itself in a form still more horrible. It is incorporated into their system of religion, and its atrocities are beyond description. It has existed among them for at least 2000 years, for Greek and Roman historians notice it, and refer to some of the very places where it is now known to exist.} The number of infantile murders in the provinces of Cutch and Guzerat alone, amounted, in 1807, ac- cording to the lowest calculation, to 3000 annually; according to another computation, 30,000.§ Females are almost the only victims. In defence of the practice, they urge the diffi- culty of rearing female children, the expense attending their education, and the small probability of their ever being mar- ried. |j Within a few years, through the benevolent exertions of some of the subjects of Great Britain, it was supposed that infanticide had been completely abolished in many of the pro- * A Sketch of Chinese History, Ancient and Modern, &c. By Rev. Charles Gutz- laff. VoL 1, p 46. (American edition,) 1834. t See a Journal of a Residence in China, &c. from 1829 to 1833. By Rev. David Abeel. pp 128, 158. New-York, 1834. t Christian Researches in Asia. By the Rev. Claudius Buchanan, D.D. English edition, p. 49. — View of the History, Literature, Religion, &c. of the Hindoos. By William Ward, D.D. p. 393. American edition.—Also Moor's Hindu Infanticide, &c. Review of the same in London Quarterly Review, vol. 6, p. 210. § Buchanan's Researches in Asia, p. 49. Also Moor's Hindu Infanticide, p. 63. || The modes of perpetrating the deed are various. Dr Buchanan states that two are principally prevalent. As soon as it is known to be a female, a piece of opium is put into its mouth; or the umbilical cord is drawn over its face, which, by pre- venting respiration, destroys it. (Researches in A«ia, p. 47. Moor's Hindu Infanti- cide, p. 55, 56.)—Another mode still more common, however, is to drown the child, as soon as it is born and ascertained to be a female, in a large vessel of milk placed in the room for that purpose. (Moor's Hindu Infanticide, p. 27. Heber's Travels, vol. 2, p. 70. American edition.) 16 INFANTICIDE. vinces. Mr. Duncan, governor of Bombay, Marquis Welles- ley, and Col. Walker, were the persons who took the lead in this affair, and whose energy and perseverance it was hoped and asserted had been crowned with complete success.* It is melancholy to be obliged to state, on the authority of a recent traveller, that the benevolent labours of these gentlemen were attended with only temporary success. Bishop Heber, in his travels in 1824 and 5, says, " Through the influence of Major Walker, it is certain that many children were spared; and previous to his departure from Guzerat, he received the most affecting compliment which a good man could receive, in being welcomed at the gate of the palace, on some public occasion, by a procession of girls of high rank, who owed their lives to him, and who came to kiss his clothes, and throw wreaths of flowers over him as their deliverer and second father. Since that time, however, things have gone on very much in the old train, and the answer made by the chiefs to any remonstrances of the British officers, is, ' Pay our daughters' marriage por- tion, and they shall live.' Yet these very men, rather than strike a cow, would submit to the crudest martyrdom."! Previously to the conversion of Otaheite to Christianity, in- fanticide was so common that it threatened the complete de- population of the island. It was found as a common practice, when the island was visited by Capt. Cook;} and just anterior to the introduction of Christianity, according to the most ac- curate estimates, at least two-thirds of the children born were destroyed. § It appears to have been confined to no rank or class of the community, but to have been universally preva- lent. Mr. Ellis states, that he did "not recollect having met with a female in the island, during the whole period of his residence there, who had been a mother while idolatry pre- *For a full account of these measures, see " Hindu Infanticide: An account of the measures adopted for suppressing the practice of the systematic murder, "by their parents, of female infants; with incidental remarks on other customs peculiar to the natives of India." Edited, with notes and illustrations, by Edward Moor, F. R. S. London, 1811. 4to. In this volume, the report of Lieut. Col. Walker is particularlv interesting. f Narrative of a Journey in the Upper Provinces of India, &c. By the Right Rev Reginald Heber, D.D. Vol. 2, p. 70. American edition. % Cook's Voyages, vol. 2, p. 72, 85. § Turnbull's Voyage round the World in 1800-2-3-4. Polynesian Researches, by William Ellis, vol. 1, p. 198. American edition. INFANTICIDE. 17 vailed, who had not imbrued her hands in the blood of her off- spring."* The effect which this practice had in diminishing the number of inhabitants, was astonishing, and affords a strong fact in refutation of the doctrine which has been maintained by some, that the practice of destroying children has a direct tendency to augment population. In 1776, when Capt. Cook visited the island, he found it to contain upwards of 200,000 souls. In less than thirty years after, this terrestrial paradise, blessed with a genial climate and a luxuriant soil, was reduced to 5000 inhabitants.! Turnbull relates, that "the missionaries made two tours whilst he was in the island, and in each of which they numbered the people ; according to the first cal- culation they were 7000, but in the last they very little ex- ceeded 5000."} It is not to be supposed that this enormous diminution of population is to be attributed solely to this cause; other causes have doubtless co-operated, particularly certain diseases which prevail to a great extent, such as fevers, dy- sentery, phthisis pulmonalis, and scrofula.§ All travellers, however, who have visited the island, concur in the opinion, that the effects of infanticide have been infinitely more inju- rious to the population than all the other causes combined. It is consoling to reflect, that through the exertions of chris- tian philanthropy, this horrid and barbarous custom has been entirely abolished. In most of the South Sea Islands, the same practice has prevailed to an enormous extent, and has only been checked by the benign influence of Christianity.|| Among the Sandwich Islanders, however, there is reason to believe that it still exists in much of its native deformity. Sometimes they strangle their children, but more frequently bury them alive. What is peculiar in the barbarity of these people, is, that even should a child be spared for a few weeks or months, they have no hesitation in destroying it at any * Polynesian Researches, vol.1, p. 198. t Turnbull, vol. 3, p. 77. t Ibid. vol. 3, p. 77-8. § Edinburgh Medical and Surgical Journal, vol. 2, p. 284-90. || For interesting notices on this subject, see Journal of Voyages and Travels by the Rev. DanielTyerman and George Bennet, esquire, vol.1, p.53; vol.2, p. 67, 162. (American edition.)—Also Polynesian Researches, by W. Ellis, vol. 2, p. 29, &c. 2* In INFANTICIDE. subsequent period. Among the Otaheiteans, on the contrary. if the child survived only a few hours, it was generally saved. At least twro-thirds of the children born, are here also sacri- ficed.* The principal cause assigned for the prevalence ofthi^ crime among these people, is their excessive indolence, and their dread of the trouble to be encountered in rearing their children. Among the Society Islands, the rules of the Areoi Institution requiring the death of all the children of its mem- bers, operated as another powerful cause. Among the natives of the interior of Ceylon, the same in- human practice prevails. When a child is born, an astrologer is consulted to foretel its future fortune ; if it should be un- happy, it is carried to the jungle and abandoned, where it is destroyed by cold, or devoured by wild beasts. Generallr speaking, all the male children, as well as the first female child, are exempted from this unhappy lot. So common is the destruction of all the rest of the female offspring, that " it has been observed, in the districts where this practice prevails, that more than one female child is rarely to be found in a .fa- mily."! The effect of this practice upon the relative propor- tion of male and female population, is very striking. According to the calculation of Mr. Marshall, the females are to the males as 84 to 100; while in England they are as 98.8 to 100.} The only extenuation offered for this crime, is the ex- treme poverty of the people. Bishop Heber, in speaking of the prevalence of infanticide in Ceylon, states that in the last general census in 1821, the number of males exceeded by 20,000 that of females; in one district there were, to everv hundred men, but fifty-five women; and in those parts where the numbers were equal, the population was almost exclusive- ly mussulman.§ The difficulty of marrying their daughters, in a country where to live single is disgraceful, is one of the * Polynesian Researches, vol. 4, p. 240. Stewart's Journal of a Residence in the Sandwich Islands, p. 185, 251. t Notes on the Medical Topography of the Interior of Ceylon. By Henry Marshall Surgeon to the Forces, pp. 22, 33, 37. London, 1821. X Ibid. p. 33. § Narrative of a Journey through the Upper Provinces of India, with Notes upon Ceylon, &c. &c. By the late Right Rev. Reginald Heber. Vol. 2, p. 197. Ameri.caia edition. INFANTICIDE. 19 principal causes, according to Heber, of this unnatural cus- tom.* The natives of New-South-Wales resort to violent and un- natural compression of the body of the mother, in order to procure abortion. This process is called by them Mee-bra, and is resorted to for the purpose of avoiding the trouble of carrying about the child when young, a duty which devolves entirely on the female. As may naturally be supposed, the mother not unfrequently falls a victim in this horrid process. Another practice still more shocking prevails, of burying a child with its mother, if she happens to die.! This practice is justified by them, upon the ground of the difficulty, and even impossibility of nursing and rearing a child under these cir- cumstances. Among the New-Zealanders, infanticide is asserted to be a common occurrence. When a girl is born, it is said the mo- ther not unfrequently destroys it, " by pressing her finger up- on the soft part between the joinings of the skull."} Among the Hottentots, infanticide appears to be a common crime. Sparman states " that the Hottentots use, in case of the mother's death, to bury alive children at the breast;"§ and Barrow describes a race of them called Bojesmans, who de- stroy their offspring on various occasions : as " when they are in want of food ; when the father of a child has forsaken its mother ; or when obliged to fly from the boors and others; in which case they will strangle them, smother them, cast them away in the desert, or bury them alive."|| The Mahometans do not appear to attach any criminality to child-murder ;TF on the contrary, the very sources of honour ' "An astrologer is consulted on the birth of a female child; and if he pronounces her to have been born under evil auspices, she is exposed alive in the woods, to be destroyed by beasts of prey or by ants—generally, I was happy to hear, without the ronsent of the mother." Ibid. vol. 2, p. 197. t Account of the English Colony of New-South-Wales. By Lieut. Col. Collins, of the Royal Marines, p. 124-5. Edinburgh Review, vol. 2, p. 34. X The Library of Entertaining Knowledge, New-Zealanders, p. 387. Cruise's Journal, p. 290. § A Voyage to the Cape of Good Hope, &c. from the year 1772 to 1776, by Andrew Sparman, M. D. vol. 1, p. 257. || An Account of a Journey in Africa, made in the years 1801 and 1802, to the resi- dence of the Booshuana Nation, &c. by John Barrow, Esq. p. 378-91. f, It is proper to state, however, that the Koran forbids it; and in the oath which Mahomet required 6f the women who joined his party, called the " women's oath," 20 INFANTICIDE. and authority among them are polluted by it. Even the pa- lace of the Sultan is constantly stained by the blood of infants. Thornton states, that the offspring of the younger princes of the royal family, who are kept in honorable confinement in the palace, are destroyed as soon as they are born.* And Blacquiere accounts for the smallness of the number of child- ren belonging to the Bashaw of Tripoli, from the fact of his encouraging his wives to evade their accouchements.! A re- cent traveller says, that the Turkish women after getting two or three children, or as many as suits their fancy to have, are addicted to procuring miscarriages, at which they or their ac- couchesses (Jewesses) are exceedingly expert, not producing constitutional injury.} Dr. Bryce, in speaking of the present state of medicine at Constantinople, says: "Midwifery is almost exclusively prac- tised by Jewish and Turkish women; and it is worthy of re- mark, that the obstetric art forms a very small portion of their adroitness or employment. All pretend to possess, and some have become famous and wealthy by their pretensions, certain means, not only to obviate sterility, but also to pro- cure abortion by administration of drugs—a practice, avow- edly tolerated,-and frequently resorted to, by Turkish females. both from their dislike to frequent pregnancy, and from com- mand of their lords, when their harem threatens to become too numerous. § In modern Egypt, nothing is more common than the procur- ing of abortion. A class of females, well known for their skill, are employed to aid those who consult them in cases of this kind. This practice, which is very ancient, surprises nobody, and a woman aborts with astonishing indifference. In the towns and villages, there are individuals who are specially employed in this barbarous business. At Cairo, there are the prohibition of infanticide was distinctly mentioned. (Buck's Theological Dic- tionary, Art. Mahomet.) * The present state of Turkey, &c. by T. Thornton, Esq. vol. 1, p. 120. f Letters from the Mediterranean, by E. Blacquiere, Esq. vol. 1, p. 90. X Records of Travels in Turkey, Greece, &c. in the years 1829, 1830 and 1831, by Adolphus Slade, Esq. vol. 2, p. 162. American edition. § Sketch of the State and Practice of Medicine at Constantinople, by C. Bryce, M. D. (Edin. Med. and Surg. Journal, vol. 35, p. 8, 9.) INFANTICIDE. 21 Arabian physicians, who for a great length of time, have fol- lowed this infamous trade. Infanticide is rarely made a sub- ject of criminal investigation. When a married woman de- stroys her new born infant, in order to bring her to punishment, two eye witnesses are necessary. If she is convicted, she has to pay a large sum of money as a fine to her husband, or if she is unable to do this, he has it in his power to imprison her. H there are nothing but suspicions and she persists in deny- ing the crime, she is only obliged to take a certain oath, to free herself. When a girl who may have become pregnant. destroys her child, to exculpate herself from the crime, she has only to liberate a male or a female slave.* Even in Iceland, we find traces of this inhuman crime. The custom appears to have been derived from their Norwe- gian ancestors, among whom it continued to prevail for near- ly one hundred years after it had been abolished in Iceland. It became extinct shortly after the introduction of Christiani- ty into the Island, which event took place at the end of the tenth century.! If we turn our attention from the old world, and direct it to the new, we shall find this crime presenting itself under forms no less horrible and disgusting. Among the natives about Hudson's Bay, it is common for the women to procure abortion by the use of a certain herb which grows there.} In Labrador, the Moravian missionaries who first landed there, found it a prevailing custom to put to death their wi- dows and orphans; not to gratify a natural ferocity of dispo- sition, but merely on account of a supposed inability to pro- vide the means of support for the helpless orphan or the de- solate widow of another. By the exertions of the missiona- ries, the practice was arrested.§ *' See a Letter on the State of Legal Medicine in Egypt, by Hamont, Directeur of the Veterinary School of Medicine, of Abon-Zabel, in the Annales d'Hygi^ne Pub- lique et de Medecine Legale, vol. 10, p. 202-3. t Dr. Holland's Preliminary Dissertation on the History and Literature of Iceland, in Sir G. Mackenzie's Travels in the Island of Iceland, during the summer of the year 1810, Edinburgh 2d Ed. p. 39. X Ellis' Voyage to Hudson's Bay, p. 198. $ Barrow's Account of a Journey in Africa in 1801 and 2. (Edinburgh Review, vol. 8, p. 438.) 22 INFANTICIDE. Nor were the savages of these inclement regions the only people who were guilty of this horrid crime. The gloomy superstition of the Mexicans delighted in human sacrifices. and the altars of their divinities were continually drenched with the blood of infants and of men.* The number of these sacrifices has doubtless been exaggerated, but the fact is un- questionable, that countless victims poured forth their lives to appease or conciliate their imaginary deities. The mothers in California are described as voluntarily de- stroying their offspring. Venegas states that the common cause of it was a scarcity of food, and that the practice was put a stop to by the Father Salva-Tierra, who ordered a double allowance to be given to women newly delivered.! Charlevoix describes a race of savages in North America, who make a practice of destroying all infants who are so un- fortunate as to lose their mothers before they are weaned; at the same time, they inter alive all the other children, upon the plea that no other female can nurse them properly.} The Peruvians, whom Dr. Robertson eulogizes for the mildness of their manners, and the benevolent spirit of their religion, § were nevertheless in the habit of sacrificing chil- dren. Acosta tells us, that in such cases as the sickness of the Inca, or doubtful success in war and other affairs, ten children were sacrificed; and upon the coronation of the Inca, two hundred were offered up. When a Peruvian father was taken sick, he sacrificed his son to Viriachocha, (the sun,) beseeching him to accept the life of his child, and to save his own. The same writer, when comparing the Peruvians and Mexicans, describes the former as exceeding the latter in the sacrificing of children; while the latter were chiefly addicted to the sa- crifice of men taken in battle, of whom they murdered an im- mense number. Robertson endeavours to rescue them from this charge, by invalidating the testimony of Acosta. He cannot, however, help confessing that the practice did prevail * Robertson's History of America, vol. 3, p. 325. f History of California, by Miguel Venegas. London, 1759. Vol. 1, p. 82. X Journal d'un Voyage a L'Amerique Septentrionale, par le P. De Charlevoix. A Paris, 1744. Vol. 3, p. 368. § History of America, vol. 3, p. 335. INFANTICIDE. 23 among " their uncivilized ancestors;" but he adds, " that it was totally abolished by the Incas, and that no human victim was ever offered in any temple of the sun." He admits, moreover, that " in one of their festivals, the Peruvians of- fered cakes of bread moistened with blood drawn from the arms, the eyebrows and noses of their children. This rite may have been derived," he says, "from the ancient practice in their uncivilized state, of sacrificing human victims."* Besides those that have been enumerated, travellers record the names of other tribes and nations inhabiting this vast con- tinent, who murder their children with impunity and without remorse. They tell us of the Abiponians, a migratory race, inhabiting the province of Chaco in Paraguay, among whom mothers have been known to destroy all their children as soon as they were born;! and of the Araucanians, a powerful nation of Chili, who permit fathers and husbands to kill their children and wives.} To the honour of our North American Indians, it deserves to be mentioned, that they are not known to be guilty of this horrid crime. Mr. Heckewelder, in his interesting account of the Indians who inhabited Pennsylvania and the neighbouring states, says, "I have never heard of any nation or tribe of Indians who destroyed their children, when distorted or de- formed, whether they were born so, or come to be so after- wards.'^ To the same effect are the testimonies of Captain Franklin and Dr. Richardson, both of whom represent infanti- cide as an exceedingly rare occurrence, and when an occa- sional instance of it takes place, is looked upon by them as a crime of the greatest magnitude. Dr. Richardson, in his in- teresting account of the Cree Indians, in giving their belief in relation to a future state, says that it is a crime which they believe to be punished hereafter. " Women who have been guilty of infanticide, never reach the Mountain (the Indian * History of America, vol. 3, p. 429. t Edinburgh Encyclopaedia, Art. Abiponians. X Ibid. Art. America. § A Narrative of the Mission of the United Brethren among the Delaware and Mo- hegan Indians, from its commencement in the year 1740, to the close of the year 1808, &uc. By John Heckewelder, who was many years in the service of that mission. 8vo. Philadelphia, p. 216. ■2i INFANTICIDE. heaven) at all, but are compelled to hover round the seats of their crimes, with branches of trees tied around their legs."* But it is unnecessary to extend this sketch any further. Enough has been recorded to give a view of the wide-spread desolations of this unnatural crime; certainly too much for the honour of human nature. PART II. Infanticide in its relations to medical jurisprudence. By infanticide in its most extensive signification, is under- stood, the criminal destruction of the foetus in utero, or of the child after it is born. It embraces, therefore, two subjects, somewhat distinct, and which require separate discussion. I. Of the murder of the foetus in utero, with an account of its various proofs and modes of perpetration. This is usually called criminal abortion. Recently the more appropriate and classical term of foeticide has been applied to it. In the following essay, these terms will be used indiscri- minately. In every instance in which a reputed case of foeticide be- comes the subject of legal investigation, the great points which present themselves are the following: 1. Has the foetus in utero been actually destroyed'? 2. Has this been brought about by intentional means, or by accidental and natural causes? These are the questions concerning which the opinion and testimony of the professional witness will be required; and these, therefore, are the subjects which it becomes necessary specially to examine. Before proceeding, however, to the discussion of these points, it becomes necessary to settle a preliminary question of great importance, and which is to de- termine, if possible, the period of gestation when the foetus is to be considered as endowed with life. * Journey to the Shores of the Polar Sea, in 1819-20-21-22: With a Brief Accouni of the Second Journey, in 1825-26-27. By John Franklin, R. N. Vol. 1, p. 151. Lon- don, 1829. INFANTICIDE. 25 In reviewing the various opinions which have been advanced on this subject at different periods, it will abundantly appear, that too often fancy has usurped the prerogative of reason, and idle speculation been substituted in the place of rational investigation. The consequence has been, that doctrines have been promulgated, not only the most erroneous and absurd in their nature, but the most dangerous in their tendencies to the best interests of society. The ancients were by far the most extravagant in their no- tions on this subject. The same fundamental error, however, pervaded all their theories. They believed that the sentient and vital principle was not infused into the foetus, until some time after conception had taken place. It is not surprising that the exact time at which this union is effected, could never be satisfactorily settled by them. According to Hippocrates, the male foetus became animated in thirty days after concep- tion; while the female required forty-two.* In another part of his works, he asserts that this does not occur until the per- fect organization of the foetus. The Stoics believed that the soul was not united to the body before the act of respiration, and consequently that the foetus was inanimate during the whole period of utero-gestation.! This doctrine prevailed until the reigns of Antoninus and Se- verus, wrhen it gave way to the more popular sentiments of the sect of the Academy, who maintained that the foetus be- came animated at a certain period of gestation. The Canon Law of the Church of Rome also distinguished between the animate and inanimate foetus, and punished the destruction of the former with the same severity as homicide.} Galen considers the animation of the fcetus to take place on the fortieth day after conception, at the same time that he supposed the fcetus to become organized.§ Others believed shorter periods sufficient; and accordingly three days and seven have respectively had their advocates. || Another contends that eighty days are requisite for the ani- * Lib. de Nat. Puer. Num. 10. t Plutarch's Morals, vol. 3„ p. 230. London. I Zacchiae Quaest. Med. Leg. lib. ix. tit. 1, 2, 5, p. 744. § Opera Galeni, de Usu Part. lib. 15, cap. 5. Lugduni, 1643. || Zacchiae, lib. 1, tit. 2, Q. x. p. 82. 3 26 INFANTICIDE. mation of the female, while only forty are necessary for the male.* Some advocate forty days as sufficient for both.! Others again make a distinction between the imperfect embryo and the perfectly formed foetus, and consider abortion of the latter only as a crime deserving the same punishment as ho- micide; a distinction,'of which it is justly remarked by a ce- lebrated writer on medical jurisprudence, "ennemie de la morale et de l'humanite, digne de l'ignorance et des prejuges de ses auteurs."} Amidst these discordant sentiments, Zacchias offers himself as a mediator, and proposes sixty days as the limit; and re- commends that any one who should cause an abortion after that period, whether of male or female, should be punished for homicide. § All the foregoing opinions, wholly unsupported either by argument or experiment, might be dismissed without a com- ment, were it not to point out the evils to which they have given rise. It may be said of them with perfect truth, that their direct tendency has been to countenance, rather than to encourage abortion, at least in the earlier stages of pregnancy. On a subject of this nature, it was to be supposed that legal decisions would be influenced in a great measure by the opinions of philosophers and physiologists; and accordingly, while the delusion of the Stoics continued its sway, the law could view nothing very criminal in wilful abortion, J| as the foetus was considered merely portio viscerum matris.H And afterwards, when the Academicians flourished, punishments very different, in the degree of their severity, were inflicted according as the abortion was supposed to be that of an ani- mate or inanimate foetus.** In modern times, an error no less absurd, and attended with consequences equally injurious, has received the sanction, not merely of popular belief, but even of the laws of most civil- ized countries. The error consists in denying to the fcetus any vitality until after the time of quickening. The codes of * Zacchiae, lib. 1, tit. 2, Q. x. p. 82. || Fodere, vol. 4, p. 382. t Ibid. If Plutarch's Morals, vol. 3, p. 230. X Foderg, vol. 4, p. 484. ** Fodere, vol. 4, p. 332. § Zacchae, lib. 1, tit. 2, Q. x. p, 83. INFANTICIDE. 27 almost every civilized nation have this principle incorporated into them; and accordingly, the punishment which they de- nounce against abortion procured after quickening, is much severer than before. The English law "considers life not to commence before the infant is able to stir in its mother's womb."* The law of Scotland, adopting the creed of the Stoics, believes the fcetus in utero, previous to quickening, to be merely pars viscerum matris. In Saxony, in consequence of the disputes of medical men on this subject, it was formal- ly decided, that the fcetus might be esteemed alive after the half of pregnancy had gone by.! The absurdity of the principle upon which these distinc- tions are founded, is of easy demonstration. The fcetus, pre- vious to the time of quickening, must be either dead or living. Now, that it is not the former, is most evident from neither putrefaction nor decomposition taking place, which would be the inevitable consequences of an extinction of the vital prin- ciple. To say that the connexion with the mother prevents this, is wholly untenable: facts are opposed to it. Foetuses do actually die in the uterus before quickening, and then all the signs of death are present. The embryo, therefore, be- fore that crisis, must be in a state different from that of death, and this can be no other than life. But if the foetus enjoys life at so early a period, it may be asked, why no indications of it are given before the time at which quickening generally takes place? To this it may be answered, that the absence of any consciousness on the part of the mother, relative to the motions of the child, is no proof whatever that such motions do not exist. It is a well known fact, that in the earlier part of pregnancy, the quantity of the liquor amnii is much greater in proportion to the size of the foetus, than at subsequent periods. Is it not, therefore, ra- tional to suppose, that the embryo may at first float in the waters without the mother being conscious of its movements, but that afterwards, when it has increased in bulk, and the waters are diminished in proportion, it should make distinct * Blackstone, vol. 1, p. 129. t Specimen Juridicum Inaugurate. Auctore Van Visvliet. p. 46. Lugduni Batavo- rum, 1760. 28 INFANTICIDE. and perceptible impressions upon the uterus? Besides, it should not be forgotten, that foetal life at first must of necessity be extremely feeble, and therefore it ought not to be considered strange that muscular action should also be proportionably weak. But granting, for the sake of argument, that the foetus does not stir previously to quickening, what does the whole objec- tion amount to ? Why, only that one evidence of vitality, viz. motion, is wanting; and we need not be told that this sign is not essential to the existence of life.* The incompleteness of the embryo previous to quickening, is no objection to its vitality. Life does not depend upon a complication of organs; on the contrary, it is found that some of the simplest animals, as the polypi, are the most tenacious of life. Besides, upon this principle, vitality must be denied to the child after birth, because many of its bones, as well as other parts of its body, are imperfect. Nor is the want of organic action any argument against this doctrine. Life appears to depend essentially as little upon organic action, as it does upon a complication of organs. If it did, the foetus, after quickening, would be just as destitute of life as before, for its brain, lungs, stomach, and intestinal canal, perform no more action at the eighth month than they do at the third. But if organic action be essential to life, how are we to account for those singular cases of foetuses born alive, and yet destitute of some of the most important organs in the body, such as the head, brain, &c. ?! And how are we to explain those temporary suspensions of organic ac- tion in the bodies of adults, which sometimes happen, without the principle of life being extinguished ? The observations of physiologists tend also to prove the vi- tality of the foetus previously to quickening. Long before quickening takes place, motion, the pulsation of the heart, and * There is a difference of opinion as to the real nature of quickening. It has been lately suggested by a writer, that it is altogether independent of any motion of the child, and that it is to be attributed to the sudden rising of the uterus out of the pel- vic cavity into the abdomen. (London Med. and Phys. Journal, vol. 27, p. 441.) If this opinion be true, it would afford another incontrovertible argument in favour of the position which I have advocated. t Saumarez' Physiology, vol. 2, p. 21; Review of Sir E. Home's paper on the Functions of the Brain; Edin. Review, vol. 24, p. 439. INFANTICIDE. 29 other signs of vitality have been distinctly perceived. Hal- ler, indeed, asserted, " that all the viscera and bones of the future foetus, nearly fluid indeed, and therefore invisible, were preformed before conception in the maternal germ." How- ever objectionable such an opinion may be, yet the fact is cer- tain, that thefostus enjoys life long before the sensation of quick- ening is felt by the mother. Indeed, no other doctrine appears to be consonant with reason or physiology, but that which admits the embryo to possess vitality from the very moment of conception. If physiology and reason justify the position just laid down, we must consider those laws which exempt from punishmest the crime of producing abortion at an early period of gesta- tion, as immoral and unjust. They tempt^o the perpetration of the same crime at one time, which at another they punish with death. In the language of the admirable Percival, " to extinguish the first spark of life, is a crime of the same nature, both against our Maker and society, as to destroy an infant, a child, or a man: these regular and successive stages of existence being the ordinances of God, subject alone to his divine will, and appointed by sovereign wisdom and goodness. as the exclusive means of preserving the race, and multiply- ing the enjoyments of mankind."* Having thus endeavoured to show that there is no period of gestation at which the foetus is not to be considered alive, I come now to take up the consideration of the questions origi- nally proposed. 1. Has the foetus in utero been actually destroyed? The proofs to establish this, are to be drawn from two sources, viz: From an examination of the reputed mother,— and an examination of the fcetus. Of the signs of abortion to be deduced from an examination of the female. In the early months of pregnancy, it is extremely difficult to ascertain whether an abortion has taken place or not. The foetus has scarcely had time to make those firm attachments * Percival's Works, vol. 2, p. 430-31. 3* -'JO INFANTICIDE. which afterwards unite it to the womb; nor has it attained to a size sufficient to produce those general changes in the constitution of the mother, nor those local alterations from the distention of the uterus and abdomen, which are afterwards occasioned. Its separation, therefore, is unattended by vio- lence, and leaves but faint, if any traces of its previous exis- tence. The hagmorrhage attending it is also of small conse- quence, inasmuch as the uterine vessels have not yet sustained any great enlargement, and therefore very speedily contract. The period to which these remarks more particularly apply, is the two first months of pregnancy, during which it is con- ceded that no satisfactory opinion can ever be formed fronv an examination of the female.* After this period, and just in proportion to the approach to the full term, will the signs be more decisive and satisfactory. For obvious reasons, I shall describe them such as they will be found when existing in their most marked and defined character, and these are the same as those which occur after ordinary delivery. The signs are deduced from three different sources, viz:— From the condition of the organs of generation themselves;— from the condition of the abdominal parietes;— and from the condition of the breasts. 1. Condition of the organs of generation. In consequence of the expulsion of the fcetus from the uterus, there are several striking changes which take place in these organs, from wThich important conclusions may be drawn. The more characteris- tic of these are the following: Labia and perineum. The labia will be found, on examina- tion, to be tumified and relaxed, and of a dark red colour: while in some cases the anterior edge of the perineum, called the fourchette, will be lacerated. These changes, of course, are owing to the unnatural irritation and distention which * Manuel de Medecine Legale. Par J. Briand. p. 67.— A Manuel of Medical Juris- prudence, by M. Ryan, M. D. Edited by R. E. Griffith, M. D. p. 129. —Marc, Dic- tionnaire de Medecine, vol. 3, p. 193. — Dr. Montgomery, in his valuable paper on the signs of pregnancy and delivery, relates the case of a lady to whom he was called. who miscarried at the end of the second month. In twenty-four hours afterwards he < found the os and cervix uteri almost completely restored to their natural state; the ■ vagina and external parts hardly if at all dilated, and very little relaxed; and the breasts exhibited very imperfectly the appearances which accompany pregnancy the ordinary sympathetic symptoms of which had been almost entirely absent. (See Cyclopedia of Practical Medicine, vol. 3, p. 504.) INFANTICIDE. 31 these parts have necessarily undergone during the passage of the foetus. Vagina. On introducing the finger into this organ, it will be found preternaturally enlarged and relaxed, from the same cause as the preceding. From the distention which it has suffered, its natural ruga? will also be obliterated, and its inner surface in consequence rendered smooth. Os and cervix uteri. On examining with the finger imme- diately after delivery, the neck of the uterus will be indis- tinct, and the mouth of that organ so dilated as to be scarcely distinguishable from the cavity of the vagina. When it is discovered, its edges will be found to be soft and flabby, and so open as to admit of the introduction of two or more of the fingers. After delivery, the os uteri gradually contracts, but never or " rarely closes to the same degree as in the virgin state."* Uterus. This is to be examined through the abdominal pa- rietes. On applying the hand to the abdomen immediately after delivery, this organ will be readily detected just above the pubes, in the shape of a hard round ball about the size of the child's head. It is during the first week after delivery, that the uterus is to be felt most distinctly in this situation; after this, the uterine tumour gradually lessens, and becomes more and more indistinct. It is at least a month, according to Burns, before the uterus returns to its natural dimensions.! TJie lochia. This is a discharge which takes place from the uterine organs immediately after the completion of delivery, and continues for a certain number of days. At first it is pure blood, and continues so during the first two or three days after delivery. It then changes to a paler colour, and finally as- sumes a whitish appearance. In some cases it eventually be- comes of a dark dirty green aspect, when it is known by the name of the "green waters." Now as this discharge comes from the relaxed and ruptured vessels of the uterus, and as its cessation depends upon the contraction of these vessels, it is evident that not merely its quantity, but its duration, must * Burns's Midwifery, p. 564. Seventh American edition. f Burns's Midwifery, p. 564. 32 INFANTICIDE. vary very greatly, according to the particular condition of the patient, and the greater or less rapidity with which the uterine vessels contract. Accordingly, it will be found that in some cases this discharge ceases in ten or twelve days, while in others it continues to the twenty-fifth or thirtieth day, and sometimes even longer.* Attending this discharge, there is an odour so peculiar that it can always be recognized by those at all conversant with it, and which is not present in any other discharge from the uterine organs. 2. Condition of the abdominal parietes. The circumstances indicative of delivery, in connexion with the abdominal pa- rietes, are their flaccidity, and the presence of the lineae albi- cantes. Flaccidity of the abdomen. On examining the surface of the abdomen after delivery, besides detecting the uterine tumour, which has been already mentioned, the abdomen will be found soft, relaxed, and frequently lying in folds. So great is this relaxation of the parietes sometimes, that they may be almost folded round the hand. This is more especially observed in those who have borne a number of children. Linece albicantes. These are shining whitish lines, to be seen on the surface of the abdomen, extending chiefly from the groins to the navel. They arise from the great distention and cracking of the skin during pregnancy, and remain fre- quently permanent for life:! They are not, therefore, to be looked upon as the evidences of recent delivery. 3. Condition of the breasts. The phenomena connected with the breasts as evidences of delivery, are their enlargement. the secretion of milk, and the presence of the areola. Enlargement of the breasts. About the third month of preg- nancy, the breasts begin to enlarge, and continue to do so until they frequently become double their original size; at the same time they become tender and painful, and have a firm lumpy feeling. After delivery, particularly if examined about the third or fourth day, they will be found full and tense. * See an Elementary Treatise on Midwifery, by A. L. M. Velpeau, M. D. Trans- lated by C. D. Meigs, M. D. p. 579. A Compendious System of Midwifery die by William P. Dewees, M. D p. 210. f Fodere", vol. 2, p. 9. INFANTICIDE. 33 Secretion of milk. This is another sign of pregnancy and delivery. It is important, however, to recollect that too much stress should not be laid upon this, apart from other indica- tions, inasmuch as it frequently takes place independently of both. Dr. Blundell relates the case of a female who had not had a child for three years; she had not suckled for some time previously, and was not pregnant, and yet the secretion of milk was so active that it flowed freely on the least pressure of the breast.* Another case is related by him, of a negress who secreted milk for twenty years after her pregnancy.! Areola around the nipple. In the virgin state, the nipple is surrounded by a circular discoloration of the skin, which is generally of a rosy tint, sometimes merely a little lighter than the natural skin. During the pregnant state, this undergoes striking changes. It becomes broader and darker, being con- verted into "a coppery red, or a dark mahogany brown."} The diameter of this circle averages from one inch to one inch and a half. Both the extent and colour of the areola differ considerably in different persons. § After a first pregnancy, it is to be recollected that the areola remains more or less per- manent; it is therefore not to be looked upon as a criterion of a recent delivery. Of all the individual signs, this is one of the most certain, and may be depended upon with a good deal of confidence, provided the discoloration be very decided, and the female has not borne children previously. * BlundelFs Midwifery, p. 112. American edition. t Ibid. p. 112. X Ibid. p. 113. § Dr. Montgomery records a case in which the diameter exceeded three inches. In negro women, the areola is almost jet black. (Cyc. Prac. Med. vol. 3, p. 474.) Dr. Montgomery, who has paid especial attention to this subject, describes other features besides mere colour, as characterizing very strikingly the areola. His words are the following: " In the centre of this circle, (the areola,) the nipple is observed partaking of the altered colour of the part, and appearing turgid and prominent; and the part of the areola more immediately around the base of the nipple, has its surface rendered unequal by the prominence of the glandular follicles, which, varying in number from twelve to twenty, project from the sixteenth to the eighth of an inch; and lastly, the integument covering the part is observed to be softer and more moist than that which surrounds it, and the breasts themselves are at the same time ob- served to be full and firm, at least more so than was natural to the person previously. Such we believe to be the essential characters of the true areola, the result of preg- nancy; and that, when found possessing these distinctive marks, it ought to be looked on as the result of that condition alone, no other cause being capable of producing it." (Cyclopaedia of Practical Medicine, vol. 3, p. 474.) 34 INFANTICIDE. Such are the signs deduced from the female, by which it is to be determined whether a delivery has taken place. From the account given of them, it is evident that many are neces- sarily evanescent in their character; and therefore, in order to obtain the fullest amount of testimony from them, the ex- amination should be instituted as speedily as possible after delivery has taken place. With regard to the latest period after delivery, at which a satisfactory decision may be made, some difference of opinion has existed. The period fixed upon by medical jurists generally, is from the eighth to the tenth day.* After this, many of them become too obscure to be relied on with any degree of certainty. Relative value of the preceding signs of delivery. In relation to the foregoing signs, it is essential to recollect that all of them have been objected to as uncertain, inasmuch as almost every one of them may be produced by other causes than de- livery. Thus, for example, the enlargement and relaxation of the external parts may arise from simple menstruation; the dilatation of the vagina and os uteri, and the enlargement of the uterus, may arise from hydatids or moles; the relaxation and marked state of the abdomen may arise from dropsy; even the areola? around the nipples, as well as the secretion of milk, may arise from other causes than pregnancy and delivery. Now it must be admitted that all these objections are, to a certain extent, well founded; and they go to show that no one sign, taken by itself, ought to be considered sufficient to esta- blish the fact. In all cases, a number of the signs should con- cur before any satisfactory conclusion can be formed. If this general caution be observed, the force of all the preceding objections will be materially weakened. Thus, for instance, menstruation may relax the vagina and external parts, at the same time that it causes a discharge from these organs. In this case, however, all the other signs will be absent. The peculiar odour of the lochia will be wanting; there will be no dilatation of the os uteri— no enlargement of the uterus— no wrinkling of the abdominal parietes—no secretion of milk, and * Paris and Fonblanque, vol. 1, p. 252. Fodere, torn. 2, p. 87. Montgomery m Cyclopaedia of Practical Medicine, vol. 3, p. 503. Griffith's Ryan, p. 133. INFANTICIDE. 35 no areola around the nipples. Again, dropsy may cause a great relaxation and wrinkling of the abdomen. I say may, because, generally speaking, unless the dropsical fluid be sud- denly removed by tapping, this will not happen, as in ordinary cases the fluid is removed so gradually that the abdomen has time to contract, and accommodate itself to the change. Ad- mitting, however, that these signs of pregnancy may be coun- terfeited by dropsy, so many others will be absent as to leave no doubt in the case. The vagina and external parts will not be affected; the os uteri will not be dilated; the uterus will not be enlarged; the breasts will have undergone no change, and there will be no lochial discharge. With regard to the secretion of milk from other causes than pregnancy, this is a fact which cannot be denied. But in ca- ses of this sort so many of the other signs of delivery will be absent as to obviate any difficulty that may arise. As to the objections founded on the existence of hydatids, it must be confessed that much more difficulty attends a cor- rect decision. These however I shall consider fully under the next head. Of the signs of abortion in cases in which the delivery is fol- lowed by the death of the female. Cases of this kind sometimes occur, and it then becomes the duty of the professional man to prosecute his researches still further by an anatomical inspection of the uterus and its ap- pendages. The uterus. In this organ, various appearances will be detected, indicating the fact of its having contained a fcetus. Its size will be different from that of the unimpregnated uterus. In the unimpregnated state, the dimensions of the uterus may be put in round numbers at three inches for its length, two for its breadth at the fundus, one inch at the cervix, and one inch for its thickness. In the gravid state, it is evi- dent that its size must vary considerably according to the size of the fcetus, and according to the quantity of liquor amnii.* * An Anatomical Description of the Human Gravid Uterus and its contents. By the Jate William Hunter, M.D. p. 2. 36 INFANTICIDE. A general average however, of its gradual changes in this respect may be put as follows:—During the first month, the uterus undergoes little or no change in its size.* During the second month it becomes considerably enlarged. About the end of the third month it will measure about five inches in length, of which the cervix will measure one inch. In the fourth month, it will measure five inches from the fundus to the beginning of the neck. In the fifth month, it will measure six inches from the fundus to the cervix. In the sixth and se- venth months it will measure about eight inches, and in the ninth it will be from ten to twelve inches from the top to the bottom.! Now in a case where a woman diesvfrom haemorrhage dur- ing labor, at the full time or immediately after, the uterus will be found like a large flattened pouch measuring from ten to twelve inches. In this case, little or no contraction having taken place, the dimensions of the uterus are little changed from what they were anterior to labor. If however uterine contractions should have taken place, the dimensions of the uterus would be considerably less. If some days had elapsed, the size would of course be still more diminished. If the ex- amination be made about two days after delivery, the uterus will be about seven inches long. At the end of a week, it will be about five or six inches,} and at the end of a fortnight about five inches long. Its shape will be different from what it is in the unimpreg- nated state. In the unimpregnated state, the uterus is a flat body, pyriform or somewhat triangular in its shape. During the first two months of pregnancy its shape remains unchang- ed; after this, the body of it becomes globular, without any material change having taken place in the neck, until about the fifth month. After this the neck grows shorter and broad- er, until in the two last months it is almost entirely obliterat- ed, and forms a part of the general cavity of the uterus. The shape of the uterus is now completely ovoid. Now if death * Maygrier's Midwifery, p. 81. t Burns' Midwifery, pp. 185, 563. % According to Burn?, " a week after delivery, the womb is as large as two fists." (Midwifery, p. 564.) INFANTICIDE. 37 takes place during or immediately after labor, the shape of the uterus will be ovoid, or if contractions have taken place, it will be globular. If on the other hand, several days have elapsed, it will have regained somewhat of its pyriform shape. Thickness of the uterus. On this point contradictory ac- counts are given. At the full time however, and when the uterus is still distended with its contents, its thickness varies very little from that before impregnation; in some cases even it appears to be thinner;* according to Hunter, its more com- mon thickness is from one to two thirds of an inch.} General- ly speaking too, the uterus is thickest at its fundus, and espe- cially where the placenta has been attached. When, how- ever, the examination is not made until some hours or days after delivery, and the uterus has had time to contract, it will then be found thicker than natural. In that state it wall often be found two inches thick.} It is well enough to recollect that gravid uteri, when injected, are much thicker than in their natural state. § Uterine blood-vessels. There is nothing in connexion with the pregnant uterus more striking, than the great enlarge- ment which the blood-vessels have undergone. Both the arteries and veins, but more especially the latter, are enor- mously enlarged from their natural dimensions. This is most strikingly observed in that portion of the uterus to which the placenta is attached. || The arteries will be found from the size of a goose quill to that of a crow quill, and downwards,1l and the veins will be found much larger. In some cases, the orifices of the veins opening into the uterus from the surface where the placenta has been attached, are large enough to admit the extremity of the little finger.** Inner surface of the uterus, and the placental mark. If the examination be made shortly after delivery, the cavity of * Monro in the Edinburgh Essays and Observations, Physical and Literary, vol. 1, p. 418. See also Hunter on the Gravid Uterus, p. 15. t An Anatomical Description of the Human Gravid Uterus and its Contents. By Williamm Hunter, M.D. p. 15. X Ibid. p. 15. § Edinburgh Essays and observations, vol. 1, p. 418. || Hunter on the Gravid Uterus, p. 17. If Edinburgh Essays and Observations, vol. 1, p. 427, 435. ** Ibid. vol. 1, p. 412. 4 38 INFANTICIDE. the uterus will be found to contain coagula of blood, or a bloody fluid. The part of the uterus to which the placenta has been attached, will be very visible, and corresponding in size to the placenta. This part will be of a dark colour, and have a gangrenous appearance; the vessels leading to it will also be much more enlarged than those of any other portion of the uterus. Ligaments of the uterus. These undergo great changes. The broad ligaments will be found effaced, in consequence of the fundus of the uterus enlarging and rising, so as to stretch them into a uniform covering of the uterus. This, of course, is only at the full term of pregnancy; at earlier periods, the condition of these ligaments will vary according to the en- largement which the uterus may have undergone. The round ligaments will be found much elongated, and thicker than in the ordinary state. In this enlarged state, they are about the thickness of the little finger; while in their natural state, they are not thicker than a crow quill. They are also exceedingly vascular—so much so, that when injected, " they seem to be little more than a bundle of arteries and veins."* Fallopian tubes. These will be found less convoluted — larger, and much more vascular than in the unimpregnated state. So great is this vascularity as frequently to give them a purplish appearance, looking very much as if they were in a state of inflammation. Generally the tube leading to the ovary from whence the ovum has escaped, will be found the most enlarged. Mr. Burns says, "the fallopian tube preserves its greater vascularity for a very considerable time, I cannot say how long, after delivery."} Ovaria. These will be found but little different from the state anterior to impregnation, with the exception of the one from which the ovum has escaped, and winch contains the corpus luteum. This ovarium can easily be identified by a peculiar fulness or prominence in one part of it, sensible both to the sight and touch, in the middle of which there is a small indentation like a cicatrix. On laying open the ovarium at * Hunter on the Gravid Uterus, p. 13. t Midwifery, p. 564. INFANTICIDE. 39 this part, there will be found a body of a very distinct nature from the rest of the ovarium; this is the corpus luteum. It is sometimes round, but more generally oblong or oval. " Its centre is white, with some degree of transparency; the rest of its substance has a yellowish cast, is very vascular, tender and friable like glandular flesh."* Such is the appearance of the corpus luteum, if examined shortly after delivery at the full time. If examined, however, at other periods, these ap- pearances will be considerably different. The earliest period after impregnation, at which the corpus luteum has been ob- served in the human subject, is in the case recorded by Sir Everard Home. Here the female died about eight days after impregnation; and on dissection, the right ovarium was found to have a small torn orifice upon the most prominent part of its external surface. On slitting open this orifice, it led to a cavity filled with coagulated blood, and surrounded by a yellowish substance.! The blood is gradually absorbed, and the cavity becomes lined with a white membrane. During the earlier months, a fluid will be found in the cavity.} Its dimensions after this become gradually contracted, and in the third or fourth month, it is about large enough still to contain a grain of wheat; after this it is completely obliterated, and in its place there is left a central white radiated cicatrix.§ This cicatrix is looked upon by Dr. Montgomery as a distinguishing characteristic of a genuine corpus luteum. || This cicatrix is not permanent, but disappears at about five months after de- livery. Such is the corpus luteum. It is largest and most vascular in the earlier periods of pregnancy; less so at delivery; and disappears altogether, according to the observations of Dr. Montgomery, at about five months after delivery. Relative value of the preceding signs drawn from an exami- ' Hunter on the Gravid Uterus, p. 14. f Philosophical Transactions for 1817, part 1. X Hunter on the Gravid Uterus, p. 74. § Montgomery in Cyclopaedia of Practical Medicine, vol. 3, p. 497. || "Of this latter appearance, (the radiated cicatrix,) it ought to be observed here, that it is visible as long as any distinct trace of the corpus luteum remains, and forms an essential character, distinguishing this body from every other that might be con- founded with it." (Ibid. p. 497.) 40 INFANTICIDE. nation after death. Striking as the foregoing signs unquestion- ably are, objections of a very serious character may be made gainst them. As these objections have actually been brought forward in criminal trials, a notice of them is unavoidable. Of these, the only ones which require consideration, are, that all the appearances just described as found on dissection after delivery, may have been occasioned by the delivery of hyda- tids or moles; and that the corpora lutea may exist indepen- dent of pregnancy and delivery. Each of these objections I shall briefly notice. 1. Hydatids. Although not of very frequent occurrence., these are sometimes found existing in the uterus. They are small vesicles, hung together in clusters, and filled with a watery fluid. Their real nature is not exactly known, although they are supposed to be animals of a very simple structure. They sometimes exist in large masses in the uterus. The origin of these curious productions is by no means established. By some it is supposed that they may exist in the uterus itself. and originate without any connexion with impregnation. This, however, is by no means certain; and the probability is that they never occur without sexual intercourse.* As commonly found, they appear to arise from the destruction of the ovum at an early period, or portions of the placenta remaining in the uterus after abortion or delivery, and degenerating into this kind of growth. Now it is very evident that some of the appearances and phenomena of pregnancy may be, and ac- tually are, simulated by the presence of these substances in the uterus. Every phenomenon that depends upon the mere distention of the uterus, and the subsequent discharge of its contents, may thus be counterfeited. So far then as the mere external appearances go, it is frequently impossible to decide whether they originate from a real fcetus, or from hydatids. Even where there is no wish to conceal the real condition of the person, it is sometimes difficult to make up a positive opi- nion. Females have in this way been themselves deceived. * Madame Boivin broadly asserts that hydatids are always the product of a degene- rated conception, and that no virgin female can ever have them. (Nouvelles Recher- ches sur l'origine, la nature, et le traitement de la mole ve'siculaire ou grossesse hyda- tique. Par Me. Boivin. Paris, 1827.) INFANTICIDE. 41 Presuming themselves pregnant, the discharge of the hydatids has led them to suppose it a real miscarriage.* In cases like those of criminal abortion, where every effort is made at con- cealment, it is of course out of the question to say which was the cause;} and the only way to settle the question, is by an examination of what may have been actually discharged from the uterus. In cases where the abortion ends in the death of the female, although we have the benefit of the additional in- formation furnished by dissection, still the inquiry is not un- attended with difficulties; and it is by no means easy to decide whether the phenomena which are observed are the result of the expulsion of a real foetus, or of hydatids. The following considerations must render this obvious. It has already been stated that, in all probability, hydatids are always the result of impregnation, the ovum, or some portion of the contents of the gravid uterus, being converted into this kind of growth. If this be so, a corpus luteum will be found, if the examination be made under favorable circumstances. Besides this, it has already been stated that every phenomenon connected with the enlargement of the uterus, and the dilatation of the os uteri, may also be produced by hydatids. Even the placental mark may be present. Cases therefore might occur, in which it wrould be impossible to distinguish between the two. I say may, because, generally speaking, in cases of hydatids, no placenta is found, and therefore they do not leave behind them any thing like the mark which is left by that body on the in- ner surface of the uterus. In cases of hydatids, the vesicles hang in clusters, attached by an intermediate membrane to the inner surface of the uterus.} This then would furnish one * An Account of some of the most important Diseases peculiar to Women. By Ro- bert Gooch, M.D. p. 216. American edition. r Gooch, after relating some cases of hydatids, says, "In the progress of these cases, it is impossible to come nearer the truth than this—that the abdomen owes its enlarge- ment to a distended uterus; but what this organ contains, is uncertain." (lb. p. 218.) X By Dr. Denman, they are described in the following manner: " Hydatids or small vesicles, hung together in clusters from cme common stem., and containing "a watery fluid, are sometimes formed in the cavity of the uterus." (Introduction to the Practice of Midwifery, p. 146. American edition.) According to Dr. Baillie, " they consist of vesicles of a round or oval shape, with a narrovi stalk to each, by which they adhere to the outside of one another. Nome of these hydatids are as large as a walnut, and others as small as a pin's head. A large hydatid has generally e number of small hydatids adhering to it by a narrow process." (Mor- bid Anatomy, p 136. American edition.) 4* 42 INFANTICIDE. mark of distinction. Another might be found in the different condition of the uterine bloodvessels. In cases of real preg- nancy, the bloodvessels, especially those confined to the pla- cental space, undergo a much greater enlargement than when hydatids alone are in the uterus. Independently, however, of all these considerations, there is not practically after all so much difficulty in these cases as might be anticipated. If hydatids are always the result of a degenerated conception, then the fact of impregnation is conceded; and this, after all, is the great point to be established in these cases. If, on the other hand, hydatids have no connexion with conception, then the question will be at once decided by the placental mark, but more especially by the existence of the corpus luteum. Besides all this, in cases where the signs of delivery are al- leged to be owing to hydatids, it is but reasonable to expect that these should be adduced in evidence, and in that case of course, all difficulty will at once be obviated. 2. Moles. These are peculiar substances contained within the cavity of the womb. They consist of a membrane en- closing generally a quantity of coagulated blood. Frequently however, they appear of a fleshy structure without any blood. In their size, consistence and structure they differ very much in individual cases. They occur too, under a variety of cir- cumstances. They have .been met with in females who have never been married, or borne any children. In some cases they have followed a natural delivery, or a miscarriage; while in others they have accompanied certain diseased conditions of the uterus. By some it is supposed that these formations never take place in the virgin state. Mr. Burns says he has never met with a case contradictory of such a supposition.* That they m%y, however, occur occasionally without any sexual intercourse, appears to be pretty well established. Now in these cases, many of the symptoms of actual preg- nancy are present. The abdomen becomes enlarged; the sto- mach is affected with nausea; and even the breasts become swollen.} Here then also, as in the case of hydatids, it is im- * The Principles of Midwifery, p. 127. t Ibid, p. 127. INFANTICIDE. 43 possible from mere external appearances to say whether these symptoms arise from genuine pregnancy or not. In cases where death takes place, and dissection has been had, the same reasoning is applicable here as in cases of hy- datids. If the mole be the product of a real conception, the great object of the investigation is at once conceded. If on the other hand, it be not the product of a real conception, then the examination of the placental mark and ovaria will indicate the fact. 3. With regard to the objection raised on the ground that the corpora lutea are sometimes found in virgins, and therefore are not to be looked upon as the infallible evidences of im- pregnation, it has been rendered more than doubtful whether a genuine corpus luteum is ever present except in cases of real pregnancy.* Of the signs of abortion, deduced from an examination of what may have been expelled from the uterus. Here there are three objects to be had in view, viz: To ascertain whether it be really a foetus that has been expelled from the uterus; and if it be a fcetus, to ascertain its age; and lastly, to ascertain the cause of its expulsion. 1. To ascertain whether it be really a foztus which has been expelled. From the difference in structure of the fcetus from hydatids and moles, it is scarcely possible that any mistake can be made in distinguishing them from one another, except in the very early months of pregnancy, say in the first two months; and at this early period, probably no medico-legal * On this subject see the luminous investigations of Dr. Montgomery, in the Cyclo- paedia of Practical Medicine. According to him the appearances which are consider- ed as corpora lutea occurring in virgins, differ from those of impregnation in all the following particulars: " 1. There is no prominence or enlargement of the ovary over them: 2. The external cicatrix is wanting: 3. There are often several of them in both ovaries, especially in patients who have died of tubercular diseases: 4. They are not vascular, and cannot be injected: 5. Their texture is sometimes so infirm that they seem to consist merely of the remains of the coagulum, and at others appears fibro- cellular and resembling that of the internal structure of the ovary, but in no instance did we ever see them presenting the soft, rich, and regularly glandular appearance which Hunter meant to express when he described them as ' tender and friable like glandular flesh:' (Description of Gravid Uterus, p. 14.) 6. They have neither the central cavity nor the radiated cicatrix which results from its closure." (Cyclopaedia of Practical Medicine, vol. 3, p. 502.) 44 INFANTICIDE. investigation could ever be instituted with any satisfactory result. 2. To ascertain the age of the fatus. This is important, inasmuch as it enables us to compare it with the appearances found on an examination of the female, to see how they cor- respond, and in this way to assist in detecting any imposition which may be attempted. In judging of the age of the fcetus, the circumstances more especially to be attended to are its length —weight—and the relative situation of the centre of the body. Notwithstanding the various observations which have been made, it appears never yet to have been settled precisely, when the ovum enters the womb, or when the embryo first becomes visible. Mr. Hunter made a dissection in which im- pregnation was supposed to have taken place nearly a month previously, and yet no ovum was detected either in the fallo- pian tubes or in the uterus.* Mr. Burns states that he exa- mined very carefully three uteri within the first month after menstruation, and in none could he discover an ovum.! By Sir Everard Home, however, a minute ovum was discovered as early as the eighth day after impregnation.} The period usually fixed upon, however, is from the nineteenth to the twenty-first day. When first seen, the ovum is in the state of a membranous egg, filled with a semi-transparent fluid, in the centre of which is the embryo. The parietes of it con- sist solely of two membranes, chorion and amnion. At first, the ovum is unattached to the uterus; afterwards it becomes united to it by means of the placenta. At about thirty days after conception, the foetus is about the size of a large ant, or, as it is described by others, of a bar- ley corn. At the end of two months, the foetus is nearly two inches in length, and its weight about one ounce; at this time, the dif- * Transactions of a Society for the Improvement of Medical and Chirurgical Know - ledge, vol. 2, p. 63. t Principles of Midwifery, p. 189, Am. Ed. X Philosophical Transactions for 1817. Mr. Burns thinks that the soaking of the uterus in spirits, practised in this case by Sir E. Home, may have rendered the ovum more distinct, and thus enabled him to detect its existence. (Principles of Midwifery, p. 189.) INFANTICIDE. 45 ferent parts of it are perfectly distinct, and even the sex can sometimes be distinguished. At the end of three months, its length is from three to five inches, and its weight about three ounces. At the end of four months, its length is from from six to seven inches, and its weight from four to five ounces. At the end of five months, the length is from eight to nine inches, and the weight from nine to ten ounces. At this pe- riod, the abdominal parts begin to predominate over the thora- cic parts. At the end of six months, the weight is from one to two pounds, the length from eleven to twelve inches, and the cen- tre of the body is at the abdominal extremity of the sternum.* At the end of seven months, the length is from twelve to fourteen inches, the weight from two to four pounds, and the centre of the body is between the umbilicus and the lower part of the sternum, but rather nearer to the latter than the former. At the end of the eighth month, the length is from sixteen to seventeen inches, the weight from three to five pounds, and the centre of the body between the umbilicus and the lower extremity of the sternum, but nearer to the former than the latter. At the end of nine months, the length is from nineteen to twenty inches,. • the weight from five to eight pounds, and the centre of the body at the umbilicus.} * For this criterion by which to judge of the age of the child, we are indebted to Chaussier. In the adult, the centre of the body is just above the pubis; in the child at birth, it is just at the umbilicus; at eight and seven months it is still higher, and at the sixth month, it is just at the lower part of the sternum. (Considerations Medico- Legales sur L'Infanticide. Par Lecieux. pp. 17, 18.) t According to experiments made in the Parisian hospitals, the following results were obtained from fifteen hundred and forty-one children who were weighed at birth, and who, with the exception of eight or ten, appeared to have attained the full term. 3 weighed 2 pounds and some ounces. 31 ..... 3 97 ...... 4 308 ...... 5 606 ...... 6 380 ..... 7 100 ..... 8 16 ...... 9 1,541 46 INFANTICIDE. It is very evident, however, that as it regards the size and weight of the foetus, there must be a very great diversity. The foregoing may serve as a general average, at the same time that it may fail to be applicable in any individual case. Sometimes a foetus of only six months, will be as large as an- other at the full time. In this case, however, notwithstanding its size, it will have all the signs of an immature fcetus, which cannot easily be mistaken. Its different members will be more or less imperfect; the colour of its skin will be lively red and transparent; the bones of the head will be soft, and the fonta- nelles very large; the hair will be very thin; the nails will be either wanting altogether, or very soft; there will be constant sleep, and an absence of the ordinary cries of the child; its movements will be feeble; and the discharge from the bowels will be either wanting altogether, or very small in quantity. All these signs will be found, of course, more or less strikingly marked, according to the approach of the foetus to the full term.* 3. To ascertain, if possible, what has been the cause of the miscarriage. If the abortion has been occasioned by the use of drugs, &c. taken by the mother, nothing can be learned as to the cause of it, whether it be voluntary or involuntary, from any examination of the foetus. In all cases its appearance will be very much the same, whatever may have occasioned its expulsion from the womb. As, however, it may have been produced by mechanical violence done to the fcetus itself, by the introduction of instruments, &c. it becomes necessary to examine it very carefully, and more especially its head, to discover the nature and extent of the wounds (if any) which may have been inflicted. The average weight fixed upon by Chaussier and Lecieux for the child at full term, is 6^ lbs. (Considerations sur L'Infanticide, par Lecieux, p. 9.) With regard to the length of the child, as the result of numerous observations, the following are fixed upon by Chaussier and Lecieux as the average: At 5 months, 9J inches. 6 ...... 12 7 ...... 14 8 ...... 16 9 ...... 18 (Considerations sur L'Infanticide, par Lecieux, p. 12.) * Manuel de Mgdecine Legale. Par J. Briand. pp. 66, 67. 1821. INFANTICIDE. 47 II. Of the means by which the death of the foetus may have been produced. Having, in the foregoing manner, examined the first ques- tion to be solved, viz. whether a foetus in utero has actually been destroyed, the second question relates to the causes by which it may have been produced. The practice of causing abortion, is resorted to by unmar- ried females, who, through imprudence or misfortune have be- come pregnant, - to avoid the disgrace which would attach to them from having a living child ; and sometimes it is even employed by married women, to obviate a repetition of pecu- liarly severe labour-pains, which they may have previously suffered. But abortion is not always associated with crime and disgrace ; it may arise from causes perfectly natural, and altogether beyond the control of the female. The physician should therefore be extremely cautious in his proceedings, even in cases of illegitimate pregnancy, and where the voice of popular prejudice seems to call upon the medical witness merely to confirm its previous, and often false decisions. The destruction of the fcetus may then result from two sets of causes. 1. The use and application of various criminal agents. 2. The ordinary and accidental causes which are known to produce it without any criminal interference. Each of these require examination, as in every trial of this kind, they may be made the subject of special inquiry by the court and jury. 1. Of the criminal means resorted to for purpose of destroying the faztus. These may be divided into general and local. To the first belong venesection, emetics, cathartics, diuretics, emmena- gogues, &c. &c. The second embraces all kinds of violence directly applied. Venesection. From the earliest periods it has been supposed that bleeding during pregnancy exercised some deleterious in- fluence upon the fcetus, and that the repetition of it would in- fallibly destroy it. Hippocrates entertained this belief,* and it has accordingly long been resorted to as one of the popular * Mulier uterum ferens abortit secta vena, eoque magis, si sit foetus grandior. (Hip- pocrates, sec. 5, aphor. 31.) 48 INFANTICIDE. modes of producing abortion. Bleeding from the foot has been supposed to be particularly effective in this way: all this is probably founded on the supposition that whenever blood is taken from the mother, the foetus also loses a proportional quantity, and that by a frequent repetition of it, the latter may eventually be bled to death. Experience however, the most ample and satisfactory, has proved conclusively, that except in particular states of the constitution, venesection, however repeated and copious, can have no direct effect upon the foe- tus; and further, that in many cases it is the most effectual agent in averting abortion. Mauriceau relates the history of two pregnant women, who were delivered at the full period, of living children, although one of them had been bled forty- eight times, and the other ninety times, for an inflammation of the chest.* By the same author, a case is recorded in which a person was bled ten times from the foot during pregnancy, without any bad effect on the foetus.! Dr. Rush, in speaking of the effects of bleeding in the yellow fever of 1793, asserts that not one pregnant woman to whom he prescribed it, died, or suffered abortion.} In his defence of blood-letting, the same writer gives us the account of one woman whom he bled eleven times in seven days, during her pregnancy; of ano- ther, who was bled thirteen times, and of a third who was bled sixteen times while in the same condition. All these women, he adds, recovered, and the children they carried duripg their illness, were born alive and in good health. § The foregoing facts, selected from a multitude of a similar character, are abundantly sufficient to show the extent to which venesection may be carried during pregnancy, without being attended with any injurious consequences to the foetus; and the effect is the same, from whatever part of the body the blood is drawn, whether from the arm or from the foot. In the cases just alluded to, it is true, blood was drawn during a state of disease, when the loss of a much larger quan- * Capuron, p. 307. f An Elementary Treatise on Midwifery, by A. L. M. Velpeau, M.D. Translated by C. D. Meigs, M.D. p. 236. X Medical Observations and Inquiries, vol. 3, p. 309. § Ibid. vol. 4, p. 302. INFANTICIDE. 49 tity can be borne than in ordinary health. Nevertheless, even in a state of health, the loss of a. very large quantity of blood is not necessarily attended by any injurious consequences to the foetus. On the other hand, it should be recollected, that when the constitution of the mother is naturally feeble and irritable, or has become much debilitated by disease, the inju- dicious loss of blood during pregnancy, may prove fatal to the foetus. In all cases therefore, the question whether the bleed- ing has had any agency in producing the destruction of the foetus must be determined by the particular circumstances of the individual case. At the same time, the mere fact of re- peated bleedings having been resorted to without any obvious necessity for it, must be held as a sufficient evidence of the intention of the person. Leeches. By some it is supposed that the application of leeches to the anus, insides of the thighs, or the vulva, has the effect of producing abortion. In this country, this practice is souncommon that we are hardly able to form any very correct opinion on the subject. A recent French writer, however, states that he has frequently applied leeches to these parts during pregnancy, in cases of intestinal affections, and in no instance did he find any bad consequences happen. At the same time he recommends great caution in the use of this remedy, especially in females who are liable to abort.* Emetics. From the well known fact, that many women are troubled with distressing nausea and vomiting during the whole of their pregnancy, and yet are safely delivered of liv- ing children at the regular period, it has been supposed that the foetus could not be much injured by the use of emetics. The fact however seems to be, that although the vomiting at- tendant upon pregnancy very seldom produces an abortion, yet that which is produced by emetics is not unfrequently follow- ed by consequences the most serious both to mother and foe- tus. In this opinion, I am supported by the authority of Mr. Burns, who says that "it is worthy of remark that abortion is very seldom occasioned by this cause, (the vomiting of preg- * Etudes Cliniques sur les Emissions Sanguines artificielles. Par A. P. Isidore Poliniere. Tom. 1, p. 34. 5 50 INFANTICIDE. nancy) though emetics are apt to produce it.* The reasons of the difference in the two cases may be the following. In the first place, the vomiting of pregnancy is less violent than that which is excited by artificial means; and in the second place, it occurs, as a general rule, only in the early months of preg- nancy, when of course less danger attends the operation. Just in proportion to the size and development of the uterus, is the danger to be apprehended from the spasmodic contraction of the diaphragm and abdominal muscles during vomiting. In the latter months of pregnancy therefore, emetics prove much more dangerous than they do at an earlier period. Notwith- standing this, even emetics do not always succeed. Velpeau relates a case falling under his own observation, in which fifteen grains of tartar emetic were taken to produce abortion. Although violent efforts at vomiting were occasioned, yet the progress of the pregnancy was not interrupted.} Cathartics. As a general rule, pregnant women are not apt to be injured by moderate purging. When attacked with dis- ease too, they may be purged very freely without any risk. During the yellow fever of 1793, Dr. Rush informs us, that he gave large and repeated purges of calomel and jalap to many women in every stage of pregnancy, and in no case did any injury ensue to the child. Nay, he adds, that out of a great number of pregnant women, whom he attended in this fever, he " did not lose one to whom he gave this medicine, nor did any of them suffer an abortion. One of them had twice miscarried in the course of the two or three last years of her life. She bore a healthy child three months after her recovery from the yellow fever."} If, however, the purging should happen to be carried too far or be continued too long; if the article used be very drastic in its nature; if it act par- ticularly on the rectum, § (between which and the mouth of the uterus there appears to be a peculiar sympathy;) or if the female be of a nervous, irritable habit, then purging may be * The Principles of Midwifery, p. 230. Seventh American edition. f Meigs' Velpeau, p. 236. \ Medical Observations and Inquiries, vol. 3, p. 249. ' § All those purgatives which produce tenesmus, are most apt to cause abortion. Hence it is too, that dysentery frequently produces this effect. INFANTICIDE. 51 and frequently is followed by the death and expulsion of the foetus. Purgatives, therefore, may or may not produce abor- tion, according to circumstances.* Diuretics. This class of agents has long been supposed ca- pable of producing abortion, and has accordingly frequently been used for this purpose. That they may'have been occasion- ally attended with success, is.very possible ; but I have no doubt that generally speaking they have failed. They cer- tainly are destitute of any specific power of exciting uterine action. Mr. Burns seems to think that they are capable of bringing on abortion, and accordingly advises that they should be avoided during pregnancy.} Still, from his own language, I should not infer that he had ever witnessed this effect, al- though he says that he has seen diaretics given very freely to pregnant women laboring under ascites.} On the other hand, there are many positive facts on record to prove that diuretics may be taken with impunity by pregnant women. Zacchias relates the case of a female, who, after an interval of five years, considered herself pregnant, and shortly afterwards was at- tacked with sciatica. Several physicians and midwives were called to examine her, and decidedly unanimously, that she was not pregnant, particularly as she lost a little blood every month, though not so much as in menstruation. They there- fore prescribed for the disease which afflicted her, bled her repeatedly in the foot, administered purgatives frequently, to- gether with diuretics and sudorifics. All this did not prevent her from bringing forth a healthy child at the end of the ex- pected time. || Concerning the oil of juniper, Fodere relates the following fact, which shews that this powerful article has failed in ef- fecting an abortion. A pregnant female took every morning for twenty days, one hundred drops of the distilled oil of ju- niper, without injury, and was delivered of a living child at the expiration of the ordinary term.H * Dr. James Johnson states that he has known a very moderate dose of calomel and rhubarb to cause a premature delivery. (Medico-Chirurgical Review, vol. 17, p. 98. f Principles of Midwifery, p. 283. X Ibid. p. 288. $ Ibid. p. 245. || Fodere, vol. 4, p. 430. If Fodere, vol. 4, p. 430. 52 INFANTICIDE. Even cantharides has been taken in very large doses, with a view of procuring an abortion, without accomplishing the desired effect. " Some years ago," says Mr. James Lucas, one of the surgeons of the General Infirmary at Leeds, " I was called to a patient who had taken about a drachm of powdered cantharides in order to induce abortion, and which brought on frequent vomiting, violent spurious pains, a tenes- mus and immoderate diuresis, succeeded by an acute fever, which reduced her to extreme weakness, yet no signs of mis- carriage appeared, and about five months afterwards she was delivered of a healthy child."* Cases, however, have occur- red in which cantharides has caused abortion. Dr. James Johnson mentions a case of this kind as occurring within his own knowledge.} Nitre. Dr. Paris relates the case of a woman in Edin- burgh, who having swallowed by mistake a handful of this salt, suffered abortion in less than half an hour.} Emmenagogues. Under this general head there are several articles which require notice. Among the more important are savine, mercury, polygala senega, and pennyroyal. Juniperus sabina, (savine.) This is a powerfully stimulating article, and as an emmenagogue, has been used with conside- rable effect. It has also long been used for the purpose of producing abortion, and no doubt possesses considerable pow- er in this way. Galen asserts that it acts with sufficient energy on the uterus to destroy the fcetus;§ and in the present day, it is said to be constantly used.by the negresses in the Isle of France with this intention. || In the case of Miss Burns, for whose murder Mr. Angus was tried at Lancaster in 1808, there is reason to believe, from the testimony offered, that savine oil had been administered to effect an abortion. That it does not always succeed, is evident from a case related by Fodere. In 1790, a poor, im- becile, and cachectic girl, in the duchy of Aoust, in the seventh * Memoirs of the Medical Society of London, vol. 2, p. 208. t Medico-Chirurgical Review, vol. 17, p. 98. X Medical Jurisprudence, by Paris and Fonblanque, vol. 3, p. 94. § Diclionnaire Mature Medicale, vol. 3, 696. || Ibid. INFANTICIDE. 53 month of her pregnancy, took from the hands of her seducer a glass of wine, in which there was mixed a large dose of powdered savine. She became so ill, that report of it was made to the magistrate, who ordered Fodere to visit her. The patient stated to him, that on taking the drug, she had felt a burning heat, accompanied with hiccup and vomiting. This was followed by a violent fever, which continued for fif- teen days. By the proper use of refrigerants, however, she recovered, and at the end of two months, was safely delivered of a healthy child.* In another case recorded by Murray, while it was success- ful in producing an abortion, it destroyed the life of the mo- ther.} Professor Christison relates, on the authority of Mr. Cockson, the case of a girl, who, to produce abortion, took a strong infusion of savine leaves. Violent pain in the abdo- men, and distressing strangury ensued. In two days after taking it, she miscarried; and in four after that, she died. On dissection, Mr. Cockson found extensive peritoneal inflamma- tion—the inside of the stomach of a re'd tint, checkered with patches of florid extravasation. The uterus presented all the signs of recent delivery.} Mercury. This has long been considered as an article capa- ble of occasioning abortion. Crude quicksilver was at one time supposed to possess this property. It was accordingly used, not merely for this purpose, but also in all cases of dif- ficult labor. It was not long, however, before it was ascer- tained that large quantities of it might be taken by pregnant women with perfect impunity. Matthiolus relates of several pregnant women, each of whom drank a pound of quicksilver to cause abortion, without any bad effect. § The same fact is confirmed by Fernelius.|| Calomel, however, is the prepa- ration of mercury most generally supposed to exert a specific influence upon the uterine organs. That it possesses the pow- er of producing miscarriage, is countenanced by the authority * Fodere, vol. 4, p. 431. t Apparatus Medicaminum, vol. 1, p. 59. Diet. Mat. Med. vol. 3, p. 696. X Treatise on Poisons, p. 531-2. Second edition. $ James' Dispensatory. || Vidi mulieres qui libras ejus biberunt ut abortum facerent, et sine noxa. (Ferne- lius.) 5* 54 INF.vNTlCIDE. of Mr. Burns, who directs that a full course of mercury should be avoided during pregnancy.* Facts, however, both numerous and conclusive, are on record to prove, that a preg- nant woman may go through a long course of mercury, with- out the least injury either to herself or to the child. Bartho- lin and Mauriceau relate several cases, in which mercury was given to salivation, to pregnant women affected with syphilis, and who all, at their full time, were safely delivered of healthy children.} Mr. Benjamin Bell, than whom I could not quote higher authority, says, "It is a prevailing opinion, that mer- cury is apt to occasion abortion, and it is therefore seldom given during pregnancy. Much experience, however," he adds, "has convinced me that this opinion is not well founded, and when managed with caution, that it may be given in suf- ficient quantities at every period of pregnancy, for curing every symptom of syphilis, and without doing the least injury either to the mother or child?'\ To the same effect is the tes- timony of Dr. Rush concerning the use of calomel in the yel- low fever of 1793. In not a single instance did it prove in- jurious to pregnant women.§ The following case wrhich fell under my own care, confirmed me in the opinion already ad- vanced. A female, eight months gone with child, was attack- ed with a violent inflammation of the lungs. After the use of the ordinary depleting remedies, I found it advisable to have re- course to mercury. She was accordingly put upon the use of small doses of calomel and James' powder. In a few days, sali- vation came on; after which, all the symptoms of her pulmo- nary complaint speedily vanished, and the patient was restored to her usual health. She was afterwards delivered of a living child at the full period. Dr. Campbell states that he was once asked to visit a younc girl, whom he found so violently salivated, with a view to ex- cite abortion, that her tongue could be compared to nothing else than a honey-comb. But notwithstanding her extreme suffering, she went to the full time.|| At the same time there * Midwifery, pp. 231, 233. f Fodere, vol. 4, p. 429. ; Bell on the Venereal, vol. 2, p. 265. American edition. § Medical Observations and Inquiries, vol. 3. pp. 249, 309. |j Introduction to the Study and Practice of Midwifery. By Wm. Campbell, M. D. p. 142. INFANTICIDE. 55 can be no question that the preparations of mercury, if given to patients predisposed to abortion, and especially if carried so far as to produce salivation, may be followed by that re- sult. Polygala seneka. This article has now been known and used in this country for a number of years, for the purpose of acting on the uterine organs, with the view of restoring menstrual secretion. The first notice which I have met with, of its pro- perties in this respect, is in an inaugural dissertation by Dr. Thomas Massie of Virginia, published in 1803. By him the action of it on the uterus is specially noticed; and the autho- rity of Dr. Archer of Maryland is given, of its being used by the common people in that state, for the purpose of procuring abortion.* That it may possess some power as an abortive, may be inferred from its acknowledged power as an emmena- gogue.! Pennyroyal. This article is reputed by some to be a power- ful abortive. Dr. Watkins relates a case, in which the mere odour of it produced abortion in a delicate woman in the fourth month.} At the Chelmsford assizes, August 1820, Robin Col- lins was indicted for administering steel filings and pennyroyal water to a woman, with the intent to procure abortion. He was convicted, and sentenced to transportation for fourteen years. § Besides the foregoing articles, belonging to the class of em- menagogues, there are others which are entitled to a place under the class of abortive agents. Secale cornutum—spurred rye—ergot. This article, at pre- sent so fashionable in obstetric practice, was first announced to the profession in this country in the year 1807, by Dr, John Stearns of New-York, as a substance capable of accelerating, in an extraordinary manner, the process of parturition. As might naturally be expected from the announcement of a re- medy so novel and unique, it excited much interest, and as soon as subsequent experience had confirmed its virtues, rose • Medical Theses. By C/iarles Caldwell, M.D. Vol. 2, p. 203. t See paper of Dr. Hartshorne in Eclectic Repertory, vol. 2, p. 201. X Coxe's Medical Museum, vol. 2, p. 431. § Paris and Fonblanque, vol. 3, p. 83. 56 INFANTICIDE. at once into the most unlimited popularity. In the year 1812, it was suggested by the editors of the New-England Journal of Medicine and Surgery, that while fully convinced of the parturient powers of the ergot, they were apprehensive that an evil of great magnitude not unfrequently resulted from its use; and that was, the death of the child. They stated that they had been led to this apprehension, from "observing that in a large proportion of cases where the ergot was employed, the children did not respire for an unusual length of time after the birth, and in several cases the children were irrecoverably dead."* The observations of numbers of highly respectable physicians since that period, have tended but too strikingly to confirm this melancholy fact. At present, it will scarcely be denied by any one acquainted with the operation of ergot, that if given in very large doses, or at improper periods, it will but too certainly prove detrimental to the life of the child.} It is to be feared, that for this purpose it has been but too frequent- ly used in this country. It cannot, therefore, be too strongly insisted upon, that the life of the mother is equally jeopardized with that of the child, by its improper use. By some it has been doubted whether the ergot is capable of producing an abortion, or whether its action is limited to the full period of utero-gestation, and when the uterus is beginning to act itself for the purpose of unloading its contents. That it does possess the power of causing abortion at any period, would seem to be proved by experiments made upon animals;} and Dr. Cha- tard records a case of abortion induced in the human female subject at the fourth month of pregnancy, by twelve grains of ergot.§ Notwithstanding all this, it is a fact that ergot is no more infallible as an abortive, than any of the agents already noticed. Dr. Condie states that several instances have come to his knowledge, in which the ergot was employed to the * Vol. 1, p. 70. t For testimony on this point, I refer to the following authorities: New-York Medi- cal Repository, vol. 12, p. 344; vol. 20, p. 11; vol. 21, pp. 23, 139. New-England Journal of Medicine and Surgery, vol. 1, p. 70; vol. 2, p. 353; vol. 5, p. 161; vol. 7, p. 216; vol.8, p. 121. New-York Medical and Physical Journal, vol.1, pp.205. 278; vol. 2, p. 30. X Philadelphia Journal of Medical and Physical Sciences, vol. 11, pp. 112-13. 6 New-York Medical Repository, vol. 21, p. 16. INFANTICIDE. 57 extent of several drachms a day, for the express purpose of inducing abortion, but without exerting the least effect upon the uterus. In all these cases, gestation continued for the full period, and the females were delivered of living children. He also states that he has known the ergot to be given in large and repeated doses, by ignorant midwives, where pains simu- lating those of parturition have occurred towards the termina- tion of utero-gestation, in order to quicken the labour; but so far from doing this, the pains have actually ceased under its use, and labour has not occurred for several weeks subseV quently.* I have myself met with one case in which a female who had had several children, took of her own accord three drachms of ergot to produce an abortion, without any effect. Actcsa racemosa. The common name of this plant is the black cohosh, or the squaw root. It is a common plant, found in every part of the United States, and the root of it is a good deal used by some of our American practitioners. Re- cently it has been brought into notice as an article possessing powers analogous to those of the ergot. By our native Indians, it appears to have been long supposed to possess properties of this sort, and Mr. Rafinesque states that it is " much used by them in facilitating parturition, whence its name—squaw root." Dr. Tully, in a paper on this subject, has recorded the testi- mony of a number of respectable physicians, who have used this article for this purpose; and, as they state, with decided success, acting very much in the same way as the ergot. A fluid drachm of the saturated alcoholic tincture acted as a suf- ficient dose, without being repeated.} According to Dr. Tul- ly, the actaea does not appear to exert the same stupefying and deleterious influence on the foetus, that he supposes is produced by the ergot. Digitalis. Of the effect of this active drug upon the uterine system, the following case is related by Dr. Campbell. " A married female, aged 26, fair complexion, relaxed, delicate habits, but not spare, the mother of several children, had ascites in her former confinement, and applied for the same * American Journal of Medical Sciences, vol. 10, p. 227. t Actaea racemosa. By William Tully, M. D. Professor of Materia Medica, in Yale College, in the Boston Medical and Surgical Journal for April 10, 1833. 58 INFANTICIDE. complaint, when in the eighth month of this, her fourth preg- nancy. In the course of twelve days, she took six drachms of the tincture of digitalis. On the twelfth day, at two A. M., the foetus still born, was thrown off before assistance could be afforded to her; and in twelve hours and a half afterwards, the woman herself expired, although she was in the most fa- vorable state when left after her delivery. The child seemed to have been but a very short time dead, for it exhibited no evidences of putrefaction. The body was examined twenty- five hours after death; it was running rapidly into putrefac- tion. About three pounds of water were contained in the chest; in the pericardium were found a few ounces of sero- sanguineous fluid; in the abdomen, the effusion was very tri- fling."* Among the local means used for procuring abortion there are only two which require to be noticed— Blows and other injuries on the loins and abdomen. In cases where severe blows have been received on the back, the dan- ger of abortion is always imminent. It is, indeed, rare that a female goes to her full time when she has received such an injury. Blows on the abdomen are equally dangerous; and in most cases of this kind, a considerable haemorrhage pre- cedes the death of the foetus. In disputed cases, where it is denied that the injury inflicted has caused the abortion, we should attend to the two following circumstances: First, whether the violence offered was sufficiently great to be considered as the sole cause; and second, whether the female was not predisposed to abortion, and had failed in some precautions, or committed some imprudence, which might have induced it. After investigating these facts, we ought to inquire whether the accused knew of the pregnancy of the female, or whether she had not provoked the blows which she received. Two cases from Belloc may serve to illustrate these distinctions. A young woman, between the third and fourth months of her pregnancy, had re- ceived, from a robust man, several kicks and blows with the fist, the marks of which were very evident. Immediately * Introduction to the Study and Practice of Midwifery, p. 141. INFANTICIDE. 59 after the accident, she was put to bed, bled, and various re- medies given her by a surgeon. The haemorrhage, however, continued, with pains in the loins and abdomen, and on the next day she had an abortion. Belloc, on being examined, declared that the accident was owing to the violence which had been inflicted.* In another case, a female brought forth a dead foetus, four months advanced, two days after a quarrel with her husband, in which she said he had struck her. In- stead, however, of lying down, or at least keeping quiet, she walked a league that day, and on the next a quarter of a league, to a place where she was to aid in bringing in the harvest; nor was it until her arrival there, that she was forced to go to bed. In this case, Belloc decides that it is very pos- sible, had she remained quiet, and called for proper aid, the abortion would not have taken place, particularly as the vio- lence used was only that of throwing her down in the street.! With regard to this cause of abortion, as well as the others that have been mentioned, it is to be understood that the life of the mother is equally exposed with that of the child. The following case, related by Dr. Smith, illustrates this fact in a striking manner, and is only one of a number which might be adduced. In 1811, a man was executed at Stafford for the murder of his wife. She was in the pregnant state, and he had attempted to induce abortion in the most violent manner, as by elbowing her in bed, rolling over her, &c.; in which he succeeded—not only procuring abortion, but along with it the death of the unfortunate woman.} By Dr. Campbell, a case is recorded of a female, who, in the last month of pregnancy, was struck on the abdomen by her husband. An extensive detachment of the placenta caused the immediate death of the foetus, and that of the mother in fifty-one hours afterwards. § The introduction of an instrument into the uterus for the pur- pose of rupturing the membranes, and thus bringing on prema- ture action of the womb. Of this villainous practice, which has * Belloc, p. 81. f Cours de Medecine Legale, par J. J. Belloc. p. 82. X Smith's Forensic Medicine, p. 305. § Introduction to the Study and Practice of Midwifery, &c. p 137. 60 INFANTICIDE. long been known and resorted to for the nefarious purpose of producing abortion, 1 shall say nothing more than to give the history of a few cases in which it was used, and which will show the effects with which it is attended. " At Durham as- sizes, in 1781, Margaret Tinckler was indicted for the murder of Janet Parkinson, by inserting pieces of wood into her womb. The deceased took her bed on the second of July, and from that period thought she must die, making use of various ex- pressions to that effect. She died on the 23d. During her illness, she declared that she was with child by a married man; and he, being fearful, should she be brought to bed, that the knowledge of the circumstance would reach his wife, ad- vised her to go to the prisoner, who was a midwife, to take her advice how to get rid of the child—being at the time five or six months gone. The delivery took place on the 10th of July, three days previous to which, a person saw the deceas- ed in the prisoner's bed-chamber, when the prisoner took her round the waist, and shook her in a violent manner five or six different times, and tossed her up and down. She was after- wards delivered at the prisoner's house. The child was born alive, but died instantly, and it was proved by surgeons to be perfect. There was no doubt but that the deceased had died by the acceleration of the birth of the child; and upon open- ing the womb of the mother, it appeared that there were two holes caused by wooden skewers, one of which was mortified and the other inflamed. Additional symptoms of injury were also discovered."* In England a very curious trial took place in 1808, of two persons, William Pizzy and Mary Codd, " for feloniously ad- ministering a certain noxious and destructive substance to Ann Cheney, with intent to produce a miscarriage." On the trial, it appeared that they had given medicines several times to produce the abortion without any effect. In consequence of this failure, Pizzy, who was a farrier, introduced an instru- ment into the vagina, and in that way destroyed the child and brought on premature delivery. This took place about six or seven weeks before the full time. Although the facts appear- * East's Crown Law, vol. 1, p. 354. Smith, p. 306. INFANTICIDE. 61 ed very clear on the trial, yet the jury brought in a verdict of acquittal.* By Fodere and Ristelheuber a case is related, in which rup- ture of the uterus and death was occasioned by the introduc- tion of a syringe with a long ivory pipe, for the purpose of producing abortion. On dissection, a foetus of about two months was discovered in the abdomen.} By Dr. Baxter, of New-York, another case is recorded, in which he was called to a female who had employed a person to procure an abortion by the introduction of a silver catheter. The only effect however, was that of wounding the os tincae, and rupturing the membranes without expelling the foetus. Fifteen days after the perpetration of the deed, Dr. Baxter found her in terrible pains, and having bled her twice without relief, he gave her ergot, to facilitate the delivery of the foe- tus, which very shortly brought it away. It was perfect, and about four months old. Unfortunately, the names of the per- sons concerned in this infamous transaction, were never di- vulged.} On this subject, the following interesting and instructive fact is related by Dr. Gooch. " Dr. William Hunter, attempt- ed this operation (introducing an instrument to puncture the membranes) on a young woman, at about the third month of pregnancy. He found that he several times punctured the cervix uteri, and the case terminated fatally. If this hap- pened to one of so much anatomical knowledge and skill, how much more probable must it be in the hands of those ignorant men, by whom, for the purpose alluded to, the operation is sometimes undertaken ! No doubt these attempts often prove fatal, but the murdered do not tell tales."§ A most extraordinary mode of causing abortion recently occurred in France, which may perhaps be appropriately no- ticed in this place. The subject, was a married woman, who had four children, and was pregnant of a fifth. At the com- mencement of her pregnancy, she was persuaded by the re- * Edinburgh Medical and Surgical Journal, vol. 6, p. 244. t Medico-Chirurg. Review, vol. 6, p. 528. t The Medical Recorder, vol. 8, p. 461, for 1325. § A Practical Compendium cf Midwifery, by Robert Gooch, M. D. p. 94. Am. Ed. 6 62 INFANTICIDE. presentations of another female, to inject sulphuric acid into the vagina as an easy mode of inducing premature labour. As may readily be imagined, excessive inflammation of the parts took place, together with great general constitutional disturb- ance, and the final result was an almost complete obliteration of the vagina. " The medical men on examination, found that a kind of irregular band surrounded and obstructed the vagina, beyond which, and on the brim of the pelvis, the head of the infant was distinctly felt, pressed forward by the uterine con- tractions. It was resolved to make an incision through the dense membrane, but when this was done, it was found it had adhered to the bladder, which the incision had completely di- vided. The delivery was not at all facilitated, and the at- tendants felt themselves compelled to perform the caesarean operation. The infant was extracted dead, apparently for some time, and the mother immediately expired."} Having thus finished the notice which I proposed to take of the methods which have been resorted to for criminally producing abortion, I must again insist upon a circumstance, already adverted to, but which cannot be too often repeated; and this is, the danger which necessarily attends the life of the mother in every attempt of this sort. Even in cases where miscarriage results from involuntary causes, and where every prudential measure has been adopted for obviating its consequences, it is well known that the mother frequently falls a victim. How much more likely is this to be the result when the miscarriage is occasioned by great and unnatural violence done to the system, and that too under circumstances which ffenerallv shut out the wretched sufferer from the benefit of all medical succour. Velpeau states that he had a female un- der his care, who produced a violent abdominal inflammation by taking medicines to promote abortion. She died on the eighth day, without any symptoms of abortion having appear- ed.} There is another circumstance also of great importance, which should not be forgotten. It has happened in some in- stances, that while the mother has lost her life in attempting t The Lanc3t, vol 8, p. 38. X Meigs' Velpeau, p. £3 J. INFANTICIDE. 63 to procure a miscarriage, the child has actually been born alive and survived. A case of this kind was witnessed by Fodere in 1791. A cook finding herself pregnant, and not being longer able to conceal it, obtained half an ounce of powdered cantharides, and mixed it with an ounce of sulphate of magnesia, and took them down in order to produce abor- tion. Some hours after, she was seized with violent cholic, and brought forth a living child, in the most horrible pains. During the succeeding night she died.* If these facts were more generally known, I suspect the attempts at abortion would be much less frequent than they are at present. With regard to the accessaries and accomplices in this crime, it would be well for them to remember, that in every experiment of this kind which they make, they take upon themselves the awful responsibility of jeopardizing not merely a single life, but two lives. As far as intention is concerned, they are in all cases as much chargeable with the death of the mother, as with the destruction of the fruit of the womb. It results, therefore, from what has been said, concerning the means of producing abortion, 1. That all of them are uncertain in their operation upon the foetus. 2. That they always endanger the life of the mother, and 3. That they sometimes destroy the mother without affect- ing the fcetus. I deem it so important to enforce these results, that I shall confirm them by the following authorities. " It is evident, I believe from experience," says Farr, " that such things, (abor- tives,) cannot act as efficient causes, without the aid of those predisposing causes, or natural habits of the body, which are necessary to concur with them. As attempts of this kind, however, should not be passed off with impunity, and as the life of the mother as well as the child is endangered by such exhibitions, if advised by any other, they should be considered as highly culpable, and for this reason should be made known."} * Fodere, vol. 4, p. 436. t Farr's Elements of Medical Jurisprudence, p. 70. 64 INFANTICIDE. "Every woman," says Bartley, " who attemps to promote abortion, does it at the hazard of her life. It may be remarked, whoever endeavors to counteract the ordinary proceeding of nature, will have in the end sufficient cause to repent the te- merity.*" "There is no drug," says Male, "which will produce mis- carriage in women not predisposed to it, without acting vio- lently on their system, and probably endangering their lives."] Smith says, "Abortion is in general injurious to health, and is seldom unaccompanied with suffering. The administration of emmenagogues to force a separation of the ovum, where the constitution has no tendency to throw it off, is highly dan- gerous to the mother. No drugs can act in this way upon the uterus, but by involving it in a violent shock given to the ge- neral system. It has frequently occurred, that the unhappy mother has herself been the sacrifice, while the object intended has not been accomplished."^ Burns says, "It cannot be too generally known, that when these medicines do produce abortion, the mother can seldom survive their effect."§ To show how difficult the perpetration of abortion some- times is, the following case will serve as an illustration. " A young woman, seven months gone with child, had employed savine and other drugs, with a view to produce a miscarriage. As these had not the desired effect, a strong leather strap (the thong of a skate) was tightly bound round her body. This too availing nothing, her paramour (according to his own con- fession) knelt upon her, and compressed the abdomen with all his strength; yet neither did this effect the desired object. The man now trampled on the girl's person while she lay on her back; and as this also failed, he took a sharp pointed pair of scissors, and proceeded to perforate the uterus through the vagina; much pain and haemorrhage ensued, but did not last long. The woman's health did not suffer in the least, and pretty much about the regular time, a living child was brought * Bartley's Treatise on Forensic Medicine, p. 5. f Male's Epitome of Juridical Medicine, in Cooper's Tracts, p. 208. X Smith's Principal of Forensic Medicine, p. 295. § Principles of Midwifery, p. 283. INFANTICIDE. 65 into the world, without any marks of external injury upon it. It died indeed four days afterwards, but its death could not be traced to the violence inflicted on the mother's person; all the internal organs appeared normal and healthy."* Velpeau makes the following statement in relation to the consequences of using instruments to procure abortion.— " Those who make use of them most frequently, fail of attain- ing their object, and succeed only in seriously injuring the womb. I once prescribed for a female, in whom such at- tempts had brought on a flooding which conducted her to the verge of the grave; she suffered horribly from pain in the in- terior of the pelvis for two months, notwithstanding which, abortion did not take place, and she is now a prey to a large ulcer of the neck of the womb. I opened the body of an un- happy creature who suffered from the like attempts, which did not succeed any better than the one above mentioned. M. Girard, of Lyons, mentions a similar instance. Very re- cently, also, (Oct. 1828,) a young woman who became preg- nant against her wishes, succeeded by such manoeuvres only in producing an organic lesion of the uterus, which, after frightful sufferings, led her to the commission of suicide."! Of the involuntary causes of abortion. Of these it is not ne- cessary to say much. They should always, however, be kept in view in medico-legal investigations on this subject, so that we may not attribute to criminal interference what is owing to some morbid derangement. Diseases of various kinds, as rheu- matism, pleurisy, small pox, typhus and yellow fevers, scar- latina, syphilis, and measles, operating on a system predis- posed by nervous irritability—a diseased state of the uterus —the intemperate use of spirituous liquors—irritation of the neighboring organs, from costiveness, tenesmus of dysentery, haemorrhoids, prolapsus ani, diarrhoea, incontinence of urine— errors in regimen and diet—violent exercise, as in walking, dancing, riding, running, &c—accidental falls—a sudden con- tortion or shock} of the body—indulgence of any violent pas- * Professor Wagner, in the London Medical Quarterly Review, vol. 2, p. 487. t Meigs' Velpeau, p. 238. X The pulling of a tooth, for instance, has been known to produce abortion. Burns on Abortion, p. 64. 6* 6C INFANTICIDE. sion of the mind, whether joyful or sad—the relation of any unexpected intelligence—a great noise*—the appearance of any extraordinary object—previous abortion—fluor albus— excessive venery—-accidental blows on the abdomen—the death of the fcetus—the attachment of the placenta over the os uteri—retroversion of the womb—haemorrhage, from what- ever source, or at any period}—all or any of these causes may give rise to abortion, without the imputation of the least crimi- nality to the female. The influence of the passions upon the uterine functions is peculiarly striking. It is an extraordinary fact, that the melan- choly and sadness caused by some great evil which is known and expected, are much less injurious to a pregnant woman, than the annunciation of some important good, or even a tri- fling misfortune which is unexpected. Fodere relates the case of some pregnant women, who, during the horrors of the French revolution, were confined in dungeons, and condemned to death; their execution was, however, delayed in conse- quence of the peculiarity of their situation. Yet notwithstand- ing the actual wretchedness of their condition, and the more terrible anticipation of future suffering, they wrent on to the full time, during which period, a fortunate change in the state of parties rescued them from unmerited punishment.} Circumstantial evidence. In concluding the subject of abor- tion, I shall make a remark or two upon the circumstantial evidence which may be adduced to prove the guilt of the accused. With regard to concealing her pregnancy, I cannot * A case, in which a great noise as a cause of miscarriage was involved, was tried in 1809, at the quarter sessions of Franklin county, in Pennsylvania. The indictment charged that Taylor, (the defendant) unlawfully, secretly, and maliciously, with force and arms, broke and entered at night the dwelling-house of James Strain, with intent to disturb the peace of the commonwealth; and after entering the house, unlawfully, wilfully and turbulently, made a great noise, in disturbance of the peace of the com- monwealth, and did greatly misbehave in said dwelling-house, and did greatly fright- en and alarm the wife of the said Strain, whereby she ?niscarried, &c. The offence w.-is held indictable as a misdemeanor. The jury found the defendant guilty; but the quarter sessions arrested the judgment upon the ground, that the offence charged was not indictable. The supreme court decided in this case, that the judgment should be reversed, and the quarter sessions were directed to proceed to give judgment against ihe defendant. Binney's Reports, vol, 5, p. 277. f P.urton's Midwifery, p. 281. Burns' Midwifery, p. 161. Burns on Abortion. lf;uailtons Midwifery. X Fodere, vol. 4, p. 422. INFANTICIDE. 67 conceive with what justice any inference can be drawn pre- judicial to her character. If her pregnancy be the result of illicit commerce, it is perfectly natural that she should make use of every effort to conceal her disgrace as long as possible. The mere fact of concealment, even if proved, ought to be considered as no evidence whatever of her guilt. If she has been known to apply frequently to the same or to different physicians to be bled, especially in the foot; if she has endeavoured to procure any of the medicines usually given to produce this effect; if any are found in her possession, or if she can be convicted of actually taking them without me- dical advice, we have then the strongest circumstantial evi- dence which the nature of the case admits of, to pronounce her intention to have been criminal. These are circumstances, however, which do not strictly come under the cognizance of the professional witness; they are matters of fact, which must be decided upon from the testimony which may be offered by the other witnesses cited to appear in the case. 2. Of the murder of the child after it is born, with an account of its various proofs and modes of perpetration. In every case in which an infant is found dead, and becomes the subject of judicial investigation, the great questions which present themselves for inquiry, are, 1. Has the child attained that size and maturity which would enable it to maintain an independent existence'? 2. Was the child born alive'? 3. If born alive, by what means did it come to its death? Having come to the conclusion that the death of the child is owing to violence, it is next to be ascertained who the per- petrator of it is. Should suspicion light upon a female as being the mother of it, the questions to be determined concerning her, are, 1. Whether she has been delivered of a child1? And, 2. Whether the signs of delivery correspond as to time, &c. with the appearances observed on the child1? These are the only points upon which the professional wit- ness can be called to give his testimony, and to the considera- tion of these I shall accordingly confine myself. 68 INFANTICIDE. 1. Proofs of a child's having attained a sufficient maturity to maintain an independent existence. Although children born before the completion of the seventh month have occasionally survived, and been reared, yet in a medico-legal point of view, no child ought to be considered as capable of sustaining an independent existence until the seventh month has been fully completed. Accordingly, if it can be proved that the child which is the subject of investigation has not attained this age, no charge of infanticide can or ought to be entertained. Even when the full term of seven months has been attained, its chances of surviving are exceedingly uncertain; and just in proportion as the child approaches the full term, is the proba- bility of its living increased. The principal signs by which a judgment is to be formed in these cases are, the weight of the child—its length—and the relative situation of the cen- of the body. These have already been noticed in a previous part of this essay, and require no additional comment.* 2. Proofs of the child having been born alive. We know no- thing of the nature of life; we judge of it only from its ef- fects, and declare that being as enjoying it, who performs the functions considered essential to it. These functions are called vital, and are usually enumerated as the three following, viz: the cerebral and nervous; the sanguineous and t\\e respiratory. This distribution can only apply, however, to the state after birth: in the foetal state, facts would seem to prove, that no- thing besides the circulation of the blood is necessary to the maintenance of the vital principle. Even the energy of the brain, which is afterwards to determine the character, and in a great measure to fix the destiny of the being it inhabits, is originally dormant, and the organ itself occasionally wanting. In cases of infanticide, it is only from the circulation and respi- ration that any thing is to be learned: the brain and nerves leave no trace of their influence behind them. Proofs of the blood having circulated after birth. There are four things in connection with this, that require investigation, viz. the character of the blood itself; the state of the heart and vessels circulating the blood; the distribution of the blood in the " See page 45. INFANTICIDE. 69 different organs of the body; and the existence of ecchymoses and extravasations. (a.) Of the character of the blood itself. By some eminent authorities, it is asserted that there is no difference in ap- pearance between the arterial and venous blood of the fcetus. Bichat investigated this point particularly, and he states that he made numerous dissections of young guinea pigs while yet in the womb of their mother, and he uniformly found the blood of the arteries and veins presenting the same appear- ance, resembling the venous blood of the adult. Not the slightest difference was observed between the blood taken from the aorta, and that from the vena cava, nor between that drawn from the carotid artery and the jugular vein. He made the same observations in three experiments of a similar nature upon the foetuses of dogs. He also frequently dissected human foetuses who died in the womb, and found the same uni- formity in the arterial and venous blood. From these facts, he concludes, that no difference exists between the arterial and venous blood of the foetus, at least in external appearance.* Velpeau and Autenreith, as the result of their experiments and observations, confirm this statement.} By other obser- vers this is positively contradicted; and it is asserted, that the difference between the blood of the arteries and veins is very obvious.} By Dr. Jeffrey, the following experiment was made. He took part of the umbilical cord and dissected away the gelatinous part of it, until he had laid bare the ves- sels, when on puncturing them, he found there was a differ- ence between the blood in the vein and the arteries. § A sim- pler mode of performing this experiment, suggested by Mr. Carr of Sheffield, is the following. As soon as the child is born and the cord divided, take the placental portion of it, around the end of which a ligature has been previously ap- plied, and cut it two or three inches from the ligature with a sharp scalpel, so as to make an even surface. If the portion * Bichat's General Anatomy. Translated by Hay ward, vol. 1. p. 355. t Velpeau's Midwifery, p. 219. X Bostock's Physiology, vol. 2, p. 157. American edition. § The Physiology of the Foetus, Liver and Spleen, by George C. Holland, M. D. p. 154. 70 INFANTICIDE. of cord be now pressed from below upwards, the blood flowing from the vein and that from the arteries will be found very different. " Sometimes a large drop of florid blood is observed to stand directly over the umbilical vein, and another dark colored over the arteries, without their being in the least mingled with each other, and in this case, the difference be- tween the two is so striking that no one can fail to observe it."* In relation to this experiment, it is to be remarked, that to render it of any force in controverting the observations of Bichat, it ought to be made upon the still born child, in whom respiration has never taken place. Performed upon the child which has been born alive and breathed, the difference be- tween the arterial and venous blood is just what might have been expected. Of its coagulation. By some it has been supposed that the blood of the fcetus does not coagulate. This, however, is a mistake. But although the foetal blood does coagulate like adult blood, yet there is this difference between them, that the coagulation of the former is by no means so firm and solid as that of the latter. This was originally observed by Four- croy,} and has since been confirmed by other observers. Tlie effect of exposing the fatal blood to the action of the at- mosphere. In the experiments made by Fourcroy, the coagu- lum, of a brown red, exposed to the atmosphere, did not be- come florid in the same manner as that of the adult. There were, however, filaments of a red colour running over the brown mass.} giving it a veined appearance. By others, this is controverted; and Dr. Blundell states that it can easily be proved that the blood of the foetus does become florid, by taking it from the umbilical vessels, and setting it aside, ex- posed in a cup to the action of the atmosphere. In a very short time, he says, it will be found to undergo a change to a bright red color; and if the clot be cut vertically in two,§ the contrast between the exposed and unexposed parts will be very striking. Here too the same remark is applicable, that * Physiology of the Foetus, &c. by George C. Holland, M. D. p. 154. t Annales de Chimie, tome 7, p. 162. ' X Annales de Chimie, tome 7, p. 163. § Blundell, in Lancet, for 1828, p. 130. INFANTICIDE. 71 was made in relation to the experiments of Drs. Jeffrey and Carr. The blood which is exposed ought to be that of the fcetus which has not respired. The blood taken from the um- bilical vessels in ordinary cases of delivery, where the child is born alive, and has breathed, is not foetal blood. Whether this precaution was observed by Dr. Blundell, does not appear from his statement. Chemical composition of faetal blood. On this subject, I be- lieve we have nothing but the analysis of Fourcroy. As the result of this, there would seem to be a real difference be- tween the composition of foetal and adult blood. According to him, the points of difference are the following: — 1. In the fcetus the coloring matter is darker, and the blood is not so susceptible of taking the brilliant red shade, on exposure to the atmosphere. 2. It contains no fibrous matter; the thickened and coagulated matter which is found in its place, resembles more gelatinous matter. 3. It does not contain any phosphoric acid.* According to the observations of Fourcroy, Tiedemann and others, it would appear, also, tjiat the proportion of serum in foetal blood is much larger than in adult blood.} In addition to the foregoing, the miscroscopical observa- tions of MM. Prevost and Dumas, have ascertained that the red globules of the blood in the foetus differ in their form and volume from those of the adult, the former being much smaller than the latter.} The foregoing facts and observations, although they go to show that there are some interesting points of difference be- tween the blood of the fcetus and that of the adult, are yet, I fear, of too delicate a nature to be rendered practically avail- able in a question of so grave import as that of infanticide. (b.) The condition of the heart and bloodvessels. Without going into any elaborate description of the circulation in the foetal state, it is only necessary to state that there are a number of striking and interesting peculiarities in the organs circulating the blood in the fcetus, which are modified or entirely lost after • Annales de Chimie, tome 7, p. 165. | Velpeau's Midwifery, p. 218. X Velpeau's Midwifery, p. 219. Bostock's Physiology, vol. 2, p. 158. Am. ed. 72 INFANTICIDE. the child is born, and respiration is established. These pecu- liarities, therefore, require to be specially noticed. They are the foramen ovale; the ductus arteriosus; the ductus venosus; the umbilical vessels, and the cord. The foramen ovale. This is an opening situated in the sep- tum which divides the right auricle from the left, and through it part of the blood is conveyed directly from the right to the left auricle. It is nearly equal in size to the mouth of the in- ferior cava, and is supplied with a thin transparent falciform valve, situated on the side of the left auricle. In this way the valve permits the flow of blood into the left auricle, but pre- vents its return into the right auricle. When the valve is closed, there is generally a small aperture still left open, where the valve falls slack, and is ready to open. The accompanying sketches will render more intelligible the relative situation and appearance of the foramen ovale. a. The ascending cava, with its hepatic branches, b b. c. The descending cava. d. The right auricle, where it lies against the roots of the aorta and the pulmonary ar- tery. i. The circle which surrounds the foramen ovale, sometimes called the isthmus vieus- setdi, but more commonly the circulus foraminis ovalis. m. The valve of the foramen ovale. n. The aperture or opening m the foramen ovale. o. The opening towards the ventricle. This sketch is intended to show the foramen ovale still more plainly. Every portion of the foetal heart is cut away, except the ventricles and the partition between the auricles. a. The ventricles. b. The vena cava, with a blowpipe in it. c c. The septum between the auricles laid open to display the foramen ovale. k k. The musculi pectinati, or muscu- lar fibres of the auricle. d. The circulus foraminis ovalis. e. The valve of the foramen ovale. i. The aperture of the valve, where the valve falh slack and opens. INFANTICIDE. 73 After birth, the foramen becomes obliterated by the closure and adhesion of the valve, and leaves behind it in the adult nothing but an oval depression in the septum between the auricles. This depression "is called the fossa ovalis, and cor- responds to the space occupied in the foetus by the foramen ovale.* In the foetal state, and anterior to respiration, this foramen is always open; and it becomes closed only in con- sequence of the blood taking a new route through the lungs, when respiration commences. If, therefore, in examining any case, the foramen ovale be found closed, it is a very decisive evidence of the child's having been born alive. It is to be re- collected, however, that this closing and obliteration of the fo- ramen ovale is a gradual process, taking sometimes from two to three weeks before it is completed. Hence it is obvious, that however strong a proof its closure may be of previous life, yet its being open is no evidence to the contrary. To render the phenomena connected with the foramen ovale available in these cases, it was suggested, originally I believe by Professor Bernt of Vienna, that although the complete closure of the foramen ovale did not take place until some days after birth, yet that during all this time it underwent certain changes, which would distinctly mark the period which had elapsed after the birth of the child. That the foramen ovale does un- dergo a series of changes during the process of obliteration, was remarked so early as 1750 by the English anatomist Rid- ley, and has since then been confirmed by the observations of anatomists and physiologists. These changes consist mainly in the position of the aperture of the foramen. In the fcetus anterior to respiration, the aperture of the foramen ovale is always found at the lowest part of the valve; as soon as re- spiration has commenced, it is gradually turned towards the right; after some weeks, it is elevated still higher; and finally, after revolving as it were around the right edge of the valve, it is found at the upper, instead of the lower side of it:} In * Bell's Anatomy, vol. 1, p. 396. American edition. See also Meckel's Anatomy, vol. 2, p. 207. American edition, by Doane. t " 1. Infaetu, omnino non respirante, hiatus foraminis ovalis ad imam partem val- oulaz reperitur, per quam sanguis e vena cava ascendente effusus, statim ad sinistrum ventriculum transjiciendus, transmigrat: "2. In infante recens nato, qui per paucula momenta respiratione usus est, apertura 71 INFANTICIDE. other words, as soon as respiration commences, the aperture of the foramen ovale moves gradually from the bottom to the top, and from left to right. Now these changes in the foramen ovale, according to Professor Bernt, will indicate not merely the existence of respiration, but also the different periods during which it has continued. With regard to the validity of this test, however, it must be obvious, that from the gra- dual manner in which these changes take place, a great many cases must occur in which they can furnish no decisive evi- dence. For instance, suppose a child had taken only one or two inspirations, sufficient to fill the lungs, and to show that it had actually been born alive, the change in the position of the foramen ovale would be so slight as to render it altogether inappreciable. Besides this, there is another consideration of great importance, which is, that from the very nature of these changes, no one would be competent to decide upon them, unless he had had the good fortune, which falls to the lot of very few, of making a great number of dissections and ob- servations upon the foetus. In the hands of the generality of physicians, it might lead to numerous and even unavoidable errors. In addition to all this, the very observations made by Bernt himself prove that the changes in the foramen ovale do not take place so uniformly and certainly, as to render it safe to draw any positive conclusion from them. On these various accounts, I must confess that I do not attach the same impor- tance to this test as is done by Professor Bernt. The ductus arteriosus. This is a vessel which passes direct- ly from the pulmonary artery, and enters the aorta just below its arch. It is a vessel of considerable size, being somewhat larger than the aorta itself in the foetus. It conveys a large portion of the blood sent into the trunk of the pulmonary ar- tery, directly into the aorta. istius foraminis e tramite suo pristino jam paululum dextrorsum defiexa conspicitur, inde sanguis e vena cava inferiori illuc appellens, cum sanguine e superiori vena cava refluo, per partem foraminis jam clausam novo incepto circuitu decurrit: " 3. In infante plures septimanas nato, apertura foraminis adJmc altius cum valvula dextrorsum svspensa deprehendilur: " 4. In adulto, demum foramen cum sua apertura et valvula plane inversion appa- ret, adeoque ejus apertura supra tuberculi Loweri marginem inferiorem penitus se recondit, cum valvula eadem transitu temporis, ni impedimentum intercurrat firmiter adhaesura." (Experimentorum Docimasiam Pulmonum Hydrostaticam Illustrantium. Centuriaj i. Sectio ii. Curante Josepho Bernt. Prefatio, p. xii. Vienna, 1824.) INFANTICIDE. 75 b b. The ventricles of the heart. c c. The places from which the auri- cles have been cut away. d. The root of the aorta, with (e e) its branches. g. The pulmonary artery. i. The right branch of the pulmonary artery. k k. The left branch. m. The ductus arteriosus, running from the pulmonary artery to the aorta, which it joins at n. o o. The aorta, increased in size after the junction of the ductus arte- riosus. In this sketch, the ductus arteriosus is unnaturally separated from the aorta, by pulling it down, and thus leaving the space (a) between them. In the foetus, the ductus arteriosus will be found open and filled with blood. After birth, it becomes obliterated and the duct itself becomes eventually changed into a ligament.* If, therefore, in any case, this duct is found permanently closed, it is a positive proof that the child has been born alive, and enjoyed it for a longer or shorter period. As, however, its closure does not take place sometimes till two or three weeks after birth, its being found open is no proof that the child was born dead. By Professor Bernt, however, it is urged that, as in the foramen ovale, a succession of changes takes place which may sufficiently mark the various intervals which have elapsed between them and the birth of the child; and upon these he has founded another test in cases of infanticide, to which he attaches great value. According to Dr. Bernt, in the mature foetus, before respiration, this duct is nearly half an inch long; its shape is cylindrical; its diameter is equal to that of the main trunk of the pulmonary artery, and more than double the capacity of the branches of that artery, each of which is equal to a crow quill. If the child has respired only a few moments, the ductus ar- ' " In the adult, it is so thoroughly obliterated, that by the most careful dissection we can show no other vestige of it than a cordlike adhesion of the aorta and pulmo- nic artery." (Bell's Anatomy, vol. 1, p. 465, Am. ed.) According to Meckel, the obliteration of the ductus arteriosus leaves behind it "a round solid cord, a line thick and about four lines long." (Meckel's Anatomy, vol. 2, p. 374. Translated by A. S. Doane, M. D.) 76 INFANTICIDE. teriosus loses its cylindrical shape; the part towards the aorta becomes contracted, and the whole duct assumes the shape oi a truncated cone, the base of which is towards the pulmonar\ artery, and the apex towards the aorta; sometimes the con- trary of this observed. If the child has lived for several hours, or for a day, it re- covers its cylindrical shape, but is greatly diminished both in length and diameter. It is now not larger than a goose quill and not more than equal to one of the branches of the pulmo- nary artery. If it has lived for some days or a week, the duct will be found wrinkled and shortened to the length of only a few lines, while its diameter is not larger thart that of a crow quill; at the same time the diameter of the branches of the pulmonary artery will be found increased to that of a goose quill. Finally, the perfect closure of the duct does not take place until after the lapse of several weeks or months.* If, therefore, the ductus arteriosus be found cylindrical in its shape, and not contracted towards the aorta, and if it equal in size the trunk of the pulmonary artery, the inference would be, that'the child was not born alive. On the other hand, if the ductus arteriosus be contracted towards the aortal end, and if its size be much less than the trunk of the pulmonary artery, the inference would be, that the child had been born alive. With the view of testing the correctness of the observa- tion of Bernt, some experiments were instituted by Orfila, and of the eight cases which he details, only four wrere found to confirm them. In one case, of a mature still-born male foetus, the ductus arteriosus was found only half the size of the trunk of the pul- * " 1. Si paucula momenta recens nati exstiterint, aortam descendentem versus sphaeroides, paulo post mutata figura cylindracea, apparuit conus truncatus, basirn cordi, apicem aorte descendenti, aut contra, obvertens: " 2. Si plures horas diemve vitam retinuerint, denuo formam cylindraceam, ast lon- gitudinem et latitudinem imminutam, diametrum caulis pennae anserinae, adeoque diametro trunci arteriarum pulmonalium longe rninorem, et illi arteriarum binarum pulmonalium fere parem exhibuit: "3. Si vitam ad plures dies septimanamve perduxerint, canalis jam rugosi longitude ad lineas aliquot, crassities ad diametrum pennce corvinae coarctata, diameter vero ar- teriarum pulmonalium ad crassitudinem caulis pennae anserinae aucta conspicitur: " 4. Poenitus autem occlusus ductus hie multo serius et incerto hebdomadum men- siumve numero deprehenditur." (Experimentorum Docimasiam Pulmonum, &e, Prsefatio, p. xv. xvi.) INFANTICIDE. 77 monary artery; it was cylindrical, half an inch long, and about as large as one of the branches of the pulmonary artery. In a second case, of a male foetus eight months old, born dead, the ductus arteriosus was found not quite half the size of the trunk of the pulmonary artery; larger than the right, and much larger than the left branch of that artery. In a third case, of a mature female infant which had lived five hours, the ductus arteriosus, so far from being cylindrical, was found dilated at its middle part, and its extremity towards the aorta much larger than that towards the heart; it was eight lines in length, and considerably diminished in size. The trunk of the pulmonary artery was sensibly larger than the left branch of that artery, but scarcely equalled in size the right branch of this vessel. In the fourth case, a female infant of full age, having lived nineteen days, the ductus arteriosus was only three lines in length, cylindrical, its size three times less than that of the trunk of the pulmonary artery, a little less in size than the right branch, but much larger than the left branch of that artery.* In four other cases of infants at full age, two of whom were born dead, it was found that the ductus arteriosus corresponded with the statements of Professor Bernt. From the foregoing, therefore, it would seem, that however correct the observations of Bernt may be as a general rule, vet they are not to be considered as invariably and universally so—a fact continually to be borne in mind in their application to cases of infanticide. The ductus venosus. This is a vessel lodged in the posterior part of the longitudinal fissure of the liver. It comes off di- rectly from the umbilical vein, and opens with the venae he- paticae into the vena cava ascendens. It is large enough to admit a common sized probe, which can easily be introduced into it through the umbilical vein. Through this vessel, a portion of the blood passing through the umbilical vein, goes directly to the cava, and then to the heart. * Legons de Medecine Legale, par M. Orfila, vol. 1, p. 388-9. Second edition. 7 78 INFANTICIDE. re. The umbilical vein. b. Branches given off to the substance of the liver. i. The vena cava ascendens. h. The ductus venosus. k k. The hepatic veins. d. The vena porta?, formed by the junction of the abdominal veins cc c. e. The cylinder of the vena portae, being its great right branch where it lies in the transverse fissure. /. The right branch of the vena portae in the liver. In the fcetus anterior to respiration, the ductus venosus is always found open, and containing blood. In the child which has respired for a certain length of time, on the contrary, it will be found collapsed, and empty of blood. The whole ves- sel, after a certain time, becomes impervious, and is finally converted into a ligament. The period at which this final change takes place, varies very much in different cases. In twenty infants who had lived three days, the ductus venosus was found empty and obliterated.* Generally speaking, this vessel is obliterated before the ductus arteriosus or the fora- men ovale. The only inferences that can be drawn from the ductus venosus, are these: if it be obliterated, it is a proof that the child has lived and respired; on the contrary, as it remains open a day or two at least after birth, its being found open is no proof that the child was born dead. * Lecons de Mgdecine Legale, par M. Orfila, vol. 1, p. 384. Second edition. INFANTICIDE. 79 The umbilical "vessels. These consist of two arteries and a vein. The former (the arteries) are nothing more than continuations of the iliac arteries. They mount up along the sides of the urinary bladder, and go directly to the umbili- cus, through which they pass, forming with the vein, the umbilical cord. These are the umbilical arteries, and they carry the blood of the foetus to the placenta. The latter (the umbilical vein,) carries the blood from the placenta to the foe- tus. It enters the fcetus at the umbilicus, and goes upwards and backwards to the great fissure of the liver. After birth, these vessels become gradually obliterated, and converted into ligaments. The period at which this obliteration takes place, varies in different subjects. It takes place however, sooner than that of any other of the foetal openings. In twenty cases of infants who died on the third day, they were in all found obliterated ; anterior to this they are open. The only infer- ence therefore, that can be drawn from finding them closed, is that the child has been alive; at the same time, their being open, is no proof that the child was born dead. With regard to the whole of the changes which take place in the circulation after birth, M. Billard has made a number of exceedingly interesting and important observations, which deserve to be recorded. Children of one day old. In eighteen children of this age, fourteen had the foramen ovale completely open; in two, its ob- literation had commenced; and in the remaining two, it was completely closed, and passed no blood. In the same infants. thirteen had the ductus arteriosus, open and full of blood ; in four, its obliteration had commenced; and in one, it was com- pletely obliterated. This last was one of the two that had the foramen ovale completely closed. The umbilical arteries were open quite to their insertion in the iliac arteries; their calibre however, was diminished by a remarkable thickening of the coats. In all these children, the umbilical vein and the ductus venosus were open, and the latter vessel generally gorged with blood. Children of two days old. In twenty-two infants of this age, fifteen had the foramen ovale quite open; in three it was al- most obliterated; and in the remaining four entirely closed. 80 INFANTICIDE. In thirteen of the same children, the ductus arteriosus was open; in six, the obliteration was commenced; and in three, it was complete. In all of the twenty-two, the umbilical ar- teries were obliterated to a greater or less extent. The um- bilical vein and ductus venosus, though empty and flat, could yet be passed with a probe of considerable size. Children of three days old. In twenty-two infants of this age, fourteen had the foramen ovale still open; in five, the obliter- ation had commenced; and in the remaining three it was com- plete. In fifteen the ductus arteriosus was still free ; in five. the obliteration had commenced; and in only two was it com- plete. These two were of the three which had the foramen ovale closed. In all the twenty-two, the umbilical vessels and ductus venosus were empty, and even obliterated. Children of four days old. In twenty-seven infants of this age, seventeen had the foramen ovale still open; and in six of these this opening was very large and distended, with a great quantity of blood; in eight, the obliteration was commenced, and in two complete. In seventeen, the ductus arteriosus was still open; in seven, the obliteration had commenced, and in- deed consisted only of a very narrow passage; in the three remaining, the obliteration was complete. The umbilical ar- teries were in almost all obliterated, even to the umbilicus, but were yet capable of being dilated, almost up to their insertion into the iliacs. The umbilical vein and the ductus venosus were completely empty and very much contracted. Children of five days of age. In twenty-nine infants of this age, thirteen had the foramen ovale yet open, although the opening did not exist in the same degree in all; (in four of them its size was large, and in the nine others, moderate;) in six the obliteration was complete, and in the remaining ten almost complete. In fifteen of these twenty-nine, the ductus arteriosus was found open; in ten of them very freely so, and in the other five the obliteration was very much advanced. In seven, this canal was completely obliterated, while in the remaining seven it was nearly so. In all, the umbilical vessels were completely obliterated. Children of eight days of age. In twenty children of this age, INFANTICIDE. 81 the foramen ovale was completely shut in eleven; incomplete- ly so in four, and open in five. In three, the ductus arteriosus was not obliterated; in six it was almost entirely obliterated; and in eleven the obliteration was complete. In fifteen the umbilical vessels were obliterated; the remaining five were not examined. In children at more advanced ages. In the most of these, the foetal openings are obliterated; nevertheless the foramen ovale and the ductus arteriosus may be found open as late as twelve or fifteen days, and even three weeks, without any particular accident happening during its life to the child.* From these observations, the conclusions may be drawn,— 1. That the foetal openings are not obliterated immediately after birth. 2. Thar the period at which they are obliterated, is extremely variable. 3. That most commonly the foramen ovale and the ductus arteriosus are obliterated towards the eighth, or the tenth day. 4. That the order in which they are obliterated is the following, viz. the umbilical arteries ob- literate first, then the umbilical vein, the ductus venosus, the ductus arteriosus, and finally the foramen ovale. 5. That their obliteration proves that the child was born alive. 6. That it * In some cases, these openings have remained for a much longer period. Mr. Burns relates the case of a person who lived to the age of between forty and fifty, in whom, on dissection, both the foramen ovale and the ductus arteriosus were open. The for- mer was equal in size to the barrel of a goose quill, while the latter was equal to that of a crow quill. From the age of three years till his death, he was incessantly ha- rassed with paroxysms of difficult breathing, cough, and discoloration of the skin. These became more and more frequent, and he eventually died of oedema and exhaus- tion. (Observations on some of the most frequent and important Diseases of the Heart, &c. By Allan Burns, Lecturer on Anatomy and Surgery, p. 17. 1809.) Corvisart relates the case of a postillion who died at the age of forty-seven, in con- sequence of local injuries which he received, in whom, on dissection, the foramen ovale was found open, and more than an inch in diameter. The ductus arteriosus was tranformed into ligament. (An Essay on the Organic Diseases and Lesions of the Heart and Great Vessels. By J. N. Corvisart. p. 209. (American edition.) A similar case is quoted by the same author from Morgagni, of a girl who died at the age of seventeen, in whom the foramen ovale was open, and large enough to ad- mit the little finger. (Ibid. p. 229.) By Dr. Perkins, a case is related of a child eleven months old, in whom, on dissec tion, the foramen ovale and the ductus arteriosus were both found open. (New-York Medical and Physical Journal, vol. 2, p. 444.) By Dr. R. K. Hoffman, another case is recorded of a child who lived to the age of nine months, and in whom, on dissection, the foramen ovale was found open. (Ibid. vol. 6, p. 250.) Another case is recorded, in which the foramen ovale was found'open in a man who died at the age of sixty. (American Journal of Medical Sciences, vol. 15, p. 223.) 82 INFANTICIDE. is impossible to infer from the fact of their not being oblite- rated, that the child has not respired, since it has been shown that the obliteration is very far from being made immediately after birth.* The umbilical cord. This is the last peculiarity of the foetal circulation which requires notice. After the birth of the child and the division of it from the placenta, it is well known, that after some days elapse, the cord separates from the child, and drops off. If, therefore, in examining a case, it be found that the cord has separated in the usual way, it is a proof that the child must have enjoyed life. As, however, the separation of the cord takes some days, it is obvious that its presence is no proof that the child was not born alive. As in the case of the foramen ovale and the ductus arteriosus, it has been sup- posed, however, that the successive changes which the umbili- cal vessels undergo, from birth until their final separation, might afford some indication of the length of time during which life had existed. M. Billard was the first person who properly in- investigated these changes. The first of these changes he de- nominates a withering of the cord. This is the incipient stage of the process of desiccation, and varies in its commencement, from five hours to three days after birth. Of eighty-six in- fants, sixteen had the cord a little withered; and of these six- teen, one was five hours old, six were a day old, four were two days old, and four were three days old. In these cases, the cord was soft, a little bluish, very flexible, filled entirely the knot of the ligature, and the cut surface was still clean. Thus the withering of the cord may take place from the first to the third day after birth. The next change which the cord undergoes, is that of de- siccation or drying. The cord now becomes of a reddish brown colour; is flattened and shrivelled; its vessels are obliterated, and it becomes tortuous and dry. This process varies in its commencement from one and two days, to four days after birth. Out of eighty-six infants, twenty-four had the process of desiccation commenced. Of these, seven were only one *Traite des Maladies des Enfens, &c. par C. M. Billard, pp. 476-80. Also Lemons de Medecine legale, par M. Orfila, vol. 1, p. 387. Second edition. INFANTICIDE. 83 day old, eleven were two days old, three were three days old, and three were four days old. In all these the cord was blackened, shrivelled, and was loose in the ligature. The pe- riod at which the desiccation is complete, varies from one to five days after birth. The general period, however, is about the third day. Out of eighty-six infants, twenty-five had the cord entirely dry; of these, one was one day old—one, a day and a half old—five were two days old—nine, three days old —four, four days old—five, five days old. By M. Billard, this desiccation is considered as a vital pro- cess, and his reasons are, in the first place, that the portion of cord beyond the ligature, or that which is attached to the pla- centa, does not undergo this process of desiccation—but de- composes and putrefies like any other dead matter—while the part of the cord between the ligature and the abdomen alone undergoes desiccation, a process entirely different from ordi- nary putrefaction. And in the second place, that the cord ceases to desiccate as soon as life ceases—that it does not de- siccate at all in the foetus which is born dead—that on the dead subject the cord undergoes a real putrefaction, which is alto- gether different from this desiccation.* The inferences drawn by Billard, from'the whole of his ob- servations, are the following: 1. The desiccation of the umbilical cord takes place during life only. 2. At the moment of death this desiccation is completely suspended, or considerably diminished. 3. If the cord be fresh, or commencing to wither, the infant may either have been born dead, or have lived only a short time. 4. If the cord has either commenced desiccating, or be com- pletely desiccated, the infant has lived at least one day.! The next change which the cord undergoes, is that of se- paration or dropping off. The period at which this takes place * Traite des Maladies des Enfans, &c. par C. M. Billard, p. 16. New-York Medi- cal and Physical Journal, vol. 6, p. 303-4. t Billard states that in foetal subjects brought in for the purposes of dissection, he always observed, that they may be kept for several days without any drying of the cord. The cord even remains sufficiently soft and its vessels sufficiently open to per- mit of their being injected. During life, on the other hand, the cord desiccates and 84 INFANTICIDE. after birth, varies very considerably. In sixteen children ex- amined by Billard, in whom the cord had separated, three were two days old; three, three days old; six were four days old ; three were five days old; one, six days old; one. seven days old.* From the fourth to the fifth day after birth, then, would appear to be the ordinary period at which the cord falls off, although it sometimes happens sooner, and some- times later. Generally, then, the cord withers during the first day, at the end of which desiccation commences; desiccation is complete on the third day, and between the fourth and fifth day the cord drops off. All this, of course, is merely general, being liable to numerous variations and exceptions. Before dismissing the subject of the umbilical cord, there is another phenomenon which requires to be noticed. Anterior to the dropping off of the cord, there is observed a red or in- flammatory circle around its attachment to the umbilicus; and by many, this has been supposed to be an evidence of vital action, and of course that the child must have been born alive. In relation to this sign, it is to be recollected that it is by no means invariably present. Indeed, according to the observa- tions of Billard, it would seem to be more commonly absent. Out of eighty-six children, he found only twenty-six who ex- hibited evident traces of this inflammatory circle.! Its absence, therefore, is by no means to be looked upon as an evidence that the child was not born alive. the vessels become obliterated from the first, second or third day For the purpose of testing these facts, he preserved a number of dead bodies of children for several days. The cord did not desiccate, but remained soft and flexible, e%en to the fourth and fifth day, and then it fell into a state of putridity. He also succeeded in injecting, by the umbilical cord, at the end of four days, the body of a still born child. The cord here was not the least desiccated, and was only very soft. (Billard, p. 21.) When the umbilical cord is left to undergo putrefaction, it becomes greenish white; after that it puckers at its extremity—the cuticle of the cord is easily separated, al- though the cord itself does not separate from the abdomen, as it does during life. The cord can be torn in different places, and if it has been in water for some time, it is soft and very fragile. Billard has never seen the cord of a child, born dead, dried up before the fifth or sixth day, and in this case it preserves its circular form and even its suppleness for a considerable time. According to the observations of M. Billard, pu- trefaction of the cord never occurs, until this process has commenced in other parts of the body. The cord, therefore, is never affected in this way, until the abdominal parietes have turned green, and the different organs are in a state of decided decom- position. (Billard, p. 23, 4.) * Billard, p. 26. + Ibid. p. 29. INFANTICIDE. 85 Cicatrization of the umbilicus. This is the last change which these parts undergo; and the period at which it takes place, is from the tenth to the twelfth day after birth. The foregoing investigations in relation to the successive changes in the umbilical cord, are important not merely to establish the fact of a child's having been born alive, but to determine how long it lived after birth. (c.) The distribution of the blood in the different organs of the body. From what has been already stated, it appears that there is a very striking difference in the mechanism of the heart and blood vessels of the foetus and those of the child after birth. A difference, therefore, in the general distribu- tion of the blood itself in these two cases, would seem to be a very natural consequence. And such indeed is the fact.— This difference is especially observed in two organs, the lungs and the liver, each of which requires distinct examination. 1. The lungs. From the peculiarity of the vascular system in the fcetus, only a very small portion of the blood goes the round of the pulmonary circulation, the greater part passing directly through the foramen ovale, and the ductus arteriosus. In the foetal state, therefore, the pulmonary bloodvessels are small, and contain scarcely any blood. As soon, however, as respiration is established, all this is changed, and then the whole mass of blood passes through the lungs for the purpose of undergoing the process of oxygenation. The pulmonary bloodvessels, accordingly, now become distended, and filled with blood. If, therefore, on examining any case, the blood- vessels of the lungs are found to be filled with blood, it is a proof that the child has enjoyed life. And on the contrary, if they are found empty of blood, .it is a proof of the child's not having enjoyed life. The means of ascertaining whether the pulmonary bloodvessels are in one state or the other, are the two following: (a.) Making incisions with a knife into the substance of the lungs. In the one case, a free effusion of blood follows the in- cision; in the other case, little or no blood follows. (6.) Ascertaining the actual weight of the lungs. When the lungs have a large quantity of blood circulating in them, it is 8 86 INFANTICIDE. very evident that they must weigh much more than when they do not have this blood circulating through them. As soon, therefore, as the blood ceases to circulate through the fora- men ovale and the ductus arteriosus, and passes through the lungs, the weight of these latter organs must be increased, and just in proportion to the increased quantity of blood cir- culating in them. This, of course, is ascertained by simply weighing them. This is what is generally known by the name of the static test. To make this available, however, it is very obvious that some standard weight of the lungs in these two states must be fixed upon, otherwise, no conclusions in any individual case can safely be drawn. Now, to esta- blish such a standard, one of two modes may be adopted, viz. either to take the average weight of a certain number of lungs, and let that be the standard, or to compare the weight of the lungs in the two cases with the weight of some third body, and thus ascertain the relative difference between them. Both of these modes have been recommended by different in- dividuals, and to test their accuracy, numerous experiments have been made. With regard to the former of these modes, the first great object is to settle what is the greatest weight to which the fastal lungs ever attain. This being established, of course, whenever the lungs go beyond this weight, it is evident that respiration has taken place. By Schmidt, the extreme weight of the foetal lungs, which they never exceed, is fixed at 1170 grains. Professor Bernt supports the observations of Schmidt. In twenty-four cases of still-born children, the greatest weight of the lungs, exclusive of a case of tubercles, was 993 grains; the medium was 550 grains. By Chaussier, it has, however, been established, that the foetal lungs do occasionally weigh more than this. "Among 104 cases of still-born children, he found the weight of the lungs greater than 1170 grains in five cases; it was 1173 in one, 1282 in a second, 1297 in a third, 1343 in a fourth, and 1637 in a fifth." Now, it has been as- certained, that in a large proportion of cases, the lungs of children which have actually respired, do not weigh as much as is here stated. Out of twenty-five cases of children that INFANTICIDE. 87 had breathed, reported by Schmidt, only four had their lungs weighing more than 1170 grains; out of thirty-seven similar cases by Bernt, only three weighed more. As to the extreme weights from the cases of Chaussier, leaving out of view the last, (1637 grains,) which may be considered as an extraor- dinary case, and an exception to a general rule, it is very rare that the lungs of a child which has breathed, weigh more than 1343. In thirty-seven cases of this kind, only three had the lungs weighing more.* From all this, it is evident that this form of the static test can be applicable only in a very limited number of cases. Where the weight of the lungs exceeds the standard here laid down, it furnishes conclusive evidence of respiration; but as this is not the case in a large proportion of cases, the evidence deduced from it can only be comparative and presumptive. The other mode of applying the static test, is that which is commonly known under the name of the person who first pro- posed it, M. Ploucquet. As this is a test of much celebrity, it requires special notice. Ploucquefs test. This test was first announced in 1782, and is founded on the relative weight of the lungs to that of the whole body. From experiments made by M. Ploucquet, he drew the general conclusion, that the weight of the lungs be- fore respiration is one-seventieth of the weight of the whole body; while after respiration has commenced, it amounts to one thirty-fifth; or in other words, that the blood introduced into the lungs in consequence of respiration, doubles their absolute weight. Beautiful and decisive as this test appears to be, and correct as the general principle upon which it is founded certainly is, objections of a very serious character have been brought 16 See on this subject an admirable review, written, I presume, by Professor Chris- tison, in the Edinburgh Medical and Surgical Journal, vol. 26, p. 376. Arrowsmith proposes 1000 grains as the extreme weight. He says, " when the foetal lungs, being naturally formed and of healthy structure, exceed 1000 grains, such weight may be considered as constituting decisive proof that the floating of the lungs and their loose and expanded appearance, do not result from insufflation practised on a dead child, but must be a consequence of the continuance of respiration and of the circulation of blood through them, and therefore of life; and even if the weight ex- ceed in any considerable degree 550 grains, the same inference is a reasonable pre- sumption." (Cyclopsedia of Practical Medicine, vol. 2, p. 689.) 83 INFANTICIDE. against it. For the purpose of showing to what confidence it is entitled, it may be proper to notice some of the more im- portant objections. Examination of objections, a. There is no fixed proportion between the weight of the lungs and the weight of the body. An appeal to facts and experiments must, of course, deter- mine the value of this objection. It seems to be conceded on all hands, that M. Ploucquet deduced his theory from a very limited number of experiments. In one child born dead, he found the comparative weight of the lungs to the body to be as 1 to 67; in another, as 1 to 70; in a third which had been born alive, it was found to be as 2 to 70, or as 1 to 35. These were all the experiments which he had made, when he pro- mulgated the general conclusion which he drew from them. As might naturally be expected from the novelty and impor- tance of the subject, it has since then attracted the attention of the ablest medical jurists, and their researches have tended very materially to diminish the confidence originally placed in this test. The most extensive experiments yet made on this subject, were those conducted by M. Chaussier at Paris, and M. Schmitt at Vienna. The following are the results of some of their observations: INFANTICIDE. 89 b. Even admitting that there is a fixed proportion between the weight of the lungs and the body, it is very different from that of M. Ploucquet. This objection is certainly supported by the experiments of Schmitt and Chaussier already recorded, as also by those of Hartmann. This latter physician makes the proportion to be, in an infant which has not breathed, as 1 to 59; and in one which has breathed, as 1 to 48. c. A third objection to this test is, that an excessive con- gestion of blood might occur in the lungs of a foetus that had never respired, which should render them equal in weight to the lungs of a fcetus which had respired.* To this M. Ploucquet himself replies, that it is not possible * Mahon, vol. 2, p. 454. 8* 90 INFANTICIDE. for such a congestion to take place in lungs that have never respired, as shall render their weight equal to that consequent upon respiration; because the foramen ovale and the canalis arteriosus offer so easy a passage to the current of blood, even when flowing with the greatest rapidity, that no determination of consequence can exist towards the pulmonary vessels. d. A fourth objection has been drawn from the alteration produced by putrefaction, in the relative weight of the lungs and body. On this, Professor Mahon remarks, " that this may be the case if the putrefaction be very great; but then the fcetus can- not be subjected to any examination upon which a medico- legal decision can be founded. But if the putrefaction has not advanced far, as the lungs resist its effects longer than any other part, we may try the application of the proposed test, to corroborate the results afforded by the hydrostatic trials."* The following observations and experiments have been in- stituted by myself, with the view of ascertaining the validity of this test: Obs. 1. In a male child in whom the respiration had been complete, the relative weight of the lungs and body was as 1 to 35if. Obs. 2. In a female child, which had respired perfectly, the proportion was as 1 to 37 £. Obs. 3. In a male child, born alive, but both body and lungs in a state of incipient putrefaction, the proportion was as 1 to 46£. Obs. 4. This was a foetus which had reached about the fifth month, and was judged to have been dead in the uterus about six days before delivery, owing to an accident which had happened to the mother. It was at present in a state of in- cipient decomposition; the lungs, however, were perfectly sound. The proportion between the weight of the lungs and the body, was as 1 to 29. Obs. 5. A fcetus between the fifth and sixth month, in a state of decomposition — the lungs sound. The proportion here was as 1 to 39|. * Mahon, vol. 2, p. 454, INFANTICIDE. 91 Obs. 6. In a male fcetus between the seventh and eighth month, which had not respired, the proportion was as 1 to 62. Obs. 7. In a male child which had respired perfectly, as 1 to 44.* Upon the whole, with regard to the general value of Plouc- quet's test, it must be conceded, that in itself, it furnishes no conclusive evidence; as presumptive evidence, however, and when used for the corroboration or correction of other tests, it may be of great value. Relative weight of the heart and lungs. From the degree of uncertainty hanging around the test of Ploucquet, Orfila was inclined to believe that a more definite proportion might exist between the weight of the heart and the lungs, and that this might serve as a test in these cases. He immediately put it to the test of experiment. For this purpose, he took the bo- dies of several foetuses, and having weighed them accurately, took out the heart and lungs, and cut off the venas cavas and pulmonary veins, as well as the pulmonary artery and aorta, as near as possible to these organs. He then opened into the heart, to let out all the blood which it contained. After this, having washed them, he weighed them separately. The re- sults were the following: * To those who may wish to investigate this subject still further, I must refer to the 400 experiments detailed in Considerations Medico-legales sur L'Infanticide. Par A, Lecieux. p. 44. 92 INFANTICIDE. D ~ brj - '3 « ° >• *J O « d ^>)io ml>o n» iO OI o!OOOCSt*(D^^COCOCOQOrtiDm ^■"^moiococDiooicccccoojcocooioj CD ° iO iO mmm snooiincomao^r-oiior-'HQoio t- I—II—I I—II—I i-H T—I i—l HHCO COOOOOOOOiOOOOOOOO Soooiooooooooooio-^ior^ SOJOCDt>OOt>rpCX)COi-cO}a>l>QOCOO) « o • a 3 aj «h '-a - W4 _j k*^ *« vj vj -_: J3c30alcJrtJlO'OS coiD43nD'0'-0'T3-C!.2i g cq^ooco-<* > T! 320, 321. X Edinburgh Review, vol. 38, p. 440. * INFANTICIDE. 179 utterly fail of accomplishing their object, which is the pre- servation of the lives of children. The records of those which have been kept with the greatest care, exhibit the most as- tonishing mortality. In Paris, in the year 1790, more than 23,000, and in 1800, about 62,000 children were brought in; and it is estimated, that eleven-thirteenths of all the foundlings perish annually through hunger and neglect.* It is stated also, that vast num- bers of the children die from a disease called l'endurcissement du tissue cellulaire, which is only to be met with in the Found- ling Hospital.! Of 100 foundlings in the Foundling Hospital at Vienna, 54 died in the year 1789. Subsequent accounts of this hospital, do not represent it in a more favorable light. In a recent description of this institution, it is stated, that " all attempts to rear the children in the hospital itself had failed. In the most favourable years, only 30 children out of the 100 lived to the age of twelve months. In common years, 20 out of the 100 reached that age, and in bad years not even 10. In 1810, 2583 out of 2789 died. In 1811, 2519 out of 2847 died. Like the cavern of Taygetus, this hospital seemed to open its jaws for the destruction of the deserted and illegiti- mate progeny of Vienna. The emperor Joseph II, frequently visited this hospital in person, and upon one occasion he or- dered Professor Boer to make a series of experiments with all kinds of food, that it might be ascertained how far diet had its share in the mortality. Twenty children were selected, and fed with various kinds of paps and soups, but in a few months most of them were dead."! In consequence of this extraordinary mortality, "in 1813, the government enacted that the foundling-house should serve merely as a depot for the children, till they could be delivered to the care of nurses in different parts of the country." In 1822, under this new system of nursing in the country, the deaths had diminished from 1 to 2, to 1 to 4£.§ In St. Petersburgh and Moscow, the Foundling Hospitals * Beckman's History of Inventions, vol. 4, p. 456-7. f Cross' Medical Sketches of Paris, p. 197. X Quarterly Journal of Foreign Medicine and Surgery, vol. 1, p. 188. $ Elements of Medical Statistics, by F. Bisset Hawkins, M. D. p. 136. 180 INFANTICIDE. have always been managed with the greatest liberality and care; and yet, in the latter city, during the twenty years sub- sequent to 1786, when the hospital was first instituted, of 37,000 children received, 35,000 at least are computed to have died. In 1811, the foundlings admitted into the hospitals ap- propriated to them, were 2517, and the deaths were 1038. In 1812, 2699 were admitted, and the deaths were 1348. In the province of Archangel, the proportion of deaths has been still greater. Of 417 foundlings admitted in 1812, 377 died the same year.* In Palermo, during the year 1823, 597 foundlings were re- ceived at the hospital in that place, of whom 429 died.! In the hospital at Metz, calculation showed that seven- eighths of the whole number of children perished. In an in- stitution of this kind in one of the German principalities, only one of the foundlings, in 20 years, attained to manhood.! The Foundling Hospital of London, exhibits rather a more favourable picture. The average of those who died there under twelve months, in ten years, was only one in six, and for the last four or five years, even less in proportion.§ The general fact is, however, sufficiently evident, that the lives of the multitudes of children are sacrificed in these hos- pitals. The causes too are evident. In some instances, it arises from the want of nurses, or the mismanagement and cruelty of those that are employed; in others, from the deli- cacy of the infant—the want of its mother's nourishment— the vitiation of the air—and the contagious diseases to which children are more peculiarly exposed. But do foundling hospitals diminish the number of infanti- cides 1 We have no evidence of such a result flowing from them. From the deleterious influence which they have upon the moral feelings of the female sex, we cannot believe that it is the case. And it is accordingly stated, that after the Foundling Institution of Cassel was established, not a year » Elements of Medical Statistics, by F. Bisset Hawkins, M. D. p. 137. f Ibid, p. 139. . X Beckman on Inventions, vol. 4, p. 456-7. § Highmore's History of the public charities in and near London, p. 727. Reet' Cyclopedia, Art. Hospital. INFANTICIDE. 181 elapsed without some children being found murdered in that place or its vicinity.* The following account of the deaths in the different found- ling hospitals of Europe, will afford ample testimony in sup- port of the opinions already advanced. It is taken from the Edinburgh Medical and Surgical Journal, vol. i, p. 321-2. "In 1751, Sir John Blaquiere stated to the House of Com- mons of Ireland, that of 19,420 infants admitted into the Foundling Hospital of Dublin, during the last ten years, 17,440 were dead or unaccounted for; and that of 2180 ad- mitted during 1790, only 187 were then alive. In 1797, he got a committee of the same house appointed, to inquire into the state and management of that institution. They gave in their report on the 8th of May, 1797; by which it appeared, that within the quarter ending the 24th March last, 540 chil- dren were received into the hospital, of whom, in the same space of time, 450 died: that, in the last quarter, the official report of the hospital stated the deaths at three, while the actual number was found to be 203: that, from the 25th of March to the 13th of April, nineteen days, 116 infants were admitted; of which number, there died 112. Within the last six years, there were admitted 12,786; died in that time, 12,651. So that in six years, only 135 children were saved to the public and to the world. "In the Charite of Berlin, where some enjoyed the advan- tage of being born in the house, and of being suckled by their mothers six weeks, scarcely a fourth part survived one month. " Every child born in the Hotel Dieu of Paris, was seized with a kind of malignant aphthae, called le muguet, and not one survived who remained in the house. "At Grenoble, of every 100 received, 25 died the first year; at Lyons, 36; at Rochelle, 50; at Munich, 57; and at Mont- pellier, even 60. At Cassel, only 10 out of 741 lived 14 years. In Rouen, one in 27 reached manhood; but half of these in so miserable a state, that of 108, only two could be added to the useful population. In Vienna, notwithstanding the princely income of the hospital, scarcely one in 19 is preserved. In * Beckman, vol. 4, p. 456. 16 182 INFANTICIDE. Petersburgh, under the most admirable management and vigi- lant attention of the Empress Dowager, 1200 die annually out of 3650 received. In Moscow, with every possible advantage, out of 37,607 admitted in the course of 20 years, only 1020 were sent out." In relation to the general effects of foundling hospitals, a most important work has recently been announced, of which only the prospectus has yet appeared, the following notice of which I take from Silliman's Journal of Science and the Arts. In collecting materials for his work, the author* has travelled over the greater part of Europe. According to this author, it is chiefly in catholic countries that foundling hospitals are found. "Austria has many such institutions; Spain reckons 67; Tuscany, 12; Belgium, 18; but France, in this respect, excels other countries—she has no less than 362. Protestant countries, on the contrary, have suppressed the greater part of those which had been specially founded for this purpose." To form an idea of the advantage of the protestant system over that of catholic countries, the author states, that "in London, the population of which amounts to 1,250,000, there were, in the five years from 1819 to 1823, only 151 children exposed; and that the number of illegitimate children received in the 44 workhouses of that city, of which he visited a large number in 1825, amounted, during the same period, to 4668, or 933 per annum; and that about one-fifth of these are sup- ported at the expense of their fathers. By a striking contrast, Paris, which has but two-thirds of the population of London, enumerated, in the same five years, 25,277 enfans trouves, all supported at the expense of the state." To ascertain the contagious influence of these houses on the abandonment of new-born children, Mayence had no establish- ment of this kind, and from 1799 to 1811, there were exposed there 30 children. Napoleon, who imagined that in multiply- ing foundling hospitals, he would multiply soldiers and sailors, opened one in that town on the 7th November, 1811, which remained until March, 1815, when it was suppressed by the Grand Duke of Hesse-Darmstadt. During this period of three * M. De Gouroff, Rector of the University of StPetersburgh, Counsellor of State, &c. INFANTICIDE. 183 years and four months, the house received 516 foundlings. Once suppressed, as the habit of exposure had not become rooted in the people, order was again restored; and in the nine succeeding years, but seven children were exposed.* List of British and American Cases and Trials for Infanticide. 1. William Pizzy and Mary Codd, tried at Bury St. Edmunds, 1808, for feloniously administering a certain noxious and destructive substance to Ann Cheney, with intent to produce miscarriage. In this case, the abortion was perfected, not by the medicine, but by the subsequent in- troduction of an instrument into the uterus. (1) 2. Charles Angus, indicted and tried at Lancaster, 1808, for the murder of Margaret Burns, of Liverpool. In this case, the prisoner was charged with endeavouring to procure an abortion, by means of an instrument, and also by the administration of drugs, which terminated in the death of the female. This is a most important and interesting case, well worthy of being studied. (2) 3. The case of Phillips, tried in January 1811, for attempting to pro- cure abortion in Hannah Mary Goldsmith, by giving savine. (3) 4. The case of Robin Collins, tried at Chelmsford assizes, 1820, for administering steel filings and pennyroyal water, with the intent to pro- cure abortion. (4) 5. The case of Margaret Tinckler, indicted at Durham in 1781, for the murder of Janet Parkinson, by having inserted wooden skewers into the uterus,, for the purpose of producing abortion. (5) 6. Sarah Hill, for infanticide. (6) 7. Mary Eastwood, for infanticide. (7) 8. Case in Scotland, for infanticide. (8) 9. Sarah Little, for infanticide, reported by P. J. Martin, surgeon. (9) 10. Bease and Elliot. Infanticide. (10) 11. Margaret Patterson. A case of infanticide, examined and reported by David Scott, M.D. of Cupar-Fife, Scotland, accompanied with remarks * American Journal of Science and the Arts, vol. 17, p. 393. (1) Edinburgh Medical and Surgical Journal, vol. 6, p. 244. (2) See Annual Medical Register for 1808, vol. 1, p. 143. Edinburgh Medical and Surgical Journal, vol. 5, p. 220. A Vindication of the opinions delivered in evidence by the medical witnesses for the Crown, on a late trial at Lancaster for murder, pp. 88. An able pamphlet written by John Rutter, M.D. of Liverpool. Paris & Fonblanque, vol. 2, p. 176. A full account of this case is also given in the Elements of Medical Jurisprudence, in the chapter on Delivery, by T. R. Beck, M.D. (3) Paris and Fonblanque, vol. 3, p. 86. (4) Ibid. vol. 3, p. 88. (5) Paris and Fonblanque, vol. 3, p. 72. Principles of Forensic Medicine, by J. Gordon Smith, M.D. p. 326. East's Pleas of the Crown, Tit. Murder. (6) Edinburgh Medical and Surgical Journal, vol. 11, p. 77. (7) Ibid. vol. 11, p. 78. (8) Ibid. vol. 21, p. 231. (9) Ibid. vol. 25, p. 34. (10) Ibid. vol. 35, p. 456. 184 INFANTICIDE. by Professor Christison of Edinburgh. This is a highly interesting case, and altogether the best reported one in the English language. (11) 12. Case of alleged infanticide at Aberdeen, 1804. The child died from inability on the part of the mother to aid it after birth. (12) 13. Case of infanticide at Aylesbury, in 1668. The woman murdered her child in a state of temporary insanity, and was acquitted on that ground. (13) 14. Mary Baker, reported by Dr. Robinson of Bridport, England, for infanticide. (14) 15. Case of infanticide, reported by W. Chamberlaine, surgeon in London. (15) 16. Case of infanticide, reported by Mr. F. H. Ramsbotham. (16) 17. A woman indicted and tried for infanticide, at the Sussex assizes, England, 1825, (17) 18. Eliza Maria Jones, for infanticide. Reported by Prof. Amos. (18) 19. A case in London, of infanticide. (19) 20. Susanna Powell. Trial for infanticide at Schenectady, State of New-York, in 1810. (20) 21. A trial for infanticide, October 1831, in Jefferson county, Ohio, before the supreme court. Reported by John Andrews, M.D. (21) 22. Trial of Hannah Hall, for murdering her illegitimate child, in the county of Chester, Penn. in 1833. Reported by Isaac Thomas, M.D. (22) (11) Edinburgh Medical and Surgical Journal, vol. 26, p. 62. (12) Paris and Fonblanque, vol. 3, p. 126, taken from Burnett's Treatise on the Criminal Law of Scotland. (13) Paris and Fonblanque, vol. 3, p. 129. (14) London Medical Repository, vol. 22, p. 346. (15) London Medical and Physical Journal, vol. 7, p. 283. (16) London Medical Repository, vol. 21, p. 344. Godman's Journal of Foreign Medicine and Surgery, vol. 4, p. 532. (17) Johnson's Medico-Chirurgical Review, vol. 9, p. 239. (18) London Medical Gazette, vol. 10, p. 375. (19) Lancet, vol. 9, p. 339. (20) Report of the trial of Susanna, a coloured woman, before the Hon. Ambrose Spencer, esquire, at a court of oyer and terminer, held at Schenectady, 23d October, 1810, on a charge of having murdered her infant bastard male child. By Henry W„ Warner. 1810. (21) American Journal of Medical Sciences, vol. 9, p. 257. f22) Ibid. vol. 13, p. 565. II. ON ACUTE LARYNGITIS. It is only very recently that inflammation of the larynx has become the subject of any special inquiry; and by many, it has been supposed that it was a disease wholly unknown until within a few years past. This supposition is, however, by no means probable. Being a disease of simple inflammation, there can be no doubt that it must have occurred, occasionally at least, from the earliest periods; and a review of their writings will convince us that it did not escape the attention of observ- ing men even in the infancy of medical science. For the purpose of establishing this fact, as well as of facilitating the inquiries of those who may hereafter be tempted to the in- vestigation of this interesting subject, I shall enter upon a few historical details. Hippocrates appears to allude very distinctly to this dis- ease in his book of Prognostics. He says, •' those anginas are very dangerous and speedily fatal, which produce no sensible change in the fauces or in the throat, which cause great pain, and induce orthopncea. They produce suffocation on the first, second, third, or fourth day."* I am aware, that a writer of no common authority, Sir Gilbert Blane, has given it as his opinion that the disease here referred to is more pro- bably the croup, because no mention is made of difficult de- glutition.! This cannot, however, be justly considered as any solid objection to the supposition of the disease being laryngitis. It should be recollected, that it was not the ob- ject of the great father of medicine to give us in his "Prog- nostics," minute and detailed descriptions of diseases. He * The Prognostics and Crises of Hippocrates, translated from the Greek, &c. By H. W. Ducachet, M. D., &c. p. 68. f Medico-Chirurgical Transactions of London vol. VI. p. 143. 16* 186 LARYNGITIS. presents us with those great and prominent features only, from which a judgment may be formed concerning the gene- ral character and the final issue of diseases; and hence it will be found, that in more instances than one, some of the most distinctive symptoms are not at all brought into view. Illustra- tions of this might be adduced in abundance. It is unneces- sary, however, to go beyond the very subject of which we are speaking for one perfectly satisfactory. In the aphorism succeeding the one just quoted, Hippocrates speaks of angi- nas accompanied with pain, tumour, and redness, and adds, that they are very fatal. Now, it is evident, that in these cases deglutition must be very greatly impeded, and yet no mention is made of this circumstance. The omission, there- fore, of any notice of difficulty of deglutition, a symptom common to all the anginas, cannot be admitted as of any great weight in determining this question. As to the conjecture, that the disease alluded to by Hippocrates is croup, upon the very principle assumed by Sir Gilbert Blane, it is attended with even greater difficulties than the one to which he op- poses it, inasmuch as nothing is said concerning cough, a symptom so characteristic of croup as to distinguish it from every other affection. Ccelius Aurelianus, in treating of the various kinds of cy- nanche, describes one, which, if it does not answer in every respect to our ideas of laryngitis, yet resembles it more closely than any other disease. He represents it as unat- tended by any evident tumour or inflammation of the fauces, and as destroying life more speedily by strangulation than any of the other forms of this affection. "At si sine mani- festo tumore fuerit passio, sequitur collorum tenuitas, cum extentione, atque subrectione inflexibili. Item vultus et ocu- lorum cavitas: frontis extentio, color plumbeus, spirationis diflicultas plurima, nullo, ut supra diximus, manifesto tumore, sive inflammatione aliqua apparente, neque in internis, neque in externis partibus, hebetudo plurima, atque imbecillitas segrotantis; et celerrimus, vel acutus cum prsefocatione, mor- tis effectus."* * De morbis acutis et chronicis, &c. lib. iii. cap. 2, p. 182, Amsteloedami, 1722. LARYNGITIS. 187 By Celsus this species of angina is also distinctly recog- nised, when he says: "Interdum enim neque rubor, neque tumor ullus apparet," &c* And afterwards, in noticing the symptoms which are common to this as well as to the form of angina attended with tumour, he adds: "Mis communia sunt; sdggr non cibum devorare, non potionem potest, spiri- tus ejus intercluditur. Levius est, ubi tumor tantummodo et rubor est, caetera non sequuntur."f Under the head of "Angina Interna," this disease is un- questionably described by Tulpius. "Varia sunt anginas ge- nera, sed nullum perniciosius illo quod produxit, vel verte- bra introrsum luxata; vel inflammatio musculorum interioris laryngis. Quorum profundus tumor, si quidem coarctet an- gustum, asperae arteriae, caput; et ligulam illi insculptam (quae sunt proxima vocis instrumenta) supprimitur non tan- tum vox; vel praecluditur quoque via spiritui; vel potius ipsi vitae. Quae sine spiritu nulli diu, durabilis. Ac proinde non inconsiderate, Hippoc. lib. iii. prog, 'latens angina vel primo, vel secundo die, lethalis.'" He then adds the following case: " Nauta pleni habitus, correptus intempesta nocte, ab ur- gente faucium angustia, traxit ilico spiritum adeo difficulter ut excitata febre, et accenso gutture, inciderit protinus in grave suspirium, spiritum turbidum, imo ipsam mortem. Cu- jus periculo, quo subtraharetur, nihil non molitum: sed ur- gentior fuit necessitas; et vehementior, ab incluso spiritu, strangulatus: quam ut juverint ipsum, vel sanguis mature ex utroque brachio detractus, vel incisaranula: vel cucurbitulae, gargarisationes, clysteres, cataplasmata: aliaque satis celeri- ter adhibita."| Riverius in his Praxis Medica, under the head ef Angina, has left us what was no doubt intended as a description of this disease. In speaking of one of the varieties of angina, he says: "In cynanche maxima est respirationis laesio, ita ut segri strangulari videantur, et paucis etiam horis aliquando strangulantur; ac non nisi erecta cervice, et aperto ore spirare * Aurel. Cornel. Celside medicina. lib. iv. cap. iv. p. 196. Lugduni Batavorum, 1746. t Ibid. X Nicolai Tulpii observations medicae, lib. i. cap. 51, p. 93. Anutelcedami, 1672. 188 LARYNGITIS. valeant. Fauces vehementer dolent,^nullus tamen rubor aut tumor, neque in faucibus intus neque extra in cervice appa- ret."* Morgagni, in his great work on the "Seats and causes of Diseases," has furnished us with a history of the symptoms and morbid appearances, on dissection, of an unequivocal case of this disease.! By Lommius a most admirable description has been given us of a species of angina, the identity of which with laryn- gitis can hardly be mistaken. "Porro mortifera est, atque omnium horrendissima angina, citissime, que incidit, et ne- cat, quae neque in cervice, neque in faucibus quicquam con- spicui, vel tumoris, vel ruboris exhlbet, simulque summi do- loris tormentum, et vejiementem febrem, atque tantum non presentem suffocationem infert. Turn profecto oculi vertun- tur, et rubent, et veluti iis qui strangulantur, prominent: vox impedita nihil significat, et qualis catulorum est, tenuis editur: os apertum hiat: frigidi seris cupidum, ex eoque spumans sa- liva movetur: lingua exeritur, crebroque, ut inanhelis propter laboris impetum equis, agitatur; potui datus liquor per nares remeat: labra livescunt: cervices rigidee contractasque sunt: ipse aeger totus inquietus est, crebro e cubili exilit, moleste supra dorsum, commodius recto collo atque capite cubat; videt, au- ditque obtuse, et prae suffbcatione non intelligit quid audiat, quid dicat, aut gerat: tandem vero strangulatu, atque synco- pe oppressus, perit."| By Boerhaave this disease is described in a manner that must convince every person that he was not unacquainted with its nature. "If the larynx," says he, "chiefly be acute- ly inflamed, and the seat of this evil be in the white muscle of the glottis, and together in the fleshy muscles, whose of- fice it is to shut the same; there ariseth a terrible quinsey, which soon strangles. The signs are, a violent pain in the raising of the larynx, upon swallowing, increased upon speak- ing or hallooing; a very shrill and shrieking voice; a very * Lazari Rivirii, opera omnia universa. Praxis Medica, lib. vi. cap. 7, p. 93. Lugduni, 1663. t Epist. xliv. 3.—Cooke's Morgagni, vol. I. p. 221, Am. ed. X J. Lommii observationes, p. 99. Amstelcedami, 1738. LARYNGITIS. 189 hasty death, with" the utmost anguish; and this is the worst kind of all, and not discernable by any outward signs."* In the treatment, he recommends copious and repeated blood- letting, purging, blisters, inhalation of warm vapors, and finally, bronchotomy. Lieutaud divides anginas into four species: the inflamma- tory, catarrhal, gangrenous, and spasmodic. The last of these he thus defines: "Convulsive angina varies much from the other species of angina, both in the greater difficulty of breathing, and in swallowing being more impeded, so that even when erect, the patient can scarcely draw breath, while, from accurate examination, there appears no mark of red- ness, obstruction, or swelling about the parts affected. Such is the violence of this disease, that it takes off some patients in a few hours."f Mead, also, in his medical precepts, gives an account of this disease as a species of quinsey, which he calls a strangu- lation of the fauces. In this affection, he says,"j" all the nerves are convulsed, and the patient drops down dead suddenly. Of this sort (of quinsey) I have seen one instance, in which, though a large quantity of blood was drawn twioe in six hours' time, yet that evacuation was of no avail. Upon dis- section, there was not even the least appearance of swelling or inflammation in the glands or muscles of the mouth and throat; but the blood vessels were turgid every where with a thick blood. This disease, however rare," he adds, "is described by Hippocrates."^ Although it appears evident from the foregoing review that this disease is very far from being of such recent origin as some have supposed, and also that, under the generic term of angina, it has been described by a number of successive writers, yet it must be admitted, that it is only within a few years that its true nature and distinguishing features have been investigated with that accuracy and precision to which its great importance so justly entitle it. That this was not * Aphorisms, 802, 809. t Synopsis of the universal practice of medicine, . 221. See also a valuable paper on Bronchotomy as connected with inflammation of the larynx, by John Wood of St. Bartholomew's Hospital, in the Medico-Chirurgical Transactions, vol. 17, p. 138. LARYNGITIS. 209 as a great improvement in the mode of performing this ope- ration.* In concluding these observations, I shall give the history of three cases, as illustrative of the varieties of this disease, which have been noticed. For the particulars of the first, I am indebted to my friend, Richard K. Hoffman, M. D. of this city. It is a melancholy instance of the overwhelming rapi- dity with which the disease sometimes destroys its victim. * I cannot do better than quote the interesting account of this operation as furnish- ed by Mr. Carmichael. " Having ascertained the lower edge of the thyroid gland, an incision, about an inch and a half in length, was made through the integuments from this point to with- in a finger's breadth of the sternum. The incision was continued between the ster- no-hyoidei and the stemo-thyroidei muscles, until the rings of the trachea were fairly exposed. This momentous part of the operation was performed in a few seconds : for with the aid of my assistants, who separated the lips of the wound by means of retractors, I was enabled to see the parts which it was necessary to divide ; and by the fore-finger of the left hand I successively felt each part previous to the applica- tion of the knife, the edge of which, after the division of the skin, was directed con- stantly upwards during the subsequent parts of the operation; and these precautions were a sufficient security against wounding the arteria innominata, which sometimes rises above the sternum, or from dividing any known or anomalous arterial branch of magnitude which might course in front of the trachea. '• This was all happily accomplished, with very little delay, and the loss of a very few drops of blood, notwithstanding the difficulty which the perpetual motion of the trachea opposes in a person incessantly gasping for breath : two, or perhaps three, oi the rings of the trachea, were then divided from below upwards, and this opening was immediately widened by means of a large pair of sharp-pointed scissors, such as I employ for the operation of hare-lip. With these I had provided myself, knowing from previous operations the difficulty of removing by the knife a slip of the rings of the trachea, as recommended by Mr. Law rence. Some little address is necessary in performing this part of the operation. The sharp point of one blade was introduced at the lowest part of the opening in the trachea, and directed outward so far as to ad- mit on the closing of the blades, of the division of an extent of the tracheal rings, equal to one half of the opening already made in them ; the flap thus made was laid hold of by a pair of dissecting forceps; the point of the scissors was again introduced into the trachea, where the last incision terminated, and carried inwards towards the central opening. Similar incisions in the same manner were made on the opposite side, and a diamond-shaped opening, capable of admitting the point of the little fin- der with ease, was left in the trachea. ° "The patient coughed up a large quantity of thick viscid phlegm through the opening, and seemed so much relieved, that the appearance of suffocation and exces- sive anxiety which her countenance displayed previous to the operation, immediately disappeared. I am satisfied, that'if the operation had been confined in this, as well as in other instances which have occurred to me, to a mere division of the rings of the trachea, that no beneficial result could have followed the measure ; and that even the introduction of a tube, which is objectionable on two accounts, would not be at- tended with any advantage ; for, first, a tube excites intolerable irritation, with vio- lent fits of couching; and, secondly, the apertures in it cannot be sufficiently large to permit the expulsion of the viscid phlegm which accumulates in most of those ca- ses where Tracheotomy is necessary." (Transactions of the College of Physicians of Ireland, vol. 4, p. 312.) 18* 210 LARYNGITIS. The second case occurred in the person of a physician of this city, and is particularly interesting as presenting more of the general inflammatory, as well as protracted character, than is usually met with in this disorder. The third is a rare and curious case, translated from the memoir of M. Bayle. CASE I. At one P. M. on the 10th April, 1823, a servant called at my office, requesting me to hasten to Mr. M., whom she re- ported to be choking to death. Taking with me some emetic medicines, a probang, and polypus forceps, which were at hand, I immediately attended. On entering the room, I was struck with the extreme anxiety expressed on the patient's countenance. His neck was denuded, the larynx moving vio- lently up and down, his eyes staring, face flushed, and cover- ed with drops of sweat. His whole frame was agitated, and the difficulty of breathing appeared almost insufferable. He pointed to a glass, containing a mixture of Cayenne pepper and vinegar, and applying his hand to his throat, reiterated in a hurried whisper, ' Can't breathe, can't breathe, cayenne pepper,' &c. On attempting to swallow a little water which was handed him, it was convulsively ejected from the mouth. I seated him near the window to examine the fauces; they were rather more red and tumid than natural, but presented to the view no other morbid nor extraneous impediment to respiration. A vein was opened in each arm, (using his cra- vats for ligatures,) and bled freely; but death supervened from suffocation, with a rapidity as great as if a strict ligature had been made on the trachea. In the short interval, not exceeding ten or fifteen minutes. from the time of my arrival, until the fatal termination of the case, no account of the previous symptoms could be obtained. It was now ascertained that he had complained of soreness of the throat the evening before, as well as at breakfast, but was not prevented from engaging in his mercantile pursuits that morning. Experiencing some difficulty of breathing, how- ever, he returned home earlier than usual for dinner, and er- roneously believing his complaint arose from the palate being LARYNGITIS. 211 down, resorted to the mixture of Cayenne pepper for relief a few moments before I was called in. On the following morning, the parts concerned in the dis- ease, as well as the pharynx, fleshy palate and tongue, were detached for examination. The mucous membrane of the fauces appeared slightly inflamed, while that of the rima glot- tidis especially, was so distended by a visible congestion of the blood vessels, together with an effusion of serum in the sub- jacent cellular texture, as effectually to conceal and shut up the passage to the windpipe. This inflamed and oedematous condition of the mucous membrane was apparent throughout the larynx, and traces of inflammation extended down the trachea, as far as its bifurcation, where our researches termi- nated. The subject was in the prime of life, of a strong constitu- tion, sanguine temperament, and of a plethoric habit of body. It was a source of satisfaction to the numerous relatives of the deceased, that two gentlemen of the highest eminence in the profession arrived almost simultaneously with myself. CASE II. Dr. F. of a sanguine temperament, and of a robust consti- tution, had been complaining for three or four days of sore- ness about the fauces, accompanied with some degree of hoarseness and continual sense of thirst. These symptoms were accompanied with considerable difficulty in deglutition, unattended, however, by any cough or expectoration. On the morning of the 17th of November, 1823, on examining the throat, I found the fauces inflamed, but not tumefied. About the middle of the day, the patient was seized with an increas- ed sense of tightness about the throat, attended with pain, great anxiety in breathing, difficulty of swallowing, and a sense of strangulation. After continuing for a few moments, these symptoms gradually abated, but were again renewed with increased violence after a short interval. Blood was im- mediately taken to the amount of forty ounces, after which an emetic of tartarized antimony and ipecacuanha was admi- nistered. The emetic produced little or no effect. Sulphate of soda, oz.j. was shortly after ordered, 212 LARYNGITIS. 7 P. M.—No abatement of the symptoms; pulse full and strong, and about 120 in a minute; skin hot and dry; the dif- ficulty of respiration, as well as of deglutition, still continu- ing, blood was again drawn to the amount of oz. xx. 18th, 9 A. M.—During the night, the patient had suffered great restlessness, accompanied with much local distress about the throat. This morning his uneasiness was excessive, in consequence of the difficulty of his respiration, and the fre- quent returns of the sense of strangulation. On pressing the region of the larynx externally, considerable soreness was complained of. The pulse still remaining full and strong, the patient was again bled oz. xvi. and put upon the use of the solution of tartar emetic. 7 P. M.—No abatement in the force or frequency of the pulse having taken place, oz. xvi. of blood were drawn. 19th, 9 A. M.—No amendment—general excitement of the system still great—pulse upwards of 100, and full—v. s. oz. xvi.—leeches to the throat, and a blister to the chest. The antimonial solution still continued. In the afternoon, oz. xvi. more of blood were taken; and in the evening ten grains of calomel were ordered. 20th, 9 A. M. — Little or no abatement of the general or local symptoms.—v. s. oz. xvi.—calomel and antimonial pow- der, in the proportion of four grains of the former and six of the latter, were directed to be given every three hours. 21st.-<-No alteration of consequence in the condition of the patient—calomel and antimonial powder continued as before. 22d. — The excitement in the system being evidently in- creased, it was deemed proper to abstract more blood: oz. xii. were accordingly taken—the calomel was still continued. 23d. — The patient states that he feels a slight moisture in the mouth and throat, the first which he has experienced since his attack. In the course of the day the gums became affected. The use of the mercury was now stopped, and a blister or- dered to be applied to the throat. 24th. — Pulse still excited: 120 to 130 in a minute.—v. s. oz. xvi.—tart. emet. solution was directed to be given every two hours; at night, Dover's powder grs. x. LARYNGITIS. 213 25th.—Rather better—continue tart. ant. and renew blister to chest. 26th.—Considerably better during the day. 27th.—During the night, the patient was attacked with a return of the fits of strangulation; they were repeated every five or ten minutes; and to such a degree as almost to threaten the immediate extinction of life. An emetic of tart. ant. and ipecac, was given, without producing any effect. In half an hour another was administered. N,o vomiting was induced. Great relaxation, however, ensued shortly after, which was succeeded by a profuse perspiration, affording decided relief. The spasms gradually subsided on this effect being produced. 10 A. M.—v. s. oz. xvi. The patient fainted from this bleed- ing, the first effect of the kind which had yet taken place, not- withstanding the numerous and copious abstractions of blood. After this an emetic of sulph. zinci dr. ss. No effect by vo- miting—it produced, however, pretty copious secretion from the mouth and fauces. For the purpose of keeping up the relaxation induced by the last venesection, tart. emet. gr. I. ipecac, gr. ij. were ordered every two hours. 28th.—Rather better—pulse 120—the tart. emet. and ipe- cac, continued. 29th.—Much better—pulse softer, 100—skin moist—expec- toration very copious—slight cough—mercurial fastor very great. The tart. emet. and ipecac, were now discontinued and a dose of senna and manna was ordered, to open the bowels. From this time he continued gradually to improve. The expectoration, however, remained very profuse for about two or three weeks. After that it subsided, and the patient reco- vered his usual health. His voice, however, has never reco- vered its accustomed tone; and, after a year's interval, it is still hoarser than natural. This case was attended by Drs. Hosack, Post, M'Lean. and the writer* * In a criticism upon this Essay in the Medico-Chirurgical Review, (see vol. 3, for 1825, p. 208,) Dr. Johnson suggests, " that much less blood would have been lost, in this case, had it been more copiously abstracted in the beginning." I admit the justice of the remark, and I will merely add, that this very case, together with every 214 LARYNGITIS. CASE III. Aneurism of the Aorta, simulating (Edema of the Glottis. Stephen Pillet, cartwright, aged 48 years, of high stature, and very robust complexion, having his muscles well developed, countenance naturally pale, the beard and the hair on the head of a deep brown, entered the Charite on the 29th of Novem- ber, 1808. He had then been sick six months, according to his own account, in consequence of a checked perspiration. He coughed and expectorated a great quantity of glairy and soapy matter; his voice was hoarse, his respiration was trou- blesome and noisy. Each inspiration was attended with a sort of hissing, or rather a peculiar sound, which might have been compared, if it had been a little more acute, to that which is produced in blowing strongly upon a hautboy; expiration, on the other hand, was free and easy. The patient experi- enced often a slight pain in the larynx; the least exercise con- siderably increased the dyspnoea, without causing, however, any palpitations of the heart. The pulse was sufficiently re- gular in the left arm, but none was perceptible in the right. This peculiarity was known to the patient, who regarded it as natural. The digestive functions were properly exercised, his size was little diminished, his flesh was firm, and without the appearance of infiltration. Six weeks before his entrance into the hospital, an issue had been made in the back of his neck, which had appeared to diminish somewhat the dyspnoea and the hoarseness; about the middle of December it was closed. The only means which were employed, were the milder aperient drinks, and the theriac in small doses. Towards the middle of January, the cough and expectora- tion were sensibly lessened; respiration seemed to be some- what more free, and less noisy; the patient walked in the yard of the hospital during the whole day, without materially in- creasing the dyspncea; he ate with a voracious appetite; he became thin, nevertheless, but slowly; he had no fever at any other that I have witnessed of this formidable disease, have only served to convince me of the correctness of the opinion which I have expressed in relation to carrying venesection, in,the first instance, to the point of syncope. LARYNGITIS. 215 time, nor even any heat of skin; he constantly felt an uneasi- ness, and sometimes a little pain in the larynx. On the 20th of January, he complained of a slight sore throat, which he had had for some time; and in reply to ques- tions put to him, he declared that he had suffered under seve- ral venereal affections. At the same time it was thought that some redness could be perceived in the velum of the palate and about the larynx. All these considerations determined the physicians to prescribe a gargle, together with a spoonful of the liquor of Yan Swieten, which did not, however, produce any effect. On the 26th, Pillet, having dined as ordinary, was seized a short time after, with a violent paroxysm of orthopncea; he could not breathe, unless when seated, stooping forwards, the arms extended, or clinging to the bedside. In this condition, the sound produced by each inspiration was much more loud than usual, the face becoming red in colour, and bordering upon the violet; the pulse was hard, slow, and unequal. At nine in the evening, a large blister was applied on the fore part of the neck. Towards midnight, respiration became more easy, and the next morning he was found, as in the preceding days, lying on his right side, breathing without much difficulty, but always with the same hissing sound accompanying each inspiration. Towards evening, a new paroxysm of orthopncea occurred much more violent than the last, and which had not abated as yet on the next morning's visit. The violet colour of the face, the extreme smallness of the pulse, announciug death to be at hand, three grains of emetic were administed, and a new blister applied, after having the part irritated with ammonia. The patient did not vomit, had some small stools, and expi- red an hour after taking the emetiq. Autopsical examination twenty hours after death. The larynx was found to be in its natural condition, to the great astonish- ment of those who had seen the patient. In the hinder part of the mouth, and in the pharynx, all was healthy. The lower portion of the trachea was compressed and flat- tened from before, backwards, by an aneurismal tumour, a 216 LARYNGITIS. little thicker than a man's fist, and of a rounded form. This tumour was formed by the aorta, considerably dilated from about an inch above its origin, to where it is buried be- tween the two pleurae. The bulging of this artery was chiefly on the posterior side, and at the expense of its posterior coat, so that the tumour, although voluminous, did not touch the sternum nor the ribs, but it bore on the vertebral column, compressing the trachea, to which it intimately adhered by a portion of its surface as large as a sous. The cavity of the sac contained a good deal of blood partly coagulated; its sides were strengthened by a layer of fibrin, about an inch thick in some places, but very thin, and almost entirely worn away toward the centre of the posterior side, where it had adhered to the trachea. In this place, all the coats of the artery were destroyed, the surface of the trachea corroded, and several cartilaginous rings denuded, and as it were dissected, and pro- jecting into the aneurismal sac. Thus the mucous membrane was the only barrier to the irruption of the blood into the trachea, and this would have been soon removed, if the death of the patient had not prevented it, because the mucous mem- brane already presented a circumscribed spot of a livid red, which appeared to be the commencement of an eschar. The remaining surface of the sac was free, and offered the same appearance as a healthy aorta. The internal membrane seemed wholly untouched. I observed, however, a slight os- sification about the size of the nail of the small finger, at the place where the sac was contracted abruptly to form the con- tinuation of the aorta.' There were five or six nearly similar ossifications, dispersed here and there in the internal part of the thoracic and abdominal aorta. This artery had, in all its extent, a more strong calibre than is natural. The arteria innominata, the sub-clavian, and left carotid. rose from the very centre of the aneurismal sac. The trunk of the first had almost entirely disappeared, so that on first examining it, the right carotid and sub-clavian seemed to rise isolated, and mere than an inch's distance from each other. The last, (right carotid) traversed in an oblique direction, and for about an inch, the thick walls of the sac, in nearly the LARYNGITIS. 217 same manner as the ureter traverses the membranes of the bladder.. By this accidental disposition the passage of the blood through the right sub-clavian must have been intercept- ed, whilst the sac was distended with blood.* No other al- teration was perceptible in this artery. All the other arteries, and the heart itself, were natural. The lungs were soft, and little elastic, but otherwise healthy. The left bronchia, which was principally compressed by the sac, was gorged with a thick, ropy, and somewhat frothy mu- cus. The right bronchia was sound: so were all the other organs of the body, &c. * This accounts for the absence of pulsation in the arm of that side. 19 ( 218 ) The following paper appeared originally in the year 1823, in the New-York Medi- cal and Physical Journal, a periodical of which the author was for some years an edi- tor. Although thrown into the form of a review, and of course published anonymous- ly, it was intended as an essay on the question of the contagiousness, or non-conta- giousness, of yellow fever, as it prevailed in New-York in the year 1822. As such it is now reprinted under the responsibility of the author's name. To this step he confesses that he is partly impelled by a wish to correct the representations of certain individuals who have seen fit to use his humble name in support of opinions on the subject bf yellow fever, which he has never entertained and never avowed. It is in consequence of such representations, that the present paper has been looked upon by some eminent individuals, as a recantation of previous faith.* Proud as the author would be of the implied magnanimity of publicly retracting what observation and reason had shown him to be erroneous, he is not justly entitled to the compli- ment. That his prepossessions may originally have been in favour of the contagious character of yellow fever, he is not prepared to deny. Educated in a school in which this was the prevalent doctrine, how indeed could it be otherwise 1 He is not aware, however, of having ever committed himself on this subject, and the whole amount of his recantation will appear from the paper itself. As an inquirer after truth, he re- frained from forming any definite opinion on so important a subject, until he should have had the opportunity of personal observation. This opportunity occurred par- tially in 1819, when the fever prevailed in this city, to a limited extent, but more par- ticularly in 1822, when it prevailed more extensively, and furnished the amplest ma- terials for making up a rational judgment. It may not be improper to observe, that in the following paper no facts have been used except those which came under the author's own observation, or which were reported by official authority. If, therefore, any error be found, it must exist in the reasonings and conclusions of the writer. The facts themselves stand uncontradict- ed by all parties. It will be observed that the following paper is confined exclusively to the subject of the contagious, or non-contagious, character of the yellow fever. The origin of the disease is purposely left out of view, as being considered to have no necessary connexion with the question at issue. For the purpose of making the argument contained in the following paper as intel- ligible as possible to the reader, it may be necessary to state a few facts in relation to the commencement and subsequent extension of the disease of which it treats. The disease made its first appearance on the 10th of July, 1822, at the lower part of Rec- tor-street, a small street opening upon the Hudson river. Three cases occurred on the same day, two of them at the house situated on one corner of the street, and one at the opposite house. In a few days several cases occurred at a neighbouring house in the same street, and from these points it continued gradually to extend itself in all directions. About the 1st of November, when the disease terminated, the cause of the disease was prevalent over the whole of the lower parts of the city, extending northward as far as Chambers-street. The portion of the city thus affected, was de- nominated and currently known by the title of the " infected district." As the poi- son spread itself, the citizens removed before it, and the limits of the district were marked by barring up the streets. The spread of the disease was announced by the occurrence of cases just beyond these limits, and when these occurred, the barriers were extended correspondingly. The sick were in all cases removed from the infect- ed parts, to other parts either of the city or of the surrounding country. The whole amount of cases that occurred, was about four hundred, of which about two hundrec and thirty terminated fatally. * De 1'opinion des Medecins Americainssurla contagion ou la non-contagion de la Ficvre Jaune. etc. 1'ar N.CIiervin, M.D. &c. p. U- 8vo. Paris 1829. See also an able Essay on Yellow Fever, by I. Gillkrest, M.D. Deputy Inspector General of tho Army From the Cyclopcedia of Practical Medicine, p 30. London. 1832. III. ON THE NON-CONTAGIOUSNESS OF YELLOW FEVER. Whether the Yellow Fever be a contagious disease or not, is a question which has long agitated the medical world, and which it does not seem probable will very soon be set- tled. It is true, indeed, that in this country a very trium- phant majority of the profession have united in the disbelief of contagion, as appertaining to Yellow Fever; yet even here, as well as in Great Britain, are to be found arrayed in defence of the opposite doctrine, not a few of the brightest names in medicine. Whatever may have been the cause of this discrepancy of opinion, the fact itself would seem to prove that it is a subject which must be surrounded by very great and numerous difficulties. That it is so in reality will not be questioned by any candid man, however fervid may be his enthusiasm in the defence of the particular creed which he may have adopted. Deeply impressed with this conviction, we had long hesitated in making up a definite opinion on this subject, until actual observation and personal experience should have enabled us to form a more unbiassed judgment than could well be done from the jarring sentiments and con- flicting statements of controversial writers. It was with the deepest solicitude, therefore^ that we watched the origin and progress of the late pestilence, which desolated the fairest portion of our city. And during its course, facts so abundant and striking were developed, as to produce a positive and complete conviction upon our minds, that contagion had no- thing to do in the propagation of the disease. These facts we propose at this time to record, accompanying them with such explanations and reasonings as they may seem to require. The believers in the doctrine of the contagious character of 220 YELLOW FEVER. Yellow Fever, may be divided into two classes. 1. Those who contend that the disease is contagious under all circum- stances, and that it may as readily display this character in the pure and healthy air of the country, as it does in the con- fined air of our cities. 2. Those who admit that in the pure air of the country it is seldom if ever contagious, while in the impure and vitiated atmosphere of our cities it proves exten- sively so. Both classes, however, agree in this; that every case of the fever which occurs, must result from contagion, as they do not admit the existence of any other cause capa- ble of producing the disease. As we wish to meet both these views of contagion, the fol- lowing facts shall be arranged under two heads: Those which prove that the Yellow Fever of 1822 was not contagious in the pure air of the country: Those which prove that it was not contagious in the vitiated and impure air of our city. I. Facts and Arguments which prove that the Yellow Fever of 1822 was not contagious in the pure air of the country. (a.) From the official returns of Dr. Joseph Bayley, Health Officer of the port, it appears that during the prevalence of the Yellow Fever in this city during 1822, seventy persons sick with that disease, were sent down to the Marine Hospi- tal,* on Staten Island. Of this number, thirty-seven died, eighteen of whom had black vomit. The first of these pa- tients was received into the hospital on the 13th of August, and died on the 15th. From that period until the final cessa- tion of the fever, patients were almost daily carried down to this place.f These cases were regularly attended by the physicians and nurses of the establishment, not one of whom became affected with the disease, nor has a single case come to our knowledge of any person taking it, who was engaged in transporting the sick from the city to the hospital. * Situated at the Quarantine establishment, aboutsix miles below the city of New York, on the west side of the bay. f A History of the proceedings of the Board of Health of the city of New-York, in the summer and fall of 1822; together with an account of the rise and progress of the Yellow Fever, which appeared during that season, and the several documents in relation to it, whici* were laid before the Board. Published by order of the Board of Health. New-York, 1823. p. 132. YELLOW FEVER. 221 The bare statement of the foregoing fact, would seem al- most sufficient of itself to settle the question, that the Yellow Fever of this season was not contagious. Aware of its im- portant bearing, the advocates of contagion have displayed no small share of ingenuity in endeavoring to weaken, if not wholly to destroy its force. One of the most strenuous and zealous of these, without denying the fact itself, endeavours to account for it in the following manner. " Of those taken to the Marine Hospital, at Staten Island," says he, " it may be remarked, that they were removed successively at distant intervals, and but two or three at a time, and therefore never accumulated. As the wards- also of this spacious building, were kept in the most perfect cleanliness, and from the healthy situation of the building, exposed to the sea, are more roomy and airy than are to be found in most other hospitals; and as there were also but few or no persons sick in the house of other diseases, during the whole of the epidemic, there was nothing for the contagion to operate upon. There are but two physicians attached to it, the Health Officer and Dr. Harrison; and no person was allowed to have any communi- cation with the sick, but the three or four nurses of the es- tablishment, who, like the physicians, had been long habitu- ated to the care of Yellew Fever patients, and were therefore less liable to take the disease, especially in the diluted condi- tion in which the poison must have existed in the airy rooms of this fine building. Their effects, of course, were not al- lowed to accompany them."* Now this explanation is equally unfortunate and unsatisfac- tory in point of fact as well as of argument. Let us briefly analyze it. In the first place, this writer tells us that the pa- tients were removed to Staten Island at "distant intervals" "and therefore were never accumulated." It is difficult to ascertain what precise meaning is attached to the word "dis- tant," as applied to periods of time; but it is fairly to be pre- sumed that something longer than twenty-four hours is intend- ed. An interval of no greater length than this cannot cer- * An account of the Yellow Fever, as it prevailed in the city of New-York, in the summer and autumn of 1822. By Peter S. Townsend, M. D. 1823, p. 383. This work contains a very full account of the disease, and embodies every thing that can be said in favour of its contagious character. 19* 222 YELLOW FEVER. tainly be considered as very "distant." If so, then this state- ment is not correct as a matter of fact. This stands proved by the official report of the health officer.1 From an analysis of this document, it results, 1. That the whole period during which patients sick with yellow fever were admitted into the hospital, was sixty-eight days; and during this time seventy persons lay sick in it. 2. That of these sixty-eight days, there were thirty on which no patients were received; on the remaining thirty- eight, from one to five patients daily were admitted. 3. That the greatest interval which elapsed between the admission of any two patients was eight days. This happen- ed at the first breaking out of the fever in the city; towards its close, in the month of October, an interval of five days; and still later in the same month, another interval of seven days occurred. Of the other intervals, there were two of two days, and six of only a single day. 4. That during the whole sixty-eight days, the hospital could never have been entirely clear of patients; and that fre- quently there must have been from ten to twelve persons sick at one and the same time. 5. That from the 23d of August the 30th of September, a period of only thirty-six days, .there were not less than fif- ty-six patients admitted. On this analysis we deem it unnecessary to make a single comment. Every reader can judge for himself what those "distant intervals" were, which prevented the pretended con- tagion of yellow fever from taking effect. But let us look at this argument in another point of view. Dr. T. asserts, that there were not a sufficient number of pa- tients "accumulated" in the hospital to enable the contagion to jdevelope itself. Now, if seventy patients lying sick in the same place, witlfm two or liree months, be not a sufficient number "to develope contagion, how can it be contended with anv sort of consistency, that a less number, under similar cir- cumstances, will produce this effect? And yet such is the fact with regard to this writer. In another part of his work which he devotes to contagion, he adduces several instances of what he calls "examples of the contagious nature of yel- YELLOW FEVER. 223 low fever,"* in which it appears that most of these supposed cases of contagion resulted from intercourse with a single in- dividual sick person. Indeed, almost every one of his exam- ples is of this character. From all this, the dilemma is inevitable. Either the seven- ty patients at Quarantine were abundantly sufficient to pro- duce contagion, if any such appertained to the fever, or the whole of Dr. Townsend's cases of contagion fall at once to the ground. It is useless to urge a difference of circumstan- ces in the two cases. Dr. T. has shut himself out from the benefit of such an exaplanation by boldly maintaining the un- qualified contagion of the disease. In the very second page of his work, he announces this doctrine. "Had not," says he, "however, the late interesting discoveries of the Spanish and French physicians, concerning the laws of yellow fever, proved past all doubt that the theory of domestic origin, and of local filth, is utterly inapplicable to tropical as well as to northern latitudes, and that this disease to all appearance pur- sues its course, independent of what in common language is un- derstood by a pure or impure air,%we should have had more reason to wonder than we now have, that it began in the part of the town where it did."f It is unnecessary to add any thing further on this head. It is self-evident, that as it regards the number and accumulation of patients, it is scarcely possible for them to have existed to a greater extent than they did at Quarantine. The total ab- sence of contagion in this place, must therefore be attributed to other causes. Let us see if any such existed. In the concluding_part of the paragraph we have just quoted, Dr. T. assigns three additional reasons why the disease did not prove contagious at the Quarantine Hospital, viz: the cleanliness and airiness of the situation, the want of subjects upon which the contagion might operate, and lastly, the in- susceptibility of the attending nurses and physicians. We shall, very briefly, take each of these in order. And first, of the cleanliness and airiness of the place preventing the ope- * Account of the yellow fever, &.c. p. 12. X Account of the yellow fever, p. 18, 19. 224 YELLOW FEVER. ration of contagion. We presume no man will deny, that if this cause could prevent the developement of a contagious character in the yellow fever at Quarantine, the same cause must produce the same effect in all other situations similarly circumstanced. This is plain and evident to the commonest capacity. Now it happens rather unfortunately for this writer, that almost every page of his work supplies us with attempts on his part to prove contagion in the very places which he has shown to be pre-eminently distinguished for their beauty, cleanliness and salubrity. Let us take, for instance, his de- scription of the part of the city where the fever prevailed. "The situation of this part of the city, near the promenade of the Battery, and fronting the Hudson, the bay of New- York, the Narrows, and the ocean, together with the spacious and airy avenues of Broadway and Greenwich-streets, which run longitudinally through it, and near and parallel to each other; and the open, unprotected position of the store-houses which stand on the wharf, expose the whole of this beautiful quarter of the city to constant ventilation, from all the cooler and purer winds of the horizon, and such as at the same time are the prevailing winds of our climate; the cold north and north- west, rushing down the Hudson from the Highlands, and the southwest and southerly breezes, which every afternoon of sum- mer sweep up from the ocean through the Narrows, and com- ing directly off the bay, render the air here always cool, agreea- ble, and refreshing."* "The wharf," in this part of the city too, "is substantially built, and being of the nature of a long quay, which runs parallel with the stores, and with but few recesses or projecting piers where filth might collect and be- come stagnant, as it does in the irregular slips on the east side of the town; the current of the river freely and constantly washes by it, and keeps it always clean."j Again: "the yards of the houses in this part of the city, in correspondence with the buildings to which they belong, are almost without a sin- gle exception, clean, airy and spacious, and enriched and or- namented with trees and shrubbery."J Again: "from the ex- tensive and beautiful promenade of the Battery on the bay, * Account of the yellow fever, &c. p. 18 t Ibid. p. 20. X Ib'd- p. 20. YELLOW FEVER. 225 at the termination of Broadway and Greenwich-streets, to Rector-street, which may be considered the northern boun- dary of the district we have been describing, this whole sec- tion is in no part of it in the least degree cramped or confined. Much the greatest portion of ground included within these limits is occupied by the streets which traverse it, to say no- thing of the large open space comprised in the yards, parti- cularly those in the rear of the houses in Broadway, on the side of Greenwich-street."* Can language be stronger, or description more vivid, to prove the entire conviction of the writer, that this spot pos- sessed in the highest perfection every advantage which could be conferred upon it by situation, cleanliness and unceasing ventilation from cool, pure and refreshing winds'! And yet notwithstanding all this, this is the very spot upon which Dr. Townsend locates his contagion, and where it displayed, ac- cording to him, its most terrific powers; and not nierely so, but he urges these very local advantages as a proof of the disease being contagious, inasmuch as there existed no local causes to which it could be attributed. It comes, therefore, with rather an ill grace from him, to contend that there was too much pure air and ventilation, forsooth, at the Quaran- rantine Hospital for contagion to exist, when he urges these very circumstances as a proof of the introduction and subse- quent propagation of the disease in the city, being the result of contagion alone. The want of subjects upon, which the contagion might ope- rate, is another reason, according to Dr. Townsend, why it did not exhibit itself at Quarantine. It is impossible to say precisely how many persons had communication with the hos- pital. Dr. Townsend asserts that there were none except the two physicians and three or four nurses belonging to the es- tablishment. This must, however, be incorrect. Besides the persons employed in conveying the sick from the city, there must have been others engaged to assist in carrying them from the wharf to the hospital. Dr. Bayley, in one of his letters to the Mayor, also speaks of a steward and an orderly man, * Account of the yellow fever, &c. p. 21. 226 YELLOW FEVER. as being attached to the hospital, and generally assisting in this business.* Besides,, deaths were continually occurring, and an additional number of persons must necessarily have been employed for burying the dead bodies. In addition to all this, there were several patients sick of other diseases in the hospital during the epidemic; so that there must have been, from the very nature of the case, a considerable number of persons who had communication with the sick—a number, at all events, large enough abundantly to test the principle of contagion. We come now to the last reason assigned by Dr. T. why the Yellow Fever did not prove contagious at the Quarantine Hospital, and that is, that as the nurses and physicians " had long been habituated to the care of yellow fever patients, they were therefore less liable to take the disease." We fear Dr. Townsend will not be borne out in this statement by facts. What proof is there that the physicians and nurses were less susceptible of taking the disease than other persons 1 Is the simple fact of their exemption to be considered as a proof? Certainly not—because that takes for granted the very point in dispute, viz. that the disease is contagious. And yet, we suspect it would be very difficult to find any other proof of this assertion. But if the attendants upon the sick were un- susceptible of the disease, when and how did they become so 1 If they were so in reality, after having attended twenty, thirty, or forty patients, they certainly could not have been so when they commenced their attendance upon the first pa- tient of which they took charge. Then, at least, they must have been as susceptible as all other persons, and yet even then we do not hear of their taking the disease. But let us look at the broad fact itself. Is it true, that attendance upon those sick with Yellow Fever, however long continued, will give a person an immunity from the disease, if exposed to the proper cause which produces it 1 We answer, no,—and appeal in proof to notorious facts which have occurred in the history of the Quarantine establishment itself, where not less than five out of seven of the physicians appointed to that sta- * History of the Proceedings of the Board of Health, &c. p. 63. YELLOW FEVER. 227 tion, have been seized withothis disease, and four have actu- ally fallen victims to it; and this too after a long seasoning, when, according to Dr. Townsend, they should have been for ever protected from its assaults. (&.) We now proceed to state the second fact in proof of the non-contagious character of the Yellow Fever. At the dis- tance of about three miles from the city, at Kip's Bay, a spa- cious two-story dwelling house was provided at the public ex- pense) for the reception of such of the inhabitants from the infected district as were unable to provide a refuge for them- selves. From the official account* given to the Board of Health by the attending physician, Dr. Drake, it appears that during the season ten persons lay sick of Yellow Fever in this establishment, two of whom died. Of the physicians and nurses in attendance, not one contracted the disease. " But to render the facts connected with this building still more con- clusive, it is stated that " besides the above sick, the house was occupied, during the unhealthy season, by the family of Mrs. Roberts, consisting of four persons; the family of Mrs. Thompson, of eight persons, and three children of the Coit family; all of whom continued in good health, with the ex- ception of two children of Mrs. Roberts, and two of the young Coits, who suffered from intermitting fever, which was doubtless to be attributed to the low wet grounds in the neighbourhood of the house."! (c.) During the prevalence of the fever, six persons lay sick of it at Greenwich, a village about a mile from the city. All of these had contracted the disease in the infected district. Five of the six died. In no instance did they communicate the disease to physicians, nurses, attendants or friends. To give additional weight to this fact, it should be recollected, that to this place had been transferred the seat of business— that in consequence of this, almost all the merchants of the city had retired to it, and that to accommodate them, hundreds of temporary buildings had been erected. From this influx of inhabitants, it may naturally be inferred that the village * History of the Proceedings of the Board of Health, &c, p. 130. t Ibid, p. 132. 228 YELLOW FEVER. was crowded to excess; and from this circumstance, as well as the want of comfortable accommodations, every thing seem- ed favourable to the propagation of the disease. Still, al- though a number of very decided cases of the fever were car- ried to this place, lay sick, and died there, it was not, in a single instance, communicated. It only remains to add, that the body of one of the patients who died here was dissected by two physicians, Drs. Donaldson and Torrey, neither of whom suffered from it the slightest indisposition. (d.) In addition to the cases already recorded, there were a large number of persons, who, after having contracted the seeds of the disease in the city, had the disease developed in them after their removal into different and distant parts of the country. There occurred about thirty-six cases of this sort, and at the following places, viz. three at Newark, N. J.; one at Harlaem; three in the city of Jersey; one at Tappan, N. Y.; six at Bloomingdale; one at Albany; three at Middle- town-Point, N. J.; four in different parts of New-Jersey; one at Newtown, L. I.; one at New-Canaan, Conn.; two at Am- boy, N. J.; one at Hempstead, L. L; one in Westchester; one at Bloomfield, N. J.; one at Woodbridge, N. J.; one at Saugatuck, Conn.; two at Bushwick, L. I.; two at Elizabeth- town, N. J.; and one at Boston. Of this number there were twenty-seven deaths. From the very extraordinary propor- tion of deaths among these cases, it is evident that they must have been very decided and malignant in their character, and yet in not a single instance was the disease communicated. In relation to the case at Boston, we have the recorded testi- mony of the editors of the New-England Journal of Medi- cine and Surgery, who state that the patient " lodged at one of the largest hotels in that place, filled at the time with per- sons from all parts of the country, and there sickened and died of the Yellow Fever;" and although "he was constant- ly watched and attended in a small and badly ventilated apart- ment, no one was in the slightest degree affected by his sick- ness."* Let us now pause and reflect upon the amount of testimony * New-England Journal of Medicine and Surgery, vol. xii. p. 384. YELLOW FEVER. 229 already advanced. It appears then, from the foregoing facts and statements, that upwards of one hundred persons, sick of Yellow Fever, (about one-fourth of all the cases,) lay in dif- ferent parts of the country, without, in a single instance, com- municating the disease. If it had been previously proposed to settle this question by actual experiments, we cannot con- ceive that any could have been suggested which would have been more satisfactory to all parties, than the very ones which actually transpired during the summer and autumn of 1822. That one hundred persons, sick of a disease highly malignant and contagious, located in different parts of the country, should not, even in a solitary instance, have communicated it to a second person, seems to us literally impossible; and we believe, that were it not for the influence of preconceived opinions, and long-cherished theories, facts of this sort would come home to the mind of every man with a force perfectly irresistible. Aware of these facts, the contagionists, so far from abandoning their favorite theory, have invented new schemes for upholding it. One of the most popular of these at present, is this, that Yellow Fever, although it may not prove contagious in the pure air of the country, yet is emi- nently so in the impure atmosphere of cities, &c. Whether any countenance was given to this doctrine, by the facts which were developed during the Fever of 1822, we now pro- pose to investigate. II. Facts and arguments which prove that the yellow fever of 1822 was not contagious in the impure air of the city. Before entering upon these, we cannot ^refrain from first making a few remarks upon the theory itself, which asserts that a disease may be contagious in one sort of air, and not so in another. Notwithstanding this doctrine has received the sanction of some very distinguished names, we have never been able to convince ourselves that it is correct in fact, or philosophical in principle. That it is not correct in fact, so far as it relates to yellow fever, we shall show directly. The grounds upon which it is conceived to be unphilosophical, are these. 20 230 YELLOW FEVER. If contagious effluvia emanate from the body of a person sick of a peculiar disease, they can be influenced by the sur- rounding air only in one of two ways. First, the surrounding air may serve simply as a medium of transmission. In this way the effluvia are diffused more widely than they would be in vacuo. It is evident, however, that here the contagion remains unchanged in its character, and produces its specific effects without any aid from the atmosphere, except that of enabling it to act at a greater distance from the sick body. Second, the contagious effluvia may enter into chemical com- bination with the surrounding atmosphere. An entirely new compound then is formed, the effects of which upon the human system must necessarily be different from those of the original contagion. These are the only possible methods in which contagious effluvia can be influenced by the surrounding atmosphere. Now, if we apply these propositions, and push them to their conclusions, they will be found to destroy completely the theory of which we are speaking. If the contagious effluvia enter into chemical union with the air, and form a new poison, then the same specific disease cannot be reproduced: this supposition, therefore, is inadmissible. If, on the other hand, the air serves merely as a medium for transmitting the poison to a greater distance, then no reason can be assigned why, if vou approach near enough to the sick body, contagion should not display itself in a pure as well as an impure atmosphere. Let us take another view of the subject. If a disease be contagious in one kind of air, and not in another, then it must acquire its contagious character from some peculiarity in the air in which it is so; and if this be the case, then the principle of contagion must exist in the air, and no reason can be as- signed why the air itself should not, under these circumstances, produce the disease, independently of all sick and diseased bodies. This seems to us to be an inevitable conclusion from the premises; and to our minds, it appears most satisfactorily to do away the necessity of resorting to contagion to account for the origin and propagation of yellow fever. On these grounds, we think the popular doctrine which supposes that YELLOW FEVER. 231 this disease may be contagious in one species of atmosphere, and not in another, is unphilosophical. But we wish not to rest this subject on abstract reasoning alone. We shall again appeal to facts, to prove that in the impure atmosphere of our city, the disease was as destitute of any contagious property as it was in the country. And for the purpose of covering the whole ground, we shall first state those which establish this in those parts of the city which were considered, as uninfected, and afterwards those which establish it in the infected parts of the city. {a.) In the uninfected parts of the city. It is difficult to as- certain precisely the number of persons that lay sick of the fever, beyond the limits of the infected districts. Dr. Town- send estimates them at one hundred and four. Admitting this to have been the whole amount, although it probably was larger, we would ask, was a single one of these known to have communicated the disease to a second person? That there was not, is a fact so notorious, that even Dr. Townsend, with all his zeal for contagion, is forced to admit it. That there may be no evasion on this subject, we shall quote his own words: "Out of the one hundred and four persons," says he, "sick of yellow fever in the uninfected parts of the city, sixty-five out of this number did not reside in the infected dis- trict, but had been employed there as labourers, or merely passed through it. These, therefore, could have brought nei- ther dirty clothing nor any other infected articles with them. Why these, however, and the remaining thirty-nine scattered over,various parts of the city, supposing some of them to have brought their bedding or clothing with them, did not communi- cate the disease to their physicians, nurses, or attendants, or to the inhabitants living in the neighbouring houses, it is perhaps impossible to say. I will not deny, that several of these cases, from the confined situation of the apartments in which they lay, and the inattention of their nurses, seemed to have been placed under circumstances particularly favourable to communicate the disease. But it must be remembered," adds our author, "that all these were individual cases, and more or less insulated, not only by being placed in parts of the city remote from each 232 YELLOW FEVER. other, but because they were in a great number of instances abandoned through fear by their relatives as well as friends, by all indeed but their physician, and some desperate fellow whom cupidity more than philanthropy tempted to do some few reluctant services to the forsaken sufferer."* Let us now look for a moment at the concessions and ad- missions which are contained in the paragraph just quoted. In the first place, it is admitted that one hundred and four persons sick of yellow fever, and lying in various parts of the city, did not communicate the disease to their physicians, nurses or attendants, or to the inhabitants living in the neighbouring houses. In the second place, it is admitted that several of these cases were placed under circumstances peculiarly favourable to communicate the disease. Is it possible for admissions to be more ample, and at the same time more fatal to the cause of contagion? As if conscious of this, Dr. T. immediately after attempts to explain them away, by asserting that the cases were individual ones, and remote from each other, and that they were in a great number of instances abandoned by their friends. With regard to the cases being individual ones, it is hardly worth notice after what has been stated in a previous part of this paper. Almost every one of Dr. T.'s instances of contagion, he attributes to communication with single indi- vidual cases. Upon his own ground, therefore, an individual case is quite abundant to propagate the disease. We cannot then permit him to contradict a principle in the present in- stance, which he has already assumed, and which forms the basis of a large portion of his reasoning. As to the abandon- ment of the patients by their friends, we can only say. that although we remained in the city during the whole of the pre- valence of the fever, and were in the daily habit of visiting persons sick with the disease, we do not recollect to have met with a single case in which a patient was left in this state of helpless and hopeless abandonment. On the contrary, several instances fell under our immediate observation, in which the most honourable and disinterested devotion in administering to the wants and comforts of the sick, was displayed even by * Account of the Yellow Fever, &c. p. 65. YELLOW FEVER. 233 persons not connected with them by the ties of blood or re- lationship. Besides, what shows conclusively that such aban- donment of patients labouring under the fever, could not in the very nature of things have existed, is the notorious fact, that every patient who, either through poverty or any other cause, could not command the attentions necessary in his case, was provided for at the public expense; and it was only those pa- tients whose friends were both able and willing to take care of them, who remained in the city. The causes assigned, there- fore, for the absence of contagion in these cases, are evidently insufficient. We shall now proceed to show, that in many of these cases admitted not to have proved contagious, there was every at- tending circumstance required by the contagionists themselves, to favour the development and operation of this supposed pro- perty of the disease; and in doing this, we shall not advance a single fact which we did not ourselves witness, or for which we have not the very best authority. Joseph Dykeman, a coloured man, who had frequented the infected district, without, however, we believe, visiting a single person labouring under yellow fever, was seized with this dis- order on the 23d of August. He lay sick in Walker-street, a few doors from Broadway, in a low, confined and damp cellar, where it seemed almost impossible that the fresh air of heaven could ever find its way. On the 28th, in company with seve- ral other physicians, we visited this man, and found him in the agonies of death. The most aggravated symptoms charac- terized this case, and at this time his eyes were fixed, his pulse was gone, his extremities were cold, blood was oozing from his mouth, and on pressing the region of the stomach, he seemed convulsed with pain. Notwithstanding all this wreck of the physical powers, the mind still retained its supremacy; and on being requested, he put out a clean and blood red tongue. In a few hours after this, he expired. Notwithstand- ing the malignity of this case; notwithstanding the patient lay in a close, ill-ventilated and filthy cellar; notwithstanding he was regularly attended by two physicians, and occasionally visited by numbers of other physicians, as well as strangers; 20* 234 YELLOW FEVER. notwithstanding his family remained with him, took care of him during his sickness, and continued to inhabit the same place after his death; notwithstanding one of the women had actually washed the clothes in which he died: notwithstand- ing all this, not a single person ever became indisposed from communication with him. E. Jackson, who had been in the infected district, was taken sick on the 27th August, and lay in a small, confined room in Chamber-street. She died on the fourth day of her disease, with decided black vomit. This person, although constantly nursed by two or three women, and visited by numbers of physicians, did not communicate the disease to a single person. We attended this woman, and visited her three or four times a day, remaining sometimes half an hour at a time, without experiencing the least inconvenience. Mary Ann Ragan, an interesting young girl, was reported sick of yellow fever on the 13th September. She had lived in the infected district, but had not been near any sick person. After sickening, she was removed to No. 2 James-slip, where she died with black vomit on the fifth day after her attack. Here this patient lay in one of the filthiest parts of the city— in the vicinity of a wharf—the very location considered by the contagionists as most propitious to the developement of conta- gion—in an apartment extremely close and uncomfortable, and scarcely large enough to contain six persons—she was at- tended night and day by her^ mother—visited daily by physi- cians from the Dispensary, as well as by others, and yet no communication of the disease took place in a single instance. Alexander Benthousen, contracted the fever on the 14th of September, in consequence of working in the infected district, without, however, having had communication with any sick person. He lived in Church-street, and lay sick there, in a low, small, and dark cellar. He was attended by his wife during the whole of his illness, and was regularly visited by several physicians, none of whom suffered the least inconve- nience in consequence of it. Mary Tirnan took the disease in the infected district, and was afterwards removed to No. 66 Cross-street, where she YELLOW FEVER. 235 died. In the room adjoining to the one in which she lay sick and died, two families lived crowded together. After the death of the patient, none of them deserted the house; and on calling there several days afterwards, we learned that none of the clothes of the deceased had been destroyed, but, on the contrary, that one of the women had washed them with per- fect impunity. Not a single inhabitant in this house nor any person who visited this patient, took the disease. James Kewin was reported sick of yellow fever, on the 8th September, and died on the 15th. He lived in the infected district, where he took the disease, and was afterwards re- moved to No. 8 Thomas-street. It was here that we saw him on the day on which he died. On entering the apartment, we found him with cold extremities, pulse scarcely perceptible, and lying in a state apparently comatose. On speaking to him, however, in a loud tone of voice, he raised himself up, glared his eyes around, and then fell back in his bed without uttering a single sound. About two hours after this he ex- pired. The place in which this patient lay, was a small and confined room, in the rear of another building. He was at- tended by a couple of females, neither of whom took the dis- ease, nor did any of the physicians who attended or visited him. James Macginnis was reported sick of the fever, on the 24th of August, at 123 Greenwich-street, and died on the 25th. During the three first days of his illness, his brother slept in the same bed with him, and afterwards attended him faithfully until he died, without suffering any ill effects. A reverend clergyman, who saw Macginnis frequently in the course of his sickness, escaped the disease, as did also all the physicians in attendance. Mary Morris, reported on the 8th of September, and died on the same day. She had been taken sick in the infected district, but had not been near any person labouring under the disease. She was removed to Desbrosses-street, and lay in a small back apartment, where we visited her. She had a nurse who attended her constantly. Neither nurse, physician, or any other person contracted the disease from this case. 236 YELLOW FEVER. In addition to the foregoing, two persons sick with yellow fever were carried to the New-York Hospital, and died there, and yet neither nurses, physicians, nor any other person, took the disease, although the wards in which they lay were filled with other patients. It would be perfectly easy for us to go on and extend this list of cases to an almost indefinite length; the materials for so doing we have in our possession, collected at the time with every regard to truth and impartiality. We believe it, how- ever, to be unnecessary, and shall therefore merely state,in general terms, that we do not know of a single instance in which individuals lying sick with the disease, in any part of the city, however filthy or uncomfortable, communicated the same to a second person; and we do most sincerely believe that no such case did occur. (b.) In the infected parts of the city. We come now to the infected districts, and notwithstanding Dr. Townsend's attempt to show that the disease was equally contagious under all cir- cumstances, it is here after all, that he makes his principal stand in defence of contagion. It is here in fact that all the contagionists are obliged to take refuge, or abandon their doc- trine altogether. Let us see whether it can be defended with more success here, than in other places. For the purpose of simplifying the subject, we shall first state the question at is- sue. The contagionists assert, that after the first cases of the disease at Rector-street, every subsequent case was the re- sult of some communication with those already sick; and that as cases multiplied, the air itself became so impregnated by the contagious exhalations, from sick bodies,* as of itself to produce the disease in those exposed to it, without immediate or direct connexion with the sick. The non-contagionists, on the other hand, assert that the disease did not spread incon- sequence of any communication with the sick, and that the infection of the district was owing to other causes than ex- halations from those sick of the fever. From tlnVstatement it appears that both agree in one thing, * " It is the sick who infect the air, not the air that infects the sick." Townsend's Account, etc. p. 111. " The air is in no other way infected than by the emanations from the sick." Ibid. p. 111. YELLOW FEVER. 237 viz. that the air in a certain portion of the city, called the " infected district," was actually impregnated with a certain poison capable of producing yellow fever, in those exposed to it, without their having any immediate communication with the sick. This being agreed upon, the only remaining ques- tion to be solved is this: was the poison, so impregnating the air, and producing such effects, an exhalation from the bodies of those who were sick with the fever, or was it not? If it was, then the contagious character of the disease is establish- ed. If it was not, then the disease cannot be considered as contagious. Our reasons for believing that the contamination of the air was not owing to any exhalations from the sick, are the fol- lowing. 1. It has already been shown, that not merely in the pure air of the country, but even in the most impure and unhealthy parts of our city, patients sick of the yellow fever, in 1822, were uniformly approached with, perfect impunity. The air, therefore, in the infected district, must have been much more venomous than the contagious poison itself, coming off direct- ly from diseased bodies. That is, the poison diluted in at- mospheric air, must have been more powerful than the pure, unmixed poison itself. A proposition, absurd in itself, and contrary to all analogy. We infer, therefore, that as the air of the infected district was more deleterious than actual con- tact with the sickj the poison existing in the air must have been some other than effluvia from the bodies of the sick. 2. If the infection of the air depended upon emanations from the sick, then it should have extended pari passu with the sick and the dead. That this was not the case is notorious. That it was not so out of the infected district, is proved by the fact, already established, that no case of communication was known; and that it was not so in the infected district, is equally evi- dent from the circumstance, that the limits of the district were only known and defined from persons being taken unexpect- edly sick, without, in many instances, any sort of intercourse with those already affected. 3. The gradual and measured extension of the limits of in- 238 YELLOW FEVER. fection, proves conclusively that it must have originated from some other cause than contagion. So regular wras this exten- sion, that attempts were made, and with apparent success, to calculate its daily progress. From the point at which it first commenced, it extended very nearly to equal distances in all directions. Can any man, of common reflection, contend that such an effect could follow from patients scattered in different directions ? 4. But what settles this beyond peradventure, is the fact, that by far the largest number of the sick did not lie in the infected district at all. From the official list published by the Board of Health, it appears that in all, not more than about one hundred and thirty lay sick in the infected districts dur- ing the whole of the prevalence of the fever, while about one hundred and seventy-two lay sick in different parts of the rest of the city. As therefore one hundred and seventy-two pa- tients did not infect the air in which they lay sick, it is rea- sonable to conclude, that a less number would not produce such an effect, and therefore that the infection of the district was not owing to the sick. From all these reasons, we conclude, that the infection of the air was not owing to contagious exhalations from the sick, but to some other cause. What this cause was, it is not our business at present to inquire. That it was a gaseous poison, is evident—that it was permanent in its action is also clear from its gradual extension until the appearance of frost. Whence or how it originated, is a question very far from be- ing-settled, the investigation of which we may perhaps take up at some future period. After the general facts and arguments which have been ad- vanced in support of the non-contagiousness of yellow fever, it might be deemed almost unnecessary to urge any thing fur- ther on the subject, were it not to notice one or two argu- ments that have been very largely insisted upon by Dr. Towns- end in defence of the doctrine of contagion. As far as we are capable of analyzing this writer's diffuse method of rea- soning, he appears to rest principally upon the following: First, the fact (as he asserts it to be) of a number of cases YELLOW FEVER. 239 occurring in individual houses; and second, that these cases did not occur simultaneously, but in succession and at deter- minate intervals. In support of the first of these arguments, the following statement is given:—"From whence it appears, that out of about four hundred and twenty-two cases, the total number this season, two hundred and ninety-five, or very nearly two- thirds, occurred in eighty-six houses, all of which were either opposite to or adjoining each other, or contained each from two to eight cases. What is still more worthy of remark, two hundred and seventy-six of the whole number of cases oc- curred in sixty-seven houses, and each one of these sixty-se- ven houses furnished from two to eight cases, and out of these same two hundred and seventy-six cases, one hundred and four died; that is nearly one-half of the whole number of deaths of yellow fever on the records of the Board of Health! This accumulation of cases in particular houses appears in a still more striking light when we call to mind that out of the re- maining one hundred and forty-six cases, which did not occur together in the same houses, sixty-five were persons who re- sided in uninfected parts of the city or in the country, and caught the disease by exposing themselves to those places in the lower part of the city where many persons had sickened. Thus, out of four hundred and twenty-two, the whole num- ber this season, there remain but eighty-one cases which did not occur in the number of more than one or as many as eight in the same house; or, in other words, there were but eigh- ty-one cases which occurred singly in different houses."* Without calling in question the accuracy of this statement we assert that it by no means proves the existence of conta- gion. 1. Because all the eases alluded to occurred in the infected district, where every person was exposed to the same common cause which produced it in the first patient. Under such cir- cumstances, the fact of half a dozen persons sickening in one house does not prove contagion any more than it does their exposure to the same general cause, producing the same ef- * Account of the yellow fever, &c. p, 115. 240 YELLOW FEVER. fects upon each. When, however, it is recollected that in houses where the sick lay in the city beyond the infected dis- trict, no such fact was known to occur, the conclusion is not only legitimate but inevitable, that when it did. occur in the infected district, it was not owing to contagion. 2. Another very satifactory reason why so large a number of cases occurred in a comparatively small number of houses is, that almost all the houses of the district were deserted by their former inhabitants. In some streets not a single one re- mained inhabited; in others, only one or two. It is evident, then, that if any cases occurred at all, they must have taken place in those solitary buildings which were occupied. If this general and almost total desertion of the district had not tak- en place, victims to the disease would have been found with- out difficulty in almost every other house. 3. Because persons inhabiting the same house, from equal predisposition, equal exposure, and similar modes of living, were most likely to be similarly affected by the common poi- son pervading the atmosphere; hence it was to have been ex- pected, if one was seized with the disease, others in the same house would also be liable to it. As to the second argument, viz: that numbers of cases oc- curred in succession, we answer that it does not prove conta- gion: 1. Because, even admitting it to the fullest extent contend- ed for, the simple fact of succession is no test of a disease being contagious. This we think may be proved satisfacto- rily by a very simple and obvious illustration frequently oc- curring. Suppose a person living in the neighborhood of a marsh, is seized with bilious remittent, a disease universally admitted not to tie contagious: he is visited by a friend, who continues with him, and attends upon him during his sickness. In a few days, this friend finds himself beginning to sicken, and is also taken with bilious remittent fever. Now, here we have actual communication with the sick—precisely the same disease reproduced—and the one taken in succession to tne other. What more can be wanting to make out a case of con- tagion? And yet all this apparent proof, conclusive as it ap- YELLOW FEVER. 241 pears, amounts to nothing. It merely proves, that both pa- tients were exposed to the influence of the miasms from the marsh, the common cause producing preciselv similar effects in both. 2. Because the fact of persons taking sick in succession may be explained satisfactorily without resorting to conta- gion. It is admitted on all hands that certain states of the system predispose persons to be acted upon by the poison of yellow fever. The depressing passions have uniformly been considered as producing this effect. Hence cautions on this subject are laid down by almost every practical writer. Now, we cannot imagine any situation more truly depressing, or one more calculated to excite fear and anxiety than that of a family remaining in a pestilential district, and accordingly none more likely to prepare the system for being assailed by the disease. More especially would all this be the case, if one of the members of a family thus situated were taken sick and it would rather be a matter of surprise than otherwise^ if with all these predisposing and exciting causes operating upon them, persons did not take the disease. On these accounts, we think that the fact of persons takino- the yellow fever in succession, even admitting it to the fullest extent contended for, does not prove any thing in favour of contagion. We have now finished what we proposed doing in the com- mencement of this article, which was to present a summary of the facts and arguments which have induced us to believe that contagion had nothing to do in the propagation of the yellow fever as it appeared in this city in the summer and au- tumn of 1822. How we have succeeded, must be left to the judgment and decision of the reader. 21 IV. ON THE USE OF MERCURY IN ONYCHIA MALIGNA. There is a species of Onychia not commonly described in the books, of which Mr. Wardrop of Edinburgh has furnish- ed a very accurate account,* and to which, from the obstina- cy and malignity of its character, he has given the appro- priate name of Onychia Maligna. In the treatment of this affection he remarks, that the only local means which he had found to relieve the patient, were the evulsion of the nail and the subsequent application of escharotics to the ulcerated sur- face. Even this treatment, painful as it is, seldom succeeds, and the patient is after all obliged to submit to amputation. In consequence of the great intractability of this troublesome complaint to the methods in ordinary use, Mr. W. was in- duced to try the effects of mercury given internally. The success of the experiment seems to have been perfect. As soon as the system became affected by the mercury, the ulce- ration assumed a healing appearance, and the bulbous enlarge- ment gradually subsided. Mr. Wardrop concludes his re- marks by stating, that " how far this treatment maybe found successful in all cases of this disease, can only be determined after considerable experience. I am persuaded, however, that there are cases wherein it will be found an efficacious re- medy." Believing the treatment suggested by Mr. W. to be a very valuable and important improvement in relieving a se- rious malady, I have thought it advisable to confirm its safe- ty and efficiency by the record of a few cases which have oc- * An account of some diseases of the toes and fingers, with observations on their treatment. By James Wardrop, Esq. of Edinburgh. (London Medico-Chirurgical Transactions, vol. v.) 244 ONYCHIA MALIGNA. curred in my own practice, and that of some of my friends. I am induced to do this more particularly at the present time, because I have reason to believe that the practice is not ge- nerally known in this city. At any rate, I had the mortifica- tion of finding, not long since, in the case of a little patient whom I was treating in this way, and with every prospect of success, that one of our surgeons who had been consulted without my knowledge, had actually amputated the finger be- fore my next visit! The origin and progress of this disease is so accurately de- scribed by Mr. Wardrop, that I shall make no apology for in- troducing it. " The commencement of the disease is marked by a degree of swelling of a deep red colour of the soft parts at the root of the nail. An oozing of a thin ichor afterwards takes place at the eleft formed between the root of the nail and soft parts, and at last the \ soft parts, begin to ulcerate. The ulcer appears on the circular edge of the soft parts at the root of the nail; it is accompanied with a good deal of swelling, and the skin, particularly that adjacent to the ulcer, has a deep purple colour; the appearance of the ulcer is very unhealthy, the edges being thin and acute, and its surface co- vered with a dull yellow or brown-coloured lymph, and at- tended with an ichorous and very fetid discharge. The growth of the nail is interrupted; it loses its natural colour, and at some places appears to have little connexion with the soft parts. In this state," he adds, "I have seen the disease continue for several years, so that the toe or finger became a deformed bulbous mass. The pain is sometimes very acute, but the disease is more commonly indolent, and accompanied with little uneasiness: this disease affects both the toes and the fingers. I have only observed it on the great toe, and more frequently on the thumb, than any of the fingers. It occurs, too, chiefly in young people, but I have often seen adults affected with it." Of the cases which have come to my knowledge, four were of the age of ten years or under, and one of the age of twen- ty-three. In one case the disease affected the thumb; in a second the great toe, and in the remainder the fingers. In ONYCHIA MALIGNA. 245 no case have I found the patient to complain of much pain. This is a very peculiar circumstance in a disease of so malig- nant a character; and it may be looked upon as a diagnostic sign between it and the common forms of onychia. Case I. Decatur Frazer, a boy ten years of age, in July, 1821, ran a small splinter, by accident, under the nail of the right thumb; in a few days the parts about the root of the nail assumed a livid colour, and at the same time began to swell, and afterwards to ulcerate. From this time the swell- ing gradually increased, and the discharge became more co- pious and offensive. In this state it Continued until about the beginning of January, 1822, a great variety of local applica- tions having been made in the mean time, without the slightest advantage. At this time the little patient was placed under the care of my friend, the late Dr. James Kent Piatt, Pro- fessor of the Institutes of Surgery in the University of Ver- mont. The extremity of the thumb had assumed a bulbous appearance, and was about double the natural size. The nail had separated in the middle and was quite loose. The matter discharged from the ulcer was thin and extremely offensive; so much so as to require frequent dressings during the day. There was no pain complained of, except a slight sensation of it whenever the ulcer was cleansed and dressed. Judging it to be a case in which mercury might prove serviceable, the blue pill was commenced with. Several of these were taken, but from the negligence of the parent of the boy, without any regularity. No effect was produced upon the gums, and no improvement visible in the appearance of the thumb. Dr. Piatt being obliged to visit the West Indies for the benefit of his health, I was requested to attend the patient. I continu- ed him under the use of the blue pill for a few days, but with- out any apparent advantage. The mother now became im- patient, and declined giving any more mercury for the pre- sent. After an interval of five or six weeks I resumed the use of mercury in the form of pills composed of calomel and opium in the proportion of one grain of the former to one- eighth of a grain of the latter, three times a day. In about ten days the mouth became affected, and a pretty free saliva- 21* 246 ONYCHIA MALIGNA. tion ensued. Almost instantaneously upon this effect being produced, the ulcer put on a different appearance. In a few days the discharge from it ceased completely, and in about three weeks the whole had healed, and the swelling almost entirely subsided. Between two and three months after thi? a new nail had grown out, and the thumb has remained heal- thy and sound to the present day. Case II. James Reden, aged six years, has onychia maligna on the second finger of the right hand. The end of the fin- ger is much enlarged beyond the natural size; has a bulbous shape, and around the ulcer, is of a livid shining appear- ance; the nail is loose and the ulceration around it discharges large quantities of fetid matter. The mother supposed it to be owing to the finger being caught in a door. Five weeks af- ter the injury, it began first to inflame around the root of the nail, and the extremity of the finger to swell. There had been no pain in it from the beginning, except when irritated by dressing, &c. Poultices and otber local applications had been used to no purpose. In this situation it had remained three months, when application for advice was made at the Dispensary. At my suggestion, Dr. Torrey, to whose dis- trict the patient belonged, began the administration of calo- mel and opium, with the view of producing salivation as spee- dily as possible. As large doses as the child could bear were accordingly given; in three days the gums were affected, and in three or four days after this the discharge ceased and the ulceration began to heal; the swelling also, gradually subsid- ed, so that in three weeks it was of the natural size, and at a still later period the nail began to grow. The mouth was kept sore in this case about a fortnight. Case III. In consequence of the success attending the pre- ceding case, Dr. Torrey was induced to have recourse to it in a lady aged about twenty-three, who was troubled with this form of onychia on the great toe. In this case the disease seems to have arisen spontaneously—at least without any known cause. As in the other cases, the ulceration commenc- ed at the root of the nail, and gradually extended around and under the nail, and discharged large quantities of offensive ONYCHIA MALIGNA. 247 matter. The toe became very much enlarged in size, and had the bulbous appearance. There was but little pain expe- rienced except in walking. In this condition it had remained about five or six months, during which period poultices and cerates had been very liberally applied. The patient was now advised to commence the use of mer- cury. She accordingly took the blue pill, until her mouth became slightly affected by it; the toe assumed at once a dif- ferent appearance; diminished in its size, and began healing rapidly. As, however, the affection of the mouth had been extremely slight, and the patient had immediately desisted from the use of the mercury, the disease returned again in a few weeks pretty much in its original form and appearance. After an interval of about a month, mercury was again ad- ministered, and with precisely similar results. Owing to the prejudices and inattention of the patient, the mercury was again suspended, as soon as the least tenderness was felt in the gums; while this continued, the amendment in the toe was as prompt and decided as before, but as this soon subsided the disease again returned. Convinced of the efficacy of the treatment from the relief which she had experienced, as well as of the necessity of con- tinuing the mercury longer than she had done, the patient now submitted herself entire to the direction of her physician. Mercury was again used until slight salivation was produced which was continued until the disease was completely remov- ed. No symptom of it has returned to this day. The whole continuance of the affection in this case was about nine or ten months. Case IV. Mary Bolan, aged five years, has onychia on the first finger of the left hand; the nail came out about two months previously to her applying for advice; the extremity of the finger is of a livid colour, and much enlarged; the site of the nail is ulcerated and discharging offensive matter. In this case mercury in the form of blue pill was given, until the gums were affected, when the discharge was arrested and the ulcer healed. 248 ONYCHIA MALIGNA. Case V. E----M----, aged ten years, ran a needle into the extremity of the second finger of the right hand, which at the time caused profuse hasmorrhage, and afterwards de- generated into onychia maligna. The end of the finger was very much enlarged, the discharge from the ulceration copi- ous and very offensive, unattended by any pain. In this state the finger had remained for several months, without being at all improved by a great variety of local domestic applications. On coming under my care, I put her immediately upon the use of the blue pill, which she took for eight or ten days. Before, however, the gums were affected, the mother became impatient and hurried away without my advice or knowledge to a surgeon of this city, who immediately relieved the pa- tient by amputating the finger! From the very exact resemblance which this case bore to the other cases, which I had seen cured by mercury, I cannot entertain the smallest doubt that the disease would have yield- ed immediately upon salivation being produced. The foregoing cases, -together with those recorded by Mr. Wardrop, seem to me to furnish very conclusive evidence in favour'of the mercurial treatment of this disease. To ensure success, however, the remedy must be properly administer- ed. Judging from what I have seen, the rule necessary to be observed is, to affect the mouth, and to keep up this ac- tion until the cure is completed; unless carried to this point I have never seen any good effects from the use of mercury in this complaint. With regard to local applications, little need be said. In a majority of the cases just related, the ulcers were merely cleansed with soap and water, and dressed with simple oint- ment. In one case the yellow wash was used, and with ad- vantage. It may not be improper to state that in one of the preceding cases, the patient had previously submitted to the excision of the nail, and afterwards to the application of caustic. This painful operation was performed twice, unattended, how- ever, by any benefit. V. HISTORY OF A CASE OF ULCERATION AND PERFORATION OF THE STOMACH, WITH OBSERVATIOXS. Ix- the month of January, 1820, I was requested to visit Mrs. P----, aged sixty years, who 1 learned had been ill for some months previously. I found her laboring under very decided sytntoms of hydrothorax, together with oedema of the lower extremities. The difficulty of breathing was so great, as to render the recumbent posture utterly impractica- ble. She complained of no pain or uneasiness in the region of the stomach, and was not troubled with nausea or vomit- ing, although her appetite had in a great measure left her. From the hopeless condition in which the patient was found, it was evident that nothing could rescue her from speedy dis- solution. Some medicine, however, was ordered, which she took very readily, and retained on the stomach, as she did also all her drinks and nourishment. No relief was obtained, and she died in a few days after I first saw her. Dissection. Leave being obtained, my friend, the late Dr. James K. Piatt, and myself, opened the body on the morning succeeding the day of the patient's death. In the chest were found traces of considerable previous disease. Extensive adhe- sions of the pleura to the parietes of the chest had taken place. The extremity of the left lung was indurated, and instantly sunk on being put into water. Within the pericardium and in the cavity of the chest nearly a quart of fluid had been ef- fused. On opening the abdomen, the liver was found in a perfectly sound condition, as were also the pancreas and spleen. Greatly to our surprise, the stomach was discovered 250 ULCERATION AND PERFORATION to be the seat of very striking and interesting morbid chan- ges. The whole of the inner surface of this organ presented a highly florid and vascular appearance, and along the lesser curvature there were five ulcers, one of which, situated about midway between the cardia and pylorus, had penetrated quite through the different coats of the stomach, and formed a cir- cular hole of about the size of a shilling. The remaining four ulcers were of various sizes, not differing much, however, in this respect, from the one just described. The edges of the ulcers were a good deal thickened, and very smooth. This was more especially the case with the one which perforated the stomach. All of them were surrounded by the vascular appearance already mentioned as characterizing the inner coat. None of the contents of the stomach had escaped into the abdomen. That this had not taken place is to be ascribed entirely to the situation of the perforation. The stomach it- self was found to contain about a pint of fluid. It will readily be imagined that the morbid appearances just described were wholly unexpected, as I had not been aware that any symp- toms of a diseased state of the stomach had beep betrayed before death. With the view, however, of obtaining more accurate information on this point, I inquired minutely into the previous history of the patient, and ascertained that she had been asthmatic, but that she had never complained of pain or uneasiness in her stomach; had never been troubled with vomiting; and that her appetite had remained tolerably good until three or four weeks of her death. OBSERVATIONS. Ulcerations of the stomach similar to those which have just been recorded, although not wholly unnoticed by preceding writers, are of so rare occurrence, that their symptoms and causes are as yet very imperfectly understood. Even Dr. Baillie, who has described with graphic accuracy the morbid appearances peculiar to them,* is by no means so full and satisfactory in his account of the symptoms as could have * The Morbid Anatomy of some of the most important parts of the Human Body, by Matthew Baillie, M. D. F. R. S., p. 90, American edition. OF THE STOMACH. 251 been wished. There is one circumstance especially connected with their history which he has failed to notice; and this is, that they may frequeutly go to the length even of perforating all the coats of the stomach without having the fact betrayed by a single symptom. The case which I have just recorded proves this in a very striking manner. There was certainly no evidence present before death of any diseased condition of the stomach, and the death of the patient was entirely owing to the dropsical affection of the chest. There is every pro- bability, too, that had she not fallen a victim to this latter disease, she might have lived a considerable time longer, not- withstanding the ulcerations in her stomach. The same gene- ral fact is confirmed by the history of several other cases found on record. That accurate observer, Dr. Pemberton, states that he has often been surprised to find very extensive mischief in the structure of the stomach, without the constitution being sen- sibly affected by it, provided the mischief was so situated as not to interrupt the passage of the food. In confirmation of this, he relates that he had seen a large schirrus in the sto- mach, near the pylorus, with an open cancer in one part of it, which had made its way through the stomach, and through the left lobe of the liver; and an adhesion had taken place between the sides of the abcess and the peritoneum; so that, he adds, "had not the patient been taken off by disease in the aorta, I have no doubt but that this abcess would have made its way out through the integuments of the abdomen. Still, however, though this must have been a disease of very long standing, the body was but little emaciated, and the patient had never shown any symptom by which such a disease of the stomach could possibly have been suspected."* Dr. Crampton, Professor of Materia Medica in Dublin, has favoured us with the history of another case of ulceration of the stomach, succeeded by perforation and the subsequent ef- fusion of the contents of the stomach into the cavity of the abdomen. The patient was suddenly seized with severe pain in her stomach, succeeded by the most agonizing pains in the * Practical Treatise on various diseases of the Abdominal Viscera, p. 129, Am. Ed. 252 ULCERATION AND PERFORATION whole abdomen. These continued without the least abate- ment until the moment of her death, which took place a very few hours after her first seizure. On dissection, there were found decided evidences of inflammation throughout the whole peritoneum, excited unquestionably by the escape of the con- tents of the stomach; and to this cause must the death of the patient be attributed. From the appearance of the perforation in the stomach, and other attending circumstances, it seems certain that the disease must have been of some considerable continuance; and yet there do not appear to have been any marked symptoms present by which it could have been de- tected. All that we are told of her previous history, is, that '•'she had been subject occasionally to pain in the stomach, as well as in both the hypochondria, but that they generally gave way to medical treatment of a few days."* To the case of Dr. Crampton, Mr. Travers, of London, has added two or three others, confirming very strikingly the same general fact, In all of the cases related by this gentleman, the patients fell victims to the peritoneal inflammation excited by the effusion of the contents of the stomach; and in every instance, with a single exception, had they enjoyed good health until this effusion took place. I am aware that it may be ob- jected, that as there is no positive evidence of any previous organic derangement, the perforation or rupture of the stomach may have taken place suddenly, without any antecedent ul- ceration. This explanation, however, is inadmissible. The absence of any adequate cause to produce such a sudden rup- ture of a healthy stomach, in the cases which have been re- ferred to, as well as the appearances of the ulcers and per- forations themselves, render this supposition wholly untenable. Nothing but the existence of a slow and protracted ulceration can at all account for these phenomena. That such ulceration does take place, and that it is followed by the consequences just mentioned, we have the very best possible evidence, even independent of that already adduced. Mr. Benjamin Gooch, in his Chirurgical Works, details the particulars of a very extraordinary case, in which an opening * Medico-Chirurgical Transactions of London, vol. 8, p. 228. OF THE STOMACH. 253 was made into the stomach, as the result of a slight external injury received twenty years before. After receiving the injury, it is stated that the patient had transient wandering- pains in the epigastric region, but never violent. In this state she remained ten years, when she was seized with an acciden- tal fever, during the continuance of which the pains increased, and a small flat tumour appeared over the bottom of the sto- mach, without, however, any external inflammation or throb- bing, and unattended with any pain upon pressure. At this time she had no complaint in her stomach. When the fever left her, she regained her former health, and continued ten years longer with very slight pains in the stomach and abdo- men, but never to such a degree as to be troublesome. At the expiration of that period, she was again attacked with fever, when the tumour became inflamed and enlarged, and finally burst, discharging through the opening the contents of the stomach. After this, she was well enough to go about her ordinary business—"food agreed with her stomach; she had no sickness," and was not costive. She lived several months after this, and died of fever, brought on by an imprudent ex- posure to cold. On dissection, the stomach, around the orifice, was found adhering to the peritoneum; and by this kind pro- vision of nature, the contents of the, stomach were prevented from falling into the cavity of the abdomen.* Dr. Male, of Birmingham, relates the case of a female, aged fifteen, who' had been complaining for two or three days, of slight pain in the bowels, when she was suddenly seized with symptoms of enteritis. Her countenance was pale and ghast- ly; pulse 150; bowels costive, &c. She expired in a few hours after the attack. On opening the body, appearances of general inflammation were found in the abdomen. " The sto- mach was empty, and appeared partially inflamed; and in the superior part, near the cardia, was a foramen, nearly circular, about three quarters of an inch in diameter, perfectly smooth and regular; it had not at all the appearance of having been eroded by the gastric juice, or of being the effect of recent in- flammation. On the opposite side of the same organ was an- * Gooch's Chirurgical Works, vol. iii. p. 163. 22 254 ULCERATION AND PERFORATION other foramen, nearly of an oval form, not quite half an inch in length, which, however, did not perforate the external coat of the stomach, but had apparently formerly done so, and afterwards became closed, and the edges united by a cicatrix; the other parts of the stomach were perfectly sound." Dr. Male states, that on inquiry, he found the patient had an attack of gastritis and enteritis about four years previously, since which she had been troubled with occasional pains in her stomach.* From an analysis of the foregoing cases, as well as a few others which are upon record, I think we may deduce the fol- lowing conclusions: (a.) That the peculiar ulceration of the stomach, just de- scribed, is very slow in its progress. (b.) That it is frequently unattended by any symptoms in- dicative of its existence.! (c.) That of the symptoms mentioned by Dr. Baillie, " pain or an uneasy feeling in the stomach," is the only one usually present; and that vomiting seldom occurs. (d.) That with the exception of the ulcerated portion, the stomach is generally found healthy. (e.) That no immediate danger to the life of the patient, at- tends simple ulcers of the stomach. (/.) That where death does ensue, it is generally the result of peritoneal inflammation, excited by the ulceration having perforated the stomach, and the subsequent effusion of the contents of that organ into the cavity of the abdomen. When this event takes place, no hope is left for the patient. Death seems inevitable. The symptoms attending this state, are very well described by Mr. Travers, and are the following: 1. Sudden, most acute and unremitting pain, radiating from the scrobiculus cordis, or the navel, to the circumference of the trunk, and even to the limbs. " I may add," says he, " a peculiar pain, though I know not how to describe the pe- * London Medical and Physical Journal, vol. xiii. p. 1G4. X The whole account given by Dr. Baillie of the symptoms, is the following " I have reason to believe that ulcers of the stomaeh are often slow in their progress. They are attended with pain or an uneasy feeling in the stomach, and what is swal- lowed is frequently rejected by vomiting. Pus and blood are likewise occasionally thrown up by vomiting." (Morbid Anatomy, p. 97.) OF THE STOMACH. 255 culiarity. Its intensity, like that of parturition, absorbs the whole mind of the patient, who, within an hour from the en- joyment of perfect health, expresses his serious and decided conviction, that if the pain be not speedily alleviated, he must die. 2. " Coeval with the attack of pain, remarkable rigidity and hardness of the belly, from a fixed and spastic contraction of the abdominal muscles. 3. " A natural pulse for some hours, until the symptoms are merged in those of acute peritonitis, and its fatal termination in the adhesive stage."* The causes of these ulcers are enveloped in much obscurity. Indeed, in most of the cases, there are none to which they can be referred. In a few instances only have they been traced. 1. External injuries, as blows, &c. upon the region of the stomach. In the case of Mr. Gooch, already recorded, there can be no doubt that this was the cause, although the injury was received twenty years before. As there was no external appearance of inflammation in this instance, it is probable that the stomach was primarily affected by the injury received; but it is impossible to determine whether the peritoneal or mu- cous coat was first affected.. At any rate, however, it makes us acquainted with a possible consequence of slight external injuries about the region of the stomach, of so serious a cha- racter, that every possible precaution should be adopted to obviate their effects.t 2. Previous disease of the stomach. In the case of Dr. Male, already related, an attack of gastritis, four years before, seems to have been the only assignable cause. 3. The accidental introduction of some poisonous substance into the stomach. I am not positive that this has actually been * Medico-Chirurgical Transactions, vol. viii. p. 244-5. t By Dr. Ebermaier, a case is related of a man fifty years of age, who had com- plained every two or three months for the last five years of his life, of pains in the abdomen. He died suddenly. On dissection, a hole, the size of a two franc piece, with callous edges, was found in the right anterior surface of the stomach. Five years before the commencement of the symptoms under which he labored, he had re- ceived a blow from the pommel of a saddle on the epigastric region. (American Jour- nal of Medical Sciences, vol. 3, p. 454.) 256 ULCERATION, etc. OF THE STOMACH. a cause of ulceration in the stomach, although it is more than probable. Dr. Pascalis records a case of perforation of the stomach, with which it appeared that the patient had lived five or six years. On dissection there was discovered a large aper- ture, of the size of a dollar; and in the cavity of the stomach a large tumour, formed by several branches or roots, proceed- ing from the internal edge of the aperture in the fundus, and lined with a strong membrane, resembling the villous coat of the stomach. Dr. P. informs us that the patient was a pain- ter and glazier by trade, and must have been exposed to the accidental introduction of arsenical or other deleterious mat- ters into the stomach.* 4. Improper and stimulating food, as well as the too fre- quent use of certain medicines, may doubtless in some instan- ces have caused it, although I have not met with any particu- lar case in which it could be traced to this source. Cases like the preceding are interesting and important, not only in a pathological point of view, but in their relations to medical jurisprudence. Appearances like those which have been described, may be confounded with the effects of poisons, and their diagnosis may become therefore a problem of the highest moment—involving character and even life. On this point, however, it is not my intention, at present, to enlarge. It has been discussed by writers of acknowledged authority, and to these I must refer the reader.f * Medical Repository, vol. xviii. p. 287. t Considerations Medico-Legales sur les erosions et perforations spontanges de l'es- tomac. Par G. Laisne. Paris, 1819. A Treatise of Poisons, by Robert Christison, M.D. &c. p. 106. Elements of Medical Jurisprudence, by T. R. Beck, M.D. and J. B. Beck, M.D., in the chapter on Poisons, by T. R. Beck, M.D. vol. 2, p. 273, 5th edition. INDEX. Page. I. On Infanticide,.................................... 7 Part I. History of Infanticide as it has prevailed in different nations, ancient and modern,.................................... 7 Part II. Of Infanticide in its relations to Medical Jurisprudence,...... 24 Of the murder of the foetus in utero, or criminal abortion, .............. 24 The period of gestation when a child ought to be considered as alive, .... 24 Signs of abortion deduced from an examination of the female,........... 29 Cases in which the abortion is accompanied with the death of the female, 35 Hydatids and moles considered as occasioning all these signs,............ 40 Signs of abortion deduced from an examination of the substance expelled from the female, ............................................... 43 Modes in which criminal abortion is perpetrated,............ ........... 47 Involuntary causes of abortion,....................................... 65 Circumstantial evidence, .... ....................................... 66 Of the murder of the child after it is born alive,..................•..... 67 Capability of a child's sustaining life after it is born,.................. 68 Proofs of the child's having been born alive,........................... 68 Proofs drawn from the blood having circulated,......................... 68 Difference of the blood of the foetus and of the child after birth,.......... 69 Pecuharities of the organs circulating the blood in the foetus — the foramen ovale — the ductus arteriosus — the ductus venosus — the umbilical vessels — the cord, .................. ,........................ 71 Difference in the distribution of the blood — in the lungs — in the liver,... 85 Ecchymosis or extravasation of blood,................................ 94 Proofs drawn from the child's having respired, ..................,...... 96 Configuration and size of the thorax,.................................. 96 Volume of the lungs, ................. ............................. 97 Relative situation of the lungs, ..................................... 98 Shape of the lungs,................................................ 98 Colour of the lungs,.................................................. 99 Consistence of the lungs, ............................................ 99 Specific gravity of the lungs—hydrostatic test—consideration of objections to it,......................................................... 100 Rules for applying this test,......................................... 125 State of the diaphragm and bladder—meconium,........................ 126 General deductions,.............................r.................... 128 Modes of perpetrating infanticide,..................................... 129 Accidental modes in which a child's life may be lost,.................. 140 Congenital malformations,............................................ 145 Congenital diseases,.............................................. 148 Circumstantial evidence,............................................ 152 Method of conducting examinations in cases of infanticide, ............ 154 Cases and illustrations, ............................................. 157 258 INDEX. Part III. Of Infanticide in its relations to Medical Police,............ 164 Laws against it, .................................................... 165 Foundling Hospitals, ............................................. I'? List of American and British cases,.................................... 183 II. On Acute Laryngitis,.............................. 185 History, ......................................................... 186 Symptoms....................................................... 191 Appearances on dissection, ........................................... 196 Causes,.............................. ....................•......... 197 Diagnosis, ........................................................ 199 Treatment,....................................................... 201 Cases............................................................ 209 III. On the Non-contagiousness of Yellow Fever,......... 219 IV. On Onychia maligna,............................. 243 V. On Ulceration and Perforation of the Stomach,........ 249 ERRATA. e 26, line 20, for encourage read discourage. 68, 15, for ten read centre. 75, 25, for it read life. 136, 27, insert almost before invariably. 151, 7 from bottom, for variosus read venosus. 228, 11, for exaplanation read explanation. f ■ ■ y- < "***w KA -At . ■f: -<} ■ ,,:f oi