§ 84. Signs of abortion during the life of the patient.

The common signs and symptoms of a recent natural delivery of a living child would for the most part usually exist in case of abortion, especially if the abortion occurs during the later periods of gestation. Where the question of delivery is presented, as in case of suspected child-murder and concealment of birth, constituting infanticide and consequently murder, the certainty with which the question may be determined by a medical expert will largely depend upon the time that has elapsed since the birth of the child: See 4 Field's Lawyers' Briefs, §§ 121– 123. "If the examination be conducted within the week, most of the following symptoms will be present; but if delayed much beyond a week or ten days, the evidences of recent delivery. will, at best, be of a somewhat indefinite character:

"1. The pulse will be a little quickened, and more than usually soft and compressible.

"2. A peculiar expression of countenance, a dark areola under and around the eyes, and a peculiar odor.about the body will be observed; the skin is usually moist, soft and relaxed.

"3. The breasts are almost certain to contain milk, and to show the areola, pigmentation and follicles already described. They will be tender and knotty, and the nipples more than usually prominent. The character of the milk should be examined. The first milk, or colostrum, is yellower, richer in salts, and of higher specific gravity than the milk afterward secreted. It also contains an enormous number of granular corpuscles, like the so-called exudation corpuscles. With reference to the silvery streaks on the breast, whilst we admit that they may indicate a previous pregnancy (or, to speak more accurately, a previous distension), it is certain they do not prove recent delivery.

"4. The skin of the abdomen will be found flaccid, and in many women thrown into folds. Numerous shiny, silvery, riband-like streaks, or cicatrices, due to atrophy of the skin, following a stretching of the integuments, may be seen on the abdomen and also on the thighs. There will probably be noticeable the dark line observed during pregnancy, passing from the navel to the pubes, whilst sometimes the muscles are separated by the median line.

5. On passing the hand downwards, or pressing it firmly over the pubic region, the enlargement of the uterus will be apparent, often remaining the size of a cricket ball for a considerable time after pregnancy. In health the involution of the uterus takes from fourteen to twenty-eight days, although in some cases (sub-involution) many weeks or months elapse before it is complete. The womb, it is to be remarked, is often felt to incline to one side.

"6. By vaginal examination the os uteri will be found gaping. Two or three fingers may be passed into it with ease, and its margins will probably be found fissured and torn. By sound, the increased depth of the uterine cavity may be ascertained.

"7. We may find the lochia exuding from the uterus. The lochial discharge is at first colored with blood, but afterwards becomes green or brown (green waters). After a week the lochia may be absent.

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8. The perinæum will in all probability exhibit more or less recent laceration, whilst the vagina and uterus will present a dark and almost bruised appearance: Tidy's Leg. Med. (1st Am. ed.) 78.

We now pass directly to the symptoms and indications of miscarriage or abortion, as manifested by the woman during life, and within a short time after the occurrence of the same. But before these signs and indications are considered it may be remarked: First, that if the symptoms hereafter mentioned occur during the earlier periods of gestation, they are at most of an exceedingly evanescent character, whilst it is fairly open to question whether they are not as a rule entirely absent; and, secondly, that some if not all of the symptoms named may be simulated by menstruation.

Mr. Tidy, in his valuable work on Legal Medicine, in presenting the signs of abortion, observes: "The signs of abortion in the living are commonly stated as follows:

"A relaxed condition of the vulva and passages, patulousness of the os uteri, the presence of a lochial secretion in the earlier stages, and a white mucous secretion at a later period, accompanied by that characteristic acrid smell common to puerperal women. The distension of the breasts. yielding a flow of milk on pressure, with a fullness and knotty feeling for a short time after

aborting, are also observable. A general anæmic appearance from loss of blood, with sunken eyes, will be noticed. A peculiar excitement of the pulse, with dryness of skin, is also invariably present. A speculum may be needed to see the lacerations of the os uteri, but as a rule they may be felt by the finger. It will, of course, be of primary importance to remark on all the signs of violence to uterus or vagina; also whether there be an excessive inflammatory condition of the genital organs. Further, all marks on the body of a female which may indicate general violence for the purpose of effecting the object in view, should be carefully recorded.

"If an abortion occurs naturally at an early period of utero-gestation, the signs usually found may be very slight or even altogether absent. After the third month the insertion of the placenta may be detected by a rough place on the inner uterine wall. In making a post mortem care is necessary in removing the utcrus and laying it open, as if there be a wound it may be suggested that it was made during the post mortem. The specimen itself should refute the charge. Punctures, lacerations and incisions in the uterus and con