9. Paternity and Affiliation.—These are often matters of great doubt. A considerable time may elapse between the absence or death of a father and the birth of his reputed child. As has already been said, three hundred days is the utmost limit to which physiologists would extend the period of utero-gestation. This subject involves questions respecting children born during a second marriage of the mother, posthumous children, bastardy, and alleged cases of posthumous children.
10. Presumption of Survivorship.—When two or more persons perish by a common accident, when a mother and her new-born child are found dead, and in a few analogous cases, important civil rights may depend upon the question which lived the longest; and great ingenuity has been displayed in elucidating the disputes which have arisen in the law courts in such cases.
11. Maladies exempting from Discharge of Public Duties frequently demand the attention of the medical man. He may be called upon to decide whether a man is able to undertake military or naval service, to act as a juryman without serious risk to life or health, or to attend as a witness at a trial.
12. Feigned and Simulated Diseases often require much skill and caution in order to detect the imposture.
13. The Signs of Death.—The determination of the actual existence of death assumes a certain importance in tropical countries, where the necessity for speedy interment may involve a risk of burial alive. Such an accident cannot well occur where a medical man confirms the existence of death, and in the United Kingdom, where burial rarely takes place before the lapse of forty-eight hours, such changes usually occur in the body as to render any error practically impossible. Within a varying period, usually not more than twelve hours, the body becomes rigid, owing to the development of rigor mortis or post mortem rigidity. The blood, which during life is equally distributed throughout the body, gravitates to the most dependent parts and develops a discoloration of the skin which is known as post mortem lividity or post mortem staining. At a variable period of time, dependent on the cause of death, also the temperature and moisture of the air to which the body is exposed, decomposition or putrefaction sets in. These changes after death are of great importance, not only as affording certain proof of death, but also because they furnish valuable information as to the probable time at which it occurred, and from the fact that they may alter or destroy evidence as to the cause of death.
14. Insanity or Mental Alienation.—A medical man may be required to give evidence in any of the law courts, civil, criminal or ecclesiastical, before commissions de lunatico inquirendo, or before a magistrate, as to the sanity or insanity of an individual; and he may have to sign certificates of unsoundness of mind with the view of providing for the safe custody and proper treatment of a lunatic. Hence he must be familiar with the chief forms of insanity (see Insanity), and be able to distinguish and treat each of these. He will also be required to detect feigned insanity, and to examine persons charged with crime with the view of preventing real lunatics from being treated as criminals.
II.—Injuries to the Person
1. Defloration.—The signs of defloration are obscure and uncertain; and it is rather by the coexistence of several of the usual marks than the existence of any one sign, that any just conclusion can be arrived at.
2. Rape.—This crime consists in the carnal knowledge of a woman forcibly and against her will. The proofs of rape apart from the consistency of the woman's story, mainly depend on the presence of marks of violence, stains, &c. In all charges of rape, the woman and her assailant should be examined as soon as possible by a medical man, but such examination, it is important to remember, can only be carried out with the free consent of the party to be examined. It is to be noted that according to English law the slightest degree of penetration is sufficient to constitute the crime of rape.
3. Mutilation.—This may consist in the cutting or maiming of any member; castration is the most important, and perhaps but rarely effected as a crime. Self-mutilation, giving rise to false accusations, is occasionally resorted to.
4. Criminal Abortion.—This crime consists in unlawfully procuring the expulsion of the contents of the gravid uterus at any period short of full term. It must be noted that while this definition may be held to recognize the induction of premature labour by medical men in certain circumstances, yet, when the operation is necessary, a medical man should always protect himself from possible misconstruction of his action (i.e. criminal intent) by having a consultation with another practitioner. The means employed in criminal abortion to procure the desired result may be classed under three heads: (1) general violence to the body, (2) administration of drugs supposed to have abortifacient qualities, (3) instrumental interference with the contents of the uterus. Among the drugs frequently employed for the purpose, although by no means always successfully, are ergot, strong purgatives, iron, rue, pennyroyal, savin.
5. Homicide.—The legal sense of the term homicide excludes such injuries as are the result of either accident or of suicide. It embraces murder or wilful homicide, manslaughter or culpable homicide, casual homicide, and justifiable homicide.
Ordinary homicide may be accomplished by several modes that may sometimes be ascertained by examination of the body, e.g. poison.
As a preliminary in all cases of homicide, it is the duty of the medical jurist in the first place to ascertain the fact of death, and to distinguish between real and apparent death; and then to determine, if possible, the period at which death took place.
Infanticide, or child murder, is by the British law treated with the same severity as the murder of an adult. Indeed infanticide as a crime distinct from murder has no legal recognition. Practically this severity defeats itself, and hence an alternative charge of concealment of birth in England, or concealment of pregnancy in Scotland, is usually preferred in such cases.
The iniquity of the old law which threw the onus of proof of stillbirth on the mother now no longer exists, and the law demands strict proof of live-birth at the hands of the prosecution. Hence the subject involves nice points of forensic medicine. The child must be proved to have arrived at the period when there was a probability of its living (proof of viability); and as the establishment of respiration is necessary to prove live-birth the evidences of this act must be carefully investigated. The size and position of the lungs, and the state of the vessels concerned in foetal circulation, must be carefully noted. The foetal lungs are dark, dense and liver-like in appearance and consistence, and sink when immersed in water; whilst the fully respired lungs are rosy, marbled, and soft and crepitant when handled. Minor degrees of respiration are recognized by the appearance of little groups of dilated air-vesicles, and by the fact that, although the lungs as a whole may sink in water, certain portions of them, into which respired air has penetrated, float in water even after subjection to firm pressure in the hand. Care must be taken, nevertheless, to exclude buoyancy of the lung due to putrefaction; in this case the air may be expelled by gentle pressure, and the previously buoyant portion of lung now sinks in water. It is impossible, however, to distinguish certainly between a lung naturally inflated and one artificially insufflated.
It must be borne in mind that, although live-birth cannot be affirmed in the absence of signs of respiration, the presence of these signs is not proof of live-birth in the legal sense of the term. The law demands for live-birth a separate existence of the child after delivery; and breathing may take place whilst the child is still either wholly or partially within the maternal passages, and in some special cases whilst still within the uterus itself.
When proofs of respiration—it may be to such an extent as to leave no doubt as to live-birth—have been found, the cause of death is then to be investigated. Wounds, and other forms of injury, must be sought for. There may be signs of strangulation, suffocation, puncture of the fontanelles and consequent injury to the brain, the administration of a poison, or other means of procuring death. It must be borne in mind that some of these causes may be brought about by omission, or even by accident. Thus strangulation may arise from natural and unrelieved pressure of the navel-string on the neck of the child; suffocation from immersion of the face of the child in the maternal discharges, or by pressure of clothes on the mouth. Death may result from haemorrhage through neglect to tie the navel-string, or the infant may perish from exposure to cold.
In the case of exposed infants it is important to ascertain the real mother. As such exposure usually takes place soon after birth, comparison of the age of the infant with the signs of recent delivery in the suspected mother is the best method of proving the relation.
