PROLONGED RETENTION OF LIFE BY 
INFANTS STILL-BORN. 
CASIiIS 
READ BEFORE THE WASHINGTON OBSTETRICAL AND 
GYNECOLOGICAL SOCIETY. 
BV 
JAMES S. BEALE, M. D., 
OF 
WASHINGTON, D. C. 
Judd & Detweiler, Printers, Case 1. December 5, 1870, Mrs. C., called at 2A.M. to 
see woman twenty years old, who was hooding away; when 
I reached the house nurse said madam was delivered of dead 
twins at 121 exactly. 1 found woman in dying condition, 
and she expired in few moments. Before leaving I asked 
where the babies were, and nurse said : “ Oh, they were both 
born dead, and so I put them in a bucket, and out in the 
shed, because they smelt so bad ; they had been dead a week.” 
1 brought the bucket in the house and examined the babies, 
one was quite dead, the other feebly respiring ; 1 used every 
effort without avail to restore the child, although at first I 
hoped I might succeed. Now, this child was in the bucket 
for probably three hours, and if the respiration had been 
even noticeable, the nurse would have wrapped the child in 
blankets, and made some effort to keep it breathing. It 
may not be out of place to state, one of the umbilical cords 
measured thirty-nine inches in length, and was very small, 
while tlie other was scarcely six inches. 
Case 2. October 12, 1873, Mrs. H., aged 28 years, first 
pregnancy, after eight hours hard labor, delivered male 
child, weighing ten pounds, great haemorrhage, which fol- 
lowed delivery, so engaged my attention that the child, which 
1 thought dead, remained unattended in a chair without cov- 
ering for at least eighteen ninutes. After fixing the patient 
as well as I could, I turned to the infant, which appeared 
quite cold, drew the tongue forward and cleared out the 
fauces, and pressed upon the chest, used cold and hot water 
for some minutes alternating, when, to ray astonishment, a 
slight inspiration was made. I could detect no heart pulsa- 
tion at all. I continued these active measures for three or 
four mintues longer, when a second respiration was made, 
but feebler than the first. I repeatedly made efforts to pro- 
cure a third respiration, but could not succeed. Now, I be- 
lieve if this child had been earlier attended, it might have 
been revived. 2 
Case 3. March 15, 1881, Miss was sent for by 
nurse to relieve woman who she said had been in labor for 
two days. I found head pressing the perineum, but after 
waiting half an hour discovered that no progress was being 
made, and as the pains were feeble, and patient in an ex- 
hausted condition, thought it best to use forceps, and with- 
out help, save from this ignorant nurse and without anaes- 
thetics, (it being three miles in the country, and not therefore 
procurable,) I succeeded in delivering the woman of a fe- 
male child about eight pounds. The child was pale and blood- 
less, the cord had two knots about one inch apart, which 
during the passage of the child may have been tightened 
to such an extent as to impede the flow of blood. I tied 
the cord at once, removed the child, and endeavored to restore 
by artificial respiration. After fifteen minutes by constant 
and careful methods, succeeded, and the next day child 
seemed well except when handled ; she seemed sore over the 
chest, doubtless caused by my efforts day before in pressing 
upon chest-walls with too much force. 
Case 4. Jan. 5, 1883, Mrs. G. called to assist a physician 
in case of breech presentation—first labor. Patient short 
in statue and delicate. She had been in hard labor for six 
hours, and the doctor informed me had made no progress 
in that time, nor had she felt the movements of the child 
for some hours, blither was given, and after some delay in 
delivering the body of the child, which was pale and blood- 
less from long pressure, a more vexatious delay occurred in 
delivering the head, but by getting my fingers into the 
child’s mouth I finally succeeded without seriously injurying 
the mother’s soft parts. The unbilicial cord was flaccid and 
pale, and I did not stop to tie, believing the child to be dead, 
and turned my attention to the slight haemorrhage which was 
taking place, and to the delivery of the placenta. After 
making the patient as comfortable as I could, which occu- 
pied twenty-five minutes, I walked into the next room to 
look at the child. There was no fire in the room, and the infant lay upon a sofa partially covered with a shawl, ap- 
parently dead and pulseless. The surface of the skin was 
cool; with a pair of sharp-pointed scissors I held in my hand, 
I pricked the calf of the child’s leg and was astonished to 
see the infant make a slight movement of the limb. I called 
the doctor and repeated the pricking, and each time the 
child seemed to show signs of live. We at once proceeded 
to employ measures calculated to promote respiration, viz., 
alternating pressure upon chest with raising and lowering 
of arms, and blowing through a napkin into the child’s 
lungs, first drawing out the tongue as far as possible. Our 
efforts were rewarded by success, and that the child lives 
and moves, and has its being, I verily believe, is due solely 
to said efforts. Since writing the above, I have recently 
been associated with a physician in a case of labor requiring 
manual interference in which the child was apparently 
dead and was resuscitated by the doctor only after the most 
persistent efforts of nearly an hour’s duration. The long- 
period during which life may under certain circumstances 
be retained by the infant who has never breathed, is full of 
interest to the physiologist, the accoucheur, and the medical 
jurist. The experiments of Legallois show that, in the mam- 
malia the foetus which has not breathed can resist death 
from submersion much longer than the foetus in which res- 
piration has been carried on. Puppies and kittens immedi- 
ately after birth, may be kept under water for twenty-eight 
minutes with impunity, when five days old they perish after 
sixteen minutes submersion, and when fifteen days old they 
die as rapidly as other warm-blooded animals of any age 
from deprivation of air. The human still-born foetus can 
probably live longer without respiration than any other 
mammalian foetus. 
From different sources the following cases are collected, 
and they are very striking and very suggestive to the 
practical accoucheur: 
Case I. A woman aged 25, who had tried to conceal her 
pregnancy, was delivered when seated on a tub. The in- 4 
fant, born without any signs of life, was buried in a sand- 
pit, and after remaining there for half an hour, was re- 
moved and lived. 
This case is described by Dr. Weese; in 1845, in the Ga- 
zette Hebdomadairn. 
Case 11. T. P., a servant, aged 23, was delivered in a 
stable, when leaning against the wall, alone and in a state 
of unconsciousness, about half-past four A. M., on the 16th 
of October, 1850. When she came to herself, she found the 
infant on the ground, having a spade lying upon it, with 
its cutting-edge turned to the body. She took the infant, 
which was perfectly cold, believing it to be dead, and with 
the placenta attached, wrapped it up in her apron and bur- 
ied it in the garden. Suspicions arose that she had been 
confined ; she confessed, and at half-past nine the infant was 
dug up from the depth of thirty centimeters. It was found 
lying on its face, with the placenta under the abdomen. 
Though cold, apparently dead, and pulseless, the cord was 
tied. For two hours a surgeon used means to reanimate it, 
when at last it began to breathe feebly, gradual signs of life 
became more evident, and it cried. Some slight wounds 
were observed on its body; wounds in the neck, which did 
not bleed at first, bled when the infant was restored. It 
took the breast greedily. On the 17th and 18th the wounds 
suppurated, and on the 19th it died of convulsions. The 
physicians entrusted with the judicial autopsy reported that 
it had been inhumed before it had breathed, and that it had 
not breathed till after it was exhumed, and that the state- 
ment of the mother was possibly true. She was therefore 
acquited of the charge of infanticide, but was found guilty 
of concealment of pregnancy. This case was reported by 
Dr. Maschka. 
Case 111. In 1851 a young woman was tried by the tri- 
bunals of Berlin, who had buried her new-born male in- 
fant, believing it to be dead. After an hour the infant was 
disinterred and recalled to life. 5 
Case IV. A girl gave birth about noon, in a private 
house, to an infant, who gave no signs of life. For an hour 
different unsuccessful attempts were made to animate it. 
The skin became blue, and gradually warmth left it. It 
was considered dead, and in three hours it was removed to 
a cold room. (This occurred in January, and the weather 
was very cold.) Towards evening it was closed up in a cof- 
fin. During the night the windows of the room remained 
open. At 11 A. M. on the following day—that is, twenty- 
three hours after the birth—Dr. Maschka, being accidently 
in the house, was asked to look at the body. It was per- 
fectly cold and blue; the eyes and mouth were shut; the 
joints and the extremities were flexible; there was neither 
rigidity nor cadeveric discoloration. Astonished at this 
latter circumstance, but not really doubting that the death 
of the infant was real, Dr. Maschka placed the stethoscope 
upon the region of the heart, when, to his amazement, lie 
distinctly heard the sounds of the heart; they were feeble, 
and at long intervals. It was impossible to appreciate the 
impulse of the heart against the walls of the chest, or to per- 
ceive any movement in the corresponding intercostal space. 
Attempts at resuscitation were made, but without any effect. 
At the autopsy on the following day cadeveric discolorations 
and rigidity were present; the lungs were of a deep red, and 
contained no air; they were heavier than water; there was 
blood in the left but none in the right side of the heart. It 
must be admitted, provided the observation of the reporter 
be correct, that this infant lived twenty-three hours after 
birth, and never breathed. 
Case V is taken from page 214, Braithwait’s Retrospect, 
Parts 31 and 32. February 20,1850, a woman was tried for 
attempting infanticide ; she had buried her infant, but it 
was dug up, breathed, and lived. The following are the 
facts : Marie and Renee lived with their father at Vern antes, 
in the arrondissement of BruegC On the 16th day of May, 
Marie was alone in the house with her father. About half 6 
past six p. in. Renee came home, found Marie in a swoon, 
and called the neighbors to her assistance. Marie soon re- 
gained her consciousness. One of the female neighbors, hav- 
ing observed numerous spots of blood, asked Marie if she 
had been confined. She replied : “ No, it is not yet time.” 
Her father, however, having observed the earth disturbed 
in a place in the garden, asked her to explain it, when she 
replied : “ I have been confined ; but as my child was still- 
born, I buried it in the garden.” The child was then dis- 
interred. It was found five centimetres (twTo inches) below 
the surface, with its face downwards, and with the placenta 
attached. Means were used to restore the infant, and it was 
ere long recalled to life. It was calculated that the infant 
had been three-quarters of an hour under ground. The ac- 
cused was acquitted. 
Bedford’s Obstet., page 371; “Of course we know the fac- 
ulty of resisting asphyxia, that is of living without breath- 
ing is very much greater in the new-born infant than in 
the adult, or in infants who have once breathed, so that if a 
child should not breathe for an hour, or even much longer 
after birth, it should not be abandoned as dead, and, there- 
fore, considered beyond remedy.” 
Cases are recorded in which resuscitation has been accom- 
plished by some of the means alluded to even after the 
asphyxia had continued for a long time. In an interesting 
article on the “ Resuscitation of Children Born Still,” by W. C. 
Rogers, M. I)., of Green Island, recently deceased, published 
in the American Medical Monthly for February, 1860, there 
is a record collected from various sources of twenty-four still- 
born infants resuscitated by artificial respiration, by both 
hot and cold, by frictions, and by Marshall Hall’s method, 
applied singly or jointly, from 10 to 90 minutes, the average 
period intervening between birth and establishment of res- 
piration being 35 minutes 30 seconds. In this article, also, 
allusion is made to the remarkable case reported by J. Foster 
Jenkins, M. D., of Yonkers, New York, in which the funis 
was pulseless for twenty-five minutes before delivery, and 7 
no attempt was made at respiration for thirty minutes after 
birth ; more than two hours constant attention was necessary 
to preserve the child’s life. Bedford further says : “A newly- 
horn infant, affected with asphyxia, should not he regarded 
as dead because its heart has coased to beat; for it has been 
demonstrated by Brachet, of Lyons, Josart, and others, that 
life may be restored after the pulsations of the heart had 
ceased for more than five minutes.” In what direct conflict 
is this fact with the opinion very emphatically expressed 
some years since by Sir B. Brodin, who wrote: “If the ac- 
tion of the heart, by which the circulation is maintained, 
should cease, as a consequence of the suspension of respira- 
tion, it can never be restored. This I positively assert, 
after having made it the subject of a very careful investiga- 
tion.” 
This ability in the new-born child to resist asphyxia ex- 
plains why in cases of death of the mother it may be ex- 
tracted alive from the uterus, through the Caesarean process, 
even after the parent has been dead for a longer period than 
half an hour. 
Dr. Brown-Sequard has shown that in these instances of 
post-mortem Caesarean section, if the mother die when the 
body is quite warm, the life of the child is in more danger 
than when the body has become somewhat cold previous to 
dissolution. It would appear then, from these experiments, 
that asphyxiated infants should not be kept near a fire, for 
the colder the temperature of the air the longer can they re- 
sist asphyxia. 
In my case of breech presentation it would probably have 
been better to have ligated the cord before the complete 
birth of the child, for in these cases of breech and foot pre- 
sentation often the child dies from haemorrhage into the 
placenta, arising from the umbilical vein being much ex- 
posed to pressure, by virtue of its superficial and unpro- 
tected position in the cord, which, together with the tenuity 
of its tunics, render it very liable to have its current oblit- 
erated; whereas, the tunics of the umbilical arteries are 8 
firmer and they themselves less exposed; thus they are, in 
a measure, protected from the consequences of slight press- 
ure. Therefore, the flow of arterial blood through the vein 
may become obliterated, whilst the venous blood continues to 
flow along the arteries from the child into the placenta with- 
out there being any counterbalancing stream; hence the 
chances of saving the child’s life are not, to say the least, 
diminished by ligative of the cord, even if pulsating. 
As I stated in the first pages of ray paper, these cases are 
of great interest to the medical jurist, for instance, in dis- 
puted cases of survivorship during parturition. If mother 
and child both die in child-bed without witnesses, the pre- 
sumption is (according to Tidy, Legal Medicine, page 34, Vol. 
IT) that the mother survived the child. “ For, Ist, there is 
a prima-facise probability of the child being still-born, and 
that a woman in, child-bed, without attention or attendance; 
will be unable to render her child the assistance necessary 
for its preservation; 2d. a large child, or external marks of 
a difficult labour, or the absence of the signs of respiration, 
would suggest the death of the child as occurring before 
that of the mother. Thus, from both points of view, the 
presumption of survivorship in those rare cases where 
mother and child both die is in favor of the mother. We 
agree with most medical jurists, that those who assert that 
the child survived the mother should be required to adduce 
definite evidence of their contention ; at the same time it 
must be remembered that although the child may die from 
cold, or from its being of unusual size, or from protracted 
labour, or from labor complicated with convulsions, or from 
pressure on the umbilical cord, or from partial detachment 
of the placenta, and other causes, nevertheless that the 
mother runs the risk (and that risk a very dangerous risk) 
of hsemorrhage.” Again, it is quite conceivable that a 
mother might give birth to a child, and herself tie the cord, 
and then die of syncope from the exhaustion consequent on 
the effort, whereas the child would be temporarily safe. 
In a case decided by the Imperial Chambers at Wetzlar 9 
in favor of the child being the survivor, it was urged that 
the mother sank exhausted by the pains of labor, and as a 
result that the child died for lack of nourishment. 
Thomas Stewart Trail, of Edinburgh, in his work on Medi- 
cal Jurisprudence says of the presumption of survivorship: 
“ When a mother and her new-born infant are found dead, 
important civil rights depend on the question, which lived 
the longest; as the husband’s right to be tenant to the 
courtesy, or the descent of property derived from the mother. 
The law of England in such cases admits such slender proofs 
of life in the foetus as would not be received elsewhere, and 
leaves much to the evidence of a medical witness. Else- 
where the child must either cry or look around to constitute 
a quick birth, but in England a quiver of the lips has been 
received as a proof of life, in defiance of physiology. In 
Scotland the viability of a child is determined by its crying, 
in France by its respiration; but in England, any tremu- 
lous motion of its muscles, however trifling, has been de- 
cided to constitute life. In other countries such slight 
movements would never be received as anything but the re- 
mains of irritability.” 
In the case of Fisch versus Palmer, 1800, published in Ed- 
inburgh, 1841, by Trail, “ The viability of the child is 
very important, and is recognized by the perfection of its 
organs, the position of the mesial line, the appearance of its 
nails and skin, the cry of the infant, and its capability of 
sucking.” This is a subject to be investigated, because in 
some instances, as I said before, if a child be born not via- 
ble, it may affect the succession of property when the mother 
dies in child-bed, and it may also bear on certain cases of 
alleged infanticide. 
Dr. Virchow, in the transactions of the Berlin ()bstetrical 
Society, proposed a sign to ascertain whether a child has 
been born alive ; or, rather, whether it lias lived more than 
two days. The test is to be found in the absence or presence 
of uric acid in the kidneys. Virchow wished to show that 
the presence of uric acid in the kidney (at once to be detected 10 
by the naked eye) is a conclusive proof chat the child found 
dead lias been born alive. The ancient anatomists remarked 
a red or yellowish substance coating the mammillae of the 
kidneys of infants, and which modern science lias found to 
be uric acid and analogous to the calculi sometimes found 
in the bladder of children. Schlossberger treats of it under 
the name of “ infractum acidi urici,” and it is easily discov- 
ered by making a transverse section of the kidney when a 
considerable number of yellowish brown and sometimes light 
yellow rays of this substance are seen ramifying from the 
tubular and sometimes from the cortical substance to the 
mammillae. Under the microscope we make out sometimes 
solid cylindrical particles of a yellowish brown color, though 
more frequently these cylinders seem to be not yet formed, 
or to be broken up into molecules of a darker color, round 
or angular, and not unlike the crystals of urate of ammonia. 
A greater quantity is obtained by pressure. The conclusions 
of Virchow—Ist, That the deposit is never found in children 
who have been born dead, or who have died within forty- 
eight hours after birth ; 2d, That the deposit is not found, 
or does not occur, until about forty-eight hours after birth ; 
3d, That the deposit is not generally found later than the 
twentieth day after birth. There are, however, exceptions 
to these rules, for the deposit was in one case found on the 
29th day after birth; and Virchow had not found it in an 
infant dead on the 10th day, nor in another on the 13th, 
nor in a third on the 6th day; these, however, may be the 
consequence of disease. It is to be hoped recent experiments 
will determine the value of Virchow’s views. 
It is of the first importance that the medical jurist should 
distinguish accurately between post-mortem ecchymoses and 
bruises, the result of violence inflicted during life. Of course 
the points of resemblance between these are often so great 
that mistakes are not only possible, but have no doubt fre- 
quently been made. In Tidy’s Legal Medicine, page 66, ap- 
pears this table, showing some of the points of difference be- tween a vital ecchymosis (bruise) and a post-mortem ecchy- 
mosis (lividity), which it may not be out of place to glance at: 
Bruise Produced During Life. 
Post-Mortem Ecchymosis. 
i. Anatomical Seat.—Effusion of 
blood from small ruptered vessels into 
the true skin and the surrounding cel- 
lular or arrolar tissue (sub cutaneous 
tissue.) 
i. Anat. Seat.—Congested capil- 
laries in the rete mucosum and vascu- 
lar tissue above the true skin. 
2. Position.—The seat of the in- 
jury. 
2. Position.—Such dependent parts 
of the body (according to how it may 
be placed) as are not subjected to 
pressure. 
3. Extent.—More or less limited to 
the parts injured. 
3. Extent.—At first the stain ap- 
pears in isolated patches, rapidly run- 
ning together, more or less, over the 
whole of the dependent portions, ex- 
cept those parts subjected to pressure 
of the surface on which the body rests. 
4. Changes of Time. - The color 
remains tolerably constant until putre- 
faction sets in. No zones of color 
form round the edge, such as occur in 
a life bruise. 
4. Changes by Time. The dark 
purple bruise, after 18 to 20 hours, or 
sometimes as late as 2 or 3 days, be- 
comes highly tinted at the edges, and 
of a more or less violet color. After 
this the color of the bruise passes 
through various shades of green, yel- 
low, and lemon, the center, however, 
always being the darkest part. Dur- 
ing these changes, which are depend- 
ent on the oxidation of the effused 
blood, the spot enlarges. The changes 
are complete in times varying from a 
few days to some weeks. 
While it appears by this table that, as a rule, the distinc- 
tions between a bruise produced during life and a post-mor- 
tem ecchymosis are fairly well defined, great caution in con- 
ducting these inquiries should be observed. 
Again, the question how far the cause of death may be de- 
termined after the lapse of a considerable interval needs con- 
sideration. It is certain that the natural causes that show 
themselves only by minute pathological conditions, will in 
most cases disappear after prolonged burial, possibly the 
marks of strangulation in infants as proof of infanticide may 
offer an exception, as the lungs themselves ordinarily resist 
decomposition for a long time, and putrefaction does not 
materially interfere with their examination. Still, although 
the lungs resist decomposition, the larynx and trachea are 12 
first of the internal parts of the body which show putrefactive 
changes, probably because they are the most ready of access 
to air. Tidy says, page 88 Legal Medicine: 
“It is to be remembered that in from three to five days 
after death in summer, and from six to eight in winter, the 
larynx and top of the mucous membrane of the trachea as- 
sumes a brownish red or olive green color, and care must 
be taken not to confound these discolorations (for the diag- 
nosis is not always easy) with the results of laryngitis or of 
death by drowning or suffocation. The hydrostatic test of 
Tidy, page 2G4, is: Ist, Remove lungs and heart entire, se- 
curing all the large vessels to prevent loss of blood; note if 
they float when placed in water en masse, using for this pur- 
pose a large vessel filled, by preference, with rain water; 2d, 
Test each lung separately in a similar manner; 3d, Cut 
each lung into ten or twelve pieces, and note whether the 
separate portions sink or float; 4th, Each piece of lung is 
now to be placed on the floor and covered over with a piece 
of board, and pressure applied by a person standing on the 
board for a few minutes. The several pieces, after this treat- 
ment, are again to be tested whether they sink or float. If 
the lungs float by all four tests, as described, there is strong 
presumptive evidence in favor of respiration, and conversely, 
if they sink, there is strong presumptive evidence in favor 
of non-respiration.” 
There is always a danger in a post-mortem, especially 
after death, by asphyxia, of the blood escaping from the 
heart when the head is opened before the thorax. 
It is always recommended where death by asphyxia is 
suspected, to examine the chest first. In such case the peri- 
cardium should be laid open and the heart examined in 
situ. The right cavities should then be exposed, by which 
means good and undoubted evidence of the actual state of 
the right heart will be secured. I should say here that in 
the case of asphyxiated infants, Tidy recommends that the 
abdomen should be opened before the thorax in order that 
the position of the diaphragm may be determined, a matter 13 
of importance in deciding whether the infant lias or has not 
breathed. 
The physiological question remains for discussion, viz ; 
How can there be circulation in the infant without respira- 
tion, and, therefore, without the production of arterial blood ? 
The movements of the heart must gradually become very 
slow, (a kind of human hybernation,) for, according to the 
experiments of M. Bouchuts, the marmot’s heart beat rang- 
ing from 80 to 90 per minute, under ordinary conditions, 
sink during hybernation to Bor 9. The cases recorded of 
profound sleep or trance show how slow and feeble the 
heart’s action consistent with life may become. It appears 
to me, Mr. President, this condition of passivedife can only 
exist when assimilation is at a minimum, and when the 
oxygen of the maternal blood is consumed very slowly. I 
should think the maternal blood must, in such cases, be 
sufficient to maintain life. 
1123 14.™ Street N. W.