Infanticide forensic medicine give detailed description

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Infanticide - Forensic Medicine: Detailed Description

1. Definition

Infanticide is the unlawful killing of a newborn child by the mother, or with her consent, shortly after birth. In Indian law (IPC), a child is considered a "child" for the purpose of infanticide up to 12 years of age, but medicolegally, infanticide refers to the killing of a neonate/newborn.

In England (Infanticide Act 1938): killing of a child under 12 months of age by the mother, whose mind was disturbed by the effects of birth or lactation.
Under Indian Penal Code (IPC): there is no separate Infanticide Act. The act is charged under Section 302 (Murder) or Section 304 (Culpable Homicide). Related sections include Section 317 (abandonment of child under 12 years) and Section 318 (concealment of birth).

P C Dikshit Textbook of Forensic Medicine and Toxicology, p. 322-323 Parikh's Textbook of Medical Jurisprudence Forensic Medicine and Toxicology, p. 465

2. Motives of Infanticide

In Uncivilized Societies:

Survival of the fittest - destruction of malformed children
Tribal superstitions - twin births, children with teeth at birth, leg presentations
Belief that devouring the firstborn adds strength and fertility

In Civilized Societies:

To get rid of illegitimate children
When the mother is a widow or unmarried
Economic and social deprivation - weaker sections of society
In communities where dowry is prevalent - female infanticide is common
Male infanticide may be resorted to by prostitutes
Unwanted pregnancy (failed contraception, failed abortion)

P C Dikshit, p. 323; Parikh's, p. 467

3. Legal Aspects

Infanticide Act (England):

1922 Act: First recognized that the mother's mental balance may be disturbed by delivery; only the mother can be charged; no age limit defined; excluded lactation
1926 Amendment: Defined age limit as child under 12 months
1938 Act (currently in force): Extended to include disturbance due to lactation; child must be under 12 months; only the mother can be charged (anyone else including the husband is charged with murder/manslaughter)

Key conditions for Infanticide Act (England):

Only the mother can be charged
The child must have been born alive (viable)
The child must have been killed
The mother must have been suffering from a disease of the mind at the time due to effects of delivery or lactation

Indian Law:

Section 302 IPC - Murder (applicable when intent is proved)
Section 304 IPC - Culpable homicide not amounting to murder
Section 315 IPC - Preventing a child from being born alive or causing it to die after birth
Section 317 IPC - Abandonment of child under 12 years (imprisonment up to 7 years)
Section 318 IPC - Concealment of birth (imprisonment up to 2 years)

P C Dikshit, p. 323-325; Parikh's, p. 467-468

4. Medicolegal Points in an Infanticide Case

When a newborn body is brought for examination, the following key questions must be answered:

Is the body that of a viable child?
Is the body that of the child of the accused?
Was the child stillborn or dead-born?
Was the child born alive?
If born alive, how long did it survive?
What was the cause of death?

P C Dikshit, p. 325

5. Viability

Viability = capability of maintaining a separate existence after birth by virtue of degree of development.

In law: a fetus that has NOT attained the completion of the 7th month of intrauterine life is non-viable (incapable of maintaining separate existence)
If evidence shows fetus < 7 months, charge of infanticide will NOT be sustained
If there is any evidence the fetus lived after birth, even in a premature child, the charge of infanticide applies

Parameters to assess viability:

Parameter	Details
General condition	Plumpness, absence of disease/malformation
Weight	2500-3300 g (full term); female ~100g less; immature = <2000g
Crown-heel length	~48-52 cm (full term)
Crown-rump length	~28-32 cm
Head circumference	~30-35 cm
Skin	Well-formed, pink, presence of vernix caseosa
Skull ossification centres	Distal femoral: 7th month; proximal tibial: 9th month
Scalp hair	>2 cm (full term)

Features of full-term mature infant:

Well-covered head with hair ~2 cm
Nails extend beyond fingertips
In males: testes fully descended into scrotum
In females: labia majora covers minora
Eyelids open

P C Dikshit, p. 325-326; Parikh's, p. 468-469

6. Signs of Live Birth

The law presumes that every newborn child found dead was born dead until the contrary is proved. In criminal cases, the only admissible evidence of live birth is expert opinion founded on postmortem examination.

A. Civil Cases

Any sign of life after complete birth is accepted:

Hearing a cry (including vagitus uterinus/vaginalis)
Seeing movement of body or limbs
Muscle contractions
Pulsations of heart or cord

Note: Vagitus uterinus = cry of the fetus while still in the uterus; vagitus vaginalis = cry in the vagina. Both occur when membranes rupture and air enters. Muscle twitching alone is NOT safe proof (cellular life continues after death of the individual).

B. Postmortem Signs of Live Birth (Internal Examination)

Respiratory System (Most Important)

1. Shape of the chest:

Before respiration: chest is flat, circumference 1-2 cm less than abdomen at umbilicus
After respiration: chest expands, becomes arched/drum-shaped

2. Position of the diaphragm:

Before breathing: diaphragm at level of 4th-5th rib
After breathing: diaphragm descends to level of 6th-7th rib

3. Appearance of lungs (most reliable macroscopic sign):

Before breathing: lungs are dark reddish-purple, collapsed, firm, liver-like (hepatized), fill only the medial part of thorax, sink in water
After breathing: lungs expand, become light red, surface appears marbled/mottled (patches of expansion alternating with collapsed areas), soft and crepitant on pressure, exude frothy blood on section
Foetal lungs may assume rosy color on exposure to air after death but air cells can never be distended

4. Hydrostatic Test (Docimasia Pulmonum; Raygat's Test):

Based on changes in specific gravity of lungs due to respiration
Non-respired lung: specific gravity ~1050 (heavier than water) - SINKS
Respired lung: specific gravity ~950 (lighter than water) - FLOATS
Procedure: Cut lungs into lobes, then into pieces, place in water; positive = float

Limitations of Hydrostatic Test (major):

Any degree of decomposition invalidates the test (putrefactive gases cause sinking or floating irrespective of breathing)
Resuscitation attempts make evaluation impossible
Stillborn lungs may sometimes float; live-born lungs of even children who lived days may sink
"Trial breathing" in utero (fetal respiratory movements) can expand alveoli in undoubted stillbirths - false positive
Histologically, it is not possible to distinguish the lungs of stillborn infants from live-born (Shapiro)
Artificial inflation can cause lungs to float - mottling is absent in artificially inflated lungs

Parikh's states: "This test is of no value whatsoever in forensic work"

5. Fodere's Test (Static Test):

Increased blood flow to lungs when respiration is established
The ratio of blood in the lungs to total body blood is higher after breathing
Lungs of a live-born child weigh 1/35 of total body weight (vs. 1/70 in stillborn)

Other Signs of Separate Existence

6. Breslau's Second Life Test (Gastrointestinal Air Test):

If air has reached the duodenum - strong evidence of separate existence (radiological demonstration)
Stillbirths show absence of air in the GIT
Air in stomach alone can occur with artificial respiration (not conclusive)

7. Wredin's Test (Middle Ear Test):

Before birth: middle ear contains gelatinous embryonic connective tissue
With respiration: sphincter at pharyngeal end of Eustachian tube relaxes, air replaces gelatinous substance within a few hours to 5 weeks
Test: Open middle ear under water; remove tegmen tympani; air coming out = positive (evidence of respiration)

8. Neonatal Line in Enamel of Teeth:

Unequivocal neonatal line in enamel of unerupted deciduous teeth = suggestive of separate existence (Gustafson, 1966)
Can also estimate duration of survival

9. Changes in Kidney and Bladder:

Brownish-yellow crystals of uric acid in renal pelvis and bladder
Absence of urine (voided after birth)

10. Food in Stomach:

Demonstration of milk in infant's stomach = suggestive of live birth and post-delivery survival

P C Dikshit, p. 327-331; Parikh's, p. 469-473

7. Duration of Survival (Extrauterine Age)

Finding	Time After Birth
Nucleated RBCs disappear	By 24 hours
Umbilical cord begins to shrink and dry	12-24 hours (shrivels by 3-4 days)
Umbilical cord falls off	5-9 days
Umbilical arteries contract and obliterate	2-3 days
Ductus arteriosus begins closure	3-4 days; fully obliterated in ~10 days
Closure of foramen ovale	2nd-3rd month (may persist up to 2 years)
Foetal Hb changes to adult Hb	Fully by 6th month
Jaundice (physiological icterus neonatorum)	2nd-5th day, disappears by 10-12 days
Air in duodenum (X-ray)	Within hours of birth

Parikh's, p. 472-473; P C Dikshit, p. 331

8. Causes of Death in Infanticide

Death may occur from:

A. Natural Causes

Immaturity (birth weight <2 kg)
Congenital malformations (incompatible with life)
Birth asphyxia
Intrauterine infections
Haemolytic disease of the newborn (erythroblastosis fetalis)
Umbilical hemorrhage from failure of cord ligation

B. Accidental Causes

Before birth (intrauterine):

Knotting or tight twisting of umbilical cord
Prolapse of cord (compression in breech presentation)
Placental infarction / disease of decidual vessels
Injury to mother (heavy blows, fall from height causing skull fracture or cerebral hemorrhage)

During and after birth (accidental):

Precipitate labor: Delivery so rapid mother was unaware; child may die from:
- Suffocation by falling into lavatory pan
- Head injury/skull fracture from a fall (~30 inch height)
- Hemorrhage from torn umbilical cord
Pseudo-precipitate delivery: Primipara confuses labor pain for evacuation urge - accidental delivery in toilet
Unconscious delivery: During epileptic fit, coma, hysteria, narcosis, deep drunkenness
Suffocation by face pressing on maternal tissues/discharges
Covered by intact membranes at birth (suffocation if membranes not removed within 20-30 minutes)

C. Criminal Causes (Homicidal)

1. Acts of Commission (Mechanical Violence):

Method	Features
Suffocation/Smothering	Hand/cloth over nose and mouth; most common method; petechiae on face, conjunctivae; frothy mucus; fingernail marks on face
Strangulation	Manual or ligature; marks on neck; hemorrhages in strap muscles
Drowning	Immersion in water, pan, bucket; frothy fluid in airways; diatoms test
Head injuries	Fracture-dislocation of skull; subdural hematoma; depressed fracture from blunt instrument
Exposure	Leaving newborn exposed to cold/heat; hypothermia
Poisoning	Opium, calotropis juice (madar), tobacco, dhatura (traditional); insulin, antihistamines, tranquilizers, hypnotics (modern); viscera preserved for chemical analysis
Stab/cut wounds	Incised wounds of neck, chest, abdomen; uncommon
Compression of skull	Pinching/squeezing of fontanelles and soft skull bones
Burning	Thermal injuries

2. Acts of Omission (Neglect):

Failure to make necessary preparations for birth (no medical aid arranged)
Omission to tie the umbilical cord after cutting - hemorrhage and death
Omission to remove child from mother's discharges (blood, meconium, liquor amnii)
Omission to protect child from cold/heat
Omission to supply proper food (starvation)

The law presumes a woman about to deliver must take ordinary precautions to save her child. Evidence of no provision of any kind made suggests intention to destroy the child, unless she was unaware of the pregnancy or fainted during sudden onset of violent labor.

Parikh's, p. 473-476; P C Dikshit, p. 333

9. Examination of the Alleged Mother

This examination has two components:

A. Signs of Recent Delivery:

Relaxed abdominal wall (striae gravidarum)
Enlarged and engorged breasts, secretion of colostrum or milk
Bruising and lacerations of perineum and vagina
Dilated os uteri; involution of uterus (uterus at umbilicus immediately after delivery, returns to pelvis by 10 days)
Lochia (reddish discharge from vagina for ~10 days postpartum)
Blood stains on clothing, bedding

B. Mental State:

General demeanor, emotional state
Evidence of postpartum psychiatric disturbance

P C Dikshit, p. 325; Parikh's, p. 476

10. Battered Child Syndrome (Related Concept)

Coined by Henry Kempe (also called Caffey's syndrome, Child abuse syndrome, Maltreatment syndrome).

Classic features (DiMaio's Forensic Pathology):

Most child homicides are NOT the classical battered baby - they are more commonly "impulse/angry homicides"
Most deaths occur in first 2 years of life, majority in first year
Craniocerebral injuries account for 72% of deaths; thoracoabdominal injuries 21%
~1/3 of children in blunt force death series showed no external evidence of injury
Most common finding in head injury deaths: subdural hematoma with or without skull fracture

Categories (DiMaio):

Classical battered child (variant: neglected/starved child)
"Impulse/angry" homicide (variant: "punished" child - often scalded)
"Gentle homicide" - smothering (variant: lethal Munchausen's syndrome by proxy)
Miscellaneous

DiMaio's Forensic Pathology, 3rd Ed., p. 3857-3893

11. Abandonment of Children (S. 317 IPC) and Concealment of Birth (S. 318 IPC)

Abandonment (S. 317):

Father or mother of a child under 12 years, or any person having care of the child, who leaves the child in any place with the intention of wholly abandoning it - punishable with imprisonment up to 7 years
If the child dies in consequence - may be tried for murder or culpable homicide

Concealment of Birth (S. 318):

Whoever by secretly burying or otherwise disposing of the dead body of a child (whether the child died before, during, or after birth) intentionally conceals or endeavors to conceal the birth - punishable with imprisonment up to 2 years
When infanticide is NOT proved, the mother is usually charged with this lesser offence
It is NOT necessary to prove that the child was born alive for this charge

12. Still Birth vs. Live Birth: Summary Differences

Feature	Stillbirth	Live Birth
Lungs (appearance)	Dark red, firm, collapsed, hepatized	Light red, mottled, crepitant, frothy
Hydrostatic test	Sink	Float (usually)
Lung: body weight ratio	1/70	1/35
Diaphragm level	4th-5th rib	6th-7th rib
Chest shape	Flat	Arched/drum-shaped
Air in GIT	Absent	Present (especially duodenum)
Middle ear	Gelatinous tissue	Air-filled (Wredin's test)
Skin	Macerated (if dead in utero >24 hrs)	Normal, vernix present
Uric acid crystals in kidney	Absent	Present
Umbilical cord	Moist, fresh, greenish	Changes progressively

Key Examinable Points (Summary)

Hydrostatic test = Docimasia pulmonum = Raygat's test; has limited forensic value
Breslau's second life test = GIT air test (duodenal air = strong evidence)
Wredin's test = middle ear air test
Fodere's/static test = lung weight ratio
Viability threshold = 7 months (28 weeks) of intrauterine life
Vagitus uterinus/vaginalis - crying in utero/vagina - is NOT proof of live birth after complete delivery
Under IPC, no separate Infanticide Act - charged under S. 302 or S. 304
Concealment of birth: S. 318 IPC, up to 2 years imprisonment
Abandonment: S. 317 IPC, up to 7 years imprisonment
Battered child syndrome coined by Henry Kempe
Most child homicides are impulse/angry homicides, NOT classical battered baby

Sources:

P C Dikshit Textbook of Forensic Medicine and Toxicology, Chapter on Infanticide, pp. 322-337
Parikh's Textbook of Medical Jurisprudence Forensic Medicine and Toxicology, Chapter 31, pp. 465-477
DiMaio's Forensic Pathology, 3rd Edition, Chapter on Infanticide, pp. 3857-3895
The Essentials of Forensic Medicine and Toxicology, 36th Edition (2026), Signs of Livebirth section

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