-Dr. Anil Aggrawal
I had just got up from the bed. It was a nice Sunday morning, and lazily I asked my wife to prepare a cup of coffee for me. Tarun, my son brought me the newspaper, and just when I sank further deep in my bed anticipating a nice sunny Sunday morning, with a cup of coffee in one hand, and the newspaper in the other, the telephone bell rang.
“Who is it?”, I asked somewhat impatiently.
“Sir, I am the Sub divisional Magistrate of this hill district located about 200 km from your place. We have a very tricky case on our hands. Could you come immediately please?” and then without waiting for my answer, added.
“I am sending the vehicle. It is a Fiat car DL 4C A 6600. It will be there in about half an hour. Please be ready with your post-mortem kit.”
“Hell”, I thought, “Why in the world did I chose forensic medicine as a career?” To be honest with you, I chose this career because I love the dead. But probably a minor reason was that by choosing it, I would not be getting any emergency calls. The dead hardly call you on Sunday mornings. And yet, here I was getting calls almost all Sundays. Well, that’s life.
I was already quite worked up by the time my wife brought me coffee. I quickly gulped it down, and became ready with my post-mortem kit. The car soon arrived at my house, and in about 6 hours took me away to a nice sleepy little hamlet tucked away in the lap of some very huge mountains. The air was so fresh and invigorating, I was glad I came there. The SDM was waiting for me at the office.
“Thank you doctor for coming. It’s already 3 pm. Let us first have some lunch and then we would talk”, and quickly he took me inside. He made some motions with his hands to his subordinates and they all swung in action. Soon trays, plates, cups with nice little eatables started pouring in.
What he told me over the lunch was this. Sushila was a 27 year old woman married to Dinesh, and both of them had a happy life. They lived about 5 km from where we were sitting. They had a neighbor called Sitaram, with whom they were having a land dispute for almost one generation now. Their (Dinesh and Sitaram’s) fathers had died while the litigation was on, and now Dinesh and Sitaram were getting on with the litigation. Sitaram had a bad reputation in the area, and he had threatened Dinesh many times with dire consequences if he did not relinquish his claim on that controversial piece of land.
However since about one year, the two had buried the hatchet, and were meeting each other regularly at least on social occasions such as Diwali, Holi, marriages etc. The case of course was going on in the court as usual. This is not a very unusual occurrence in our country. Land disputes do go on, while people mix together in social occasions.
About a week back Sushila gave birth to her first son in a local hospital. When she started having labor pains - at about 4 pm - she was taken to the local hospital, and admitted there. Soon the word spread among the locality and many people gathered at the hospital. Many of them came with sweets. Dinesh’s mother and Sushila’s parents were there to receive them. Sitaram also came to congratulate the young couple. After exchanging some pleasantries most of them melted away. By the time the baby was born - at about 3 am the next day- only Dinesh, Sushila’s father and Sitaram were outside the labor room. All of them distinctly heard the baby’s cries. Dinesh and Sushila’s father became ecstatic and ran outside to phone their friends. Only Sitaram remained there. When they came back after fifteen minutes after telephoning all the relatives they found Sitaram talking with the doctor in somber tones. They were told that the child had been born dead! They could not believe their ears. They had heard the child’s cries with their own ears. This definitely meant that the child had been born alive. How could the doctor play this fast one on them by saying that he had been born dead. Definitely there was something black at the bottom.
When the police made enquiries, both Dinesh and Sushila’s father asserted that they had heard the child’s cries standing outside the labor room. Sitaram was also standing along with them, but when he was asked about it, he said he hadn’t heard any such cries, and may be Dinesh and his father-in-law were mistaken. Sometimes you do listen what you want to listen. This now became a two versus one story, and naturally a lot of doubt started whether the baby had actually cried or not. This was important, because if the baby had cried he had been born alive, and somebody - most probably Sitaram - had killed him. And if the baby had not cried, then it was possible that he was a case of a still born child.
Many fingers started raising at Sitaram. He did have an old rivalry with Dinesh, and he had a strong motive to harm him. He was alone for as much as 15 minutes outside the delivery room, and the nurse told to the police that for five minutes after the baby was born, there was no one in the delivery room, as they had to rush to the next room for an emergency case. In these five minutes, it was quite easy for Sitaram to enter the room and -say- strangle the child. Sushila was of course too exhausted to note anything. She had probably passed out for some time after delivery.
The doctor and nurse were questioned. The doctor was a young man, who had passed his MBBS only a year back, and had taken up this job to pass his time while he studied for his post-graduate entrance examination. The nurse was also very young and inexperienced. They had probably already sensed some medico legal problems and had become very defensive. Both of them asserted that the baby was born dead.
As you can very well understand, things had become very complicated by now with some saying the baby was born alive and others saying he was born dead. The only way to solve this puzzle was to order an autopsy. Since in that little hamlet no expert forensic expert was available, the autopsy was entrusted to a young pediatrician named Dr. Harish.
I looked at the autopsy report. It was a fairly nice job, considering it was done by a pediatrician. I certainly could not do a pediatric job as nicely as he had done this forensic job being a pediatrician. He had conducted the hydrostatic test and had found it to be positive and in addition had found several semilunar marks around the baby’s neck. As we all know these semilunar marks indicate nail marks and often form on the neck in cases of throttling or manual strangulation. As regards hydrostatic test, I am sure all of us know about it, but just for recapitulation, it is an interesting test which tells us - the forensic pathologists- whether a baby was born alive or not. The premise is that if the baby was born alive, he would have respired - at least once - and this would fill his lungs with air, making their specific gravity less than that of water. If on the other hand, the baby was born dead, he would not have respired and his lungs’ specific gravity would remain more than that of water. So what one does in such cases is just to dissect out the lungs and put them in water. If the lungs float, the test is positive - meaning thereby that the infant was born alive - and if the lungs sink, the test is negative implicating the opposite conclusion. To be sure, the actual test is much more complicated than this, but this is the gist. There are some problems with the test, with many pathologists claiming that it is not an infallible test, but we will leave aside those controversies for the time being.
As I told you, the doctor had made a fairly thorough post-mortem. His conclusions were summed up like this:
“The baby had been born alive, and survived probably five minutes. The cause of death was asphyxia due to manual strangulation.”
This raised a very strong finger of suspicion at SitaRam, and the police arrested him. The basis of arrest was of course the implicating post-mortem report.
But SitaRam was a well-connected man. He contacted someone high up in the political hierarchy, and got an order for a repeat post-mortem. And this post-mortem had to be done by a forensic expert of some standing. That is how I came into this picture. My job was of course to conduct the autopsy again, and find out if the earlier findings by Dr. Harish were alright.
I must say, this was not an enviable task. First autopsy destroys many organs, and disturbs their natural relationships with one another. A repeat autopsy is at least ten times as difficult as the first one, yet the SDM had reposed his faith in me, and I had to live up to my reputation.
The first thing I did was to talk to SitaRam at length. Now after remaining in this specialty for almost 25 years now, I have developed a knack of sensing when a person is speaking the truth. I don’t know how I do it, but I can give you some pointers. When you question a suspect, look straight in his eyes. If his eyes flinch, he might be speaking a lie - otherwise he would look straight at you too. Look at his fingers, and observe any fine tremors there. Look at his Adam’s apple, while he is speaking and look for the very faint quivering there. Touch his hands and see if he has just those tiny traces of sweat on his hands. These little things tell me if the person is speaking the truth. An accomplished liar can consciously control his voluntary nervous system, but can’t control his sympathetics and parasympathetics, and they usually give him away. Above all there is this sixth sense which has developed in me, which tells me if the person is speaking the truth.
After talking to Sitaram for about an hour, I was convinced he was not the murderer. He was definitely at loggerheads with Dinesh and Sushila, but he would not go to the extent of killing their new born son. Either the infant had been born dead in the first place, or he had been killed by someone other than Sitaram.
There were some difficulties though. First of all, courts don’t act on hunches. They need real proof. I could tell them, I had a knack of knowing a liar, but they would still want scientific proof, and I had to get one. When Dinesh and his father-in-law left the hospital to phone their relatives, their was no one beside the labor room except Sita Ram, so there was no question of someone else killing the new born infant. So I was left with just one option; that the infant was born dead.
But what was I to make of the positive hydrostatic test? And furthermore how was going to explain the tell-tale semilunar nail marks on the neck of the infant. That was the main question.
Without waiting further, I demanded to see the infant’s body. It was lying in the cold room of the mortuary, and was brought out for me. I looked at him. He was a nice sweet little boy. It was heart-rending to see his chest and abdomen all sewed up (after the first autopsy). I closely examined the so-called nail marks on his neck, and I must say, they were looking quite similar to the usual nail marks that we see day in and day out in cases of manual strangulation. There were no other injuries on the infant’s body.
I opened the stitches and examined the internal organs closely. I looked at his lungs, which definitely seemed inflated. I conducted the hydrostatic test again, and it was undoubtedly positive. In addition I conducted some additional tests which the previous doctor had not done. For instance, I also conducted the so-called Wreden’s test (sometimes wrongly called as "Wredin's test"). First suggested by R. Wreden in 1868 (in Otitis media neonatorum), this is a rather dubious test, yet in a case of second post-mortem, it was strongly indicated. If not for anything else, then just for confirmation. For the purposes of recapitulation again, this test relies on the fact that a fetus’s middle ear contains jelly like material till he resides in the womb. When he is born and takes a deep breath, his Eustachian tubes open and air enters through them to the middle ear. So if you find a small bubble in the middle ear, you can be quite sure, the baby was born alive. On the contrary if you find just jelly like material in the middle ear, the baby was most probably born dead. Again this is a highly controversial test, and no pathologist worth his salt performs this test these days. But as I told you earlier, this was a case, where we were leaving no stones unturned.
[More information on Wreden's test for the more scientific minded amongst you. In 1873 - five years after the initial report by Wreden - another scientist Wendt reported in Arch. f. Heilkunde that if the infant respired when he was immersed within the amniotic fluid, one could detect even amniotic fluid in the middle ear of such babies. Based on the researches of these two scientists, the test is often known as Wreden-Wendt test, or Wreden-Wendt tympanic cavity test.
One may also want to go through the following paper for the details of the test:
Jobba G, Sandor T. (1971) Medicolegal evaluation of the Wreden-Wendt tympanic cavity test [Article in German]. Z Rechtsmed 69(3):173-6
Or you may want to click on the following link
One may also want to go through the following paper for the details of the test:
Wreden’s test also came positive and I was quite depressed. The baby had indeed been born alive. So depressed was I that I came back to my hotel, and tried to sleep. Tried hard as I would, I couldn’t sleep. After sometime, I went out for a walk in the mountain roads. The fresh air invigorated me. After about one hour of aimless stroll, I came back and slept.
Probably I kept dreaming of the case. I know this because at 4 am, I suddenly got up. I had probably dreamt something strange. I kept sitting for some time, and then I remembered there was a phenomenon called vagitus vaginalis, which is such a rare phenomenon, that most people take it as a myth. Here we might be dealing with a case of vagitus vaginalis. You might be wondering what this strange term means. Let me explain. In the nineteenth century, there were a number of reports by reputed obstetricians, which stated that a fetus can in fact respire while he is still in the vaginal canal. He can emit a cry in the vaginal canal, while he is being born! This would be heard as a muffled cry by people standing close by, and anyone would swear he had heard the infant cry. There is a still stranger phenomenon known as vagitus uterinus, in which the baby cries while he is still higher up - in the uterus. Well here we probably had a case either of vagitus vaginalis or vagitus uterinus. These babies who utter such a cry either inside the vagina or uterus may be born alive or dead. If born alive, naturally no problem would occur, but if such babies were born dead, they could land the doctor in severe trouble. Relatives standing outside the labor room would invariably have heard the cry and they would hold the doctor responsible for the death of the baby. They would keep asserting the baby was born alive, and died subsequently due to doctor’s negligence. I personally know of many such cases, in which doctors had to face the patients’ ire.
The more I thought about it, the more I got convinced that I could convince any court of law about its possibility. I had xerox copies of all those reports of vagitus vaginalis and vagitus uterinus. And if so many reputed obstetricians had seen this phenomenon, certainly this phenomenon was possible in our case too.
But what indeed remained to be explained were the strange looking semilunar marks on the baby’s neck. They did look like nail marks, indicating someone had tried to kill him. If he was born dead, why anyone in the world would try to kill him. I could not solve this problem despite thinking deeply about it. Finally I got tired and slept again.
Next day I took out the body of the infant again from the cold room and looked closely at his neck. There were these unmistakable nail marks. There was no doubt about that. I was quite nonplussed. Without having the faintest idea of what I was doing, I began examining his abdominal contents.
Suddenly I was gripped with excitement. When I looked near the area of his liver, I found that the baby had not just one, but two ligamentum teres. The previous doctor had probably missed this strange finding. And I wouldn’t blame him for that, for he was so inexperienced. Now before you throw up your arms in despair, let me tell you a little bit about this strange structure. In a fetus, originally there are two umbilical veins which take oxygenated blood from the placenta to the fetus. After sometime, the right umbilical vein disintegrates; only the left persists. After birth the baby starts respiring and this umbilical vein becomes quite redundant. Nature has a way of dealing with this new situation. This umbilical vein obliterates and becomes a ligament like structure in about 3-5 days after birth. This ligament like structure is called ligamentum teres. This is a very useful marker for forensic pathologists. By seeing this structure, they can tell how long the child survived after being born. For instance if we see only the umbilical vein, we can say, that the child died within 3-5 days of being born, but if we see a ligament in its place we would be quite sure that the child survived at least 3 days after being born - probably more.
Does that meant, the little child survived 3 days after birth? Not in the least. The child’s death immediately after death was so well documented that there was not an iota of doubt about it. It was probably a case of very early disintegration. Such cases do occur once in a while. But what surprised me no end was that he was showing not just one, but two ligamentum teres. To my feeble mind, the only implication was that his right umbilical vein had not obliterated early in his uterine life. It had persisted till birth and only after that it obliterated.
Well, I am no anatomist, and did not want to make any further conjectures on it. So I phoned, one of the best anatomists I know of - Professor J.M. Kaul of our own anatomy department. What she told me over the phone was quite surprising to me. She said that in some lower animals, the right umbilical vein does persist till birth. She was not aware of any case where it was seen in humans, but if I had seen one this must be a case of atavism.
You might accuse me of throwing one technical term after other, but I can’t help it. I was taking things as they were coming to me. Thankfully I did know something about atavism, so I did not have to bother her more for that. I thanked her profusely and rushed back to mortuary.
Atavism is a technical term which comes from the Latin at, meaning above or beyond and avus, meaning a grandfather. Thus Atavism literally means “above a grandfather”. It refers to a reversion or throw-back of an inherited characteristic which has skipped a number of successive generations. To the best of my knowledge, the presence of a cervical rib in a human being is a good example of atavism. Evolutionarily there has been a reduction in the number of ribs, especially in the region of our pectoral and pelvic girdle (to allow for greater freedom of movement), but every once a while we see persons with cervical ribs. These people are very good living examples of atavism.
Well, what about this boy. I dissected his neck, and was amazed to see not just one, but two cervical ribs - both on sixth and seventh cervical vertebra. Are you getting the picture now? This boy was showing several primitive characteristics. In other words, he showed many atavistic characteristics. Probably my salvation lay in him showing atavism. What about neck scales? Lower animals like snakes and crocodiles show scales on their necks, while humans do not. Was it possible that his little boy showed another atavistic character in his neck? Was it possible that those little semilunar marks on his neck were not nail marks, but very primitive scales? I could not rule the possibility out, as this boy was showing so many of the atavistic characters.
I am no biologist, and I contacted a very prominent biologist - Dr. Lalji Singh of Hyderabad. He told me to send over some of the skin samples from those semilunar marks, so that he could put them to tests. I did exactly that. He examined them in great detail and his reports really astounded me - well! Not so much after what I had been seeing all throughout.
Those semilunar marks were not nail marks at all. They were very tiny scales which were probably again a relic from the past. He had histological reports with him to confirm his findings. Those semilunar marks did not show the structure of skin, but that of scales! So this little child indeed showed a number of atavistic characters.
I will now tell you what exactly happened. This child cried probably in the vagina, because of which his hydrostatic test - and other tests depending on respiration - came positive. In fact he died somewhere within the birth canal probably because of fetal distress. In addition, he showed a number of atavistic characters, one of which was tiny scales over his neck, which looked exactly like nail marks. These marks stumped not only the young inexperienced Dr. Harish, but even me.
I was very happy when the court accepted my findings, and released SitaRam. He came to me and thanked me no end. I was happy I could do justice to that person. Meanwhile, I am told, Dr. Kaul has written a very good paper on atavism, and is going to Berlin to deliver it there. As for Dr. LaljiSingh, he is trying to find the incidence of atavism in Indian children, taking that child as an example. As for me, I am burdened with more dead bodies and more post-mortems. Well, who cares. The dead are after all ones whom I love most!
***IMPORTANT NOTE: THIS MATERIAL IS COPYRIGHTED BY THE AUTHOR AND MAY NOT BE REPOSTED, REPRINTED OR OTHERWISE USED IN ANY MANNER WITHOUT THE WRITTEN PERMISSION OF THE AUTHOR
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