SUFFOCATION, HANGING, STRANGLING, AND THROTTLING
SUFFOCATION
Death from suffocation is said to result from any impediment to the
respiration which does not act by compressing the larynx or trachea.
Suffocation may therefore be caused by pressure on the chest, as in
persons crushed in a crowd. It may also be due to the respiration of
certain gases, or to the presence of pulverulent substances in the air,
which act by choking up the air-passages. Imprisonment in any confined
space may cause death from suffocation, and abscesses bursting into
the trachea, or vomiting matters in drunken persons lodging in the
windpipe, may be attended with a like result. Pressure on the umbilical
cord whilst the child is in the maternal passages causes death from
suffocation.
=Signs of Death by Suffocation.=--The first effect of arrest to the
passage of air into the lungs is the stagnation of blood in the
capillaries of the lungs. Non-arterial blood then goes to the brain and
consciousness is soon lost. The respiratory sensation is then arrested
by the circulation of venous blood. The left side of the heart becomes
emptied, and then weak; the right side full and engorged. The great
venous trunks are also more or less full, and the abdominal viscera,
liver, spleen, and kidneys congested. The arrest of the heart‘s action
is a secondary effect; the right side is paralysed by being too full,
the left by being empty. These signs may be said to be typical, or,
rather, are to be expected in death due to suffocation, but it must
be distinctly stated that they are not always present. The right side
of the heart is not in all cases engorged with blood; and Christison
warns medical men against expecting “strongly marked appearances in
every case of death from suffocation.” The heart, moreover, continues
to contract after the lungs have ceased to perform their duty. Death
is thus due to apnœa--that is, death beginning at the lungs--and not
to syncope. Death in some cases is from neuro-paralysis or nervous
apoplexy. In death by shock, which in most cases is instantaneous, both
sides of the heart are equally filled. Death, the result of disease,
may present all the signs of death from suffocation, and no suspicion
may be aroused as to the cause of death from the _post-mortem_
appearances, especially if putrefaction have set in.
The following table is given as an aid to diagnosis in this form of
death:
Points to be noticed in forming a Diagnosis of Death by Suffocation
1. _The Blood._--There is _unusual fluidity_ of the blood found in
death by suffocation, however produced. This condition is sometimes
present in deaths due to certain diseases, fevers, &c., and in cases of
narcotic poisoning. Even with the blood in this condition, the presence
of coagula in the cavities of the heart is not infrequent. The colour
of the blood is changed to a dark purple, but in suffocation by carbon
monoxide it is red.
2. _Animal Heat._--In persons who have died from suffocation the animal
heat is long retained.
3. _Cadaveric Rigidity._--Other things being equal, the _rigor mortis_
is as well marked in this kind as in other forms of death.
4. _The Lungs._--Hyperæmia of the lungs is rarely absent. In
most cases both lungs are engorged in about equal proportions.
Hypostasis--_post-mortem stains_--must not be mistaken for capillary
engorgement.
5. _The Heart._--Engorgement of the right side of the heart, the left
being empty, or nearly so. It is advisable always to examine the heart
first, and then the lungs. The pulmonary artery is also much congested.
6. _Capillary Ecchymoses._--These appear as purplish-red spots on the
pulmonary pleuræ, on the surface of the heart, aorta, in the thymus,
and on the diaphragm. They may appear on the above-mentioned parts in a
fœtus suffocated _in utero_ by pressure on the cord. These ecchymoses
are rarely seen on adults, most frequently on infants, due probably
to the thinness of the coats of the capillaries, which are ruptured
in the efforts made to breathe. They are not a positive sign of death
from suffocation, as they have been seen in death due to cholera,
typhus, and other diseases. They are present also where death is due to
hanging, drowning, &c.
7. _Condition and Appearance of the Trachea._--The mucous membrane of
the trachea is injected, and appears of a cinnabar-red colour. This
is present in every case of death by suffocation, and must not be
confounded with the dirty cherry-red or brownish-red coloration due
to putrefaction. Remember also that the trachea putrefies early. If
suffocation be slowly produced, a quantity of frothy mucus may be found
in the windpipe, and also in the smaller tubes of the lungs. Always
examine, especially in cases of supposed infanticide, the trachea for
foreign bodies, the presence of soot, &c. The presence of sand, ashes,
&c., in the œsophagus and stomach in persons buried in these materials,
is presumptive of the person having been placed in them prior to death.
8. _Kidneys, Vena Cava, &c._--The quantity of blood in the kidneys
is always considerable. The abdominal veins are all more or less
congested, and the external surface of the intestines presents numerous
traces of venous congestion.
9. _The Brain._--Apoplexy of the brain, as secondary to the pulmonary
apoplexy, may be more or less present, attended by its well-known
appearances.
10. _Face, Tongue, and Mouth._--The expression of the face is not
characteristic of death by suffocation, and differs in no particular
from that common to other forms of death, being more frequently pale
than turgid; and the starting of the eyes, popularly ascribed to
this form of death, is not often seen. The tongue may or may not be
protruded beyond the teeth. The presence of _froth_ about the mouth is
not constant, and is of common occurrence in those dying from natural
causes. The tympanum may be ruptured.
=Was the suffocation homicidal, suicidal, or accidental?=--Suffocation
may occur accidentally during the act of swallowing, and by foreign
bodies placed carelessly in the mouth and then drawn suddenly into the
windpipe, or by blocking the pharynx or œsophagus, also from being
smothered by sinking into sand, grain, mud, and such-like, or by the
bed-clothes in cases of epilepsy during a fit. Examine the lips for
the presence of ecchymosis and other marks of violence. A man, some
years ago, was accused of having caused the death of his wife by
strangulation, for which he was indicted, and tried before the High
Court of Justiciary in Scotland. The _post-mortem_ examination revealed
the cause of death as due to suffocation, and the following injuries
were found on dividing the windpipe, which contained a quantity of
frothy mucus: in the interior of the larynx there was a considerable
extravasation of blood lying beneath the investing membrane, and
passing up on both sides and behind, as far as the chink of the
glottis, and above that opening into the ventricles of the larynx.
There was here, also, a fracture of the right wing of the thyroid
cartilage, by which its lowest horn was wholly detached, and the
cricoid cartilage was broken in two places at opposite sides of its
ring. The defence was that she had fallen accidentally while in a state
of drunkenness, and had thus produced the fatal injuries.
The man was acquitted, the legal opinion in favour outweighing the
medical opinion against the theory of accident. The above case created
some discussion at the time, and induced Dr. Keiller to make several
experiments as to the possibility of fracturing the cartilages of the
larynx. The following are his conclusions:
1. That _ordinary_ falls on the human larynx are
apparently not capable of producing fractures of its
cartilages, and even _falls from a height with superadded
force_ appear to be unlikely to do so.
2. That _severe pressure applied from before
backwards_, so as strongly to compress the larynx against
the vertebral column, or _violent blows inflicted over the
larynx by means of a heavy body_, are sufficient to cause
fractures of the larynx. Fractures so produced, however,
will be most discernible on the _internal_ surface, and
generally _in or near the mesial line_.
3. _Violent compression_ applied to the _sides of
the larynx_ (as in ordinary _manual throttling or
strangulation by grasping_), is, of all applied forces,
the most likely to produce fractures of the alæ of the
thyroid cartilage, or even of the cricoid cartilage, and
fractures so produced are most perceptible, as well as most
extensive, on the _external_ surface of the larynx. By
this _lateral_ mode of applying force, the _hyoid
bone_ is almost most readily broken.
4. That the condition of the larynx in regard to the absence
or presence of ossific deposit materially influences
its liability to fracture from external violence. If
altogether cartilaginous, partial slits or splittings may
be produced. If partly ossified, fractures may be produced
by a comparatively moderate degree of applied violence,
and if extensively or entirely ossified, extreme violence
will generally be required to produce laryngeal fracture
(_Edinburgh Medical Journal_, 1855-56).
Homicidal suffocation may be due to forcibly introducing foreign bodies
into the air-passages, especially in children; adults suffocated thus
are generally under the influence of alcohol or drugs, or enfeebled
from disease. Suicidal suffocation by these means is generally limited
to lunatics.
[Illustration:
Fig. 16.--The pulse in this case became slower than
normal. Five minutes after the drop the type reached
that of bradycardia, then recovered itself, and even
14½ minutes after the drop was beating with normal
frequency, but in the meantime had become very feeble.
1. The day before execution, 102 per minute.
2. 5 minutes after the drop, 54 per minute.
3. 7 minutes, 102 per minute.
4. 10 minutes, 96 per minute.
5. 13 minutes, 66 per minute.
6. 14½ minutes, 72 per minute.]
[Illustration:
Fig. 17.--The pulse in this case became accelerated
and then fell again, but was feeble throughout.
1. The day before execution, 84 per minute.
2. 3½ minutes after the drop, 162 per minute.
3. 4 minutes, 156 per minute.
4. 5½ minutes, 132 per minute.
5. 6½ minutes, 102 per minute.
6. 9 minutes, 84 per minute.
7. 11½ minutes, 78 per minute.
8. 12½ minutes, 78 per minute.]
[Illustration:
Fig. 18.--In this case the pulse rate increased,
and then fell to 72 per minute towards the end.
1. 1 week before execution, 60 per minute.
2. 2½ minutes after the drop, 162 per minute.
3. 3 minutes, 138 per minute.
4. 3½ minutes, 132 per minute.
5. 4½ minutes.
6. 5¼ minutes, 168? per minute.
7. 5¾ minutes, 108 per minute.
8. 7 minutes.
9. 8½ minutes.
10. 10 minutes, 72 per minute.
11. 12 minutes.]
Homicidal suffocation by compression of the chest has been effected
in infants; in adults it is combined with the covering of the nose
and mouth. The victims are generally old or enfeebled. Suffocation of
infants may be homicidal, or accidental, due to “overlaying”; in the
latter the greatest mortality is amongst the youngest infants. A child
ten months old may struggle and free itself or awaken the mother.
In France a favourite mode of committing suicide by suffocation is the
use of irrespirable gases--carbonic acid, carbon monoxide, and the
like. Collateral circumstances must be taken into consideration, and
will more or less help to point to the true cause of death.
The cause and nature of the death in all of its forms just mentioned
are in general the same. Pressure on the trachea--thus arresting
respiration--and also on the important vessels and nerves of the neck,
results in death, which may be brought about in four different ways:
1. Cerebral congestion, or apoplexy.
2. Congestion of the lungs and heart--apnœa or asphyxia.
3. Combination of above--apoplexy and asphyxia or apnœa.
4. Neuro-paralysis--nervous apoplexy, or syncope.
The following table will show the relative frequency of each form of
death:
Remer. Casper.
Apoplexy 9 9
Asphyxia 6 14
Mixed 68 62
-- --
83 85
-- --
=Traumatic asphyxia= occurs when a heavy weight such as a fall of
earth or masonry compresses the chest, and thoracic respiration is
impossible. The head and neck appear ecchymosed, the purplish-blue
lividity generally ending abruptly at the lower part of the neck
or upper part of the thorax, about the level of the clavicles.
The conjunctivæ are ecchymosed, and there may be epistaxis. This
discoloration does not disappear on pressure by the finger, indicating
its petechial character. If the person survive long enough, the
discoloration gradually disappears, passing through the colour changes
of an ordinary ecchymosis.
The effects on the eyes may be such as to be followed by changes in the
retina, and optic atrophy leading to loss of vision.
Parts of the neck pressed upon by clothing may escape ecchymosis, and
present a white mark of almost normal skin.
HANGING
Death by hanging is caused by the more or less perfect suspension of
the body by a cord applied around the neck, the weight of the body
acting as the constricting force.
The body need not hang completely, partial suspension is sufficient
to cause death. The ligature surrounds the neck above the thyroid
cartilage, the epiglottis is pushed against the back of the pharynx,
the base of the tongue and the soft parts are pressed into the cavity
of the pharynx, so that the obliteration of the naso-pharyngeal and
the laryngeal passages is complete. Death is due to asphyxia and
pressure on the cervical blood-vessels, even if the air-passages be
not completely occluded; stoppage of the cerebral circulation being
sufficient to cause death; in such a case the signs of asphyxia are
absent.
Consciousness is quickly lost, due to pressure on the vessels, and, for
this reason, in accidental or suicidal hanging the person is prevented
from making any effort to save himself.
=Post-mortem Appearances.=--The _external appearances_ are more or less
those described under “Death from suffocation.” In the greater number
of cases the face bears a quiet, placid expression, no turgidity or
lividity being noticeable. The eyes are usually half open, but not
protruded, and the condition of the pupils variable. The tongue may be
protruded, but just as often not. The face may be pale or livid, and
a bluish colour present on the free border of the lips. Cyanosis and
swelling of the face are only present when the death agony has been
long; they soon disappear.
Ecchymosis of the conjunctiva, and on the outer surfaces of the lids
may be present. The escape of urine, fæces, and semen may take place,
but are not characteristic, and are extremely rare.
Casper states that in not one of the many cases he had examined of
persons hanged has he ever “found an erection of the male organ,”
and he also asserts that the emission of semen is extremely rare.
Seminal emissions take place more frequently in persons who have been
shot, and also in those who have been poisoned by irrespirable gases
or by hydrocyanic acid. As a test of strangulation, it is therefore
worthless. Tardieu, however, only noticed the escape of urine and fæces
in two out of forty-one cases; it is by no means a test of hanging, as
it may occur after death if the body is shaken in a cart, or roughly
used when first found. A fat person dying of apoplexy may have a mark
round the neck as if strangled. Injury to the spinal cord due to
fracture or dislocation of the cervical vertebræ is rare in suicidal
hanging. Fracture of the spinal ligaments and of the hyoid bone is also
rare. Rupture of the internal and middle coats of the carotid arteries
sometimes occurs. But it appears that considerable damage is done to
the soft parts of the neck by the present judicial mode of hanging with
the “long drop.”
Dr. Dyer has recorded (_New York Medical Journal_, vol. iii., 1866)
some experiments he made on the eyes of a man and some dogs killed by
hanging. He found certain transverse fissures across the lens, which he
is inclined to think are characteristic of this mode of death. Dr. R.
F. Hutchinson states that an invariable sign of death from hanging is
_the flow of saliva out of the mouth, down the chin, and straight down
the chest_. The appearance is unmistakable and invariable, and _could
not occur in a body hung up after death_, the secretion of saliva being
a living act (Chevers). Death from hanging may take place although the
toes or other parts of the body rest on the ground. Death is complete
in four or five minutes.
=Marks of the Cord, &c.=--The mark of the cord is nearly always
present. It varies with the breadth and hardness of the ligature, but
is often interrupted. Its irregularities are reproduced on the skin.
It is sometimes only seen on one side. In strangling, the mark is low
down, most frequently encircling the neck; in hanging, the mark is
generally above or on the thyroid cartilage, and carried obliquely
upwards. The mark of the cord may be of a dirty yellowish-brown colour,
and, when cut into, feels more or less hard and leathery. In general
appearance it is not unlike the mark left by mustard-plasters or
blisters applied within a short time of death. This effect is probably
produced by the rubbing off of the epidermis, and subsequent drying up
of the cutis on exposure to the air. At other times the mark may be of
a dirty reddish or bright blue colour; or, lastly, there may be little
or no mark present, or the edges may assume a livid red coloration,
being nothing more or less than a _post-mortem_ stain.
=May the mark of the cord be produced after death?=--On this point
Casper says: “That any ligature with which any body may be suspended
or strangled, not only within a few hours, but even days after death,
especially if the body be forcibly pulled downwards, may produce a mark
precisely similar to that which is observed in most of those hanged
while alive.” And the same authority also adds that “the mark of the
cord is a purely cadaveric phenomenon.”
=Accidental= hanging is rare, and generally happens with children
while playing at hanging, or by accidentally becoming entangled in a
window-blind cord or swing rope, or by the neck-band of an article of
clothing by which they may become accidentally suspended from the spike
of a railing.
=Homicidal= hanging is rare, but the body may be suspended after death
from violence, to simulate suicide; and it may have to be decided
whether the hanging took place during life or after death.
The mark of the cord is of no assistance, rents in the carotids with
extravasation into the coats of the vessels indicate _ante-mortem_
suspension. The flow of saliva down the chin to the body indicates
suspension before death. It is important to examine the body for
injuries which could not be self-inflicted, and to remember the
possibility of poison having been administered with suspension after
death.
=Suicidal= hanging is the most common, as it is a favourite mode of
death with suicides. The absence of marks of injury on the body found
suspended, and the want of evidence as to a previous struggle having
taken place, all point to suicide. The fact that the feet are found in
contact with the ground does not militate against the probability of
suicidal hanging; and it appears that in India the natives seldom hang
themselves from any height, and are most frequently found with their
feet on the ground. A person may take poison first, and hang himself
before the poison has had time to prove fatal.
STRANGLING
Death is due to pressure made on the neck by any form of ligature
carried circularly round the neck, without suspension. The cord in
hanging is, as a rule, placed more obliquely than in strangling.
The mode of death is the same as in hanging. The _post-mortem_
appearances are similar to those of hanging, practically those of
asphyxia. The mark on the neck is the principal feature. In position
it is generally horizontal and situated below or on a level with the
thyroid cartilage. It more completely encircles the neck. It may be
interrupted in places if an irregular ligature has been used, causing
irregular pressure. Its character depends largely upon the nature
of the ligature. If the constriction has been uniform a continuous
depression is produced which may be marked by ecchymosis. If the skin
has been abraded, the line dries, and has a brownish, parchment-like
appearance and feeling. If the ligature has been removed before life
is quite extinct, the depressed line may disappear or be but slightly
evident.
A soft, broad ligature may leave no mark on the neck, if not applied
too tightly, or for too long a time. Should the victim have been
strangled in the recumbent posture, and dragged upwards and backwards
by the ligature, the mark will be on a slant as in hanging. According
to the amount of violence used injuries may be caused to the deeper
structures of the neck, such as effusion of blood into muscles,
fractures of the thyroid or cricoid cartilage; rupture of the tympanum
and epistaxis may take place.
=Accidental= strangulation may occur when a cord suspending a weight on
the back and passing across the chest slips and encircles or compresses
the neck.
Falling out of bed, with entanglement in the clothes or nightdress, may
cause strangling by tightening of the neck-band round the neck.
=Homicidal= strangling is as common as homicidal hanging is rare.
It is difficult to hang a man, but easy to strangle him, because
consciousness is rapidly lost, and the victim is unable to offer any
resistance once the cord is tightened round the neck. In homicidal
strangling the murderer generally uses a great deal more violence than
is necessary, and so there is found after death much more local injury
in such cases.
Severe local injuries, such as fracture of the laryngeal cartilages or
hyoid bone, denote homicide, as they are rarely noticed in suicidal
strangulation.
There may also be signs of general violence about the face, neck,
chest, or other parts of the body. The position of the knot affords
no material help, as the murderer may tie it in any position, but
more than one knot, especially if in different positions, points to
homicide. It must be remembered that finger-nails or other marks in
the vicinity of the ligature may be present in cases of suicides, from
the slipping of the cord or the determined attempts of the suicide
to carry out the act, or plucking at the cord involuntarily. When a
person is first strangled, then hung, there would be two marks--one
probably horizontal, the other slanting.
=Suicidal= strangulation is rare. The knot is generally adjusted at
the front or side of the neck, the cord may encircle the neck several
times. Injuries to the deep structures of the neck are absent. Signs of
general violence are not necessarily present.
If there be two marks upon the neck, one due to an attempt at
strangulation, the other to suspension, in a suicide, the first would
be the less marked, the latter more pronounced, whereas in homicide the
strangulation mark would be most distinct.
THROTTLING
Throttling is strangling by means of the hand or hands alone, and is
due to constant pressure of the fingers upon the throat. Very little
pressure is required to occlude the glottis; it can be done with
slight pressure of the thumb and forefinger on the side of the thyroid
cartilage.
The impression of the fingers and thumb upon the throat have
characteristic marks. They are usually to be seen on both sides of the
throat. The thumb mark is on one side, and the marks of the fingers,
separated from one another or clustered together, are on the other,
the thumb mark being the highest. When grasped from the front by the
right hand, the thumb mark will be on the right side of the throat.
If the victim be throttled by the two hands at the same time, as when
on the ground, the thumb marks are on the same side. If the assailant
be left-handed, and has used this hand to grip the throat, the thumb
mark will be on the left side of the victim. The finger marks are one
above the other. The marks may appear as ecchymoses if the examination
be made soon after death; if later, they may appear and feel like
parchment, and of a brownish colour. Crescentic marks of finger-nails
may be present, also other scratches in the vicinity. Other marks of
general violence may be present, and should the victim have fallen
to the ground, the head may be injured. Much blood is effused in the
tissues of the neck and the laryngeal cartilages, and the hyoid may be
found fractured; the carotids may escape injury, but not always.
The mucous membrane of the cheeks may be found lacerated. Where the
victim is thrown to the ground and knelt upon, fracture of the ribs and
ecchymosis of the chest wall may occur.
In a case examined by me of combined strangling and throttling, marks
of the ligature and fingers were both present, and on the clavicles
separate marks produced by the knuckles while tying the cord. These
knuckle marks did not show up till some time after death. Effusions
of blood were present in the tissues of the neck on each side of the
larynx, and amongst the muscles on both sides, and in the sheath of the
left carotid artery.
The hyoid bone was fractured in two places in its left half. The
thyroid cartilage was fractured vertically on each side of the middle
line into three pieces, the central portion having fallen behind the
other two into the cavity of the larynx. The right wing of the thyroid
was comminuted. The cornua were fractured. The cricoid cartilage was
also fractured posteriorly, and into three pieces in front. Effusions
of blood in the fractured areas had formed beneath the mucous membrane.
Effusion of blood was present on the front wall of the pharynx and the
upper part of the œsophagus. The right carotid artery was atheromatous,
and linear and star-shaped fissures were present, the latter surrounded
by a ring of sub-intimal effusion of blood.
On the right side of the thorax the fifth rib was fractured at the
junction with its cartilage, and on the left side the second, third,
fourth, fifth, and sixth ribs were fractured close to their cartilages,
and again from three to five inches further back. Blood effusions in
the tissues of the chest wall and under the pleuræ were present in the
region of the fractures.
A handkerchief was found tight on the neck and tied with two knots
both fastened securely. It was probable that the handkerchief had been
tied on after the throttling, as the knot ends were too short to allow
a sufficient pull on them to cause the injuries. Throttling may be
regarded as a homicidal act; although one or two instances of suicidal
throttling have been recorded in the insane.
=Judicial Hanging.=--In judicial hanging the prisoner is suspended by a
rope with a running noose around the neck, after a sudden drop of from
six to eight feet according to the weight of the body. The noose may be
arranged with the knot or slip-ring fixed at the side below the ear, or
in front so as to jerk the head backwards. The sudden and severe strain
upon the neck produces fracture or dislocation of the spinal column
at the second or third cervical vertebra, with rupture of the spinal
cord. Other local injuries occur, such as rupture of cervical muscles,
fracture of the larynx, and even lacerated wounds of the neck. The head
has even been severed completely from the body, and the deep structures
of the neck have even been so lacerated that the body has hung by skin
only, stretched to the thickness of two or three fingers. Death is said
to take place from shock, pressure on the vagi, and asphyxia, probably
also cerebral apoplexy. When death is instantaneous, the body hangs
motionless, the head fallen over the side opposite the knot, and the
neck stretched.
The heart may, however, continue to beat for a varying period after
apparent death--in some cases even as long as 14½ minutes. The
following interesting series of pulse tracings were taken by Dr.
Llewellyn Morgan, of Liverpool, and kindly placed at my disposal. In
No. 1 the heart beats could be recorded at the wrist for 14½ minutes
after the drop; in No. 2 for 12½ minutes; and in No. 3 for 12 minutes.
The frequency and character of the beat is variable, but in each case
shows a practically normal rate towards the end. (See Figs. 16, 17, 18.)
Apart from the local injuries to the neck, the external appearances in
judicial hanging are similar to those in other forms.