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IMPUTED STRANGULATION.

of violence done to the neck; and the account given by the impostor will be inconsistent in its details and not reconcilable with the ordinary effects of homicidal strangulation. Tardieu met with a case in which a young woman of good social position wishing to excite public sympathy alleged that she had been made the victim of a political conspiracy. One evening she was found at the door of her room apparently in a very alarming state: she could not speak, but indicated, partly by gestures and partly by writing, that as she was entering her room a man had attempted to strangle her by pressing his hand upon her neck and at the same time had stabbed her in the chest with a dagger. On close examination it was found that there were two stabs which had penetrated only through the outer clothing. But the most singular effect of the alleged attempt at strangulation was that, instead of producing a difficulty of speaking and alteration of the voice, it had been followed by complete dumbness. Tardieu could find on the neck no trace of any attempt at strangulation; and on reassuring the young lady that the loss of voice under such circumstances could not last for more than a minute, she at once admitted that there was no foundation for the charge. (Ann. d'Hyg., 1859, t. 1, p. 163.) On this occasion no person was accused; but the case is different when, for the purpose of extortion or other base motives, one or more persons are charged with an attempt at murder. A flagrant instance of this kind occurred in France, in which a wealthy merchant of Montpelier was charged by his servant, Maurice Roux, with having attempted to murder him by strangulation. The case was tried in March, 1864, before the Court of Assizes of the Bouches du Rhone; and, fortunately, for the interests of justice, as well as for the credit of medico-legal science in France, it ended in an acquittal of the accused. (Affaire Armand et Maurice Roux, Paris, 1864; Relat. Méd. Lég. de l'Affaire Armand, etc., par Tardieu; Ann. d'Hyg., 1864, t. 1, p. 415.)

It may be observed, in reference to these imputed cases, that men who deliberately strangle others either draw a cord tightly, or secure it by a knot. The pressure to the neck is not so gentle as to leave no mark whatever, or to allow the strangled person to breathe and watch all that goes on around him. Slight marks of violence about the neck should be therefore viewed on these occasions with suspicion. If, as is most improbable in attempted homicide, the cord is left only loosely coiled around the neck, the person assaulted necessarily retains the power of breathing and calling for assistance; but if the hand of a murderer has been at work it is effectually tightened and the person dies in a few minutes. A charge of this kind, where there can be no witness but the person making it, requires to be supported, not by medical probabilities, but by the strongest medical facts. These ought to show that there are marks of violence on the neck such as an assassin would be likely to inflict, and, at the same time, such as the person making the charge would not be likely to produce, or have the power of producing, on himself,

DEATH FROM SUFFOCATION.

425

SUFFOCATION.

CHAPTER XLI.

SUFFOCATION FROM MECHANICAL CAUSES.-Cause of DEATH.-APPEARANCES AFTer death. EVIDENCE OF DEATH FROM SUFFOCATION.—ACCIDENTAL, SUICIDAL, AND HOMICIDAL 8 FFOCATION.-SMOTHERING.

By suffocation we are to understand that condition in which air is prevented from penetrating into the lungs, not by constriction of the windPope, but by some mechanical cause operating on the mouth externally, or the throat, windpipe, or air-passages internally. In this sense it will be perceived that drowning is one form of death from suffocation, the water being an effectual medium for preventing access of air to the lungs. The term "suffocation" is applied to various conditions in which the symptoms and effects differ. There may be a simple privation of air; the air respired may not be renewed from the want of proper ventilation; or the air which is breathed may be mixed with certain noxious gases or Vapors which, by absorption into the blood through the air-cells of the Jungs, may destroy life like poisons. The symptoms preceding death, the disposition to recovery, and the post-mortem appearances in fatal cases will differ under the circumstances. It will be sufficient at present to Ponsider the most simple form of suffocation which is within the reach of experiment, namely, that which depends on the privation of air by substances blocking up the air-passages, or by the covering of the mouth and strils. A committee of the Medico-Chirurgical Society performed a series of experiments on dogs, in which a tube was inserted into the windpipe and breathing either took place or was completely arrested, according to whether the tube was kept open or closed by an accurately-fitting plag. When the tube was closed, the animal, after a variable number of seconds, made strong efforts to breathe; and when these ceased, unless air was speedily admitted, it died. From nine experiments on the dog, the average duration of the respiratory movements, after the animal had been completely deprived of air, was four minutes and five seconds. The average duration of the heart's action was seven minutes and eleven seconds; and it further appeared that, on an average, the heart's action Continued for three minutes and fifteen seconds after the animal had ceased to make these efforts to breathe. In respect to the rapidity with which death takes place in animals, the following conclusions were drawn: first, a dog may be deprived of air during a period of three minutes and ifty seconds, and afterwards recover without the application of artificial means; and second, a dog is unlikely to recover, if left to itself, after having been deprived of air during a period of four minutes and ten seconds. As in drowning, the shorter the interval between the last respiratory efforts and the readmission of air the greater the probability of recovery. (Med.-Chir. Trans., 1862, vol. 45, p. 454.) The results of

426

SUFFOCATION-TIME OF DEATH.

these experiments in reference to the duration of life under privation of air may be considered applicable to a human being. It is not likely that a man would survive under these circumstances longer than a dog, and it may therefore be fairly inferred that the life of a man would be destroyed in from four to five minutes after the power of breathing had been completely arrested.

There are many varieties of death by suffocation, all which are of great medico-legal interest: 1. The close application of the hand over the mouth and nostrils, or the placing of a plaster or cloth over these parts, combined with pressure on the chest: this was formerly not an unfrequent form of homicidal suffocation. 2. Smothering, or the covering of the head and face with articles of clothing, etc., which effectually prevent breathing. 3. The accidental or forcible introduction of foreign bodies into the mouth and throat. 4. The flow of blood into the windpipe from a severe wound in the throat, or from the bursting of a blood vessel or aneurismal sac. 5. In wounds of the throat, when the windpipe is completely divided, the lower end may be so drawn into the wound as to produce a closure of the orifice and intercept the passage of air. One or other of these causes frequently operates to render a wound in the throat fatal. 6. The plunging of the face into mud, snow, dust, ashes, feathers, leaves, or similar substances. In all these cases death takes place from asphyxia, and with great rapidity, if the chest sustains at the same time any degree of forcible compression. 7. Swelling or spasm of the glottis produced by the contact of corrosive liquids or boiling water. In one case death was probably caused by the application of a strong solution of nitrate of mercury to an ulcer in the throat.

Suffocation may arise from morbid causes operating mechanically to prevent respiration, such as a diseased state of the parts about the throat, an enlargement of the glands, the bursting of a tonsillary abscess, or the effusion of lymph, blood, or pus into the windpipe or about the opening of the larynx (rima glottidis). Any of these causes may suddenly arrest the act of breathing a fact which can only be determined by a careful examination of the air-passages. Accidental suffocation may arise from large masses of food blocking up the larynx. If the glottis (the opening of the windpipe) be completely closed by food, death may take place suddenly; although the person so situated may be capable of making some exertion or of moving from the spot. Mackenzie relates a case in which a man was suddenly choked by swallowing a large piece of meat; he immediately walked across the street to a chemist's shop, and, soon after entering it, he fell down in a state of insensibility. After death, the throat was found to be filled with a piece of beef, which rested on the glottis, and had pressed the epiglottis forward. Part of the mass had entered the windpipe through the rima glottidis, and had thus caused death by suffocation. It is probable that, in this and similar cases, the foreign body does not so completely close the aperture as to prevent some degree of respiration, but, the blood being imperfectly aerated, asphyxia is speedily induced. (Edin. Month. Jour., July, 1851, p. 68.) A man, æt. 31, was put to bed drunk, having previously vomited; and shortly afterwards he was found dead. On inspection, Jackson discovered the usual appearances of asphyxia, i. e. congestion of the lungs and of the right cavities of the heart. He was thus led to examine the air-passages carefully, and he found lying over the upper opening of the larynx (rima glottidis) a thin and transparent piece of potato-skin so closely applied to the fissure as to prevent breathing. The man had died accidentally suffocated from this mechanical cause. He had had potatoes for dinner the day before; the

SUFFOCATION FROM ACCIDENT OR DISEASE.

427

e of skin had probably been thrown up at the time of vomiting, and I been drawn back by inspiration into the singular position in which it as found. Owing to intoxication, the deceased was unable to cough it (Edin. Med. and Surg. Jour., April, 1844, p. 390.) Wright describes case of an old woman who, during a violent fit of coughing, suddenly back in her bed, struggled convulsively, and died in a few seconds. Ater death, a pellet of tough mucus was found in the rima glottidis, so the deceased was literally suffocated with her own phlegm. (Pathol. I searches, 1850, p. 7.) A man was suffocated while at dinner by swal sing his artificial teeth. In another case, a man died from suffocation swallowing an oyster. In the case of a child, æt. 8, it was proved that cation had been caused by a gooseberry which had been swallowed, king up the glottis. In the Lond. Med. Gaz., vol. xxix. p. 146, there is a case reported in which a child was suffocated by a pea.

A person may die suffocated, not from the act of swallowing food, but reason of part of the contents of the stomach finding their way into air-passages. Whenever vomiting is followed by an inspiration while e vomited matters are in the mouth, the food is liable to be drawn by ration into the windpipe, bronchi, and pulmonary cells, and to cause focation. Pressure on the body may have the same effect as the act of Touiting. A man was struck several blows with the fist; he was then Sed in the nape of the neck, and finally his body was trampled on by assailants. He died before any assistance could be rendered. On inpection the air-passages were found to contain a large quantity of pulpy after such as existed in the stomach. The wounds received were only -wounds, no large blood vessel having been injured. Nevertheless, De expert attributed death to loss of blood from the wounds; another assigned it to asphyxia from the food vomited by the deceased passing o the lungs during an inspiration. Engel and Hauska were able to ve that asphyxia was the cause of death, and that the assailants were sponsible. The food had been forced into the fauces by the act of rapling on the body. (Ann. d'Hyg., 1868, t. 1, 450; t. 2, 226; and 19. t. 1, 471.) This mode of death by suffocation, as a result of vioe to the abdomen, is probably more frequent than it is commonly suped to be. It is likely to occur in the maltreatment of drunken persons. 1.1889 a man was convicted of the murder of a woman, Selina Troughear Reg. v. Kerr, Carlisle, Sum. Ass., 1889). From the evidence it appeared at the woman died whilst, or shortly after, a rape was committed on her the prisoner, accompanied with brutal violence. The actual cause of ah was suffocation brought about by the vomiting of a hearty meal. In connection with this case I am indebted to a distinguished Queen's Consel for the following legal memorandum: If a man in committing a ape on a woman, or in assaulting her to cause grievous bodily harm, causes ler to vomit, whereby she is suffocated, he commits an act of constructive urder; but if the vomiting and death were the result of an attempt only rape, he is guilty of manslaughter. If, on the other hand, the woman sented to have carnal intercourse, and all that the man did to her was The rude violence of a rough drunken man without intent to injure he Would have committed no offence whatever, even though what he did ased her to vomit, and thus led to her death from suffocation. Behrend as reported a case in which suffocation was caused by the aspiration of food, with a full account of the post-mortem appearances, in Horn's Verteljahrsschrift, 1868, 1, 123. Accidental suffocation from food is one of those causes of violent death which is recorded in the Registrar-General's

428

SUFFOCATION-CAUSE OF DEATH.

returns. It appears from the report of mortality in England and Wales that in one year there were 81 deaths from this cause.

A person has been wrongly charged with causing the death of another when the cause was really owing to the impaction of food in the larynx. An instance of this kind occurred at Hillingdon (Lancet, 1850, i. p. 313). The deceased had a quarrel with the accused, and they were seen to fall to the ground together while struggling and fighting. They were separated. About two hours afterwards the deceased, who appeared quite well, was observed to rise from the dinner-table and leave the room. He was found leaning against the cottage, as if in a falling position, and he expired in two or three minutes. The person with whom the deceased had been fighting was charged with manslaughter before a magistrate. At the inquest the medical witness stated he found the organs of the body, excepting the brain, in a very healthy state. The brain was excessively congested, and he attributed death to apoplexy. The coroner desired the witness to examine the mouth and throat (which he had omitted to do at the inspection), as, from the suddenness of death after eating, he (the coroner) thought the man might have been choked. This opinion turned out to be correct. A large piece of meat was found wedged in the opening of the throat; this had caused death by suffocation. It had not completely closed the air-passages in the first instance; hence the man was able to move from the dinner-table. The person accused of manslaughter was discharged. A medical jurist, however, must not lose sight of the fact that a foreign substance may be homicidally impacted in the larynx, and that, except by a careful examination of the body, death may be wrongly assigned to accident. A case reported by Littlejohn is in this respect instructive. In examining the body of a woman who it was stated had died suddenly, he found a quart-bottle cork inserted tightly into the upper part of the larynx. The sealed end was uppermost, and was roughened by the passage of the screw. Fractures of the ribs were found, and it was quite clear that deceased had not died a natural death. It was suggested that the deceased while extracting the cork from the bottle with her teeth, might, by the sudden impetus of the contained fluids, have drawn it into the position in which it was found. But this theory was negatived by the sealed end of the cork being uppermost in the throat, as well as by the structure of the parts. The medical opinion was that the cork must have been forcibly placed there by another person while the woman was in a helpless state of intoxication. There was no reason to doubt that this was a deliberate act of murder. Five persons were present with the deceased at the time of her death, but it was impossible to fix with certainty upon the person who had committed the act, and the man on whom the strongest suspicion fell was acquitted on a verdict of "not proven." (Edin. Med. Jour., Dec. 1855, p. 511; and for a report of the trial, see p. 540.)

Cause of Death.-In suffocation death takes place from asphyxia; and this occurs with a rapidity proportioned to the degree of impediment existing to the passage of the air. There does not seem to be any reason to attribute death to apoplexy. The congestion of the cerebral vessels may be regarded as a consequence of the disturbance of the functions of the lungs. If the veins of the neck were opened, so as to prevent an accumulation of blood in the vessels of the brain, it is pretty certain that the prevention of respiration would destroy life under the same circumstances and within the same period of time; therefore we may regard death from suffocation as resulting from pure asphyxia. In treating a case of suffocation, we have simply to allow of the renewal of air by removing, if this