  Suffocation is the name applied to both the act of and condition resulting from the deprivation of atmospheric air. If the deprivation is due to mechanical interference, the term MECHANICAL SUFFOCATION is used. Mechanical interference may be by pressure upon or obstruction within some portion of the respiratory tract. Suffocation by pressure upon the neck is called hanging when the constricting force is the weight of the body itself; and strangulation in all other cases. German writers designate strangulation by cords, ropes, and the like as Erdrosselung, and by the hand as ErwÜrgung; French writers do not make this distinction. In English the word throttling is probably oftener applied to strangulation by the hand than by cords. The term suffocation is also applied in a special sense to the act and result of pressure on the mouth, nose, or chest and abdomen, stopping the breathing; or of obstruction within the respiratory tract; or of pressure upon the tract from the oesophagus, etc.; or of breathing of irrespirable gases. Strangulation is almost always homicidal, hanging almost always suicidal, and suffocation (limited) usually accidental, but also often homicidal. Strangulation may be admitted, therefore, as including all cases of suffocation by pressure on the neck, whether by cords or the hand; but excluding hanging. It will facilitate the study of the subject if we use the word ligature as a general term to cover the many forms of cords, ropes, etc., used in strangulation and hanging. The word GARROTING is often used to indicate the forcible compression of the neck by the hands of thieves. The assault is usually made from behind, and the victim is robbed while the throttling proceeds. The brevity of the process explains why death is not more frequent. The word garroting comes from the Spanish; criminal execution in Spain and Italy is An examination of the reported cases of strangulation and hanging shows a great variety of forms of ligature: cords, ropes, thread, thongs, lassos, flexible twigs, bamboos, leather straps, girdles, turbans, fishing-nets, collars, cravats and other forms of neckwear, bonnet strings, handkerchiefs, sheets, etc. Women have even strangled themselves with their own hair (Case 34). Stones, sticks, coal, and other hard substances have sometimes been inserted in the ligature to increase the pressure (Cases 36, 38, 42, 43, 44). Drunken and otherwise helpless persons have been strangled by falling forward with the neck against a firm substance. STRANGULATION.Symptoms and Treatment.The symptoms and post-mortem appearances in strangulation will vary, according as the deprivation of air is sudden or gradual, partial or complete; and whether there is coincident pressure on the great arteries, veins, and nerves of the neck. The deprivation of air disposes to asphyxia; pressure on the great arteries by cutting off the supply of arterial blood to the brain disposes to anÆmia of the brain and syncope; pressure on the great veins, by preventing the return of blood to the heart, to congestion of the brain and coma; pressure on the great nerves, the pneumogastrics, to syncope. Statistics of hanging show that in about seventy per cent of cases death is by a mixture of asphyxia and coma. While it is probable that the proportion is less in strangulation, yet it is also probable that a mixed result frequently occurs. Asphyxia is from a priv. and sf????, pulse—absence of pulse. Apnoea from a priv. and p???, I breathe—absence of breathing. Syncope, s????p?, a faint; suspended animation from sudden failure of heart. Coma, ??a, deep sleep. Richardson Quinquaud Page First. A short stage. (In the human subject this stage could scarcely last longer than fifty seconds, which is said to be the extreme limit of the most expert divers. The breath can be held longest if a number of deep breaths have previously been taken, so as to surcharge the blood with oxygen.) Second. The stage of “besoin de rÉspirer,” when the want of air begins to be felt; the animal makes vigorous and violent efforts to overcome the obstacle. This stage may continue for three to four minutes. Third. Unconsciousness supervenes with irregular and spasmodic movements; efforts at respiration continue. Fourth. Efforts at respiration cease, but the heart still beats. This stage may last from two to four minutes. Hofmann The post-mortem appearances in such an animal were as follows: the lungs were pale, reddish, not much distended; there were a few dilated air-cells toward the anterior border; hemorrhages irregularly dispersed over the surface of the lung, varying in number and size. The right cavities of the heart contained dark fluid blood, the left were empty. The pulmonary artery and systemic veins, even the smallest branches, were gorged with dark blood. Page adds that when the Colin Faure The symptoms of strangulation in the human subject resemble closely those just described as occurring in the dog. The FIRST or PRELIMINARY STAGE lasts a variable time, according to the suddenness and completeness with which the access of air is prevented; it lasts until there is a demand for the air. In a case of homicide, injuries may be inflicted on the victim in this stage which may have an important bearing on the cause of death. Blows on the head may cause unconsciousness, or even apoplexy; upon the stomach, may cause syncope; stab-wounds may tend to cause death from hemorrhage. The SECOND STAGE begins with the demand for air and lasts till unconsciousness supervenes. It is characterized by frantic efforts to breathe, efforts in which the entire body takes part. If the subject is conscious, he is intensely so; the expression of the face is intense; the eyes may protrude, the hands be clinched; the memory is unusually active, and the events of a The THIRD STAGE usually appears suddenly, and is characterized by unconsciousness and irregular involuntary movements, i.e., spasms; these may end in opisthotonos; the veins become turgid, and hemorrhages may occur from the eyes, nose, mouth, throat, ears, and into the connective tissues of the lungs, pleura, pericardium, etc. The circulation of venous blood in the arteries is shown by the general lividity, especially where the skin is thin, as the lips and tips of fingers. Hofmann The FOURTH STAGE begins with the cessation of spasms and of efforts to breathe. The subject is quiet, but the heart still beats. The stage ends with the cessation of the heart-beat. Discharges of semen, urine, and fÆces may occur in the first and second stages, from terror; in the second and third from the general agitation, and in the third and fourth from paralysis. Strangulation according to Bernard Lukomsky Some writers, as Taylor and Tidy, think that death occurs sooner in the human subject than in the lower animals; where the access of air is suddenly and completely prevented death may be immediate. Tardieu says that death follows pressure of the hand sooner than that of a ligature. Fleischmann Dr. G. M. Hammond Should the subject recover from the immediate effects of the strangulation there may yet be serious secondary results. Among these are convulsions and paralysis; extreme swelling of face, neck, and chest; loss of voice; lesions of larynx and lungs; abscesses. Death may occur suddenly and remotely from one of the sequelÆ. In the treatment of strangulation the first indication obviously is to remove the pressure from the neck. Artificial respiration will probably be required, and may be aided by ammonia applied to the nostrils, tickling of the fauces, and galvanism. Colin Limousin The after-treatment will depend on the after-conditions. The prognosis is good if there is no serious injury to the neck and treatment is promptly applied. Post-Mortem Appearances.The post-mortem appearances in strangulation are external and internal. The external appearances are of two kinds: those directly due to violence and accident and those due to asphyxia. External Appearances Directly Due to Violence or Accident.—The MARKS on the neck. In some fatal cases there are either no marks at all or they are but slight; this is more likely to be the case in suicides than homicides, and is usually due to the ligature being soft and yielding. The victim of a homicide may, however, first be stunned and afterward strangled. Marks are said to be plainer after the body has become cold and where subjects have recovered from attempts at suicide. The marks of the ligature in strangulation usually encircle the neck more completely and more horizontally than in hanging. These conditions may, however, be reversed, because a body may be dragged by the neck after strangulation, and there have been suicides by hanging in whom the mark of the cord was horizontal. As a rule, however, a horizontal mark with the knot on the same level as the cord, especially if below the larynx, suggests strangulation rather than hanging; and if there are several marks the probability is even greater. In compression with the fingers the marks are not in a horizontal but oblique line. The mark of the ligature is usually circular, well defined, The parchment skin seen in hanging is seldom seen in strangulation. Neyding The violence used may cause ecchymoses and abrasions of the skin of the neck adjacent to the mark of the ligature. The marks of very different constricting ligatures may be Where a hard substance like a piece of coal or stone is inserted into the ligature, usually then a soft cloth, and presses directly against some part of the neck, there is usually a corresponding bruise. Marks of pressure by the thumb and fingers are usually on the front of the neck, and either just above or below the larynx. In many cases these marks are only those of the finger-tips with some scratches. These marks may show definitely the probable size of the assaulting hand, and whether right or left. Marks of strangulation may disappear rapidly after the removal of the ligature. Assailants usually constrict the neck much more violently than is sufficient to cause death. Marks of violence on the neck are, therefore, greater in strangulation than in hanging. A great variety of external injuries other than those on the neck have been found in the different cases reported where other forms of violence were used. With few exceptions such additional injuries indicate homicide. External Appearances Due to Asphyxia.—A few of these have already been given under the caption “Symptoms.” If death occurs quickly there may not be any signs of asphyxia. The general LIVIDITY which comes on in the second stage usually remains after death. The face varies in color from violet to black and may be swollen. Casper Dastre and Morat Post-mortem stainings (hypostases) are usually darker in strangulation than in other forms of death. They appear soon, as does also putrefaction, because of the quantity and fluidity of the blood. Signs of HEMORRHAGE from the nose, eyes, and mouth may be visible; as also bloody froth from the mouth and nose. Chevers The FACE usually shows pain and suffering; although sometimes the features are calm. In the latter case there may have been syncope. The EYES are usually staring, prominent, and congested, and the pupils dilated. Casper The TONGUE is often swollen, dark, protruding, and sometimes bitten. Maschka The HANDS are usually clinched and may have in their grasp articles which, under the circumstances, have a medico-legal value. The EXTERNAL GENERATIVE ORGANS are sometimes congested; erection of the penis may have taken place and persisted. The vagina may be moist. Tardieu, Devergie, and Casper Involuntary discharges of urine, fÆces, and seminal fluid may have occurred. There is nothing characteristic in their appearance. All the external appearances of asphyxia are usually more marked in strangulation than in hanging. Internal Appearances.—The mark. Usually there is hemorrhage into the loose connective tissue under the mark and in the subjacent muscles; in most cases isolated and circumscribed, but sometimes extending beyond the line of the mark. Hemorrhage from compression by the fingers is more marked than that from ligature. The CAROTID ARTERIES may suffer rupture of their inner and middle coats, especially in atheromatous subjects and when the compression has been great. Friedberg The NECK occasionally suffers extreme injury, and, owing to the violence used, this occurs oftener in strangulation than in hanging. The HYOID bone may be fractured (see Case 5). Maschka The TRACHEA is sometimes torn, or may be folded on itself. The cartilages of the LARYNX, especially if calcareous, may be fractured. This is more likely to affect the thyroid than cricoid. The fracture would appear to occur only as the result of enormous force; especially in the young in whom the cartilages are so elastic. The experiments of Keiller Chailloux Internal Appearances Due to Asphyxia.—The VEINS of the entire body are distended with very dark and very fluid blood, while the arteries, especially in the young, are mostly empty. Experiments on the lower animals have shown that The Heart.—The right side, especially the auricle, is usually full of dark fluid blood, due to the mechanical impediment to the passage of blood through the lungs. If the heart continues to beat after the respiration has ceased the right ventricle is commonly well contracted, like the left cavities, and nearly empty, the lungs being much congested. Sometimes the left cavities of the heart contain blood. This would be most likely to occur if the heart should stop in the diastole. Sometimes clots are found in the right ventricle. Maschka The LUNGS are usually much congested, resembling red hepatization, except that the blood is darker. Hemorrhages (apoplexies) into the substance of the lungs are common. Tardieu found patches of emphysema due to rupture of the surface air-vesicles, giving the surface of the lung the appearance of a layer of white false membrane. Ogston admits this occurrence in pure strangulation but to a less extent in mixed cases. Liman The lungs are sometimes anÆmic. In healthy young subjects, especially children, the blood-vessels of the lungs often empty themselves after the heart stops. The lungs may, therefore, be bloodless, but emphysematous from the violent efforts to breathe. Page’s experiments on the lower animals showed the lungs of a pale reddish color and not much distended; a few dilated air-cells might be seen toward their anterior borders, and there might be small hemorrhages over the surface. His experiments appear to show that subpleural ecchymoses occur as a result of violent and repeated efforts to breathe. Among other experiments The BRONCHIAL TUBES are usually full of frothy, bloody mucus, and the mucous membrane is much congested and shows abundant ecchymoses. The lining membrane of the LARYNX and TRACHEA is always congested and may be livid; the tube may contain bloody froth or blood alone. Tidy comparing strangulation and hanging concludes that because strangulation is usually homicidal, and greater violence is used, therefore the external marks are more complete in strangulation and the congestion of the air passages is invariably much greater. Maschka found the PHARYNX cyanotic in 216 of 234 cases of asphyxia. The other MUCOUS MEMBRANES are generally much congested. Serum is found in the serous cavities. Maschka The BRAIN and membranes are sometimes congested; occasionally apoplectic. Maschka The ABDOMINAL ORGANS are generally darkly congested, although Maschka denies this for the liver and spleen in asphyxia. The congestion of the viscera generally is doubtless due largely to the prior congestion of lungs and engorgement of heart. Page Langreuter The Proof of Death by Strangulation.Tidy In estimating the value of testimony it will be well to consider the following facts: A victim may be strangled without distinct marks being found. The practice of the thugs shows that this may be done with a soft cloth and carefully regulated pressure without making marks. Taylor, The subject while intoxicated or in an epileptic or hysterical paroxysm may grasp his neck in gasping for air, and leave finger-marks. Different constricting agents may make quite similar marks. Marks may be made on the neck within a limited time after death, similar to those made during life. Tidy’s experiments led him to fix this limit at three hours for ecchymoses and six hours for non-ecchymosed marks. Taylor, It is, however, unlikely in such post-mortem attempts at deception that the other conditions usual in strangulation would be found—such as lividity and swelling of face; prominence and congestion of eyes; protrusion of tongue; rupture of surface air-vesicles and apoplexies in the lung; congestion of larynx and trachea, etc. No conclusion can be drawn from the presence or absence of any single appearance. A cord may be found near a body or even around its neck; there may even be a mark around the neck. These may be attempts at deception. Marks much like those of violence may be made by tight collars and handkerchiefs remaining until the body is cold. Cases are reported of bodies having been first strangled and In apoplectics with short and full neck we may find at the borders of the folds of skin in the neck one or more depressions, red or livid, that bear some resemblance to the marks of a ligature; but on section there are no ecchymoses. Froth, tinged with blood, in the air-passages is considered by Tardieu The marks of topical medical applications, as plasters, sinapisms, etc., must not be confounded with marks of violence. In strangulation by ligature the marks are usually horizontal; in hanging, oblique. In hanging too they are usually dry and parchmenty. Ecchymoses are more marked in strangulation. The dotted markings of face, neck, and conjunctivÆ described by Tardieu are more characteristic of strangulation. The principal distinctions between strangulation and suffocation would be the absence in the latter of marks on the neck. Taylor The only motive for attempting to simulate strangulation on a corpse would seem to be to inculpate an innocent person. Both suicides and murderers are usually more violent than is necessary to destroy life; murderers more than suicides. Putrefaction may cause external marks to disappear. All marks on a body should be carefully noted; the cavities of the skull, thorax, and abdomen carefully examined; the possibility of death having occurred from other causes, even in strangulation, must be considered. As Taylor well says, our judgment must not be swayed to the extent of abandoning what is probable for what is merely possible. In all cases the cord or strangulating ligature should be carefully examined for marks of blood, for adherent hair or Strangulation: Accidental, Suicidal, Homicidal, Simulated.The question whether a case of strangulation is accidental, suicidal, or homicidal is very difficult to answer. Accidental strangulation is rare. If the body has not been disturbed, there is usually no difficulty in arriving at a conclusion; but if disturbed a satisfactory conclusion may not be reached. It is worthy of mention that the umbilical cord may be twisted around the neck of a new-born infant and may have caused strangulation; the mark may give the appearance of death by violence. Suicidal strangulation is rare. The experiments of Fleischman (supra) suggest that one may commit suicide by compressing his throat with his fingers (see Case 48). Where a ligature of any kind has been used it is important to notice the number and position of the knots. In a general way a single knot either in front or at the back of the neck might suggest suicide; more than one would suggest homicide. There are, however, exceptions. Suicide has been committed by mere pressure of a cord fixed at both ends a short distance from the ground; by twisting a rope several times around the neck and then tying it (the coils may continue to compress even after death); by tightening the cord with a stick or other firm substance; by tightening the cords or knots by means of the hands or feet or some portion of the lower limbs; by the use of a woollen garter passed twice around the neck and secured in front by two simple knots, strongly tied one to another. It is difficult to simulate suicide; requires great skill and premeditation on the part of a murderer. “The attitude of the body, the condition of the dress, the means of strangulation, the presence of marks of violence or of blood on the person of the deceased, on his clothes or the furniture of the room, or both, rope or ligature, are circumstances from which, if observed at the time, important medical inferences may be Strangulation is generally HOMICIDAL. The marks of fingers or of a ligature on the neck suggest homicide. This is true even if the mark is slight; because infants and weakly persons may be strangled by the pressure of the hands on the throat. Even a strong man, suddenly assaulted, may lose his presence of mind and, with that, his power of resistance; with approaching insensibility his strength still further diminishes. This is true even if his assailant is the less powerful. It requires more address to place a ligature on the neck than to strangle with the hand. A victim may be made insensible by drugs or blows and then strangled by a small amount of compression; or suffocation by gags and strangulation may both be attempted. The importance of considering the position and number of the knots in a cord is mentioned under suicidal strangulation. In homicide, in addition to the marks on the neck, there is likely to be evidence of a struggle and marks of violence elsewhere on the body. It is important, therefore, to notice any evidence of such a struggle. The nature of the cord may assist in identifying the assailant. It must be remembered that homicidal strangulation may be committed without disturbing noise even when other persons are near. Simulation.—False accusations of homicidal strangulation are on record. Tardieu The celebrated Roux-Armand ILLUSTRATIVE CASES.Homicide.1. Cullingworth: Lancet, May 1st, 1875, p. 608.—Woman. Believed to have been intoxicated. Face, especially right side, swollen and livid; a little blood had oozed from mouth, nose, and inner angle of each eye. Immediately over (in front of?) larynx and on each side of middle line were marks of irregular outline such as might be caused by pressure of thumb and fingers. Several dark, bruise-like discolorations 2. Taylor: “Med. Jur.,” Am. Ed., 1892, p. 412.—Man and woman. Strangled by cord, tied so tightly that there was hemorrhage from mouth and nose. 3. Harvey: Indian Med. Gaz., December 1st, 1875, p. 312.—Hindoo woman, age 45. Strangled with the right hand. Necroscopy: Two contusions and abrasions on temple. Neck discolored from right to left jugulars; marks of thumb on right side and three fingers on left, extending from jugulars to windpipe. Eyes half protruded. Tongue discolored. Blood-vessels full of clots. Brain congested (?) and showed external hemorrhages (?). Lungs normal. Heart empty. Liver ruptured to the extent of four inches, with adherent blood-clot. Spleen, stomach, and intestines normal. Muscles of chest, both sides, congested, discolored, and there were clots of blood over and under them. First six ribs of left side and first three of right fractured. 4. Harris: Ibid., p. 313.—Boy, age 10. Abrasions over front of neck, especially near left ear, probably from ligature; also abrasion on upper part of chest, probably from forcible pressure. Underneath these marks the veins were much distended. Trachea minutely congested; contained much frothy fluid. Lungs showed rupture of some of the air-vesicles; entire tissues distended with blood and frothy fluid. Dark fluid blood in both sides of heart. Large quantity of fluid in pericardium. Brain much congested. Eyes congested. Tip of tongue between teeth. Other organs normal. 5. Mackenzie: Ibid., February, 1889, p. 44.—Hindoo woman, age not given, strangled by another, stronger woman. Necroscopy: Abrasion on front and lower part of neck just above sternum and clavicles; four inches long, three broad; five superficial lacerated wounds on sides of neck, four on left, one on right, apparently nail scratches. Two contusions below and behind lower jaw. Also contusions on thighs. No spots of ecchymosis on neck. Contusion under skin of lower part of neck and upper part of chest, eight inches long, four broad. Left greater cornu of hyoid bone fractured. Both upper cornua of thyroid cartilage fractured; cricoid fractured on each side. Larynx, trachea, and bronchi contained pink frothy mucus; mucous membrane congested. Lungs much congested; pink frothy mucus in bronchi; no emphysema nor apoplexies. Right side of heart full of dark blood; left side empty. Liver, spleen, and kidneys congested. Stomach and 6. Mackenzie: Ibid., August, 1888, p. 232.—Hindoo man, age about 30. Strangled by soft cloth cord. Necroscopy: Circular mark of cord, one-fourth inch diameter around lower part of neck; indistinct in front, but distinct at sides and back. Superficial abrasions of lips and right cheek as from a gag. Faint marks of blisters on temples. Fingers not clinched. Face livid, swollen. Eyes closed; conjunctivÆ congested; corneÆ hazy; pupils normal. Tongue protruding and bitten; not swollen. Fluid blood oozing from mouth and nose. Clotted blood under scalp of left temple. Skin beneath cord had the color and consistence of parchment. Muscles not torn. Hyoid, thyroid, and cricoid not injured. Larynx, trachea, and bronchi empty; congested. Lungs much congested. Some dark fluid blood in right side of heart; left side empty. Liver, spleen, and kidneys congested. Small patch of congestion in stomach. Intestines normal. Bladder normal, contained some urine. Brain congested. 7. Ibid., p. 234.—Hindoo woman, age about 40. Broad, circular, depressed “parchment” mark, one inch broad, around the neck, between hyoid bone and thyroid cartilage; made by two pieces of cloth, each three feet seven inches long and one inch broad, twisted into a single cord and tied tightly by three ordinary knots on right side of neck. Superficial wound on left side of head above ear. Face turgid, swollen. Eyes closed. Tongue between teeth and bitten; not swollen. Muscles of neck uninjured. Trachea uninjured. Lungs congested. Right side of heart full of dark fluid blood; left side empty. Liver and spleen congested. Other organs, including brain, normal. 8. Ibid., p. 235.—Hindoo woman, age about 25. Piece of cloth twisted tightly twice around mouth. Double cord made of two twists of thin coir rope tied tightly around middle of neck just below thyroid cartilage; beneath the cord the skin was “parchment” like. No injury to muscles of neck nor windpipe. Eyes closed. Face not flushed. Tongue not ruptured nor bitten. Hands not clinched. Larynx, trachea, and lungs congested. Right side of heart full of dark fluid blood; a little fluid blood in left. Liver, spleen, and kidneys congested. Other organs, including brain, normal. Dr. Mackenzie considered death to be due to “asphyxia or suffocation.” 9. Harvey: Ibid., January 1st, 1876, p. 2.—Hindoo woman, age 12 or 13. Faint mark on front of neck; none at back. Severe bruise on top of head, under which was much clotted blood, but no fracture. Lungs congested. Clots in right ventricle; left empty. Brain, larynx, and trachea congested. The examiner believed that she had been stunned and then suffocated by pressure of some soft substance against the neck. 10. Ibid.—Hindoo man, age 20. Dead seven days; much decomposition 11. Ibid.—Cases of strangulation by sticks and other hard substances. Boy, age 7 or 8. No external marks of violence. There was hemorrhage from mouth and nose. Face swollen and crepitant. Congestion of subcutaneous tissues and bruising of muscles of right side of neck. Mucous membrane of larynx and trachea covered with blood. Lungs much congested; blood in both pleural cavities. Heart empty; bloody serum in pericardium. Brain congested; slight hemorrhage on surface. Abdominal organs normal. Dr. Harvey states that the boy was no doubt strangled by pressure of a lathi on his neck. 12. Ibid.—In another subject two sticks were tightly tied together, one pressing on the front, the other on the back of the neck, flattening larynx and other soft parts. In the following case some hard substance, like a brick, had been wrapped in a cloth and used for compression. Boy, age 15. Necroscopy: Large dark ecchymosis in subcutaneous tissue of front of neck and upper part of chest. Also marks of violence on chest and left side of face. Dissection of neck showed blood-clot and also laceration of muscles. Trachea folded on itself, showing that compression had lasted several minutes. Tongue protruding and bitten. Eyes closed. Features calm. Trachea much congested. Lungs congested. Great veins of heart and neck full of fluid blood. Heart, dark fluid blood in both sides, mostly in right. Brain and membranes much congested. 13. Pemberton: Lancet, May 22d, 1869, p. 707.—Woman, age 60. Found dead. Nose partly displaced and cartilages injured. Lips pale. Mouth closed. Lividity of front of neck from jaw to sternum. Cricoid cartilage ossified (cretified?) and broken on left side; hemorrhage in surrounding tissues. Lungs and heart as usual in suffocation. 14. Cullingworth: Med. Chron., Manchester, 1884-85, i., p. 577.—Woman, married, found dead. Bruise and ecchymosis beneath the ear; effusion of blood in underlying tissue. Other bruises on face, etc. Several bruises in mouth, on lips and tongue. Blood dark and fluid. Brain and membranes much congested. No marks of injury on throat. Lungs congested; surfaces emphysematous. Heart contained dark fluid blood. Urine and fÆces had been discharged. 15. The GouffÉ Case.—Murdered by Eyraud and Bompard in 1889. Archiv anthropologie criminelle, Paris, 1890, v., pp. 642-716; vi., 1891, pp. 17 and 179. Reports by Bernard, Lacassagne, and others. 16. Horteloup: Ann. d’HygiÈne, 1873, xxxix., pp. 408-416.—Man found dead on some leaves in a fountain at bottom of staircase; skull and spine fractured. The murderers stated that they had struck him on the head with a crutch; then, believing him to be dead, carried him and threw him into the fountain. When examined, his face was livid, tongue between teeth and bitten nearly in two; and three parallel abrasions on left side of neck and one on right; slight wounds about the face in addition to the fractures mentioned. No report of examination of lungs or larynx. Horteloup concluded that the man had been strangled to death, and that when thrown into the fountain, alighting on his head, the jaws were brought together and tongue bitten. 17. Laennec: Journ. de med. l’ouest, 1878, xii., pp. 68-71.—Woman, age 53; attempted strangulation by her husband. There were slight ecchymoses on each side of neck under angle of jaw, most marked on left side; when seen, she complained of lassitude and lively pain in hypochondria and region of lower ribs antero-laterally; no sign of lesion. She stated that she was awakened from sleep by pressure on neck and chest and feeling of suffocation; she soon lost consciousness and so remained for some hours. Her statements were corroborated by other testimony. Laennec considered the case one of prolonged syncope from pressure on carotids. 18. Lancet, ii., 1841-42, p. 129.—Woman, found dead, her clothing on fire and lower part of her body burnt. Necroscopy showed face and neck swollen as low as thyroid cartilage, and purple; eyes prominent and congested; mouth closed; tongue not noticed; front of neck below swollen part showed two dark-brown hard marks and slight marks also of pressure; on incision the vessels were engorged. Blood, fluid; brain, congested. There were no vesications from the burns and no sign of inflammation. 19. Alguie: “Étude mÉd. and exp. de l’homicide rÉel ou simulÉ par strangulation, relativement aux attentats dont Maurice Roux a ÉtÉ l’objet,” Montpellier, 1864, p. 121.—This essay contains the reports of many interesting experiments on animals and the cadaver. His conclusions in this case were that the victim had first been struck on the neck by a club; then a ligature was placed on the neck, with 20. Gatscher: Mittheil. d. Wien. med. Doct. Colleg., 1878, iv., p. 45.—A man found hanging. The examiner declared that he had hung himself. Eight years afterward, suspicion of violence. A commission appointed. The protocol had shown the blood fluid; a red-brown dry furrow around the neck; ecchymoses in connective tissues of same; the entire back and posterior parts of limbs showed post-mortem suggillation. The commission declared that the man had been strangled, had lain for at least three hours on his back, and then been hung up. The murderer confessed. 21. Ibid., p. 46.—Woman, age 50, found dead in bed. Blood fluid; two ecchymoses size of beans in crico-thyroid muscles of each side; patch of hepatization size of fist, in lung; injury of body. The examiner declared that she had been strangled by compression of larynx with two fingers, but he could not say how long the pressure had continued, that is, whether she had died of the strangulation or of the pneumonia. The assailant stated that he had choked her and when she seemed to be dead, had left her. The woman lived alone. 22. Waidele: Memorabilien, 1873, xviii., pp. 161-167.—Husband and wife quarrelled and fought; he stated that he choked her with her neck handkerchief, and as she turned round toward him, then choked her with his hand until she died. The examiner declared that she died of asphyxia; there was a brownish-red dry streak on each side of the neck in the laryngeal region corresponding to the handkerchief, and also two small abrasions of skin which might have been made by the hands; he concluded, however, that she had been choked to death by the handkerchief, because there were no ecchymoses. 23. Rehm: Friedreich’s BlÄtter f. ger. Med., 1883, xxxiv., pp. 325-332.—Woman, age 37. Choked by the hand on the neck, and at the same time assailant’s knee pressed against her abdomen, pressing her against a wall, causing hemorrhage around the pancreas. Death stated as due to asphyxia. 24. SchÜppel: Vier. ger. Öff. Med., xiii., 1870, pp. 140-156.—Woman, just delivered of child, and boy ten years old, were burnt to death in a fire which consumed their house. Examination of the bodies showed upon the neck of the boy a groove, and his tongue protruded. The husband was charged with murder, was imprisoned, and committed suicide. 25. Weiss: Ibid., xxvii., 1877, pp. 239-244.—Woman strangulated by the bands of her nightcap. 26. Isnard and Dieu: Rev. cas jud., Paris, 1841, p. 101.—Man, age 65. Marks of fingers on face and neck. Opinion that he had been assaulted by two men. The two murderers confessed. 27. Friedberg: Gericht. gutacht., 1875, pp. 211-224.—Woman 26. Tardieu: “Pendaison,” p. 223.—New-born infant. Question whether its death was due to asphyxia from compression of neck by the mother with her hand to hasten delivery. He doubted the possibility of the mother thus assisting her child. But the direction of the seven excoriations on its face contradicted the mother’s statement. The traces of finger-nails were distinct. The lungs and alimentary canal showed that the child had lived. Opinion given, infanticide. 29. Ibid., p. 219.—Woman, advanced in years, habits dissipated; found strangled. Four excoriations on left side of larynx, one on right; blood in subcutaneous tissue. Marks of nails and long scratches on wrist. Injuries on face and left breast. She had been strangled by one hand on her neck while the other was over her mouth and nose. Face livid; eyes congested; frothy bloody liquid flowing from mouth and nose; tongue behind teeth; bloody froth in larynx and trachea; lungs large, much congested, splenized in places, surface emphysematous, looking like white spots; black fluid blood in heart; brain somewhat congested. 30. Ibid., p. 216.—Wife of the celebrated painter Gurneray; found dead in bed, where a fire had been placed and slowly burnt and charred her lower limbs, belly, chest, and right hand. A running noose around her neck. Injuries of head; face livid; tongue between teeth; brain normal; mark of cord slight; subcutaneous tissue infiltrated with blood. Marks of pressure on chest; bloody froth in trachea; lungs congested; heart contained fluid blood. Opinion given that she had been struck on head, causing unconsciousness; then partly stranded and partly suffocated by pressure on neck and chest. Body afterward burnt to cover up the crime. 31. Ibid., p. 211.—Three murders by one man. All women. All injured about the head and then strangled by both hand and ligature. Two died; one had an odor of alcohol and had apparently not resisted. The third was resuscitated. She was strong and stout, and resisted. Marks of fingers and nails on neck. Afterward she had headaches and giddiness for a long time. Suicide.32. Francis: Med. Times and Gaz., December 2d, 1876, p. 634.—Hindoo lunatic, a giant, strangled himself. He passed two or three coils of stout thread around his neck, attached the ends securely to his wrists, and then extended his arms to their utmost limit. This occurred during a ten-minute absence of his attendant, who, returning, found the man had fallen to one side from a kneeling position, with his back against a wall, quite dead. No reason to suspect homicide. 33. Badahur: Indian Med. Gaz., December, 1882, p. 330.—Hindoo woman, age about 17, strangled herself with the border of her saree. Necroscopy: Circular depressed mark caused by the border of a band of cloth, which she had passed in three coils around her neck, the coils tightly overlapping each other; the short ends had been knotted together with a “granny” knot at the back of the neck, like the native women tie up their hair. The coils were so tight that they had to be cut off. Face swollen, dark purple; conjunctivÆ congested. Tongue between the shut teeth; bloody froth issuing from mouth and nostrils [the examination was in September, thirty hours after death]. Skin of neck reddened in nearly a continuous line all around, both above and below the band, about three-fourths inch wide, evidently caused by the pressure of the three folds. Considerable ecchymosis above and below the coils; the neck underneath the folds was swollen and red. Brain and membranes much congested. Trachea, pharynx, and oesophagus congested. Lungs congested. Right cavity (auricle?) of heart full, left empty. Liver, spleen, and kidneys congested. Intestinal peritoneum congested. Stomach contained half-digested food. Small intestines empty; fÆces in large intestine. Bladder empty. Uterus and appendages congested; no evidence of catamenia. 34. Harris: Ibid.—Woman; made a loop of her hair around her neck, knelt down so as to put it on the stretch; when found, was nearly dead. 35. Geoghegan: Taylor’s “Med. Jur.,” Am. Ed., 1892, p. 413.—Informed Dr. Taylor of a suicidal strangulation by a ribbon. The mark on the neck nearly disappeared after removing the ligature. There was bleeding from one ear, from rupture of tympanic membrane. No froth from mouth or nostrils; but little lividity or swelling of face. 36. Taylor: “Med. Jur.,” Am. Ed., 1892, p. 418.—Boy: found dead with handle of pitchfork under necktie; marks of strangulation on larynx; eyes and tongue protruded; tongue livid and marked by teeth; brain congested. Also man found dead with handkerchief tied around neck and twisted by razor strop. Taylor considered both as suicides. Also a third case (Amer. edit., 1880, p. 465). A man of unsound mind twisted a fishing-net firmly around his neck several times; it remained secure without the aid of a knot. 37. Fargues: Rec. de mÉm. de mÉd., etc., Paris, 1869, xxii., pp. 443, 444.—Soldier, age 32, while drunk, strangled himself with his handkerchief, wrapping many folds around his neck, making a deep furrow without ecchymosis; face pale, eyes closed, lips partly closed. 38. Borchard: Jour. de mÉd. de Bordeaux, 1860, v., p. 349 et seq.—Collation of cases of suicide by strangulation: First, an officer who placed his sabre scabbard under his cravat. Second, a woman strangled herself with a silk cravat, tightly tied. Third, a man tied the sleeve of his jacket around his neck and fastened the end to a window, so that 39. Hofmann: Wien med. Presse, 1879, xx., p. 16, et seq. Also Lehrbuch, p. 559.—Woman, age 20, found dead in bath-room, with a thick thread passed three times around the neck, and tied tightly in front at the second and third turns; so tightly that even after cutting the cords the pressure continued. No signs of violence. (Illustration.) 40. Zillner: Wien med. Woch., 1880, xxx., pp. 969, 999.—Woman, age 33; found dead on the floor; a neck-handkerchief tied in a firm knot in front of the neck; and underneath, a cord passed twice around the neck and knotted in front in the middle line between the larynx and hyoid bone. Blood was flowing from the ears. No sign of violence or struggle. 41. Bollinger: Friedreich’s BlÄtter f. ger. Med., 1889, xl., p. 3.—Man, age 48; melancholic; found dead. Had torn up part of a sheet, fastened it around his neck and the ends around a bed-post, then placed his feet against the farther post and pressed, tightening the ligature. (Illustration.) 42. Roth: Ibid., p. 9.—Man, age 68; melancholic; found dead in bed. Had made loose ligature of cravat, tied into it a piece of wood; the ligature lay in front of larynx. Had attempted suicide once before. 43. Ibid.—Son-in-law at 36 years of age had committed suicide in the same way. 44. Ibid.—Man, age 63; found dead in his bed; cord around neck inclosing piece of wood. 45. Maschka: Vier. ger. Öff. Med., 1883, xxxviii., pp. 71-77.—Woman, age 45. A cloth was found wound tightly three times around her neck in front of larynx, and tied in a simple knot. There were also injuries of the head. At first it was thought that she had been murdered, but Maschka concluded that she had committed suicide. 46. Ibid.—Woman; supposed to have been murdered by her son. There were marks on the neck and other injuries, and hemorrhage into the brain. Maschka concluded that the marks on the neck were not due to strangulation. 47. Hackel: Dorpat Diss., 1891, p. 34.—Man, age 48; strangled himself with part of a mattress. Was found lying on his back, dead, holding the ends in his hand. There was a double mark of ligature. 48. Binner: Zeitsch. f. Med-beamte, 1888, i., pp. 364-368.—Woman; suicided by choking herself with her hands. For other cases, see Tidy, “Med. Jur.,” Cases 20 to 65; Maschka, “Handbuch,” p. 625. Accident.49. BÉdiÉ: Rec. de mÉm. de MÉd., etc., Paris, 1866, xvi., pp. 482-484.—Soldier, age 39, found dying, lying on his bed; had returned to 50. LiÉgey: Jour. de MÉd. chir. et pharm., Brussels, 1868, xlvi., pp. 339-342.—Infant, age 8 months, accidentally strangled; it had been placed in its cradle; coverlet over it and held in place by a cord passed across. Some time afterward it was found dead beside the cradle, its head hanging with the right side pressing on the cord. LiÉgey had the mother replace everything as it had been and satisfied himself that the above statement was correct. When found, the face was pale, eyes and mouth closed; transverse furrow on right side of neck, level of larynx, 3.5 cm. long, one deep; muscles in vicinity congested. Lungs congested. Right side of heart contained clotted blood; left side nearly empty. He concluded that the case was one of accidental strangulation. 51. Friedberg: Gericht. gutacht., p. 240.—New-born child found dead in closet. Mother stated that she had taken the child by the neck and drew it into the world. Opinion given that the child had been accidentally choked to death by the hand. For other cases, see Tidy, “Med. Jur.,” Cases 15 to 19, 59, and 62; Maschka, “Handbuch,” p. 623. HANGING.Hanging is a form of mechanical suffocation by ligature of the neck, in which the constricting force is the weight of the body itself. The French call it “Pendaison” or “Suspension,” preferably the former; the Germans, “ErhÄngen.” The expression “incomplete hanging” is applied to those cases in which the subject is partially supported; kneeling, sitting, or otherwise. The same expression has also been used for cases which did not prove fatal. The pathological effects of hanging are partly those of strangulation, to which must be added the effects of the weight or fall of the body, sustained as it is only by some form of ligature around the neck. These additional injuries will, of course, be proportioned to the weight of the body, length of rope, and suddenness of the fall. In some countries, as the United States, England, Germany, and Austria, hanging is a mode of capital punishment. It is desirable that for judicial purposes it should be divested, as far as possible, of unnecessarily cruel features; the victim should quickly be made insensible, and death be speedy. Many suggestions to this end have been made, among which is that of Haughton. He recommended that the drop be long, say ten feet, so that the cervical vertebrÆ may be dislocated. He also advised that the knot be placed under the chin. Others advise that it be placed under the left ear; and others yet, as Barker, of Melbourne, Hanging is a common mode of suicide, especially in insane asylums and prisons. It is sometimes accidental, and rarely homicidal. It is said to have been attempted for erotic purposes. The compression of the neck acts in line with the axis of the body; while in strangulation it acts perpendicularly to that axis. The final cause of death will depend on: 1. The suddenness and completeness of interference with the access of air; asphyxia. 2. Pressure on the large veins of the neck, preventing the return of blood from the head, causing congestion of brain and coma. 3. Pressure on the large arteries of the neck, preventing access of blood to the brain; causing anÆmia of the brain and syncope. 4. Injury to spinal cord or pneumogastric nerves or all of them; causing paralysis. A combination of numbers 1 and 2 is usually found in suicidal hanging; and probably all of them in homicidal and judicial Mackenzie, The following conditions tend to produce asphyxia: a tight ligature, or a loose ligature above the hyoid bone. To produce coma, a loose ligature pressing against the hyoid bone or larynx, especially a cretified larynx. To both asphyxia and congestion of brain, a ligature just beneath the lower jaw, or around lower part of neck. Hofmann Von Buhl The vertebral arteries being much smaller than the carotids, the circulatory disturbance in the brain is not adjusted with sufficient promptness. Compression of the pneumogastrics, according to Waller, Hofmann says that the compression irritates and, in a higher degree, paralyzes the pneumogastric nerves and causes disturbance of the action of the heart. Faure Coutagne believes that the pressure on the pneumogastric nerve is a factor in causing death. He hung two dogs; in one the pneumogastric nerves were dissected out and placed in front of the ligature; this dog (No. 1) lived a quarter of an hour and died of pure asphyxia with efforts at inspiration continued to the end. The other dog (No. 2), in Tidy states that a dog lived for three hours suspended by a rope placed above an opening in the windpipe; and that Smith In a small proportion of cases of hanging, homicidal and judicial, death occurs by dislocation of the spine. This is said to have been first noticed by the celebrated Louis, who states that the Paris executioner was in the habit of giving a violent rotary movement to the body of the convict as the trap was sprung, causing a dislocation of the odontoid process and compression of the cord and almost instant death. Taylor Death may occur from secondary causes after apparent recovery; from congestion of brain and other lesions of the nervous system; these may prove fatal at remote periods. Fracture of the odontoid process according to M. de Fosse is more common than dislocation, and the giving away of the intervertebral substance more likely than either of the others. Besides the ropes used as ligatures in judicial hanging, almost every conceivable article that could be made into the semblance of a cord has been used by suicides; usually, however, some portion of the bedding or clothing. When one resolves on suicide, all the precautions of the managers of prisons and asylums fail to prevent. The secondary effects in those who recover involve the respiratory organs—dyspnoea, cough, bloody sputa, bronchial rÂles, and fever; or the nervous system—aphonia, dysphagia, numbness, chilliness, spasms, pains in neck, face, or shoulder; sometimes paralysis of bladder and rectum, and loss of memory. The marks on the neck slowly disappear. Symptoms in Hanging.Obviously these will be in some respects identical with those of strangulation. In considering the latter, some of the similarities and dissimilarities of symptoms and post-mortem appearances of strangulation and hanging were mentioned. Death may be immediate and without symptoms. There is, of course, no preliminary or “waiting” stage, as in strangulation, except in those rare cases of suicide where the subject inclines his body forward with his neck against the ligature, his body being near the floor or ground. The absence of a drop makes this condition very similar to ordinary strangulation. The body of a victim of homicide might be similarly placed for the purpose of deception, and also that of a subject previously made unconscious; in these cases the symptoms and appearances would resemble those of strangulation. In other words it is necessary that there should be a drop or fall, or at least the weight of the body, to produce the characteristics of hanging. The jerk of the fall or sudden dependence of the body upon the ligature causes a much greater constriction of the ligature on the neck, and in a different direction, than in strangulation; and also a much greater pressure on the blood-vessels and nerves of the neck. Tidy divides hanging into three stages: First stage: Partial stupor lasting thirty seconds to three minutes, according to the length of the drop, the weight of the body, and tightness of the constriction. The testimony seems to be uniform that there is no pain in this stage; indeed, that the feeling is rather one of pleasure. Chowne Taylor Second stage: The subject is unconscious and convulsions usually occur. The convulsed face, however, is a part of the general agitation and does not indicate pain. In judicial cases the face is covered with a cap. Sometimes there are no spasms. Urine, fÆces, and semen may be discharged in any stage. Jaquemin, however, in forty-one cases of hanging, noted discharge of urine and fÆces only twice. Semen has, however, been found in the urethra where none was ejected externally. Third stage: All is quiet except the beating of the heart. As a rule, the pulse may be felt for ten minutes. Blankenship In judicial executions, however, the right auricle is found in action when the subject is taken down at the end of the usual period of suspension (see Case 89). Tardieu mentions a case where the heart was beating 80 to the minute one and one-half hours after supposed death. It is probable that in these cases the deprivation of air and compression of the vessels has not been complete. In such cases life may sometimes be restored. Cases are reported where restoration has been possible within a period of a half-hour of suspension; although the fatal period is usually five to eight minutes at most. If, however, the tissues and especially the spinal cord are injured, or the ligature has compressed below the larynx, the chance of recovery is very small, even if the body is cut down at once. According to Faure, animals experimented upon die in twelve to twenty minutes. Many cases of “incomplete” hanging have been reported; where the feet touch the floor, or would do so if the subject should choose to have it so. Tardieu Fig. 22.—Suicide of Prince CondÉ. (See page 763.) In one of the experiments of Faure In incomplete hanging the upper limbs may have any position; the lower limbs are disposed according to the position of the body (Cases 1, 10, 18, 19, 20, 22, 24, 26, 28, 37, 43, 50, 56). Faure Francis Bacon records that he knew a man who wanted to find out by experience if there was any suffering in hanging. He placed the cord around his neck and stepped off a bench, intending to step back again, but became immediately unconscious and would have died but for the opportune arrival of a friend. He said he saw a light before his eyes. Treatment.The first indications obviously are to let the subject down, and remove all constriction of neck and chest. Artificial respiration should then be used, and this may be assisted by the vapor of ammonia to the nose and tickling the fauces. If the body is warm, cold affusions may be applied to the head and chest, and galvanism may be used. If the body is cold, apply warmth. Friction of the limbs aids in restoring warmth. If the subject can swallow give stimulants; these may also be used by rectum. Venesection may be required to relieve cerebral congestion or distention of the right heart and pulmonary circulation. The following cases illustrate what may be done to resuscitate one who has been hanged: A man, age 35, in good health, weight one hundred and sixty pounds, was executed with a drop of over six feet; the rope slipped behind the mastoid process. After three minutes his struggles Very few, comparatively, however, have been restored after hanging. For cases of recovery see Medical Times and Post-Mortem Appearances.The post-mortem appearances are external and internal. The external appearances are those due to the action of the ligature on the neck and to other violence, if any has been done, and those due to asphyxia or syncope. The MARKS of the ligature. If the suspension be very brief and the ligature soft and supple, and the body instantly cut down after death, there may be no mark. Allison Harvey Coutagne, The direction of the mark is usually oblique, following the line of the lower jaw upward and backward behind the mastoid processes; it may, however, be horizontal. If the ligature encircles the neck more than once, one mark may be circular, the other oblique. If a running noose is used the mark may be circular, and be seen all the way around the neck, looking like the mark of a strangulation. Taylor In four-fifths of the cases (117 out of 143, Tardieu) the mark is found between the chin and larynx; in nearly all the remaining fifth, over the larynx; in a very few below the larynx; the last position is due to the protection of the neck by a handkerchief or beard, or where there is some anatomical or pathological peculiarity which prevents the ligature from going higher. Hofmann The mark will vary in character according to the kind of ligature used, its mode of application, the vitality of the tissues, and the period that has elapsed since death. The result is different according as the knot or loop is single or double, a running or slip knot. The mark may differ in character in one part of the neck from another. The same furrow may be soft in one part and dry in another. The width of the mark does not necessarily correspond to the diameter of the ligature. A double mark usually means that the ligature has been twice passed around the neck, although the marks may not be continuous or parallel. Tardieu states that a large single leather thong pressing on the neck only by its borders may make a double mark. The mark is usually depressed. The depth of the depression, groove, or In about two-thirds of the cases the bottom of the furrow, the place of greatest pressure, is white, especially so where the knot is tied; while the edges of the furrow are usually slightly raised and red or livid. If the subject is very fat, there may be only a slight depression. Harvey The skin beyond the furrow is usually violet. Authors differ as to whether this is due to congestion or hemorrhage. Roth The dry, hard, yellowish-brown, or reddish-brown “parchment” furrow, described by writers, is said to be common. Ogston Slight abrasions and ecchymoses are sometimes found in the furrow. Ecchymoses alone do not indicate whether suspension has been before or after death; but abrasions with hemorrhage strongly suggest suspension during life. Devergie regards ecchymoses of the neck as strongly suggestive of homicide. Neyding Roth The furrow, when once distinct, remains constant for a long time after death, even in putrefaction. Marks from soft substances, however, disappear sooner than those from strong and uniform compression. The NECK nearly always appears stretched. According to Roth the mobility of the head is increased by this stretching. The HEAD is always inclined to the opposite side to that of the knot. In suicides the head is usually bent forward on the chest. The HANDS are often clinched so tightly that the nails are driven into the palms. This occurs more especially when the hanging has been done with violence. When the feet touch the ground, as often occurs in suicide, the hands may be stretched out. Roth found the hands and feet flexed in 44 of 49 cases. Taylor says that we may expect to find the hands clinched when constriction of the neck is sudden and violent. The LEGS are usually livid. The FACE varies with the duration of the suspension; at first it is pale, afterward livid; congested and swollen, if the The TONGUE is usually livid and swollen, especially at the base. According to Tidy, Dr. Guy looks on this as showing that suspension took place very probably during life. In about one-third of the cases the tongue is protruded and compressed between the teeth; sometimes bitten. Some observers found it protruded only as a result of putrefaction. The protrusion of the tongue is not believed to depend on the position of the ligature. Hackel in 67 cases found the tongue lying forward in all cases where the cord was between the larynx and the hyoid; in 55 per cent in front of the teeth, in 18 per cent between the teeth; where the ligature was lower down, the tongue was behind the teeth. He found by experiment that in the spasmodic expiratory effort the tongue was thrust forward; in the inspiratory movement, drawn backward. He concluded that the forward movement was the result of reflex action. Maschka Harvey, after examining reports of nearly fifteen hundred hangings, says: “In the majority of instances immediately after death Bloody froth is sometimes seen at the nose and mouth. Saliva is invariably secreted and runs out of the mouth down on the chin and chest. Its presence is considered as evidence that suspension occurred during life. The URINE and FÆCES are sometimes found to have been expelled. These discharges occur in all kinds of violent death. Tardieu found them, however, but twice in 41 cases of hanging. Roth in 49 cases found discharges of fÆces in 17 and urine in 4; in 15 cases not noticed. Harvey mentions a case where internal piles had burst, and there were stains and clots of blood about the perineum and anus. In such cases without careful examination there would naturally be a suspicion of violence. In about one-fourth of the cases the GENITAL ORGANS are congested. The penis is large and more or less erect; seminal fluid, generally prostatic, and sometimes mixed with blood, is often expelled. The fluid may pass only into the urethra and it may be necessary to press the urethra to secure it. The clitoris may be found erect, and there may be a sort of menstrual flow. Orfila showed by experiment that swelling of the sexual organs and emission of semen can be produced after death in those who had been suspended during life. The flow of semen is found in all kinds of death by violence. Roth in 39 cases of hanging of men found the penis enlarged 18 times and ejaculation in 19. Hackel found the penis swollen in 43 per cent of cases of asphyxia. Erection may come on soon or late, even days after death. Internal Appearances.—The CONNECTIVE TISSUE UNDER THE MARK is usually white and condensed, the more so if the body has been long suspended. This dryness or condensation was found by Hackel in 52 per cent of hangings. Deeper-seated parts are injured only when the hanging has been violently done. The MUSCLES, especially the sterno-mastoid, are sometimes The LARYNX may be fractured or dislocated. These lesions are very rare in suicide; more frequent in homicide and judicial hanging, and in the old where the cartilages are calcareous. Remer found the injury in but 1 case in 101 of suicidal hanging. Barker found the larynx lacerated in his judicial cases. The HYOID BONE is rarely dislocated. Orfila mentions a case of fracture. Barker found the bone usually fractured in judicial cases. In the case of Wirtz (supra) the greater cornu was broken. Pellier reports 2 cases. Hofmann Dr. Barker, of Melbourne, The CAROTID ARTERIES may be injured; usually the inner and middle coats are torn; and hemorrhage may occur into the wall of the vessel. The common carotids are the ones usually affected, and just below the bifurcation, but the external is also occasionally injured. The injury is said to be due to the stretching and squeezing of the artery, stretching being the most effective since the rupture often occurs at a distance from the mark of the ligature. Such injury of the artery does not prove that hanging took place during life because it has been produced on the cadaver; but hemorrhage into the wall of the vessel or wound or rupture after death is very improbable. Maschka says the lesion is very rare. Tardieu says that the injury to the carotid is rare and therefore unimportant. Pellier reports 4 cases of rupture of carotid in a total of 23. Levy records the experiments of Hofmann, of Vienna, and Brouardel Hofmann Ecker The LARYNX and the TRACHEA are usually deeply congested, of a red color; a violet color indicates putrefaction. Ogston reports mucus but not bloody froth 9 times in the pharynx, 6 in the trachea, and 4 in the lungs, in a total of 40 cases. In one case there was a quantity of blood in the larynx and pharynx. Taylor thinks that pinkish froth in the trachea indicates incomplete obstruction; and Chevers that it is due to spasmodic efforts to breathe when the obstruction is nearly complete. Chevers always found clear mucus in the larynx and upper part of trachea, each follicle being marked by a minute The condition of the lungs and heart varies according to whether death is due to syncope or asphyxia. Ogston found, in 22 cases, the lungs were expanded in 4 and collapsed in 2. Harvey says the LUNGS are congested in over seven-eighths of the cases; emphysematous in a few; and subpleural ecchymoses present in a few. Patenko Harvey states that the presence of serum in the PERICARDIUM seems more a matter of time elapsed after death than anything else. Still the fact is that it is found much oftener in strangulation than in hanging. The difference is explained by the comparative slowness of death in strangulation. Harvey finds that in about one-half of the cases, if the body is fresh, the right side of the HEART, pulmonary artery, and venÆ cavÆ are full of dark fluid blood, the lungs being also much congested, and the signs of death by asphyxia well marked. When blood is found in both sides of the heart, it is probable that death is due to neuro-paralysis. When decomposition is advanced all the cavities are often empty. Taylor says that if the examination is delayed for several days, the distention may not be observed. The STOMACH is often much congested, and this fact might sometimes suggest the possibility of poisoning. The LIVER, SPLEEN, and KIDNEYS are usually much congested. Hofmann The BRAIN is rarely much congested. In 101 cases Remer found hemorrhage but once; and in 106 cases Casper failed to find it. Tardieu The conjunction of the following appearances would suggest that the hanging had been of some duration: lividity of face, congestion and prominence of eyes, dryness of skin under the ligature, deep furrow, congestion of sexual organs, swelling and lividity of lower limbs, hypostatic congestion of lungs. Page experimented on a young cat and young dog; both were hung in the same way. Examination of the cat showed the veins generally engorged; sublingual veins much engorged; tongue protruded slightly and much swollen; no frothy mucus in bronchi. In the dog the tongue did not protrude and was not swollen; right cavities of heart contained blood, left empty; brain and other organs normal. In the cat, the lungs were uniformly congested, dark red; no ecchymoses. In the dog, the lungs were much distended, posterior borders mottled Pellereau Proof of Death by Hanging.As in strangulation, no single sign in any given case is sufficient of itself to prove that death was caused by hanging. But the sum total of the lesions found, viewed in the light of the surroundings of the body, will suffice to lead to a definite conclusion. The fact that a body has been found suspended does not of itself prove that hanging caused the death, because the victim may have been killed in some other way, and the body afterward hung up to avert suspicion. Chevers records many cases of this kind. The value of the presence or absence of marks on the neck and the characters of the marks has been questioned. Orfila, Casper, and Vrolik have shown by experiment that if a body is hanged within one or two hours after death the furrow, parchment skin, lividity, and the density of the connective tissue will appear just as is seen when suspension has occurred during life; but ecchymoses and infiltration, clotted blood in the If a cord is removed immediately after death, there may be scarcely any mark at all. Tardieu collected 261 cases of suicide by hanging where the subject was not entirely off the ground. In 168 the feet rested on the ground; in 42 the subject was kneeling; in 29 lying down; in 19 sitting, and 3 were huddled up or squatting. Fatal hanging may, therefore, occur in almost any position of body. He shows incomplete hangings by thirteen plates. Taylor also collected reports of 11 cases in a few years; in 3 the subjects were nearly recumbent; in 4, in a kneeling position; in 4, sitting. Remer in 101 cases of suicidal hanging found in 14 that the body was either standing or kneeling; in 1, sitting. Duchesne published 58 cases of partial suspension, 26 of which were new. Some of these failures of complete suspension were due to soft and elastic cords. Taylor says that “that which is difficult to a conscientious medical jurist in confining himself to the medical facts is often easily decided by a jury from these as well as the general evidence afforded to them.” The limbs may be secured by the suicide before hanging himself. Persons even with some disability of the hand have suicided by hanging. Blindness is no obstacle, nor age; a boy as young as nine and a man as old as ninety-seven. Burger Hanging—Suicidal, Homicidal, or Accidental?Hanging is usually suicidal. Lesser Feebleness of body does not preclude subjects taking their lives in this way. They sometimes also wound or poison themselves first and hang themselves afterward. A subject being found suspended in a room fastened on the inside, would be suggestive of suicide. The absence of signs of struggling or of any marks of injury also favors the idea of suicide. The possibility of a suicide breaking a rope, being injured by the fall, and rehanging himself successfully, must be admitted (Cases 57, 58). The possibility of blood flowing after death must not be forgotten. It is worthy of note that after beating or other violence children and women may commit suicide from shame. Again, as Tardieu says, many have hung themselves while partially intoxicated, and it is likely that some such have just previous to the suicide met with falls or other accidents which have left marks like those of violence. He also records the case of a woman who fastened a cord to a bed-post, put her head in a noose while kneeling on the bed, and made a deep wound in her arm with a razor. She closed the razor, laid it aside, and fainted from loss of blood. She must then have fallen forward and died from the pressure of the cord on her neck. Homicidal hanging is rare but does occur. Where the hands are tied together; where the injuries produced by the cord are severe; where there are contusions and well-marked ecchymoses; where the laryngeal cartilages and hyoid bone are fractured or the cervical vertebrÆ dislocated or fractured; or where the carotids are injured or there is hemorrhage into their walls; where there are severe wounds, the hemorrhage from which would be sufficient to threaten syncope; where there are many marks of violence on the body; where there is evidence of a severe struggle—in all these cases murder may be reasonably suspected. The number, situation, extent, and direction of Homicidal hanging may be committed by an assailant who is strong on a subject who is weak, on a child, a woman, an old person; on one stupefied by liquor or narcotic poison; or by many combined against one person. Cases are reported where injuries were inflicted or poison given, and the subject was afterward hanged to avert suspicion. Most of these cases are those of murder either by strangulation or suffocation (Cases 64, 65, 67, 68, 69, 70, 74). Sometimes hanging is accidental. Children and even older persons play at hanging successfully. Taylor mentions the case of a boy who witnessed a hanging and afterward tried the experiment himself to ascertain the sensation, and caused his own death. Tardieu Tardieu gives a number of cases of suicidal hanging which were falsely attributed to criminal violence, in which the pressure of public opinion joined to circumstances improperly explained by inexpert physicians caused deplorable judicial errors. ILLUSTRATIVE CASES.Suicide.1. Harvey: Indian Med. Gaz., 1876, xi., p. 2.—Man, age 30. Found hanging by turban to bars of cell door; slip-knot around neck; heart beating feebly; died in about a minute after being cut down. “The point of suspension was forty-seven inches from the ground, the position 2. Ibid., p. 3.—Insane man, age 60. Put his neck in a V-shaped fork of a tree and let his body swing. A broad abrasion found on each side of neck. Scalp, brain, and membranes much congested; reddish serum in lateral ventricles; two ounces clear fluid in pericardium. Lungs congested; all the heart cavities contained blood. 3. Ibid., p. 5.—Woman, age 28. Two marks of ligature on neck; one deep and circular passed up behind left ear; the other passed from the circular mark behind, crossed it on either side under lower jaw, thence up to chin. Appeared at first to be a case of strangulation following hanging; but the two marks were finally explained, that after the body was taken down it was ordered up again until the police should arrive. 4. Ibid., p. 5.—Man, age 45; first cut his throat and then hung himself. “He had probably only just had time to hang himself before dying.” 5. Ibid., p. 30.—Woman; hung herself with a twisted cloth. There was much ecchymosis about the neck and upper part of chest; lungs much congested; fibrin clot in left mitral orifice; liver, spleen, and stomach congested; transverse ligament of atlas ruptured. 6. Ibid.—Man, age 39. Distinct mark of cord around neck; no other mark of violence; laceration of larynx and dislocation of odontoid process; hands clinched; involuntary discharge of semen; thoracic and abdominal organs normal. 7. Ibid.—Man, age 70. Mark of cord around the neck, superficial in front, deep behind; second cervical vertebra dislocated; tongue slightly protruding; fingers clinched; meningeal vessels engorged; lungs tubercular, congested; right heart contained a little coagulated blood. 8. Ibid.—Sex and age not given. Found hanging on a tree; usual signs; odontoid process fractured; rope in a double noose without knot, a common dooree, such as is used for drawing water. 9. Ibid., p. 32.—Man, age 50. Face livid, eyes red and protruding; teeth clinched; lower jaw retracted; tongue behind the teeth; hands and feet contracted; anus covered with fÆcal matter; circular depressed mark of cord around neck, hard as parchment, slightly ecchymosed along edges; some infiltration of blood in connective tissue beneath the cord; some tearing of soft parts; laryngeal cartilage displaced. Brain and membranes congested. Right cavities of heart distended with dark blood. Trachea congested. 10. Hurpy: Ann. d’ Hygiene, 1881, vi., pp. 359-367, with illustration.—Woman, age 77, suicided by hanging in the following way: a Fig. 23.—Suicide. The cord on the neck is 44 cent. from the cord on the table leg; vertex of head 30 cent. from table leg. Case reported by Hurpy (see p. 717, Case 10). 11. Champouillon: Same journal, 1876, xlvi., p. 129.—Man, age 62; first tried to suffocate himself with charcoal smoke and then hung himself, but the rope broke and the body fell. He lived two days. 12. Pellier: Lyon thesis, 1883, No. 188, p. 72.—Boy, age 16, hung himself; rope broke; he was resuscitated; reddish circular furrow on neck, not like parchment; he had erection and ejaculation; buzzing in his ears and flashes before his eyes. 13. Lacassagne: Pellier thesis (supra), p. 71.—Man; hung himself; was cut down and sent to hospital; was aphonic for four days; then a severe bronchitis set in, and at the end of a week a gangrenous expectoration. The mark of the cord lasted fifteen days. 14. Maschka: Archiv. de l’anthrop. crim., Paris, 1886, i., pp. 351-356.—Man, age about 60, found dead under a tree in the woods near Prague. No sign of violence. A cord thick as a sugar-loaf around the neck; another cord attached to a branch of the tree. There was at first a strong suspicion of violence, but the conclusion reached was that he had hung himself and that the body had fallen from breaking of the cord; that death was due to asphyxia was shown by the furrow on the neck, the dark liquid blood, and the congested lungs. There was no infiltration below the furrow in the neck, and no lesion of larynx. The man had shown signs of melancholy. 15. Friedberg: Virchow’s Archiv, 1878, lxxiv., p. 401.—Suicidal hanging. Examination twenty-eight weeks after death. The front of the neck showed a groove above the larynx, firm and of gray color; ecchymosis in subcutaneous tissue. 16. Bollinger: Friedreich’s BlÄtt. f. ger. Med., 1889, xl., p. 7.—Man, age 48; found dead. Had made a ligature out of a night-gown and tied it around his neck, the other end around top of a low bed-post; his neck hung by the ligature placed below the larynx. Illustrated. 17. Med. Times and Gaz., London, 1860, ii., p. 39.—Woman; had collected accounts of celebrated persons who had been hanged; finally hanged herself. 18. E. Hoffman: Mitt. d. Wien. Med. Doct. Colleg., 1878, iv., pp. 97-112.—1st. Woman, age about 25; found dead sitting in bed, a handkerchief around her neck fastened to the bed-curtain. The police thought she had been killed and then hung, but the physician concluded that she had committed suicide. An examination of the stomach showed that she had previously tried to poison herself with arsenic. 19. 2d. Woman, age 51; found hanging in half-lying position. 20. 3d. Man, age 50. First tried to kill himself with phosphorus, then sulphuric acid; finally hung himself in a half-kneeling position. 21. MÜller-Beninga: Berlin. klin. Woch., 1877, xiv., p. 481.—Man, age 40; hung himself. There was no swelling of genitals and no soiling of clothing. Necroscopy showed death from asphyxia, and in urethra near meatus quite a quantity of seminal fluid, as shown by microscopical examination. 22. Tardieu: Op. cit., p. 18.—The Prince of CondÉ was found hanging in his room, August 27th, 1830. He was suspended by two handkerchiefs to a window fastening, his feet, however, touching the floor. The knot was at the back of the neck (as shown by the illustration), the face turned slightly to the left, the tongue protruding; face discolored; mucus at the mouth and nose; arms hanging and stiff; fists shut; heels raised; knees half bent. The text says that the knot was nearly under the right ear, but the illustration shows a different position (see Fig. 22, p. 743). 23. Allison: Lancet, 1869, i., p. 636.—Three cases of suicide by hanging, in which there was no mark: 1st. Woman, hung herself with a piece of sheep-net band; cut down before death. 2d. Man, hung with plough-string; cut down in about six minutes. 3d. A heavy man. 24. Tardieu: Op. cit., pp. 93-105.—Woman, died of coma and asphyxia from suicidal hanging, according to report of Drs. Costan and Facieu. Tardieu approved their report. It was at first thought a case of homicide with subsequent hanging, more especially because of the kind of knot used, noeud d’artificier. But Tardieu showed that it was also a noeud de batalier. Her feet touched a chair, and her knees were bent. There was a neckcloth in front of her mouth, but it did not seem to have interfered with respiration. 25. Ibid., pp. 67-72.—The famous case of Marc-Antoine Calas, who committed suicide by hanging (see Voltaire, “TraitÉ sur le tolÉrance,” etc., in Nouv. Philos. Histor., 1772, xxxii., p. 30). He hung himself to a door. No sign of violence. The city hangman said it was impossible for a man to commit suicide in that way. The father was accused and convicted of homicide. Tardieu shows that the act was a suicide. 26. Ibid., p. 72.—Another famous case. A woman, age 30, hung herself to the key of her bedroom door. Her husband cut her down. He was accused and convicted of the crime and condemned to prison, where he died. Tardieu showed that the case was one of suicide. 27. Hofmann: Wien. med. Presse, 1880, xxi., p. 201.—Man, age 68, suicide by hanging. There was profuse hemorrhage from both ears. 28. Ibid.: 1878, xix., pp. 489-493.—Woman, found dead sitting in bed. She first tried to poison herself with arsenic, then hung herself. 29. Ibid.—Man, tried to poison himself with phosphorus and sulphuric acid, then hung himself. There was a transverse rupture of the sterno-cleido mastoid muscle and suffusion in its sheath. 30. Maschka: Wien. med. Woch., 1880, xxx., pp. 714, 747, 1075.—Man, age 63. It was at first a question of suicide by hanging or homicide by strangling. He concluded that it was the former. 31. Ibid.—Also man, age 58. Similar case. Same opinion. 32. Ibid. 1883, xxxiii., pp. 1118-1120.—Woman. age 23. Question whether she committed suicide by hanging or was strangled and then hung. Opinion, that it was a case of suicide. 33. Hofmann: Allg. Wien. med. Zeit., 1870, xv., pp. 192-214.—Man, age 60. Suicide by hanging or homicide; opinion, that it was the former. 34. Van Haumeder: Wien. med. Woch., 1882, xxxii., pp. 531-533.—Suicide by hanging or homicide. There were many wounds in the head; these occurred during the delirium of typhus. 35. Maschka: “Sammlung gericht. Gutacht.,” etc. (Prag), Leipzig, 1873, p. 137.—Boy, age 9; found dead in sitting position. Injuries on neck and elsewhere. Question, had he hung himself or been choked? Were the injuries inflicted before or after death? Opinion, suicide. 36. Ibid., p. 144.—Boy, age 13. Found hanging in sitting position. Question whether murder, suicide, or accident. Opinion, suicide. 37. Ibid., p. 149.—Woman, age 60; found hanging, sitting position. Suicide or homicide. Opinion, suicide. 38. Ibid., p. 156.—Woman, age 30; found hanging. Opinion, suicide. 39. Ibid., p. 165.—Man, age 63. Suicide by hanging, or homicide by strangling? Opinion, suicide. 40. Berliner: Viert. f. ger. Med. und Öff. San., 1874, xx., pp. 245-253.—Woman, age 30; found hanging. Opinion, suicide. 41. Deininger: Friedreich’s BlÄt. ger. Med., 1884, xxxv., pp. 47-59.—Woman, age 61; found hanging. Opinion given, suicide. 42. Mader: Bericht d. k. k. Rud. Stift., Wien. (1875), 1876, p. 378.—Woman, age 43; tried to hang herself. She was at once cut down, bled, and taken to hospital unconscious. Next day, face red; pulse and temperature normal. Third day, conscious and could speak, but not aloud; tongue twisted and turned to right; paralysis of right hypoglossal nerve. Uvula drawn to left. Skin of right limb felt “furry.” Applied electricity and gave strychnine; phonation was more distinct during the use of the battery. Two months later she was still aphonic, but the vocal cords were in better action. The right hemiparesis was lessened. 43. Grant: Lancet, 1889, ii., p. 265.—Man, age 48; found sitting against a door, hung to the knob by a handkerchief. 44. White: Lancet, 1884, ii., p. 401.—Woman, age 53, insane. Made several attempts at suicide; once with a stocking around her neck, once with an apron; the last time by fastening a portion of her dress to a ladder. She was quickly cut down, cold affusion applied, and artificial respiration (Sylvester). The eyes were prominent and glassy, pupils widely dilated, no reaction to light; conjunctivÆ insensitive; lips livid; tongue swollen and pale; face pale; oblique depressed mark on neck, most marked on left side; skin cold; no pulse; no heart-beat recognizable; no respiration; no reflex action. Galvanism failed to arouse any muscular action. The details are too numerous to give all of them. There was reduplication of heart-sounds for several days, due to interference with pulmonary circulation. She recovered both bodily and mental health. 45. Richards: Indian Med. Gaz., 1886, xxi., p. 78.—Man, age 20; suicide; was cut down and lived for four days. 46. Kite: Univ. Med. Mag., 1888-89, i., p. 475.—Man, age 69; suicide. 47. Terrier: Prog. MÉd., 1887, vi., pp. 211-214.—Two men, age 29 and 25, insane. Attempted suicide by hanging. Both resuscitated. 48. Nobeling: Aertz. Intellig.-bl., 1884, xxxi., p. 213.—Two suicides by hanging; men, ages 24 and 40. 49. Ritter: Allg. Wien,. med. Zeit., 1886, xxxi., p. 375.—Soldier, found hanging. Cut down in ten minutes. Artificial respiration applied; fifteen minutes later, an effort at respiration; face changing from blue to white and then to red; pulse small, irregular; still unconscious; mark of ligature distinct; a few hours later had a maniacal seizure; gave morphia hypodermically and he slept; was also aphonic. Gradually recovered and returned to duty. 50. Strassmann: Viert. f. ger. Med., 1888, xlviii., pp. 379-381.—Three 51. Balta: Pest. Med. Chir. Presse, 1892, xxviii., p. 1244.—Man, age 45-50; hanging; suicide. Thyroid cartilage and hyoid bone broken. Fig. 24.—Double Suicide 52. Hackel: Op. cit., p. 35.—Man, found hanging to a beam by a sheet. Had previously tried to choke himself with his hands. 53. Ibid.—Two cases of suicidal hanging where the cord made no mark. In the first the body hung free; in the second the body was partly supported. In the first there was no rubbing of the skin; in the second the body was soon cut down. 54. Freund: Wien. klin. Woch., 1893, vi., pp. 118-121.—Man, found hanging; cut down, but could not be resuscitated. Ligature between hyoid bone and larynx, then crossed over itself about middle line of neck, passed up along each side of face, knotted above the head, then thrown over a beam, and on the other side the loop was caught between his legs. 55. Hoffman: Op. cit., p. 525, illustrated.—Case communicated by Dr. Rosen, of Odessa. Man, age 21, and woman, age 17, hung themselves by same ligature thrown over an open door, one of them on each side. They had previously tried other means of suicide without success (see Fig. 24). 56. Ibid., p. 530.—Man found hanging by handkerchief to branch of tree but sitting on the ground. Mark of handkerchief superficial and pale. When the necroscopy was made the mark had disappeared. Also a similar suicide where there was no mark at all. 57. Ibid., p. 541.—Man found hanging to a window. Another man cut the cord and the suspended one fell into a cellar, fracturing his skull. 58. Ibid.—Man found hanging; cut down; the fall caused rupture of liver. 59. Ibid., p. 539.—Drunkard hung himself; there was evidence that he had previously injured himself during his drunkenness. 60. Ibid.—Boy hung himself because he had been punished by the See also Taylor, “Medical Jurisprudence,” pp. 451-452; Tidy, “Medical Jurisprudence,” incomplete hanging, Cases 33 to 36 and 62; Hofmann, “Lehrbuch,” p. 538. Homicide.61. Harvey: Indian Med. Gaz., 1876, xi., p. 3.—Woman, age 20, feeble. Her mother-in-law had kicked her; she probably had fainted; supposing her to be dead, the husband hanged her to a tree within half an hour after the supposed death. Autopsy: No marks of injury; oblique mark of cord on right side of neck; tip of tongue between the teeth; face somewhat livid; right side of heart full of dark blood; lungs congested posteriorly. 62. Ibid., p. 4.—Woman, age 38. Rope close under the chin passed upward behind the ears. Head bent on chest. Large wound above clavicle. Under the rope was a depression (made after death) but no hemorrhage. Much blood in abdomen and a hole in the liver. Kidney bruised and blackened. Right lung torn through; blood in pleurÆ. Wounds were supposed to be gunshot, but the husband confessed that he had thrust a sharp solid bamboo into her body and afterward hung it up. She died of hemorrhage. 63. Rehm: Friedreich’s BlÄt. f. ger. Med., 1883, xxxiv., pp. 332-362.—Man, age 73; first roughly maltreated; afterward hung. 64. Tardieu: Op. cit., p. 125.—Woman found hanging in her room. Circumstances indicated homicidal strangulation and that the hanging was done to avert suspicion. Post-mortem examination showed the base of the tongue ecchymosed, and ecchymosis extending up to the soft palate; mucous membrane of pharynx congested; connective tissue and mucous membrane between hyoid bone and larynx congested posteriorly; epiglottis showed slight ecchymosis, mucous membrane red. These ecchymoses were not caused by the cord, for the latter was placed below the hyoid bone and this bone was not broken. There were also marks on the collar-bone like the mark of two hands. 65. Ibid., p. 124.—Girl, 15 years old. Body found hanging. Post mortem showed beyond doubt that she had been violated, then strangled, then hung. Her head showed many ecchymoses from either the fist or the foot; blood flowing from left ear. Brain slightly congested. Tongue between teeth, bitten and bloody. On front of neck were two marks: the lower were impressions of fingers close together, nearly uninterrupted, and which had bruised, flattened, and tanned the skin, which here was dry, hard, and horny. This lesion was above the intraclavicular notch and extended toward the sides of the neck with regularity of curve and neatness of imprint, evidently made with 66. Ibid., p. 122.—Woman found hanging in her room, and was resuscitated. She stated that the man who lived with her had tried to strangle her and then hung her. Tardieu saw her in hospital. Respiration short and embarrassed; pains in neck and jaw. Found narrow, circular, sinuous, horizontal, uninterrupted line around the neck below thyroid cartilage; line everywhere equal, deep, and three to four mm. wide; the skin excoriated and covered with thick crust. Below this were several superficial excoriations. There were many contusions on other parts of the body. Tardieu concluded that the mark on the neck was from attempt to strangle; the wounds elsewhere to prevent resistance. She had at the time pulmonary consumption. She died of this disease aggravated by the assault. 67. Ibid., p. 106.—The Duroulle affair. Woman found hanging. Presumption of homicide; arrest of husband; acquitted. She was found with her face to the floor, one end of a cord around her neck; another similar cord attached seven feet above to a rafter, over which it passed three times. Bidault and Boulard reported it a suicide. The results of the post mortem were as follows: Skin of a red-violet color; face swollen; eyes prominent and congested; conjunctivÆ a vinous red; lips violet; tongue swollen, tip between teeth; froth in air-passages; lungs congested; brain congested; blood fluid. Circular depression around neck with congestion of skin above and below; ecchymosis in subcutaneous tissue on level of angle of jaw and about one centimetre in size, supposed to correspond to the knot. Tardieu reported that the marks rather resembled those of strangulation than hanging; the ecchymoses were more like those produced by the hand over the mouth. The marks on the face supposed to have been made by a supposed fall of the body were by him considered to have been caused by violence. He believed the woman had been strangled and then hung. 68. Ibid., p. 130.—The Daugats affair. Man found hanging, sitting on the ground, head and trunk somewhat inclined to the left; legs stretched out; clothing not disordered; the part of the cord which was around the neck was applied to the neck of the waistcoat and shirt; on his head a woollen cap. The ground had been recently swept. Necroscopy twenty-four hours afterward. Face pale; right eye open and prominent, left closed; mouth closed, contained food apparently from 69. Passauer: Viert. f. ger. Med. und Öff. San., 1876, xxiv., pp. 26-49.—Woman found hanging in a kneeling position. The ligature on the neck was loose. The necroscopy showed the following: Tongue between the teeth; eyelids swollen and livid; livid spots on face and left ear; lower lip torn; a number of marks on neck; one red stripe not sharply limited; skin not parchmenty and no ecchymosis; ecchymoses of scalp; periosteum of skull reddened; hemorrhage in temporal muscle; brain and pia mater congested; much fluid in ventricle. Larynx and trachea dirty red-brown; right side of heart empty; a little dark fluid blood in left; great vessels, including aorta, containing much dark fluid blood. Lungs congested and oedematous. Liver, spleen, and kidneys congested. Opinion given that she died of asphyxia and was either choked or hanged. Reference to Royal College of Medicine, KÖnigsberg, where the opinion was given that she died of injuries on head and neck and was afterward hanged. 70. Becker: Same journal, 1877, xxvii., pp. 463-473.—Woman, age 52; found hanging. Death caused by shock and incipient asphyxia from strangulation and probably the wounds on head and limbs. 71. Maschka: “Samm. gericht. Gutacht.,” etc. (Prag), Leipzig, 1873, published a number of interesting cases, in each of which there was a question raised as to the cause of death. 72. Ibid., p. 127.—Man found dead. Had he been strangled or hung, or had he died some other way? Opinion, death from paralysis of the brain. 73. Ibid., p. 133.—Woman, age 42; found hanging; a mark around her neck. Did she hang herself or die of other injuries? Opinion, died of other injuries. 74. Rehm: Friedreich’s BlÄtt., 1883, xxxiv., pp. 322-362.—Man, age 73; found hanging. Opinion, while weak, sick, and suffering from wounds inflicted by his own son, he was hanged by his daughter-in-law. 75. Hofmann: “Lehrbuch,” p. 538.—A father hung his five children, the eldest 9 years. Another man hung two children, the eldest 13 years. See also Tidy, “Med. Juris.,” Cases 40, 48, 51, 57(?), 58(?); “Hanging after Death,” Case 50. Judicial Hanging.76. MacLaren: Indian Med. Gaz., 1873, viii., p. 234.—Three cases of judicial hanging; hung at the same time and cut down and necroscopy begun forty minutes afterward; drop twelve inches. In the first and third there were reflex movements for a few minutes after drop fell. First man, age 40; pupils slightly dilated; no protrusion of tongue or eyeballs; mark of cord above thyroid cartilage; no discharge of semen or fÆces; ecchymosis under cord, left side; dislocation of atlas from axis; odontoid ligaments ruptured; transverse ligament uninjured. Brain and membranes much congested; clear fluid in lateral ventricles. Lungs collapsed, anÆmic; one ounce straw-colored serum (measured) in pericardium; dark fluid blood in both ventricles of heart; liver much congested. 77. Second man, age 16; pupils widely dilated; eyeballs protruding. Marks of cord same as in preceding case. No discharge of fÆces or semen. No ecchymosis under cord; dislocation and rupture of ligaments between axis and third vertebra. Brain did not show well-marked congestion. Lungs collapsed and anÆmic. One and one-quarter ounces serum (measured) in pericardium. Heart normal; dark blood in both ventricles; liver normal. 78. Third man, age 20; pupils slightly dilated; eyeballs and tongue not protruded. Marks of cord as in preceding. No discharge of fÆces or semen. Slight ecchymosis under cord; mark in front of neck. Dislocation of occipital bone from atlas. Brain and membranes much congested. Lungs collapsed and anÆmic. Half ounce serum in pericardium. Heart normal; dark fluid blood in both ventricles; liver normal. 79. Cayley: Ibid., p. 122.—Man, age 35; executed by hanging. Scarcely any convulsive movements after drop fell. Necroscopy two hours afterward. No congestion or protrusion or swelling of the tongue; no muscular rigidity or contractions. About half-way around the neck was indentation of cord, obliquely directed; hardly perceptible in front; its surface appeared rubbed and compressed; no discoloration; no ecchymosis under skin. Cord lay across upper part of thyroid cartilage. Larynx and trachea not injured. Fracture and dislocation of upper cervical vertebrÆ. Lungs collapsed, not congested. Pericardium empty; heart distended, left side with red blood just beginning 80. Garden: Same journal, 1880, xv., p. 12.—Man, age 40, weight about one hundred and twenty pounds; drop two feet; was in a fainting condition, and had to be supported; was not probably fully conscious when platform fell. There were spasmodic retractions of arms and legs for about two minutes; forty seconds after the drop his jungeas fell off; his penis was in strong erection, and the ejaculatory movements were seen. Necroscopy one and one-quarter hours after drop fell. Head and limbs cold; eyes open, natural; tongue not protruding; fingers clinched; superficial veins contained fluid black blood. Mark of cord extended from just below left mastoid process, where the knot was applied, across the thyro-hyoid membranes to a place on right side about two inches below ear. There was scarcely a trace of it behind. Skin dark and ecchymosed, but no ecchymosis of subcutaneous connective tissues. No discoloration nor fracture in neck. Subarachnoidal fluid in excess; puncta vasculosa unusually numerous. Under surface of epiglottis reddened and showed two small dark red ecchymoses; mucous membrane of larynx and trachea pale. Lungs showed venous congestion; no infarctions or small ecchymoses; right lung emphysematous; the left showed old firm adhesions throughout. Heart large, flabby, pale, a very little blood in each ventricle; subpericardial ecchymosis one-fourth inch square anteriorly, another larger one posteriorly; extensive pericardial adhesions. Liver and kidneys congested. 81. See two cases of judicial hanging by Wilkie, same journal, 1881, xvi., p. 275. 82. Porter: Archiv. Laryngol., New York, 1880, i., p. 142.—Redemier hung. Drop five feet. Pulse beat rapidly a few minutes, then lessened in frequency and stopped beating in fifteen minutes. During this time there was violent spasm of muscles of thorax and upper limbs. Necroscopy, dark groove around neck crossing larynx just below pomum Adami. Brain congested. Lungs emphysematous. Cricoid cartilage fractured diagonally. Laryngeal mucous membrane showed ecchymosis and oedema. VertebrÆ neither fractured nor dislocated. 83. Another criminal hung at the same time had dislocation of cervical vertebrÆ. 84. Fenwick: Canada Med. Jour., 1867, iii., p. 195.—Man executed; drop six feet; second cervical vertebra torn from attachment to third; medulla torn across; hyoid bone and tongue torn from thyroid cartilage; general congestion of viscera; lenses normal; eyes congested; clot between sclerotic and choroid coats left eye. 85. Dyer: Trans. Amer. Ophthal. Soc., 1866, p. 13.—Man, age 24; weight one hundred and seventy-four and a half pounds; drop three feet; knot under left ear; for two minutes at intervals, slight motion of abdomen, like effort at respiration, and at same time knees drawn 86. Dyer: Same Trans., 1869, pp. 72-75.—Man hung. One eye showed fracture of lens, the other lens showed fine lines. A second case showed dislocation of a cataractous lens. A third showed fissure of lens. 87. Green: Same Trans., 1876, p. 354.—Man hung; drop seven or eight feet. Died quietly and without struggle. One-half to one hour after drop fell, eyes were examined. No lesion of capsule or lens. 88. Keen: Amer. Jour. Med. Sci., 1870, lix., p. 417.—Two criminals hung; drop five feet. Hyoid bone fractured in one; no fracture of vertebrÆ in other. 89. Clark: Boston Med. and Surg. Jour., 1858, lviii., p. 480.—Execution of Magee. Man, age 28; weight 130 pounds. Drop seven to eight feet. No struggle nor convulsion. Urine discharged at once. Seven minutes after drop fell, heart-beat one hundred; nine minutes, ninety-eight; twelve minutes, sixty and fainter; fourteen minutes, not audible; twenty-five minutes, body lowered. Face purple; pupils dilated; eyes and tongue did not protrude. Mark of cord just above thyroid cartilage, a deep oblique furrow except a small space under left ear; knot over mastoid process. Forty minutes, cord and strap removed; body, especially face, became paler. Necroscopy a little over an hour after drop fell. Body pale; skin mottled; small ecchymosis just above line of cord right side. Right sterno-mastoid muscle torn. Hyoid bone fractured; spine not injured. No seminal discharge. Ninety minutes, pulsation in right subclavian vein; heart-beat, eighty per minute; thorax opened, heart exposed; right auricle showed full and regular contractions and dilatations. The spinal cord was then divided. One hundred and twenty minutes, heart-beats forty per minute. These pulsations of right auricle continued at intervals for three and a half hours longer; readily excited by point of scalpel. Heart normal; left ventricle contracted; right ventricle not so; no coagulation. Brain normal; lungs collapsed; liver and spleen congested; mucous membrane of small intestine pinkish; other organs normal. In the discussion, Dr. Gay thought the absence of cerebral congestion was due to the circulation continuing in the left carotid. 90. Hofmann: Wien. med. Woch., 1880, xxx., pp. 477-480.—Man, a criminal, hung; after hanging ten minutes, the body was cut down. Examination half-hour after drop fell. He was resuscitated and partly regained consciousness, but died three days afterward of oedema of 91. Kinkhead: Lancet, and 701-703.—Cases of hanging. In one, the body of the third cervical vertebra was broken across and the two pieces separated; in another case dislocation of second and third cervical vertebrÆ. 92. Nelson: Southern Clinic, 1885, viii., pp. 198-202.—Two colored men hung; drop five feet. In one there was atlo-axoid dislocation. 93. Dercum: Phila. Med. Times, 1886-87, xvii., p. 368.—Description of the brain of a man executed by hanging. 94. Kirtikar: Trans. M. and P. Soc., Bombay, 1885, vi., pp. 104-107.—Man, age 25, and woman, age 35. Both hanged. Drop nine feet. Knot tied over cricoid cartilage, a little to left side. In falling, the knots slipped to below the ear. There was fracture of the body of third cervical vertebra and rupture of ligaments. The cord was ruptured in each; in the woman in two places—once at the third cervical, the other at the dorso-lumbar junction. 95. Lamb: Med. News, Philadelphia, 1882, xli., pp. 42-45.—Execution of Guiteau. Drop six feet; knot placed under left ear, but slipped to back of head. Yellowish furrow a few lines wide around the neck, directed downward and forward. Sterno-mastoid muscles torn transversely about midway of their length. Thyro-hyoid ligament ruptured; hyoid bone and thyroid cartilage widely separated. Large blood-vessels not injured. No fracture or dislocation of vertebrÆ. 96. Thomson and Allen: Catalog. Surg. Sec. Army Med. Mus.; specimens 298 to 302.—Execution of Wirtz. Rope one-half inch diameter; drop five feet; knot under left ear. Several slight shrugs of shoulders, after which body was quiet; let down in fifteen minutes. No involuntary evacuation. Face pale, placid. Eyes partly open; pupils dilated; slight injection of conjunctivÆ. Mouth open; tongue not protruding. Just above thyroid cartilage extending on right side from median line in front to spinous process was a dirty brown deep furrow with congested walls; on left side a line of discoloration due to direct action of rope. Soft parts above and below the line much swollen, particularly on right side. Larynx and hyoid bone unnaturally mobile. Right trapezius muscle torn; sterno-mastoid divided transversely, leaving an interval of two inches. Slight ecchymoses between muscle and larynx. Ecchymoses on ligamentum nuchÆ. Hyoid bone, both greater cornua fractured and dislocated from body; lesions more marked on right side. Several small ecchymoses in vicinity. Larynx not injured. Brain normal. No bloody or frothy mucus in See also Tidy, “Med. Juris.,” Cases 1 to 4 and 60. Accident.97. Harvey: Indian Med. Gaz., 1876, xi., p. 3.—Boy, age 1½ years; was swinging by two ropes attached to two posts; the ropes became twisted around his neck. Necroscopy showed mark of very small rope in front of neck from ear to ear; mucous membrane of larynx dark; lungs much congested. 98. Hackel: Op. cit., p. 35.—Man, age 19, sitting on a load of wood, with the lines around his neck, fell and was hung by the lines. 99. Biggs and Jenkins: New York Med. Jour., 1890, lii., p. 30.—Case 16; child, 6 months old, sitting on a high chair, fell between the chair guard and seat and was asphyxiated by compression of neck. See also Tidy (op. cit.), Cases 53 and 54. SUFFOCATION.The term suffocation is applied in a special sense to the act and condition of preventing access of air in other ways than by pressure on the neck, as by pressure on the chest, by obstruction at the mouth or nose, by obstruction in the air-passages or on them from neighboring organs, by irrespirable gases, etc. This article will consider all of these except drowning and irrespirable gases, which are treated of elsewhere by other writers. Smothering is generally understood to mean the act and effect of stopping the mouth and nose. Causes.External Causes.—Overlaying is a frequent cause of suffocation in infants, which in such cases have usually occupied the same bed with one or both parents. In some cases the parents have been drunk or otherwise unable to prevent the injury, and the infant may also be partly stupefied with the alcohol derived from its mother’s milk. Infants are also sometimes overlaid by domestic animals. Again, they have been suffocated by being pressed too closely to the mother’s breast, or Infants are sometimes smothered for mercenary purposes. Persons have been suffocated by the pressure of a crowd. Pressure on the chest combined with forcible closure of the mouth and nose was the method of Burke and Williams, in the notorious burking murders (Case 58). The close application of a hand, cloth, or plaster over nose and mouth is of itself sufficient to cause suffocation, especially in children and feeble persons. Pressure on the abdomen crowds up the diaphragm and interferes with breathing. It is very likely that no external mark will be found in cases of pressure on the chest and abdomen, but the lungs will be marbled and emphysematous. Taking plaster casts of the face and neck without inserting tubes in the nostrils has caused death in some cases. Suffocation often follows the falling of walls, houses, banks of earth, piles of coal or corn or wheat. One may fall into and be imbedded in some mobile substance as coal, wheat, corn, quicksand, or nightsoil, and be suffocated. Infants have been destroyed Internal Causes.—The air-passages may be closed up by foreign bodies within them, or within adjoining organs, especially the oesophagus. A great variety of substances in one of these two ways has caused suffocation: mud, cotton, rags, corn, meat, beans, pepper, potato skins, the fang of a tooth, artificial teeth, buckles, shells, flint, buttons, screws, crusts of bread, bones, fruit, stones, heads of grass, coins, slate pencils, nuts, nut-shells, shot, penholders, worms, fish, etc. (see Cases 6 and 55). Taylor Should an inspiration occur in the act of vomiting, the A case of suffocation in an infant by retraction of the base of the tongue is recorded. It has been stated that negroes have committed suicide by doubling back the tongue into the throat, or, as it is called, swallowing the tongue. Cases are recorded of artificial teeth having fallen from the mouth into the air-passages during anÆsthesia and sleep, and in epileptic and puerperal convulsions. It would appear advisable that these teeth should be worn only while eating (Case 13). Hemorrhage from the lungs, from rupture of an aneurism or from injury of the mouth or throat, may make its way into the air-passages and cause suffocation. So also the bursting of an abscess of the tonsils or other part near the air-passages (Case 7). Œdema of the glottis from scalding or other irritation of the fauces or glottis, or from disease of the kidneys; tumors pressing on some portion of the air-passages; rapid, profuse bronchial secretion in infants; acute double pleuritic effusion; cheesy glands ulcerating into trachea; simultaneous oedema of both lungs—all of these may cause suffocation (Cases 18 and 49). [For cases of enlarged thymus gland, see Hofmann, op. cit., pp. 587, 588.] Paralysis of the muscles of swallowing, from diphtheria or It is not necessary that the air-passages should be absolutely closed to cause suffocation. The cause of death is more likely to be pure asphyxia, because of the absence of the complicating pressure of the hand or ligature on the vessels and nerves of the neck, and of fracture of larynx or vertebrÆ. Symptoms.—Foreign bodies Partial closure of the larynx, most likely caused by a flat or irregular substance, rather than globular, may cause gradual asphyxia with symptoms of apoplexy, making the diagnosis difficult. When a foreign body remains a long time in the larynx, spasmodic cough and croupy breathing usually ensue, expectoration tinged with blood, hoarseness, or complete aphonia, pain, dyspnoea, possibly crepitation and dulness over the lungs. The case may end suddenly in death from closure of the glottis, or the foreign body may pass into the trachea and set up a new train of symptoms, or it may be expelled. The frequency with which foreign bodies in the pharynx or oesophagus obstruct respiration, and the facility with which they may usually be removed, suggest a careful examination. Otherwise the patient may be treated indefinitely for supposed obstruction in the air-passages. Foreign bodies in the oesophagus have perforated into the trachea, and even the lungs, heart, and aorta. In complete suffocation death will occur in from two to five minutes (see remarks under Strangulation). Death may also occur instantaneously. The experiments of the Committee on Suspended Animation The death of Desdemona (Shakespeare’s “Othello”) has been much criticised. The declaration that she was strangled (or suffocated) does not consist with the symptoms described (see Med. News, Philadelphia, May 1st, 1886, p. 489). Treatment.The obvious indication is to search for and remove the obstruction. The means and methods of treatment are fully treated of in surgical works, but may be briefly mentioned here. Laryngoscopical examination may be necessary. A curved forceps is usually the best instrument for removing the foreign body. A tallow candle may serve to push it into the stomach if there is no bougie at hand. Suction may be used. Sneezing may be brought on by tickling the nostrils; coughing by tickling the glottis; vomiting by irritating the fauces, or by emetic; the body of the subject may be inverted and in this position the fauces may be tickled, or fingers may be passed back into the pharynx. Johnson Noble recommends inversion of the body in new-born infants Hamilton With regard to insufflation, Le Bon Fell Dew After the removal of a foreign body the irritation remaining may cause a sensation as if the body was still lodged. Death may occur from hemorrhage after its removal. Post-Mortem Appearances.These are mainly those of asphyxia. There may also be evidences of external violence, homicidal or accidental, as of pressure on the chest. Persistent deformity, flattening of the nose and lips, and excoriation of these parts may result from forcible closure of mouth and nose. The SKIN AND CONJUNCTIVA usually show patches of lividity and punctiform ecchymoses; especially lividity on the lips and limbs. The face may be pale or violet; it is often placid, especially if the suffocation is accidental. Tardieu The EYES are usually congested. Mucus and sometimes bloody froth are found about the NOSE and MOUTH. The TONGUE may or may not protrude. The BLOOD is usually dark and very fluid. Wounds after death may bleed. According to Tardieu The BRAIN and pia mater are generally congested. This is said to be invariable if the eyes are congested. Mackenzie in thirteen cases found the brain congested in all. The HEART varies much in appearance and condition. The right side is often full of blood; occasionally empty. Sometimes subpericardial ecchymoses are found, usually along the coronary vessels. The blood in the heart may be partly coagulated if the agony has been prolonged and there has been a partial access of air, which is gradually diminished. Mackenzie The TRACHEA is usually bright red and often contains bloody froth. The LARYNX or trachea as well as PHARYNX or ŒSOPHAGUS may contain a foreign body. If the latter has been removed the resulting irritation may be seen. The LUNGS are sometimes congested, at others normal; color red or pale. Sometimes one lung only is affected. They may be emphysematous. Mackenzie found them congested in all of thirteen cases examined by him. The lungs of young persons may be found comparatively small, almost bloodless, and emphysematous. Tardieu, Albi, and others believed that the punctiform subpleural ecchymoses indicated suffocation, and were due to small hemorrhages from engorged vessels which ruptured in the efforts at expiration. These spots are usually round, dark, from the size of a pin-head to a small lentil, and well defined. They are not like the petechiÆ in the lungs and heart after purpura, cholera, eruptive fevers, etc., nor like the hemorrhages under the scalp after tedious labor, all of which are variable in The ecchymoses are partly the result of venous stasis, which overcomes the resistance of some capillaries; and the latter rupture, partly from the aspirating action of the thoracic wall, the lung being unable to fill itself with air, but mainly Mackenzie, in thirteen cases of suffocation from various causes, failed to find the Tardieu spots either externally or internally. Briand and ChaudÉ Ogston They may be recognized as long as the lung tissue is unchanged. The apoplectic spots in the lungs seen in strangulation are not found in suffocation. Tardieu The LIVER, SPLEEN, and KIDNEYS are generally congested; the kidney more than the other organs named. The spleen is said to be often anÆmic. Semen has sometimes been found, unexpelled, in the urethra. Page Proof of Death by Suffocation.It is sometimes difficult in a given case to state WHETHER DEATH IS DUE TO SUFFOCATION. There is no lesion which of itself could be accepted as proof. But a collation of the lesions Infants have been found alive four and five hours after having been buried in the earth. The committee on “Suffocation,” of the New York Med. Leg. Soc., reported Tardieu It must not be forgotten that an intoxicated person or one in an epileptic spasm is practically helpless, and can, therefore, be suffocated, accidentally or otherwise, under circumstances in which one in possession of his senses would be able to escape. Accidental, Homicidal, and Suicidal Suffocation.Accidental suffocation is frequent, as has already appeared. Suicidal suffocation is very rare. Homicidal suffocation occurs. Foreign bodies have been forced into the Death by suffocation In infants, suffocation is, of course, either accidental or homicidal; in adults usually accidental. The absence of signs of a struggle in adults suggests accident; unless there is cause of suspicion of previous stupefying with narcotics. Taylor In ten years, 3,612 deaths were reported in the city of London, of infants smothered by being overlaid. Infants may be born into a mass of blood and fÆces, from which the unattended mother in her weakness may be unable to remove them. Page 1. Huppert: Vier. ger. Med. und Öff. San., 1876, xxiv., pp. 237-252.—Two cases. A man choked by piece of bread in pharynx. Second, an epileptic, suffocated by flexion of chin on larynx. In both cases seminal fluid was found in urethra near meatus, unexpelled; determined by microscope. 2. Johnson: Lancet, 1878, ii., p. 501.—Boy swallowed penny, became black in face; eyeballs protruded; symptoms soon subsided. Some hours afterward it was found that he could not swallow solids, and liquids only with difficulty and coughing. Throat much irritated; discharge of mucus sometimes tinged with blood, from mouth; moist rattling noise in throat in respiration; frequent cough; could not sleep. Laryngoscope showed penny in upper part of oesophagus, just below laryngeal opening. Removed by long curved forceps. 3. Ibid.—Man suddenly fell while at dinner; face blue; breathing stertorous. Died. Piece of tendon found under epiglottis. 4. Ibid.—Boy, age 5 years. Button in larynx. Aphonia, dyspnoea, stridulous breathing. Distress gradually subsided. Many years afterward found mucous membrane of larynx thickened; vocal cords red and uneven. 5. Ibid.—Man, drunk, swallowed a half-sovereign. Urgent dyspnoea; pain in throat; aphonia; stridulous breathing; dysphagia; cough; copious mucous expectoration. Laryngoscopic examination showed coin in oesophagus. The crico-thyroid membrane was incised and coin pushed upward and ejected. 6. Med. Times and Gaz., 1874, i., p. 486.—Man, age 20, had severe dyspnoea. In taking a living fish in his teeth (it was about four inches long and had large dorsal fin), the fish passed into the pharynx and lay doubled up. Impossible to remove it because of spines. Tracheotomy at once. Twenty-four hours afterward the fish had decomposed enough to be partly removed. Patient died of exhaustion. 7. Littlejohn: Edin. Med. Jour., 1875, xx., p. 780.—Woman found dead in bed. Suffocated by pus from abscess of tonsil which burst during sleep. Found pus in air-passages down to smallest bronchi; lungs congested; right side of heart distended with dark fluid blood; left side contracted and nearly empty. Blood everywhere fluid. Some lividity of face. The woman had died quietly lying beside her husband, who was not awakened. 8. Sayre: New York Med. Jour., 1874, xix., p. 420.—Girl, age 7, swallowed a bead. Had continuous cough; much pain under middle of sternum. The bead moved upward and downward in respiration. Tracheotomy. Four days afterward she coughed the bead out, inspired once, and apparently died. Artificial respiration used; alcohol injected into rectum; galvanization of phrenic nerves. She finally coughed up a piece of thick mucus and recovered. 9. Duffy: Trans. Med. Soc. No. Car., 1874, p. 126.—Boy, age 8, swallowed a cow-pea. It lodged in the trachea. Some months afterward, laryngotomy performed. The boy seemed to die at once. Artificial respiration used. After a while he expelled first some mucus, then the pea. Recovered. 10. Tardieu: Op. cit., p. 290.—Man, age 50, found dead on the floor. At base of neck and front of chest were many punctated ecchymoses. Brain and lungs much congested; the latter showed subpleural spots. Tongue and lips bitten. Death was due to cerebral and pulmonary congestion from an epileptic seizure. 11. Oesterlen: Vier. f. ger. Med. und Öff. San., 1876, xxiv., p. 10.—Woman, age 30, epileptic. Found dead. Examination showed signs of asphyxia; blood-vessels engorged, marked oedema of lungs, etc. Opinion given that she died in epileptic paroxysm, and certain injuries observed were caused by a fall. 12. Tardieu: Op. cit., p. 322.—Two children, one 2 months old, the other 18 months old; in bed together. The older overlay the younger, which died. Necroscopy: lungs voluminous, in places congested, in others pale; abundant subpleural ecchymoses; quite emphysematous. Fluid blood in heart. 13. Blum: New York Med. Jour., 1885, xlii., p. 207.—Woman, found dead. Vulcanite plate of usual size, with four teeth attached, found wedged in trachea about two inches below larynx. 14. Wyeth: Same journal, 1884, xl., p. 487.—Boy, age 12, inspired a pin-dart in trying to blow it through a blowgun. Violent cough, 15. Partridge: Same journal, 1890, li., p. 303.—Child, 4 months old, found dead; fluid, partly digested milk in air-passages. 16-41. Biggs and Jenkins: Same journal, 1890, lii., p. 30.—Report of many cases of fatal suffocation from foreign bodies, etc. Boy, age 15—collar-button in larynx. Boy, age 10—mass of butter in larynx. Boy, age 5—bronchial gland discharged into trachea at bifurcation. Boy, age 3—screw in larynx. Boy, age 5—rubber balloon with whistle attached; it was partly inflated with each expiration. Girl, age 10—a “jack” in larynx. Man, age 45—had been drinking freely; piece of meat in larynx. Man, age 40—piece of meat in larynx and pharynx. Man, age 40—ditto. Insane patient—piece of meat in trachea. Man—piece of meat in larynx. Man, age 40—crackers and cheese in larynx. Child—rubber nipple in larynx. During administration of ether, patient vomited; vomitus entered larynx. Two children in bed asleep; one, 3 years old, overlay the face of the younger, age 5 months. Woman, age 25, epileptic—fell on a child and smothered it. Two children found dead, covered with bedclothing. Man, age 21, epileptic—found lying on his face in bed. Girl, age 12, epileptic—ditto. Woman, age 21—ditto. Girl, age 18—ditto. Woman, age 35, epileptic—fell on the floor. Woman, age 28—ditto. Man, age 35, epileptic; vomited while in spasm; vomitus entered larynx. From Dr Janeway: Man, epileptic, fell on his face in pile of manure, which entered larynx. Man, drunk, lying on his face. 42. Roy. Indian Med. Gaz., 1880, xv., p. 71.—Man, believed to be drunk, had vomited in bed; vomitus entered trachea and bronchi. 43-47. Mackenzie: Same journal, 1890, xxv., p. 257.—Reports fatal cases: Boy—bone button in larynx. Sailor—meat in larynx. Boy—vomited matter in larynx. Infant—while taking the breast, a rush of milk suddenly filled the air-passages. Also three cases of crushing under walls; two buried in loose earth; two crushed in a crowd; one by bags of grain. 48. Feulard: Bull. Soc. Anat., 1883, viii., pp. 384-386.—Woman, age 79. Piece of beef in larynx. Necroscopy showed hematoma in dura mater. 49. Poupon: Bull. Soc. Clin., Paris (1882), 1883, vi., pp. 236-238.—Boy, age 5½ years. Death from cheesy gland in trachea. 50. Pons: Jour. MÉd., Bordeaux, 1889-1890, xix., pp. 57-61.—Woman, age 24. Death from oedema of larynx from presence of particles of food. 51. KemÉny: Wien. med. Blat., 1890, xiii., p. 37.—Man, age 45. Suffocated by curdled milk in air-passages. 52. Maschka: Vier. ger. Med., 1885, xliii., pp. 11-14.—Man, age 65. Accidental compression of chest. 53. Heidenhain: Same journal, 1886, xliv., pp. 96-101.—Vomited matter passed into air-passages while subject was drunk. 54. Langstein: Wien. med. Woch., 1880, xxx., pp. 624-626.—Child found dead in bed; had vomited food while asleep and breathed it into air-passages. 55. Ward: Catalog. Army Med. Mus., Med. Sec., p. 33.—Soldier, age 17; choked to death by lumbricoid worm passing from pharynx into right bronchus. Specimen 7,737. Suicide.56. Sankey: Brit. Med. Jour., 1883, i., p. 88.—Epileptic; found dead in bed, lying on his back. A round pebble in each nostril; strip of flannel rolled up and stuffed in throat. 57. Macleod: Ibid., 1882, ii., p. 1246.—Suicidal maniac. Had to be fed because he refused food. Was seen to be blue in the face and breathing hard. His mouth was forced open; roll of flannel found in throat. Macleod refers to another case, a woman in dissecting-room, with similar roll of flannel in throat. See Tidy, “Med. Jur.,” Cases 15 to 17. Homicide.58. Christison: Edin. Med. Jour., 1829, xxxi., pp. 236-250.—The famous Burking case. A woman was struck down to a sitting posture. Burke then threw himself on her, kept her down by the weight of his body, covered her mouth and nose with one hand and placed his other hand under the chin for ten to fifteen minutes, till she died. Necroscopy showed a severing of the posterior ligamentous connections of the third and fourth cervical vertebrÆ, with blood in spinal canal but not under the dura mater; cord not injured. Christison made experiments to ascertain if the injury to spine had been made during life. 59. Hackel: Dorpat Diss., 1891, p. 35.—Case of choking with pressure on breast and belly. Woman found lying on floor, with many injuries. 60. Tardieu: Op. cit., p. 315.—New-born infant; found buried in earth. Mother stated that the child had not breathed. Putrefaction had begun. There was a brownish tint of skin of upper front part of neck below jaw; drops of sanious fluid flowing from nose; umbilical cord had not been tied; subcutaneous hemorrhage in right temporal region; brown bruised surface and contused wounds of pharynx, where 61. Tardieu: Op. cit., p. 323.—New-born infant found under a cask, partly eaten by a dog. The head showed transverse flattening and subcutaneous hemorrhage. Lungs voluminous, rosy; abundant subpleural ecchymoses; hemorrhage in left lung. Heart filled with fluid blood. Coagulated blood in abdomen. Opinion given, suffocation by pressure on head, chest, and abdomen. The mother confessed that she had placed the child under the cask. 62. Ibid., p. 325.—New-born infant found buried in the earth; gravel and earth in pharynx and oesophagus down nearly to stomach, and in trachea and right bronchus. Lungs congested, crepitant. Opinion given, that the child had been buried while living. 63. Ibid., p. 326.—New-born infant found in ashes; nose and lips obstructed, mouth filled; ashes in oesophagus and stomach; none in larynx or trachea. Lungs distended with air, emphysematous; subpleural ecchymoses; fluid blood in heart. 64. Ibid., p. 327.—New-born infant, buried in bran; nose and mouth filled; some in trachea; none in oesophagus or stomach. Lungs distended with air, emphysematous; subpleural ecchymoses; heart empty. 65. Devergie and Raynaud: Ann. d’Hyg., 1852, xlviii., pp. 187-206.—Man found dead on a pile of grain; mouth, nose, and eyes contained some of the grain; some also in stomach, larynx, trachea, and bronchi. Some marks of injury on face and other parts of body. Internal signs of asphyxia. Opinion given, that the case was homicide. The defence offered was that the man had fallen into the grain. 66. Rauscher: Friedreich’s Blat., 1886, xxxvii., pp. 324-330.—Woman, age 71, suffocated by a cloth over nose and mouth. See Tidy, “Med. Jur.,” Cases 1 to 11.
DEATH FROM SUBMERSION IN ITS MEDICO-LEGAL RELATIONS. BY IRVING C. ROSSE, A.M., M.D., F.R.G.S. (Eng.), Professor of Nervous Diseases, Georgetown University; Membre du CongrÈs International
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