SUFFOCATION.
Suffocation may be defined, the destruction of life by the suspension of the function of respiration, occasioned by external violence. Unless we add “by external violence” we shall perceive that the definition would be far too comprehensive; and the term Suffocation would be made to embrace a much wider range of subjects than its popular acceptation would allow. If the physiological views be correct which we have adopted and explained in the foregoing section, “On the causes and phenomena of sudden death,” we should be compelled, without such a protecting adjunct, to include under the history of Suffocation, not only the phenomena of Drowning, Strangling, Hanging, Smothering, and noxious inhalation, but even those of Apoplexy, fatal Intoxication, and various diseases of the brain and spinal marrow, together with the effects of a great proportion of Poisons; for by such agents death is undoubtedly occasioned through the failure of the respiratory functions.
In Death from Suffocation the heart continues to pulsate for several minutes after the breathing has entirely ceased, in consequence of which the blood which passes through the pulmonary vessels no longer receives the influence of oxygen, and therefore black blood circulates; the brain, it would appear, soon feels the want of the florid arterial stream, by which alone its energies can be maintained. Bichat has shewn that when dark coloured blood is injected into the vessels of the brain, by means of a syringe connected with the carotid artery, the functions of the brain become immediately disturbed, and, in a short time, entirely cease; the effect is precisely similar, whether the dark coloured blood be transmitted to the brain by the syringe of the experimentalist, or by the heart itself. It is not until after the full effects of the suspended respiration are thus produced on the brain, that the motions of the heart become enfeebled, and that the ventricles contract less powerfully, and at longer intervals; at length, the action of the heart is altogether arrested, and if the thorax be examined at the instant that the circulation has ceased, nothing is observed, except a slight tremulous motion of the auricles; the cavities of the left side are much contracted, and contain only a small quantity of blood, while the right auricle and ventricle, and the large vessels communicating with them, are distended to an unusual size. This state of the heart, it will be observed, is very different from that which we have described as constantly occurring after Syncope. In the contemplation of these phœnomena, a question very naturally suggests itself in regard to the probable interval which elapses between the cessation of respiration, and the consequent failure of the heart’s action; in other words, it may be asked, how long can the heart support its contractions without the aid of respiration? It would appear that this interval not only varies in duration in different animals, but even in the same animal under different circumstances, such as that of age,[[25]] capacity of the thorax, quantity of air in the lungs, state of the stomach, and general vigour of the animal; but in man, under the most favourable circumstances, it is extremely doubtful whether the heart ever continues to pulsate for so long a period as five minutes[[26]] after the lungs have ceased to perform their office; and it is very questionable whether, in most instances, the interval is not considerably shorter than this.
BY DROWNING.
It was formerly believed that Asphyxia[[27]] from drowning, always depended upon the lungs and intestinal canal being filled with water;[[28]] whereas it is hardly necessary to observe that it alone depends upon the blood, in consequence of the suspension of breathing, ceasing to possess the qualities which are essential to the preservation of life. M. Gauteron immersed a dog for more than a quarter of an hour, without inflicting the least injury, having previously inserted a long tube in the trachea, which was kept elevated during the experiment above the surface of the water.
If a small animal be immersed in water, contained in a transparent glass vessel, the phenomena of drowning are readily discernible; there is first a deep expiration, by which bubbles of air are expelled from the lungs; there is then an effort to inspire, but the effort is ineffectual; there being no air which can be received into the lungs, and a spasm of the muscles of the glottis seems to forbid the admission of any considerable quantity of water into the trachea. The attempts to breathe are repeated several times, and at each attempt at expiration a small proportion of air is expelled from the mouth and nostrils, until the air-cells of the lungs are almost emptied;[[29]] then the animal becomes insensible; and convulsive action of the voluntary muscles mark the instant when the brain begins to suffer from the influx of the dark coloured venous blood. After the cessation of these convulsive actions, the animal becomes motionless, and gives no sign of life; but if the hand be applied to the thorax, the actions of the heart, gradually becoming fainter and fainter, indicate that some remains of vitality still linger in the system. Before the circulation of the blood altogether ceases, the muscles of respiration once more resume their actions, and ineffectual efforts are made to breathe. It is a remarkable circumstance that the diaphragm continues to exert itself nearly as long as the heart itself, and that the interval between the cessation of the motions of the diaphragm and that of the motions of the heart, which is so short in animals that die by strangulation, is still shorter in those who perish by drowning.[[30]] These phenomena follow each other in rapid succession, and the whole scene is closed, and the living animal is converted into a lifeless corpse, incapable of recovery, in the brief space of a few moments, (Brodie’s Manuscript Notes). If however the animal be taken out of the water before the total extinction of life, and the diaphragm contract afterwards, so as to draw air into the lungs before the action of the heart has ceased, the circulation is maintained, and the animal continues to respire; he will thus have escaped immediate death from suffocation; but his life still remains in jeopardy, for there is a second period of danger, and one at which death may take place, when we are the least prepared to expect it; for the dark coloured blood which has been transmitted through the circulatory system, during the suspension of respiration, would seem to act like a narcotic poison upon the brain; no sooner therefore does it enter that organ, but deleterious effects are produced, the animal at first falls into a state of stupor, the pupils of the eyes become dilated, the respiration laborious, the muscles of the body convulsed, and the animal dies, poisoned by its own blood.
The body of a person who has died from drowning exhibits a physiognomy which it is important to notice. The whole surface is distinguished by a remarkable coldness and pallor; the eyes are half open, and their pupils considerably dilated; the tongue is pushed forward to the internal edges of the lips, and sometimes wounded; and the mouth and nostrils are covered with foam. At other times, instead of a pallid visage, we have one that is swelled, and bloated with livid blood.
Upon dissection we shall perceive the vessels of the brain more or less gorged with blood;[[31]] in the trachea a watery and bloody froth will be found; the lungs will appear expanded, full of frothy mucus, and, generally, livid; the right cavities of the heart gorged with blood, the left nearly empty; and it has been sometimes noticed that the blood remains fluid[[32]], and follows after every incision by the scalpel. The stomach will generally be found to contain some water. Hebenstreit also states, that since in the act of drowning the person dies on an inspiration, the diaphragm is necessarily found convex, or bent towards the abdomen; this statement however is erroneous.
Upon these appearances we have a few observations to offer, especially as they have given origin to some important questions; and first, with respect to the presence of water in the stomach and lungs, than which few indications, connected with the subject of drowning, have given occasion to greater controversy.[[33]] For since it hath been observed that water is rarely found in the stomach or lungs of a person who has been submerged after death, it was inferred that the presence of that fluid in these organs necessarily proved that the individual must have been plunged into the water during life. As a general proposition this may be admitted as correct, although it is liable to certain exceptions with which the medical jurist ought to be acquainted; we may, for instance, suppose a case, in which the submerged person may be so plunged at once under water, as to have been suffocated without his previously coming to the surface, and when asphyxia has taken place, the powers of deglutition, on which the presence of water in the stomach wholly depends, are at an end; or we may suppose that the party in question faints from terror; a remarkable instance of this kind is quoted by Foderè,[[34]] from Plater, of a young woman, who having been condemned to be drowned for infanticide, fainted at the moment she was plunged in the water, and having remained for a quarter of an hour under its surface, recovered after being drawn out.[[35]]
With respect to the presence of water in the bronchiæ and lungs, we may observe that, in the violent struggles of a drowning man, a certain portion of water generally passes the epiglottis; and being immediately mixed with the air and mucus of the trachea, constitutes that frothy mucus, which we have described as being so highly characteristic of this species of violent death; although we are not to conclude with Larrey, that it is the immediate cause of dissolution in such cases. The quantity of water, however, thus forced into the pulmonary structure, is extremely small, for its entrance is powerfully opposed by a spasm of the muscles of the glottis;[[36]] were it to occur in any considerable quantity, and to appear in its fluid state, instead of that of froth, the influence would clearly be, that it had passed in after death.
Although the presence of this frothy matter must be considered as a strong presumptive proof that the person found in the water had perished by drowning, the converse of this proposition is by no means established by the absence of such an indication.
The buoyancy of the human body is another point in the history of Drowning, which has occasioned much discussion; and in solving the problem, so highly important in its forensic relations, whether a body found in the water, had been drowned, or thrown in after death, it has been considered by some physiologists as capable of affording a certain degree of presumptive evidence, although we are inclined to attach but little or no importance to such an indication. The specific gravity of the human body, under ordinary circumstances, is very little greater than that of fresh water, so small indeed is the difference that, when the lungs are inflated, a man will float[[37]] with little or no effort, if he have sufficient self possession, and does not attempt to raise too great a portion of his body out of the sustaining fluid;[[38]] but, when the air of the lungs is expelled, and probably, at the same time, a certain quantity of water is taken into the stomach,[[39]] the body becomes specifically heavier, and the victim sinks. It may be assumed as a general rule, that no newly drowned body floats, although many facts have been adduced in support of a contrary opinion; the naval custom of loading the dead bodies with weights, before they are consigned to a watery grave, is not for the purpose of sinking the corpse, but for preventing its rising after the process of putrefaction has commenced. The period during which a body will remain at the bottom cannot be very accurately determined, as the change does not take place until a sufficient quantity of air be generated to buoy it again to the surface; in the melancholy instance of the loss of the Royal George, the dead bodies were observed ascending to the surface of the sea, on or about the fifth day. The general position of a body which has thus risen, provided there be no external or adventitious circumstances to change it, is such, that it floats nearly immersed, the face, arms, and legs hanging downwards, and the loins being uppermost; this is the form which the body must mechanically and hydrostatically assume, if the sustaining power of generated air be, as it generally will, in the cavity of the abdomen, where putrefaction is more likely to commence; for the head and limbs are generally[[40]] specifically heavier than water, while the trunk, especially if inflated with air, is somewhat lighter.
It has been said that a position, different from that which we have just described, will take place where the person has been strangled, and the body then thrown into the water; for in this latter case, it is contended, that the lungs will be distended with air, and that consequently, the sustaining power must be in the thorax; in support of this opinion the story of the appearance of Caraccioli[[41]], Admiral of the Neapolitan navy, has been ingeniously adduced; this unfortunate man was hanged in pursuance of the sentence of a court martial, and his body was committed to the deep in the usual manner; thirteen days after which, while the King of Sicily was walking on the deck of Lord Nelson’s ship, he suddenly exclaimed with a yell of horror—“Vien! Viene!”—The Admiral’s corpse, breast high, was seen floating towards the ship; the shot that had been attached to the feet for the purpose of sinking it, not being sufficiently heavy. This may perhaps be explained by supposing that the corpse was stiff before it was immersed, in which case, the centre of gravity being exceedingly low on account of the shot tied to the feet, he must have floated upright, wherever the buoyant power from generated air might be situated. At all events, we feel no hesitation in at once rejecting the proposition, for the support of which it has been brought forward; the fact is that, in relation to gaseous contents, the lungs are the same in strangled, as in drowned persons; for in both cases a quantity of air is forcibly expelled from them before dissolution.