ILLUSTRATIVE CASES.
Accidental.
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 œsophagus, 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, dyspnœa, 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 dyspnœa; pain in throat; aphonia; stridulous breathing; dysphagia; cough; copious mucous expectoration. Laryngoscopic examination showed coin in œsophagus. 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 dyspnœa. 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 œdema 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, gasping for breath, lividity of face for a few minutes; symptoms subsided leaving slight cough. The dart had lodged in right bronchus beyond first bifurcation, as shown by hissing, fluttering sound in both inspiration and expiration. Tracheotomy. The dart could not be reached. At a later date the dart was brought up into the mouth by a strong expiration.
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 œdema 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 particles like ashes and vomited matter were found. Lungs filled the pleural cavities, were rose-colored and showed abundant punctated subpleural ecchymoses; bloody, frothy mucus in trachea and bronchi; some serum in pericardium; respiration had been complete. Opinion given, that the infant had been suffocated by obstruction of pharynx, probably by fingers.
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 œsophagus 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 œsophagus 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 œsophagus 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
d’Anthropologie Criminelle, etc.