THROTTLING
Throttling is strangling by means of the hand or hands alone, and is due to constant pressure of the fingers upon the throat. Very little pressure is required to occlude the glottis; it can be done with slight pressure of the thumb and forefinger on the side of the thyroid cartilage.
The impression of the fingers and thumb upon the throat have characteristic marks. They are usually to be seen on both sides of the throat. The thumb mark is on one side, and the marks of the fingers, separated from one another or clustered together, are on the other, the thumb mark being the highest. When grasped from the front by the right hand, the thumb mark will be on the right side of the throat. If the victim be throttled by the two hands at the same time, as when on the ground, the thumb marks are on the same side. If the assailant be left-handed, and has used this hand to grip the throat, the thumb mark will be on the left side of the victim. The finger marks are one above the other. The marks may appear as ecchymoses if the examination be made soon after death; if later, they may appear and feel like parchment, and of a brownish colour. Crescentic marks of finger-nails may be present, also other scratches in the vicinity. Other marks of general violence may be present, and should the victim have fallen to the ground, the head may be injured. Much blood is effused in the tissues of the neck and the laryngeal cartilages, and the hyoid may be found fractured; the carotids may escape injury, but not always.
The mucous membrane of the cheeks may be found lacerated. Where the victim is thrown to the ground and knelt upon, fracture of the ribs and ecchymosis of the chest wall may occur.
In a case examined by me of combined strangling and throttling, marks of the ligature and fingers were both present, and on the clavicles separate marks produced by the knuckles while tying the cord. These knuckle marks did not show up till some time after death. Effusions of blood were present in the tissues of the neck on each side of the larynx, and amongst the muscles on both sides, and in the sheath of the left carotid artery.
The hyoid bone was fractured in two places in its left half. The thyroid cartilage was fractured vertically on each side of the middle line into three pieces, the central portion having fallen behind the other two into the cavity of the larynx. The right wing of the thyroid was comminuted. The cornua were fractured. The cricoid cartilage was also fractured posteriorly, and into three pieces in front. Effusions of blood in the fractured areas had formed beneath the mucous membrane. Effusion of blood was present on the front wall of the pharynx and the upper part of the œsophagus. The right carotid artery was atheromatous, and linear and star-shaped fissures were present, the latter surrounded by a ring of sub-intimal effusion of blood.
On the right side of the thorax the fifth rib was fractured at the junction with its cartilage, and on the left side the second, third, fourth, fifth, and sixth ribs were fractured close to their cartilages, and again from three to five inches further back. Blood effusions in the tissues of the chest wall and under the pleuræ were present in the region of the fractures.
A handkerchief was found tight on the neck and tied with two knots both fastened securely. It was probable that the handkerchief had been tied on after the throttling, as the knot ends were too short to allow a sufficient pull on them to cause the injuries. Throttling may be regarded as a homicidal act; although one or two instances of suicidal throttling have been recorded in the insane.
Judicial Hanging.—In judicial hanging the prisoner is suspended by a rope with a running noose around the neck, after a sudden drop of from six to eight feet according to the weight of the body. The noose may be arranged with the knot or slip-ring fixed at the side below the ear, or in front so as to jerk the head backwards. The sudden and severe strain upon the neck produces fracture or dislocation of the spinal column at the second or third cervical vertebra, with rupture of the spinal cord. Other local injuries occur, such as rupture of cervical muscles, fracture of the larynx, and even lacerated wounds of the neck. The head has even been severed completely from the body, and the deep structures of the neck have even been so lacerated that the body has hung by skin only, stretched to the thickness of two or three fingers. Death is said to take place from shock, pressure on the vagi, and asphyxia, probably also cerebral apoplexy. When death is instantaneous, the body hangs motionless, the head fallen over the side opposite the knot, and the neck stretched.
The heart may, however, continue to beat for a varying period after apparent death—in some cases even as long as 14½ minutes. The following interesting series of pulse tracings were taken by Dr. Llewellyn Morgan, of Liverpool, and kindly placed at my disposal. In No. 1 the heart beats could be recorded at the wrist for 14½ minutes after the drop; in No. 2 for 12½ minutes; and in No. 3 for 12 minutes. The frequency and character of the beat is variable, but in each case shows a practically normal rate towards the end. (See [Figs. 16], [17], [18].)
Apart from the local injuries to the neck, the external appearances in judicial hanging are similar to those in other forms.
CHAPTER IX
DROWNING
Death by drowning occurs when the breathing is arrested by watery or semi-fluid substances, blood, urine, or the muddy semi-fluid matter found in cesspools and marshes. It is not necessary for the whole body to be submerged. Death may result if the face alone be immersed, as in the case of a man in a fit of drunkenness being drowned in the water contained in the imprint of a horse‘s hoof left in the mud.
In addition to the changes in the internal organs, identical with those present in persons who have died from suffocation or hanging, water is found in the lungs or stomach.
Death may be due to—
- (a) Apoplexy.
- (b) Asphyxia.
- (c) A combination of the two.
- (d) Neuro-paralysis.
Death from pure apoplexy is rare; and it may be affirmed that death from syncope never occurs in the drowned without leaving some signs of asphyxia.
It is more difficult to restore the drowned than those dying from mere stoppage of air from entering the lungs. Few if any persons recover who have been submerged four minutes, and even in cases where this time has been exceeded, followed by recovery, this result is probably due to the person fainting before entering the water.
In death from drowning, the lungs are distended and overlap the heart, and have a peculiar spongy feeling. They also contain a quantity of frothy fluid, which cannot be produced in the dead body, as it is the result of the violent efforts made by the individual to breathe in the act of dying. This frothy condition of the fluid in the lungs is an important sign of death by drowning, especially if the fluid corresponds with that in which the individual is said to have perished. It is just possible, however, that the person may have been first suffocated, and then thrown into the water, froth in the trachea being found in those suffocated; but in this case the froth is small in quantity, and not watery. The froth in the drowned is like that made with soap and water, and is not viscid, thus differing from bronchitic exudation. Water in the stomach is an important indication of death from drowning, especially if the water contained in the stomach can be shown to possess the same characters as that in which the body was found. Water in the intestines is still more important. In a great number of cases this, however, must be next to impossible; when it can be identified, the value of this sign is enhanced by the fact that water does not enter the stomach in those submerged after death, unless putrefaction be far advanced, or the body has lain in very deep water. Casper concluded that a person had been drowned, by finding a small quantity of mud in the stomach after putrefaction had set in. Water, however, may be absent from the stomach if the person fall into the water in a state of syncope, and it may be present if the person has taken a draught of water before submersion.
The effect of season on putrefaction in water is shown in the following table:
| Summer. | Winter. | ||||
| 5 to 8 | hours | produce | as much change | as 3 to 5 | days. |
| 24 | “ | “ | “ | 4 to 8 | “ |
| 4 | days | “ | “ | 15 | “ |
| 10 to 12 | “ | “ | “ | 28 to 42 | “ |
| (Devergie.) | |||||
Of the external signs, the presence of sand, gravel, or mud under the nails may or may not be an important sign, for sand or mud may collect under the nails during the efforts to drag the body from the water; but weeds, &c., grasped in the hands show that there has been a struggle, and point to death from drowning. The cutis anserina—goose skin—present generally on the anterior surface of the body, and not, however, peculiar to death from drowning, is important as a sign of recent vitality. The face of those who have been drowned, and then quickly removed from the water, is pale, and in most cases not swollen; the eyes may or may not be closed; and not infrequently round the mouth there is more or less froth, especially when death is due to apnœa. In summer, however, after two or three days, and longer in winter, the face assumes a reddish or bluish-red coloration, putrefaction taking place about the head and upper extremities earlier than in other forms of death. The contraction or retraction of the penis is a well-marked sign of death by drowning, and Casper asserts that he has “not observed anything similar so constantly after any other kind of death.” Ogston states that he has met with two cases of erection of the penis in the drowned.
The question as to how long a body may remain in the water before it floats has given rise to considerable discussion, without, however, arriving at any very definite conclusion. It may be stated in general terms that, as floating depends to some extent on the rapidity in which putrefaction supervenes on submersion, bodies float earlier in summer than in winter, in salt than fresh water, clothed than naked. In India bodies have floated in twenty-four hours after immersion. Females and children float more readily than males. A body from various causes may float within a few hours of its submersion, especially if the body be that of a female, fat and clothed. The old idea that the body of a person thrown into water during life sinks, but that a dead body under like conditions floats, is a fiction now exploded.
Suicide or Homicide?—Homicide by drowning is rare, except in children. Accidental and suicidal drowning are common enough.
The signs to be sought for in the drowned are—(1) Absence of any injury. (2) Cutis anserina and retracted penis. (3) Water and mud in the stomach. (4) Froth in the air-passages. (5) Distended lungs. (6) General signs of death by asphyxia.
It should be remembered that the fact of the hands being tied together, or to the feet, does not militate against suicide by drowning.
If wounds and other injuries be found on the body, the question arises as to whether the injuries were sufficient in themselves to cause death, and then as to whether they were caused during life. A person jumping from a height into the water may sustain severe injuries—dislocation of both arms, fracture of the skull and of the vertebræ, or even lacerated wounds of more or less severity. The absence of the signs proper to death by drowning, coupled with the presence of external injuries, would point to death by violence prior to immersion. The presence of signs of drowning, and injuries, sufficient to have caused death in themselves, would indicate that they had occurred after death.
The following considerations may assist in forming an opinion:
- 1. Previous history of person found in the water.
- (a) Any history of suicidal tendency.
- (b) Any motive that would render suicide probable.
- 2. Height from which the person fell.
- 3. Absence or presence of signs of death by drowning.
- 4. Absence of stakes or other objects in the water that might
- have caused injuries to anyone falling against them.
The time required to cause death by drowning is so short that persons seldom recover after submersion for three or four minutes; but the cessation of respiration is no guide to the extinction of life, and an attempt at resuscitation should always be made, for if the respiration be fairly restored the heart will soon act. Nay more, as pointed out before, in cases of so-called asphyxia, the heart may continue to act for several minutes after the entrance of air to the lungs has been arrested, and in judicial hanging it frequently happens that the pulse at the wrist can be felt for ten or twelve minutes after suspension. (See [Figs. 16], [17], [18].)
Recapitulation of the Post-mortem
Appearances in the Drowned
I. External
1. In the Skin.—Rose-coloured patches may be present on the face and neck. The condition of goose skin—cutis anserina—is hardly ever absent even in summer. The cutis anserina is not, however, characteristic of drowning, as it may be present in other forms of violent death, and also in some persons during life. It is a vital act, the result of nervous shock, and does not depend upon the temperature of the water for its production; still, it points to recent vitality.
2. The Tongue.—The tongue is just as often found behind the jaws as between them (Casper).
3. The Hands and Feet.—The hands and feet acquire a greyish-blue colour when the body has lain in the water from twelve to twenty-four hours. The skin also becomes corrugated in longitudinal folds. The greyish-blue condition of the hand is known as the “cholera hand.” The nails may contain particles of sand and weeds. “No corrugation or discoloration of the skin of the hands or feet is ever observed on the body of anyone drowned who has been taken out of the water within half an hour, within two, six, or even eight hours” (Casper). The same authority states he has produced these effects by laying the hands after death in water, or wrapping them in cloths kept constantly wet for a few days.
4. The Genitals.—Contraction of the penis and dartos is an almost constant symptom, and Casper has “not observed anything similar so constantly after any other kind of death.” It is due, probably, to the same cause as the cutis anserina, which Brettner attributes to “bundles of unstriped muscular fibres, lying in the upper stratum of the true skin, surrounding the sebaceous glands, and forcing them forwards by their contraction, thus making the cutis anserina. Precisely similar unstriped muscles are found in the subcutaneous cellular tissue of the penis; they run principally parallel to the long axis of the member, but very often large bundles run across it.” The action of cold and fright is to induce contraction of these cutaneous muscles, with a resulting contraction of the penis.
II. Internal
1. The Brain.—Cerebral hyperæmia is most rare in the drowned, but cerebral hypostasis is not infrequently mistaken for it.
2. The Trachea.—The mucous membrane of the trachea and larynx is always more or less injected, and is of a cinnabar-red, which must not be mistaken for the dirty, brownish-red colour, the result of putrefaction. A white froth, but seldom bloody, is also found in varying quantity in the trachea, and is a most important sign of vital reaction, but its diagnostic value is destroyed by putrefaction. Sometimes a portion of the contents of the stomach may be found in the trachea. When this occurs it is due to the act of coughing, induced by the admission of water into the lungs. The contents of the stomach are forced into the mouth, and then drawn into the lungs during the next attempt at inspiration. This indicates that the person entered the water during life. In cases where death has taken place from syncope little or no froth may be found in the trachea.
3. The Lungs.—The lungs are completely distended, almost entirely overlapping the heart, and pressing close to the ribs. They are spongy to the feel, and when cut into, a considerable quantity of bloody froth escapes. The froth found in the lungs is the result of the powerful attempts to breathe, and cannot be produced by artificial means. It adheres not to the sides of the bronchial tubes, as does the exudation of bronchitis or pneumonia. The distension of the lungs is due partly to an actual hyperæmia, and partly to inhaled fluid. Water is present in the pleural cavities.
4. The Heart and Great Vessels.—As is common to other forms of asphyxia, the left side of the heart is entirely, or almost entirely, empty; the right, on the contrary, is engorged. This condition of the heart is, therefore, not a diagnostic sign of drowning, and is absent in the drowned when death takes place by neuro-paralysis; in fact, in some cases of undoubted drowning, both sides have been found empty, probably, however, the result of putrefaction (Ogston). The same may be said of the accompanying congestion of the pulmonary artery.
5. The Blood.—As is common in all forms of death where respiration has been arrested, the blood is found to be remarkably fluid, and of a cherry-juice colour. M. Faure in his monograph on asphyxia states that he has found large and firm clots in the right side of the heart in the drowned who have not remained long under water. The blood is diluted with water, most marked in the left side of the heart. The amount of dilution is greater in slow drowning.
6. The Stomach.—Casper considers that the presence of fluid in the stomach, corresponding to that in which the body is found, is “an irrefragable proof of the actual occurrence of death from drowning,” and that the swallowing of it must have been a vital act of the individual dying in the water. The absence of water from the stomach does not negative death from drowning. Water is not always present. It is possible for it to reach the stomach of a submerged body after death.
Water in the intestines is a more reliable sign of death from drowning, and indicates submersion during life. It is only after very long submersion and under great pressure that water finds its way into the intestines after death.
N.B.—Putrefaction in the drowned in most cases commences in the upper part of the body, and extends downwards. The face, head, and neck are first attacked. This is the reverse of putrefaction in air.