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[751] says that the face has the appearance of any other corpse. Liman[752] found the face livid in only one of fourteen cases. Hofmann[753] says that the cyanosis appears during the agony because of paralysis of the circulation and gravitation of blood. The cyanosis of the face, projection of the eyes, and congestion of the conjunctivæ are due to the expiratory effort. These signs are also seen in fat persons who do not die of strangulation. Tardieu[754] mentions a dotted redness or minute ecchymosis of the conjunctivæ and skin of face, neck, and chest as constant; but this cannot be considered characteristic, because it has been seen, though not so well marked, in death from other causes. It has been found in suffocation from compression of the chest and belly; and also where there is respiratory interference in the prolonged efforts of tedious labor and in convulsions. Liman[755] found it in those who were hung. It is due, according to Hofmann,[756] to increased blood pressure and consequent hemorrhages. It is of importance as tending to show that there was stasis of blood in the head and face during life. Liman[757] found cyanosis in the conjunctivæ, lips, back of mouth, and in the muscles. Maschka[758] in 234 cases of asphyxia found capillary hemorrhages of the eyes and eyelids 87 times.
Dastre and Morat[759] claim that in asphyxia the cutaneous circulation becomes more active than in the normal state, while at the same time the vessels of the abdominal cavity are contracted. Laffont[760] considers the mechanism of this peripheral dilatation.
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[761] never saw bleeding from the ears in strangulation. Taylor[762] states that Dr. Geoghegan informed him of a case of suicidal strangulation by a ribbon; the violence was great, there was bleeding from the ear, and the drum was found ruptured. In this case the mark on the neck, which was deep, nearly disappeared after the ligature was removed. Taylor also says Wilde, of Dublin, saw a case of rupture of drum and hemorrhage in strangulation. Pellier[763] says that Littré mentions a case of rupture of tympanic membrane in strangulation by a cord. Zoufal and Hofmann have offered explanations of the occurrence (Case 35).
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[764] doubts their prominence. Budin and Coyne[765] state that in asphyxia the dilation of the pupil progresses to a maximum and then convulsions occur. Ophthalmoscopic examination during the dyspnœa of asphyxia shows a lessened fulness of the retinal vessels.
The TONGUE is often swollen, dark, protruding, and sometimes bitten. Maschka[766] states that if the ligature lies above the hyoid bone, the tongue will be drawn backward; if over or below the bone, the tip of the tongue may appear more or less between the jaws.
The HANDS are usually clinched and may have in their grasp articles which, under the circumstances, have a medico-legal value.