Text-book of forensic medicine and toxicology

by R. J. M. Buchanan

4. The Lungs.—Hyperæmia of the lungs is rarely absent. In most cases both lungs are engorged in about equal proportions. Hypostasis—post-mortem stains—must not be mistaken for capillary engorgement.

5. The Heart.—Engorgement of the right side of the heart, the left being empty, or nearly so. It is advisable always to examine the heart first, and then the lungs. The pulmonary artery is also much congested.

6. Capillary Ecchymoses.—These appear as purplish-red spots on the pulmonary pleuræ, on the surface of the heart, aorta, in the thymus, and on the diaphragm. They may appear on the above-mentioned parts in a fœtus suffocated in utero by pressure on the cord. These ecchymoses are rarely seen on adults, most frequently on infants, due probably to the thinness of the coats of the capillaries, which are ruptured in the efforts made to breathe. They are not a positive sign of death from suffocation, as they have been seen in death due to cholera, typhus, and other diseases. They are present also where death is due to hanging, drowning, &c.

7. Condition and Appearance of the Trachea.—The mucous membrane of the trachea is injected, and appears of a cinnabar-red colour. This is present in every case of death by suffocation, and must not be confounded with the dirty cherry-red or brownish-red coloration due to putrefaction. Remember also that the trachea putrefies early. If suffocation be slowly produced, a quantity of frothy mucus may be found in the windpipe, and also in the smaller tubes of the lungs. Always examine, especially in cases of supposed infanticide, the trachea for foreign bodies, the presence of soot, &c. The presence of sand, ashes, &c., in the œsophagus and stomach in persons buried in these materials, is presumptive of the person having been placed in them prior to death.

8. Kidneys, Vena Cava, &c.—The quantity of blood in the kidneys is always considerable. The abdominal veins are all more or less congested, and the external surface of the intestines presents numerous traces of venous congestion.

9. The Brain.—Apoplexy of the brain, as secondary to the pulmonary apoplexy, may be more or less present, attended by its well-known appearances.

10. Face, Tongue, and Mouth.—The expression of the face is not characteristic of death by suffocation, and differs in no particular from that common to other forms of death, being more frequently pale than turgid; and the starting of the eyes, popularly ascribed to this form of death, is not often seen. The tongue may or may not be protruded beyond the teeth. The presence of froth about the mouth is not constant, and is of common occurrence in those dying from natural causes. The tympanum may be ruptured.

Was the suffocation homicidal, suicidal, or accidental?—Suffocation may occur accidentally during the act of swallowing, and by foreign bodies placed carelessly in the mouth and then drawn suddenly into the windpipe, or by blocking the pharynx or œsophagus, also from being smothered by sinking into sand, grain, mud, and such-like, or by the bed-clothes in cases of epilepsy during a fit. Examine the lips for the presence of ecchymosis and other marks of violence. A man, some years ago, was accused of having caused the death of his wife by strangulation, for which he was indicted, and tried before the High Court of Justiciary in Scotland. The post-mortem examination revealed the cause of death as due to suffocation, and the following injuries were found on dividing the windpipe, which contained a quantity of frothy mucus: in the interior of the larynx there was a considerable extravasation of blood lying beneath the investing membrane, and passing up on both sides and behind, as far as the chink of the glottis, and above that opening into the ventricles of the larynx. There was here, also, a fracture of the right wing of the thyroid cartilage, by which its lowest horn was wholly detached, and the cricoid cartilage was broken in two places at opposite sides of its ring. The defence was that she had fallen accidentally while in a state of drunkenness, and had thus produced the fatal injuries.

The man was acquitted, the legal opinion in favour outweighing the medical opinion against the theory of accident. The above case created some discussion at the time, and induced Dr. Keiller to make several experiments as to the possibility of fracturing the cartilages of the larynx. The following are his conclusions:

1. That ordinary falls on the human larynx are apparently not capable of producing fractures of its cartilages, and even falls from a height with superadded force appear to be unlikely to do so.