Definition – Suffocation means a group of conditions of violent asphyxiation, where passage of air between the atmosphere and the lungs is prevented by mechanical ways other than constriction of neck or drowning.
Types of suffocations –
According to the frequency of occurrence, suffocations are of the following types –
(1) Smothering ; (2) Traumatic asphyxia ; (3) Choking ; (4) Gagging ; (5) Overlying ; (6) Burking.
Definition – In smothering, respiration is prevented by the closure of the mouth and the nasal opening.
Cause of death – In all cases of smothering death is due to asphyxia.
Circumstances of smothering deaths —
Smothering deaths may be accidental, homicidal or rarely suicidal.
Accidental smothering – It occurs in
1. An intoxicated or unconscious person lying in prone position. Similar may be the case with epileptics, during the attack of fit.
2. Children playfully covering their head and mouth with a plastic or polythene bag.
3. Infants while suckling their sleeping mother’s breast.
4. Insane or epileptics or intoxicated persons falling upon a heap of dust, grain or flour.
5. During masochistic practice of self asphyxiation.
6. A baby may be smothered under a heap of mattress on a bed.
7. Foetus born without rupture of membrane (born in caul) may get smothered or die drowning death due to inhalation of amniotic fluid.
Homicidal smothering is caused in the following ways –
1. By pressing the face and the nose of the victim by hands.
2. Same thing may be caused by a towel, pillow.
3. The face may be pressed on the ground to cause smothering.
4. A person may be smothered by tying a plastic bag or some other substance around his mouth and nose.
Suicidal smothering may be attempted –
1. By tying a plastic bag around head including the mouth and the nose, with application of several knots untill the person becomes unconscious.
2. By tying a pillow in front of his face, with several knots untill the person becomes unconscious.
3. By arranging self burial under a heap of mattresses on a bed.
Post-mortem findings –
External findings –
External findings vary according to the nature and method used to cause the smothering.
In case of homicidal smothering caused by hands, there will be abrasions and contusions over and around the mouth and the nose. The abrasions are usually crescent shaped nail scratch abrasions. There may be fracture of the nasal cartilage and there may be bleeding from the nose with occasional bleeding from the mouth. If smothering has been caused by some soft material, then there may not be much external sign near the mouth and the nose. But there may be depression of the nose with bleeding from the nose. The inner aspects of the lips may show abrasion, contusion or even laceration, due to friction with the teeth. There may be loosening of the teeth with signs of bleeding from the gum. In case the face is pressed against some hard surface, there will be gross abrasion, contusion and even laceration on the skin around the mouth and the nose. In such a case, possibility of fracture of the nasal bone or cartilage is more. Injury to the inner aspect of the lips, soft gum and dislocation of teeth are more common and extensive. In homicidal smothering, there may be signs of struggle or resistance over other areas of the body.
In accidental smothering due to compression over the mouth and nose there will be abrasions, contusions or even laceration outside the mouth and the nose with fracture of the nasal bone or the cartilage and bleeding from the nose and the mouth. Abrasions, contusions, lacerations may be found in the inner aspects of the lips and the soft gum with fracture dislocation of the teeth. In epileptics there may be injury on the tongue due to its being bitten by teeth. In accidental smothering due to fall on dust or flour etc. stain of these materials may be present outside the mouth and nose as also inside the mouth and nasal cavity. There will not be any mark of resistance or violence at any other part of the body. In case the smothering occurs due to compression against some soft material then there may not be much findings, as already seen in case of homicidal smothering by soft materials. In case of smothering under the mother’s breast, the delicate tissue of the nose and face of the infant will be compressed and pale.
Smothering during masochistic practice will be clear from the evidences present at the site, like porno books or nude pictures, exposed private parts of the victim, wearing dress of opposite sex and the method of inducing self smothering.
Suicidal smothering –
In suicidal smothering the method adapted is not disturbed and thus the mouth may be seen to be closed with a pillow tied in front, or a plastic bag may be seen tied around the head and the mouth. There may be some local effects of pressure but no remarkable injuries will be there.
Other external findings in all cases of smothering will be those of asphyxia like cyanosis, prominent bluish post-mortem staining, involuntary discharge of faecal matter or urine etc.
internal findings –
Internally, apart from the findings mentioned in relation to the lips, gums and teeth, in case of smothering due to fall on dust or flour like substance, the same may be found in the respiratory tract lumen. Rest of the internal findings will be in the line of classical asphyxia, with dark fluid blood, congested organs, congested lungs with petechial haemorrhagic spots in the undersurface of the pleura and congestion and haemorrhagic spots in the substance of the brain and the layers of the meninges.
In traumatic asphyxia, there is forceful compression of the chest which prevents respiratory movements of the chest wall and also causes injury to the chest wall.
Circumstances of traumatic asphyxia –
1. Due to house collapse.
2. When stampeded by a crowd, running in panic and without any sense, as it occurs for example, due to outbreak of fire in a cinema hall or at a public gathering.
3. By being run over by a vehicle.
4. Due to collapse of a wall inside a mine.
5. When held between the buffers of two bogies of a train.
Post-mortem findings –
Externally, in addition to the signs of asphyxia, there will be extreme congestion along with findings akin to haemorrhagic spots, above the level of the compression. The part lower to that level may not show any such finding. In case of house collapse, there will be stain of dust and soil over the body. In case of being run over by a vehicle there will be tyre and grease marks on the body. In case of stampede there will be foot marks on the chest and sometimes laceration. There may be external injuries in the form of abrasion and bruise.
Internally, in case of house collapse there will be evidence of inhalation of dusts and debris, inside the respiratory tract. Among the other findings, signs of asphyxia in the organs and blood, signs of injury which is often extensive with fracture of the ribs, injury to the liver, lungs, heart etc. and presence of blood in the thoracic and abdominal cavity, may be there.
If the patient survives, then the spots akin to haemorrhagic spots pass off within about two weeks without passing through the colour changes seen in case of bruises.
Definition – In choking the air passage is occluded either by some foreign materials or due to some pathology or foreign substance in the neighbouring structure (e.g. oesophagus).
Circumstances of choking –
1. Slipping of a food bolus in the respiratory tract.
2. Children, chewing a toffee, or playing with a button or a coin in mouth, may get choked when that slips down through the larynx.
3. Children, sucking a piece of balloon to puff it or inflate it inside the mouth, may get choked if that slips inside the larynx.
4. Fisherman, after a catch, when holds the fish temporarily between the teeth or lips, that may accidentally slip downward and choke him.
5. People may be choked due to inhalation of irritating gas like chlorine gas, vapour of an acid etc. Laryngeal spasm and excessive mucus secretion cause choking in these cases.
6. When food substance gets lodged and remains fixed at some curvature or constriction of the oesophagus, that may cause choking from outside the lumen of the trachea or the larynx.
7. Similarly, any swelling, abscess or new growth on any neighbouring structure will cause obliteration of the lumen of trachea and larynx and may cause choking.
8. Slipping of ‘an artificial denture inside the larynx is another cause of choking.
Cause of death – asphyxia, and vagal inhibition (occasional).
Post-mortem findings –
There will be signs of asphyxia both externally and internally. The cause of choking may be detected during the postmortem examination.
Medicolegal significance – Choking is almost exclusively accidental in nature. Homicidal choking is an impossibility. Though homicidal choking is argumentatively possible with infant victims, it is not necessary to choke the infant to fulfil the purpose because gagging in that case can serve the purpose more easily. Suicidal attempt of choking can only be thought of in case of mental unsoundness of a person.
“Cafe Coronary” – This is a misnomer which came into existence from a situation of choking by a food bolus, in a restaurant, in which the signs symptoms at the initial phase appeared similar to those of a cardiac attack, With pain in the chest, respiratory distress and circulatory collapse. The person died, was intoxicated and during post mortem examination the exact cause of the episode i.e., choking was revealed.
In this type of violent asphyxiation, cloth is pressed inside the mouth cavity which also creates pressure over the posterior wall of the fauces. This is mostly homicidal and the victims are mostly unwanted infants. But sometimes unconscious persons may be gagged and after death the substance used may be removed from the mouth. Accidental gagging may occur if a set of artificial denture accidentally slips and blocks the posterior wall of the mouth cavity causing asphyxia and death.
1. Signs of asphyxia, externally and internally.
2. Presence of the gagging material inside the mouth cavity.
3. Congestion and at times abrasion and contusion inside the mouth cavity.
In this condition young individuals (usually infants or very young children) die due to asphyxia, when they get compressed under the body of an intoxicated adult bed partner. This is purely accidental in nature.
During postmortem examination, the face, nose and the chest of the victim child will appear compressed and pale. There will be signs of asphyxia in the rest of the body parts and the organs.
Cause of death may be due to the combined effect of smothering and compression over the chest arresting the respiratory movement of the chest.
In fact, this condition is the combination of smothering, palmar strangulation and traumatic asphyxia. This term has come into use from the name of one of the two persons who used to kill their victims by this method, after giving them shelter in their inn and intoxicating them with alcohol and then supply their dead bodies to the Department of Anatomy in the Edinburgh School of Medicine, in 19th century. In the process of killing, one Willium Burke used to sit on the chest of the victim by closing the victim’s mouth and compressing his neck with hand and Willium Hare, the other partner used to pull the legs of the victim in this state. In 9 months, they sold 16 bodies to Dr. Knox of the school of Medicine, at a price of 7 pounds and 10 shilling for each dead body. Willium Burke and Willium Hare had two other female accomplices. Though the plan was in origin hatched by Hare and his associate Maggie, only Burke and his associate Nell were tried and Burke was condemned to death and Nell was aquitted due to lack of evidence. But Nell and Maggie were much tortured by the enraged public and Hare became untraceable. Dr. Knox was not tried.