CHAPTER VIII.

DEATH BY ASPHYXIA

Hanging. Hanging consists in the suspension of a person by a cord or other means or constriction around the neck whereby the weight of the body exerts sufficient traction on the cord to cause very quickly loss of consciousness, arrest of respiration, and death. The weight of the body may be brought into it as a factor either by removing the support from beneath the victim or by raising the victim from where he stands. In the execution of criminals the support is removed from beneath the victim, and the body drops until suddenly checked by the

rope.

The cause of death may be either suffocation due to shutting off the air to the respiratory organs, or to disturbance of circulation of the brain where the vessels of the neck are compressed, or it may be due to injury of the spinal cord, caused by dislocation or fracture of the cervical vertebræ. This latter is the usual condition in judicial cases. Pressure upon the pneumogastric nerve may play an important part in producing death by hanging. Death by hanging may not be due to asphyxia alone and may be caused in spite of asphyxia.

Dr. Reineboth reports a case where tracheotomy was performed upon a man and a canula introduced to enable the man to breathe, but the patient was able to commit suicide by hanging, with the noose above the opening of the canula; so that there was no interference with respiration. Death appeared to take place rapidly, and probably as a result of unconsciousness and subsequent inability of the victim to rescue himself. Postmortem, the cerebrum was found anemic; there was fullness of the arteries at the base of the brain and hyperemia of the pons and medulla, but there were no signs of asphyxia.

Generally in cases of hanging the rope is between the larynx and the hyoid bone, and Hofmann states that death is due not to compression of the larynx, but to obstruction of the pharynx.

The SYMPTOMS of pressure upon a carotid are cyanosis, dizziness, fainting, followed by unconsciousness, and later spasmodic contraction. of the muscles and an increase in the blood-pressure and in the pulse

rate.

Unconsciousness undoubtedly in many cases comes on immediately, although death may not ensue for some time later.

Tidy divides the phenomena of hanging into three stages: There is first a partial loss of consciousness, with stupor. The initial symptoms which are described by those who have recovered are intense heat in the head, brilliant flashes of light before the eyes, deafening sounds in the ears, and a heavy feeling in the lungs; ineffectual efforts to breathe are often made after the air-passages are closed; this stage may last from thirty seconds to three minutes; there is probably no pain endured by the victim during this stage.

In the second stage the victim is entirely unconscious, and convulsions usually occur, though they may be entirely lacking. The urine and feces are expelled in this stage, if at all. The hands are clenched and the diaphragm and intercostal muscles act spasmodically, and there is twitching of the lower limbs.

In the third stage the only sign which shows life is the heart's action. This may be observed for ten minutes after the "drop" but there are occasional exceptions.

Tardieu reports a case where the heart beat at the rate of 80 per minute for an hour and a half after the man was supposed to be dead.

The duration of the hanging sufficient to cause death varies to a considerable extent. As a rule, resuscitation is not possible after five minutes' suspension. The situation of the noose may not be such as to prevent absolutely respiration and may prolong this time. Other circumstances as to whether the noose tightens above, across, or below the thyroid, the length of the fall, the weight of the person, and his powers of resistance are to be considered. Death is more instantaneous when damage is done to the spinal cord. This is always attempted in cases of judicial execution. If a sudden twist is given when the body drops fracture of the vertebræ is more likely to occur, and death come on quickly. Dislocation of the spine is most easily accomplished by placing the knot under the chin. Resuscitation is very difficult, and impossible unless there is only very slight injury to the neck, and the more severe symptoms of coma have not supervened.

The TREATMENT for resuscitating a person from suspension is to cut him down and to remove all tight clothing, especially from around the neck and chest. Cold affusions may be made to the head and chest; coughing or sneezing may be induced by ammonia or other stimulants; friction of the limbs, hot applications and blankets, and the subcutaneous injections of brandy or ether are often useful. The indications are to keep up the respiration, or to restore it if not present; to keep the heart going; to relieve the congested blood-vessels, and to keep up the bodily warmth.

POSTMORTEM APPEARANCES may be divided into the external and the internal. Externally, where the death was due to asphyxia principally, the lividity and facial expression may be that of simple suffocation, but more often the face is not congested, the eyes are not prominent, and the tongue does not protrude beyond the teeth. The neck may show evidence of ruptured muscles or fractured or dislocated vertebræ by the irregularities in its contour. The most significant external evidence is the mark of the cord itself upon the neck. There is almost always some impression. The furrow around the neck may be either single or multiple, depending upon the number of turns of the rope. Where there are several loops of the rope around the neck there will be several lines lying parallel to each other. Where other material than rope has been used, such as bedding, pillow-cases, stockings, etc., instead of a sharply defined, distinct line, there will be a constriction of varying width, and the indentation is not marked. The direction of the rope should be carefully noted, in order to differentiate hanging, which is more often suicidal, from homicidal strangulation. In the former the direction is upward toward the point of the knot; whereas in strangulation the line, as a rule, goes directly around the neck. The course of the noose is usually between the hyoid bone and the angle of the jaw although it may be lower down. Dislocation and fracture of the hyoid bone, fracture of the laryngeal cartilages, and dislocation or fracture of the cervical vertebræ may occur, but rarely in suicidal cases. Rarely, also, does decapitation by the rope occur, and so far as is known this has never occurred suicidally. The position of the head has some value as a sign of suspension during life. The most common position is a marked flexure forward, the chin resting on the front of the upper portion of the sternum. The head is also found inclined away from that side on which the knot is. This forward and lateral inclination may be considered typical, but if the knot remains under the chin the head will be pulled up and backward, with marked flexure of the posterior portion of the neck. Saliva sometimes falls from the corners of the mouth, and by some authorities this is regarded as a sign of value that the body was suspended during life, as it cannot be produced in a dead body.

The appearance and evidence of genital excitement is sometimes observed upon the bodies of those dying by hanging, but they are of no diagnostic significance as they are found in other forms of violent death. The internal coat of the carotids is often ruptured, especially in old people.

The differential diagnosis between suspension before and after death is of great importance, as people have been murdered and their bodies hung up to simulate suicide.

Accidental suspension is rare, although it has occurred; but these cases are generally so easily determined that they need not concern us here.

Homicidal hanging is no doubt rare. It presumes great inequality of strength and energy in the two parties, which is always presumed to be in favor of the assailant. Therefore, in homicidal hanging the victim is generally a child or a woman or one much exhausted by disease or other cause. Or he may be drunk, or unconscious, or otherwise incapable of defense; or he may be overcome by inequality in numbers, as in lynching. In these cases evidence must show violence and struggling, as it cannot be supposed that murder or hanging could be performed without some resistance on the part of the victim or some violence on the part of the murderer. The injuries especially suggested are scratches and bruises on various parts of the body, dislocations and fractures, especially of the fingers, and ecchymoses about the head and back. Sometimes the victim is first strangled and then suspended, but in these cases the chances are that there would be the marks of the fingers or cord upon the throat. The situation of these indications must be such that the person could not have readily produced them himself, and a decision that homicide has been committed must not be made without taking into consideration that many of the above injuries may have been self-inflicted, as well as the suspension.

In the case of discovering the suspension of a dead body, it must be noticed if there are indications that the body was strung up so that the feet are clear of the floor or other support. While it is true that homicide by hanging may be made to simulate suicide for purposes of concealment, on the other hand suicides occasionally feign the method of homicides to create this suspicion. Such a case has been reported by Heinrich. A woman's body was found hanging from a branch of a tree; her feet were clear of the ground; decayed leaves were in her mouth. A paper pinned upon her dress had written upon it, "Three of us committed the murder. We found on her one thaler and fifteen groschen. She only prayed for her two children." No marks of violence or anything suggestive of a struggle was found on or about her. The decision after a full investigation was that death was due to suicide. Postmortem appearances after death by hanging may be described by an abstract from the official report on the body of Guiteau who died by judicial hanging in Washington, D. C., for the murder of President Garfield.

The body, which was of a faint yellowish tinge, was that of a man about 5 feet 7 inches in height, and weighed 145 pounds. Examination Draper, "Legal Medicine."

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of the eyes showed the pupils were slightly and equally dilated; the vitreous was cloudy and the fundus indistinguishable; the conjunctiva of the left eye was congested. Two hours later an appearance as of transverse fracture of the lens was noticed. There was a yellowish furrow, a few lines in width, extending around the neck downward and forward on a line with the rope. On dissection, the sterno-cleido-mastoid muscles were found to be ruptured about half way between their points of origin and insertion. The thyro-hyoid ligament was also ruptured and the hyoid bone and the thyroid cartilage were widely separated. The large blood-vessels of the neck were engorged, and there was neither fracture nor dislocation of the vertebræ.

The pia mater was anemic anteriorly, and posteriorly there was slight hypostasis. The cerebral vessels appeared to be normal in all respects. There was no roughening of the inner surface of the skull. The brain was firm; its weight, including the cerebrum, pons and medulla, and a portion of the dura was 49 ounces; the white substance was almost absolutely anemic.

The usual median incision was made and the abdomen opened. There was extravasation of blood in the right pectoralis major muscle, near the second rib. The adipose layer of the abdominal section was one inch in thickness; the dome of the diaphragm extended up to the fourth rib on each side. There were old pleuritic adhesions at the apex of the right lung; the upper and middle lobes were congenitally united by connective tissue; the lung was normal throughout; there were also old pleuritic adhesions of the left lung to the diaphragm and between the lobes. The heart weighed 10 ounces; its muscular substance was apparently normal; there was an abundance of fat on its anterior surface and a villous patch of old pericarditis. Near the apex of the right ventricle the valve contained a little blood, just forming a clot. The valves were normal. The aorta was slightly atheromatous for a short distance above the valves. All the abdominal viscera presented large accumulations of fat; they were normally situated. The liver was congested. The gall-bladder contained a little bile. The spleen was lobulated and enlarged and weighed 18 ounces, the capsule was bluish, the substance brown; the Malpighian bodies were hypertrophied. The pancreas was normal. The stomach contained food. The intestines appeared normal and were not opened. The kidneys were congested.

Strangulation. Strangulation is the compression of the neck in any form or manner, not necessarily with a rope, and without the weight of the body entering as a factor in any way; while hanging is constriction of the neck by a ligature, and the weight of the body is the effective force by which the constriction produces fatal results. Death by strangulation may be caused by throttling, or manual strangling, and secondly by means of a ligature, such as a rope. This latter form is by far the most common.

In manual strangulation pressure is made upon the trachea or larynx, both laterally and from before backward against the spine. The back of the neck is held against some resisting surface, or by the assailant's