florid; chest and body generally well developed; mammæ slightly so; armpits and pubes showing precocious puberty; right shoulder more developed than left; left axilla more than usually hollow, as if a bottle or hard substance had been kept there; thighs well rounded, but the legs below the knee small in proportion-less developed than the thighs; soles of the feet soft, bearing no evidence of being used for locomotion. "Head. On removing calvarium, found the vessels on the surface of brain turgid, the membranes quite healthy, brain beautifully developed, the anterior lobes especially, cerebellum of ordinary size (on cutting into the substance it was found firm, having a large por tion of cineritious matter, a few red spots only visible on the cut surface); ventricles empty, base quite normal, containing no fluid. "Chest.-Lungs collapsed, free, rather small, but quite healthy in color and touch. Heart in every respect natural; pericardium containing no fluid or adhesions. "Abdomen. The whole alimentary canal free from any thickening or contraction, and perfectly healthy throughout. Stomach of ordinary size, containing no food, but about half an ounce of a thickened acid mucous exudation; duodenum containing a little of the same fluid tinged with bile; jejunum also a little of the same fluid, as well as the ileum, where it became slightly grumous. Five halfgrown lumbrici, and one full-grown, were in the ileum. In the cecum the fluid became thicker but same in character. Colon fairly distended with gas, and, with the rectum, contained about eight ounces of hardened feces-not in one spot, but diffused through its entire length. Anus pervious, having a little thickened mucus therein; bladder empty; uterus small, but quite healthy; spleen normal, also kidneys and liver; gall-bladder distended with healthy bile; omentum contained a little fat. The body measured fifty-three inches in length; and under the integument was a thick layer of fat; from half an inch on the thorax to one inch on the lower portion of the abdomen." It may be mentioned that the parents of the deceased girl were tried for having caused her death. The father was sentenced to imprisonment for twelve months, and the mother for six months, it being represented that she acted under the orders of her husband. 335. Diagnosis of starvation.- In estimating the value of the postmortem appearances, as evidence of death from starvation, it should be remembered that, unless there is absence of disease sufficient to have induced the emaciation and anemic condition described, death cannot be attributed to starvation as its cause. There are many diseases which would produce a similar condition of the body-some by mechanical obstruction to the ingestion of food, some by interference with the digestion and absorption of the food, others by their direct influence upon the metabolism of the tissues. Hence, the medical witness should be extremely cautious in attributing the death of the individual to starvation, especially in the presence of any other pos sible cause of emaciation. CHAPTER VIL SUFFOCATION. 336. Definition. 337. Modes. 338. Symptoms. 339. Post-mortem signs. 340. Diagnosis. 341. Cases; accidental suffocation. 341a. Suicide. 341b. Homicide. 336. Definition.- Suffocation is the general term used to signify the impeding of respiration; but all methods of impeding respiration are not included. The exclusion of air by submersion in a liquid is considered as drowning; the compression of the trachea by pressure on the outside of the neck is strangulation, or throttling, or hanging, depending on the method by which the compression is produced. There remain, however, for suffocation the cases where insufficient or inappropriate air is breathed, where the respiratory openings are closed, where the respiratory passages are closed from within, where the respiratory movements of the lungs or chest are limited, either by pressure on the chest walls or by pressure on the lungs from inside of the thorax, as in the cases of pleurisy with effusion or pneumothorax. Where there is interference with respiration from obstruction of the broncioles as in disease, interference with the nervous control of the muscles of respiration, as in certain drug poisonings, or where there is a vaso-motor cramp, as in epilepsy. There may be the same symptoms, and similar post-mortem findings, but the cases are not considered as simple suffocation. 337. Modes.-Suffocation by an insufficient allowance of air is seen where the person is shut up in a limited space, as in a trunk or drawer, or where he is buried alive; by closure of the respiratory openings when the hand or a cloth or a pillow is held over the mouth and nostrils; closure of the respiratory passages from within in the cases where some foreign substance is crowded into the pharnyx or larynx, blocking the entrance of air; by interference with the respir atory movements, as in compression in a crowd, or in cases of infants who, during sleep, are lain upon by a bedcompanion. 338. Symptoms.-The symptoms of suffocation appear first in the modifications of breathing. In a few seconds after the air supply is cut off respiratory movements become rapid and forcible and of a marked inspiratory character. At the beginning of the second minute there is a loss of consciousness, convulsions, and the respiratory movements become expiratory in character. In the middle of the second minute there is an expiratory spasm, lasting about a second, which is followed by a deep inspiratory movement. Then comes the stage of terminal respirations, of short, deep, snappy respiratory movements with open mouth, which come at increasing intervals and with decreasing force until they cease.1 The convulsions of the sec ond stage are very constant, and not rarely at their height cause opisthotonos. Their intensity and duration depend on the strength and age of the person. They may be absent in the weakened, in those dying in their own expirations, as where the quantity of air is limited, in persons whose nervous systems are dulled, as in the intoxicated, or in the cases of gradual suffocation. During the convulsive stage the action of the heart is slowed and the blood pressure increased. It is then that the characteristic ecchymoses under the skin and serous membranes are formed. Later the action of the heart becomes more rapid, finally growing slower and weaker, and ceases after the respirations have stopped. To estimate the time between the cutting off of the supply of air and death, Vibert2 performed some experiments upon dogs, hermetically sealing the trachea. From the time that the trachea was sealed till the cessation of respiration was on the average four minutes and five seconds. The limits of this period were three minutes and a half to four minutes and a half. The time from the cutting off of the supply of air till the cessation of the heart-beat was, on the average, seven minutes and eleven seconds. The limits of this period were from six minutes forty seconds to seven minutes and forty-five seconds. 339. Post-mortem signs. The post-mortem signs of suffocation seem to be more marked the more rapid and complete the asphyxia, and the greater the resistance and struggles of the person. The external appearances in the characteristic cases are the lividity of the face, lips, and finger nails; the prominence of the eyes; the suffusion of the conjunctivæ, the protrusion of the tongue, and the dark, bloody * Hofmann, Ger. Med., 1902, p. 513. 'Vibert, Précis de Méd. Lég., p. 125. froth at the mouth. Minute ecchymoses on the neck and chest are common. In many of the cases, however, the only signs externally are the blueness of the lips and the mucous membrane of the mouth. The body cools slowly and cadaveric changes set in early. The internal appearance which is the most constant and valuable is the condition of the blood, which shows the dark color, and does not readily clot in the body. All of the organs are congested, but the lungs are especially well filled with blood. The right side of the heart is filled with blood, and the left side empty in the typical cases, but there are many exceptions to this rule. The small, sharply circumscribed ecchymoses beneath the pleura and pericardium-the taches de Tardieu-are most constant in children, and are found in certain cases in adults; but they are significant of asphyxia, rather than of suffocation. They may be found also on the liring membrane of the heart and aorta, and in the mucous membrane of the larynx and trachea, also within and upon the thymus gland. The permanence of these spots renders them valuable signs. Tardieu found them under the pleura of the fetus which had been for ten months in a privy well. They are of value only when associated with other signs indicating the mode of death. 340. Diagnosis. It will be observed, also, that the other above signs are merely those of asphyxia in general. In hanging, strangulation, and drowning, there are one or more signs characteristic of the agent by which life is extinguished, the presence of which, together with the general signs of this kind of death, is almost, if not quite, conclusive. But in other modes of suffocation, if any trace of the instrumentality by which death was produced is found, it will be most probably due in homicidal cases, to haste on the part of the assassin, and yet cannot afford any addition to the medical evidence. Thus, if a person has been smothered with the bedclothes, or suffocated by a hand held before the mouth, or by compression of the chest, a distinct and satisfactory indication of the fact will seldom be had. For this reason the medical examiner will often be at a loss whether to ascribe the death to natural or to violent causes. may be one of apoplexy, of faucial disease, or of pulmonary congestion, or may be due to a variety of accidental causes, not apparent without a careful inspection of the body. This must, therefore, in all cases where it is important to remove doubt, be conducted in the most careful and searching manner. The absence of any characteristic mark to indicate the mode of death gives a latitude to conjecture, and to the proposition of general questions, which, in case of trial, will The case |