Asphyxia

“ Asphyxia is difficulty of taking in breath; apnœa is breathlessness. There is asphyxia when the blood from the heart can go to the lungs, but there is no access of air; apnœa, when there is access of air, but the blood fails to reach the lungs. In asphyxia the lungs obstruct the circulation; in apnœa the obstruction is in the heart. In asphyxia the air cannot reach the blood; in apnœa the blood cannot reach the air.
Quinquaud [730] and Fredericq [731] conclude from experiments on animals that asphyxia is due to the deficiency of oxygen, not to the accumulation of carbon dioxide. ”

“ In Greek religion it is associated with Persephone, the dead, and the underworld.
Asphyx ́ia, literally, the state of a living animal in which no pulsation can be perceived, but the term is more particularly applied to a suspension of the vital functions from causes hindering respiration. The normal accompaniments of death from asphyxia are dark fluid blood, a congested brain and exceedingly congested lungs, the general engorgement of the viscera, and an absence of blood from the left cavities of the heart while the right cavities and pulmonary artery are gorged. ”

“ Blood in this condition fails to excite the respiratory centre in the medulla, and respiration ceases. To avoid confusion the term asphyxia had better be retained, especially as it is most commonly used and generally understood. Asphyxia, or death from defect in the quality of the blood, is brought about when any impediment is placed on the healthy action of the lungs. Experiment has shown that for a short time after respiration has ceased, the heart still continues to act, and that if the impediment to the proper aeration of the air by the lungs be removed, life may be prolonged. ”

“ Causes of Asphyxia.—1. Mechanical obstruction to the air passages: foreign bodies, exudations, tumours, suffocation, strangulation, drowning, hanging, spasm of glottis from mechanical irritation, or irritant gases.
2. Interference with the action of the respiratory muscles: exhaustion of the muscles from cold; paralysis of muscles from injury to or disease of respiratory centre; poisons acting on the centre; continued pressure on walls of the chest; fixation of muscles from tetanus or strychnine poisoning. ”

“ 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. ”

“ It must not be thought that asphyxia is always the mode of death in those submerged, although it is commonly present in a certain number of cases. Other causes may often modify the circumstances of the death or directly produce it, as congestion of the brain and syncope, or the cause of death may be a mixed one. Occasionally one reads accounts of persons resuscitated from drowning who, on recovering from the primary effects of the asphyxia, die suddenly without apparent cause after a lapse of a few minutes or several days. ”

“ There is certainly a very great difference between asphyxia that happens to an adult, and the state in which the fœtus is found, since, if the first is prolonged, organic life ceases, while this life is in full activity in the fœtus. Thus there is no resemblance in the composition of the black blood in the arteries in asphyxia and that in the arteries of the fœtus. ”

“ It is, “there is risk of 135asphyxia when the anæsthetic vapour is not sufficiently diluted with air.” When the vapour is not sufficiently diluted with air, the risk is one of sudden death, by paralysis of the heart. Chloroform does not yield enough vapour, at the natural temperature and pressure of the atmosphere, to exclude the air to the extent which would cause asphyxia. When chloroform vapour largely diluted with air is long continued, it may cause, not real asphyxia, but a mode of death resembling it, owing to the medulla oblongata and nerves of respiration becoming over narcotised. ”

“ They may die rapidly with symptoms of asphyxia if they are forced to move until completely exhausted. In others, after a rest of several hours, the breathing becomes slower, the anxiety less and normal conditions return.
In sheep the same general signs may be seen: panting respiration, cyanosed mucous membranes and extreme anxiety, while death follows rapidly in the same way, with symptoms of asphyxia.
The diagnosis is extremely easy. The prognosis is grave.
Treatment consists in prompt and free bleeding to prevent pulmonary congestion. The animals should be rested in a shady, sheltered spot. ”

“ Pressure on the trachea—thus arresting respiration—and also on the important vessels and nerves of the neck, results in death, which may be brought about in four different ways:
1. Cerebral congestion, or apoplexy. 2. Congestion of the lungs and heart—apnœa or asphyxia. 3. Combination of above—apoplexy and asphyxia or apnœa. 4. Neuro-paralysis—nervous apoplexy, or syncope.
The following table will show the relative frequency of each form of death:
Traumatic asphyxia occurs when a heavy weight such as a fall of earth or masonry compresses the chest, and thoracic respiration is impossible. ”

“ In examining the fatal cases reported by different authors, Foucart, Dieulafoy, Mercier, Lerebenthel, and Gagnet, we find other modes of death in addition to those by oedema of the lung, such as asphyxia and pulmonary emboli, and, as connected with the heart, syncope and cardiac thrombosis. In most of the cases these accidents resulted indirectly from the operation in twenty-four hours or a longer time. In a case reported by Guyot it occurred three days afterward. Congestion by itself may cause sudden and rapid death by determining asphyxia. ”

“ Symptoms.—Inhalation of the pure gas causes spasm of the glottis, insensibility, and death from asphyxia, at once; diluted, causes sense of weight in forehead and back of head, giddiness, vomiting, somnolence, loss of muscular power. Insensibility, stertorous breathing, lividity of face and body, and death from asphyxia. Convulsions occasionally.
Post-Mortem Appearances.—Face swollen and livid, or calm and pale; lividity is most marked in eyelids, lips, ears, etc.; limbs usually flaccid, abdomen distended; right side of heart, lungs, and large veins, gorged with dark-coloured blood. ”

“ When a man dies by asphyxia, it means that the action of the muscles by which he breathes is stopped, or the work of his lungs prevented by injury, or the free passage of air arrested, as in drowning, or strangulation. It may also mean that embolism has taken place, and the pulmonary artery is blocked, withholding blood from the lungs. ”

“ While death from asphyxia as ordinarily brought about by the short drop is a barbarism which should not be tolerated in this humanitarian age, yet it might be accomplished without much suffering. If this mode of death be determined upon, then the constriction should be complete, and the compression of the blood-vessels, both veins and arteries, and if possible also the nerves, is of even more importance in the production of rapid unconsciousness than the occlusion of the windpipe. ”

“ What consumptives want is pure air, not physic, plenty of meat and plenty of bread.—DR. MARSHALL HALL.]
6. Asphyxia (as-fix'-i-a) .—When a person is drowned, strangled, or choked in any way, what is called asphyxia occurs. The face turns black; the veins become turgid; insensibility and often convulsions ensue. If relief is not secured within a few minutes, death will be inevitable. [Footnote: The lack of oxygen, and the presence of carbonic-acid gas, are the combined causes. Oxygen starvation and carbonic-acid poisoning, each fatal in itself, work together to destroy life.] ”

“ There are few parts, where the influx of the black blood is more visible, than in the skin; the livid spots so frequent in asphyxia, are only the effect of the obstacles which it meets with, in its passage towards the general capillary system, to the organic contractility of which it is not a sufficient excitant. ”

“ In addition to the changes in the internal organs, identical with those present in persons who have died from suffocation or hanging, water is found in the lungs or stomach.
Death may be due to—
(a) Apoplexy. (b) Asphyxia. (c) A combination of the two. (d) Neuro-paralysis.
Death from pure apoplexy is rare; and it may be affirmed that death from syncope never occurs in the drowned without leaving some signs of asphyxia.
It is more difficult to restore the drowned than those dying from mere stoppage of air from entering the lungs. ”

“ Convulsions arise from almost any cause—from worms in children, affections of the brain in adults, hysteria, and in some persons the taking of chloroform. Adults are sometimes attacked by such convulsions. Affections of the spinal cord or eating indigestible food will produce them. I know no instance in which convulsions have arisen from retching and vomiting. I agree with Dr. Copland that these convulsions sometimes end immediately in death. The immediate proximate cause of death is frequently asphyxia.
By Lord Campbell: Death from a spasm of the heart is often described as death by asphyxia. ”

“ In cases of death by asphyxia, in which the hæmoglobin is in combination with CO2, the blood, if removed and examined immediately after death, gives a spectrum of reduced hæmoglobin, but on exposure to the air it rapidly changes to oxyhæmoglobin. The period after death at which blood is usually submitted for medico-legal examination is sufficiently late to allow of this change, and so prevents the possibility of determining death by asphyxia by spectroscopic examination of the blood. ”

“ As to the tissues affected, they, however, appear to me to present the anatomical characteristics of the consequences of local inflammation.
“But when the application of very adhesive substances upon the whole of the body quickly suppresses the cutaneous exhalation, and consequently prevents the action of the air upon the skin, death takes place much more speedily, and appears to be the result of true asphyxia. The breathing of the animals experimented upon, is difficult; they take deep inspirations, in order to inhale a larger quantity of air than usual ”

“ In subjects dying of asphyxia the lungs and right heart are congested, and the blood may be black, only loosely coagulable and with free hæmoglobin. There is congestion of the intestinal as of the respiratory mucosa, and also of the liver, spleen and kidneys. The congested bladder usually contains urine contrary to what is the case in rabies. ”

“ Now, as long as the first period of asphyxia continues, I have observed that, by the transfusion of red blood into the brain, from the heart of another animal, the movement of the creature which is dying will be restored by degrees, and the cerebral functions resume in part their activity ”

“ In fact, it is estimated by Taylor, in his "Medical Jurisprudence," that of all drowned persons twenty-five per cent, die of pure asphyxia, and in the remainder the asphyxia is complicated by syncope and apoplexy. The chances are, then, three out of four, that a person who falls into the water and drowns will die a painless death, because he becomes insensible on the instant. ”

“ In impending asphyxia the dashing of cold water over the face and chest, and the use of artificial respiration, should be tried, and even tracheotomy or laryngotomy if practicable. In all cases every effort should be made to discover any causes likely to produce nervous irritation, such as teething, intestinal worms, &c., and to deal with these by appropriate remedies. ”

“ In the last moments of existence of whatever death the individual may have died, we shall always observe the lungs become embarrassed and cease to perform their office, for some time previous to the total suspension of the functions of the heart. The blood makes its circle through the system, after ceasing to receive the influence of the air, and consequently in its venous state; accordingly it must remain so in the organ in every case, although [266] the circulation be much less evident, than in asphyxia, for it is in this circumstance that consists, the great peculiarity of asphyxia. ”

“ Coutagne [803] thinks œdema of the lungs, “œdema carminé,” has an important part in causing death.
The following conditions tend to produce asphyxia: a tight ligature, or a loose ligature above the hyoid bone. To produce coma, a loose ligature pressing against the hyoid bone or larynx, especially a cretified larynx. To both asphyxia and congestion of brain, a ligature just beneath the lower jaw, or around lower part of neck. ”

“ In my different experiments with regard to asphyxia, I have remarked, that if after shutting the cock of the syringe, the animal agitate the chest by similar movements to those of inspiration and expiration, the blood is a longer time in losing its red colour, than in the case where the breast remains at rest. Such motion and agitation must cause a circulation of air in the cells, in consequence of which, a greater number of its points must be presented to the circulating fluid. ”

“ In fermentation the oxygen may be completely consumed.
The abdominal organs, particularly the intestine, are congested, as a result of impediment to the venous circulation. The thoracic organs exhibit the lesions of asphyxia.
Pathogeny. Death is due to carbonic acid poisoning, brought about in two different ways—viz., progressive asphyxia, caused by inability to inflate the lungs, and absorption of carbonic acid gas from the rumen; by virtue of the laws of diffusion, part of the gas contained in the rumen passes into the blood. ”