Asphyxiation

“ Craig paused a moment, but no one showed any evidence of being more than ordinarily impressed.
“This poison, I find, acts on the so-called endplates of the muscles and nerves. It produces complete paralysis, but not loss of consciousness, sensation, circulation, or respiration until the end approaches. It seems to be one of the most powerful sedatives I have ever heard of. When introduced in even a minute quantity it produces death finally by asphyxiation—by paralysing the muscles of respiration. This asphyxia is what so puzzled the coroner. ”

“ T71.141 Asphyxiation due to smothering under another person's body (in bed) , accidental Asphyxiation due to smothering under another person's body (in bed) NOS T71.143 Asphyxiation due to smothering under another person's body (in bed) , assault T71.144 Asphyxiation due to smothering under another person's body (in bed) , undetermined T71.15 Asphyxiation due to smothering in furniture T71. ”

“ The deprivation of air disposes to asphyxia; pressure on the great arteries by cutting off the supply of arterial blood to the brain disposes to anæmia of the brain and syncope; pressure on the great veins, by preventing the return of blood to the heart, to congestion of the brain and coma; pressure on the great nerves, the pneumogastrics, to syncope. Statistics of hanging show that in about seventy per cent of cases death is by a mixture of asphyxia and coma. While it is probable that the proportion is less in strangulation, yet it is also probable that a mixed result frequently occurs. ”

“ 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 some persons, particularly in heavy or aged ones, the sharp and sudden violence of the shock is sufficient to burst some blood-vessel, and the gush of blood into the brain-substance renders the criminal immediately unconscious. But apoplexy rarely kills suddenly; even such persons really die of asphyxia. In feeble persons, the simple concussion of the brain may be sufficient to bring on insensibility, like a stunning blow on the head, without any visible lesion of the organ ”

“ Distended lungs. (6) General signs of death by asphyxia.
It should be remembered that the fact of the hands being tied together, or to the feet, does not militate against suicide by drowning.
If wounds and other injuries be found on the body, the question arises as to whether the injuries were sufficient in themselves to cause death, and then as to whether they were caused during life. A person jumping from a height into the water may sustain severe injuries—dislocation of both arms, fracture of the skull and of the vertebræ, or even lacerated wounds of more or less severity. ”

“ Death from Asphyxia.—Among the forms of violent death due to this cause are drowning, hanging, strangulation, garotting, smothering, suffocation from choking, mechanical interference with the expansion of the chest walls, as when persons are crushed together during a panic in a fire, breathing poisonous gases, such as carbonic acid or carbonic oxide. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ Some men, however, with strong necks and coarse organizations, do not become unconscious from the shock of the fall, and suicides generally have no fall; so that, in such cases, death supervenes by asphyxia. But even here the process is not a simple one. It is complicated by a congestive apoplexy; i.e., such an overfilling of the blood-vessels of the brain as to produce unconsciousness by pressure on the brain-substance, but without the actual rupture of any artery. And in these cases, too, insensibility comes on so rapidly that death is really painless. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ Doctor examines body--finds no evidence of violence, except slight discoloured mark on one side of neck--opinion of inspector that something, chain probably, has been wrenched off by assassin--is also of opinion that death could not have been thus caused. Doctor says death is caused by blood-poisoning--evidence being, swollen condition of body, protruding tongue, discolouration of skin--thinks it must be poison--makes minute examination--finds on neck slight scratch just on jugular vein, greatly inflamed--is of opinion that assassin has wounded victim in neck with poisoned dagger or knife. ”

“ Both the respiration and the action of the heart became affected, while at short intervals sharp pangs shot through the chest, as if a bullet had passed through heart and lungs, causing me to stagger as if struck by a leaden missile. Then the pulsation of the heart would cease for a time that seemed an age, and then it would give six or seven leaps as if it would force its way through the chest. Then the lungs would refuse to act, and I stood gasping in vain for breath, as if the arm of a garotter were round my neck. Then the sharp pang would shoot through the chest, and so da capo. ”

“ In wounds of blood-vessels death may occur from the entrance of air into them. In some cases where this is supposed to have occurred it is quite probable that death was really due to hemorrhage. A considerable quantity of air may enter the circulation, especially the arterial circulation, without a fatal result. When death does occur it is owing (1) to “mechanical over-distention of the right ventricle of the heart and paralysis in the diastole,” or (2) to “asphyxia from obstruction to the pulmonary circulation consequent upon embolism of the pulmonary artery.” ”

“ 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.] ”

“ When an animated body or a part only of the body is immersed a sufficient time in water or any liquid medium whatever in such a way as to exclude fresh air from the respiratory orifices, suffocation follows, and death by submersion or drowning takes place.
The phenomena occurring in such instances are mostly those common to imperfect aeration or non-aeration of the blood, and for this reason the majority of medical writers describe asphyxia or apnœa, that is, death beginning at the lungs, as the determining cause of death by drowning. ”

“ It was formerly supposed that the escape of air by the wound was a sufficient proof that the lung had been opened by the projectile; but it is evident that it is not so, as the air may enter by the wound and be forced out again by the expansion of the lung in inspiration, or by the action of the chest on expiration. If air and frothy mucus with blood, as noticed in one of the cases recorded in the Crimean campaign, escape by the wound, there can be no doubt of the nature of the injury. Emphysema is not common in penetrating gunshot wounds, but occasionally [85] happens. ”

“ 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. ”

“ The symptoms once produced, the course is rapid, and consists, first, of acceleration of the respirations, and then a progressive slowing, soon followed by convulsions. The convulsions are probably produced by the interference with the respiration and the deficient oxidation of the blood, and are therefore, the so-called “carbonic acid convulsions.” There is paresis or paralysis of the limbs. Death seems to occur from asphyxia, and the heart beats for one or more minutes after the respirations have ceased. If the dose is so small as not to produce death, no after-effects have been observed ”

“ After a minute the muscles relax, and the patient sinks back exhausted, consciousness being preserved throughout. Any noise, a draught of air or a touch may cause a convulsion. If the case is about to terminate fatally the spasms rapidly succeed each other and death usually occurs within two hours, either from asphyxia produced by spasm of the respiratory muscles or more rarely from exhaustion. After death the position of the body may or may not be flexed; usually rigor mortis develops rapidly. ”

“ The condition of the heart and lungs is not constant; the general appearances resemble those in death from asphyxia.
Table giving the Diagnosis of Several
Forms of Insensibility
Injury to the Head—Concussion of the Brain.—The symptoms are very similar to those of shock, with unconsciousness, but it may be possible to rouse the person. The pupils are equal and dilated or contracted, and react sluggishly to light. The breathing is shallow and slow with sighing, the pulse feeble. The muscles are relaxed but not paralysed. ”