MEDICO LEGAL ASPECT OF SUFFOCATION

1. By:
Pragati
Msc part 1

2.  Suffocation is caused
by deprivation of
oxygen either due to
lack of oxygen in
environment or from
obstruction of air
passages. In general
it indicates asphyxia.

3.  It happens usually when a person is either
weak on unconcious due to drug or in sleep
and his/her mouth and nose is pressed with
a cloth or a pillow.

4.  It is impossible to commit a suicide through
suffocation. But it is possible by burying the
face again the bed clothing, mostly seen in
mental patients. Sometimes cut throat
wounds can also lead to the obstruction due
to soft part choking the throat. It can also be
done by covering face by plastic bag.

5.  It is the most common suffocation. At times
infants gets suffocated with the weight of bed
cloths or due to the weight on their mother’s
hand while sleeping.
 A child may get suffocated while playing with
bags.
 A person might fall in mud and get
suffocated.

6. smothering
gagging
choking
Traumatic
suffocation
overlying
burking
Due to irrespirable
gases

7.  Smothering refers to
death resulting from
mechanical occlusion
of the mouth and nose
that prevents breathing.
 The smothering agent
is usually a fabric, an
impervious sheet or a
hand, though occasionally
a mobile solid such as sand,
mud, grain or flour may be
responsible for blocking the
air-passages.

8.  There are scratch abrasions, finger nail
marks, laceration of soft parts of victim’s
face.
 There may be bruising and laceration of lips,
gums and tongue.
 Face is pale and white.

9.  Suicidal smothering can occur in mental patients or
prisoners.
 Suicide is practicable merely by burying the face in
a flock mattress or even it would appear by lying
against the bed clothing to obstruct the nose and
mouth, especially when drunk.
 The death by cutthroat may occasionally terminate
by smothering.
 The circumstances of accidental smothering vary
according to the age of the victim. The bedclothes
covering the nostrils and mouth of the infant infants
during first month of life especially premature.

10.  Homicidal smothering of an adult by
smothering is possible when there is a gross
disparity between the assailant and the
victim or else when the victim is helpless by
virtue of his age, ill health or incapacity from
drink or drugs or when stunned by a blow.
 It is a common mode of infanticide.
 Usually the assailant uses far more force
than is necessary to kill and consequently
finger-marks in the form of scratches and
bruises are found over the victim’s face.

11.  Mechanical obstruction of oral cavity is termed as gagging.
It is usually resorted to prevent the victim from shouting for
help & death is usually not intended.
 At times, it may be homicidal, particularly when victims
are infants or in individuals incapacitated by alcohol or
drugs, old, infirms. initially the gag only blocks the mouth
and permits air entry through nostrils. Later the gag
becomes progressively soaked with saliva &/or mucus,
becomes impervious and gets sucked in with inspiratory
gasps. Finally it obstructs the nasopharynx leading to
complete obstruction of airways & may cause unforeseen
death.
 The sequence of physiological events is bradycardia,
decrease in respiration, eventual cessation of respiration,
slowing and finally flattening of EEG.

12.  In case of gagging,
gag should be
examined for saliva,
mucous and blood.
 Sometimes Sudden
death due to
vegal inhibition also
occurs.
 Sruggle marks
can also be seen in various cases.

13.  It is seen most commonly when an infant is
put to bed with one or more adults. During
the night, one of the adult inadvertently rolls
on to or otherwise crushes and asphyxiates
the infant by compressing the chest thus
preventing respiratory movement and
occluding the nose and mouth with bedding
or the body of the adult. Later on the adult
rolls off the child. The next morning the child
is found dead without any evidence of
trauma.

14.  Presence of petechial haemorrhages
beneath the conjunctiva, epicardium and
pleura.
 Evidence of contact flattening of face and
nose may or may not be there. This is
suggestive of infant being laid on the face at
the time of or after death.
 Blood tinged froth from mouth and nostrils
that may stain the bed clothing.
 Absence of injury marks over the body.

15.  Burking is a form of
traumatic asphyxia plus
smothering that is
homicidal in nature.
 It was named after
criminals named Burke
and Hare during 1820s.
 External sign of
suffocation is absent
in this case.

16.  It is a form of asphyxia
caused by an obstruction
within the air passage.
It is almost always
accidental and is
usually due to inhalation
of a foreign body, but it
can be caused by the
inhalation of the products
of disease or by anatomical
changes due to disease.
The usual mechanism of
asphyxia in choking is simple
mechanical obstruction.

17.  One of the commonest causes of choking is the
entry of food into the air passages. If food enters
the larynx during swallowing, it usually causes
gross choking symptoms of coughing, distress and
cyanosis, which can be fatal unless the obstruction
is cleared by coughing or some rapid treatment is
offered. However, if the piece of food is large
enough to occlude the larynx completely, it will
prevent not only breathing but also speech and
coughing. The individual may die silently and
quickly, the cause of death remaining hidden until
the autopsy. This is the so-called café coronary

18.  Inhalation of foreign body into the glottis such as bolus of meat,
potato, button, coins, marbles, corns, fish, screws, pins or
artificial dentures.
 Inhalation of vomited material in an unconscious, when
intoxicated, during anaesthesia or epileptic fits.
 Belching out of milk by infants and young children may be
aspirated into the air passages.
 Inhalation of products of disease or violence such as blood or
pus while haemoptysis in Tuberculosis, rupture of an aortic
aneurysm in air passages, or due to flooding of air passages
with pus and necrotic debris in a lung abscess.
 Anatomical changes due to disease such as a bronchial growth,
laryngeal oedema and tumours, pharyngeal abscess,
angioneurotic oedema.
 In conditions such as poliomyelitis or bulbar palsy, accidental
inhalation of food occurs due to disturbance in swallowing
mechanism.

19.  Presence of impacted foreign body in the air
passages.
 Regurgitated food particles such as vomitus,
milk etc may be found mixed with mucus in
trachea, bronchi and lower bronchioles.
 All organs are congested.

20.  Asphyxia caused due to mechanical fixation
of the chest so that normal movements of
chest wall are prevented.
 This occurs when a large weight falls onto or
presses down on an individual’s chest or
upper abdomen.
 The most common form of traumatic
asphyxia encountered is while repairing a
car the jack slips and the vehicles falls on
top of the individual.

22.  Black blue discoloration of the skin of head, neck and
upper trunk
 numerous petechiae , conjunctiva and retinal
haemorrhages
 intense cyanosis of deep purple or purple-red colour
cyanosis above the level of compression usually to the
level of third rib.
 Haemorrhage is seen in the tissues around the site of
compression whereas below the level of compression, skin
is pale and mild cyanosis may be seen.
 Areas of pallor are seen at the level of collar of the shirt,
folds or creases of garments.
 Internally, there is often no evidence of trauma in spite of
the heavy weight on the chest. In addition, fracture of ribs
may be present.

23.  Deaths from suffocating gases are not due to the
toxic nature of the gases, but rather to
displacement of oxygen from the atmosphere.
Carbon dioxide and methane are two most
commonly encountered suffocating gases. Both are
essentially nontoxic and odorless and are found in
sewers and mines.
 The cause of death can be determined from the
circumstantial evidences as there are no specific
autopsy findings. If death is prolonged, the
individuals appear cyanotic with petechial
haemorrhages of the epicardium and visceral
pleura.

24.  Cyanosis
 Lips, gums and tongue is swollen
 Petechial haemorrge in internal organs
 Blood stained froath can be seen in nostrils.
 Swollen face.
 Oedma in organs.
 Right side of the heart becomes congested
in various cases of burking and traumatic
asphyxia.

25.  Simpson's Forensic Medicine 13th ed. - J.
Payne-James, et. al., (Hodder-Arnold, 2011)
BBS.
 Textbook of Forensic Medicine and
Toxicology, Fifth Edition - Krishan Vij.
 Forensic-Medicine; Dikshit
 Google images

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