cidal act, yet one case of suicidal throttling has been recorded by Binner. A woman, aged forty, suffering from melancholia, who had previously made several attempts upon her life, was found dead in bed, in a crouched position, with both hands compressing the throat; the elbows were supported on the knees, and the back was leaning against the wall; there were marks of her finger nails on both sides of the throat, and death had resulted from compression of the throat by the fingers.

SUFFOCATION

Suffocation is that form of death from asphyxia in which air is prevented from entering the lungs, not by constriction of the larynx or trachea, nor by submersion in water, but by some mechanical cause, which may operate in one of the three following ways: (i) externally, by blocking the mouth and nostrils; (ii) internally, by blocking the throat, larynx, or trachea; and (iii) mechanical pressure on the thorax, such as occurs in great crowds of people.

Suffocation, therefore, differs from the other modes of death. from asphyxia, in that it may be caused by diseased or morbid conditions apart from external agency. An adult person, if deprived of air by covering the mouth and nostrils, generally dies in from four to five minutes. Experiments made on dogs by suffocating them show that in their case the average duration of the respiratory movements, after the animal has been completely deprived of air, is four minutes and five seconds; the average duration of the heart's action is seven minutes and eleven seconds.

Various modes of death by suffocation.-I. Smothering, by covering the mouth and nostrils with some soft material or with the hand, or by compressing the mouth and nose so as to exclude air.

II. The accidental or forcible introduction of foreign bodies into the mouth and throat.

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III. The plunging of the face into such substances as dust, snow, mud, feathers, leaves, &c.; this form of death is actually a combination of the two former modes of death by suffocation.

IV. Closure of the opening between the vocal cords from oedema or spasm of the glottis, or from accumulation of the products of exudation (as may occur in connection with membranous croup and diphtheria).

V. Obstruction of the trachea either with blood from a wound in the throat or from the bursting of an aneurism, or with pus from the bursting of a pharyngeal abscess.

VI. Obstruction of the lower portion of the trachea in a case of cut-throat, owing to retraction of the lower end and covering by the soft parts.

VII. Mechanical pressure on the thorax, such as from a person kneeling on the chest, or by the application of weights to the chest, or by pressure such as may occur in great crowds of people.

Smothering. This is a very common mode of destroying new-born children; it is easily accomplished, no characteristic signs are left, and death, in such cases, is frequently attributed to convulsions. Smothering is the most frequent cause of violent death among infants, and overlaying is the commonest way in which such infants meet with death. Overlaying is caused by some part of the person of the parent, or other individual sleeping in the same bed as the infant, covering the mouth and nostrils of the child so as to produce suffocation. An infant may also be easily suffocated by the bed-clothes accidentally covering the mouth and nostrils. Many cases of overlaying, no doubt occur from the mother being in an intoxicated condition, when she is less likely to be aware of her dangerous proximity to the child, and when the infant may probably have been previously stupefied with alcohol conveyed to it in the mother's milk. In some cases it is to be feared that the temptation of burial-club money is responsible for violent death by smothering. It is possible for an adult to be accidentally smothered in bed; a man was found dead in bed,

lying with his face downwards and one arm under his head. The medical evidence showed that the cause of death was suffocation, by reason of the deceased having turned with his face to the pillow, and so covered his mouth and nostrils.

Amongst other causes of accidental smothering may be mentioned mere continued pressure of the child's face against the mother's breast in the act of suckling, and the seizure of epileptics with fits when in bed, the face becoming buried in the bed-clothes or bedding. Homicidal suffocation by smothering is, as a rule, only resorted to in the cases of infants and young children, and occasionally in old and infirm adults. Suicidal smothering is almost unknown.

The accidental introduction of foreign bodies into the mouth and throat leading to suffocation occasionally occurs from the attempt to swallow too large a bolus or mass of food, or during the act of vomiting from a sudden inspiratory effort drawing some of the vomit into the larynx or air-tubes. In some cases of death from either of these causes, the fatal event may occur with great rapidity, especially if the individual be advanced in years; in such sudden cases, there may be no signs whatever of death from asphyxia revealed at the post-mortem examination, death probably having been due to syncope.

Suicidal suffocation from the forcible introduction of foreign bodies into the mouth and throat is practically limited to the insane. In one instance, a young woman committed suicide by thrusting a ball of hay into the pharynx behind the larynx, it being just visible when the mouth was widely opened. In another case, a woman was found suffocated in bed with part of a stocking protruding from her mouth; the portion within the mouth and pharynx was removed with great difficulty. Sankey1 describes the case of a male epileptic who committed suicide in an asylum, and was found dead, lying on his back in bed with a round pebble in each nostril, and a strip of flannel rolled up and stuffed into the throat.

Brit. Med. Jour., 1883.

Homicidal suffocation from the forcible introduction of foreign bodies into the mouth and throat is seldom met with, except in infants and young children. In the case of children various substances such as pieces of cloth, pieces of paper, sand, earth, and artificial teats - have been found in the mouth and pharynx. The following case is peculiar. In 1889 a man was convicted of the murder of a woman (Reg. v. Kerr, Carlisle Sum. Ass., 1889). It appeared that the woman died whilst, or shortly after, a rape was committed on her by the prisoner, accompanied by brutal violence. The actual cause of death was suffocation brought about by the vomiting of a hearty meal. A case reported by Littlejohn illustrates the necessity of care in distinguishing homicidal from accidental suffocation. While examining the body of a woman who was stated to have died suddenly, he found a quart-bottle cork firmly fixed in the upper part of the larynx. The sealed end of the cork was uppermost, and it had the marks of a corkscrew on it. Fractures of the ribs were found, and it was evident that the deceased had not died a natural death; the epiglottis, trachea, and larynx were considerably injected. It was suggested, at the trial, that the deceased, while extracting the cork from the bottle with her teeth, had, by the sudden impetus of the liquid issuing from the bottle, drawn it into the position in which it was found. This view was negatived by the fact that the sealed end of the cork was uppermost, and also by the marks of the corkscrew. The medical opinion was that the cork had been forcibly pushed into the larynx, while the woman was in a helpless state of intoxication. Although there was no reason for doubting that this was a deliberate act of murder, yet the person on whom the strongest suspicion fell was acquitted on the Scotch verdict of 'Not proven.'

Taylor and Stevenson point out a dangerous practice common among ignorant nurses, which, without exciting suspicion on the part of a coroner or medical witness, may be an occasional cause of death in infants. In order to quiet a child, and to enable a nurse to sleep without disturbance, a bag made of

wash-leather or rag, containing sugar, is thrust into the child's mouth. It is thus completely gagged, and the child soon becomes quiet, respiring chiefly through the nostrils. If these by any accident become obstructed, or if, by the act of inspiration, the bag should fall to the back of the throat, death from suffocation results, the infant being helpless. The suspension of breathing may be so gradual that the child may die without crying or without the occurrence of convulsions. The removal of the bag from the mouth, as no violence has been used, will remove every trace of the cause of death; and, in order to exculpate herself, the guilty person may ascribe death to 'fits.'

Post-mortem appearances of death from suffocation. There may or may not be any of the signs indicative of death from asphyxia (see p. 106), so that the absence of the so-called signs of death from asphyxia does not exclude the possibility of death having resulted from suffocation. The real cause of death may not be detected unless the air-passages from the mouth down. to the bronchi are systematically examined, a procedure which should always be observed at post-mortem examinations made for medico-legal purposes. External signs of general violence, such as bruises, scratches, &c., should be carefully looked for. Homicidal suffocation, however, may leave behind it no characteristic evidence. The sub-pleural ecchymoses, first mentioned by Tardieu, are of no diagnostic value, as they may occur in death from other forms of asphyxia, or from pathological states, and they are not, by any means, always present in cases of death from suffocation. If death has taken place quickly, there may be no congested condition of the lungs, nor any engorgement of the right side of the heart. Doubtless many cases of death from suffocation have been attributed to convulsions.

In 1883 a terrible catastrophe occurred in Sunderland by which about 200 children met with their death from suffocation by compression of the chest. A panic occurred in the gallery of a public hall which was occupied by some hundreds of children, who, in rushing downstairs, were arrested by a closed door. A block occurred at the bottom of the steps, and about