Chapter XXXVIII: Section 6: ,216, same as 303, N. Y. P. C (19)

68. _Ibid., p._ 130.—The Daugats affair. Man found hanging, sitting on the ground, head and trunk somewhat inclined to the left; legs stretched out; clothing not disordered; the part of the cord which was around the neck was applied to the neck of the waistcoat and shirt; on his head a woollen cap. The ground had been recently swept. Necroscopy twenty-four hours afterward. Face pale; right eye open and prominent, left closed; mouth closed, contained food apparently from the stomach; tongue retracted; slight mark on neck under which the tissue was normal: atlas dislocated on axis, but tissues around were normal; no lesion in spinal canal; penis not erect; moisture having the odor of urine on the shirt; large ecchymosis and infiltration of left cheek; extensive contusions on scrotum, with hemorrhagic infiltration, especially around right testicle. Veins of head engorged with black fluid blood. Brain normal. Some black fluid blood in right cavities of heart, left side empty. Lungs black. Other organs normal. Causse and Orfila concluded that the man had been suffocated and then hung. The wife and son confessed that they had injured the testicle through the pantaloons; he then fainted; they then suffocated him with the woollen cap placed over the mouth and nose; the son kneeled on the man’s belly, the body was then hung up and the head violently twisted.

69. _Passauer: Viert. f. ger. Med. und öff. San., 1876, xxiv., pp. 26-49._—Woman found hanging in a kneeling position. The ligature on the neck was loose. The necroscopy showed the following: Tongue between the teeth; eyelids swollen and livid; livid spots on face and left ear; lower lip torn; a number of marks on neck; one red stripe not sharply limited; skin not parchmenty and no ecchymosis; ecchymoses of scalp; periosteum of skull reddened; hemorrhage in temporal muscle; brain and pia mater congested; much fluid in ventricle. Larynx and trachea dirty red-brown; right side of heart empty; a little dark fluid blood in left; great vessels, including aorta, containing much dark fluid blood. Lungs congested and œdematous. Liver, spleen, and kidneys congested. Opinion given that she died of asphyxia and was either choked or hanged. Reference to Royal College of Medicine, Königsberg, where the opinion was given that she died of injuries on head and neck and was afterward hanged.

70. _Becker: Same journal, 1877, xxvii., pp. 463-473._—Woman, age 52; found hanging. Death caused by shock and incipient asphyxia from strangulation and probably the wounds on head and limbs.

71. _Maschka: “Samm. gericht. Gutacht.,” etc. (Prag), Leipzig, 1873_, published a number of interesting cases, in each of which there was a question raised as to the cause of death.

72. _Ibid., p. 127._—Man found dead. Had he been strangled or hung, or had he died some other way? Opinion, death from paralysis of the brain.

73. _Ibid., p. 133._—Woman, age 42; found hanging; a mark around her neck. Did she hang herself or die of other injuries? Opinion, died of other injuries.

74. _Rehm: Friedreich’s Blätt., 1883, xxxiv., pp. 322-362._—Man, age 73; found hanging. Opinion, while weak, sick, and suffering from wounds inflicted by his own son, he was hanged by his daughter-in-law.

75. _Hofmann: “Lehrbuch,” p. 538._—A father hung his five children, the eldest 9 years. Another man hung two children, the eldest 13 years.

See also Tidy, “Med. Juris.,” Cases 40, 48, 51, 57(?), 58(?); “Hanging after Death,” Case 50.

JUDICIAL HANGING.

76. _MacLaren: Indian Med. Gaz., 1873, viii., p. 234._—Three cases of judicial hanging; hung at the same time and cut down and necroscopy begun forty minutes afterward; drop twelve inches. In the first and third there were reflex movements for a few minutes after drop fell. _First man_, age 40; pupils slightly dilated; no protrusion of tongue or eyeballs; mark of cord above thyroid cartilage; no discharge of semen or fæces; ecchymosis under cord, left side; dislocation of atlas from axis; odontoid ligaments ruptured; transverse ligament uninjured. Brain and membranes much congested; clear fluid in lateral ventricles. Lungs collapsed, anæmic; one ounce straw-colored serum (measured) in pericardium; dark fluid blood in both ventricles of heart; liver much congested.

77. _Second man_, age 16; pupils widely dilated; eyeballs protruding. Marks of cord same as in preceding case. No discharge of fæces or semen. No ecchymosis under cord; dislocation and rupture of ligaments between axis and third vertebra. Brain did not show well-marked congestion. Lungs collapsed and anæmic. One and one-quarter ounces serum (measured) in pericardium. Heart normal; dark blood in both ventricles; liver normal.

78. _Third man_, age 20; pupils slightly dilated; eyeballs and tongue not protruded. Marks of cord as in preceding. No discharge of fæces or semen. Slight ecchymosis under cord; mark in front of neck. Dislocation of occipital bone from atlas. Brain and membranes much congested. Lungs collapsed and anæmic. Half ounce serum in pericardium. Heart normal; dark fluid blood in both ventricles; liver normal.

79. _Cayley: Ibid., p. 122._—Man, age 35; executed by hanging. Scarcely any convulsive movements after drop fell. Necroscopy two hours afterward. No congestion or protrusion or swelling of the tongue; no muscular rigidity or contractions. About half-way around the neck was indentation of cord, obliquely directed; hardly perceptible in front; its surface appeared rubbed and compressed; no discoloration; no ecchymosis under skin. Cord lay across upper part of thyroid cartilage. Larynx and trachea not injured. Fracture and dislocation of upper cervical vertebræ. Lungs collapsed, not congested. Pericardium empty; heart distended, left side with red blood just beginning to clot; right side with fluid black blood. Liver and other abdominal organs much congested. No discharge of fæces or semen.

80. _Garden: Same journal, 1880, xv., p. 12._—Man, age 40, weight about one hundred and twenty pounds; drop two feet; was in a fainting condition, and had to be supported; was not probably fully conscious when platform fell. There were spasmodic retractions of arms and legs for about two minutes; forty seconds after the drop his _jungeas_ fell off; his penis was in strong erection, and the ejaculatory movements were seen. Necroscopy one and one-quarter hours after drop fell. Head and limbs cold; eyes open, natural; tongue not protruding; fingers clinched; superficial veins contained fluid black blood. Mark of cord extended from just below left mastoid process, where the knot was applied, across the thyro-hyoid membranes to a place on right side about two inches below ear. There was scarcely a trace of it behind. Skin dark and ecchymosed, but no ecchymosis of subcutaneous connective tissues. No discoloration nor fracture in neck. Subarachnoidal fluid in excess; puncta vasculosa unusually numerous. Under surface of epiglottis reddened and showed two small dark red ecchymoses; mucous membrane of larynx and trachea pale. Lungs showed venous congestion; no infarctions or small ecchymoses; right lung emphysematous; the left showed old firm adhesions throughout. Heart large, flabby, pale, a very little blood in each ventricle; subpericardial ecchymosis one-fourth inch square anteriorly, another larger one posteriorly; extensive pericardial adhesions. Liver and kidneys congested.

81. See two cases of judicial hanging by _Wilkie, same journal, 1881, xvi., p. 275_.

82. _Porter: Archiv. Laryngol., New York, 1880, i., p. 142._—Redemier hung. Drop five feet. Pulse beat rapidly a few minutes, then lessened in frequency and stopped beating in fifteen minutes. During this time there was violent spasm of muscles of thorax and upper limbs. Necroscopy, dark groove around neck crossing larynx just below _pomum Adami_. Brain congested. Lungs emphysematous. Cricoid cartilage fractured diagonally. Laryngeal mucous membrane showed ecchymosis and œdema. Vertebræ neither fractured nor dislocated.

83. _Another_ criminal hung at the same time had dislocation of cervical vertebræ.

84. _Fenwick: Canada Med. Jour., 1867, iii., p. 195._—Man executed; drop six feet; second cervical vertebra torn from attachment to third; medulla torn across; hyoid bone and tongue torn from thyroid cartilage; general congestion of viscera; lenses normal; eyes congested; clot between sclerotic and choroid coats left eye.

85. _Dyer: Trans. Amer. Ophthal. Soc., 1866, p. 13._—Man, age 24; weight one hundred and seventy-four and a half pounds; drop three feet; knot under left ear; for two minutes at intervals, slight motion of abdomen, like effort at respiration, and at same time knees drawn up a little. Death speedy and quiet. Cut down at end of thirty minutes. Necroscopy thirty-five minutes after drop. Body and head moist and warm; emission of semen; face livid; upper lid discolored; abrasion of skin under right ear; deep red mark around neck. Eyeballs not prominent; eyelids closed; corneæ dull; pupils a little dilated. _Both lenses fractured._ Brain normal; spinal cord normal. Heart empty.

86. _Dyer: Same Trans., 1869, pp. 72-75._—Man hung. One eye showed _fracture of lens_, the other lens showed fine lines. A second case showed dislocation of a cataractous lens. A third showed fissure of lens.

87. _Green: Same Trans., 1876, p. 354._—Man hung; drop seven or eight feet. Died quietly and without struggle. One-half to one hour after drop fell, eyes were examined. No lesion of capsule or lens.

88. _Keen: Amer. Jour. Med. Sci., 1870, lix., p. 417._—Two criminals hung; drop five feet. Hyoid bone fractured in one; no fracture of vertebræ in other.

89. _Clark: Boston Med. and Surg. Jour., 1858, lviii., p. 480._—Execution of Magee. Man, age 28; weight 130 pounds. Drop seven to eight feet. No struggle nor convulsion. Urine discharged at once. Seven minutes after drop fell, heart-beat one hundred; nine minutes, ninety-eight; twelve minutes, sixty and fainter; fourteen minutes, not audible; twenty-five minutes, body lowered. Face purple; pupils dilated; eyes and tongue did not protrude. Mark of cord just above thyroid cartilage, a deep oblique furrow except a small space under left ear; knot over mastoid process. Forty minutes, cord and strap removed; body, especially face, became paler. Necroscopy a little over an hour after drop fell. Body pale; skin mottled; small ecchymosis just above line of cord right side. Right sterno-mastoid muscle torn. Hyoid bone fractured; spine not injured. No seminal discharge. Ninety minutes, pulsation in right subclavian vein; heart-beat, eighty per minute; thorax opened, heart exposed; right auricle showed full and regular contractions and dilatations. The spinal cord was then divided. One hundred and twenty minutes, heart-beats forty per minute. These pulsations of right auricle continued at intervals for three and a half hours longer; readily excited by point of scalpel. Heart normal; left ventricle contracted; right ventricle not so; no coagulation. Brain normal; lungs collapsed; liver and spleen congested; mucous membrane of small intestine pinkish; other organs normal. In the discussion, Dr. Gay thought the absence of cerebral congestion was due to the circulation continuing in the left carotid.

90. _Hofmann: Wien. med. Woch., 1880, xxx., pp. 477-480._—Man, a criminal, hung; after hanging ten minutes, the body was cut down. Examination half-hour after drop fell. He was resuscitated and partly regained consciousness, but died three days afterward of œdema of lungs after repeated severe convulsions. He had tumors of the neck which probably interfered with the compression of the trachea. See also Allg. Wien. med. Zeit., 1880, xxv., p. 161, and Wien. med. Blät., 1880, i., pp. 423-430; translated in Ann. Mal. Oreill. and Larynx, Paris, 1880, vi., pp. 99-112.

91. _Kinkhead: Lancet_, and 701-703.—Cases of hanging. In one, the body of the third cervical vertebra was broken across and the two pieces separated; in another case dislocation of second and third cervical vertebræ.

92. _Nelson: Southern Clinic, 1885, viii., pp. 198-202._—Two colored men hung; drop five feet. In one there was atlo-axoid dislocation.

93. _Dercum: Phila. Med. Times, 1886-87, xvii., p. 368._—Description of the brain of a man executed by hanging.

94. _Kirtikar: Trans. M. and P. Soc., Bombay, 1885, vi., pp. 104-107._—Man, age 25, and woman, age 35. Both hanged. Drop nine feet. Knot tied over cricoid cartilage, a little to left side. In falling, the knots slipped to below the ear. There was fracture of the body of third cervical vertebra and rupture of ligaments. The cord was ruptured in each; in the woman in two places—once at the third cervical, the other at the dorso-lumbar junction.

95. _Lamb: Med. News, Philadelphia, 1882, xli., pp. 42-45._—Execution of Guiteau. Drop six feet; knot placed under left ear, but slipped to back of head. Yellowish furrow a few lines wide around the neck, directed downward and forward. Sterno-mastoid muscles torn transversely about midway of their length. Thyro-hyoid ligament ruptured; hyoid bone and thyroid cartilage widely separated. Large blood-vessels not injured. No fracture or dislocation of vertebræ.

96. _Thomson and Allen: Catalog. Surg. Sec. Army Med. Mus._; specimens 298 to 302.—Execution of Wirtz. Rope one-half inch diameter; drop five feet; knot under left ear. Several slight shrugs of shoulders, after which body was quiet; let down in fifteen minutes. No involuntary evacuation. Face pale, placid. Eyes partly open; pupils dilated; slight injection of conjunctivæ. Mouth open; tongue not protruding. Just above thyroid cartilage extending on right side from median line in front to spinous process was a dirty brown deep furrow with congested walls; on left side a line of discoloration due to direct action of rope. Soft parts above and below the line much swollen, particularly on right side. Larynx and hyoid bone unnaturally mobile. Right trapezius muscle torn; sterno-mastoid divided transversely, leaving an interval of two inches. Slight ecchymoses between muscle and larynx. Ecchymoses on _ligamentum nuchæ_. Hyoid bone, both greater cornua fractured and dislocated from body; lesions more marked on right side. Several small ecchymoses in vicinity. Larynx not injured. Brain normal. No bloody or frothy mucus in air-passages. Lungs not congested. One drachm of straw-colored serum in pericardium. Heart empty. Abdominal organs normal. Bladder somewhat distended with urine.

See also Tidy, “Med. Juris.,” Cases 1 to 4 and 60.

ACCIDENT.

97. _Harvey: Indian Med. Gaz., 1876, xi., p. 3._—Boy, age 1½ years; was swinging by two ropes attached to two posts; the ropes became twisted around his neck. Necroscopy showed mark of very small rope in front of neck from ear to ear; mucous membrane of larynx dark; lungs much congested.

98. _Hackel: Op. cit., p. 35._—Man, age 19, sitting on a load of wood, with the lines around his neck, fell and was hung by the lines.

99. _Biggs and Jenkins: New York Med. Jour., 1890, lii., p. 30._—Case 16; child, 6 months old, sitting on a high chair, fell between the chair guard and seat and was asphyxiated by compression of neck.

See also Tidy (_op. cit._), Cases 53 and 54.

SUFFOCATION.

The term suffocation is applied in a special sense to the act and condition of preventing access of air in other ways than by pressure on the neck, as by pressure on the chest, by obstruction at the mouth or nose, by obstruction in the air-passages or on them from neighboring organs, by irrespirable gases, etc.

This article will consider all of these except drowning and irrespirable gases, which are treated of elsewhere by other writers.

=Smothering= is generally understood to mean the act and effect of stopping the mouth and nose.

CAUSES.

=External Causes.=—OVERLAYING is a frequent cause of suffocation in infants, which in such cases have usually occupied the same bed with one or both parents. In some cases the parents have been drunk or otherwise unable to prevent the injury, and the infant may also be partly stupefied with the alcohol derived from its mother’s milk. Infants are also sometimes overlaid by domestic animals. Again, they have been suffocated by being pressed too closely to the mother’s breast, or by covering with bedclothes, shawls, etc. Noble[883] attributes some cases of asphyxia in the new-born to anæmia of the brain from pressure on the skull by forceps, etc., and recommends as treatment for this condition hanging the child head downward, so that the blood may gravitate to the brain (Cases 12 and 30).

Infants are sometimes smothered for mercenary purposes.

Persons have been suffocated by the pressure of a crowd. Pressure on the chest combined with forcible closure of the mouth and nose was the method of Burke and Williams, in the notorious _burking_ murders (Case 58). The close application of a hand, cloth, or plaster over nose and mouth is of itself sufficient to cause suffocation, especially in children and feeble persons. Pressure on the abdomen crowds up the diaphragm and interferes with breathing. It is very likely that no external mark will be found in cases of pressure on the chest and abdomen, but the lungs will be marbled and emphysematous.

Taking plaster casts of the face and neck without inserting tubes in the nostrils has caused death in some cases. Suffocation often follows the falling of walls, houses, banks of earth, piles of coal or corn or wheat. One may fall into and be imbedded in some mobile substance as coal, wheat, corn, quicksand, or nightsoil, and be suffocated. Infants have been destroyed[884] by burying them in manure, ashes, bran, etc. In these cases there is not only the entrance of the foreign body into the air-passages, but the pressure of the mass against the chest and abdomen.

=Internal Causes.=—The air-passages may be closed up by foreign bodies within them, or within adjoining organs, especially the œsophagus. A great variety of substances in one of these two ways has caused suffocation: mud, cotton, rags, corn, meat, beans, pepper, potato skins, the fang of a tooth, artificial teeth, buckles, shells, flint, buttons, screws, crusts of bread, bones, fruit, stones, heads of grass, coins, slate pencils, nuts, nut-shells, shot, penholders, worms, fish, etc. (see Cases 6 and 55). Taylor[885] states that there were eighty-one deaths in one year in England and Wales from food in the air-passages.

Should an inspiration occur in the act of vomiting, the vomitus may pass into the air-passages; a similar accident may occur in a person who attempts to swallow and speak at the same time. Infants have been suffocated by inspiring vomited milk. Fitz[886] states that food may pass from the digestive tube to the air-passages after death.

A case of suffocation in an infant by retraction of the base of the tongue is recorded. It has been stated that negroes have committed suicide by doubling back the tongue into the throat, or, as it is called, swallowing the tongue.[887] In giving anæsthetics, the subject being supine, and the head and neck somewhat flexed, the tongue, epiglottis, and soft palate may fall backward and suffocation may follow. Howard[888] states that pulling the tongue forward under such circumstances may reopen the pharynx, but will not lift the epiglottis. The thorax should be raised and head and neck extended backward. He believes that in giving anæsthetics the head should be lower than the shoulders. In order to avoid vomiting no food should be taken for some hours before the anæsthetic.

Cases are recorded of artificial teeth having fallen from the mouth into the air-passages during anæsthesia and sleep, and in epileptic and puerperal convulsions. It would appear advisable that these teeth should be worn only while eating (Case 13).

Hemorrhage from the lungs, from rupture of an aneurism or from injury of the mouth or throat, may make its way into the air-passages and cause suffocation. So also the bursting of an abscess of the tonsils or other part near the air-passages (Case 7).

Œdema of the glottis from scalding or other irritation of the fauces or glottis, or from disease of the kidneys; tumors pressing on some portion of the air-passages; rapid, profuse bronchial secretion in infants; acute double pleuritic effusion; cheesy glands ulcerating into trachea; simultaneous œdema of both lungs—all of these may cause suffocation (Cases 18 and 49). [For cases of enlarged thymus gland, see Hofmann, _op. cit._, pp. 587, 588.]

Paralysis of the muscles of swallowing, from diphtheria or other cause, predisposes to suffocation. Progressive asthenia in which the muscles are exhausted; injury of spinal cord or pneumogastrics; paralysis of muscles of respiration from the use of curare; the spasms of tetanus and strychnia poisoning; the entrance of air into the pleural cavities with collapse of the lungs—all tend to cause mechanical suffocation either by pressure or by paralysis (for deaths in epileptics, see Cases 1, 10, 11, 33, and 40).

It is not necessary that the air-passages should be _absolutely_ closed to cause suffocation.

The _cause of death_ is more likely to be pure asphyxia, because of the absence of the complicating pressure of the hand or ligature on the vessels and nerves of the neck, and of fracture of larynx or vertebræ.

=Symptoms.=—Foreign bodies[889] entering the trachea naturally fall toward the right bronchial tube instead of the left because of the size and position of the entrance of the right tube. If then but one tube is involved, the signs will usually be on the right side; whereas if the foreign body stop in the larynx or trachea, both sides will be affected. The latter condition is much more dangerous. The symptoms would be resonance over the lung with the respiratory murmur partly or wholly absent; less mobility; puerile breathing on the unaffected side. In either case there may at first be little disturbance, especially if the shape of the foreign body is such as not to greatly interfere with the access of air; otherwise there may be at once, and almost always will be after a time, more or less urgent dyspnœa. Diminution of the necessary oxygen may cause convulsions, apoplexy, and other brain symptoms. Acute emphysema of the portion of lung not obstructed may follow its forcible distention. The local effect of the foreign body is an irritation which causes spasm and cough. It may be carried upward by the expirations and downward again by each inspiration. Inflammation is likely to appear eventually and may involve the lung. If the obstruction is not complete there may follow periods of alternation of good and bad health, ending perhaps in recovery. The foreign body may be expelled after a greater or lesser interval. On the other hand death may result from secondary causes. In the absence of correct history the symptoms may lead to a wrong diagnosis and inappropriate treatment; as where a patient whose symptoms resulted from the presence of a piece of bone in the larynx, was treated for syphilis. A foreign body may be coughed up from the lung into the trachea and fall backward into the opposite lung.

Partial closure of the larynx, most likely caused by a flat or irregular substance, rather than globular, may cause gradual asphyxia with symptoms of apoplexy, making the diagnosis difficult.

When a foreign body remains a long time in the larynx, spasmodic cough and croupy breathing usually ensue, expectoration tinged with blood, hoarseness, or complete aphonia, pain, dyspnœa, possibly crepitation and dulness over the lungs. The case may end suddenly in death from closure of the glottis, or the foreign body may pass into the trachea and set up a new train of symptoms, or it may be expelled.

The frequency with which foreign bodies in the pharynx or œsophagus obstruct respiration, and the facility with which they may usually be removed, suggest a careful examination. Otherwise the patient may be treated indefinitely for supposed obstruction in the air-passages. Foreign bodies in the œsophagus have perforated into the trachea, and even the lungs, heart, and aorta.

In complete suffocation death will occur in from two to five minutes (see remarks under Strangulation). Death may also occur instantaneously.

The experiments of the Committee on Suspended Animation[890] showed that when the trachea of a dog was exposed, incised, and a tube tied in, the average time covered by the respiratory efforts after stopping up the tube with a cork was four minutes five seconds; the heart-beat stopping at seven minutes eleven seconds on the average. After four minutes ten seconds it seemed to be impossible for the dog, unaided, to recover. Faure[891] made the following experiment upon a large dog: He fixed a cork in the trachea. At first the dog was quiet; it then extended its neck, parted its jaws, and made efforts as if to vomit; then tried to walk, but its gait was uncertain; fell down and rose up. Its eyes became dull, and finally it fell down on its side, and became convulsed; then after several seconds stretched itself out. The thoracic movements were at first tumultuous, then became rapidly feeble; the heart beating very slowly. At the necroscopy the lungs filled the thorax, were full of thick dark blood and emphysematous. The blood was black and fluid in the left ventricle and arteries, and in the right cavities and veins resembled molasses. Liver darkly congested. There was no mucus in the trachea and no ecchymosis in the lungs. He also (p. 306) tried the experiment upon a large dog of fastening boards against its thorax and tightening them by means of cords. For some minutes it was quiet, but suddenly it became much agitated, stood upon its hind legs, threw itself against the wall, rolled on the ground, and uttered frightful cries; finally fell on its side. There was no movement of the thorax, but the muscles of the neck and belly were in full and rapid action, dry and sonorous râles were heard, and a large quantity of mucus appeared at the nose and mouth. The movements grew feebler, the respirations infrequent, and at the end of thirty-four minutes it was dead. The necroscopy showed the blood black and thick; heart relaxed; lungs red, a little emphysematous, containing but little blood, and on their surface were blackish points and small red spots.

The death of Desdemona (Shakespeare’s “Othello”) has been much criticised. The declaration that she was strangled (or suffocated) does not consist with the symptoms described (see _Med. News_, Philadelphia, May 1st, 1886, p. 489).

TREATMENT.

The obvious indication is to search for and remove the obstruction. The means and methods of treatment are fully treated of in surgical works, but may be briefly mentioned here.

Laryngoscopical examination may be necessary. A curved forceps is usually the best instrument for removing the foreign body. A tallow candle may serve to push it into the stomach if there is no bougie at hand. Suction may be used. Sneezing may be brought on by tickling the nostrils; coughing by tickling the glottis; vomiting by irritating the fauces, or by emetic; the body of the subject may be inverted and in this position the fauces may be tickled, or fingers may be passed back into the pharynx. Johnson[892] says that at the moment of inversion the patient should try to take a deep inspiration; this opens the glottis and facilitates the expulsion of the foreign body. The inspiratory current has no appreciable effect in retarding the movement of the foreign body in the direction of gravity.

Noble recommends inversion of the body in new-born infants in which asphyxia may be supposed to be due to anæmia of the brain. Tracheotomy or laryngotomy may be necessary. It may be necessary to administer oxygen. Foreign bodies like beards of grass and fish-heads can be withdrawn only with difficulty because of their sharp projections. Intense suffering and dyspnœa in a robust subject may necessitate venesection. Generally speaking it is better to bring up the foreign body than to push it down into the stomach. Beveridge suggests to blow into the ear, to induce a reflex action and cause expulsion of the foreign body. Cold affusions, artificial respiration, galvanism, frictions of the limbs, artificial heat, stimulants by mouth and rectum, may one or all be needed.

Hamilton[893] says that it is useless to expect good results from electricity if five minutes have elapsed since life appeared to be extinct; Althaus,[894] that three hours after death the muscles will cease to respond to faradization; and Richardson,[895] that a low temperature prolongs the sensitiveness of the muscle.

With regard to insufflation, Le Bon[896] objects to it in asphyxia as being hurtful and not useful. Colin[897] tamponed the trachea of a horse; in four minutes fifty seconds it was apparently dead; the tampon was removed and insufflation practised for fifteen to twenty minutes without effect. He claims that artificial respiration is useless after the circulation ceases.

Fell[898] and O’Dwyer[899] recommend forced inspiration. McEwen[900] uses a tracheal tube by the mouth.

Dew[901] offers a new method of artificial respiration in asphyxia of the new-born; Lusk[902] considers the subject of life-saving in still-births; Forest,[903] artificial respiration in the same; Read[904] discusses Schultze’s method with approval; Duke[905] plunges the infant into hot water; Richardson[906] recommends artificial circulation by injection of vessels, or electric excitation; Jennings[907] recommends the same; Richardson[908] also considers fully the subject of artificial respiration and electrical excitation; Woillez[909] has described and recommended what he calls a spirophore.

After the removal of a foreign body the irritation remaining may cause a sensation as if the body was still lodged.

Death may occur from hemorrhage after its removal.

POST-MORTEM APPEARANCES.

These are mainly those of asphyxia. There may also be evidences of external violence, homicidal or accidental, as of pressure on the chest. Persistent deformity, flattening of the nose and lips, and excoriation of these parts may result from forcible closure of mouth and nose.

The SKIN AND CONJUNCTIVA usually show patches of lividity and punctiform ecchymoses; especially lividity on the lips and limbs. The face may be pale or violet; it is often placid, especially if the suffocation is accidental. Tardieu[910] admits that infiltration of the conjunctiva and punctiform ecchymoses of the face, neck, and chest may also be found sometimes in women after severe labor, and in epileptics. He records the result of the examination of those who died from suffocation at the Pont de la Concorde, 1866. The face and upper parts of the trunk were generally light red to a deep violet or black color, with punctated blackish ecchymoses on the face, neck, and upper part of chest.

The EYES are usually congested. Mucus and sometimes bloody froth are found about the NOSE and MOUTH. The TONGUE may or may not protrude.

The BLOOD is usually dark and very fluid. Wounds after death may bleed. According to Tardieu[911] fluidity of the blood is most constant in compression of the chest and abdomen, as also its accumulation in the vessels and right side of heart. Its color varies from red to black.

The BRAIN and pia mater are generally congested. This is said to be invariable if the eyes are congested. Mackenzie in thirteen cases found the brain congested in all.

The HEART varies much in appearance and condition. The right side is often full of blood; occasionally empty. Sometimes subpericardial ecchymoses are found, usually along the coronary vessels. The blood in the heart may be partly coagulated if the agony has been prolonged and there has been a partial access of air, which is gradually diminished. Mackenzie[912] found the right cavities full and the left empty in nine out of thirteen cases. Johnson[913] as a result of experiment on animals claims that when access of air is prevented there is a rise in pressure in the arteries, the right side of the heart fills, the pulmonary capillaries become empty, and therefore the left side of the heart becomes empty. As a result of further experiments[914] he verified his former conclusion, and added that in the last stage of asphyxia there is increased pressure on the pulmonary artery and lessened pressure in the systemic vessels. He thinks[915] that when both sides of the heart contain blood, there is paralysis of vaso-motor nerves and the arteries.

The TRACHEA is usually bright red and often contains bloody froth. The LARYNX or trachea as well as PHARYNX or ŒSOPHAGUS may contain a foreign body. If the latter has been removed the resulting irritation may be seen. The LUNGS are sometimes congested, at others normal; color red or pale. Sometimes one lung only is affected. They may be emphysematous. Mackenzie found them congested in all of thirteen cases examined by him. The lungs of young persons may be found comparatively small, almost bloodless, and emphysematous. Tardieu, Albi, and others believed that the _punctiform subpleural ecchymoses_ indicated suffocation, and were due to small hemorrhages from engorged vessels which ruptured in the efforts at expiration. These spots are usually round, dark, from the size of a pin-head to a small lentil, and well defined. They are not like the petechiæ in the lungs and heart after purpura, cholera, eruptive fevers, etc., nor like the hemorrhages under the scalp after tedious labor, all of which are variable in size. These punctiform spots are usually seen at the root, base, and lower margin of the lungs. Hofmann states (“Lehrbuch”) that they are found in the posterior part of the lungs and in the fissures between the lobes. They are indisputably frequent after death from suffocation, and if well marked either in adults or infants that have breathed, they indicate suffocation, unless some other cause of death is clear. Simon, Ogston, and Tidy, however, have shown that they are sometimes absent in fatal suffocation, and are sometimes present in the absence of suffocation, as after hanging and drowning; in fœtuses before labor has begun; often in still-births, although some of these are probably due to suffocation from inhaling fluid or from pressure. Also in death from scarlet fever, heart disease, apoplexy, pneumonia, and pulmonary œdema. Grosclaude[916] quotes from Pinard, who declares that these ecchymoses are found in fœtuses which die from arrest of circulation. Grosclaude himself made a large number of experiments on animals by drowning, hanging, and strangling, and fracturing the skull. The ecchymoses were found in nearly all the cases.

The ecchymoses are partly the result of venous stasis, which overcomes the resistance of some capillaries; and the latter rupture, partly from the aspirating action of the thoracic wall, the lung being unable to fill itself with air, but mainly[917] from vaso-motor contraction and lateral pressure at the maximum of the asphyxia, the time of tetanic expiration. If the asphyxia is interrupted before this stage, the spots do not appear. Similar ecchymoses may be found under the scalp, in the tympanum, retina, nose, epiglottis, larynx, trachea, thymus, pericardium, in the parietal pleura, along the intercostal vessels, rarely the peritoneum, in the stomach, and sometimes the intestines; and in other parts of the body, especially the face, base of neck, and front of chest; in convulsive affections, as eclampsia and epilepsy, and in the convulsions of strychnia and prussic acid poisoning there may be suffusion and congestion of the lungs though not the punctated spots.

Mackenzie, in thirteen cases of suffocation from various causes, failed to find the Tardieu spots either externally or internally. Briand and Chaudé[918] state that they are less constant and characteristic in those who have been buried in pulverulent substances.

Ogston[919] holds that in infants that are smothered the ecchymoses are found in greater number in the thymus gland; while in adults dying from other forms of asphyxia they were found only once in that gland. The spots are found in clusters in infants that are smothered, but only single and scattered in adults who die from drowning, hanging or disease. They were wanting in the lungs of but one infant.

They may be recognized as long as the lung tissue is unchanged. The apoplectic spots in the lungs seen in strangulation are not found in suffocation.

Tardieu[920] from experiments on animals and examination of twenty-three new-born infants who showed traces of violence around the mouth, found the lungs rather pale and anæmic, subpleural ecchymoses well marked. All the deaths were rapid. In cases of compression of chest and abdomen[921] the congestion of the lungs was extensive, and pulmonary apoplexy frequent; more so than in other forms of suffocation. He gave strychnia to animals which died in convulsions, and found very irregular and partial congestions, generally not marked because death was so prompt; blood always fluid; no subpleural ecchymoses.

The LIVER, SPLEEN, and KIDNEYS are generally congested; the kidney more than the other organs named. The spleen is said to be often anæmic. Semen has sometimes been found, unexpelled, in the urethra.

Page[922] experimented on three kittens, suffocating them in cinders. The post-mortem examinations showed the veins engorged, left side of heart empty, right side full of dark, half-clotted blood. Lungs distended, much congested, color violet; many small fluid hemorrhages in substance; no subpleural ecchymoses. Frothy mucus tinged with blood in trachea and bronchi; bronchi congested. Brain and abdominal organs normal.

PROOF OF DEATH BY SUFFOCATION.

It is sometimes difficult in a given case to state WHETHER DEATH IS DUE TO SUFFOCATION. There is no lesion which of itself could be accepted as proof. But a collation of the lesions found taken in connection with the surroundings of the body will in many if not in most cases lead to a definite conclusion.

Infants have been found alive four and five hours after having been buried in the earth.[923] If the pulverulent material has penetrated into the œsophagus and stomach, the burial has occurred during life. Exceptionally when burial has occurred after death and traces of the material are found in the air-passages, they are _not_ found in the œsophagus or stomach.

The committee on “Suffocation,” of the New York Med. Leg. Soc., reported[924] the following group of appearances as evidences of death by suffocation: The general venous character of the blood, the turgidity of the larger veins, the congestion of the parenchymatous organs, especially at the base of the brain, the lungs congested in a variable degree and œdematous, frothy mucus in the bronchi, the right side of the heart always fuller than the left. Fitz[925] holds that suffocation is a condition composed of a group of symptoms and appearances due most probably to accumulation of carbon dioxide in the blood and a deficiency of oxygen. The appearances are: The blood dark and fluid (though in gradual suffocation there may be clots in the right side of the heart), the right side of the heart full, venous congestion of the lungs (not constant), interstitial emphysema of the lungs, and venous congestion of the liver, kidneys, and brain. He prefers the word _engorgement_ to congestion in this connection.

Tardieu[926] holds that when in infants buried in pulverulent substances we find emphysema of the lungs in high degree, bloody froth in the air-passages, abundant subpleural and subpericardial ecchymoses and the blood fluid, the burial has occurred during life. The same lesions are found in small animals similarly treated.

It must not be forgotten that an intoxicated person or one in an epileptic spasm is practically helpless, and can, therefore, be suffocated, accidentally or otherwise, under circumstances in which one in possession of his senses would be able to escape.

ACCIDENTAL, HOMICIDAL, AND SUICIDAL SUFFOCATION.

=Accidental suffocation= is frequent, as has already appeared. =Suicidal suffocation= is very rare. =Homicidal suffocation= occurs. Foreign bodies have been forced into the air-passages. Smothering has been done by holding the face in various materials to prevent access of air; by pressure on the chest; by forcible closure of the mouth and nose as in burking; by laying compresses over the face, as in the case of King Benhadad,[927] whom Hazael killed. “And it came to pass on the morrow that he took a thick cloth and dipped it in water, and spread it over his face so that he died; and Hazael reigned in his stead.” Benhadad was already quite ill and not expected to live.

Death by suffocation[928] may be considered as presumptive of homicide unless the facts are already referable to accident.

In infants, suffocation is, of course, either accidental or homicidal; in adults usually accidental. The absence of signs of a struggle in adults suggests accident; unless there is cause of suspicion of previous stupefying with narcotics.

Taylor[929] calls attention to a dangerous practice among some attendants upon infants, of putting into the mouth of the child to quiet it a bag containing sugar; and instances a case in which the child would have died of suffocation but for the fortunate discovery of a part of the bag protruding from the mouth.

In ten years, 3,612 deaths were reported in the city of London, of infants smothered by being overlaid.[930]

Infants may be born into a mass of blood and fæces, from which the unattended mother in her weakness may be unable to remove them.

Page[931] shows by experiment that the inspiratory effort when violently exerted is sufficient to convey small objects into the air-passages. Cinders passed thus into the trachea and œsophagus of kittens and rabbits. Berenguier[932] experimented on new-born pups, placing them in ashes, plaster, and starch. In ashes they lived fifteen hours; these found their way into the middle of the œsophagus, but were stopped at the glottis. Plaster and starch formed a paste with the oral mucus and the movement of the mass was not so great as the ashes. In no case did either of the materials pass beyond the glottis. Tardieu[933] examined three infants which had been buried during life. One was in ashes: the nose was obstructed, mouth full: ashes also in the œsophagus and stomach, but none in larynx or bronchi. The second infant was in manure; a greenish stuff was found in the mouth and stomach. The third in bran (confessed to by the mother); the nose and mouth were full, but there was none in the throat; a few grains in the trachea. Tardieu experimented on rabbits and Guinea pigs by burying them in bran, sand, and gravel, some of them being alive and the others dead. In those buried alive he found the substance filling the mouth and nose to the base of the tongue; in most of the cases the œsophagus and trachea were not penetrated. In the animals first killed and then buried, the substance had not passed into the mouth or nose. In one case only he found ashes in the larynx and trachea of a rabbit which had been buried many hours after death in a box of ashes. Matthyssen[934] held a Guinea pig, head downward, with its nose under mercury; the lungs were full of globules of mercury (which has a specific gravity of 13.5). A dog was plunged head first into liquid plaster-of-Paris; the plaster was found in the bronchial tubes.

ILLUSTRATIVE CASES.

ACCIDENTAL.

1. _Huppert: Vier. ger. Med. und öff. San., 1876, xxiv., pp. 237-252._—Two cases. A man choked by piece of bread in pharynx. Second, an epileptic, suffocated by _flexion of chin on larynx_. In both cases seminal fluid was found in urethra near meatus, unexpelled; determined by microscope.

2. _Johnson: Lancet, 1878, ii., p. 501._—Boy swallowed penny, became black in face; eyeballs protruded; symptoms soon subsided. Some hours afterward it was found that he could not swallow solids, and liquids only with difficulty and coughing. Throat much irritated; discharge of mucus sometimes tinged with blood, from mouth; moist rattling noise in throat in respiration; frequent cough; could not sleep. Laryngoscope showed penny in upper part of œsophagus, just below laryngeal opening. Removed by long curved forceps.

3. _Ibid._—Man suddenly fell while at dinner; face blue; breathing stertorous. Died. Piece of tendon found under epiglottis.

4. _Ibid._—Boy, age 5 years. Button in larynx. Aphonia, dyspnœa, stridulous breathing. Distress gradually subsided. Many years afterward found mucous membrane of larynx thickened; vocal cords red and uneven.

5. _Ibid._—Man, drunk, swallowed a half-sovereign. Urgent dyspnœa; pain in throat; aphonia; stridulous breathing; dysphagia; cough; copious mucous expectoration. Laryngoscopic examination showed coin in œsophagus. The crico-thyroid membrane was incised and coin pushed upward and ejected.

6. _Med. Times and Gaz., 1874, i., p. 486._—Man, age 20, had severe dyspnœa. In taking a living fish in his teeth (it was about four inches long and had large dorsal fin), the fish passed into the pharynx and lay doubled up. Impossible to remove it because of spines. Tracheotomy at once. Twenty-four hours afterward the fish had decomposed enough to be partly removed. Patient died of exhaustion.

7. _Littlejohn: Edin. Med. Jour., 1875, xx., p. 780._—Woman found dead in bed. Suffocated by pus from abscess of tonsil which burst during sleep. Found pus in air-passages down to smallest bronchi; lungs congested; right side of heart distended with dark fluid blood; left side contracted and nearly empty. Blood everywhere fluid. Some lividity of face. The woman had died quietly lying beside her husband, who was not awakened.

8. _Sayre: New York Med. Jour., 1874, xix., p. 420._—Girl, age 7, swallowed a bead. Had continuous cough; much pain under middle of sternum. The bead moved upward and downward in respiration. Tracheotomy. Four days afterward she coughed the bead out, inspired once, and apparently died. Artificial respiration used; alcohol injected into rectum; galvanization of phrenic nerves. She finally coughed up a piece of thick mucus and recovered.

9. _Duffy: Trans. Med. Soc. No. Car., 1874, p. 126._—Boy, age 8, swallowed a cow-pea. It lodged in the trachea. Some months afterward, laryngotomy performed. The boy seemed to die at once. Artificial respiration used. After a while he expelled first some mucus, then the pea. Recovered.

10. _Tardieu: Op. cit., p. 290._—Man, age 50, found dead on the floor. At base of neck and front of chest were many punctated ecchymoses. Brain and lungs much congested; the latter showed subpleural spots. Tongue and lips bitten. Death was due to cerebral and pulmonary congestion from an epileptic seizure.

11. _Oesterlen: Vier. f. ger. Med. und öff. San., 1876, xxiv., p. 10._—Woman, age 30, epileptic. Found dead. Examination showed signs of asphyxia; blood-vessels engorged, marked œdema of lungs, etc. Opinion given that she died in epileptic paroxysm, and certain injuries observed were caused by a fall.

12. _Tardieu: Op. cit., p. 322._—Two children, one 2 months old, the other 18 months old; in bed together. The older overlay the younger, which died. Necroscopy: lungs voluminous, in places congested, in others pale; abundant subpleural ecchymoses; quite emphysematous. Fluid blood in heart.

13. _Blum: New York Med. Jour., 1885, xlii., p. 207._—Woman, found dead. Vulcanite plate of usual size, with four teeth attached, found wedged in trachea about two inches below larynx.

14. _Wyeth: Same journal, 1884, xl., p. 487._—Boy, age 12, inspired a pin-dart in trying to blow it through a blowgun. Violent cough, gasping for breath, lividity of face for a few minutes; symptoms subsided leaving slight cough. The dart had lodged in right bronchus beyond first bifurcation, as shown by hissing, fluttering sound in both inspiration and expiration. Tracheotomy. The dart could not be reached. At a later date the dart was brought up into the mouth by a strong expiration.

15. _Partridge: Same journal, 1890, li., p. 303._—Child, 4 months old, found dead; fluid, partly digested milk in air-passages.

16-41. _Biggs and Jenkins: Same journal, 1890, lii., p. 30._—Report of many cases of fatal suffocation from foreign bodies, etc. Boy, age 15—collar-button in larynx. Boy, age 10—mass of butter in larynx. Boy, age 5—bronchial gland discharged into trachea at bifurcation. Boy, age 3—screw in larynx. Boy, age 5—rubber balloon with whistle attached; it was partly inflated with each expiration. Girl, age 10—a “jack” in larynx. Man, age 45—had been drinking freely; piece of meat in larynx. Man, age 40—piece of meat in larynx and pharynx. Man, age 40—ditto. Insane patient—piece of meat in trachea. Man—piece of meat in larynx. Man, age 40—crackers and cheese in larynx. Child—rubber nipple in larynx. During administration of ether, patient vomited; vomitus entered larynx. Two children in bed asleep; one, 3 years old, overlay the face of the younger, age 5 months. Woman, age 25, epileptic—fell on a child and smothered it. Two children found dead, covered with bedclothing. Man, age 21, epileptic—found lying on his face in bed. Girl, age 12, epileptic—ditto. Woman, age 21—ditto. Girl, age 18—ditto. Woman, age 35, epileptic—fell on the floor. Woman, age 28—ditto. Man, age 35, epileptic; vomited while in spasm; vomitus entered larynx. _From Dr Janeway_: Man, epileptic, fell on his face in pile of manure, which entered larynx. Man, drunk, lying on his face.

42. _Roy. Indian Med. Gaz., 1880, xv., p. 71._—Man, believed to be drunk, had vomited in bed; vomitus entered trachea and bronchi.

43-47. _Mackenzie: Same journal, 1890, xxv., p. 257._—Reports fatal cases: Boy—bone button in larynx. Sailor—meat in larynx. Boy—vomited matter in larynx. Infant—while taking the breast, a rush of milk suddenly filled the air-passages. Also three cases of crushing under walls; two buried in loose earth; two crushed in a crowd; one by bags of grain.

48. _Feulard: Bull. Soc. Anat., 1883, viii., pp. 384-386._—Woman, age 79. Piece of beef in larynx. Necroscopy showed hematoma in dura mater.

49. _Poupon: Bull. Soc. Clin., Paris (1882), 1883, vi., pp. 236-238._—Boy, age 5½ years. Death from cheesy gland in trachea.

50. _Pons: Jour. Méd., Bordeaux, 1889-1890, xix., pp. 57-61._—Woman, age 24. Death from œdema of larynx from presence of particles of food.

51. _Kemény: Wien. med. Blat., 1890, xiii., p. 37._—Man, age 45. Suffocated by curdled milk in air-passages.

52. _Maschka: Vier. ger. Med., 1885, xliii., pp. 11-14._—Man, age 65. Accidental compression of chest.

53. _Heidenhain: Same journal, 1886, xliv., pp. 96-101._—Vomited matter passed into air-passages while subject was drunk.

54. _Langstein: Wien. med. Woch., 1880, xxx., pp. 624-626._—Child found dead in bed; had vomited food while asleep and breathed it into air-passages.

55. _Ward: Catalog. Army Med. Mus., Med. Sec., p. 33._—Soldier, age 17; choked to death by lumbricoid worm passing from pharynx into right bronchus. Specimen 7,737.

SUICIDE.

56. _Sankey: Brit. Med. Jour., 1883, i., p. 88._—Epileptic; found dead in bed, lying on his back. A round pebble in each nostril; strip of flannel rolled up and stuffed in throat.

57. _Macleod: Ibid., 1882, ii., p. 1246._—Suicidal maniac. Had to be fed because he refused food. Was seen to be blue in the face and breathing hard. His mouth was forced open; roll of flannel found in throat. Macleod refers to another case, a woman in dissecting-room, with similar roll of flannel in throat.

See Tidy, “Med. Jur.,” Cases 15 to 17.

HOMICIDE.

58. _Christison: Edin. Med. Jour., 1829, xxxi., pp. 236-250._—The famous Burking case. A woman was struck down to a sitting posture. Burke then threw himself on her, kept her down by the weight of his body, covered her mouth and nose with one hand and placed his other hand under the chin for ten to fifteen minutes, till she died. Necroscopy showed a severing of the posterior ligamentous connections of the third and fourth cervical vertebræ, with blood in spinal canal but not under the dura mater; cord not injured. Christison made experiments to ascertain if the injury to spine had been made during life.

59. _Hackel: Dorpat Diss., 1891, p. 35._—Case of choking with pressure on breast and belly. Woman found lying on floor, with many injuries.

60. _Tardieu: Op. cit., p. 315._—New-born infant; found buried in earth. Mother stated that the child had not breathed. Putrefaction had begun. There was a brownish tint of skin of upper front part of neck below jaw; drops of sanious fluid flowing from nose; umbilical cord had not been tied; subcutaneous hemorrhage in right temporal region; brown bruised surface and contused wounds of pharynx, where particles like ashes and vomited matter were found. Lungs filled the pleural cavities, were rose-colored and showed abundant punctated subpleural ecchymoses; bloody, frothy mucus in trachea and bronchi; some serum in pericardium; respiration had been complete. Opinion given, that the infant had been suffocated by obstruction of pharynx, probably by fingers.

61. _Tardieu: Op. cit., p. 323._—New-born infant found under a cask, partly eaten by a dog. The head showed transverse flattening and subcutaneous hemorrhage. Lungs voluminous, rosy; abundant subpleural ecchymoses; hemorrhage in left lung. Heart filled with fluid blood. Coagulated blood in abdomen. Opinion given, suffocation by pressure on head, chest, and abdomen. The mother confessed that she had placed the child under the cask.

62. _Ibid., p. 325._—New-born infant found buried in the earth; gravel and earth in pharynx and œsophagus down nearly to stomach, and in trachea and right bronchus. Lungs congested, crepitant. Opinion given, that the child had been buried while living.

63. _Ibid., p. 326._—New-born infant found in ashes; nose and lips obstructed, mouth filled; ashes in œsophagus and stomach; none in larynx or trachea. Lungs distended with air, emphysematous; subpleural ecchymoses; fluid blood in heart.

64. _Ibid., p. 327._—New-born infant, buried in bran; nose and mouth filled; some in trachea; none in œsophagus or stomach. Lungs distended with air, emphysematous; subpleural ecchymoses; heart empty.

65. _Devergie and Raynaud: Ann. d’Hyg., 1852, xlviii., pp. 187-206._—Man found dead on a pile of grain; mouth, nose, and eyes contained some of the grain; some also in stomach, larynx, trachea, and bronchi. Some marks of injury on face and other parts of body. Internal signs of asphyxia. Opinion given, that the case was homicide. The defence offered was that the man had fallen into the grain.

66. _Rauscher: Friedreich’s Blat., 1886, xxxvii., pp. 324-330._—Woman, age 71, suffocated by a cloth over nose and mouth.

See Tidy, “Med. Jur.,” Cases 1 to 11.

DEATH FROM SUBMERSION

IN ITS

MEDICO-LEGAL RELATIONS.

BY

IRVING C. ROSSE, A.M., M.D., F.R.G.S. (ENG.),

_Professor of Nervous Diseases, Georgetown University; Membre du
Congrès International d’Anthropologie Criminelle, etc._

DEATH BY SUBMERSION OR DROWNING.

GENERAL CONSIDERATIONS.

THE frequence and importance of drowning having arrested attention from the days of Noah’s Ark and those of Hippocrates down to the present time, it is quite possible to array in chronological order the fictitious, transitory, and positive periods that mark the sequence of ideas touching the subject.