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Chapter: Forensic Medicine: Asphyxia

Causes of asphyxic death: Smothering

This is the result of occlusion of the external airways, namely the mouth and nose.

Smothering

This is the result of occlusion of the external airways, namely the mouth and nose. Examples include occlusion with a hand, impermeable material (a plastic bag) or even solid material (sand and grain). The individual can also lay face down on an impermeable surface, for instance when an intoxicated person is lying face down on a wet cushion covered by vomit. Note that cot death or SIDS is not caused by smothering.

Smothering can occur due to an accident, suicide or murder.

``Gagging'' refers to a situation where a piece of cloth is used to forcibly close the mouth. It is often associated with the introduction of a piece (ball or plug) of material into the mouth of the victim. This is common when intruders overpower a person and gag him in an effort to silence him. The mandible is often displaced backwards and fixed in that position so that the victim cannot swallow. The saliva will with time cause the material over the mouth and nose that was initially permeable, to become impermeable. At the same time ineffective swallowing movements may cause the material in the mouth to move backwards towards the throat. Ultimately the victim suffocates, and the initial crime of theft and assault becomes an (unforeseen) case of culpable homicide or murder.

The post-mortem examination often shows no signs of trauma or asphyxia. Local trauma or injuries to the lips, nose and mucosa of the mouth may sometimes be visible, especially when the airways were forcibly occluded. It is important to remember that babies and some old people have no teeth, and will therefore not necessarily have any mouth lesions. It is also important to remember that the inner aspects of the mouth must always be examined, as the delicate membrane connecting the lips with the gingiva on the midline, is often injured, even if the individual has no teeth. It is also important not to confuse hypostasis and peri-oral pallor in cases where the body is lying in the prone position.

``Asphyxic'' signs include petechiae of the face and conjunctiva, especially if there was a struggle.

 

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