Autoerotic asphyxia is the term used to describe those fatalities occurring during some form of soli- tary sexual activity. Many other terms have been used to describe deaths such as these including sexual asphyxia, sex hanging, asphyxiophilia, Kotzwarrism, autoasphyxiophilia and hypoxyphilia.
The recurrent feature tends to be the use of a device, appliance or restraint that causes neck compression, leading to cerebral hypoxia, with the aim of height- ening the sexual response. Such deaths, which usu- ally involve men, occur predominantly as a result of failure of safety devices.
The presence of the following features should be considered when ‘diagnosing’ autoerotic asphyxiation:
■ evidence of solo sexual activity;
■ private or secure location;
■ evidence of previous similar activity in the past;
■ no apparent suicidal intent;
■ unusual props including ligatures, clothing, and pornography;
■ failure of a device or set-up integral to the activ- ity causing death.
Death results from the application of pressure to the neck, and as with other ligature-related deaths, the presence of classic asphyxial signs is variable. The presence of gags or other means of occluding the airways may lead to a death more akin to upper airway occlusion than pressure to the neck, and the addition of an asphyxiant substance (such as nitrous oxide gas) within coverings over the head may lead to suffocation.
The presence of injuries suggestive of assault must be looked for carefully, and the possibility of third-party involvement must always be considered in such cases.
Figure 15.15 Suicidal plastic bag asphyxia. Suffocation by plastic bag often leaves no autopsy asphyxial signs, and removal of the bag by another individual prior to autopsy would cause signifi cant interpretation problems.
F urther information sourc es
■ Further information sources
Adelson LA. The Pathology of Homicide. A Vade Mecum for Pathologist, Prosecutor and Defense Counsel.
Springfield, IL: Charles C Thomas, 1974.
Adjutantis G, Coutselinis A, Dritsas C. Suicidal strangulation.
Forensic Science 1974; 3: 283–4.
Alexander S, Ping WC. Fatal ventricular fi brillation during carotid sinus stimulation. American Journal of Cardiology 1966;18: 289–91.
Bell MD, Rao VJ, Wetli CV, Rodriquez RN. Positional asphyxiation in adults. A series of 30 cases from the Dade and Broward County Florida Medical Examiner Offi ces from 1982 to 1990. American Journal of Forensic Medicine and Pathology 1992; 13: 101–7.
Boghossian E, Clement R, Redpath M, Sauvageau A.
Respiratory, circulatory, and neurological responses to hanging: a review of animal models. Journal of Forensic Sciences 2010; 55: 1272–7.
Busuttil A. Asphyxial deaths in children. Chapter 16. In:
Busuttil A, Keeling JW (eds) Paediatric Forensic Medicine and Pathology. London: Hodder Arnold, 2008; p. 329–35.
Byard RW. Autoerotic death. In: Payne-James JJ, Byard RW, Corey TS, Henderson C (eds) Encyclopaedia of Forensic and Legal Medicine. Volume 1. Oxford: Elsevier Science, 2005;
p. 157–65.
Byard RW, Bramwell NH. Autoerotic death. A defi nition.
American Journal of Forensic Medicine and Pathology 1991;12: 74–6.
Byard RW, Cohle SD. Accidents. In: Byard RW (ed.) Sudden Death in Infancy and Childhood and Adolescence, 2nd edn.
Cambridge: Cambridge University Press, 2004; p. 11–73.
Byard RW, Wilson GW. Death scene gas analysis in suspected methane asphyxia. American Journal of Forensic Medicine and Pathology 1992; 13: 69–71.
Byard RW, Gilbert JD, Klitte A, Felgate P. Gasoline exposure in motor vehicle accident fatalities. American Journal of Forensic Medicine and Pathology 2002; 23: 42–4.
Clement R, Redpath M, Sauvageau A. Mechanism of death in hanging: a historical review of the evolution of pathophysiological hypotheses. Journal of Forensic Sciences 2010; 55: 1268–71.
Cohen MV. Ventricular fi brillation precipitated by carotid sinus pressure: case report and review of the literature.
American Heart Journal 1972; 84: 681–6.
Daly MD, Angell-James JE, Elsner R. Role of carotid-body chemoreceptors and their refl ex interactions in bradycardia and cardiac arrest. Lancet 1979; 1: 764–7.
Di Maio DJ, Di Maio VJM. Forensic Pathology. Boca Raton, FL: CRC Press, 1993.
Duband S, Timoshenko AP, Morrison AL, Prades JM, Debout M, Peoc’h M. Ear bleeding: A sign not to be underestimated in cases of strangulation. American Journal of Forensic Medicine and Pathology 2009; 30:175–6.
Ely SF, Hirsch CS. Asphyxial deaths and petechiae: a review.
Journal of Forensic Sciences 2000; 45: 1274–7.
Gill JR, Ely SF, Hua Z. Environmental gas displacement: three accidental deaths in the work place. American Journal of Forensic Medicine and Pathology 2002; 23: 26–30.
Gilson T, Parks BO, Porterfi eld CM. Suicide with inert gases.
American Journal of Forensic Medicine and Pathology 2003;24: 306–8.
Greenwood RJ, Dupler DA. Death following carotid sinus pressure. Journal of the American Medical Association 1962;181: 605–9.
Härm T, Rajs J. Types of injuries and interrelated conditions of victims and assailants in attempted and homicidal strangulation.Forensic Science International 1981;
18: 101–3.
Hood I, Ryan D, Spitz WU. Resuscitation and petechiae.
American Journal of Forensic Medicine and Pathology 1988;9: 35–7.
Humble JG. The mechanism of petechial haemorrhage formation.Blood 1949; 4: 69–75.
Khokhlov VD. Pressure on the neck calculated for any point along the ligature. Forensic Science International 2001;
123: 178–81.
Lasczkowski G, Risse M, Gamerdinger U, Weiler G.
Pathogenesis of conjunctival petechiae. Forensic Science International 2005; 147: 25–9.
Maxeiner H, Brockholdt B. Homicidal and suicidal ligature strangulation – a comparison of the post-mortem fi ndings.
Forensic Science International 2003; 137: 60–6.
Plattner T, Bollinger S, Zollinger U. Forensic assessment of survived strangulation. Forensic Science International 2005;153: 202–7.
Pollanen MS. Subtle fatal manual neck compression.
Medicine, Science, and the Law 2001; 41: 135–40.
Prinsloo I, Gordon I. Post-mortem dissection artefacts of the neck; their differentiation from ante-mortem bruises. South African Medical Journal 1951; 25: 358–61.
Purdue BN. Asphyxial and related deaths, Chapter 15. In:
Mason BN, Purdue BN (eds) The Pathology of Trauma, 3rd edn. London: Arnold, 2000; p. 230–52.
Puschel K, Türk E, Lach H. Asphyxia-related deaths. Forensic Science International 2004; 144: 211–14.
Rao VJ, Wetli CV. The forensic signifi cance of conjunctival petechiae.American Journal of Forensic Medicine and Pathology 1988; 9: 32–4.
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American Journal of Forensic Medicine and Pathology 1982;3: 253–8.
Rossen R, Kabat H, Anderson JP. Acute arrest of cerebral circulation in man. Archives of Neurology and Psychiatry 1943;50: 510–28.
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Schmunk GA, Kaplan JA. Asphyxial deaths caused by automobile exhaust inhalation not attributable to carbon
1 5 Asph yxia
monoxide toxicity: study of 2 cases. American Journal of Forensic Medicine and Pathology 2002; 23: 123–6.
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Simpson K. Deaths from vagal inhibition. Lancet 1949;
1: 558–60.
Swann HG, Brucer M. The cardiorespiratory and biochemical events during rapid anoxic death; obstructive asphyxia.
Texas Reports on Biology and Medicine 1949; 7: 593–3.
Verma SK. Pediatric and adolescent strangulation deaths.
Journal of Forensic and Legal Medicine 2007; 14: 61–4.
Walker A, Milroy CM, Payne-James JJ. Asphyxia. In: Payne- James JJ, Byard RW, Corey TS, Henderson C (eds) Encylopedia of Forensic and Legal Medicine. Oxford:
Elsevier, 2005.
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21: 387–9.
Chapter Immersion and drowning
16
■ Introduction
The presence of a body in water does not necessar- ily indicate drowning. Most bodies found in water are there as a result of accident or suicide. However, certain clues when a body is recovered (e.g. liga- tures to hands and feet) may suggest a criminal act.
Drowning can occur in only a few inches of water, and when investigating a possible drowning death as much knowledge as possible of the circumstances and locus is needed to make a proper and accurate determination of the cause of death. Jumping or div- ing into water may result in limb or head injuries that render a person incapable of swimming. Bodies are frequently retrieved from water; this process in itself may require the expertise of marine recovery units as there may be considerable hazard in ensur- ing the body is returned to dry land. The process of recovery may hamper investigation and contaminate a potential crime scene.
The pathological investigation of deaths follow- ing the recovery of a body from water is difficult, given that a wide range of potential explanations
for death exist; some examples are given in Box 16.1.
The pathologist must attempt to address all of these potential explanations for death and determine if there is any pathological evidence capable of sup- porting a diagnosis of drowning. The death inves- tigation must also address other questions such as how did the individual get into the water and what prevented survival?
Box 16.1 Examples of reasons for death in a body recovered from water
● Died of natural causes before entering the water (e.g. a myocardial infarction)
● Died of natural causes while in the water, having entered the water either voluntarily or accidentally (e.g. micturating into a canal and losing balance)
● Died from exposure and hypothermia in the water (particularly in the thin, the young and the elderly)
● Died of injuries or other unnatural cause before entering the water (e.g. an assault)
● Died of injuries after entering the water (e.g. being hit by a boat or jet ski)
● Died from submersion, but not drowning
● Died from true drowning as a result of aspiration of water into the lungs
■ Introduction
■ Evidence of immersion
■ Post-mortem artefact and immersion
■ Pathological diagnosis of drowning
■ Alternative mechanisms of death in immersion
■ The role of alcohol in drowning
■ Other investigations in bodies recovered from water
■ Further information sources
1 6 Immers ion and dr owning
■ Evidence of immersion
A number of changes appear on the skin and body surface after a body has been in water for enough time. The changes described later appear at very vari- able times, as there are many factors that may influ- ence how these changes appear. Relevant factors that may influence the condition of a body include whether the water is salt or fresh, whether the water source is tidal or non-tidal, the presence of possible predators, water temperature, clothing worn on the body and type of surface at the base of the water.
Generally, if left in water for long enough, the skin of the hands and feet will become wrinkled and macerated. The fingertips become opaque and wrinkled (‘washerwoman’s fingers’; Figure 16.1) within a few hours of immersion in cold water (and a shorter time in warm water). As immersion time increases, macerated skin begins to separate, lead- ing to skin peeling and ‘degloving’ of the skin of the hands and feet (Figure 16.2). Loss of pigment lay- ers may be apparent, causing colour change in skin, which can sometimes mislead as to the ethnic origin of the deceased.
Estimating the post-mortem interval from signs of immersion, and decomposition, in a body recovered from water is completely unreliable and entirely temperature dependent. Once again there is an oft- quoted (but not evidence-based) ‘rule of thumb’ rec- ognizing that decomposition in water in temperate climates occurs at roughly half the rate of a body left in air.
Bloating of the body (face, abdomen and geni- tals) owing to gas formation in soft tissues and body cavities is often evident after approximately
a few days’ immersion in temperate conditions, after which skin and hair loosening leads to their detachment. However, the skin and hair can remain in situ for weeks at a time.
Gaseous decomposition and bloating often causes the body to ‘float to the surface’ of the water in which it is submerged, leading to its discovery. If the body has a lot of fat it may sink for only a short period, even in the absence of bloating.
■ Post-mortem artefact and immersion
Bodies moved by the flow of water may come into contact with sand/silt, rocks, piers and other under- water obstructions, all of which can injure the skin and deeper structures (Figure 16.3) Contact of a body with propeller blades classically leads to deep
‘chop’ wounds and/ or lacerations. Post-mortem injuries produced in such circumstances must be differentiated from ante-mortem injuries suggestive of assault.
Other artefactual injuries characterized by immer- sion include damage to the body by marine life (for example, fish, crustaceans, molluscs and larger animals; Figure 16.4) and as the post-mortem interval increases, fragments/limbs may become detached and lost.
Figure 16.1 ‘Washer woman’s hands’. Waterlogged skin after 1 week of immersion in a cold climate.
Figure 16.2 Peeling of the epidermis from the foot (degloving) following a few weeks of immersion.