SUFFOCATION 165 1. Smothering or Closure of the Mouth and Nostrils.—Infants are often accidentally smothered by being overlaid by their mothers when they are drunk. This is more common among the lower classes of women in England. In India, such cases are rare, as infants are generally not allowed to sleep in the same bed with their mothers, but are placed in separate cradles; however, they are sometimes smothered by inexperienced girl mothers who press them too closely to the breast when suckling. A com- mon method of killing infants and children is to close the mouth and nos- trils by means of the hand, bed clothes, soft pillows or mud. Cases have been recorded of adults being accidentally smothered by plaster of Paris at the time of taking a cast or mould, or by falling face downwards into vomited matter, flour, cement, sand or mud, especially when drunk or during an epileptic fit. 2. Obstruction of the Air-passages from within.—This may be due to— (a) The presence of foreign bodies, such as a piece of meat, potato skin, fruit-stone, corn, button, coin, cork, rag, India-rubber teat, live fish, round-worm, loose artificial teeth, mud, cotton, leaves, etc. It is not necessary that a foreign body should be of such a size as to block the air-passages completely. Even a small object blocking the lumen partially may cause death by spasm. On the 26th September 1912, a Mahomedan girl, about 10 years old, was standing in a street in Agra with her infant sister, one year old, in her arms, when a boy playfully gave her a push from behind. The infant girl fell and died immediately. On post- mortem examination a split gram (chaneki dal) was found to be obstructing the lumen of the larynx. It appears that the infant girl had a parched gram in her mouth at the time of the fall, and it got into the larynx during the involuntary inspiratory movement. Dr. G. B. Sahay, Police Surgeon, Patna, described to me a similar case which occur- red to him on the 12th September 1939. A male child, one year old, was playing alone on a veranda, while his mother was busy with her work in the house. All of a sudden the child shrieked, became blue in the face and died in a few moments. The mother accused her neighbour of having practised witchcraft on the child, but post-martem examination showed that the upper part of the windpipe was found clogged by a whole parched gram with marks of teeth bite. On the 10th April 1929, a Hindu male, aged 60 to 65 years, died all of a sudden while trying to hire an ekka, for proceeding to his house. At the post-mortem examina- tion I found a carious tooth lying in the glottis and death was caused by suffocation due to spasm of the glottis brought on by the tooth lying there. Vomited matter may regurgitate into the larynx, and by inspiratory efforts may be aspirated into the smaller bronchi and may cause suffocation. This is especially common in acute alcoholism, and occasionally occurs during a fit of epilepsy or in a case of badly administered anaesthesia. It must be remembered that the contents of the stomach fall into the larynx and tra- chea after death owing to pressure of the gases of decomposition, but they cannot reach the smaller bronchi. (b) Diseases, such as tumours pressing on some portion of the air- passages, or a false membrane a%in diphtheria or cedema of the glottis, or effusion of blood from haemoptysis^ epistaxis and wounds of the throat, or pus from an abscess in the tonsils or caseating glands ulcerating into the trachea. A foreign body in the pharynx or oesophagus may cause obstruct tion pressing on the windpipe from behind. 3. Pressure on the Chest—This may occur accidentally through the chest being pressed violently in crowds at big fairs, or by being ixampfecl upon in the rush of such crowds. Pressure on the chest may also occur ia railway > inotor-car or other vehicular accidents or "by burial under the <&$** ris oŁ a falling wall or roof. Cases of compression of the chest homicidal!^ are also met with in India.