From Dental to Mental Institutions: An American Dentist and a British Psychiatrist Highlight Insanity Following Nitrous-Oxide Administration.

In 1887, American dentist Samuel J. Hayes published reports associating unoxygenated anesthetics with asphyxia and insanity, and then British psychiatrist George H. Savage published a report of cases of insanity following nitrous-oxide anesthesia in British journals.

The diving reflex and asphyxia: working across species in physiological ecology.

Beginning in the mid-1930s the comparative physiologists Laurence Irving and Per Fredrik (Pete) Scholander pioneered the study of diving mammals, particularly harbor seals. Although resting on earlier work dating back to the late nineteenth century, their research was distinctive in several ways. In contrast to medically oriented physiology, the approaches of Irving and Scholander were strongly influenced by natural history, zoology, ecology, and evolutionary biology. Diving mammals, they argued, shared the cardiopulmonary physiology of terrestrial mammals, but evolution had modified these basic adaptive processes in extreme ways. In particular, seals' remarkable ability to hold breath, lower metabolism, produce energy anaerobically, and resist asphyxiation, provided a sharp contrast with terrestrial mammals, including humans. This diving physiology was an extreme elaboration of a general regulatory mechanism that allowed seals and other diving mammals to remain active underwater for extended periods. The decrease in heart rate referred to as bradycardia or the "diving reflex" was highly developed in diving mammals, but also found in less developed form in many other organisms faced by asphyxia. It therefore served as a kind of "master switch" for lowering metabolism in diving, hibernation, parturition, drowning, and other physiological responses involving lack of oxygen. Studying bradycardia unified a wide diversity of physiological phenomena, while also providing a context for contrasting the physiological responses of various species, including humans. Conducted in the laboratory and the field, this research served as a bridge between a comparative physiological ecology focused on non-human species and a human-centered general physiology.

Histopathological Study of a Mummified Eye and Optic Nerve from a Strangled Peruvian Mummy.

We present the histopathological findings of a naturally mummified eye from the Peruvian Lambayeque culture (900-1,200 AD), in which rehydration, light microscopy, and scanning electron microscopy allowed a detailed analysis of several eye tissues including the eyelids, sclera, and optic nerve, the latter showing evidence of hemorrhage likely related to the documented strangulation as the cause of death. We conclude that histopathological analysis of rehydrated mummified tissues can provide valuable information from fragile eye structures including the optic nerve, and these findings can be useful from a forensic point of view.

[TO CURE THE APPARENTLY DEAD. NOSOLOGY AND MEDICAL RESUSCITATION IN ITALY(XVIII CENT.)]. / CURARE LA MORTE APPARENTE. NOSOLOGIA E TECNICHE DI RIANIMAZIONE NELL' ITALIA DEL SETTECENTO.

The first specific techniques and triages for medical resuscitation developed in the XVIII century, specifically to rescue the drowned persons. The topic of resuscitation in strictly connected to the theme of the apparent death, to the dread of the "buried alive", to the progress of forensic medicine and to the administrative and legislative policies. The contribute aims to focus on the contribution of the medical and pathologic nosology about the conception of the apparent death, read as asphyxia.

How was the Turin Shroud Man crucified?

As the literature is not exhaustive with reference to the way the Turin Shroud (TS) Man was crucified, and it is not easy to draw significant information from only a "photograph" of a man on a linen sheet, this study tries to add some detail on this issue based on both image processing of high resolution photos of the TS and on experimental tests on arms and legs of human cadavers. With regard to the TS Man hands, a first hypothesis states that the left hand of the TS Man was nailed twice at two different anatomical sites: the midcarpal joint medially to the pisiform between the lunate/pyramidal and capitate/uncinate bones (Destot's space) and the radiocarpal joint between the radio, lunate and scaphoid; also the right hand would have been nailed twice. A second hypothesis, preferred by the authors, states that the hands were nailed only once in the Destot's space with partial lesion of the ulnar nerve and flexion of the metacarpophalangeal joint of the thumbs. With regard to the TS Man feet, the imprint of the sole of the right foot leads to the conclusion that TS Man suffered a dislocation at the ankle just before the nailing. The entrance hole of the nail on the right foot is a few inches from the ankle, and excludes a double nailing. The nail has been driven between the tarsal bones. The TS Man suffered the following tortures during crucifixion: a very serious and widespread causalgia due to total paralysis of the upper right limb (paradoxical causalgia); a nailing of the left wrist with damage to the ulnar nerve; a similar nailing of the right wrist; and a nailing to both feet using one only nail that injured the plantaris medialis nerves. The respiratory limitation was probably not sufficient to cause death by asphyxiation. Also considering the hypovolemia produced by scourging and the many other tortures detectable on the TS, the principal cause of death can be attributed to a myocardial infarction.

Atypical suicides or the first undiagnosed autoerotic deaths in Europe?

Autoerotic accidental deaths (AAD) are increasingly reported deaths occurring during solitary sexual rituals used to enhance sexual excitement. The majority of these fatalities involve hanging or other form of self-inflicted asphyxia. The German medical literature, with the first recognized AAD published in the early 1900s, has antedated by decades the first significant AAD reports (1950-1953) in English. Early contributions in languages other than English and German are mostly overlooked in current AAD reviews, although AAD were recognised in some European countries as early as the 1940s and 1950s. For a variety of reasons, it is likely that, before the description of the first AAD in the medical literature, some asphyxia deaths have been classified as suicides with peculiar features, instead of as accidents resulting from life-threatening sexual practices. In the present study, we review and comment on three such atypical asphyxia deaths investigated in central Europe (Austria, Italy, Switzerland) during the period 1821 to 1927. The retrospective analysis of these cases revealed some circumstantial and individual features which nowadays could be linked to AAD, and disclosed the reluctance of medical examiners to analyse their motivational, and possibly sexual, background. The medico-legal approach to some autopsy findings of these cases also illustrates some controversial diagnostic issues regarding mechanical asphyxia, issues recurrently debated during the 19th century.

The crucifixion of Jesus: review of hypothesized mechanisms of death and implications of shock and trauma-induced coagulopathy.

The crucifixion of Jesus is arguably the most well-known and controversial execution in history. Christian faithful, dating back to the time of Jesus, have believed that Jesus was executed by crucifixion and later returned physically to life again. Others have questioned whether Jesus actually died by crucifixion, at all. From review of medical literature, physicians have failed to agree on a specific mechanism of Jesus' death. A search of Medline/Pubmed was completed with respect to crucifixion, related topics, and proposed mechanisms of Jesus' death. Several hypotheses for the mechanism of Jesus' death have been presented in medical literature, including 1) Pulmonary embolism 2) Cardiac rupture 3) Suspension trauma 4) Asphyxiation 5) Fatal stab wound, and 6) Shock. Each proposed mechanism of Jesus' death will be reviewed. The events of Jesus' execution are described, as they are pertinent to development of shock. Traumatic shock complicated by trauma-induced coagulopathy is proposed as a contributing factor, and possibly the primary mechanism, of Jesus' death by crucifixion.

Origin of the cannula for tracheotomy during the middle ages and Renaissance.

The purpose of this article was to trace the historical origin of the inserted cannula during tracheotomy. Tracheotomy is mentioned in most ancient medical texts, but the origin of cannula insertion into the windpipe is unclear. We reviewed the incunabula and Renaissance texts reporting the utilization of surgical cannulas and tracheotomy. The incunabula disclosed extended use of surgical cannulas during the middle ages and Renaissance. Although tracheotomy was advocated in acutely suffocating patients for a disease of the throat termed squinantia or angina, the first report of the procedure was found only at the end of the middle ages and a second during the middle Renaissance. The introduction of cannula use in tracheotomy was supported by a semantic misinterpretation by Antonio Musa Brasavola. The historical origin for tracheotomy in the middle ages and Renaissance is conflicting. Antonio Brasavola wrongly interpreted Avicenna's oral cannula introduced into the windpipe for angina. This misinterpretation allowed Giulio Casserio to draw the first curved cannula introduced for used during tracheotomy.

Hangman's fracture: a historical and biomechanical perspective.

The execution technique of hanging, introduced by the Angle, Saxon, and Jute Germanic tribes during their invasions of the Roman Empire and Britain in the 5th century, has remained largely unchanged over time. The earliest form of a gallows was a tree on which prisoners were hanged. Despite the introduction of several modifications such as a trap door, the main mechanism of death remained asphyxiation. This created the opportunity for attempted revival after the execution, and indeed several well-known cases of survival following judicial hanging have been reported. It was not until the introduction of the standard drop by Dr. Samuel Haughton in 1866, and the so-called long drop by William Marwood in 1872 that hanging became a standard, humane means to achieve instantaneous death. Hangmen, however, fearing knot slippage, started substituting the subaural knot for the traditional submental knot. Subaural knots were not as effective, and cases of decapitation were recorded. Standardization of the long drop was further propagated by John Berry, an executioner who used mathematical calculations to estimate the correct drop length for each individual to be hanged. A British committee on capital sentences, led by Lord Aberdare, studied the execution method, and advocated for the submental knot. However, it was not until Frederic Wood-Jones published his seminal work in 1913 that cervical fractures were identified as the main mechanism of death following hanging in which the long drop and a submental knot were used. Schneider introduced the term "hangman's fracture" in 1965, and reported on the biomechanics and other similarities of the cervical fractures seen following judicial hangings and those caused by motor vehicle accidents.

The socio-demographic profile of hanging suicides in Ireland from 1980 to 2005.

This paper provides a comparison of the socio-demographic profile of hanging suicides and suicides by other means in Ireland from January 1st 1980 to December 31st 2005. Data on 9674 suicides occurring in that time frame was provided by the Central Statistics Office of Ireland (CSO). 4031 (42%) of these deaths involved suicide by 'hanging, suffocation or strangulation' (HSS), with the remainder being suicides by other means. Binary logistic regressions were used to examine six potential risk factors for suicide across the two groups: Gender, marital status, employment in the agricultural sectors, residential location (urban/rural) and age were entered in Block 1 of the analysis, with year of death (pre 1994 vs. post 1994) added in a second block. Results indicate that those dying through hangings were statistically more likely to be male (OR=3.1, 95% CI=2.8-3.5), single (OR=1.3, 95% CI=1.2-1.4), rural-dwelling (OR=1.1, 95% CI=1.0-1.2), agri-employed (OR=1.3, 95% CI=1.1-1.4) and to have died since 1994 (OR=2.3, 95% CI=2.1-2.5). The magnitude of the group effect was moderate for all but the gender and time period comparisons. Hanging suicide victims (m=37.7, sd=16.7) were also significantly younger than other suicide victims (mean=42.72, sd=16.7), although the size of the effect was small (r=.16). Overall the six variables explained 6% of the variance in the criterion variable.

[Tardieu's spots and asphyxia--a literature study]. / Uber die Tardieu'schen Flecke--eine Literaturstudie.

Subpleural, epicardial and pericranial ecchymoses have been described in cases of suffocation since the 18th century. In the 19th century, great diagnostic importance was attributed to ecchymoses. Tardieu was the most determined defender of the specificity of ecchymoses for suffocations. He thought that he could diagnose violent suffocation by means of ecchymoses and claimed that he was able to differentiate violent suffocation from other unnatural causes of death (hanging, choking, strangulation, and drowning). Other physicians, among them numerous German medical examiners, proved Tardieu's opinions wrong by means of observations and animal studies. The most dedicated disputant against Tardieu's false doctrines was Liman. According to today's knowledge of pathophysiology, the haemorrhages concerned cannot have a specificity for suffocation or even a specific form of suffocation. Therefore, the confusing term of "suffocation haemorrages" should be avoided.

The crucifixion revisited.

This article is a follow up of an original article by the author on the crucifixion of Jesus published in the March 1989 issue of the JMSMA. The pathogenesis of the death of Jesus is still widely debated with vastly divergent views as to the specific cause of His death. The author's views have been challenged in the literature. As a result, he has done spirometry studies of volunteers hanging on a cross and has a better understanding of the physiology of the terminal events. That information is presented in this update.