Burking, Choking & Traumatic Asphyxia

Burking is a method of homicidal smothering combined with traumatic asphyxia. It originates from the acts of William Burke and William Hare, who murdered 16 persons in Edinburgh (1827–1828) and sold the bodies for anatomical dissection.

The victim was intoxicated, thrown to the ground, and Burke would sit or kneel on the chest while covering the nose and mouth. Hare dragged the victim by the feet, ensuring rapid asphyxia without leaving obvious marks.

Choking is asphyxia caused by obstruction within the air-passages.

Usually accidental. Occurs in young children, elderly, psychiatric or infirm individuals, especially when swallowing ability is impaired.

Common scenarios:

• Food inhalation during meals, laughing, crying.
• Vomitus inhalation during alcohol intoxication, anaesthesia, epilepsy.
• Blood from facial injuries blocking the airway.
• Infants inhaling regurgitated milk.
• Foreign bodies: meat bolus, seeds, stones, coins, toys, dentures, rags.
• Accidental aspiration of gauze packs during surgery.
• Suppression of gag reflex due to sedatives in mental institutions.

Microscopy: intense interalveolar oedema and desquamated respiratory epithelium.

Occurs due to:

• Diphtheria, mononucleosis, H. influenzae infection.
• Aortic aneurysm rupture into air passages.
• Haemoptysis from TB.
• Laryngeal/lung growths, abscesses, oedema from steam, chemicals.
• Severe allergic reactions—bee, wasp, hornet stings; penicillin reaction.
• Blows to the neck causing oedema + vagal inhibition.

Rare; usually in mental patients or prisoners where a foreign body is intentionally forced into the throat.

Usually seen in infanticide—paper or cloth stuffed into the pharynx or larynx. Very rare in adults unless the victim is incapacitated.

• Asphyxia
• Cardiac inhibition (most common)
• Laryngeal spasm
• Delayed death: pneumonia, lung abscess, bronchiectasis

Large foreign bodies may obstruct the larynx → fatal anoxia. Small objects → laryngeal spasm. Reflex parasympathetic inhibition may cause sudden cardiac arrest.

Foreign body at tracheal bifurcation causes irritation and cardiac inhibition. In bronchus → reflex cardiac inhibition.

Occurs in intoxicated restaurant patrons who suddenly collapse while eating. Misdiagnosed as a heart attack.

Autopsy: large bolus of poorly chewed food obstructing the larynx.

Treatment: Back blows, chest blows, removal with fingers/forceps.

Results from mechanical fixation of the chest, preventing normal respiratory movements. Always accidental.

Causes:

• Crowd crush—stampede, riots, enclosed gatherings.
• Building collapse, mining cave-ins, tunneling accidents.
• Vehicle collapse—jack failure while repairing cars.
• Assault—victim jumped or stamped upon.
• Jack-knife position: thighs forced against chest.