Autopsy Coverup: Epstein Murdered in his cell by Mossad trained “mechanic”

Other terms used in medical forensic pathology include burking, garroting, throttling, chokehold, and carotid sleeper hold. Chest compression combined with smothering is called burking after the 19th-century criminal W. Burke, who killed victims in this manner.³³ Garroting or throttling usually refers to ligature or manual strangulation, respectively,¹⁰⁸ although garroting was initially a method of legal execution in Spain.⁶⁶ A chokehold is a forearm or cylindrical object placed across the neck and pulled back with the other hand, causing airway compression and frequently laryngeal fractures, whereas with a carotid sleeper hold, the airway remains open while the carotid arteries are compressed.¹¹⁹

Despite the plethora of literature available, medical pathologists are frequently in a quandary regarding the diagnosis asphyxia-related deaths.^42,78,103 Depending on the mechanism, individuals dying due to asphyxia may or may not have lesions, and to further complicate the matter, the lesions of asphyxia may resemble those arising from other causes.^19,100,108 The 5 classic tenets of death due to asphyxia of cyanosis, fluidity of the blood, engorgement of the right ventricle, visceral congestion, and petechiae are now refuted and are often referred to as “the obsolescent quintet.”^{19,78,85,96,103,108} Veterinary pathologists know that cyanosis, fluidity of the blood, and visceral congestion are common postmortem findings and are not etiologically specific.

Of the 5 lesions, petechiae are the most compelling indicator of fatal neck compression,^19,78,108their presence indicating impaired venous return from the head. Increased intravascular pressure due to compression of neck veins and concurrent arterial flow ruptures postcapillary venules,^12,19,78,108 producing petechiae.⁹⁶ If the arterial vascular supply and venous return are completely obstructed, petechiae will not occur as blood is prevented from entering the tissue. The development of petechiae in fatal neck compression depends on the duration, consistency, and intensity of the force applied to veins and arteries, and if present, a detailed examination of the neck is warranted. Petechiae may be visible in tissues and mucous membranes anterior to the area of neck compression: in the skin, conjunctiva, sclera, larynx, and oral mucosa.^{14,19,42,77,82,83,97} Mechanical or crushing trauma of the chest or abdomen causes marked congestion and petechiation cranial to the injury site.¹⁹ Petechiae, however, are not specific lesions of fatal neck compression because strenuous sneezing, coughing,^19,46,108vasculopathies, and coagulation disorders can also cause petechiae.³³ The disposition of the body, particularly if the animal was in an inverted position when found, is particularly important as congestion and petechiae can develop in dependent sites due to livor mortis.^103,108Tardieu spots, a term used in the medical forensic pathology literature, specifically refers to subpleural petechiae^103,108,127 but is often used to describe petechiae in soft tissues to infer asphyxial death.^108,119 This eponymous term should be avoided in veterinary forensic pathology, and the distribution and location of petechiae should be described to avoid confusion and the implicit causal inference of this label.

Pulmonary edema with or without hemorrhage, atelectasis, and interstitial emphysema are common macroscopic and microscopic lesions in animal and human victims of strangulation and suffocation* but also occur with a myriad of other conditions. Proponents of semiquantitative morphologic analyses of histological sections claim that pulmonary lesions of strangulation, hanging, drowning, and suffocation can be distinguished in people^32,52 but do not address the effect of decomposition on histological detail.⁹⁴

Reflex cardiac arrest following neck trauma and stimulation of the carotid sinus is a presumptive mechanism of death currently debated by medical forensic pathologists, especially when anatomic lesions are absent.^{6,34,42,96,114,119} A meta-analysis of hanging deaths in people concluded that concurrent underlying conditions such as cardiac disease, sympathetic stimulation, and/or drug abuse are present in suspected cases of reflex cardiac arrest.¹¹⁴Similarly, bradycardia with subsequent cardiac asystole as a result of vagal stimulation in cases of hanging has been argued for over 120 years.²³ In their review of the historical proposed mechanisms of death in hanging, Clement and coauthors²³ remarked that those who supported the concept of vagal stimulation considered it only as a potential but unproven mechanism of death. In some textbooks of forensic pathology, vagal stimulation is considered a mechanism of death resulting from strangulation or from foreign body esophageal occlusion,^35,108 but this is discounted by others because there is no supporting scientific proof.^33,96