Autopsy: Obstruction by bed clothing, a pillow, a cushion, etc., applied with skill, may not leave any external signs of violence, especially in the young and the old, except sign of asphyxia. When the face is pressed into a pillow, the skin around the nose and mouth may appear pale or white due to pressure, with cyanosis of the face. Saliva, blood, and tissue cells may be found on the pillow. If the orifices are closed by the hand, there may be scratches, distinct nail marks, or lacerations of the soft parts of teh victim's face. The lips, gums and tongue may show brusing or laceration, slight bruising may be found in the mouth and nose, which should be confirmed by microscopy. The asphyxial signs and symptoms are severe, because death usually results due to slow asphyxia and often the fatal period is 3 to 5 minutes. The head and face may show intense congestion and cyanosis with numerous petechial haemorrhages in the skin of the face and beneath the conjunctivae. Blood may ooze out from the mouth and nose. The tongue may be protruded and may have been bitten. Petechiae are usually present, even in cases where hypoxic changes are slight. Often, the head and face enclosed in a plastic bag are pale, with few petechial haemorrhages in the eyelids and pricaridum. In some cases, death is rapid due to reflex cardiac arrest, and asphyxial signs are absent. In environmental sufficiation, congestion and cyanosis may or may not be present; petechial haemorrhages are rare.
Internal: Blood-stained frothy fluid is present in air-passages. Mucus may be found at the back of the mouth. Slight acute emphysema and oedemoa of the lungs with scatterd areas of atelectasis, petechiae and congestion are the major findings. The internal organs are deeply congested and sometimes show small haemorrhages.
Homicidal smothering is extremely difficult to detect. The autopsy may reveal asphyxia, but there may not be any corroberative medical evidence to prove foul play. The pathological changes must be interpreted keeping in view the medical history of the deceased, the scene of the death, and the specific circumstances surrounding the death.
