Burking as a cause of homicidal asphyxia: A forensic case report

Burking a rare and distinct form of homicidal asphyxia is when the perpetrator(s) obstruct all the external respiratory orifices while simultaneously applying thoracic compression. It is historically associated with the 19th-century serial killers Burke and Hare. It is a complex form of 'complicated asphyxia' which can present significant diagnostic challenges due to its potential for subtle or overlapping postmortem findings. This report describes the autopsy and forensic investigation of a 35-year-old male victim of a suspected homicide. External examination revealed periorbital ecchymosis, conjunctival petechial haemorrhages and extensive bruising over the chest and abdomen, as well as traumatic injuries to the lips and perioral region. Internal examination confirmed the mechanical nature of death, revealing bilateral rib fractures with associated soft tissue haemorrhage and bilateral traumatic pneumothorax. The cause of death was determined to be from traumatic asphyxia combined with smothering, which was later confirmed by suspect confessions detailing the restraint of the victim and the application of pressure to the chest and mouth. This case highlights the importance of precise anatomical dissection and the incorporation of scene intelligence to distinguish burking from isolated traumatic asphyxia or smothering. Identifying the specific pattern of thoracic and facial injuries in these rare instances is crucial for accurate medico-legal conclusions and to reconstruct violent encounters involving multiple assailants.