Accidental fatal asphyxiation by sand inhalation.

A 36 year old laborer was pronounced dead by the casualty doctor on arrival to the hospital. To avoid blame, witnesses and fellow workers fabricated a scenario that resulted in the doctor certify death as due to myocardial infarction. The body was then taken to the mortuary of the Department of Forensic Medicine as a routine procedure to furnish a medico-legal report, which is a pre-requisite for bodies to be taken out of the country. No external injuries were found by the authors who noted deposition of sand all over the clothed body of the deceased. Some sand was also seen inside eyes, mouth and external ear canals. X-ray examination showed radio-opacities in pharynx, larynx, trachea, bronchi and esophagus. The forensic medical examiners (authors) requested permission for autopsy from the director of public prosecution. Autopsy demonstrated that death was due to asphyxiation due to inhalation and swallowing of sand. Consequent on the opinion of the forensic medical examiners the police opened an inquiry. It was established that the deceased was accidentally buried alive when a wheeled loading shovel emptied its load of sand over him at a construction site. The initial misdiagnosis was attributed to failure of the hospital doctor to realize the significance of the presence of sand in exposed orifices. The false account of the circumstances of death had also contributed to that misdiagnosis.