forensic science and forensic medicine asphyxial death
TRANSCRIPT
Law
Forensic Science and Forensic Medicine
Asphyxial death: hanging, strangulation, drowning
DESCRIPTION OF MODULE
Items Description of Module
Subject Name Criminology
Paper Name Forensic Science and Forensic Medicine
Module Name/Title Asphyxial death: hanging, strangulation, drowning
Module Id LAW/CJA/VIII/36
Objectives
Learning Outcome:
To make the learners understand the need of studying
asphyxial deaths based on their mechanism.
To make the learners understand processes to determine
the various type of asphyxia operating in different case
and manner of death.
To make the learners understand the mechanism of
oxygen supply to the blood and tissues with respect to
interference with respiration.
Prerequisites General understanding of the Obstructions to the air
passages due to hanging, strangulation or other asphyxia
deaths and occlusion of the air passages within as in
drowning or laryngeal spasm.
Key words
Asphyxia, hanging, strangulation, drowning,
entomology.
Asphyxia
Asphyxia is a common term applied to the condition where to a more or less degree
interference with the respiratory exchange occurs. It is the condition where oxygen
supply to blood and tissue is restricted below the normal level causing any
interference with respiratory system. 1,2. It can also be considered as state of hypoxia
Role Name Affiliation
Principal Investigator Prof. (Dr.) Ranbir
Singh
Vice Chancellor, National
Law University, Delhi
Co-Principal Investigator
Paper Coordinator Prof. (Dr.) Sally
Lukose
Dean, School of Basic and
Applied Sciences, Galgotias
University, Greater Noida.
Content Writer/Author Ms. Neeharika
Srivastava
Assistant Professor, Galgotias
University, Greater Noida,
U.P.
Content Reviewer
or the lack of oxygen below the required level. Effect of asphyxia can be divided in
four stages: 3,4
Stage of inspiratory dyspnoes where deep and forceful respiration occurs, cyanosis
lasts for a minute or so.
Stage of expiratory dyspnoea with spasmodic efforts at expiration. At this stage,
consciousness is lost, pupils dialated and high blood pressure are the symptoms.
Next is the fall in blood pressure, resulting in increased pulse rate. Sometimes
defecation occurs. Erection of penis and ejaculation of semen may also occur.
At last, respiratory movements cease except for terminal irregular occasional
respiration. Heart beats for next 10-15 minutes.
Causes of asphyxia: 2
Obstruction in air passage due to mechanical asphyxia
Causes blockage of external respiratory orifices, as in smothering.
In case of drowning, occlusion of the air passage
As in case of traumatic asphyxia, pressure on chest.
Inhaling the toxic gases like carbon monooxide.
In case of strychnine poisoning, spasm of the respiratory muscles.
in case of narcotics and anesthetia administered, paralysis of the respiratory
centre.
1 (Premature and Congenitally Diseased Infants, by Julius H. Hess, M.D., Chapter X,
Diseases of the Respiratory Tract, parikh).
2 parikh
3 chapter 11, asphyxia, Ass. Prof.Dr. Atef Foda & Dr. Eslam Samy, 117-129). (Nandy
A.; Principles of Forensic Medicine; Edition 2005; p. 319-327.
4 Dixit P.C.; Textbook of Forensic Medicine and Toxicology; Edition 2007; p. 294,
300.)
Signs of asphyxia: 5,2,6,7,8,9
1- Cyanosis: (greek ‘dark blue’)
The quantity of oxyhaemoglobin and reduced haemoglobin in red blood cells
determine the Cyanoses.
When oxygen is lacking, the usual pink colour of well oxygenated blood might get
converted to blue-purple.
There should be at least 5gm% of reduced haemoglobin for cyanosis to become
evident.
2- Congestion:
Due to susceptibility of capillaries to hypoxia there occurs capillo-venous congestion
following visceral congestion resulting in stasis of blood in the dialated capillaries and
venules.
There is redistribution of blood upto certain extrant due to gravity and to some extent
by rigor mortis.
Systemic and pulmonary congestion and dialaltion of right side of heart are the sure
sign of asphaxial death.
3- Fluidity of blood:
It has been established that fibrinolysin are found in cadaver.
Fluidity depends upon fibrinolysin and amount of fibrinolysin depends upon the
rapidity of death rather the cause.
5 sympsom
6Ely SF and Hirsch CS, Asphyxial deaths and petechiae: a review. / Forens Sci
2000;45(6):1274-1277.)
7 Roughead W, Burke and Hare, ed 3. Edinburgh, Cited in Poison C, Gee DJ, Knight
B: The Essentials of Forensic Medicine, New York, Pergamon Press, 1985.)
8 Knight BH, The significance of the postmortem discovery of gastric contents in the
air passages. / Forens Sci 1975; 6:229-234.)
9Feldman EA, Traumatic asphyxia: Report of three cases./ Trauma 1969; 9:345- 353
4- Pulmonary edema:
It is of no or less value in diagnosis of death that whether it is due to respiratory
failure.
Lungs should be weighed properly to know the extent of edema.
5- Pulmonary hemorrhages:
Due to trauma of pharynx against the anterior surface of spine , there is larfe
submucosal hemorrhages.
Rupture of submusous venous plexus at this site is due to serious venous congestion.
6- Petechial hemorrhages:
Petechial hemorrhages or tardieu spots are develop from:
Due to Increased venous stasis causing congestion which results in increased pressure
causing rupture of the vessels.
There occurs increased permeability due to hypoxia.
Tardieu spots are usually pinhead in appearance,but vary in size and shape.
7- Stasis hemorrhages:
Found in case of homicidal strangulation
Usually found beneath the mucosa of larynx in the subglottic space.
Classification of asphyxia death 2,10
Sauvageau A., Boghossian E.; Classification of asphyxia; The need for
standardization; J. Forensic Sci.; 2010; 55; 1259-67.
Hanging:
Hanging is a mode of death in which death occur because of the compression of neck
as a result of suspension of body through a ligature. The constricting force results
from the weight of the body or a part of body weight acts as a constricting force.
Virtually all the suicide cases are suicidal in nature. Diagnosis of antemortem
hanging is important to acertain the death from hanging. There are few features which
can ascertain death by hanging: Ligature mark with vital reaction, Saliva dribbing
from mouth, Ecchymosis of larynx or epiglottis, Fracture of hyoid cartilage and hyoid
bone. 2,5,11
There are chances of complete or incomplete suspension of the body:
Complete hanging:
Here the body is completely suspended in air
Constricting force is the weight of the body.
Partial/incomplete hanging:
Here the constricting force is weight of the haed.
Lower part of the body like toes, feet , knee and buttocks generate the constricting
force.
Figure: (a) complete hanging (b) partial hanging
11 A Study of Gross Postmortem Findings in Cases of Hanging and Ligature
Strangulation, Mohammed Musaib M. Shaikh, H. J. Chotaliya, A.D. Modi, A. P.
Parmar, S. D. Kalele, J Indian Acad Forensic Med. Jan-March 2013, Vol. 35, No. 1
ISSN 0971-0973. ,
2 Parikh’s Text book of medical jurisprudence Forensic Medicine and Toxicology
CBS publisher and distributors PVT.LTD.
5 Simpson's Forensic Medicine, 13th Edition, Jason Payne-James, Richard Jones,
Steven B Karch, John Manlove, August 26, 2011 by CRC Press.
Cause of death in hanging:
Hanging may resulting death due to one or combination of following reasons of
immidiate death: 12,13,14,5
1- Asphyxia:
ligature forces the root of tongue aginst the pharynx and folds the epiglottis over the
entrance of larynx to block the passage of air.
A minimum weight of 15 kg is required to compee the trachea
2- Injuries to spinal cord:
When hanging is exercised with a long drop
Upper cervical cord is stretched
Immediate unconsciousness
Heart and respiration may continue for upto 10-15 minutes
Congestive changes are absent
3- Vagal inhibition:
By compression of the neck
Cab be considered as a possible cause where there is no or minimal congestive
changes.
4- Mechanical constrictions of the structures of the neck:
Combined obstructive asphyxia and interfered cerebral circulation is most common
cause of death
5- Cerebral anoxia:
Carotid artery occludes with 4-5 kg tension
Vertebral artery with 20 kgs tension
12 (Ashok Kumar Samanta, Soumya Rajan Nayak. Newer trends in hanging death.
Journal of Indian Academy of Forensic Medicine. 2012, Vol. 34 (1) pp 37 – 39.)
13 (Paliwal P. K, Basant Lal Sirohiwal, Vijay Pal Khanagwal, Hitesh Chawla. A drop of
saliva de-codes the mystery of hanging body. Journal of Indian Academy of Forensic
Medicine. July-Sep 2011, Vol. 33, No. 3.pp280-282.
14 Chormunge Patil, Mahajan S. V, Bhusari P. A. Hanging vs. strangulation a
comparative study. Journal of Forensic Medicine, Science and Law. Jul-Dec 2011.
Vol. 20, No.2 pp 1-5)
5 siympson
Reasons for delayed death:
Aspiration pneumonia
Infections
Hypoxic encephalopathy
Edema of lungs
Encephalitis
Cerebral abscess
Autopsy findings: 2,5,15,16
External:
Neck may be stretched or elongated
Head bend is opposite to the knot
Face is pale usually
Face may be swollen but swelling disappears when rope is cut down
Petechiae present on the skin
Dribbing of saliva
Bloody froth may present caused by congestion of lungs
Pulmonary edema
In the middle ear hemorrhage may be seen
Semen drops may come out of penis
Lower limbs show hypostasis
Internal:
Absence of Petechiae because of complete obstruction in the arterial system
Saliva run from mouth down the chest
Fracture of the hyoid bone and thyroid cartilage (considered antemortem)
Vertebral artry may show rupture
Thyrohyoid ligament is torn
Trachea show Petechiae haemorrhages over the epiglottis, trachea and larynx.
Abdominal organs are congested.
15 Zine K. U., Tandle R. M., Varma N. M., Jambure M. P. Accidental Ligature
Strangulation with Avulsion of Scalp. Journal Indian Academy Forensic Medicine.
July-Sept 2011, Vol. 33, No.3, pp 267 – 268.
16 Punia R. K, Gupta B. M. A rare case of ligature strangulation with salivary
staining. Journa)( Sauvageau A., LaHarpe R, Geberth VJ; Agonal sequences in eight
filmed hangings: Analysis of respiratory and movement responses to asphyxia by
hanging; J Forensic Sci. 2010; 55; 1278 – 81.
Strangulation
Strangulation is another form of asphaxia where death is due to constriction of neck
by a ligature or other mean bvut without suspending the body. Broadly it is of two
types (1) ligature strangulation and (2) manual strangulation. There also may be some
more type:
Ligature Strangulation: strangulation is by means of ligature.
Throttling or manual strangulation: compressing the victim;s neck by the hand
Mugging: compressing the victim’s neck against the forearm
Garroting: attacking the victim from behind, grabbing his neck or throwing a ligature
over neck and tightening it.
Bansodala: compressing the neck by means of two sticks.
Areas which are more presumptive of strangulation are head and neck and a thorough
examination of these area can be used to ascertain death by strangulation.
Medico legal importance of strangulation:
In homicidal cases:
Single turn of ligature with one or more knot
Abrasion around the neck due to ligature movement
Mark of struggle (absent in case of weak or frail individual)
In Accidental cases:
Children are more prone as they can get entangled in rope while playing.
Intoxicated person by tie, scarf or collar.
Umbilicle cord can strangulate the foetus.
In suicide cases:
Injuries are less marked as less force is applied.
No sign of struggle
Ligature is found at scene
17 (Chormunge Patil, Mahajan S. V, Bhusari P. A. Hanging vs. strangulation a
comparative study. Journal of Forensic Medicine, Science and Law. Jul-Dec 2011.
Vol. 20, No.2 pp 1-5)
Cause of death:
Asphyxia
Anoxia
Congestion
Vagal inhibition
Autopsy:
External:
Ligature mark on the middle or lower part of neck
Depending upon the compostion of the ligature it will shown regular or irregular
pattern around the neck
Mark is depressed at any level on the neck-usually at the level of thyroid cartilage or
below.
Mark may be found around the neck but is more prominent in front and sides of neck.
Marks may be interrupted by clothing or victim’s finger or ornaments.
Mark is usually transverse but sometimes oblique as well.
Internal:
Laceration of muscles.
Injuries to blood vessels
Hyoid bone fracture usually not seen.
Fracture thyroid is more common.
Fracture of cricoids is rare, but if pressure is used may be seen.
Organs are congested.
18 (Sheikh M. I. and Agarwal S. S. Medico-legal implications of hyoid bone fracture-
a study paper. Journal of Indian Academy of Forensic Medicine. 2001 Vol. 23.
Number 4. pp 61 - 63.)
19 (Zine K. U., Tandle R. M., Varma N. M., Jambure M. P. Accidental Ligature
Strangulation with Avulsion of Scalp. Journal Indian Academy Forensic Medicine.
July-Sept 2011, Vol. 33, No.3, pp 267 – 268.)
Drowning
Drowning is a form of asphyxial death due to aspiration of fluid into the air
passages by submersion of the body in water or some other liquid medium.20,21
Complete submersion not necessary, submersion of nose and mouth of a living
person under water is enough. Types of drowning:
Drowning is mainly of four types:
1- Wet drowning: when more water goes to lungs.
2- Dry drowning: no water goes to lungs, death is due to
laryngeal spasm.
3- Secondary drowning:
Survival beyond 24 hours, victim may survive or die
later
Injury to CNS is reported
Hypothermia and low oxygen delivery to vital tissues
are the main factors towards morbidity and mortality.
4- Immersion drowning: Death is due to vagal inhibition
following cardiac arrest. In drowning this may be brought about by
A sudden water entry to larynx.
Falling in water in a way such that it strikes the
abdomen suddenly, especially the epigastric region.
Sudden entry of cold water into the ears.
Medico legal importance of drowning:
Sure signs of drowning,
Could still be identified in putrefied bodies,
Could give an evidence of the site of drowning (fresh or salt water species).
Whether the death was due to drowning or other cause?
Length of time the body was in water.
Whether it was accidental/suicidal/homicide
20(Auer A, Möttönen M (1988). Diatoms and drowning. Z Rechtsmed 101: 87-98.)
21Davis J (1986). Bodies found in the water: an investigative approach. Am. J.
Forensic Med Pathol 7: 281-287
The change occur in body simply tells about the duration of submersion of body in
water. Changes are result of imbibition of water in outer layer of body. Changes start
to develop first in finger tips (3-4 hours) later spreading to entire hand (24 hours). By
careful examination of these changes duration of submersion can be determined.
In a couple of hours only, skin starts developing wrinkles
In about 12 hours of submersion, cuticle becomes bleached.
In 24 hours saddening of skin can be seen.
In about 48 hours of submersion, cuticle of skin starts separating from palm and foot
and can be peeled off by 3-4 days.
Usually body starts to float in about 24 hours of submersion in summer in 2- 3 days in
winter.
Autopsy/ diagnosis of death by drowning can be ascertained by (a) External sign (b)
internal sign (c) biochemical test and (d) analysis through diatoms. 22,23,24,25
External sign:
Clothing and skin is wet, cold and pale
Hypostasis is pink in color due to oxygenation or may be cyanotic
Upper parts of body show postmortem staining
Petechial haemorrhage may be present
Pupil dialated
Cyanosis may be present
Rigor mortis takes place early
White and leathery froth sometimes with blood is present over the mouth and nostril.
When chest is pressed more froth comes out.
Cutis anserine (Due to spasm of the erector pilae muscles and due to exposure to cold
water at the time of death) or goose skin is present
Cadaveris spasm: presence of weeds in grass in hands.
Washerwomen’s hand: saddening of the skin due to absorption of water.
22 DiMaio DJ, DiMaio VJM (1989) Drowning. In: DiMaio DJ, DiMaio VJM, eds.
Forensic pathology. Elsevier, Amsterdam pp. 357-365.)(Hendey NI (1973).
23 The diagnosis value of diatoms in the cases of drowning. Med Sci Law 13(1): 23-
34.)
24(Knight B (1991). Immersion deaths. In: Knight B, ed. Forensic Pathology,
E.Arnold, London pp. 360-374.
25 Ludes B, Fornes P. (2003). Drowning in : Forensic Medicine : Clinical and
Pathological Aspects. Payne-James J, Busuttil A, Smock W eds, Greenwich Medical
Media, pp 247-257)
Internal signs:
Paltauff’s haemorrhages:
Present in the lower lobes of lungs
Red or grey patchy appearance
This condition of lung is also known as emphysema aquosum and trockenes oedema.
Microscopic findings of drowning lungs:
Following stages are encountered
Thickness of the alveolar wall is reduced to capillary width
Alveolar are more distended and capillaries lie separately.
Capillaries appearance is thread like, lumina is observed occasionally.
Involve only scattered alveoli.
Water in stomach and duodenum:
When water is taken in excess, it passes to the duodenum.
Froth in air passage:
In case of fresh drowned bodies, froth comes out from mouth and nostril.
Froth is odema fluid from lungs
Froth consist of proteinaceous exudates and surfactant mixed with the drowning
medium water.
Over-inflation of lungs:
Lungs may be over-inflated filling the thoracic cavity.
Biochemical tests:
Many workers have worked on the biochemical and biophysical tests on drowning
related cases including calcium, magnesium or specific gravity of plasma but the
results are not rewarding. The rapid onset of post mortem changes in case of
drowning may be considered as one of the reason which is obscuring the reliability of
biochemical tests. 26
Diatoms (bacillariophyceae) is a photosynthetic unicellular algae with silicaceous
exoskeleton is found in water.
There are nearly 15,000 species of diatom found in fresh and sea water.
A broad classification of diatom can be (1) oligohalophilic: live in fresh water (2)
mesohalophilic: in sea water with salinity more than 0.05%.
26 Analysis of diatoms: (Ludes B, Coste M, North N, Doray S, Tracqui A, Kintz P
(1999). Diatom analysis in victim's tissues as an indicator of the site of drowning. Int
J Legal Med 112: 163-166.)
Different types of diatoms27
When a person drowns in water containing diatoms, many diatoms reaches to
pulmonary parenchyma. From there they enter into blood stream through the alveolar
walls during forceful inspiratory or expiratory efforts. Once they enter in blood , are
distributed in whole body through blood stream. This presence of diatom makes the
basis of diatom test in drowned individuals.
When person is not drowned oe a body is thrown in water after death, diatom are
though able to reach lungs by passive perlocation but cannot reach to distant organs.
Hence organs examined routinely for the presence of diatoms are lung, liver, brain
and bone marrow. 28
27 Forensic diatomology, ANU SASIDHARAN*, RESMI S, HEALTH SCIENCES,
2014; Vol.3,No.1 January –March, ISSN 2319 – 4154.
28 (Ludes B, Quantin S, Coste M, Mangin P (1994). Application of a simple
enzymatic digestion method for diatom detection in the diagnosis of drowning in
putrefied corpses by diatom analysis. Int J Med 107: 37-41.)
Figure: Diagrammatic representation of transmission of diatoms
There may be cases where the person was not drowned but diatoms were present or
may be absent when person was drowned. Such conditions can arise due to:
Seasonal variation
Due to havinf raw fruits or vegetables which have been in contact of soil diatoms
Having their ubiquitous nature, they are present in soil, water and in air.
Sometimes they can penetrate the intestinal lining and can directly get in the blood
stream.
Certain food like selfish contain diatoms.
In such conditions, following are the requirements which should be fulfilled:
Diatoms species recovered from body organs and from water of submersion should be
same.
They must be present in approximate same proportion. 29, 30,31
29 Neidhart DA, Greedyke RM (1967). The significance of diatom demonstration in
the diagnosis of death by drowning. Am J Clin Pathol 48(4): 377-382.
30 Pollanen MS (1997). The diagnosis value of the diatom test for drowning, II.
Validity: analysis of diatoms in bone marrow and drowning medium. J Forensic Sci
42(2): 286-290.
31Pollanen MS (1998). Forensic diatomology and drowning. Elsevier (Amsterdam)
ed.