23475424 Violent Asphyxial Deaths

8/9/2019 23475424 Violent Asphyxial Deaths

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Violent asphyxialViolent asphyxial

deathsdeathsDefinition: In violent

asphyxial deaths, the process ofrespiration i.e., the exchange of

air between the atmosphere andthe lungs beds is prevented bysome violent mechanical means.


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Types of violent asphyxiaTypes of violent asphyxia

1. Hanging

2. Strangulations3. Drowning

4. Suffocations


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HangingHanging

Definition :

Hanging is a process in which the body issuspended with a ligature around the neck

which causes constriction of the airpassage preventing exchange of airbetween the atmosphere and the alveoliof lungs, leading to asphyxia and death.

The constricting force is either the weightof the whole body or the weight of thehead alone.


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Types of hangingTypes of hanging((on the basis ofon the basis ofthe position of the knot used)the position of the knot used)

1. Typical hanging. In a typicalhanging, the knot of the ligature

should be at the nape of the neck

on the back. Typical hanging is notvery common in occurrence.


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2. Atypical hanging. In atypical

hanging, the knot of the ligaturemay be at any site other than the

nape of the neck. It may be near

one angle of the mandible, near themastoid, or below the chin.


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Hence in case of typical hanging,

maximum pressure is exerted in the

front of the neck, on the midline, i.e.,over the wind pipe. The pressure over

the jugular veins and the carotid

arteries are comparatively less butequal on both sides.


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In atypical hanging, the

commonest site for the knot is nearone side mastoid process or near

the angle of mandible.

Occasionally, it may be below the

chin.


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When a knot is on one side, the pressure

over the vessels on both side is not equal

and it also takes more time for total

occlusion of the wind pipe. When the knot

is blow the chin, there may not be much

evidence of asphyxiation as the respiratorytract is not directly compressed.


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Types of hangingTypes of hanging (according to(according to

the degree of suspension)the degree of suspension)

1. Complete hanging. In this

variety, the body is fully suspended

and no part of the body touches the

ground. The constricting force hereis the weight of the whole body.


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2

. Incomplete or partial hanging. In

this variety the lower part of the body

is in touch with the ground. Sometimes

only the toes, sometimes the whole

foot or feet, sometimes the

knees(hanging in kneeling position),

sometimes the buttock(hanging in

sitting position),may be in touch with

the ground.


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Partial hanging is taken

to be diagnostic of beingsuicidal in nature.


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The ligature materials in casesThe ligature materials in cases

of hangingof hangingThe ligature material may be anything

which may be tied around the neckwith some additional length for fixing

it to the point of suspension. It can be

a rope, electric wire, belt, neck tie,

bedsheet, scarf, cycle chain or any such

thing.


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The knotThe knotThe knot may be a fixed

one(double or more), or itmay be a slipping knot or a

running noose.


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Precise causes of deathPrecise causes of death

due to hangingdue to hangingThough a form of violent

asphyxia, not in all cases ofhanging death occurs due toasphyxia. Any of the

followings may be the actualcause of death.


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1. Asphyxia along with apoplexy

due to simultaneous pressure over

larynx and jugular veins. Thecombined effect of asphyxia and

apoplexy is the cause of death in

most cases.


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2. Asphyxia alone.

3. Apoplexy alone.

4. Cerebral anaemia or

ischaemia due to pressure over

carotid and vertebral arteries.


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5. Vagal shock. This may

occur due to inhibition ofthe heart due to irritation

of the carotid sinus.


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6. Fracture dislocation of the

second and third cervicalvertebrae, which causes injury

to the medulla and the upper

part of the spinal cord, as in

case of judicial hanging.


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Postmortem

appearance of hanging


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A.External findings

A.External findings

1. The ligature mark.

In most cases of death due tohanging, the ligature mark

around the neck is very muchconspicuous.


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The ligature mark in case of

hanging is oblique, non-continuous, placed high up

around the neck, grooved,

parchmentised and abraded at

places.


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The ligature mark is non-

continuous because of a gap atthe nape of neck due to hairintervening between the ligature

material and the skinunderneath. There may also besome gap near the site of the

knot due to the pull on the knotfrom the point of suspensionabove


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The upper margin of the ligature

mark has a line of postmortemstaining, all around above the

ligature mark. This is due tosettling of blood, from head and

neck above the level of

constriction, caused by the

ligature material.


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When the knot is in contact

with the skin, it is usuallyinverted V shaped, due toextension of ligature materialdownward on both sides fromthe knot above. The point of

contact of the skin with the knotmay leave a deep parchmentisedabraded impression.


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Factor which influence theFactor which influence the

appearance of the ligatureappearance of the ligaturemarkmark

A. The ligature material.

B. Period of suspension.

C. Degree of suspension.


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D. If something, say, the collar of

the shirt intervenes between theligature material and the skin of the

neck then the ligature mark will

not be prominent.


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E. The weight of the body of

the deceased.F. Tightness of the ligature.

G. Slipping of the ligaturematerial.


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H. When the ligature is

applied in multiple turns,then there will be

multiple,parallel, groovedligature marks.


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I. Design of a ligature

material, e.g. of a rope ora cord may get imprinted

on the ligature mark.


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J. The ligature material may

be in situ around the neck ormay be sent along with the

dead body or may be absentaltogether.


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2.The dimensions of the neck

2.The dimensions of the neck

Due to prolonged suspension, the

neck becomes slender andincreases in length. This will not be

seen in suspension for a short

period.


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3.Bending of the neck

3.Bending of the neck

The neck gets flexed to the side,

opposite the side of the knot. Thestate of bending will continue until

the onset of decomposition.


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4. The face may be pale

or flushed or congested.


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5. Tardieus spots may be

present on the forehead, overthe eyelids, under the

conjunctiva and sometimesnear the temple.


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6. Tongue may be partly

protruded out in between thelips and during the stage of

rigor mortis may also be bitten

in between the jaws.


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7.7. Dribbling of salivaDribbling of saliva..

Dribbling of saliva is a

very constant andimportant finding in a

case of death due tohanging.


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Dribbling of saliva occurs from the

angle of the mouth which is at alower level i.e., from the angle

opposite the side of the knot. When

the knot is on the nape of the neck

it occurs across the middle of the

lower lip. When the knot is underthe chin, then it occurs through

either or both angles of the mouth.


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The saliva drops down in

front of the chest when thebody is bare or it stains theclothes in front, when thedeceased is dressed. Whendried or partly dried, it

becomes quite fixed andcannot be easily removedor rubbed out.


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Dribbling of the saliva is considered

a very important phenomenon insupport of death due to antemortemhanging, as because, excessive

salivation is an antemortem reactionwhich occurs due to irritation of thesubmandibular salivary glands

during life, due to the pressure andfriction caused by the ligaturematerial.


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8.P

eculiar distribution of the8.

P

eculiar distribution of thepostmortem stainingpostmortem staining

As the body remains suspended in

the upright position after death, the

postmortem staining will be present

over the lower limbs, lower parts ofthe upper limbs and the upper

margin of the ligature mark.


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Occasionally, in the lower limbs,

there may be multiplehaemorrhagic spots due to rupture

of the capillaries, due to being

over-distended by blood.


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This distribution of the

postmortem staining is howevernot confirmatory of the death

being due to hanging. It onlyspeaks that the body was in a

state of suspension in upright

position for a considerable

period after death.


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Thus, if a dead body is placed

after death, in upright positionin a state of suspension with aligature around the neck, then

similar distribution ofpostmortem staining will bethere, provided that sufficienttime has been allowed to pass, inthat position of the body.


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9. The hands are usually

clenched. Sometimes the

hands may show

presence of fibers, like

that of jute when a jute

rope has been used.


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10. Fingertips,

nailbeds, and lips show

sign of cyanosis.


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11. In males there may be

involuntary discharge ofsemen.


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12. In both sexes there

may be involuntarydischarge of fecal matter

and urine.


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13. In addition, there may

be some abrasions at placeslike lateral aspects ofshoulder, due to friction

with a wall or a post or apillar, which occurs during

suspension, particularlyduring the last phase of lifewhen there is convulsion.


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14. In some cases, the right

side eye remains open with

more dilatation of the rt.

pupil, whereas the left eyeremains closed and left pupil

less dilated.Th

is is known asLe facie Sympathique.


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B. Internal findingsB. Internal findings--

1. In some cases, the

tongue is slightlyprotruded out and in

others the tongue ispushed back.


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2. Larynx and trachea

are congested. There

may be Tardieus spots

under the mucus

membrane of the

trachea and larynx.


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3. Lungs are congested.

There will be presence of

Tardieus spots on the

undersurface of the pleura

which are particularly

abundant at the interfaces

of the lobes.


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4. Brain is congested,

oedematous with presence ofhaemorrhagic spots. Similar

findings are present in thelayers of meninges.

5. All the organs arecongested.


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6. Maximum findings are available

in the TISSUE

OF THE

NE

CK.


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(a). The subcutaneous

tissue underneath theligature mark is dry,white, firm and glistening.

The platysma and thesternomastoid muscle

may sh

owh

aemorrh

agesand are even occasionallyruptured.


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(b). The hyoid bone

may be fractured inpersons, more

commonly above the ageof40 years. Fracture of

thyroid in hanging casesseems to be a rarity.


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. There may be transverse

tear of the intima of thecarotid arteries.


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(d). Larynx are congested.

There may be Tardieus spotsunder the mucus membrane

of the larynx.


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(e). In case of JUDICIAL

HANGING or where there isa drop from a reasonableheight, the ligature around

the neck causes a forcefuljerky impact on the neck atthe end of the fall. In such

cases there will be fracturedislocation of the C2 and C3or C3 and C4 vertebrae.


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In case of fracture of C2

and C3 the fractured pieceof the odontoid process ofthe C2 vertebra causes

damage to the medulla. Inother cases there is

corresponding injury to themeninges and the spinalcord.


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(f) In a few cases,posterior wall of theoesophagus may showcongestion due tocompression againstthe cervical vertebrae.


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MEDICOLEGAL ASPECTSMEDICOLEGAL ASPECTS

OFHANGINGOFHANGING


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A. Suicide hangingA. Suicide hanging

Hanging in its face value goes in

favor of being suicidal in nature. The

place of occurrence is secluded. The

point of suspension remains

approachable to the suicide. Partial

hangings are almost always suicidal

in nature. There may be a suicidal

note left behind.


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There should be a motive for

committing suicide. Often asuicide failing in othermethods to end life. May

lastly adapt this methodsuccessfully. In these casesevidence of some other

adapted methods may bepresent on the body.


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B. Homicide hangingB. Homicide hanging

1. Homicedal hanging is rare.It is not ordinarily possiblewith an adult victim, ifhe is

not intoxicated or not madeuncinscious by some othermeans, like head injury.Alternatively, the victim iseither a child or a very

deilitated person.


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2. Usually the rope is first

fastened around th

e neck andthen it is pulled over a high pointof suspension. Hence, there will

be presence of evidence ofpulling or dragging of the victimon the ground as also presence ofevidence of friction at the pointof suspension , with the ligaturematerial.


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3. The hand of the victim may

show presence of foreignmaterial like foreign hair or

button. The hands, feet and

the mouth of the victim may

be tied. Signs of struggle may

be present on the body of thevictim and at the place.


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C. ACCIDENTAL HANGINGC. ACCIDENTAL HANGING

The following circumstances ofaccidental hanging may beencountered:-

In factories, a worker working ata height if falls accidentally, mayget hanged on a sling or rope.

Similarly, if during such a fall thenecktie gets fixed at some point,then the victim may die due to the

effect ofhan in .


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2. Similar deaths may occur

in case of a trapeze playerwhen his grips slip and his

chin gets entangled on theswinging sling.


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3. When a person on the

top of a ladder suddenlymisses a step, in course of

falling down,h

ish

eadmay get fixed in between

two steps and he may die

due to constriction of the

neck in suspension.


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4. Infants while

accidentally slippingdown in between the

side grills of the crib,may die due to

constriction of th

e neckwith the body being ina suspended position.


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5. Children while

playfully acting judicialhanging, may actually

be hanged to death.


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6. In course of

masochistic practice the

victim may accidentally

die due to hanging.

Such person gets sexual

gratification by partial

asphyxiation.


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He arranges the

situation by placing anoose around his neckand creates a state ofpartial asphyxiation inhimself by pulling the

other end of the rope,across a pulley type

arran ement.


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After getting sexual

orgasm he releases thepull on the rope. In course

off such practices thevictim may fail to release

the pull and die due to

hanging.


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Males are the exclusive victims.The circumstance in such a

case is sufficient to indicate theactual nature and mode ofdeath. The victim is found

either naked or female dresswith pornographic pictures atthe place of occurrence. Often,

some soft cloth is placedaround, in between the ropeand the neck.


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D.Postmortem hangingD.Postmortem hanging

Often a victim is killed

by some other means andthen hanged to simulate a

suicidal death.


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As in case ofhomicidal hanging,

there will be evidence ofdragging of the body on the

ground and friction at the point

of suspension of the ligaturematerial, as the ligature is first

tied around the neck of the dead

body and then the body is

hanged.


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The unapproachability of the

point of suspension by thevictim, the signs of

disturbance and the evidence

of the actual cause of death,

present on the dead body, are

the other features which makethe fact (post mortem

hanging)clear.


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StrangulationsStrangulationsDefinition in strangulation, the

exchange of air between theatmosphere and the lungs is

prevented by way of constriction ofthe neck by means of a ligaturematerial or by some other means,without suspending the body, wherethe force of constriction is appliedfrom outside and is not the weight ofthe body or the head of the victim.


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Types of strangulationsTypes of strangulations

According to the mode of

causation,strangulations are

of the following types-

1. Strangulation by ligature.

2. Manual strangulation or


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2. Manual strangulation orthrottling. In this form of violent

asphyxiation, the neck iscompressed with fingers. Theupper part of the neck is mostly

affected and th

e pressure isexerted there, against themandible. The neck may be

compressed from th

e front, backor from any side and one or bothhands may be used.

3. Strangulation by means other than a


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3. Strangulation by means other than a

ligature material or hand or limbs.

Strangulation may be caused bycompressing the neck in between two

sticks or rods, by compressing the neck

against the ground or wall by a stick infront, or by pressing the neck on the

ground by foot.


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4. Garrotting . In garrotting, a loop

of a th

in string is th

rown aroundthe neck of the unaware victimfrom his back. Then this ligaturematerial is rapidly twisted with thehelp of two sticks tied at the freeends of the string, so as to constrictthe neck strongly. The unawarevictim is very rapidly asphyxiatedand dies. This is just a variety ofstrangulation by ligature.


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BANSDOLLA is a form

of strangulation in whichthe neck is compressed in

between two bamboo

sticks, one in front and

another on the back, or

with one bamboo stick

against the ground.


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5. Mugging. Strangulation

of the neck by compressing it in

the knee bent or elbow bent.

Table. Difference in postmortemTable. Difference in postmortem


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pp

appearance between hanging andappearance between hanging and

strangulation by ligaturestrangulation by ligatureHanging strangulation by ligature

(1)Ligature

mark

(2)Abrasions

and

ecchymosis

(3) Bruising

oblique, encircling the

neck uncompletely, high up

the neck,between the chin

and larynx. The base is

pale, hard and parchment-like.

About the edges of ligature

mark not common.

Of the neck muscles less

common.

transverse, encircle the neck

completely, below the

thyroid cartilage. The base

is soft and reddish.

About the edges of ligature

mark are common.

Of the neck muscles more

common.

Table Difference in postmortemTable Difference in postmortem


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strangulation by ligaturestrangulation by ligatureHanging Strangulation by ligature

(4) Neck

(5)Subcutaneo

us tissues

(6) Hyoid bone

(7) Thyroid

cartilage

(8) Larynx

and trachea

Stretched and elongated.

White, hard and glistening

under the mark..

Fracture may occur

Fracture is less common.

Fracture rare

Not stretched and elongated.

Ecchymosed under the mark.

Fracture is uncommon

Fracture is more common

Fracture may be found

Table Difference in postmortemTable Difference in postmortem


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strangulation by ligaturestrangulation by ligatureHanging Strangulation by ligature

(9)

Emphysematou

s bullae

(10) Carotid

arteries

(11) Face

Not present on the

surface of the lungs.

Horizontal intimal tear

may be seen

Usually pale and

petechiae are notcommon.

Very common on the surface of

the lungs.

Horizontal intimal tear is rare

Congested, livid and marked

with petechiae.


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strangulation by ligaturestrangulation by ligature

Hanging Strangulation by

ligature

(12) Signs of

asphyxia

(13) Tongue

(14) Saliva

External signs less

marked.

Protrusion is less

marked.

Often runs out of mouth

External signs well-marked.

Protrusion is more marked.

Absent


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Medicolegal aspects ofMedicolegal aspects of

strangulationsstrangulations

Strangulations in their facevalue are homicidal in nature.


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Inh

omicidal strangulationby ligatures, anything

which can be twisted, may

be used as ligature material.

The knot may be a half

knot or a full knot or adouble or tripple knot.

Th ill b k f


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There will be marks of

violence, at different otherplaces of the body. The site

will be approachable to

others and there will be

marks of disturbance at the

site.

If the hands of the deceased


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If the hands of the deceased

are in a state of cadavericapasm, then the grip may

show the presence of

foreign scalp hair of torn

fibers of a cloth or a button.

There may be homicidalwounds on the body.

When a person after being


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When a person after being

strangled, is pulled headward

with the free end of the rope,

then the ligature mark, instead

of being circular and continuous,will be like that ofhanging being

oblique and non-continuous.

Suicidal and accidentalstrangulations are not common.

Th ttli f ll ti l


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Throttling, for all practical

purposes, are alwayshomicidal. It is claimedthat accidental throttling

death may occur due tovagal inhibition when one

playfully manipulates orpresses the neck ofhisfriend.

Strangulation caused by other


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Strangulation caused by othermaterials, palmar

strangulation,garrotting andmugging, if diagnosed properly,then must be taken as homicidal

in nature, except in some cases ofhouse collapse and similarcircumstances when a beam like

structure if falls on the neck of alying person, may strangle himto death.

Strang lation like marks ma be


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Strangulation-like marks may befound caused by a necklace or acord round the neck, when theneck swells during the state ofdecomposition. In case of

decomposition, even withoutthese materials around the neck,strangulation may be doubted

due to the fold of the skin at theupper part of the neck caused byswelling of the neck.

DROWNINGDROWNING


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DROWNINGDROWNING

Definition . Drowning is a form ofviolent asphyxiation where therespiratory passage is occupied byfluid i.e., water, due to submersionunder water and inhalation of water.To be drowned, it is not necessarythat the whole body should be under

water. Submersion of mouth andnasal openings by any means issufficient for that purpose.

Types of drowningTypes of drowning


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Types of drowningTypes of drowning

Depending on differentcircumstances, effects andfactors, we get the following

types of drowning 1. Dry drowning

2. Wet drowning

(a). Fresh water drowning

(b). Salt water drowning


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3. Shallow water drowning

4. Immersion syndrome

5. Secondary drowning


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1. Dry drowning1. Dry drowning

In about 10% to 20% of deathsdue to drowning no water isfound in the lungs during the

postmortem examination. Theseare the circumstances wheredeath actually occurs due to

submersion or drowning, yet thelungs remain dry or water-free.


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Dry drowning may occur in two

ways.1. During first inhalation of

water, there is severe laryngealspasm which does not allow anywater to enter the lungs though

death

occurs due to asph

yxia dueto laryngeal spasm in acircumstance of drowning.

2 Wh d th


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2. When death occurs

due to vagal inhibitionofheart before

complete submersionof the body under thewater, as it happens incase of immersionsyndrome.

Wet drowning


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Wet drowning

In this variety, the waterenters the lungs. The effects of

water entering th

e lungsdepend on, whether

submersion has occurred in

freshwater or it has occurred

in salt water.

3 Shallow water drowning


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3. Shallow water drowning

alcoholics, epileptics,infants and children and

unconscious persons maydie due to drowning in

shallow water, in a shallow

pit or a drain.

I h ll d i


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In shallow water drowning,

the whole body need not besubmerged. Submersion of

face alone is sufficient tocause drowning if the

mouth and the nose

remains under the water.

4 Immersion syndrome4 Immersion syndrome


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4. Immersion syndrome4. Immersion syndrome

This is a condition which is found intemperate and cold zones. Usually

the young swimmers are the victim.

When they drive in very cold water,they may suffer from vagal

inhibition of the heart and die

sudden death in water, even thoughthey may be good swimmers


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5.Secondary drowning5.Secondary drowning

This is not drowning in the truest sense,but a complication or sequelae ofdrowning. After a few days of recovery

from drowning, the victim may sufferfrom pulmonary infection and edema.Ultimately the person may die due toasphyxia of pulmonary origin. Due to its

etiological background, such adevelopment is termed as secondarydrowning.

Signs of submersion in a dead


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Signs of submersion in a dead

body removed from water 1. When freshly removed from water,

the body and the clothes will be wet.

Irrespective of the time passed afterrecovery of the body from the water,

there will be sand and mud stain on

the body, hair and clothes. Thisfinding is not specific of antemortem

drowning or death due to drowning.


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2. Development of cutis

anserina (goose skin likeappearance of the surface of

the body) is another non-

specific finding which also

does not tell about the

antemortem or post-mortemnature of drowning.

Cutis anserina develops due to


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Cutis anserina develops due tocontraction of the erector pilaemuscles of the skin occuring dueto contract of the body with thecold water. It also occurs in alldead bodies during the state ofrigor mortis of the muscle of theskin. Cutis anserina is not

appreciable when decompositionof the dead body starts.


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3. Retraction of the

scrotum and penis in

males is another non-

specific finding, which

occurs due to

submersion, whether

before or after death.

4.changes in the skin of the palm


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4.changes in the skin of the palmand sole, like that which occurs

in a washer-women is yetanother non-specific sign ofsubmersion of a body under

water for some hours whichhasno relationship specifically withantemortem or postmortem

drowning. The skin of the palmsand soles are bleached,sodden,corrugated and thickened.

5. Presence of mud, sand , gravel


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and weed in the hand, in a state

of cadaveric spasm is one of theconfirmatory signs of death due

to drowning, because th

ecadaveric spasm of the hands

indicate the last work of the

person whichhe performedduring the process ofhis death.

Presence of sand weed etc


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Presence of sand, weed etc.

in the hand in that state,indicates that, just before

deathhe tried to grab the

soil at the bottom of the

water. This means that at

the time of deathhe wassubmerged under the water.

6. Presence of copious fine white


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6. Presence of copious fine white

froth near the mouth and the nasal

opening is another vital finding in

a case of death due to drowning. It

occurs due to th

e ch

urning effectof the air in the alveoli the water

inhaled and the mucus secretion

from the respiratory tract wall.The churning effect results from

the violent effort for respiration.

Another feature of this frothing is


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Another feature of this frothing is

th

at, it continues to come out for aconsiderable period, even if wipedout again and again. Continuousfrothing is a very very strongfinding in support of death due todrowning but is not absolutelyconfirmatory, as it may occur inthose cases where death is precededby pulmonary edema.

7. Presence of sand and mud


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7. Presence of sand and mudin the nail beds, though not inthe tight grip of cadavericspasm, is another important

finding in support ofantemortem drowning andbears weight in this respect,

though not as forceful as thecadaveric spasm.

8 Suffused and congested


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8. Suffused and congested

conjunctiva is anotherexternal finding of

antemortem drowning

which also carry

reasonable weight towards

antemortem phenomenonof the drowning.


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9. Distribution ofpostmortem staining in abody removed from water

is somewhat differentthan in other dead bodies

and is usually found overthe head, face and neck.

10 S d d d


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10. Sand and mud

may be present inside

the mouth cavity and

the nose.

11 A dead body


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11. A dead body

recovered from a pondor river may bear post

mortem injury due toeating by fish or otheraquatic animals or dueto impact with someprojecting substances.

I t l fi diI t l fi di


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Internal findingsInternal findings--

1. The mouth cavity

will show presence ofsand, mud etc.which are

not of much significance.

2 Sand mud or weed


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2. Sand, mud or weed

may be present in theesophagus which is also

not very muchsignificant in support of

death due to drowning.

3 The lumen of the larynx


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3. The lumen of the larynx,

trachea, bronchus andbronchioles show presence

of fine forth mixed with

sand and mud. This is a

very important sign of



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4.Presence of sand and

mud in the lower

respiratory tract is more

important than their

presence in the upper

respiratory tract.


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5. The lungs are voluminous,

edematous, have balloon likeappearance with marks ofindentation over the surface

by ribs. The lungs pit onpressure. When incised, thecut surfaces ooze frothy thinfluid blood.(aqueousemphysema)


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5. The stomach may show

presence of water, sand, mudand weed.

6. Presence of water, sand etc.


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,in the upper part of the

intestine is diagnostic of deathdue to drowning, becausepassing of these substancesthrough the pylorus needsantemortem process of

peristaltic movement andopening of the pyloricsphincter.

7 The blood is thick in


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7. The blood is thick in

case of death due todrowning in salt water,

and is thin due tohaemolysis in case of

drowning in fresh water.

8. Laboratory findings8. Laboratory findings--


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(a). Detection of diatoms in

some remote organs and

tissues including brain andbone marrow. This is one of

the most dependable signs of

death due to drowning but

there are fallacies.

(b). Blood chemistry: According


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( ) y g

to Gettler, in case of fresh water

drowning, haemodilution occurs

in the right side chambers of the

heart early and for t

his t

he

chloride value of the blood on the

right side chambers may come

down to the 50% of the normalvalue.

Conversely, in salt water


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drowning, there is

haemoconcentration whichaffects the left side chambersof the heart first and as aresult there is increase in thelevel of chloride in the blood

of th

e left side ch

ambers ofthe heart by 30% to 40%.


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. Microscopic changes in

the blood: In fresh waterdrowning there is both

haemodilution andhaemolysis which leads toboth absolute and relative

low count of the R.B.C.


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In salt water drowning,

there is

haemoconcentration which

causes relative increase inthe R.B.C. count. The

R.B.C.s shrink and appearcrenated.

O SO S


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DIATOMSDIATOMS--

These are unicellular algae

whichhave inert silicon coating

around them. These are presentin all natural water sources,

more abundantly in pond water

or in a lagoon, or where thewater is stagnant.

Th l f t i


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They are less frequent in

streams or in rivers where

the water is frequently

polluted by chemicals andindustrial refuse.

When a drowning person inhales


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water and when the alveoli get

distended with water and air, thealveolar walls may get rupturedexposing the capillaries which

are also ruptured along with.The water from the alveolar sacsalong with diatoms it contains,

enters the circulation and arecarried to distant organs andtissues.

Hence, in a body removed from


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water, if diatoms can be

demonstrated in the tissues of somedistant organs(distant from the lungs

and the body surface, to exclude the

chance of contamination of the tissueby surface diatoms), then it goes

strongly in support of death due to

drowning. There are of coursecertain fallacies of the presence of

diatoms in the tissue.

Test for presence ofTest for presence of

didi


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diatomsdiatoms

1. By histological examinationdiatoms can be demonstrated in

th

e lungs or rarely in some oth

ertissue, provide that plenty ofdiatoms were present in the

submerging water and a goodnumber of them entered in thecirculation.

2. Diatoms can be


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demonstrated,alternatively andcomparatively moreeasily, by acid digestionof the bone marrow,

brain or tissue fromother organs.

Value and fallacy of diatom


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y

testAlong with test of tissue

for diatoms, a sample of th

ewater from which the body

has been recovered, should

be subjected to control test.

If similar type of diatoms are not


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ypavailable in both the test sampleof the tissue and the sample ofwater for control test or ifdiatom is only present in thetissue then it can be concludethat diatom entered the bodytissue of the victim during theusual process of drinking waterwhich contained diatoms.

On the other hand


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On the other hand,

diatoms may not be

observed in the tissue,

even if drowning wasantemortem and the

water contained diatom.

If diatoms are present in


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both test sample of tissueand control sample ofwater, then it is strongly

presumed that drowningwas antemortem in natureand occurred in that water.But still it is not conclusivein all cases.


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Even if the drowning was not

antemortem in nature, similar

diatom may be present in both

the test sample and the controlsample, if the victim was

habituated to drink water from

the same source during his/herlife.

This is because when a person


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This is because when a person

drinks water a little of thewater may trickle down the

larynx and trachea etc. and

may reach the lungs bed and

enter the circulation through

some weak point of thealveolar walls.

In spite of chances of


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fallacy, if similardiatoms are available,both in the tissue andthe water then, that actsas a strong evidence of


Medicolegal aspects of


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g p f

drowning or submersion of abody in water or questions

which arise after removal ofa dead body from water. The

following medicolegal

questions may arise in

connection with such a case:

1. Whether drowning wasantemortem or postmortem


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antemortem or postmortem.

2. If drowning was antemortemwhat was the precise cause ofdeath?

3. What was the nature ofdrowning, suicidal, homicidal oraccidental?

4. What is the time of death andwhen did the submersion occur?

5. Was any other offenceinvolved in the case?


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involved in the case?

6. If the body is unidentified thenestablishment of the identitybecomes an important step of

investigation.7. If the body has been recovered

from a river, then it is necessary

to know the actual place ofdrowning.

1.Whether drowning was


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antemortem or postmortem

Of all the postmortemfindings available in a dead body

recovered from water, only someexternal and internal findingsand some laboratory findingsfocus light on whether drowningwas antemortem or postmortem.These are-

(a). Cadaveric spasm of theh d i h f


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hands with presence ofsand,mud,weed etc.in the grip.

(B). Copious, white fine froth

through the nose and mouth.( c). Presence of similar froth

along with sand, mud etc., in

the lumen of the whole of therespiratory tract.

(d). Voluminous lungs, like


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balloons, with indentation

or presence of marks of

ribs on the surface;

discharge of copious frothy

fluide blood from the cut

surface; emphysemaaquosum change;

presence of thin haemolysed


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p y

fluid blood in the spaces at theundersurface of the pleura on the

lower lobes and at the interfaces

of the lobes and absence oftardieus spots are the important

feature of antemortem drowning

deaths.

(e). Presence of water, sand, mud


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(e). Presence of water, sand, mud

and weed in the stomach and theupper part of the small intestine.

(f). Presence of diatoms in the

distant organs or tissue, similar

to those present in the water

wh

ere th

e body of th

e victim wassubmerged.


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(g). Difference in the chloride levels in the

blood of both side chambers of the heart.


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(h). Changes in the blood in addition to

the above, like haemoconcentration,

increased plasma magnesium level,relative increase in the R.B.C. count,

about 40% decrease in the blood volume,

crenated appearance of the R.B.C.s

under the microscope in case of saltwater drowning


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Increase blood volume(even up to

70%)due to haemodilution, haemolysis

with

absolute and relative decrease inR.B.C.count, increased potassium level in

the plasma in case of fresh water

drowning.

In case of dry drowning, it is verydifficult to say if death occurred due


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difficult to say if death occurred due

to drowning, because almost all thereliable signs of death due todrowning including the laboratorytests are those of wet drowning.Hence,in dry drowning,circumstancial evidences becomeimportant to come to the conclusion

whether death was due tosubmersion under water.

Suffocation deathsSuffocation deaths


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Definition :

Suffocation means a group of

conditions of violent asph

yxiation,where passage of air between the

atmosphere and the lungs is

prevented by mech

anical waysother than constriction of neck or

drowning.

Types of suffocationsTypes of suffocations


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Types of suffocationsTypes of suffocations

According to the frequency of

occurrence, suffocations are of the

following types-


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(1). Smothering

Definition - in smothering

respiration is prevented by

the closure of the mouth and

th

e nasal opening.

(2). Traumatic asphyxia


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Definition - in traumaticasphyxia, there is forcefulcompression of the chest

which preventsrespiratory movements ofthe chest wall and also

causes injury to the chestwall.

(3). Choking

D fi iti i h ki


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Definition in chokingthe air passage isoccluded either by some

foreign materials or dueto some pathology orforeign substance in theneighboring structure(e.g.esophagus).

(4). Gagging


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Definition in this type ofviolent asphyxiation, cloth

is pressed inside the

mouth cavity which also

creates pressure over the

posterior wall of thefauces.

Overlying


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Definition in this condition

young individuals (usually

infants or very young children)

die due to asphyxia, when theyget compressed under the body

of an intoxicated adult bed

partner. This is purely

23475424 Violent Asphyxial Deaths

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Transcript of 23475424 Violent Asphyxial Deaths