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.