Introduction
Asphyxia is a life-threatening
condition caused by a severe lack of oxygen to the body, leading to tissue
damage, unconsciousness, and death if not treated immediately. It is caused by
interference with breathing—such as choking, drowning, strangulation, or
suffocation—resulting in decreased oxygen and increased carbon dioxide in the
blood. Every type of asphyxial death in forensic is discussed below
DEATH FROM ASPHYXIA – HANGING
Definition
Hanging is a form of asphyxial death caused by suspension
of the body by a ligature around the neck, the constricting force being
the weight of the body.
TYPES OF HANGING
1. Based on Body Position
- Complete hanging – Entire body is suspended.
- Partial hanging – Part of the body touches the ground (kneeling, sitting, lying, etc.).➝ Most suicidal cases are actually partial.
2. Based on Knot Position
- Typical
hanging – Knot at occiput (back of neck).
- Atypical
hanging – Knot at side, front, or any other part
of the neck.
3. Based on Manner of Death
- Suicidal
– Most common.
- Homicidal
– Rare, usually associated with signs of struggle.
- Accidental
– Rare (e.g., children, auto-erotic).
MECHANISM OF DEATH IN HANGING
Death occurs due to multiple factors:
- Asphyxia
– Compression of airway.
- Venous
congestion – Jugular vein compression → cerebral hypoxia.
- Vagal
inhibition – Pressure on carotid sinus → cardiac arrest.
- Fracture
of cervical vertebrae – Rare, common only in judicial hanging
(fracture of C2–C3 = Hangman’s fracture).
ANTEMORTEM SIGNS OF HANGING
- Struggle
marks (in suicidal incomplete hangings rarely)
- Cyanosis
- Petechial
hemorrhages
- Congestion
of face
POSTMORTEM FINDINGS IN HANGING
A. External Findings
1. Ligature Mark
- Oblique,
non-continuous, above the level of thyroid cartilage.
- Pale,
parchment-like, dry.
- More
prominent on the opposite side of the knot.
- In
typical hanging, mark runs upward and backward to the occiput.
2. Saliva Dribbling
- Running
down from the mouth, usually on one side.
- Considered
a strongest sign of antemortem hanging.
3. Face Findings
- May be
pale or congested.
- Petechial
hemorrhages may or may not be present.
- Tongue
protrusion is variable.
4. Other External Signs
- Stretched,
elongated neck (rare).
- Abrasions
or bruises around neck (if struggle or movement).
- Dribbling
of urine or feces in some cases.
POSTMORTEM FINDINGS IN HANGING
A. External Findings
1. Ligature Mark
- Oblique,
non-continuous, above the level of thyroid cartilage.
- Pale,
parchment-like, dry.
- More
prominent on the opposite side of the knot.
- In
typical hanging, mark runs upward and backward to the occiput.
2. Saliva Dribbling
- Running
down from the mouth, usually on one side.
- Considered
a strongest sign of antemortem hanging.
3. Face Findings
- May be
pale or congested.
- Petechial
hemorrhages may or may not be present.
- Tongue
protrusion is variable.
4. Other External Signs
- Stretched,
elongated neck (rare).
- Abrasions
or bruises around neck (if struggle or movement).
- Dribbling
of urine or feces in some cases.
POSTMORTEM FINDINGS IN HANGING
A. External Findings
1. Ligature Mark
- Oblique,
non-continuous, above the level of thyroid cartilage.
- Pale,
parchment-like, dry.
- More
prominent on the opposite side of the knot.
- In
typical hanging, mark runs upward and backward to the occiput.
2. Saliva Dribbling
- Running
down from the mouth, usually on one side.
- Considered
a strongest sign of antemortem hanging.
3. Face Findings
- May be
pale or congested.
- Petechial
hemorrhages may or may not be present.
- Tongue
protrusion is variable.
4. Other External Signs
- Stretched,
elongated neck (rare).
- Abrasions
or bruises around neck (if struggle or movement).
- Dribbling
of urine or feces in some cases.
MEDICO-LEGAL ASPECTS
- Hanging
is usually suicidal.
- Assess
for any signs of struggle, intoxication, or homicide.
- Ligature
must be preserved for laboratory and pattern comparison.
- Inquest
must consider scene examination.
DEATH FROM ASPHYXIA – STRANGULATION
Definition
Strangulation is a form of asphyxial death caused by constriction
of the neck by a ligature, hands, or any other object, without
suspension of the body.
TYPES OF STRANGULATION
1. Ligature Strangulation
Neck compressed by rope, wire, cloth, dupatta, etc.
2. Manual Strangulation (Throttling)
Neck compressed by hands, thumb, fingers, or forearm.
3. Mugging / Garroting
Neck compressed by hook, stick, or knee applied from
behind.
4. Bansdola / Spanish Windlass
Twisting a stick inserted in ligature to increase pressure.
MECHANISM OF DEATH
Death occurs mainly due to:
1. Asphyxia
Compression of airway → obstruction.
2. Venous Congestion
Compression of jugular veins → cerebral hypoxia.
3. Carotid Artery Pressure
Stops blood flow to brain → rapid unconsciousness.
4. Vagal Inhibition
Pressure on carotid sinus → sudden cardiac arrest (seen in
manual strangulation).
ANTEMORTEM SIGNS
- Signs of struggle and resistance common.
- Nail marks, scratches, abrasions.
- Cyanosis, petechiae.
- Frothy discharge in some cases.
POSTMORTEM FINDINGS IN STRANGULATION
A. External Findings
1. Ligature Mark (in ligature strangulation)
- Horizontal,
transverse, completely encircles the neck.
- Located
low on the neck, usually below the thyroid cartilage.
- Not
oblique, unlike hanging.
- Abraded,
reddish, may show patterned imprint of ligature.
2. Injuries on Neck (Manual Strangulation)
- Finger
marks, abrasions.
- Nail
scratches (crescentic).
- Bruises
around mouth, jaw, and chin.
3. Face
- Congested,
cyanosed.
- Marked
petechial hemorrhages in eyelids, conjunctiva.
- Swollen
lips and protruded tongue.
4. Signs of Struggle
- Multiple
abrasions, bruises on body.
- Defence
wounds on hands and forearms.
B. Internal Findings
1. Neck Structures
- Extensive
hemorrhage in neck muscles.
- Fracture
of hyoid bone (common).
- Fracture
of thyroid cartilage.
- Rupture
or tearing of strap muscles → confirms antemortem violence.
2. Airway
- Congested mucosa.
- Blood-stained froth in trachea.
3. Lungs
- Heavy,
congested, oedematous.
- Tardieu’s
spots present.
4. Brain
- Marked
congestion and edema.
DIFFERENTIATING STRANGULATION FROM HANGING
|
Feature |
Hanging |
Strangulation |
|
Ligature mark |
Oblique, above thyroid cartilage |
Horizontal, below thyroid cartilage |
|
Body weight |
Acts as force |
No body weight; external force used |
|
Fracture of hyoid |
Rare (except elderly) |
Common |
|
Internal neck injuries |
Minimal |
Severe, extensive |
|
Dribbling of saliva |
Common |
Rare |
|
Face |
Pale or congested |
Cyanosed, congested |
|
Common manner |
Suicidal |
Homicidal |
MEDICO-LEGAL ASPECTS
- Strangulation
is almost always homicidal.
- accidental
and suicidal cases are extremely rare.
- Presence
of struggle marks, defensive injuries, multiple bruises
strongly support homicide.
- Ligature
must be preserved for pattern comparison.
- Thorough
scene investigation required.
DEATH FROM ASPHYXIA – DROWNING
Definition : Drowning is a form of asphyxial death caused by submersion of the mouth and nose into water, leading to inability to breathe, hypoxia, and death.
TYPES OF DROWNING
1. Wet Drowning
Water enters lungs → most common (80–90%).
2. Dry Drowning
Due to laryngospasm → little or no water enters
lungs.
3. Secondary Drowning
Death occurs hours after rescue due to pulmonary
oedema.
4. Immersion Syndrome (Hydrocution)
Sudden cardiac arrest due to vagal inhibition when a
person jumps into cold water.
5. Near Drowning
Survival after submersion (may later die due to
complications).
MECHANISM OF DEATH
- Asphyxia
(major mechanism)
- Cardiac
arrhythmias due to dilution of electrolytes
- Vagal
inhibition (particularly in cold water)
- Pulmonary
oedema
ANTEMORTEM SIGNS
- Struggle
marks (scratches from aquatic plants)
- Water
swallowing
- Presence
of foreign material in airways (sand, weeds)
- Cyanosis
POSTMORTEM FINDINGS IN DROWNING
A. External Findings
1. Wet Clothes, Mud, Weeds
Indicates death in water or postmortem immersion.
2. Cutis Anserina (Goose Skin)
Due to contraction of tiny muscles around hair follicles.
3. Washerwoman’s Hands and Feet
Wrinkling, sodden, bleached skin due to water absorption
(appears after 30 min – 1 hr).
4. Froth at Mouth and Nostrils
- Fine,
white, persistent froth → characteristic sign.
- If
wiped off, it reappears.
5. Skin Abrasions
Caused by contact with rocks, plants, animals (postmortem or
antemortem).
6. Eyes
- Open
or closed
- Conjunctiva
congested
- Sometimes
fine petechiae
B. Internal Findings
1. Lungs
- Voluminous,
ballooned, emphysematous, overlapping the heart (ballooned lungs).
- Waterlogged,
heavy, edematous.
- Presence
of frothy fluid on sectioning.
- Subpleural
petechiae known as Paltauf’s Hemorrhages.
2. Stomach
- Water
in stomach (as a result of swallowing).
- May
contain sand, weeds, mud.
- Water
may also be found in small intestines.
3. Air Passages
- Froth
and water in trachea and bronchi.
- Presence
of foreign matter (sand/algae).
4. Middle Ear
- Rupture
of tympanic membrane in some cases (pressure).
5. Diatoms
- Diatoms
in bone marrow, brain, and organs support antemortem drowning.
- Used
mainly in freshwater drowning.
6. Blood
- Hemodilution
(in freshwater drowning).
- Increased
magnesium (in seawater drowning).
FRESHWATER VS SEA WATER DROWNING
|
Feature |
Freshwater |
Sea Water |
|
Water movement |
Hypotonic |
Hypertonic |
|
Blood effect |
Hemodilution |
Hemoconcentration |
|
Lung appearance |
Ballooned, overinflated |
Heavy, stiff lungs |
|
Mechanism |
Ventricular fibrillation |
Pulmonary edema |
MEDICO-LEGAL ASPECTS
- Most
cases are accidental.
- Suicidal
drowning occurs, especially in females (jumping into wells/ponds).
- Homicidal
drowning is rare; usually in children, intoxicated, or unconscious
individuals.
- Important to investigate the scene, clothing, injuries, and toxicology.