Strangulation

Definition: It is a form of violent asphyxial death

caused by constriction of air passage at the neck by
means of a ligature or by any means other than
suspension of the body.
Here the force of constriction is applied from outside
(exogenous in origin) and is not the weight of the
body or the head of the victim.
• Types:
- According to the mode of causation, strangulations
are of following types:
1. Ligature strangulation: When ligature material is
used to compress the neck.
2. Manual strangulation or throttling: When human
fingers, palms or hands are used to compress the
neck.
3. Mugging: Strangulation caused by holding the neck
of the victim in the bend of elbow or knee of the
assailant. It is an attack, usually from behind, and
may leave no external or internal injury mark. It is
also known as chokehold. This hold is not permitted
in wrestling, because of its danger.
4. Bansdola: A bamboo or stick is placed across the
back of the neck and another across the front. Both
the ends are tied with a rope due to which the victim
is squeezed to death. When a foot or knee is placed
across the front of throat & pressed while the victim
is lying on ground, same condition will follow. If a
stick or foot is used, a bruise is seen in the centre,
across the trachea corresponding to the width of the
object used.
5. Garrotting: Strangulation is caused by compression
of the neck by a ligature which is quickly tightened
by twisting it with a lever (rod, stick or ruler) known
as Spanish windlass which results in sudden loss of
consciousness and collapse. Garrotting as a mode of
execution was practiced in Spain, Portugal &Turkey.
An iron collar was tightened by a screw for
strangulation.
6. Strangulation by means other than a ligature
material or by hands or limb.
 1. Ligature Strangulation
• Here the ligature material is tightly tied around the
neck.
• Ligature material: this may be a rope, a napkin, a
handkerchief, a scarf, a saree, a wire, a dupatta, a
belt etc.
• The knot: the knot may be incomplete or half knot
or full or double or multiple.
• Cause of death: it is combined effect of apoplexy &
asphyxia.
1. Asphyxia due to elevation of the larynx and tongue
closing the airway at pharyngeal level.
2. Cerebral anoxia due to venous congestion. It as
alone can rarely cause death
3. Vagal inhibition.
4. Rarely, fracture dislocation of cervical vertebrae.
• Post-mortem Examination:
a. External Findings:
1. Face
i. Face is congested, swollen and cyanosed. Tardieu's
spots are present on the forehead, temples, eyelids
and conjunctiva; more abundant than in hanging.
ii. Eyes: eyes may be partly open and the eyeballs &
tongue are protruded.
 Eyes are prominent, wide open, conjunctiva
congested, pupils dilated, sub-conjunctival
hemorrhage is present.
iii. Lips, fingernails and ear lobules are cyanosed;
postmortem lividity marked on the skin above the
ligature.
iv. Tongue is swollen, dark colored, may protrude out
of mouth and bitten by teeth.
v. Bloodstained frothy fluid and mucus may escape
from mouth and nostrils.
2. Neck: Ligature mark (‘furrow’)
• Ligature mark is a well-defined groove, which is
slightly depressed and of same width as that of
ligature material. Groove may be narrow at parts due
to folding of ligature.
• The ligature mark is at or below the level of the
thyroid cartilage.
• It is circular, continuous, abraded & contused or
sometimes parchmentised.
• The mark of the knot is usually in front but may be
at any place.
• In many cases the ligature material is left around
the neck.
• There may be more than one turn of ligature mark.
It is more prominent when ligature material is tough
& narrow & is left in situ for sometime.
• A very thin wire type ligature material may act as a
cheese cutter & cut superficial tissues.
3. The post mortem staining is deep & prominent.
4. There may be involuntary discharge of urine &
faecal matter.
5. In male, semen ejaculation is there but less
common than hanging.
6. In case of struggle, there may be evidence of
abrasions, fingernail scratch marks, and contusions
7. If the hands are found in the state of cadaveric
spasm then the grip may contain foreign hair, fabric
or buttons belonging to assailant.
b. Internal findings:
1. neck:
• Bruising of the subcutaneous tissue and muscles of
neck, especially underneath the ligature and knot.
There may be bruising or laceration of the sheath of
carotid arteries.
• Injury of hyoid bone is not commonly noticed,
because the level of constriction is well below and
traction on the thyrohyoid ligament is negligible.
• Fracture of thyroid cartilage, one or both the
superior horns may be seen.
• Sub-capsular and interstitial thyroid hemorrhages
are common.
• Fracture of cricoid cartilage is less common.
• Rings of trachea may sustain fracture when
considerable force is applied.
• Bruising of the root of the tongue and floor of the
mouth may occur.
• The mucus membrane of larynx & trachea is
congested with blood stained frothy mucus &
presence of petechial h’gic spots.
• Lymphoid follicles at the base of the tongue and the
palatine tonsils are congested.
• Mucous membrane of the pharynx, pyriform
sinuses, epiglottis and larynx usually show areas of
hemorrhagic infiltration.
• Fracture/dislocation of cervical vertebrae is not
common, may occur in infants if associated with
twisting of the neck.
2. Lungs are congested, edematous with numerous
subpleural petechial hemorrhages.
3. Brain is congested with petechiae in white matter.
4. All other organs are congested.
• The time required to cause the death depends on
the strength of neck muscles & the resistance
offered by them & the amount of force applied &
duration of application of force.
• If the victim doesn’t die then left over unconscious
due to cerebral anoxia.
 2. Throttling or Manual Strangulation
Definition: Asphyxia produced by compression of the
neck by human hands.
• The upper part of neck is mostly affected & the
pressure is exerted there against mandible.
• The neck may be compressed from the front, back
or from any side, one or both hands may be used.
• Cause of death
i. Asphyxia from obstruction of respiration.
ii. Cerebral anoxia from interference with cerebral
circulation.
iii. Vagal inhibition from pressure on carotid nerve
plexus consisting of fibres of vagus, sympathetic &
glossopharyngeal nerves. About half of the deaths
are due to vagal inhibition.
- In throttling, the force applied, resistance offered by
the neck musculature, the site of application of
force & its duration affects the process of death.
- Pressure must be applied for 2 min or more to cause
death.
• Post mortem Examination:
a. External findings:
- Evidence of constriction of the neck with the help of
 fingers will be in the form of nail scratches & bruises
caused by nails and finger tips.
- When pressure is prolonged, the classical signs of
asphyxia may be seen- cyanosis, edema & congestion of
the face, Tardieu's spot in the eyes and face, and
sometimes bleeding from nose and ears.
- The tips of the fingers produce bruises. They may be
oval or round and 1.5-2 cm in size.
- Multiple abrasions on the neck may also result from
use of victim's hands in an effort to dislodge the
assailant's grip.
- Presence and extent of fingertip bruising & nail scratch
abrasions will tell us Relative position of victim and
1. If the assailant uses single hand from front: Thumb
will be applied on one side & other fingers on
opposite side of neck. Grip from right hand produces
a bruising due to bulb of pressing thumb
over the cornue of hyoid/thyroid on anterolateral
surface of right side of victim's neck and several
fingertip bruising marks and overlying nail scratch
abrasions over left side. Concavities of nail markings &
their direction will indicate the relative position of
victim and assailant.
2. If the assailant uses both hands: evidence of
pressure of thumb mark of one hand and finger
marks of other hand are usually found on either side
3. Attacked from back/ from one side: according to
the position of the fingers the position of bruises
and abrasion vary.
• Because of struggle and resistance, marks of
bruising and abrasions may be found over the face,
nostrils, lips, chin, cheeks, forehead and lower jaw
of the victim. These can also be caused in an effort
to stop the victim from shouting or crying for help.
b. Internal findings:
i. Extravasation of blood in subcutaneous tissues
underneath the external marks of bruising &
abrasions is the most significant internal sign.
ii. Inward compression fracture of either or both side of
cornu of hyoid bone is the most diagnostic finding of
throttling
iii. Fracture of superior horns of thyroid cartilage is
common, though both horns do not get fractured
Simultaneously.
iv. Tear/laceration of platysma or sternomastoid
muscles may be seen.
v. Congestion & Tardieu’s spots under the mucous
membrane of larynx, epiglottis, pharynx, & peritonsillar
region.
vi. The oesophagus is compressed against the body of
cervical vertebrae, the post. Wall of oesophagus may
vii. Lungs are congested. Emphysematous, multiple
Tardieu’s spots under pleura.
viii. Other organs are congested. Brain & meninges are
congested
ix. Blood is dark.
• Medico legal aspect of throttling:
1. Self-throttling is impossible, because as soon as
unconsciousness supervenes, the hand will relax and
the grip will be released.
2. Homicidal throttling: Common mode of homicide as the
hand is immediately available and method of choice in
infants. Victims are usually infants, women. In adults,
signs of struggle are usually present,
Strangulation other than ligature/throttling
- Strangulation caused by compressing the neck in
between two sticks or rods or by compressing neck
against ground by foot.
- Bansdolla is a form of strangulation in which neck is
compressed in between two bamboo sticks, one in
front & another on back or with on one bamboo
stick against ground.
• Post mortem findings:
a. External findings:
- Gross contusion & abrasion of the part which are
compressed by stick or foot.
- If the victim is strangled in supine position, then
extensive bruises or abrasions may be found on
back.
b. Internal findings:
- There will be gross extravasation of blood with
contusion & even laceration of soft tissue of neck.
- Fracture of thyroid cartilage & tracheal rings.
- Contusion of larynx, trachea & esophagus.
- Fracture dislocation of cervical vertebrae &
laceration of spinal cord & its meninges.
 Garrotting
• Strangulation is caused by compression of the neck of
unaware victim by a thin string which is quickly
tightened by twisting it with a lever (rod, stick or
ruler) known as Spanish windlass which results in
sudden loss of consciousness and collapse.
• Garrotting as a mode of execution was practiced in
Spain, Portugal and Turkey. An iron collar was
tightened by a screw for strangulation.
• In India this method was used in lonely places to kill
or rob the people by Thagis. The ligature material is
thrown on victim then rapidly twisted with the help of
two sticks tied at the end of strings. The unaware
 Mugging
• Strangulation caused by holding the neck of the victim in
the bend of elbow or knee of the assailant. It is an attack,
usually from behind, and may leave no external or
internal injury mark.
• It is also known as chokehold. This hold is not permitted
in wrestling, because of its danger.
• Externally:
- Signs of struggle, signs of asphyxia.
- No any signs of violence or strangulation on neck due to
soft muscles of arm or leg.
• Internally:
- In some case fracture dislocation of cervical vertebra,
• Medico legal aspect of strangulation:
1. Strangulation is commonly homicidal in nature with
the any ligature material, half/full, single/ multiple
knots. Marks of violence. Hands may be found in the
state of cadaveric spasm. Scene of crime is disturbed.
2. Suicidal strangulation is not common. But following
methods can be followed:
a. Person gives multiple turns of ligature till he
becomes unconscious.
b. Ties multiple knots
c. By twisting the stick tied to free end of rope.
d. He ties some weight to one end and throw it down.
3. Accidental strangulation:
a. By neck tie fixed with something.
b. Kulis , porters who carry weight on their head with
supportive belt.
c. Cord around neck in foetus.
d. Painful sexual practice (masochism).
e. Children when playing with such material.