Strangulation


 It’s a form of asphyxial death caused by
 the constriction of neck by ligature or
 by any means
 without suspending the body.
 By ligature.
 Manual strangulation
Or
 Throttling.
 Causes of Death

 Asphyxia
 Anoxia
 Congestion
 Vagal inhibition
 Combination of any of the
above
 Autopsy Findings

 Externally-usually those of asphyxia.
 Ligature Mark

 Well defined, slightly
depressed at any level on the
neck-usually at the level of
thyroid cartilage or below.

 Encircles the neck

transversely-more prominently
at the front than the sides.
 Ligature (cont..)

 It may be interrupted by
clothing or victims finger or
ornaments.

 May be oblique if the victim is

sitting and assailant is
standing.
 Fold marks on neck

 Seen in infants and children with short
neck.

 Tight collar may produce a mark similar.

 Examination of ligature-for
 Blood,
 Fragments of epidermis,
 hair or other substances.
 Sign of struggle.
 Internal

 Laceration of muscles.
 Hyoid bone fracture usually not
seen.
 Fracture thyroid is more common.
 Fracture of cricoid is rare but if
pressure is used may be seen.
 Organs are congested.
Medico-Legal Aspects

Suicide
 Its rare but possible cord may be
used and twisted with a stick.
 Congestion is very prominent
because of slow obstruction.
 Continued

Homicide
 Common form of murder-associated
with sexual offences.
 Infanticide-by strangulation with
umbilical cord.
 Evidence of struggle, surprise attack,
under intoxication, weak personality.
 Common methods of Homicidal
strangulation

Throttling
 Compression of neck by hands.
 Bruises produced by tips of
fingers.
 More force is used than is
necessary.
 Marks of thumb on one side and
fingers on other side.
 Continued

 Pressure of nails produce cresentic
marks with or without incision,
concavities follow anatomical
shape of the nail margin and nails
with straight border give
unpredictable results.
 Hyoid bone fracture and bruising
can be seen with careful neck
dissection.
 Continued

Bansdola
 Practiced in north India.
 Bamboo or sticks are used.
Garrotting
 Victim is attacked from behind without
warning,ligature thrown round the neck and
tightened.
Mugging
 Strangulation by holding the neck in the bend
of the elbow/knee.
 Continued

Accidental
strangulation
 Children may get entangled during play.
 Infants are strangled in their cots,
 When the neck is caught in sidebars.
 Alcoholics, epileptics and insane persons are
susceptible for accidental strangulation.
Suffocation

 Suffocation

Suffocation
 It’s a form of asphyxia caused by mechanical
obstruction to air passage due to causes other
than constriction of the neck.

Smothering
 It’s a form of asphyxia caused by closure of
external respiratory passage either by hand or
other means or introduction of foreign
materials like cloth or paper etc.
 Medico-Legal importance

Suicide

 Not possible by hands.
 Possible by means of tying polythene bag over
the head/burring the face in mattress.
 Creating suffocation in the closed and non-
ventilated rooms.
Homicidal
 Possible when victim is incapacitated by
drugs/alcohol can be smothered.
 Continued

Accidental
 Infants/children by weight of clothes
etc.
 While playing with plastic bags.
 In adults-plastic bags for auto erotic
exercise as partial anoxia enhances
sexual sensation.
 Mothers-during breast feeding.
 Postmortem findings.


 Asphyxial signs.

 Abrasions & bruises around the

lips and cheeks.

 Injuries on inner side of lips.

 
Gagging
 It results from closure of mouth by a cloth or
similar material causing obstruction to the
larynx or force the base of the tongue against
the fauces.

Overlying
 Compression of chest to prevent breathing.
 Mother infants.
 Forceful pressure over the chest.
 
Burking
 Method of homicidal smothering.
 Practiced by “Burk” and “Hare”

Chocking
 Caused by obstruction within air passage.
 Usually accidental.
 From diseases-Diphtheria ,laryngeal spasm,
infection etc.
 Hyoid bone Fracture

 Inward fracture.
 Antero-posterior fracture.
 Avulsion fracture.
 Inward fracture


 Seen in throttling-main force is an inward
compression on the hyoid bone.

 Fingers squeeze the greater horns towards

each other , due to which the bone may be
fractured and post fragments displaced
inwards.
 Antero-posterior compression fracture


 In case of hanging, the hyoid bone is forced
directly backwards due to which, the
divergence of greater horns is increased which
may fracture with outward displacement of
the posterior small fragments.

 Ligature strangulation, run over accidents.

 Avulsion fracture

 Very rare and is due to over activity of
neck muscles without direct action or
injury to hyoid bone.

Incidence-
 Hanging 15-20% above 40yrs age.
 Very common in throttling.
 Diagnosis of throttling


 Cutaneous bruising and abrasions.
 Extensive bruising with/without rupture
of neck muscles.
 Engorgement at/above the constriction.
 Fracture of larynx, thyroid cartilage and
hyoid bone.
 Cricoid I almost exclusively fractured in
case of throttling.
 Asphyxial signs.
 Chocking

 Obstruction within the air passages.
 Accidental inhalation of food when the victim
is laughing or crying.
 Vomited material may be inhaled by a person
under the influence of drink or anesthetic
drug.
 Large food bolus, piece of meet seeds or fish,
teeth(loose), marbles in children.
 From diseases-diphtheria, laryngeal edema,
bronchial growths. Hemorrhages.
 Causes of death

 Asphyxia,
 vagal inhibition,
 laryngeal spasm,
 infection.
 Café coronary


 Impaction of food in the sensitive larynx
causes sudden death due to cardiac arrest.

 Healthy intoxicated person in hotel while

eating
 suddenly turns blue,
 coughs violently-collapses and
 dies.
Café coronary(cont..)

 At autopsy a large food bolus seen in
the respiratory tract-larynx obstructing
air passage.
 Signs of chocking are absent because of
high blood alcohol which inhibits the
gag reflex.
 Post-mortem appearance-the foreign
body is embedded in a thick mucus in
the trachea.
 Traumatic Asphyxia

 Its due to respiratory arrest due to mechanical
fixation of chest so that the respiratory
movements are prevented.
 E.g.: Stampede in a theatre or in places where
crowded gatherings are [Link] of earth-coal
mines,tunneling accidents etc.
 Post-mortem appearances


 An intense deep purple red
colour of
 the head,
 neck and
 upper part of chest above the
level of constriction.