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 MECHANICAL Asphyxia-
(Part1: General features of asphyxia, hanging &
strangulation )
Asphyxia
 Asphyxia

Greek word implying – “pulse less ness”

or
absence of pulsation .
 Few other definations…..
Hypoxia-
Inadequate supply of oxygen to the tissues (or
impaired cellular utilization of oxygen)
Hypoxemia-
Decreased carriage of oxygen in the arterial
blood
Anoxia-
Absence of oxygen
 Anoxic anoxia Anemic anoxia
Prevention of oxygen from Inability of blood to carry
reaching the lungs sufficient oxygen - low
hemoglobin

Histotoxic anoxia
Stagnant anoxia Oxygen freely available
Circulation impaired - lack but cannot be utilized
of oxygenated blood by tissues egs: cyanide
transported to the poisoning, co2
tissues poisoning etc
Asphyxial Triad
 Other Asphyxial Signs

1. Pulmonary odema
2. Engorgement of right side of heart
3. fluidity of blood
4. Bleeding from ear and nose
1. Cyanosis
Greek word– ‘dark blue’

• Bluish discoloration of
skin, mucous
membrane & of internal
organ
5 g of reduced haemoglobin per 100 ml of
capillary blood.
• parts having abundant capillary & venous
circulation
lips,
tip of nose ,
nail-beds,
ear lobes,
tip of tongue etc.
 2. Increased capillary
permeability(congestion)
oxygen tension capillary dilatation

stasis of blood

fluid exudes in tissue spaces

odema of tissues
 3. Engorgement of right side of heart
& fluidity of blood.

Non-specific phenomena
Due to generalized rise in venous pressure.
Petechial haemorrhages
• Tardieu’s spots
• Bayard’s ecchymosis

• Small pin-head size

collections of blood
• Venular in origin

• d/t acute rise in venous pressure leads to

rupture of thin walled venules. (palpebral,bulbar
& unsupported serous membrane like pleura &
epicardium)

• antemortem & postmortem .

Clinical effects of Asphyxia
 Classification of asphyxia
From medicolegal point-of-view:
1. Mechanical asphyxia
Physical impediments

2. Non-Mechanical asphyxia
Physiological impediments
 2.Non- Mechanical Asphyxia
Exclusion of oxygen
-depletion & replacement by another gas.
-chemical interference with its uptake &
utilization.
- insufficient oxygen in the atmosphere itself.
 Egs….
• High altitude
• inhalation of co
• sewer gases
• pure helium
 Mechanical
asphyxia

Submersion of means other Compression

Compression of
neck
mouth & nostrils than & mechanical
under fluid compression at fixation of
neck & chest( Crush
drowning asphyxia
Hanging Strangulations Drowning (Suffocation) /traumatic
asphyxia)
 Hanging
voilent asphyxial deaths due to compression of
the neck, as a result of suspension of the body
by means of ligature in such a manner ,that
the whole weight of the body or part of the
body weight acts as a constricting force.
 Ligature
Any material used for compressing neck with
some extra length for suspension.

Eg…rope, dhoti, saree, chunni, turban, belt,

gown, neck-tie etc.
 Classification of hanging
A. On basis of position of the knot
i. Typical Hanging
ii. Atypical Hanging

B. On the basis of degree of suspension

i.Complete Hanging
ii. Incomplete/ partial Hanging
 ON BASIS OF POSITION OF KNOT
Typical hanging- Atypical hanging
point of suspension point of suspension is
placed centrally over at any other position
the occiput , .
i.e Commonest location is
the knot is at the nape ---mastoid process or
of the neck on the angle of mandible or
back. under chin
A B C
Atypical hanging
ON BASIS OF DEGREE OF SUSPENSION
Complete hanging Incomplete or partial
hanging
body is fully
suspended Only a part of the body
weight act as
& no part of the body constricting force.
touches the ground .
i.e hanging in lying ,
sitting or kneeling
constricting force = position.
whole weight of the Constricting force =
body Weight of head
Complete Hanging
 Force required for compression

(4-5 kgs)

(2kg) (15kgs)

Vertebral arteries=30kgs
 Causes of death
1. Asphyxia
2. Venous congestion
3. Combined asphyxia & venous congestion***
4. Cerebral anemia
5. Reflex vagal inhibition
6. Fracture/dislocation of cervical vetebrae-
seen in judicial hanging
 Fatal period
Depends on mechanism of death

Immediate –if cervical vertebrae is fractured

Rapid –asphyxia
Least rapid- if coma is responsible

Usual period is 3-5 mins extending to 5-8 mins

 Symptoms
• Only few survivors(near hanging)
• Flashes of light & hissing sound in ears
• Sensation of warmth & tingling
• Feeling of stupefaction ,
• intense mental confusion
• incoherent thoughts & feeling of
helplessness.
• unconciousness & convulsions
 Signs
• Face congested & red
• Cyanosis marked
• Neck veins of the temple congested
• Dribbling of saliva from angle of mouth
 Autopsy findings

• Photography of the victim along with ligature

(if present) is recommended.
 Imp. point
After describing the manner of application of
ligature, condition, type & location of the knot

ligature material to be removed by cutting it

away from knot & both ends secured, then
properly labelled, sealed & handed over to
police.
Ligatures
 EXTERNAL FINDINGS
General External Findings
Face pale Face congested
• vagal inhibition or • asphyxia
injury • Venous congestion
to spinal cord

• Complete hanging • Incomplete hanging

Eyes
closed or partly
+ protruding ,
petechial haemorrhages
(subconjunctival region).

Le facies Sympathique -----

Eye on same side remain open
with dilated pupil.
Petechial haemorrhages
Tongue
Swollen & blue , forced in
between teeth , bloody
froth seen

Saliva
Dribbling from angle of mouth
( opposite to knot)
** absent-vagal inhibition ,
cervical fracture
Neck
Stretch & elongated in prolonged & complete
hanging

Hands
Clenched,
sometimes shows presence of fibres or any
other material involved in hanging(cadaveric
spasm )
Genitals
male- Engorgement of penis(d/t hypostasis) &
discharge of semen
Female-engorgement of vagina, blood-stained
fluid discharge.
- Urine & faeces may escape d/t relaxation of
sphincters
Postmortem staining-
glove & stocking

Cyanosis-
Deep cyanosis seen in the lips, fingertips, nail-
bed, tip of the nose & ear lobules.
 Local external findings

The principal external mark

Ligature mark on neck

Type of pressure abrasion

• single
• high up above the thyroid
cartilage
• grooves & furrows( fresh-
inconspicous & yellow
after sometimes-
dark brown & parchment like).
• oblique directed
backwards & upwards
• Incompletely encircle the
neck **
• Width of ligature either
equal or less than width
of ligature material
Inverted V-shaped at neck
Appearance of ligature depends upon :
1. Composition of ligature material:
2. Period of suspension
3. Degree of suspension
4. Weight of the body
5. Tightness of ligature
6. Single or multiple turn
7. Intervening material
8. Slipping of ligature material
9. Design of ligature material
Hanging by a broad ligature (Dupatta)
 INTERNAL FINDINGS
First to dissect head then thorax**.
Y-shaped incission is preferred **.
 General internal findings

Lungs- congested, distended, emphysematous

with plenty of tardieu spots subpleurally
Brain – congested, multiple tardieu spots
Heart- right full left empty.
Viscera- all abdominal organs congested
Blood- fluid & purplish.
b. Local internal findings.
Layer by layer dissection of skin

Subcutaneous tissue under ligature mark(in

prolonged hanging)—dry, white & glistening

.
Platysma & SCM ms. Ruptured only when
sufficient voilence has been used.

In some case cornua of thyroid cartilage is

fractured(old)

Epiglottis is congested, mucous membrane of

trachea congested
 Medicolegal aspects
1. Suicidal hanging:
Hanging is considered to be suicidal unless the
circumstancial & other evidences are strong enough
to rebutt the presumption

2. Accidental hanging:
Common can occur accidentally while at work , or
playing , showing some performance in circus. Etc.
Auto-erotic hanging is an eg. Of accidental hanging
Auto-erotic hanging

Asphyxiaphilia
Hypoxiphilia
Kotzwarism
Masochistic hanging
Sexual asphyxia
• Erotic fantasies deliberately induced by
cerebral ischaemia– Common in adolescent
males
Scanned with CamScanner
• Masochism
• Transvestism
• Voyerism

• MLI- if misdiagnosed as suicide

 3. Homicidal hanging
Rare only seen in children , old or person
incapacitated with drugs or alcohol.

Lynching
Judicial hanging.
 Lynching

• m/c in North America– where a black used to

be lynched by white angry mob.
• Word’ lynch’ –
• Extrajudicial execution
• To put person to death by mob action for an
alleged offence without a legal trial.
 Judicial hanging

• Justifiable homicide
• Atypical hanging (Knot is submental or sub
aural.
• complete hanging & drop at least 2m .
• Fracture of cervical column(m/c C2 -C3
fracture & some C3-C4 very rarely C1-C2)
• Compresses or lacerates the spinal cord –
instantaneous death.
• Congestive changes absent in autopsy
• pharynx is injured, intima of carotid arteries
show transverse tears and separation of pons
& medulla
Features A/M hanging P/M hanging
1. Salivary dribbling marks +ve -ve
2. Fecal & urinary stains +/- -ve
3. Ligature marks
• Direction Oblique Horizontal
• Continuity Non-continous Continous
• Level in neck Above thyroid At or below thyroid
• Parchmentization +nt -ve
• Vital reactions +nt -ve
4. Knot Single/simple ,on one Multiple/on occiput
side of neck or chin
5. p/m staining
• Above ligature mark +nt -ve
• Glove & stocking like +nt -ve
6.Evidence of injury-
• Self-inflicted +nt -ve
• Struggle -nt +ve
7. Elongation of neck +nt -nt
8. Cyanosis Deeply +ve -nt/faintly +nt
9. Emphysematous bullae on lungs -nt +nt
10. Point of suspension Compatible with self Not so
suspension.
STRANGULATION
 Defination…..

Voilent 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.
 Types
1. Ligature strangulation
2. Throttling/manual strangulation /palmar
strangulation
3. Mugging
4. Bansdola
5. Garroting
6. Accidental strangulation.
 LIGATURE STRANGULATION.

Voilent form of asphyxial death which results

from constricting the neck by means of
ligature without suspending the body.
THROTTLING /MANUAL STR./PALMAR STR.

Constriction produced by pressure by the fingers

& palm upon the throat.
* Hyoid bone # commonly seen (old age)
(inward compression #)
 BANSDOLA
Practiced in N-India

Strong bamboos or lathi placed across the

throat end another across the back of the
neck.
 GAROTTING

In 1862 in India , m/c used by ‘thugs’.

A method used for judicial execution in Spain ,

Portugal, turkey.
Garotte machine- works on technique
of spanish windlash,
 MUGGING
Holding neck of victim
in the bend of elbow
or knee of the
assailant.

Also known as choke

hold or arms lock
 ACCIDENTAL STRANGULATION

• Entanglement of scarf, neck-tie in any running

machinery
• Strangulation by umbilical cord
• Children while playing
 Symptoms
Complete occlusion of Windpipe not
windpipe completely closed
Face cyanosed,
Powerless to call for
assistance, becomes bleeding from mouth
insensible & may die ,nostrils & ears ,
instantly. hands clenched ,
. convulsions precedes
death
 Cause of death

1. Asphyxia
2. Venous congestion
3. Combined asphyxia & venous congestion
4. Cerebral anemia
5. Reflex Vagal inhibition- m/c
6. Fracture/dislocation of cervical vertebrae-
very rare.
 Local external findings:
(constriction of neck by ligature)
1.low down below thyroid
cartilage
2. horizontal**,
completely encircle
the neck
3. marks may be multiple
& also more than 1
firm knot
**mark oblique-
when victim dragged by cord after he is
strangled in a recumbent posture
Lig. Applied from behind (garroting)
4.Base of mark- grooved/
furrowed, soft & reddish
5. Margins ecchymosed
6. Adjacent to skin- abrasions
& ecchymosis
7. Minutes fibres & other
material from ligature can
be present deeply
embedded in the ligature
mark**

**lifted with transparent

adhesive tapes.
 Throttling
Marks found on either side of
windpipe.

Thumb mark-usually high &

wider on one side
Finger marks- situated on opp.
Side
obliquely downwards &
outwards
one below the other
disc shaped bruises 1-2cm in dia.

k/a six penny bruises (initially red

,later on dark,dry &
parchmentised)
Finger nail marks- linear /
cresentric

When both hands used –

all fingers on one side &
thumb marks on
otherside.
Abrasion & bruises on the mouth, nose, cheeks,
forehead, lower jaw or any other body part --- sign of
struggle
c. Bansdola :

Bruises in middle of front of neck across the windpipe

Width of bruise corresponds to the width of subs.

Used.

Similar marks on nape of neck – if 2 sticks are used.

 General external findings
1. Face puffy & cyanosed with
petechiae
2. Eyes, prominent , bulging,
conjuntiva suffused, &
petechiae present.
3. Pupils dilated
4. Lips cyanosed
5. Bloody froth from mouth &
nostrils
6. Frank blood from
mouth,nose,ears---
indicating great voilence.
7. Tongue –
swollen,bruised,protuding,ocassionally bitten
by teeth.
8. Hands usually clenched
9. Genital organs congested, discharge of urine ,
feces & seminal fluid.
10. p/m lividity – on dependent parts
rigor mortis- sets in early.
Internal appearance:

Extravasation of blood into s.c tissues under

ligature mark or finger marks & adjacent
muscles of neck.
Sometimes laceration of the sheath of carotid
arteries & internal coats with effusion of blood
• Fracture of greater
cornua of hyoid bone &
also superior cornua of
thyroid (rare)----
common in old age & in
throttling.
4. Larynx & trachea congested , contains frothy
mucus

5. Cartilage of larynx & trachea rings may be #

when great force used.
6. Lungs :
congested , haemorrhagic patches +nt
petechiae +nt
on section- dark fluid blood
emphysematous bullae on surface (d/t
over distension & rupture of inter-alveolar
spaces)
7.Heart : Rt. Full Lf.- empty
8. Organs-congested
9. Brain- congested with petechial
haemorrhages
 Medicolegal importance

1. Always homicidal unless & until proved

* signs of struggle both at the scene & on victims

body

* evidence of sexual assualt +nt

2.Suicidal – rare
i. lig.around neck once or twice or > & finally tying of
free ends
ii. spanish windlash technique- single turn ligature
around neck, small piece of rod/stick passed
through ligature & twisted as lever.
iii. running noose free end winded around the rt.
Hand or weight is put or thrown over bed end
Self strangulation by hands not possible.
3. Accidental:

• Entanglement of scarf, neck-tie in any running

machinery
• Strangulation by umbilical cord
• Children while playing
4. Pseudo-strangulations-
Seen in fat obese person or children – where neck fold
are present . & due to pm lividity , it appears like
ligature mark.
Also seen in person wearing tight collar etc.

Dignosed- by dissection
p/m lividity in fat obese person after
putrefaction sets in.
Hanging Strangulation
Feature Hanging strangulation
1.Cause Suicidal Homicidal
2.Face Pale, petechiae rare Congested,livid ,petechiae +
3.Saliva Saliva dribbling marks +nt on -nt
angle of mouth , chin & chest
4.Bleeding Nose ,mouth & ears –rare +nt
5.ext. signs of asphyxia Less marked More marked

6.neck- i. length Elongated & stretched Not so

ii.ligature mark Oblique, non-continous,high up Horizontal,continous,low
in the neck,Base-hard,yellow & down, base of groove soft &
parchment like,Abrasion& reddish,abrasion &ecchy.
ecchymosis around lig. Mark rare around lig mark +
iii. S.c White , hard, & glistening. Ecchymosed ,torned
iv. Neck ms. Injury rare Injury common
7. Carotid a. rupture, # ofRare (only in judicial hanging) Commonly seen
larynx & trachea & # # of thyroid # of hyoid
dislocation of cervical
vetebrae.
8. Signs of struggle. Not seen +nt usually
9. Emphysematous bullae -nt +nt
10. Signs of sexual -nt Sometimes +nt
assault.