Details about asphyxia and all types of asphyxial deaths. Details about mechanism of hanging, strangulation, suffocation. Details of traumatic asphyxia. Detailed description of drowning deaths.

1. ASPHYXIA
Dr. Sunil Duchania
MBBS (MAMC), MD (LHMC)
Certification in Medical Negligence in India
Founder- Forensic Extracts
Founder- SABAL Medico legal Consultancy
Former President RDA LHMC, Delhi
Vice-President FORDA, India

2. Asphyxia is a condition caused by interference
with respiration, or due to lack of oxygen in respired
air, due to which the organs and tissues are deprived
of oxygen (together with failure to eliminate CO2),
causing unconsciousness or death.

3. Adelson defined asphyxia as, “the physiological and chemical
state in a living organism in which acute lack of oxygen available
for cell metabolism is associated with inability to eliminate
excess of carbon dioxide”
Some authors also defined asphyxia as “(State) condition of the
body in which the supply of oxygen to the blood and tissues has
been reduced appreciably below minimum critical level for
maintenance of vital functions of the body by any mechanical
interference with respiration”.
The term “Anoxia” means lack of oxygen.
The word asphyxia is from Ancient Greek α-
"without" and sphyxis, "squeeze" (throb of
heart)- Pulselessness

4. Gordon’s Classification of Anoxia
Anoxic Anoxia: Oxygen from the atmosphere cannot get entry into blood. E.g.
Hanging, Strangulation, breathing in contaminated atmosphere etc.
Anaemic Anoxia: Oxygen carrying capacity of the blood is reduced. e.g., carbon
mono oxide poisoning, acute massive haemorrhage etc.
Stagnant Anoxia: where the circulation of blood is impaired so that there is of
oxygenated blood transport to the tissues.eg. Heart failure, shock.
Histotoxic Anoxia: Oxygen although freely available in the bloodstream, cannot
be utilized by the tissues due to defect in enzymatic process.eg. Acute cyanide
poisoning.

5. The normal levels of oxygen in the arterial blood (pO2) with
a 95% saturation of hemoglobin ranges from 90 to 100
mm Hg in a healthy young adult. The same is 65–80
mmHg in above 60 years of age. Hypoxia occurs when PO2
is less than 60 mmHg even though the hemoglobin
is 90% saturated. Severe hypoxia occurs when PO2 is 40
mmHg. Death occurs when PO2 is less than 20 mmHg.

6. Mechanical asphyxia: Air passages blocked mechanically.
Hanging
Strangulation
Suffocation
Entrapment
Smothering
Gagging
Choking
Burking
Overlaying
Traumatic asphyxia
Environmental
Postural or positional
Drowning
.
Classification

7. Pathological: Entry of oxygen in lungs decreased due to
disease of upper respiratory tract or lung. e.g. bronchitis,
acute oedema of glottis, laryngeal spasm.
Toxic: Poisonous substances preventing use of oxygen.
Carbon monoxide poisoning, paralysis of respiratory
centre by opium, barbiturates, strychnine etc.
Environmental: Insufficient oxygen in inspired air. eg.,
enclosed spaces, irrespirable gas in environment as in
sewer gas, high altitude etc.
Traumatic: Bilateral Pneumothorax, pulmonary fat
embolism from fracture of long bones, pulmonary
thrombo-embolism due to injury of lower limb etc.
Iatrogenic: anaesthetic deaths

8. Stage of DYSPNEA: It is due to stimulation of the respiratory center
due to excess of CO2.
Clinical picture: Slight cyanosis.
Stage of CONVULSIONS: - It is due to cerebral irritation. The patients
gives expiratory effort to breathe.
Clinical picture: Cyanosis, hypertension, loss of consciousness, constricted
pupils.
Stage of EXHAUSTION: Finally the person undergoes stage of
exhaustion.
Clinical picture: Loss of consciousness, flaccid muscles & lost reflexes,
deep cyanosis, dilated pupils, irregular breathing (cheyne-stokes
respiration).

9. Death occurs in about 3-5 minutes.
The triad of symptoms of asphyxia are : Congestion,
cyanosis and petechial hemorrhage.
1. Petechial Hemorrhage: Is mainly due to raised
venous pressure, leading to impaired venous return. As a
result of which, there is over distension and rupture of
venules, leading to rupture of the venules. 15 to 30
seconds duration of raised venous pressure is sufficient to
cause petechae. Size of petechae varies from 0.1 to 02
mm and larger size is termed as ecchymosis. It may be
seen anywhere including viscera.

11. Tardieu spots are petechial and purpuric hemorrhages that
develop in areas of dependency secondary to the rupture of degenerating
vessels under the influence of increased pressure from gravity.

12. 2. Cyanosis: Is due to reduced oxygen supply to the tissue.
Cyanosis is a Greek word meaning ‘dark blue’. In order to appreciate
cyanosis, the haemoglobin percentage should be more than 5gm% so
it is not apparent in anaemia. It is the bluish discoloration of the skin,
mucous membrane and internal organs.
3. Congestion and edema: Congestion occurs due to obstructed
venous return and capillo-venous congestion.

14. Causes of asphyxia
✶Obstruction to the air passages due to
hanging, strangulation or throttling.
✶Causes of external respiratory orifices,
as in smothering.
✶Occlusion of the air passages within as in
drowning or laryngeal spasm.
✶Pressure on the chest, as in traumatic
asphyxia

15. ✶Inhalation of irrespirable gases like
carbon monoxide.
✶Spasm of the respiratory muscles, as in
strychnine poisoning.
✶Paralysis of the respiratory center, as by
narcotics and anesthetics.
✶Obstruction to the upper respiratory
passage in cases of angioneurotic
oedema.

16. ✶ Asphyxia
✶
Reduction in o2 tension
Deficient oxygenation in lungs
✶ Capillary dilatation
✶Reduced pulmonary flow
✶ Capillary stasis
✶Diminished venous
return to heart Capillary engorgement
✶ Stasis of blood in organs

17. Mechanical asphyxial deaths or Violent
asphyxial deaths
✶Hanging
✶Strangulation
✶Suffocation
✶Drowning

18. Hanging
✶Hanging is a form of asphyxial death
which is caused by the suspension of
the body by ligature which encircles
the neck, the constricting force being
the weight of the body.

20. Types
✶Complete hanging.
✶Partial hanging.
✶Typical hanging.
✶Atypical hanging.

21. Complete hanging
✶When feet do not touch the ground
and the weight of the body acts as a
constricting force.
Partial hanging
✶When the weight of the head and not
the whole body acts as a constricting
force is known as partial hanging.

25. Typical hanging
✶The ligature is situated in the midline
above the thyroid cartilage and runs
symmetrically upwards on both sides
of the neck to the occipital region.
Atypical hanging
✶Any variation of this standard
position.

27. Ligature
✶Not particular, like
ropes,chains,wire,leather
straps,belts,scarf,dhoti,sarees etc.
✶Its important to match the ligature with
the ligature mark and see if its strong
enough to bear the weight and jerk of the
body.
✶Cut the ligature away from the knot.

28. Symptoms
✶So rapid that they are rarely observed.
✶Flashes of lights before the eyes, ringing
in the ears.
✶Unconsciousness and death.
✶The individual can do nothing to help
himself even if it were possible.
✶Respiration stops before the heart which
may continue for 10-15min.

29. Causes of death
Asphyxia
Ligature forces the tongue up and
occludes air,15kg tension occludes
the trachea.
Cerebral congestion
Obstruction of jugular veins by
compression with 2kg weight tension.

30. Cerebral anoxia
✶Carotid artery occludes with 4-5kgs
tension and vertebral artery with 20kgs
tension.
✶Reflex vagal inhibition.
✶Fracture dislocation of cervical spine t the
level of 2,3,and 4 vertebrae.
✶Combination of any of the above.

31. Postmortem appearance
External appearance.
Internal appearance.
External appearance
-Above the ligature.
-Beneath the ligature.
-Below the ligature.

32. Above the ligature mark
✶Tilt of the head.
✶Protrusion of tongue.
✶Dribbling of saliva.
✶Le Facia Sympathique.
✶Tardieu spots.
✶Congestion of the face.
✶Petecheal haemorrhages.
✶Middle ear haemorrhages.

34. Beneath the ligature
✶Fixed or running noose.
✶Position of the knot.
✶Course of the ligature.
✶Width and multiplicity.
✶Point of suspension.
✶Slipping of ligature.
✶Weight of the body.

38. Below the ligature
✶Postmortem lividity (Glove and
Stocking)
✶Relaxation of sphincters.
✶Injury to legs.(partial hanging)

40. Internal appearance
✶Haemorrhages in the neck.
✶Dry,white and glistening.
✶Rupture of platysma and
sternomastoid.
✶Transverse tear in the intima of
carotid artery.
✶Fracture of hyoid, cricoid and thyroid
cartilages.
✶Congestion of organs.
✶Petechial hemorrhages.

45. Diagnosis
✶Ligature mark around the neck.
✶Presence of abrasions, echymosis
and redness around the ligature
mark.
✶Trickling saliva from the mouth.
✶Echymosis of larynx and trachea.
✶Rupture of intima of carotids.
✶Signs of asphyxia.

46. Medico-Legal Aspects
✶Was the death due to hanging?
✶Whether hanging was suicidal,
homicidal or accidental?
✶Typical oblique,non-continuous,high
up ligature mark.
✶Abrasions and ecchymosis above and
below the ligature mark.
✶Extravasation-tear of the intima of
the carotids.
✶Saliva and signs of asphyxia.

47. Suicidal
✶Usually full suspension.
✶Ligature tied to beam,hook,fan,tree
etc.
✶Suspension without any platform is
unusual in suicide.
✶Occasional nail mark-may be self
inflicted while trying to free
himherself.
✶Suicidal note.

49. Homicidal
✶Extremely rare, except in case of
lynching.
✶Difficult, unless the victim is unconscious
by injury or by drugs.
✶Marks of violence may be seen on the
body.

50. Postmortem
hangingSuspension
✶Person murdered and the dead body
suspended to simulate suicide.
✶Usually the rope is tied first to the neck
and then around the beamhook where
beam shows evidence of rope being pulled
from below upwards.
✶Ligature mark may be produced if the body
is suspended within 2hrs after death.

51. Judicial hanging
✶Drop of 5-7meters.
✶Fracture dislocation at cervical 2-3
or 3-4.
✶Transection of spinal cord.
✶Tear of intima of carotid artery.
✶Injury to pons and medulla

53. The ligature marks of the hanging (in suicide)
usually will be?
a. Oblique, non-continuous, usually above the level of thyroid cartilage
b. Horizontal, continuous, usually at or below the level of thyroid
cartilage
c. Oblique, continuous around the neck, below the thyroid cartilage
d. Horizontal, non-continuous, at the thyroid cartilage

54. During the post-mortem, the neck
cavity is examined at?
a. The beginning
b. The middle
c. The end
d. Any time

55. When a hanging is called typical
hanging, the knot of the rope will be at?
a. Nape of the neck
b. Mastoid process
c. Thyroid cartilage
d. Hyoid bone

56. When the body is suspended on ligature on the
neck, and some of body parts are touching the
ground or other article is termed as?
a. Complete hanging
b. Partial hanging
c. Incomplete hanging
d. Both partial or incomplete hanging

57. In the case of hanging, the knot of ligature may press
the cervical sympathetic ganglia on that side, leads to
the eye on that side may remain open and pupil is
dilated, this feature is known as?
a. Asphyxia syndrome
b. Hanging death syndrome
c. Le Facie sympathique
d. All of these

58. 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.

59. Causes of death
✶Asphyxia
✶Anoxia
✶Congestion
✶Vagal inhibition
✶Combination of any of the above

60. 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.
✶It may be interrupted by clothing or
victims finger or ornaments.
✶May be oblique if the victim is sitting
and assailant is standing.

63. 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.

65. Internal
✶Laceration of muscles.
✶Hyoid bone fracture.
✶Fracture thyroid is more common.
✶Fracture of cricoid is rare, but if
pressure is used may be seen.
✶Organs are congested.

66. Medico-Legal aspects
Suicide
✶Its rare but possible.
✶Cord may be used and twisted with a
stick.
✶Congestion is very prominent

67. Homicide
✶Common form of murder-associated
with sexual offences.
✶Infanticide-by strangulation with
umbilical cord.
✶Evidence of struggle, surprise attack,
under intoxication, weak personality.

68. Common methods of
Homicidal strangulation

69. 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.

71. 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.

72. Bansdola
✶Practiced in north India.
✶Bamboo or sticks are used.
Garroting
✶Victim is attacked from behind
without warning, ligature thrown
round the neck and tightened.

75. Mugging
Strangulation by holding the neck in the bend of the
elbow/knee.

76. 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.

77. Hyoid bone fracture
✶Inward fracture.
✶Antero-posterior fracture.
✶Avulsion fracture.

78. 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.

79. 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.

80. 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.

85. 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.

88. 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.

92. 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.

94. 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.

97. 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.

98. 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.

99. 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.

100. 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.
✶At autopsy a large food bolus seen in the
respiratory tract-larynx obstructing air
passage.

103. 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.

104. 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 there.
✶Fall 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.

105. Traumatic asphyxia, or Perthes's
syndrome, is a medical emergency caused
by an intense compression of the thoracic
cavity, causing venous back-flow from the
right side of the heart into the veins of the
neck and the brain
Exhalation against the closed glottis along with the
traumatic event causes air that cannot escape from
the thoracic cavity.
Instead, the air causes increased venous back-
pressure, which is transferred back to the heart
through the right atrium, to the superior vena cava
and to the head and neck veins and capillaries

107. Sexual asphyxias
✶Partial asphyxia causes cerebral
disturbances with feeling of sexual
gratification.
✶Pressure on carotids/trachea leads to
hallucinations of an erotic nature.
✶Associated with masochism and
transvestitism.
✶Usually can be seen in young males.
✶Place-victims own house-bed/bath room.
✶Padding of neck.

108. ✶Ligature, a running noose, the free end of
which is tied to limb, weight of the body is
used to control the ligature.
✶Naked, pornographic literature etc.
✶Its due to retrograde displacement of
blood from superior venacava into
subclavian veins of the head and neck due
to sudden compression of the chest blood
does not enter the upper limbs due to the
valves.

109. ✶Blood goes into the valve less veins
of the head & neck causing stasis
and engorgement of the vessels and
rupture of the distal venules and
capillaries causing petecheal
hemorrhages.
✶If patient survives-purple colour
gradually disappears within 14-15
days.

111. 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 fluid medium.
✶Complete submersion not necessary,
submersion of nose and mouth is enough.

112. Classification
✶Typical
✶Atypical
Typical drowning
✶Obstruction of air passages and lungs by
inhalation of fluid and is known as “Wet
drowning”.
✶Typical signs are found at autopsy.

113. Atypical drowning
✶Conditions in which there is very little or
no inhalation of water or fluid in the air
passages.
✶Dry drowning.
✶Immersion syndrome(vagal inhibition).
✶Submersion of the unconscious.
✶Secondary drowning syndrome/near-
drowning.

114. Typical drowning
✶Fresh water drowning.
✶Salt water drowning.
Fresh water drowning
✶Water cross the alveolar membrane into the
circulation.
✶Produces marked hypervolemia.
✶Red cells swell or burst-hemolysis-liberation of
potassium.
✶Circulation will suffer 50% dilution within 2-3
min.

115. ✶The heart is submitted to the insult of
anoxia, hypervolemia, potassium excess
and sodium deficit.
✶Ventricular fibrillation due to anoxia and
potassium excess within 4-5 min.
Salt water drowning
✶Marked hyper tonicity of the inhaled
water cause loss of fluid from circulation
into the lungs-fulminating pulmonary
edema and progressive hypervolemia.
✶Circulatory shock and cardiac arrest.

116. Atypical drowning
Dry drowning
✶Intense laryngeal spasm due to entry of
water into nasopharynx and larynx.
✶Very little water enters into lungs.
✶Best case for resuscitation.
Immersion syndrome
✶Due to sudden impact with very cold
water and causes death from cardiac
arrest.
✶Victims are young people with excess of
alcohol.

117. ✶It also result from falling or diving with feet or
duck diving by the inexperienced swimmers.
✶Loss of consciousness instantaneous and death
occurs in few minutes.
✶Autopsy disclose non of the usual signs of
drowning.
Submersion of the unconscious
✶Commonly seen if the victim is suffering from
disease like epilepsy, heart diseases and is
drunk or head injury during fall.

118. ✶Ballooning of the lungs may be absent.
✶Formation of the foam my be negligible.
✶Complete picture of death by drowning is
not found.
Secondary drowning/near-drowning
✶Its mainly due to infection from
inhalation of contaminated water.
✶Lung complications,oxygen lack,tired
heart muscle and cerebral edema.

119. ✶A victim look alert and breathing, may
respond to initial resuscitation.
✶Late stage-respiratory distress,
hypotension and cardiac arrhythmia may
cause death.

120. Vicious cycle of drowning
✶ Deep inspiration
✶Need for air
✶ Water enters resp.passage
✶Air driven out of lungs
Cough reflex

121. Postmortem findings
External findings
✶Fine froth at the nose and mouth. its
white or rarely blood stained, leather-
like, abundant and increases in
amount with compression of the
chest.
✶Rarely the presence of weeds, mud
etc in the tightly clinched hand.

123. Cadaveric
Spasm

124. Cutis anserina (Goose skin)
✶Due to spasm of the erector pilae
muscles and due to exposure to cold
water at the time of death.
✶Rarely seen in India.
✶Skin appears granular and puckered,
with hair standing on the end.
✶Extremities are mainly affected.

127. ✶The skin of the finger, palms and
later the soles of the feet may be
wrinkled, bleached and sodden.
✶Due to osmotic action of water,on
thickened epidermis.
✶This immersion changes known as
Hands and Feet of a Washer-Woman.

131. Internal findings
✶Lungs & respiratory tract:-
✶Airways filled with froth,sand,weeds etc
found in the water.
✶Lungs are voluminous,edematous,doughy
to feel with rib markings.
✶Paltauf’ hemorrhages seen.
✶C/s:- Oozing out of blood stained frothy
fluid and ballooning of the lungs is known
as “Emphysema Aquosum”.
✶Wt upto 2 kgs.

133. ✶Watery fluid transudates into pleural
cavities during putrefaction.
✶Hydrostatic lung:- 2meters depth-
20min.
✶Hemorrhages in the middle ear &
mastoid air cells.
✶Water in the stomach & intestine.

134. Biochemical changes
“Getlers test”
Chloride content in chambers of the heart normally
600mg/100ml.
Chloride decreases by 50% in fresh water &
increases of 40% in salt water.
Test is of doubtful value in
-Septal defects
-Putrefaction
-Death due to vagal inhibition
-Chloride in water

135. Diatoms
✶Microscopic unicellular algae present in
water.
✶Silicaceous cell wall which resists acid
digestion,heat and putrefaction.
✶Size 10-80 microns.
✶Only a live body with a circulation can
transport diatoms from lungs to the brain
or bone marrow.
✶Isolation- acid digestion of tissue
commonly bone marrow, lung, blood and
kidney-centrifugation and washing.
Residue is examined under phase contrast
microscopy.

137. Medico legal aspects
✶Whether the death was due to
drowning or other cause?
✶Length of time the body was in
water.
✶Whether it was
accidental/suicidal/homicide?
✶“Brides of the bath case”

142. Cause of death
✶Asphyxia
✶Ventricular fibrillation
✶Laryngeal spasm.
✶Vagal inhibition.
✶Exhaustion.
✶Injuries.
✶Fatal period 4-8min.

143. Diagnosis of drowning
✶Froth
✶Weeds & gravel/soil in hand.
✶Voluminous lungs.
✶Diatoms in tissues.

144. Abduction fracture of greater horn of hyoid bone is
usually seen during post mortem finding in the case
of?
a. Hanging
b. Strangulation
c. Blunt trauma on the head
d. Road traffic accident

145. Autoerotic hanging is also known as?
a. Sexual asphyxia
b. Asphyxiophilia
c. Hypoxiphilia
d. All of these

146. Which is sure sign of ante mortem
hanging:
A)Sub conjunctiva hemorrhage
B) Neck elongated
C) Secretion of saliva from mouth angle
D) Ligature mark around the neck

147. Burking is an example of:
A) Strangulation & hanging
B) Smothering & Traumatic asphyxia
C) Choking & smothering
D) Homicidal strangulation

148. Whenever large crowd gather in an enclosed
place and stamped upon then common cause of
death is:
A) Overlaying
B) Traumatic asphyxia
C) Choking
D) Smothering

149. In sexual asphyxia the manner of
death is:
A) Suicidal
B) Accidental
C) Homicidal
D) None of the above

150. Paltauf’s hemorrhage found in:
A) Heart
B) Lungs
C) Trachea
D) Intestine