1) Asphyxia and suffocation can occur due to various causes that reduce oxygen supply or interfere with respiration, such as hanging, strangulation, drowning, or inhalation of toxic gases. 2) Hanging is a form of asphyxial death caused by suspension of the body by a ligature around the neck. Complete hanging involves the feet not touching the ground, while partial hanging only involves the upper torso weight. 3) Strangulation is asphyxial death caused by constriction of the neck without body suspension. Throttling uses hands to compress the neck, while ligature strangulation uses a rope or other material.

1. APR/16 /2014
DES BY: K. ALMAAS DES BY: K.W
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2. Presenter:
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Kaleemullah

3. ASPHYXIA AND SUFFOCATION
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4. • It is a condition that if oxygen supply to the
blood and tissues is reduced because of
interference with respiration,it is also called
AnoxiaAnoxaemiaHypoxia.
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5. • 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.
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6. • 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.
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7. • Cyanosis, capillary dilatation, capillary stasis, rise
of capillary pressure.
• Increased capillary permeability, and relaxation
of sphincters.
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8. Asphyxia
Reduction in o2 tension
Deficient oxygenation in lungs
Capillary
dilatation
Reduced pulmonary flow
Capillary stasis
Diminished venous
return to heart Capillary
engorgement
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9. 1. Hanging
2. Strangulation
3. Suffocation
4. drowning
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10. • 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.
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11. According to the weight
exerted:
• Complete hanging.
• Partial hanging.
According to ligature:
• Typical hanging.
• Atypical hanging.
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12. 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 upper torso and not the
whole body acts as a constricting force is known
as partial hanging.
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13. 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.
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14. 14

15. Ligature
• Not particular, like ropes, chains, wire, leather
straps, belts, scarf, 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.
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16. 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.
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17. 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 wt tension.
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18. Cerebral anoxia
• Carotid artery occludes with 4-5kgs tension
and vertebral artery with 20kgs tension.
• Reflex vagal inhibition.
• Fracture dislocation of cervical spine at the
level of 2,3,and 4 vertebrae.
• Combination of any of the above.
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19. Postmortem appearance
 External appearance.
 Internal appearance.
External appearance
• Above the ligature.
• Beneath the ligature.
• Below the ligature.
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20. 1- Above the ligature
mark
• Tilt of the head.
• Protrusion of tongue.
• Dribbling of saliva.
• Congestion of the face.
• Petecheal haemorrhages
• Middle ear haemorrhages
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21. 2- 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.
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22. 3- Below the ligature
• Postmortem lividity (Glove and Stocking)
• Relaxation of sphincters.
• Injury to legs.(partial hanging)
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23. 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 haemorrhages.
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24. Diagnosis
• Ligature mark around the neck.
• Presence of abrasions, ecchymosis and redness
around the ligature mark.
• Trickling saliva from the mouth.
• Ecchymosis of larynx and trachea.
• Rupture of intima of carotids.
• Signs of asphyxia.
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25. 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.
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26. 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.
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27. 27

28. 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.
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29. 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.
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30. 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
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31. STRANGULATION
• It’s a form of asphyxial death caused by the
constriction of neck by ligature or by any means
without suspending the body:
1. By ligature.
2. Manual strangulation
3. Or Throttling.
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32. Causes of death
• Asphyxia
• Anoxia
• Congestion
• Vagal inhibition
• Combination of any of the above
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33. Autopsy finding
• 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.
• It may be interrupted by clothing or victims
finger or ornaments.
• May be oblique if the victim is sitting and
assailant is standing.
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34. 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.
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35. 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.
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36. Medico-Legal aspects
Suicide
• Its rare but possible, rope may be used and
twisted with a stick.
• Congestion is very prominent because of slow
obstruction.
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37. Homicide
• Common form of murder-associated with sexual
offences.
• Infanticide-by strangulation with umbilical cord.
• Evidence of struggle, surprise attack, under
intoxication, weak personality.
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38. 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.
• Pressure of nails produce crescentic 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. 38

39. 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.
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40. 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.
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41. 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.
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42. 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.
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43. 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.
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44. 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.
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45. 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.
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46. Hyoid bone fracture
• Inward fracture.
• Antero-posterior fracture.
• Avulsion fracture.
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47. 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.
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48. 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.
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49. 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.
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50. 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.
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51. 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.
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52. Causes of death
• Asphyxia,vagal inhibition,laryngeal
spasm,infection.
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53. 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.
• 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.
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54. 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.
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55. 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.
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56. • 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.
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57. • 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.
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58. 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.
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59. 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.
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60. 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.
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61. Typical drowning
• Fresh water drowning.
• Salt water drowning.
Fresh water drowning
• Water cross the alveolar membrane into the
circulation.
• Produces marked hypervolaemia.
• Red cells swell or burst-hemolysis-liberation of
potassium.
• Circulation will suffer 50% dilution within 2-3
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62. • The heart is submitted to the insult of
anoxia,hypervolaemia,potassium excess and sodium
deficit.
• Ventricular fibrillation due to anoxia and potassium
excess within 4-5 min.
Salt water drowning
• Marked hypertonicity of the inhaled water cause loss of
fluid from circulation into the lungs-fulminating
pulmonary edema and progressive hypovolaemia.
• Circulatory shock and cardiac arrest.
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63. 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.
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64. • 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.
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65. • 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.
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66. • A victim look alert and breathing,may respond to initial
resuscitation.
• Late stage-respiratory distress,hypotension and cardiac
arrhythmia may cause death.
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67. Vicious cycle of drowning
• Deep inspiration
• Need for air
• Water enters resp.passage
• Air driven out of lungs
Cough reflex
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68. 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”
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69. 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.
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70. 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.
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71. • 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.
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72. 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.
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73. • 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.
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74. 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
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
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75. 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.
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76. Cause of death
• Asphyxia
• Ventricular fibrillation
• Laryngeal spasm.
• Vagal inhibition.
• Exhaustion.
• Injuries.
• Fatal period 4-8min.
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77. Diagnosis of drowning
• Froth
• Weeds & gravel/soil in hand.
• Voluminous lungs.
• Diatoms in tissues.
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78. Design By: Kaleemullah (Wardak)
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