Dr. Hammad's document discusses asphyxial deaths and their classification. It covers various types of asphyxia including mechanical asphyxia caused by suffocation, hanging, and strangulation. Autopsy findings for each type are described, such as ligature marks and petechial hemorrhages. Causes of death include anoxic anoxia and reflex cardiac arrest. Homicidal, accidental, and suicidal cases are addressed. Drowning is also discussed, distinguishing between wet and dry types. In summary, the document provides a comprehensive overview of classifications, mechanisms, autopsy findings, and medicolegal aspects of asphyxial deaths.
4.11.24 Mass Incarceration and the New Jim Crow.pptx
Asphyxial death
1. ASPHYXIAL DEATHS
Dr. M. Hammad
Department Of Forensic Medicine
Asphyxia
Commonly means “Lack of Oxygen”.
In Greek meaning applying “Pulselessness/absence of pulsations
It is defined as interference with the process of oxygenation in the lungs.
In Forensic context Asphyxia: Air is physically prevented to enter the air passages at
any part from nose and mouth to the alveolar membranes.
Classification of Gordon
1. Anoxic anoxia
2. Anaemic anoxia
3. Histotoxic anoxia
4. Stagnant anoxia
Anoxic anoxia
1. By obstruction to air passages
Suffocation, Smothering,
2. By obstruction to the air passage down to the respiratory tract
Drowning, Choking, throttling, hanging and strangulation
3. Excessive compression of the chest and abdominal wall
4. Primary cessation of respiratory movements causing respiratory failure
as in narcotic poisoning , electrical injury
5. Inhalation of irrespirable gases
CO2 and CO
Anaemic anoxia
Reduced oxygen carrying capacity of the blood.
Histotoxic anoxia
Depression of the oxidative process in the tissues.
2. As in hydrocyanic Acid poisoning.
Stagnant anoxia
Insufficient circulation of the blood in the tissue,
As in traumatic shock,
Classification of Asphyxia
Mechanical asphyxia
Pathological asphyxia
Toxic asphyxia
Environmental asphyxia
Iatrogenic asphyxia
Mechanical asphyxia
Obstruction of air passages in an unnatural way either from within or by exerting
pressure from the outside.
These includes;
1. Suffocation
2. Hanging
3. Strangulation
4. Sexual Asphyxia
5. Drowning
Pathological Asphyxia
Transfer of oxygen to the lungs is prevented due to blockage caused by any
disease.
Toxic Asphyxia
Uptake of oxygen is prevented in the lungs due to presence of some poisonous gases
like carbon monoxide.
Environmental Asphyxia
Insufficiency of oxygen in the inspired air
(Deep wells or closed spaces)
3. Iatrogenic Asphyxia
Associated with Anesthesia and surgery
Physiology of Fatal Asphyxia
It has three phases of short durations.
Unconsciousness occurs in about one minute followed by death in about 2-4
minutes.
Phases of Fatal Asphyxia
Phase –I initiates with the stimulation of the respiratory center increasing both
rate and amplitude of the respiratory movement. Cyanosis begins to appear.
Phase – II Is characterized by struggle to breath. The cyanosis deepens with
engorgement of the neck veins. Generalized congestion and Petechial
hemorrhages start appearing. The victim becomes confused and later goes
unconscious
Phase – III unconscious, which leads to the coma. Breathing becomes irregular
, shallow, gasping.
Biochemistry of Fatal Asphyxia
PO2 reduced.
PCO2 increased.
pH decreased.
Increased Blood sugar.
Na decreased.
K increased.
Pathology of Fatal Asphyxia
Nonspecific pathological changes
Specific pathological changes
4. Nonspecific pathological changes
1. Visceral congestion & congestion of face.
2. Oedema
3. Petechial haemorrhages
4. Cyanosis
5. Postmortem fluidity of blood.
6. Cardiac dilatation
Congestion
Red appearance of the skin due to obstruction of venous drainage.
Oedema
Swelling of the tissues due to transudation of fluid from the veins.
Cyanosis
Blue color imparted to the skin by deoxygenated blood.
Petechial haemorrhages
Tiny pin point hemorrhages in the skin/tissue due to damage of vessels and
leakage of blood by increased venous pressure.
Also seen in violent sneezing and coughing…
Specific pathological changes
1. Signs of compression of upper airways as in hanging, strangulation & throttling.
2. Occlusive blockage of the mouth & nose as in smothering.
3. Presence of foreign body as in choking.
4. Flooding of airways as in drowning.
5. Penetrating & non penetrating trauma to the chest as in traumatic asphyxia
Suffocation ,Hanging, Strangulation
Suffocation
5. It is defined as manual obstruction to the air passage caused by closing of the
external orifices of Nose & mouth.
Types
1. Smothering
2. Gagging
Smothering
Smothering is defined as closing of air passages externally either by hands or by a
soft material.
Mechanism of suffocation
Anoxic anoxia
ML importance
Accidental
Homicidal
Suicidal
Accidental smothering
Overlaying:-
Infants & children it is defined as smothering of the child by overlaying their
mother during sleep.
It also occurs in inexperienced mother presses the child too closely to the breast
when feeding the baby.
Accidental smothering
Alcoholics: In inebriated state of mind roll over and bury their face in soft bed.
In Epileptic: when a person suddenly falls into a bin of dust or flour.
Homicidal
Killing of infants by smothering & gagging
6. In adults – not common
Burke & Hare in Scotland– 1820’s (To supply the dead bodies to Edinburgh
medical school for anatomical dissection.)
Burking Burke sat on the chest of victim, covered with one hand victims
mouth & nostrils and with the other hand pushed the jaw upwards while Hare
hold legs of victim.
Autopsy findings in Smothering
External Autopsy findings:
When hands have been used
Nail scratches, Abrasions, Bruises(especially the fingertips bruises), lacerations of
the soft parts of the face.
Lips gums and tongue may show bruising and or laceration.
Bruising on the inner aspect of lips from pressure against the teeth, with or
without bruising of the gums and tongue.
When some clothing, soft material or pillow has been applied There may be
no external signs of violence
Internal Autopsy findings
Lungs may show edema, congestion and areas of Petechial hemorrhages.
Blood should be examined for drugs.
Gagging
Gagging is stuffing of mouth with a cloth or with any soft material and blocking
entry of air into these passages.
It may be homicidal, particularly when victims are infants or individuals
incapacitated by alcohol or drug, old,
Gag not only blocks the mouth but also prevents the entry of air through the
back of throat coming through the nostrils.
7. Death in such cases is due to pharyngeal obstruction
Autopsy findings in Gagging
Autopsy findings depend upon the intensity of struggle to breath and some time
may be negligible or absent.
If gag has been removed , mucosal bruising , abrasions or lacerations,
individually or in varying combinations, may be evident on the lips, soft palate
and in the pharynx.
There may be present traces of the material in the mouth and between the
teeth.
Choking
It refers to the blockage of internal upper respiratory passages by some
solid/semi-solid material.
Impaction of foreign body in pharynx, larynx, trachea or bronchi.
Common agents may be;
Piece of food, lump of meat, coins, buttons , set of false teeth, marbles, corns
etc.
In epileptic , tongue falling back
Mechanism of death
1. Anoxic anoxia
2. Reflex cardiac arrest vagal inhibition.
3. Laryngeal spasm
Foreign body in the respiratory tract especially in the bronchi may result in
delayed deaths from pneumonis, lung abscess or bronchiectasis.
Medicolegal importance
Mostly accidental
8. Children often place objects such as marbles, coins, buttons or beads in their
mouth and these objects may pass in to larynx or trachea during inspiration.
In case of stupor (partial or nearly complete unconsciousness) Ex. From acute
Alcoholic intoxication vomited material may be inhaled and result in choking.
Mentally ill & intoxicated person a portion of food bolus in the mouth may trickle
down into the air passages & block it.
Café Coronary Syndrome
Is a condition of accidental choking where a bolus of food produces a complete
obstruction of the larynx.
It is so called because it mimics a heart attack.
Death in these cases is usually due to reflex cardiac arrest.
Iatrogenic choking May result from loose teeth during dental procedures,
detached pieces of tracheal cartilage during tracheostomy or surgical swabs
during surgery on the throat which may go down in to the larynx & trachea.
All such cases may lead to criminal negligence.
Homicidal deaths uncommon
Suicidal choking is very rare
Autopsy findings
Non specific general pathological asphyxial changes
Mouth , pallet & pharynx should be examined for injuries
Hanging
It is defined as constriction of the neck by a ligature, after suspension in air. The
constricting force is the weight of the body.
Types of Hanging
On the Basis of position of the Knot
Typical hanging
9. Atypical hanging
On the Basis of degree of suspension
Complete hanging
Partial hanging (incomplete hanging)
On the Basis of position of the Knot
Typical Hanging: when the knot is present over the occipital region.
Atypical Hanging: when the knot is present at ant other point.
On the Basis of degree of suspension
Complete Hanging: When feet do not touch the ground and the weight of the
body acts as constricting force.
Partial or Incomplete Hanging: When feet touch the ground and the weight of
the head and partial weight of body act as constriction force.
Pressure needed to occlude neck structures
According to Brouardel:
Jugular veins ------------- 4.4 pounds ( 2kg)
Carotid artery ------------11 pounds (4-5 kg)
Trachea ------------------ 33 pounds (15 kg)
Polson & Gee have confirmed these findings.
Mechanism of death
Cerebral congestion due to compression of the jugular veins
Cerebral anoxia by compression of carotid arteries
Hypoxic hypoxia /Anoxic anoxia due to obstruction to airways being caused by
the upward displacement of the base of the tongue against the palate & the
posterior pharyngeal wall.
10. Reflex cardiac arrest caused by compression of the carotid sinus or the vagus
nerve.
Fracture displacement of cervical vertebrae injury to the spinal cord especially
in judicial hanging
Combination of any of above.
Fatal period
Judicial hanging It is instantaneous from fracture dislocation of cervical
vertebrae usually the 3rd
& 4th
and rarely the 2nd
one.
Reflex cardiac arrest immediate
Otherwise 3- 5 min (8 min)
Autopsy findings
External findings:
Neck is stretched
Congestion of face, head and neck.
Petechial hemorrhages
Lips, nose, fingers are cyanosed
Tongue dry, protruded, bluish or black.
Dribbling of saliva due to pressure on the salivary glands.
Postmortem Lividity
Specific findings
Ligature mark
Type: ropes, wires, belts, electric cords, piece of cloth.
Site: above the thyroid cartilage (80%)
Knot: single or multiple with fixed noose or a running noose
Direction: upwards, backwards and inverted V shaped.
11. Ligature mark absent at site of knot.
Groove: pale, yellow brown, dry, hard and parchment like.
Pattern of ligature may imprinted on skin as pressure abrasion called mirror
image phenomenon.
Edge: congested and hyperemic.
Head inclined opposite side to the knot.
Internal findings
Bruising of the connective and muscular tissues
Under surface of the ligature mark
Injury is more severe in judicial hanging
Fracture of hyoid bone
Fracture of laryngeal cartilages
Hyperemia of trachea, epiglottis and lymph nodes
MEDICOLEGAL ASPECTS
Ante mortem or post mortem
Homicidal ,suicidal or accidental
o Ante mortem hanging
Presence of abrasions
Vital reaction
Area of hyperemia or ecchymosis
o Suicidal hanging
Common in females
Signs of struggle are absent.
Scene of crime – no disturbence
12. History of depression, anxiety, family and economic problems.
Calm place,
Locked inside
Suicidal notes.
o Homicidal hanging
Rare
In cases of judicial hanging (justifiable hanging ) & lynching (non justifiable
hanging)
Accidental hanging
Uncommon
Sexual asphyxia or auto erotic hanging
Auto erotic asphyxia
Sexual pleasure can be achieved by partial reduction of blood supply to the brain.
Sexual deviation
More common in males
Abnormal sexual behavior like masochism and transvestism.
Psychological autopsy
Hallmarks
Padding under noose
Naked or sami-naked
Feminine attire
Pornographic literature
Drug abuser.
STRANGULATION
13. Violent asphyxia caused by constricting the neck by some means other than
weight of the body
Types
Ligature strangulation
Throttling , manual strangulation
Mugging
Bansdola
Garroting
Autopsy findings
Non specific
Cyanosis
Visceral congestion
Petechial hemorrhages
Swollen, bruised, bitten & protruded tongue
Bleeding from the ears
Raised body temperature by 2-3 C
Special
Ligature mark
Depressed grooved
Color
Continuity
Position of knot
Number of turns
Pattern (Mirror image phenomenon)
14. Injuries to the soft tissues of neck
Fracture of hyoid bone
Fracture of laryngeal cartilages
THROTTLING
Constriction of the neck of a person by another person with one or both hands. It
is also called manual strangulation
MECHANISM OF DEATH
Hypoxic hypoxia or anoxic anoxia
Reflex cardiac arrest
Cerebral anoxia
AUTOPSY FINDINGS
NON SPECIFIC
Facial congestion
Cyanosis
Petechial hemorrhage
Visceral congestion
Tongue bruised
Bleeding from ear
Body temperature raised
Specific pathological changes
External injuries
With one hand or two hands
Superficial bruises of skin & crescentric abrasion caused by fingernail impressions
on both sides of neck
15. Right handed or left handed compression.
Injuries to the cervical tissues
Bruises
Section of lymph nodes show hemorrhages
MEDICOLEGAL ASPECTS
a. Homicidal
b. Accidental
TRAUMATIC ASPHYXIA
Also called crush asphyxia
Is form of asphyxia resulting from trauma to the chest, person is unable to
breath.
Autopsy findings
Deep cyanosis of face
Numerous petechiae
A demarcating line
DROWNING
Defective oxygenation of the lungs due to the presence of fluid in the respiratory
tract.
Medium of drowning
Water
Oil
Dye
Chemical solution
16. Types of drowning
Typical (Wet type)
Atypical (Dry)
*Dry drowning
*Immersion syndrome ( vagal inhibition).
*Submersion of unconscious.
Secondary
Dry / Atypical drowning
15-20%
When no water enters into the lungs and death occurs by laryngeal spasm.
Death is instantaneous
IMMERSION SYNDROME
(vagal inhibition, Hydrocution)
Death results from cardiac arrest due to vagal inhibition.
Produces by:
Cold water
Falling into water with feet first
Duck diving
Diving horizontally
WET DROWNING
Mechanism is different in fresh water or sea water
In fresh water
Large volume of water into lungs then blood.
Hemodilution
Hypervolemia
17. Hemolysis of RBCs
Rise in the level of potassium
NaCl , Ca2+
, proteins & Hb are reduced
The hypoxia & hemodilution result into the ventricular fibrillation
Fatal period is 3-4 minutes
Drowning in sea water ( NaCl-3%)
Rapid diffusion of salts into the blood
Increase in NaCl & Mg2+
Fluid moves into lungs
Hemo concentration
Fulminant pulmonary edema
Hypotension
Hypovolemia
Bradycardia & death
Fatal period 7—9 min.
SECONDARY DROWNING
(NEAR DROWNING)
Person survived and death is due to complications.
Metabolic acidosis
Hypoxic encephalopathy
Chemical pneumonitis
Severe infections
Mechanism
a. Period of voluntary apnea
b. CO2 level raised
18. c. Respiratory centre stimulated
d. Inevitable inspiration
e. Inhalation of water into lungs
f. Swallowing of water into the stomach
g. Specific gravity of body is raised & body sinks below surface
h. Respiratory efforts continues.
i. Filling of air passages and lungs with water.
j. Water acts as an irritant.
k. Secretion of mucous
l. Water, respiratory mucous and air churned up.
m.Fine froth.
Causes of death
1. Anoxia / hypoxia
2. Laryngeal spasm
3. In fresh water drowning ventricular fibrillation
4. In sea water cardiac arrest
5. Vagal inhibition
6. Hypothermia
Autopsy findings
External appearances:
Wet clothes.
Skin is wet, cold ,clammy and pale.
Face cyanosed
Eyes :semi open or closed. Conjunctivae congested & pupils dilated
Hypostasis on the dependent parts
Rigor mortis
SIGNS OF GREAT IMPORTANCE
Fine froth(champignon de mouse) at mouth & nostrils (froth is not seen when
death result from laryngospasm )
Presence of weed, mud in tightly clenched hands (instantaneous rigor/cadaveric
spasm)
19. Signs of submersion
Goose skin (cutis anserina)
Sodden & wrinkled feet & hands (washer women’s hands)
INTERNAL APPEARANCE
Special pathological changes in wet drowning
Edema aquosum (emphysema aquosum or trockenesodem). Ballooning of lungs.
Impression of ribs
Surface pale
On section, blood stained frothy fluid.
Tardieu ‘s spots(paltauf ‘s hemorrhage) it is sub-pleural haemorrhages due to
rupture of alveolar walls.
Fluid in pleural cavities
Fine blood stained white froth
Foreign materials like algae, weeds, mud, sand depending on the medium of
drowning
Regurgitated particles of food
Heart
Right Heart & large veins distended with dark red blood
Stomach & intestines
Stomach may contain water
In dead bodies, it is not possible for water to get beyond the cardiac sphincter &
into the stomach & intestine
Biochemical changes in blood
In fresh water, haemodilution occur, viscosity of blood is decreased, it leads to
lyses of RBCs with liberation of potassium.
Water entering lungs ,diffused in to pulmonary circulation and passing to left side
of heart.
The chloride content of the left side of heart decreased.
In salt water drowning ,all above changes are reversed.
20. There is heamoconcentration ,viscosity of blood is increased , RBC ‘s are crenated
and chloride content of heart is increased.
Gettler`s test
Gettler devised test to estimate chloride content of blood from both sides of
heart.
Blood is withdrawn from each ventricle of heart.
The chloride content of blood is then analyzed.
Normal chloride content in each chamber is 600mg/100ml.
A difference of 25mg/100 ml is significant for drowning.
Diatoms test
Diatoms: Microscopic unicellular algae, having a siliceous cell wall, resist acid,
heat and putrefaction.
Only live body with a circulation can transport diatoms.
Sample of material obtained from femoral or sternal bone marrow.
MEDICOLEGAL ASPECTS.
Whether death was due to drowning.
Manner is homicidal, suicidal, or accidental.
Time since death from drowning.
Whether death was due to drowning
Persistent, perfuse, fine froth at mouth and nose.
Material grasped in hands.
Fine typical froth in air passages.
Edematous conditions of lungs.
Diatoms in tissues specially brain and bone marrow.
Gettler`s test
21. SUICIDAL, HOMICIDAL OR ACCIDENTAL
SUICIDE
Fairly common in women.
May take her child with her.
Attach wait to her body.
May take poison, cut her throat.
Homicidal drowning
Rare except in infants and children, stupefied and overpowered adults.
Injuries may be found on the body.
Accidental drowning
Very common.
Injuries may be sustained during accidental fall.
Time since death from drowning
A water proof wrist watch.
Cooling rate is twice as compared to air.
Rigor mortis sets early.
Wrinkling of skin.
Bleaching of cuticle.
Sodden appearance of epidermis.
Floating of the body.
Body infected with flees and lices.
Putrefactive changes.
Skin of the hands and feet loose and peels like gloves and stocking.
Absence of signs
22. Death due to shock or laryngeal spasm.
First killed and then thrown in water.
Minimal signs in submersion of unconscious.
Injuries
Could be suicidal, homicidal or accidental.
May sustained while falling.
May be caused by water animals or by passing boats.