Strangulation

STRANGULATION
&
OTHER MECHANICAL
ASPHYXIA
DR. M. RAMYA KRISHNA , BHMS,MD
(PAEDS)

 It is that form of asphyxia, which is caused
from constriction of the neck by a ligature
without suspending the body.

 (1 ) Strangulation by a ligature.
 (2) Manual strangulation or throttling.
 (3) Garroting.
 (4) Mugging.
 (5) Bansdola.

 Asphyxia
 cerebral anoxia or venous congestion
 combined asphyxia and venous congestion
 vagal inhibition.

 Signs depends on the extent of venous
congestion, vagal effect and respiratory
obstruction.
 Intense congestion and deep cyanosis of the
head and neck is seen.
 Face - bluish patches and is swollen
 Eyes - wide open, bulging and suffused
 Pupils – dilated
 Tongue - swollen and often bruised, dark-
coloured and protruded.

CONT…
 Petechial haemorrhages are common into the
skin of the eyelids, face, forehead, behind the
ears and scalp.
 Blood-stained froth may escape from the
mouth and nostrils
 Bleeding from the nose and ears

CONT…
 Hands - clenched.
 Genital organs – congested with discharge of
urine, faeces and seminal fluid.
 These external signs may be absent if death
occurs quickly from vagal inhibition, due to
pressure on carotid sheath.
 A sudden compression of the windpipe causes
almost immediate unconsciousness and
death.

It may consist of a wide variety of objects
such as
 cords,
 wires,
 ropes,
 belts,
 scarves,
 ties,
 towels,
 stockings,
 bed linen, etc.

 External: The Ligature Mark - transverse, but is
more prominent at the front and sides than at the
back
 Location- about the middle or below the thyroid
cartilage.
 If the ligature has been tightened by pulling on the
crossed ends, the marks produced by the two
ends will be at different levels.

CONT..
 The mark may be oblique as in hanging, if the
victim was sitting and the assailant applied
ligature on the neck while standing behind
him, thus using the force backwards and
upwards, or if the victim has been dragged by
a cord after he has been strangled in a lying
down posture.

CONT..
 Petechial haemorrhages are usually found
immediately adjacent to the ligature mark,
which is a confirmation that the mark was
made during life.
 The base becomes dry, hard and parchment-
like several hours after death if the skin has
been abraded.

CONT…
 The pattern of the
ligature may indicate
the agent, e.g., a woven
belt, plaited electric
wires, links of chains,
spiral rope patterns,
etc.
 If a rough ligature is
used, the skin may
show marked abrasions
and haemorrhages, and
the deep muscles of the
neck are grossly
bruised

CONT…
 If the ligature used is soft
and yielding, e.g., a
towel, scarf, etc.,
 If it is removed soon
after death, the mark in
the neck may be very
slight or absent.
 The deep muscles of the
neck may show little or
no bruising.

Internal changes
 Severe congestion and Haemorrhage into the
tissues in and above the area compressed.
 The extent of the bruising depends upon the
degree of pressure used.
 The larynx, trachea and bronchi are congested
and contain frothy, often bloodstained mucus.

CONT…
 Subcapsular and Interstitial thyroid
haemorrhages are common.
 Lungs - congested and show ecchymoses and
larger subpleural haemorrhages.
 Silvery-looking spots under the pleural surface
due to rupture of the air cells, which disappear
on pricking, are seen in more than fifty percent
cases.

CONT…
 Hyoid bone may be fractured in older persons
in 10 to 15 % of cases.
 Fracture of the thyroid cartilage is more
common of one or both superior horns.

 Depressed marks are seen on the dead
bodies of infants and children, in whom the
neck is short which are produced from folds in
the skin due to bending of the head.
 A similar mark of depression is found in
 short-necked persons ,
 tight collars,
 buttoned shirt at the neck, or
 other clothing round the neck.
PSEUDO-STRANGULATION

 RARE
 Various Methods –
 (1) The ligature is tightened like a tourniquet,
but the person can apply a single or double
knot, before consciousness is lost.
 (2) Several turns of rope are tied round the
neck with a knot which is usually single and in
front or at the side or back of the neck.
SUICIDAL STRANGULATION

 (3) A cord may be tied around the neck and
twisted tightly by means of a stick or some
other solid material used as a lever.
 (4) A running noose is applied to the neck and
the free end of the rope to which a weight is
attached, is thrown over the end of the bed on
which the victim lies.

 (5) By leaning with the whole weight of his
body on a cord passed round the neck and
attached to a fixed point.
 In all cases of suicidal strangulation, the
ligature should be found in situ, and the body
should not show signs of violence or marks of
struggle.

HOMICIDAL STRANGULATION
 common form of murder.
 Many of the victims are adult women, and
frequently strangulation is then associated with
sexual assault.
 Usually there is a single turn of ligature round
the neck, with one or more knots (granny or
reef-knots) at the front or side of the neck.

 When there are two or more firm knots, each
on separate turns of the ligature, homicide is
almost certain.
 Abrasions are usually seen due to movement
of the ligature across the neck.
 Circumstantial evidence, such as time, place,
locked doors, and windows, motive, etc.,
is almost the only evidence to
suggest either suicide or homicide.

ACCIDENTAL STRANGULATION
 (1) Children may get entangled in ropes during
play, or the neck may be caught in window cords,
etc.
 (2) Infants are sometimes strangled in their cots
when the neck is caught inside bars, in
restrainers, braces, etc.
 (3) Persons under the influence of alcohol,
epileptics, and imbeciles may be strangled either
by a tight scarf or collar and neck tie.
 (4) It may occur if an intoxicated person rests the
neck against a bar or other hard object.

 (5) It may occur when a string used in
suspending a weight on back, slips from
across the forehead and compresses the neck.
 Accidental strangling may occur in uterus
when the movement of the foetus causes the
umbilical cord to encircle the neck.
 Ligature marks produced after death do not
show bruising.

DIFFERENCE
Trait Hanging Stangulation
by ligature
(1) Ligature mark It is oblique, does
not completely
encircle the neck;
usually seen high
up in the neck
between the chin
and the larynx.
base is pale, hard
and parchment-
like.
It is transverse,
completely
encircling the
neck; usually seen
low down in neck
below the thyroid
cartilage.
The base is soft
and pale or
reddish.
(2) Abrasions and
ecchymoses
About the edges of
ligature mark NOT
About the edges of
ligature mark is

by ligature
(3) Bruising: Of the neck muscles
less common.
Of the neck
muscles more
common.
(4)
Subcutaneous
tissues:
White, hard and
glistening under the
mark.
Ecchymosed under
the mark.
(5) Neck: Stretched and
elongated.
Not stretched or
elongated.
(6) Signs of
asphyxia:
External signs less
marked.
External signs well
marked.
(7) Face: Usually pale and
petechiae are not
common.
Congested, bluish,
and marked with
petechiae.

by ligature
(8) Tongue: Swelling and
protrusion is less
marked.
Swelling and
protrusion is more
marked.
(9) Saliva: Often runs out of
mouth.
Absent.
(10) Bleeding: From the nose,
mouth and ears not
common.
From the nose,
mouth and ears
common.
(11) Involuntary
discharge:
Of faeces and urine
less common.
Of faeces and
urine more
common.
(12) Seminal
fluid:
At glans is more
common.
At glans is less
common.

by ligature
(13) Larynx and
trachea:
Fracture rare. Fracture is
more common.
(14)
Emphysematou
s bullae:
Not present on
the surface of
the lungs.
Very common
on the surface
of the lungs.
(15) Carotid
arteries:
Damage may
be seen.
Damage is
rare.
(16) Thyroid
cartilage:
Fracture is less
common.
Fracture is
more common.
(17) Hyoid
bone:
Fracture is
more common.
Fracture is less
common.

THROTTLING OR
MANUAL STRANGULATION
 Asphyxia produced by
compression of the neck by
human hands is called
throttling.
 Death occurs due to
occlusion of carotid arteries
or vagal inhibition which is
much more common than in
ligature strangulation,
hanging excepted.

Postmortem Appearances
External:
 The situation and extent of the
contusions on the neck will depend upon:
1. the relative positions of the assailant and
victim,
2. the manner of grasping the neck,
3. the degree of pressure exerted upon the
throat

CONT…
 The bruises are produced
by the tips or the pads of
the fingers.
1. A grip from right hand
from the front produces a
thumb impression on the
right side of the victim's
neck,
2. Several fingermarks are
seen on the left side of
the neck obliquely
downwards and

 When fresh, the bruises are soft and red,
but after several hours they appear brown,
dry and parchment-like.

 Fingernail abrasions: two types:
 (1) When the pressure is static, regularly
curved (crescentic), comma-like, dash-like
or straight, up to 1.5 cm. in length and a
few millimetres in width.
 (2) When the nails skid down the skin,
parallel, linear lines several cm. in length
may be seen.

Bruising may not be seen:
 (1) If a soft material is kept between the
hand and throat,
 (2) If pressure upon the neck is
maintained until after the death of the
victim.
 (3) If the victim is unconscious and
amount of pressure to the neck is minimal.
 Congestive asphyxial signs appear in 15
to 30 seconds of pressure on the neck.

Internal changes
 Bruises may be found in the deep layers of
skin, in the superficial and deep fascia, on the
sheaths of the muscles, and in the substance
of the thyroid gland.
 The bruises are usually separate, and usually
the muscles are involved.
 Deep congestion is seen in central or whole
posterior part of tongue.

 Muscles, especially the sternomastoid may be
torn.
 Haemorrhages - pharynx, tonsils, base of the
tongue and upper part of the larynx.
 Lungs - congested with subpleural petechial
haemorrhages and Pulmonary oedema .
 Brain - congested and may show petechial
haemorrhages in white matter.

 Fractures: Common in old persons with
calcified cartilages.
 Fracture of the superior cornu of the thyroid
cartilage at its base is common.
 Fractures of the hyoid bone with inward driving
of its distal fragments occur in 30 to 50% of
cases, either due to direct lateral compression
or due to indirect violence.

 Rapid death: Rapid or instantaneous death
can occur due to sudden cardiac arrest, when
a pale face with no signs of asphyxia is seen.
 Palmar strangulation: The palm of one hand is
placed horizontally across the mouth and
nostrils without using the fingertips, its
pressure being reinforced by placing the other
palm on the top of it at right angles, the heel of
the upper palm pressing upon the front of the
neck.

 The face is congested with petechiae.
 Diffuse bruising with fracture of thyroid
cartilage may be seen. In most cases, the
victim is intoxicated.
 Suicide by throttling is not possible because
the compression of the windpipe produces
rapid unconsciousness and the fingers are
relaxed.

HOMICIDAL THROTTLING
 Common mode of homicide.
 The victims are usually infants, children or
women.
 Adults can be throttled when under the
influence of drugs or drink, or stunned, or
taken unawares.
 In an adult, signs of struggle are usually
present, but if the throat is forcibly grasped
suddenly and firmly compressed, the victim
cannot struggle.

ACCIDENTAL THROTTLING
 A sudden application of one or both hands on
other persons throat as a demonstration of
affection, in joke, as a part of physiological
experiment, etc., may cause death from
cardiac inhibition.

HYOID BONE FRACTURES
Three groups.
(1) Inward Compression Fractures: common in
throttling, where the main force is an inward
compression acting on the hyoid bone.
 The fingers of the grasping hand squeeze the
greater horns towards each other, due to
which the bone may be fractured and the
posterior fragment is displaced inwards.

 (2) Anteroposterior Compression Fractures: In
cases 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 fragment.
 Outward fractures of greater horn of hyoid
bone are seen in ligature strangulations, run
over motor vehicle accidents, blows on the
front of the neck, etc.

 (3) Avulsion
Fractures: Also
called "tug" or
"traction" fractures.
 They occur due to
muscular
overactivity without
there being direct
injury to the hyoid
bone.

GARROTTING
 The victim is attacked from behind without
warning.
 The throat may be grasped or a ligature is
thrown over the neck and quickly tightened by
twisting it with a lever, which results in sudden
loss of consciousness and collapse.
 The assailant is then able to tie the ligature
with one or more turns.
 This method is usually used in lonely places to
kill travellers and to rob them.

CONT…
 An iron collar tightened by a screw for
strangling (Spanish Windlass) as a mode of
execution was once employed in Spain.

MUGGING
 Strangulation is caused by
holding the neck of the victim in
the bend of the elbow.
 Pressure is exerted either on
front of the larynx, or at one or
both sides of the neck by the
forearm and upper arm.
 Bruises behind the larynx and in
the strap muscles of the neck

BANSDOLA
 One strong bamboo or stick is placed across
the back of the neck and another across the
front.
 Both the ends are tied with a rope due to
which the victim is squeezed to death.

SUFFOCATION
 Form of asphyxia where entry of air to the
lungs is prevented by any means other
than pressure on the neck or drowning.
 Environmental Suffocation: Death from
hypoxic hypoxia may result from breathing
in a vitiated atmosphere (deficient in
oxygen).
 Deaths are almost always accidental.

 Suffocation occurs in air-tight place, such as
when children become locked in disused
refrigerators or large boxes or trunks during
play.
 Petechial haemorrhages are absent.
 Congestion and cyanosis may or may not be
present.

SMOTHERING
 A form of asphyxia which is caused by closing
the external respiratory orifices either by the
hand or by other means, or by blocking up the
cavities of the nose and mouth by the
introduction of a foreign substance, such as
mud, paper, cloth, etc.

 Suicide by Smothering: Impossible.
 Suicide is possible in the mental patients or
prisoners by burying their face in a mattress or
lying against the bed clothing to obstruct the
nose and the mouth.
 Suicidal smothering can be effected by tying a
polythene or similar bag over the head

Accidental Smothering
 Most fatal smotherings are accidental.
 (1) An epileptic or intoxicated person may smother
himself accidentally by burying his face in a pillow,
or covering with bed clothes.
 (2) A person may accidentally fall into a large
quantity of semi-solid or finely divided material,
like mud, ashes, feathers, grain, sand, coal dust,
etc., so that his mouth and nose are covered by
the substance.
 (3) Children may be suffocated accidentally while
playing with plastic bags.

 (4) Plastic bags may be applied to the head for
experiment or autoerotic exercise, as partial
asphyxia is believed to increase sexual
sensation.
 (5) It also occurs if the membranes remain
round the head of the newborn after delivery.

Homicidal Smothering
 Usually the mouth and nose
are closed by a hand or cloth,
or the face may be pressed
into a pillow.
 It is possible where the victim
is incapacitated from drink or
drugs, very weak, child or old
person, in illness, and when
the victim is stunned by a
blow.

FINDINGS
 The asphyxial signs and symptoms are severe
because death usually results due to slow
asphyxia.
 If the orifices are closed by the hand, there
may be scratches, distinct nail-marks, or
lacerations of the soft parts of the victim's face.
 The lips, gums and tongue may show bruising
or laceration.

 Blood may ooze out from the mouth and nose.
The tongue may be protruded, and may have
been bitten.
 In some cases death is rapid due to reflex
cardiac arrest, and asphyxial signs are absent.

 Internal: Blood-stained frothy fluid is present in
air-passages.
 Major findings - Slight acute emphysema and
oedema of the lungs with scattered areas of
atelectasis, petechiae and congestion.
 The internal organs are deeply congested and
sometimes show small haemorrhages.

GAGGING
 Form of asphyxia which results from pushing a
cloth or soft object into the mouth, or from the
closure of mouth and nose by a cloth or similar
material, which is tied around the head.
 Almost always homicidal and the victim is
usually an infant.
 Sudden death due to reflex
vagal inhibition may occur.
 The gag should be examined
for buccal epithelial cells.

OVERLAYING
 very rare
 results due to compression of the chest, so as to
prevent breathing.
 During sleep, the older person rolls on to, or
crushes the infant.
 The thoracic movements are limited and
respiratory exchange is either reduced or
completely prevented.
 The nostrils are often filled with froth, which may
be bloodstained and this may stain the pillow or
garment.

CHOKING
 Form of asphyxia caused by an obstruction
within the air-passages.
 The foreign body becomes arrested at, or just
below the vocal cords and may produce an
inflammatory reaction with oedema.

Causes
 Accidentally inhaled during a meal especially when the
victim is laughing or crying.
 Vomited matter inhaled during a fit of epilepsy under the
influence of drink or of an anaesthetic
 Infants usually regurgitate clotted milk after a meal, and
this may fall into the larynx.
 Impaction of solid bodies, such as seeds, piece of meat,
onion, potato, live fish, cotton or a set of false teeth may
cause asphyxia.
 Gauze inserted during an operation can be inhaled and
cau e death.

 Suicidal - Rare. usually in mental patient or
prisoners.
 Homicidal - very rare , may occur by stuffing a
piece of cloth or paper into the pharynx or
larynx seen in infants or disabled/diseased
ones.
 Accidental – Common, from objects being
lodged in the throat is seen in infants, elderly,
psychiatric patients, acutely intoxicated where
the ability to swallow or masticate is severely
impaired.

Cause of Death
 Asphyxia.
 Cardiac inhibition.
 Laryngeal spasm.
 Delayed death may result from pneumonia,
lung abscess or bronchiectasis.

CAFE CORONARY
 Sudden and unexpected death occurring during a
meal due to accidental occlusion of the airway by
food.
 Person suddenly turns blue, coughs violently, then
collapses and dies.
 Death appears to be due to a sudden
heart attack.
 The clinical signs of choking are absent,
because high blood alcohol content
which anaesthetises the gag reflex.

 TREATMENT: A blow on the back or on the
sternum may cause coughing and expel the
foreign body.
 If this is not successful, the foreign body should
be removed from the hypopharynx with the
middle and index fingers or with forceps.
 Autopsy: Poorly chewed food will be found in
the mouth, throat, larynx or trachea.

Strangulation

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