A State in which

Body Lacks O2

or

Defective Aeration of Blood

Most important cause –

Mechanical Interference with Respiration

Asphyxia

ASPHYXIA

Capillary

Dilatation

Pooling of Blood

Reduced Venous Return To Heart

Reduced Pulmonary Blood

Flow

Deficient Oxygenation

Vicious Circle

of Asphyxia

1

(A)Non- Specific – Parenchymal Degeneration of Tissues

(B) Specific1) Cyanosis (Bluish Discoloration)

Due to · Decreased O2 tension in bld &

· Increased reduced Hb

Becomes apparent when at least 5 gm of red. Hb is present

Blood is Purple / Dark in color.

Bluish color is Marked over: areas of PM Staining, Lips,

organs with abundant capillary & venous bld (Lungs, Liver,

spleen, kidneys)

Effect of Asphyxia

2. Increased Capillary Permeability

Blood transudes into tissue spaces - Gelatinous

Moistening of Organs.

Excess Fluid in Serous Cavities (Pleura & Pericardium)

Tissue Edema (Mediastinum & Lungs)

Effect of asphyxia

3) Petechial Hemorrhage / Tardieu Spots

French Police Surgeon described them in 1866

Mechanism:

Anoxia – Blood Stasis - Increased Capillary Permeability

& Raised Intracapillary Pressure

Dark Red,

Well defined,

Round,

Pin-head sized

Effect of asphyxia

3) Petechial Hemorrhage / Tardieu Spots

Present at sites where capillaries are least supported

[Face, Conjunctiva, Meninges, Serous Surface of

Heart

&

Lungs]

Effect of asphyxia

Pronounced in areas where Intracapillary pressure Rises rapidly

- Above the Level of Neck Constriction

Better appreciated in

- Fair Skinned Persons &

- Fresh Dead Bodies

Petechial Hemorrhage

Presence of Tardieu spots - Not diagnostic of asphyxia

May be found in:

Bleeding Disorders,

Coronary Thrombosis, Electrocution, Poisoning,

Anticoagulant Therapy, Thrombocytopenia.

But in these cases - Distribution is Generalized.

Absence of Tardieu spots - Does NOT Exclude Asphyxia

Petechial Hemorrhage

If Dead Body is suspended for Long time - Gravitation of

blood in dependant body parts – Over distension - Rupture of

Capillaries.

Present on Hands & Legs

Features:

1. Larger

2. Less Circumscribed

3. Does NOT appear on - Serous Surface of Heart & Lungs

Postmortem Petechial Hemorrhage

Cessation of Respiration due to Mechanical Force (violence)

1. Hanging

2. Strangulation

a. Ligature - Strangulation

b. Manual - Throttling

3. Suffocation

4. Drowning

Violent Asphyxial Deaths

Type of Violent Asphyxial Death in which

body is suspended with Ligature around Neck

resulting in Constriction of Air passages

preventing Exchange of air between Lungs & Atmosphere

HANGING

Based on Position of Knot

1. Typical Knot - At the Nape

2. Atypical Knot - At any site other than NapeCommonest site -

Angle of mandible orMastoid Process

Types of Hanging (classification)

Complete HangingBody is - Fully Suspended NO Body part touches the ground. Constricting force - Weight of body

Incomplete / Partial Hanging Body is - NOT Fully suspended some Body part touches the ground. Some Body weight is transmitted to ground through the part touching the ground

BASED UPON THE DEGREE OF SUSPENSION

Depends on - Effect of Neck Compression

If Pressure on Larynx is prominent

Symptoms of Asphyxia Predominate.

Respiratory Distress, Cyanosis,

Convulsions, Confusion,

Ringing in the ears.

SYMPTOMS OF HANGING

Pressure on Jugular Vein

Severe Pain on the side opposite the knot

Pt. Hemorrhages on Forehead, Eyelids & Conjunctiva

Pressure on Carotid Artery

Immediate Unconsciousness

Failure of Resp. Center (reduced blood supply to brain)

Asphyxia & Apoplexy - simultaneous pressure on Larynx &

Jugular Vein

Asphyxia alone

Apoplexy alone

Cerebral ischemia (pressure over carotid & vertebral A

Vagal shock: Inhibition of heart due to vagal stimulation.

Injury to medulla (Fracture dislocation of C2-C3 Vertebrae)

CAUSE OF DEATH

Force of constriction required to occlude:

Jugular Vein ------------2Kg.

Carotid Artery -----------3.5 Kg.

Trachea -------------------15 Kg.

Vertebral Artery ---------16.5 Kg.

Fatal Period

About 3-5 minutes

Instantaneous - Fracture dislocation C.Vertebrae – medulla injured

Occlusion of Carotid & Vertebral A - Fatal Period is shorter

Death due to Asphyxia - Fatal Period is longer

Post Mortem Changes External Findings

Face - Pale, Congested, Swollen, Pt. hm.

Eyeballs - Prominent due to congestion.

Tongue - Protrude – due to Pressure at its base

Exposed part of Tongue - Dark Brown / Black

Salivary stains at Angle of Mouth opposite to the Side of Knot

(due to Dribbling of Saliva)

Neck – Stretched,

Head - Inclined opposite to the side of knot

PM staining –

Circumferentially on dependant parts of Arms & Legs,

Face & Neck above the ligature.

Bluish discoloration of Hands, Nail Beds & Lips.

Tardieu Spots on Forehead, Eyelids & Conjunctiva.

Involuntary Discharge of Semen & Fecal matter.

Pressure Mark around the Neck.

Abraded Contusion

Immediately after Death - Appears as Pale Groove.

Later - Yellowish Brown, Dry, Hard, Parchment like.

Edges of Groove - Hyperemia & Pt. hm.

LIGATURE MARK

Situated - Above the level of thyroid cartilage &

directed obliquely upwards along the line of mandible &

Reaches Mastoid Process behind the ears.

Non-continuous (Incomplete)

May be absent at - Back of Neck or Below the Knot.

LIGATURE MARK

1. Ligature Material

Tough & Narrow – Prominent Mark

Soft & Broad – Faint Mark

2. Period of Suspension:

Longer Period - Deep & prominent mark

3. Degree of Suspension:

Complete Hanging – Mark is Prominent

APPEARANCE OF L. MARK DEPENDS ON

4. Body Weight :

Heavy Body: Mark is Prominent.

5. If something intervenes between L. material & Neck -

LM is Less Prominent.

6. LM also depends on Number of turns around the Neck

Larynx & Trachea - Congested.

Larynx, Trachea, Pleura - Petechial Hm

Internal Organs - Congested.

S/C tissue underneath L. Mark - Dry, Pale, Firm & Glistening

Platysma & Sternomastoid Ms - Injured

Internal findings

Fracture Hyoid Bone

More common in Hanging than Ligature Strangulation

HANGING

Ligature Strangulatio

n

Fracture Hyoid Bone

Less common in Hanging than Throttling

Hyoid bone m/b fractured in persons > 40 yrs

# Greater Cornua – at Junction of Inner 2/3rd & outer 1/3rd

Fractured Ends - Displaced Outwards.

Carotid Arteries - Transverse Tear in Tunica Intima.

Lymph Nodes Above & Below LM - Congested.

Judicial Hanging - # Dislocation of C2-C3 / C3-C4

Ante-mortem or Post-Mortem ?

Ante-mortem Hanging

1. Dribbling of Saliva (Angle of Mouth)

2. Pt. Hm. & Ecchymosis underneath LM

3. Carotid A. - Tear in Tunica Intima,

- Extravasation of bld. within the vessel wall

4. Congestion & Hm of Lymph Nodes - Above & below LM

Medico legal Aspects

Suicidal, Homicidal or Accidental

Hanging - Most commonly Suicidal

Partial hanging - Almost always Suicidal

Signs of Struggle – Absent, However self Inflicted injury/due to

convulsions may be present

Homicidal – Rare

Lynching - Mob kills a person by hanging him publicly.Accidental Hanging – Rare

Fall from Height – Victim get hanged on a Rope / Neck-tie

Children - while playing (imitate Judicial Hanging)

Sexual Asphyxia / Auto-Erotic Hanging

Sexual perverts get Sexual gratification by Partial Asphyxiation

Place a Noose around his Neck &

Pulls other end of rope across a pulley (create Partial Asphyxia).

After gratification - releases the pull.

May become semi conscious and unable to release the pull

- Dies due to Asphyxia.

Victim - Naked / Dressed in Female dress

pornographic literature lying along.

Violent Asphyxial death caused by

constriction of Neck by means other than body weight

STRANGULATION

Strangulation Ligature

Throttling / Manual Strangulation

Hand

Mugging Elbow / Knee bent

Bansdola Stick

Cause of Death - Same as Hanging.

Postmortem Appearance

Asphyxia, Face - Congested & Cyanosed.

Eye balls - Prominent.

Tongue – Protrudes, may be Bruised & Bitten.

Tardieu Spots – Abundant

Sub Cunjunctival Hemorrhage.

PM staining - Dark & Prominent.

Injuries on other Body Parts - Due to Struggle

Strangulation

Neck injuries

L Mark - At or Below Thyroid level

Horizontal, Encircles the Neck Completely.

May be Absent at Back (due to hair / cloth)

May be Oblique – If victim is Dragged with Ligature or

Strangulated in Recumbent Position.

S/C Tissues under LM – Ecchymosis

Neck Ms, Laryngeal Cartilages, Trachea, Carotid A. - Injured

(injury more extensive than Hanging)

Superior Horn of Thyroid Cartilage – Commonly Fractured

Hyoid Bone Fracture: Rare (Level of constriction is Below Hyoid)

Hyoid Bone Fracture may be present if

1. Excessive force is used

2. Age more than 40 yrs

Broken Fragments are displaced outwards.

Strangulation

Homicidal - Most Common

Knot – At Back of Neck.Mouth – Gagged; Limbs – TiedSigns of Struggle – PresentIn Females – Signs of Sexual Assault

Infanticide - by passing Umbilical Cord around the Neck.

Suicidal – Rare

Knot – usually at Front

Using such a Method - that ligature remains Tight without

any victim’s effort.

Strangulation… Medicolegal Aspects

Accidental – Rare

Neck tie / Scarf - Caught in moving machinery

Strap placed on Head may slip

and compress the Neck

During Birth – Umbilical Cord gets twisted

around the Neck

Strangulation… Medicolegal Aspects

PM Findings

Signs of Asphyxia - Petechial Hemorrhages

Asphyxial Signs are minimal in Cardiac inhibition due to

Pressure on Carotid Sinus / Vagus N.

Tongue – Protrude; may be Bitten

Eye Balls Prominent.

Signs of Struggle

Neck- Bruises - Oval & Larger (thumb)

- Multiple & Smaller (Fingers)

Throttling- Manual Strangulation

Neck - Scratch marks (Multiple, Crescent shaped)

Internal Findings

S/C Tissues underneath Bruises & Nail Marks – Hemorrhage

Superior Horns of Thyroid Cartilage Fracture - More common

than Hyoid Bone Fracture.

Hyoid Bone Fracture common in persons > 40 yrs.

Internal Organs – Congested.

Throttling- Manual Strangulation

Homicidal - Almost Always

Accidental - Rare - Sudden holding of neck - Vagal Inhibition

Suicidal - Extremely rare

- Self Throttling is Impossible - as victims becomes

Unconscious - Hands Relax and Grip is released

Throttling… Medicolegal Aspects

Ante-mortem Throttling

1. Bruises on the Neck

2. Swelling of Tissues at and above the level of Compression

3. Bruises of Larynx, Trachea, Surrounding Muscles of Neck

4. Fracture - Thyroid cartilage & Hyoid Bone - Hemorrhage at

the Fractured ends.

5. General Signs of Asphyxia

Throttling… Medicolegal Aspects

Mugging / Choke Hold

Strangulation by Compressing Neck with Elbow / Knee Bent

Garroting

Victim is Strangled by throwing a

Ligature over the Neck from back and Tightening it quickly.

Loss of consciousness – Rapid.

It can kill a Strong man without any Sign of Struggle

Bansdola

Neck is Compressed between 2 bamboo sticks (one

placed in front & other behind the neck).

Sticks are tied at one end & a rope is passed at the other

end to bring the sticks together

Neck can also be compressed with one stick against the

ground.

Exchange of Air between Atm. & Lungs is prevented

by means other than Neck Constriction &

Drowning

Types:

1. Smothering 2. Choking

3. Gagging 4. Burking

5. Traumatic asphyxia

SUFFOCATION

Smothering

Air exchange is prevented by - closure of Mouth & Nostrils

PM Findings

homicide - Nail Marks & Contusions around mouth & nose

(Absent if a cloth is used)

Inner side of Lips & Gums- Abrasion, Contusion, Laceration

Fracture Nasal Cartilage. Bleeding from nose.

Fracture dislocation of teeth.

Signs of Struggle on other body parts

Accidental Smothering

Abrasion, Contusion, Laceration around mouth & nose and

Injury on inner side of Lips & Gums - May be present

Fracture Dislocation of Teeth.

Signs of Struggle - ABSENT

In epilepsy - Tongue bitten & injury to other body parts

Fall on Dust / Flour – Traces of these materials present in

Mouth & Nose

Smothering due to masochistic activity

circumstances :-

Pornographic Literature,

Exposed Private Parts,

Wearing Dress of opposite sex

Method used for Self Smothering

Suicidal Smothering

Pillow tied around Mouth & Nose

Plastic Bag around Head

Local effect of pressure but NO remarkable injuries.

Medicolegal Aspects of Smothering…

Accidental (Most Common)

Alcoholics / Epileptics –

Fall on Bed - Burry their Face in Bed - Fail to revert

to favorable posture (Postural / Positional Asphyxia)

Accidental Smothering

Child Birth - Placental Memb. adhere Mouth & Nose

Overlaying - Mother rolls over the baby during sleep.

Children - while playing with Plastic Bags.

Accidental Smothering

Sexual perverts - Cover their head with plastic bags.

Glue Sniffing (Solvent Abuse)

Victim re-breathes plastic bag contents (glue)

Glue solvents (Xylene) induce drowsiness

Moisture accumulates in plastic bag –

Bag adheres to mouth & nose – Breathing is blocked.

Cause of Death – Asphyxia or

Arrhythmias (Halogenated hydrocarbons in solvent)

Trauma to Chest, Abdomen / Back - Prevent Resp. movement

E.g House Collapse, Stampede,

Run over by Vehicle,

Fall of Earth on Trench workers

PM Findings

Signs of Asphyxia.

Deep Cyanosis of face, Numerous petechiae

Traumatic Asphyxia

Demarcation Line b/w discolored Upper Body and

Normal Lower Body.

Chest Compression–Back pressure-Displace blood in opp.

Direction (From SVC to Head & Neck Veins - No valves in SVC)

Valves in Subclavian Veins – Prevents blood to enter Veins of Upper Limbs.

Traumatic Asphyxia…

Pressure on Chest-Blood Flows in Opposite Direction

Blood unable to cross the Valve

Blood cannot cross the Valves

Gets pooled in Head & Neck, Upper part of Chest

Face & Neck – deeply Cyanosed

Eyes – Blood Shot

Petechiae – Scalp, Face, Neck & Shoulders

Heart & Lung – Injured

Ribs – Fractured (Bilaterally at the angles)

Other Body parts - Injuried (depending on cause of Trauma)

Traumatic Asphyxia

Most Commonly Accidental

Mothers – Roll over a baby - Traumatic Asphyxia

Can be Homicidal (Burking Phenomenon)

Traumatic Asphyxia… Medicolegal Aspects

Lumen of Air Passage occluded by :-

Foreign Material / Pathology in Resp. Tract or Esophagus.

Size of Object – NOT Important

Object smaller than lumen may cause spasm of Air passage

Cause of Death

Asphyxia, Vagal Inhibition,

Laryngeal Spasm / Bronchospasm

Choking

PM Findings:

Asphyxial signs.

On Autopsy - Cause of Choking may be found.

Chocking is most commonly Accidental

May occur due to Foreign material in Air Passages

Choking

Inhalation of Vomitus –

due to Drunkenness, Anesthetic agent, Epilepsy or

Coma.

Regurgitation of Milk (Infants)

Bleeding into Resp. Passages

(Cut Throat Injuries, Tonsillectomy / Tooth Extraction)

GAGGING

Cloth is pressed inside the mouth

Gag blocks the mouth – Blocks passage of Air coming

from Nostrils to pass through Back of Throat.

Gag become moist due to Saliva - Obstruct cloth Pores –

Leads to complete Obstruction of Air Passage.

Autopsy findings:

Lips, Soft palate & Pharynx - Abrasion, bruise & lacerations.

Medicolegal aspects:

Mostly Homicidal (in Infants / children)

Adult - Gagged to prevent shouting (Death is Accidental)

Gagging

Choking - Obstruction of larynx due to Food Bolus

Occurs in Cafe / Restaurant

Sudden Collapse mimics Coronary Heart Attack.

common in suppressed Gag Reflex- (Intoxication, Sedation)

Cause of Death

Asphyxia or

Reflex Cardiac Arrest (Stimulation of Laryngeal N.)

CAFE CORONARY

Food bolus impacted in Larynx.

Death is Accidental (Relatives can claim Insurance benefits)

Timely treatment can save the person.

Blow on Back / Sternum or pressure on Abdomen

(Heimlich Maneuver) Violent Coughing - Expels foreign body

Café Coronary… Autopsy Finding

Combination of Smothering & Traumatic Asphyxia.

Burke & Hare used to kill the Victims and sell their body to

Edinburgh Medical School for dissection.

Burke used to Sit on Chest of inebriated Victim and

Cover Mouth & Nose with one Hand &

Push the Jaw Upwards with other hand,

Hare pulled the Victim by holding the feet.

BURKING

Passage of Air between Atmosphere & Lungs is prevented by

Submersion of Body in Water / Fluid.

Types : - 1) Typical 2) Atypical.

Typical drowning (Wet Drowning)

Typical Signs of drowning are present

Exchange of Air is blocked by :- Inhalation of Fluid

It may be Fresh Water or Salt Water Drowning.

Drowning

Water moves from Lungs to Bld Vessels

Hyper-volemia & Hemodilution.

RBCs Burst & Hemolysis occurs - Liberation of K++

Decrease in Na++ & Cl -

Vent. Fibrillation due to:

Anoxia, Hypervolemia, Hyperkalemia & Na ++ deficit

Fatal Period: 4 - 5 mts (Five)

Fresh Water Drowning

Due to Hypertonicity of water -

Water moves from Bld Vessels to Lungs (Pulmonary Edema)

HypoVolemia, HemoConcentration, Crenated RBCs, Hypoxia

Circulatory Shock - Cardiac Standstill

Fatal Period - 8-12 mts.

Salt Water drowning

Very little or NO inhalation of water into Air passages.

1. Dry Drowning

20% cases of drowning are due to Dry Drowning.

Water enters Larynx - Sustained Laryngeal Spasm.

Very less Water enter Lungs

Cause of Death - Asphyxia.

Atypical Drowning

2. Immersion Syndrome (Vagal Inhibition)

It may occur in:

Sudden Impact with very Cold Water.

Falling or diving in Water with Feet first.

Horizontal Entry into Water (Impact on Epigastrium)

Cause of Death: Vagal Inhibition

Atypical Drowning

3. Submersion of Unconscious

Victim is Semiconscious / Unconscious during fall in water

(Epilepsy, Drunk, Head Injury or Dizzy due to HT,)

Typical findings drowning – Absent

4. Near Drowning / Sec. Drowning Syndrome

Complications or Sequelae of Drowning in victims who survive.

Hypoxic encephalopathy & Secondary changes in lungs

(fibrosing alveolitis) due to infection from inhaled water

Atypical drowning

Lungs - Rigid, Stiff & heavy but are NOT edematous.

Microscopically lungs show ARDS

Death occurs after some hours or days.

Cause of Death: Combination of

Cerebral Hypoxia,

Pulmonary Edema,

Aspiration Pneumonitis,

Electrolyte Imbalance & Metabolic Acidosis.

Mechanism of Drowning

Non-Swimmer Falls in Water –

Sinks due to (1) Body Weight (2) Force of Fall

Rises to the Surface due to

(1) Buoyancy of Body (2) Struggling Movements.

Shouts for Help & Tries to Breath -

Water is Swallowed & Aspirated - cause Violent Coughing –

Air expels & its space is filled by water - Sp. Gravity of Body Increases –

Victim Sinks - Struggling Movements - Comes to Surface –

Again Sinks (due to inhalation of more water)

This continues several times till he finally sinks

Sign / Symptoms

Auditory & Visual Hallucinations

Return of Memory of Past Events.

Confusion

CAUSE OF DEATH:

Asphyxia

Vent. Fibrillation In Fresh water drowning.

Cardiac Standstill In Salt water drowning

Other causes of death:

1. Vagal inhibition

2. Hypothermia,

3. Sec. Drowning Syndrome,

4. Injury to Head / other Vital organs during fall,

5. Cardiac failure,

6. Rupture of Cerebral Aneurysm.

Cause of Death can be

(1) Drowning alone or

(2) Combination of Drowning + Disease / Trauma

POSTMORTEM CHANGES:

External Changes

Body & Clothes: Wet (if body is recently recovered from water)

Skin - Wet, Cold & Pale (contraction of blood vessels)

Face - Cyanotic

Conjunctiva - Congested.

PM Staining may be Absent (body constantly moving)

When present it is confined to - Head & Neck, Front of Chest

Rigor Mortis

Appears Early (muscular exhaustion)

Passes off Late (cold water)

Fine Froth from Mouth & Nostrils

White, rarely Blood Tinged, Lather like

Abundant & Increases with Compression of Chest,

Reappears on applying Pressure.

Mechanism of Froth Formation

Water in Resp. passage – acts as irritant – Stimulates secretion

of mucus –

Air & Mucus Churned up (due to Violent Respiratory efforts)

Fine Froth is produced

Froth is also Present in Poisoning –

Opium, Cocaine, OPC & Barbiturates.

In poisoning, froth is Neither so Fine,

Nor so Copious & Persistent and

Typical signs of Drowning are Absent.

Froth may be Absent in death due to Laryngeal Spasm.

Cadaveric Spasm

may be present in localized group of Muscles (Hands)

Weeds / Mud may be found tightly clenched in the Hands.

Cuties Anserina / Goose skin –

Skin appears Granular & Puckered with

Hair standing on the end.

Due to spasm of Erector Pillae muscles (due to Cold).

Not diagnostic of Drowning. (also occurs due to Rigor Mortis)

Skin of Hand & Feet - Wrinkled, Bleached & Sodden.

Due to Immersion in Water.

Not Diagnostic of Drowning

Indicates that Body remained in Water for some time.

Hands & Feet of Washer-woman:

Emphysema Aquosum (Ballooning of Lungs)

Lungs - Voluminous, Water Logged,

Bulge out on Opening Chest Cavity.

Impression of Ribs on its surface &

Surface: Pale, Pitting Edema.

On Cut Section - Blood stained Fluid Oozes out.

Tardieu Spots - Scanty

- Bld Vessels get Compressed by Water filled

Alveoli

Internal Findings

Microscopic,

Unicellular Algae,

Present in Natural water (single or in colonies).

Size varies from 10-80 µ

Sillicacious Cell Wall - Resist Acid, Heat & Putrefaction

Diatoms

Drowning - Victim inhales water –

Alveoli distend - Alveolar wall rupture –

Water along with diatoms moves from Alveoli into Circulation

and carried to Distant Organs (Brain, bones etc)

- Detected Microscopically

- Indicate Antemortem Drowning

Diatoms enter the blood

1. Deceased did NOT drink this water just before drowning

2. All the species present in Test sample are

also present in Control sample.

3. Different Species of diatoms in Test sample & Control

sample are in similar proportion.

Diatom Test is Valid if

Diatom test:

5-10 gm of Bone marrow kept in

10 ml conc. HNO3 + 0.5 ml conc. H2SO4 for 12 hrs

Fluid is washed with DW and Centrifuged Repeatedly

Final residue - Examined under Phase contrast Microscope

Diatoms resist Putrefaction - Test is valid in decomposed bodies

Diatom Test is Negative in

Postmortem Drowning &

Dry Drowning.

Signs of Ante mortem Drowning

1. Persistent, Copious, Fine Froth - from Mouth & Nose.

2. Fine froth in Air passages.

3. Diatom Test - Positive.

4. Edematous Lungs.

5. Cadaveric spasm - Hands Tightly Clenched containing

material present under

water

MEDICOLEGAL ASPECTS

Suicidal Drowning Signs of Struggle Absent.

common in Indian females (Dowry death).

Victim may tie her hands / legs & attach weight before jumping

She may take Poison, Cut her throat before drowning

Dead body may be injured by sea animals –

Injuries will be postmortem NO Vital Reaction.

Homicidal drowning Common

- Body remains concealed for some time

- It is carried to distant place.

PM Findings of drowning - Almost similar in Suicidal,

homicidal or accidental

death

Circumstances of the Case helps to find the manner of death

Anoxic - Prevention of O2 from reaching Lungs

Stagnant - Impaired Blood Flow resulting in Lack of

oxygenated Bld transport to Tissues

Anemic - Low Hb - Inability of Blood to carry O2

Histo-toxic Tissues Destruction – Tissues cannot use O2

Hypoxia (classification)

Cause of Death SignsVagal Inhibition No Asphyxial signs

Death instantaneous

Slight Vagal Effect &

Some Venous Constriction

Slight Asphyxial SignsCyanosed face; Suffused EyesOccasional Petechial Hm.

Moderate Venous Constriction &

Some Resp. Obstruction

Moderate Asphyxial SignsCyanosed Face, Bulging Eyes, Conjunctival Ecchymosis & Few petechiae

Pronounced Venous & Resp. obstruction

Slight Arterial Constriction

Well marked Asphyxial SignsDeeply Cyanosed face, Blood Shot Eyes, Bitten Tongue, many petechiae in Scalp, Conjunctivae & Face.

Rope & knot may formFixed Noose

Two Limbs of Rope near Knot

are Pulled upwards

Inverted V shaped Mark

At apex of V - Mark is Absent

(Head tilts away from the knot)

Running noose: End of Rope is passed through the loop (slip knot)Noose tightens in Horizontal plane LM - Horizontal. - additional Vertical mark (due to suspending ligature)

Gettler Test

In a living person

Cl level of Bld. In Left & Right chambers of Heart - Equal

According to Gettler

In Fresh Water Drowning

Hemo-Dilution of Right side Chambers - occur Early

Cl level of blood in Right side is 50% of Normal value

(Normal Value = 600mg/100ml)

In Salt Water Drowning

Hemo-Concentration occurs on Left side First

30-40% increase in Cl level in Left Chambers of Heart

Gettler Test is NOT Significant if:

1. Victim had Patent Foramen Ovale, or VSD or

2. Drowning in Water with Saline Conc = Blood

3. Advanced Stage of Decomposition