Violent asphyxial deaths

By Dr. Naveen

Violent asphyxial death
1.

asphyxial deaths, the process of respiration i.e., the exchange of air between the atmosphere and the lungs beds is prevented by some violent mechanical means.

Definition: In violent

 Violent

asphyxia can be caused by -  (1). Constriction of the neck.  (2). By closure of nose and mouth.  (3). By occlusion of the lumen of the air passage by some materials .  (4). By restricting the movement of the respiratory muscles.

2. Types of violent asphyxia
 1).

Hanging  2). Strangulations  3). Drowning  4). Suffocations

Hanging
 1.Definition

:

– Hanging is a process in which the body is suspended with a ligature around the neck which causes constriction of the air passage preventing exchange of air between the atmosphere and the alveoli of lungs, leading to asphyxia and death.

In hanging, the constricting force is either the weight of the whole body or the weight of the head alone.

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2.Types of hanging
1). Typical hanging. In a typical hanging, the knot of the ligature should be at the nape of the neck on the back. Typical hanging is not very common in occurrence.

 2).

Atypical hanging. In atypical hanging, the knot of the ligature may be at any site other than the nape of the neck. It may be near one angle of the mandible, near the mastoid, or below the chin.

 Hence

in case of typical hanging, maximum pressure is exerted in the front of the neck, on the midline, i.e., over the wind pipe. The pressure over the jugular veins and the carotid arteries are comparatively less but equal on both sides.

In

atypical hanging, the commonest site for the knot is near one side mastoid process or near the angle of mandible. Occasionally, it may be below the chin.

When

a knot is on one side, the pressure over the vessels on both side is not equal and it also takes more time for total occlusion of the wind pipe.

When

the knot is blow the chin, there may not be much evidence of asphyxiation as the respiratory tract is not directly compressed.

Types of hanging
 1.

Complete hanging. In this variety, the body is fully suspended and no part of the body touches the ground. The constricting force here is the weight of the whole body.

 2.

Incomplete or partial hanging.
The lower part of the body is in touch with the ground. Sometimes only the toes, sometimes the whole foot or feet, sometimes the knees, sometimes the buttock,may be in touch with the ground.

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Partial hanging is taken to be diagnostic of being suicidal in nature.

The ligature materials in cases of hanging
 The

ligature material may be anything which may be tied around the neck with some additional length for fixing it to the point of suspension. It can be a rope, electric wire, belt, neck tie, bed sheet, scarf, cycle chain or any such thing.

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The knot
The

knot may be a fixed one(double or more), or it may be a slipping knot or a running knot.

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Precise causes of death due to hanging
Though

a form of violent asphyxia, not in all cases of hanging death occurs due to asphyxia. Any of the followings may be the actual cause of death.

 1.

Asphyxia along with apoplexy due to simultaneous pressure over larynx and jugular veins. The combined effect of asphyxia and apoplexy is the cause of death in most cases.

2.

Asphyxia alone. 3. Apoplexy alone. 4. Cerebral anaemia or ischaemia due to pressure over carotid and vertebral arteries.

5.

Vagal shock. This may occur due to inhibition of the heart due to irritation of the carotid sinus.

6.

Fracture dislocation of the second and third cervical vertebrae, which causes injury to the medulla and the upper part of the spinal cord, as in case of judicial hanging.

Postmortem

appearance of hanging

A. External findings
1.

The ligature mark. –In most cases of death due to hanging, the ligature mark around the neck is very much conspicuous.

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–The ligature mark in case of hanging is oblique, noncontinuous, placed high up around the neck, grooved, parchmentised and abraded at places.

 The

ligature mark is noncontinuous because of a gap at the nape of neck due to hair intervening between the ligature material and the skin underneath. There may also be some gap near the site of the knot due to the pull on the knot from the point of suspension above.

 The

upper margin of the ligature mark has a line of postmortem staining, all around above the ligature mark. This is due to settling of blood, from head and neck above the level of constriction, caused by the ligature material.

 When

the knot is in contact with the skin, it is usually inverted “V” shaped, due to extension of ligature material downward on both sides from the knot above. The point of contact of the skin with the knot may leave a deep parchmentised abraded impression.

Factor which influence the appearance of the ligature mark
 A.

The ligature material.  B. Period of suspension.  C. Degree of suspension.

 D.

If something, say, the collar of the shirt intervenes between the ligature material and the skin of the neck then the ligature mark will not be prominent.

E.

The weight of the body of the deceased. F. Tightness of the ligature. G. Slipping of the ligature material.

H.

When the ligature is applied in multiple turns, then there will be multiple,parallel, grooved ligature marks.

I.

Design of a ligature material, e.g. of a rope or a cord may get imprinted on the ligature mark.

J.

The ligature material may be in situ around the neck or may be sent along with the dead body or may be absent altogether.

2. The dimensions of the neck
 Due

to prolonged suspension, the neck becomes slender and increases in length. This will not be seen in suspension for a short period.

3. Bending of the neck
 The

neck gets flexed to the side, opposite the side of the knot. The state of bending will continue until the onset of decomposition.

4.

The face may be pale or flushed or congested.

5.

Tardieu’s spots may be present on the forehead, over the eyelids, under the conjunctiva and sometimes near the temple.

6.

Tongue may be partly protruded out in between the lips and during the stage of rigor mortis may also be bitten in between the jaws.

7. Dribbling of saliva.  Dribbling of saliva is a very constant and important finding in a case of death due to hanging.

 Dribbling

of saliva occurs from the angle of the mouth which is at a lower level i.e., from the angle opposite the side of the knot. When the knot is on the nape of the neck it occurs across the middle of the lower lip. When the knot is under the chin, then it occurs through either or both angles of the mouth.

 The

saliva drops down in front of the chest when the body is bare or it stains the clothes in front, when the deceased is dressed. When dried or partly dried, it becomes quite fixed and cannot be easily removed or rubbed out.

 Dribbling

of the saliva is considered a very important phenomenon in support of death due to antemortem hanging, as because, excessive salivation is an antemortem reaction which occurs due to irritation of the submandibular salivary glands during life, due to the pressure and friction caused by the ligature material.

8. Peculiar distribution of the postmortem staining
 As

the body remains suspended in the upright position after death, the postmortem staining will be present over the lower limbs, lower parts of the upper limbs and the upper margin of the ligature mark.

 Occasionally,

in the lower limbs, there may be multiple haemorrhagic spots  due to rupture of the capillaries, due to being overdistended by blood.

 This

distribution of the postmortem staining is however not confirmatory of the death being due to hanging. It only speaks that the body was in a state of suspension in upright position for a considerable period after death.

 Thus,

if a dead body is placed after death, in upright position in a state of suspension with a ligature around the neck, then similar distribution of postmortem staining will be there, provided that sufficient time has been allowed to pass, in that position of the body.

9.

The hands are usually clenched. Sometimes the hands may show presence of fibers, like that of jute when a jute rope has been used.

10.

Fingertips, nailbeds, and lips show sign of cyanosis.

11.

In males there may be involuntary discharge of semen.

12.

In both sexes there may be involuntary discharge of fecal matter and urine.

 13.

In addition, there may be some abrasions at places like lateral aspects of shoulder, due to friction with a wall or a post or a pillar, which occurs during suspension, particularly during the last phase of life when there is convulsion.

 14.

In some cases, the right side eye remains open with more dilatation of the rt. pupil, whereas the left eye remains closed and left pupil less dilated. This is known as “Le facie Sympathique”.

B. Internal findings1.

In some cases, the tongue is slightly protruded out and in others the tongue is pushed back.

2.

Larynx and trachea are congested. There may be Tardieu’s spots under the mucus membrane of the trachea and larynx.

 3.

Lungs are congested. There will be presence of Tardieu’s spots on the undersurface of the pleura which are particularly abundant at the interfaces of the lobes.

 4.

Brain is congested, oedematous with presence of haemorrhagic spots. Similar findings are present in the layers of meninges.  5. All the organs are congested.

 6.

Maximum findings are available in the TISSUE OF THE NECK.

– (a). The subcutaneous tissue underneath the ligature mark is dry, white, firm and glistening. The platysma and the sternomastoid muscle may show haemorrhages and are even occasionally ruptured.

 (b).

The hyoid bone may be fractured in persons, more commonly above the age of 40 years. Fracture of thyroid in hanging cases seems to be a rarity.

©.

There may be transverse tear of the intima of the carotid arteries.

(d).

Larynx are congested. There may be Tardieu’s spots under the mucus membrane of the larynx.

 (e).

In case of JUDICIAL HANGING or where there is a drop from a reasonable height, the ligature around the neck causes a forceful jerky impact on the neck at the end of the fall. In such cases there will be fracture dislocation of the C2 and C3 or C3 and C4 vertebrae.

In case of fracture of C2 and C3 the fractured piece of the odontoid process of the C2 vertebra causes damage to the medulla. In other cases there is corresponding injury to the meninges and the spinal cord.

(f)

In a few cases, posterior wall of the oesophagus may show congestion due to compression against the cervical vertebrae.

MEDICOLEGAL ASPECTS OF HANGING

A. Suicide hanging
 Hanging

in its face value goes in favor of being suicidal in nature. The place of occurrence is secluded. The point of suspension remains approachable to the suicide. Partial hangings are almost always suicidal in nature.

 There

may be a suicidal note left behind. There should be a motive for committing suicide. Often a suicide failing in other methods to end life. May lastly adapt this method successfully. In these cases evidence of some other adapted methods may be present on the body.

B. Homicide hanging
 1.

Homicidal hanging is rare. It is not ordinarily possible with an adult victim, if he is not intoxicated or not made unconscious by some other means, like head injury. Alternatively, the victim is either a child or a very debilitated person.

 2.

Usually the rope is first fastened around the neck and then it is pulled over a high point of suspension. Hence, there will be presence of evidence of pulling or dragging of the victim on the ground as also presence of evidence of friction at the point of suspension , with the ligature material.

 3.

The hand of the victim may show presence of foreign material like foreign hair or button. The hands, feet and the mouth of the victim may be tied. Signs of struggle may be present on the body of the victim and at the place.

C. ACCIDENTAL HANGING

The following circumstances of accidental hanging may be encountered:– In factories, a worker working at a height if falls accidentally, may get hanged on a sling or rope. Similarly, if during such a fall the necktie gets fixed at some point, then the victim may die due to the effect of hanging.

–2. When a person on the top of a ladder suddenly misses a step, in course of falling down, his head may get fixed in between two steps and he may die due to constriction of the neck in suspension.

–3. Infants while accidentally slipping down in between the side grills of the crib, may die due to constriction of the neck with the body being in a suspended position.

–4. Children while playfully acting judicial hanging, may actually be hanged to death.

–5. In course of masochistic practice the victim may accidentally die due to hanging. Such person gets sexual gratification by partial asphyxiation.

–He arranges the situation by placing a noose around his neck and creates a state of partial asphyxiation in himself by pulling the other end of the rope, across a pulley type arrangement.

– After getting sexual orgasm he releases the pull on the rope. In course off such practices the victim may fail to release the pull and die due to hanging.

– Males are the exclusive victims. The circumstance in such a case is sufficient to indicate the actual nature and mode of death. The victim is found naked at the place of occurrence. Often, some soft cloth is placed around, in between the rope and the neck.

D. Postmortem hanging
Often

a victim is killed by some other means and then hanged to simulate a suicidal death.

 As

in case of homicidal hanging, there will be evidence of dragging of the body on the ground and friction at the point of suspension of the ligature material, as the ligature is first tied around the neck of the dead body and then the body is hanged.

 The

unapproachability of the point of suspension by the victim, the signs of disturbance and the evidence of the actual cause of death, present on the dead body, are the other features which make the fact (post mortem hanging)clear.

Strangulations
 Definition

– in strangulation, the exchange of air between the atmosphere and the lungs is prevented by way of constriction of the neck by means of a ligature material or by some other means, without suspending the body, where the force of constriction is applied from outside and is not the weight of the body or the head of the victim.

Types of strangulations
 According

to the mode of causation,strangulations are of the following types–1. Strangulation by ligature.

– 2. Manual strangulation or throttling . In this form of violent asphyxiation, the neck is compressed with fingers. The upper part of the neck is mostly affected and the pressure is exerted there, against the mandible. The neck may be compressed from the front, back or from any side and one or both hands may be used.

– 3. Strangulation by means other than a ligature material or hand or limbs. Strangulation may be caused by compressing the neck in between two sticks or rods, by compressing the neck against the ground or wall by a stick in front, or by pressing the neck on the ground by foot. BANSDOLLA is a form of strangulation in which the neck is compressed in between two bamboo sticks, one in front and another on the back, or with one bamboo stick against the ground.

– 4. Garrotting . In garrotting, a loop of a thin string is thrown around the neck of the unaware victim from his back. Then this ligature material is rapidly twisted with the help of two sticks tied at the free ends of the string, so as to constrict the neck strongly. The unaware victim is very rapidly asphyxiated and dies. This is just a variety of strangulation by ligature.

–5. Mugging. Strangulation of the neck by compressing it in the knee bent or elbow bent.

Table. Difference in postmortem appearance between hanging and strangulation by ligature
Hanging (1)Ligature mark strangulation by ligature oblique, encircling the transverse, encircle the neck uncompletely, high neck completely, below up the neck,between the the thyroid cartilage. chin and larynx.

(2)Abrasions About the edges of and ecchymosis ligature mark not common. (3) Bruising Of the neck muscles less common.

About the edges of ligature mark are common. Of the neck muscles more common.

Table. Difference in postmortem appearance between hanging and strangulation by ligature
Hanging
(4) Neck Stretched and elongated.

Strangulation by ligature
Not stretched and elongated.

(5) Hyoid bone (6) Thyroid cartilage (7) Larynx and trachea

Fracture is uncommon Fracture may occur Fracture is more common Fracture is less common. Fracture may be found Fracture rare

Table. Difference in postmortem appearance between hanging and strangulation by ligature
Hanging (8) Emphysematous bullae Not present on the surface of the lungs. Strangulation by ligature Very common on the surface of the lungs.

(9) Carotid arteries Horizontal intimal tear may be seen Usually pale and petechiae are not common.

Horizontal intimal tear is rare

Congested, livid and marked with petechiae.

(10) Face

Table. Difference in postmortem appearance between hanging and strangulation by ligature
Hanging
(11) Signs of asphyxia (12) Tongue External signs less marked. Protrusion is less marked. Often runs out of mouth

Strangulation by ligature
External signs well-marked.

Protrusion is more marked.

(13) Saliva

Absent

Medicolegal aspects of strangulations
Strangulations in their face value are homicidal in nature.  In homicidal strangulation by ligatures, anything which can be twisted, may be used as ligature material. The knot may be a half knot or a full knot or a double or tripple knot.

There will be marks of violence, at different other places of the body. The site will be approachable to others and there will be marks of disturbance at the site. If the hands of the deceased are in a state of cadaveric spasm, then the grip may show the presence of foreign scalp hair, of torn fibers of a cloth or a button. There may be homicidal wounds on the body.

 When

a person after being strangled, is pulled headward with the free end of the rope, then the ligature mark, instead of being circular and continuous, will be like that of hanging being oblique and non-continuous.  Suicidal and accidental strangulations are not common.

 Throttling,

for all practical purposes, are always homicidal. It is claimed that accidental throttling death may occur due to vagal inhibition when one playfully manipulates or presses the neck of his friend.

 Strangulation

caused by other materials, palmar strangulation,garrotting and mugging, if diagnosed properly, then must be taken as homicidal in nature, except in some cases of house collapse and similar circumstances when a beam like structure if falls on the neck of a lying person, may strangle him to death.

 Strangulation-like

marks may be found caused by a necklace or a cord round the neck, when the neck swells during the state of decomposition. In case of decomposition, even without these materials around the neck, strangulation may be doubted due to the fold of the skin at the upper part of the neck caused by swelling of the neck.

DROWNING Definition . Drowning is a form of violent asphyxiation where the respiratory passage is occupied by fluid i.e., water, due to submersion under water and inhalation of water. To be drowned, it is not necessary that the whole body should be under water. Submersion of mouth and nasal openings by any means is sufficient for that purpose.

Types of drowning

Depending on different circumstances, effects and factors, we get the following types of drowning –
– 1. Dry drowning – 2. Wet drowning
• (a). Fresh water drowning • (b). Salt water drowning

– 3. Shallow water drowning – 4. Immersion syndrome – 5. Secondary drowning

1. Dry drowning
 In

about 10% to 20% of deaths due to drowning no water is found in the lungs during the postmortem examination. These are the circumstances where death actually occurs due to submersion or drowning, yet the lungs remain dry or water-free.

Dry drowning may occur in two ways.
– (1). During first inhalation of water, there is severe laryngeal spasm which does not allow any water to enter the lungs though death occurs due to asphyxia due to laryngeal spasm in a circumstance of drowning. – (2). When death occurs due to vagal inhibition of heart before complete submersion of the body under the water, as it happens in case of immersion syndrome.

Wet drowning
 In

this variety, the water enters the lungs. The effects of water entering the lungs depend on, whether submersion has occurred in freshwater or it has occurred in salt water.

3. Shallow water drowning alcoholics, epileptics, infants and children and unconscious persons may die due to drowning in shallow water, in a shallow pit or a drain. In shallow water drowning, the whole body need not be submerged. Submersion of face alone is sufficient to cause drowning if the mouth and the nose remains under the water.

4. Immersion syndrome
 This

is a condition which is found in temperate and cold zones. Usually the young swimmers are the victim. When they drive in very cold water, they may suffer from vagal inhibition of the heart and die sudden death in water, even though they may be good swimmers.

5. Secondary drowning

This is not drowning in the truest sense, but a complication or sequelae of drowning. After a few days of recovery from drowning, the victim may suffer from pulmonary infection and edema. Ultimately the person may die due to asphyxia of pulmonary origin. Due to its etiological background, such a development is termed as secondary drowning.

Signs of submersion in a dead body removed from water
 1.

When freshly removed from water, the body and the clothes will be wet. Irrespective of the time passed after recovery of the body from the water, there will be sand and mud stain on the body, hair and clothes. This finding is not specific of antemortem drowning or death due to drowning.

 2.

Development of cutis anserina (goose skin like appearance of the surface of the body) is another nonspecific finding which also does not tell about the antemortem or post-mortem nature of drowning.

Cutis anserina develops due to contraction of the erector pilae muscles of the skin occuring due to contract of the body with the cold water. It also occurs in all dead bodies during the state of rigor mortis of the muscle of the skin. Cutis anserina is not appreciable when decomposition of the dead body starts.

 3.

Retraction of the scrotum and penis in males is another non-specific finding, which occurs due to submersion, whether before or after death.

 4.changes

in the skin of the palm and sole, like that which occurs in a washerwomen is yet another non-specific sign of submersion of a body under water for some hours which has no relationship specifically with antemortem or postmortem drowning. The skin of the palms and soles are bleached, corrugated and thickened.

5. Presence of mud, sand , gravel and weed in the hand, in a state of cadaveric spasm is one of the confirmatory signs of death due to drowning, because the cadaveric spasm of the hands indicate the last work of the person which he performed during the process of his death. Presence of sand, weed etc. in the hand in that state, indicates that, just before death he tried to grab the soil at the bottom of the water. This means that at the time of death he was submerged under the water.

 6.

Presence of copious fine white froth near the mouth and the nasal opening is another vital finding in a case of death due to drowning. It occurs due to the churning effect of the air in the alveoli the water inhaled and the mucus secretion from the respiratory tract wall. The churning effect results from the violent effort for respiration.

 Another

feature of this frothing is that, it continues to come out for a considerable period, even if wiped out again and again. Continuous frothing is a very very strong finding in support of death due to drowning but is not absolutely confirmatory, as it may occur in those cases where death is preceded by pulmonary edema.

 7.

Presence of sand and mud in the nail beds, though not in the tight grip of cadaveric spasm, is another important finding in support of antemortem drowning and bears weight in this respect, though not as forceful as the cadaveric spasm.

 8.

Suffused and congested conjunctiva is another external finding of antemortem drowning which also carry reasonable weight towards antemortem phenomenon of the drowning.

 9.

Distribution of postmortem staining in a body removed from water is somewhat different than in other dead bodies and is usually found over the head, face and neck.

 10.

Sand and mud may be present inside the mouth cavity and the nose.

 11.

A dead body recovered from a pond or river may bear post mortem injury due to eating by fish or other aquatic animals or due to impact with some projecting substances.

Internal findings 1.

The mouth cavity will show presence of sand, mud etc.which are not of much significance.

 2.

Sand, mud or weed may be present in the esophagus which is also not very much significant in support of death due to drowning.

 3.

The lumen of the larynx, trachea, bronchus and bronchioles show presence of fine forth mixed with sand and mud. This is a very important sign of death due to drowning. Presence of sand and mud in the lower respiratory tract is more important than their presence in the upper respiratory tract.

 4.

The lungs are voluminous, edematous, have balloon like appearance with marks of indentation over the surface by ribs. The lungs pit on pressure. When incised, the cut surfaces ooze frothy thin fluid blood.

 5.

The stomach may show presence of water, sand, mud and weed.

 6.

Presence of water, sand etc. in the upper part of the intestine is diagnostic of death due to drowning, because passing of these substances through the pylorus needs antemortem process of peristaltic movement and opening of the pyloric sphincter.

 7.

The blood is thick in case of death due to drowning in salt water, and is thin due to haemolysis in case of drowning in fresh water. (a). Detection of diatoms in some remote organs and tissues including brain and bone marrow. This is one of the most dependable signs of death

8. Laboratory findings-

 (b).

Blood chemistry: According to Gettler,in case of fresh water drowning, haemodilution occurs in the right side chambers of the heart early and for this the chloride value of the blood on the right side chambers may come down to the 50% of the normal value.

 Conversely,in

salt water drowning, there is haemoconcentration which affects the left side chambers of the heart first and as a result there is increase in the level of chloride in the blood of the left side chambers of the heart by 30% to 40%.

 ©.

Microscopic changes in the blood: In fresh water drowning there is both haemodilution and haemolysis which leads to both absolute and relative low count of the R.B.C.. In salt water drowning, there is haemoconcentration which causes relative increase in the R.B.C. count. The R.B.C.s shrink and appear crenated.

DIATOMS These

are unicellular algae which have inert silicon coating around them. These are present in all natural water sources, more abundantly in pond water or in a lagoon, or where the water is stagnant. They are less frequent in streams or in rivers where the water is frequently polluted by chemicals and industrial refuse.

When a drowning person inhales water and when the alveoli get distended with water and air, the alveolar walls may get ruptured exposing the capillaries which are also ruptured along with. The water from the alveolar sacs along with diatoms it contains, enters the circulation and are carried to distant organs and tissues.

Hence, in a body removed from water, if diatoms can be demonstrated in the tissues of some distant organs(distant from the lungs and the body surface, to exclude the chance of contamination of the tissue by surface diatoms), then it goes strongly in support of death due to drowning. There are of course certain fallacies of the presence of diatoms in the tissue.

Test for presence of diatoms
 1.

By histological examination diatoms can be demonstrated in the lungs or rarely in some other tissue, provide that plenty of diatoms were present in the submerging water and a good number of them entered in the circulation.

 2.

Diatoms can be demonstrated, alternatively and comparatively more easily, by acid digestion of the bone marrow, brain or tissue from other organs.

Value and fallacy of diatom test

Along with test of tissue for diatoms, a sample of the water from which the body has been recovered, should be subjected to control test. If similar type of diatoms are not available in both the test sample of the tissue and the sample of water for control test or if diatom is only present in the tissue then it can be conclude that diatom entered the body tissue of the victim during the usual process of drinking water which contained diatoms.

 On

the other hand, diatoms may not be observed in the tissue, even if drowning was antemortem and the water contained diatom.

 If

diatoms are present in both test sample of tissue and control sample of water, then it is strongly presumed that drowning was antemortem in nature and occurred in that water. But still it is not conclusive in all cases.

Even if the drowning was not antemortem in nature, similar diatom may be present in both the test sample and the control sample, if the victim was habituated to drink water from the same source during his/her life. This is because when a person drinks water a little of the water may trickle down the larynx and trachea etc. and may reach the lungs bed and enter the circulation through some weak point of the alveolar walls.

 In

spite of chances of fallacy, if similar diatoms are available, both in the tissue and the water then, that acts as a strong evidence of death due to drowning.

 Medicolegal

aspects of drowning or submersion of a body in water or questions which arise after removal of a dead body from water. The following medicolegal questions may arise in connection with such a case:

 1.

Whether drowning was antemortem or postmortem.  2. If drowning was antemortem what was the precise cause of death?  3. What was the nature of drowning, suicidal, homicidal or accidental?  4. What is the time of death and when did the submersion occur?

 5.

Was any other offence involved in the case?  6. If the body is unidentified then establishment of the identity becomes an important step of investigation.  7. If the body has been recovered from a river, then it is necessary to know the actual place of drowning.

1.Whether drowning was antemortem or postmortem
 Of

all the postmortem findings available in a dead body recovered from water, only some external and internal findings and some laboratory findings focus light on whether drowning was antemortem or postmortem. These are-

 (a).

Cadaveric spasm of the hands with presence of sand,mud,weed etc.in the grip.  (B). Copious, white fine froth through the nose and mouth.  ( c). Presence of similar froth along with sand, mud etc., in the lumen of the whole of the respiratory tract.

(d). Voluminous lungs, like balloons, with indentation or presence of marks of ribs on the surface; discharge of copious frothy fluide blood from the cut surface; emphysema aquosum change; presence of thin haemolysed fluid blood in the spaces at the undersurface of the pleura on the lower lobes and at the interfaces of the lobes and absence of tardieu’s spots are the important feature of antemortem drowning deaths.

 (e).

Presence of water, sand, mud and weed in the stomach and the upper part of the small intestine.  (f). Presence of diatoms in the distant organs or tissue, similar to those present in the water where the body of the victim was submerged.

 (g).

Difference in the chloride levels in the blood of both side chambers of the heart.

 (h).

Changes in the blood in addition to the above, like haemoconcentration, increased plasma magnesium level, relative increase in the R.B.C. count, about 40% decrease in the blood volume, crenated appearance of the R.B.C.s under the microscope in case of salt water drowning

 Increase

blood volume(even up to 70%)due to haemodilution, haemolysis with absolute and relative decrease in R.B.C.count, increase potassium level in plasma in case of fresh water drowning.

In case of dry drowning, it is very difficult to say if death occurred due to drowning, because almost all the reliable signs of death due to drowning including the laboratory tests are those of wet drowning. Hence,in dry drowning, circumstancial evidences become important to come to the conclusion whether death was due to submersion under water.

Suffocation deaths
 Definition

:

– Suffocation means a group of conditions of violent asphyxiation, where passage of air between the atmosphere and the lungs is prevented by mechanical ways other than constriction of neck or drowning.

Types of suffocations
 According

to the frequency of occurrence, suffocations are of the following types-

–(1). Smothering – • Definition - in smothering respiration is prevented by the closure of the mouth and the nasal opening.

– (2). Traumatic asphyxia – • Definition - in traumatic asphyxia, there is forceful compression of the chest which prevents respiratory movements of the chest wall and also causes injury to the chest wall.

 (3).

Choking –

– Definition – in choking the air passage is occluded either by some foreign materials or due to some pathology or foreign substance in the neighboring structure(e.g. esophagus).

 (4).

Gagging –

– Definition –in this type of violent asphyxiation, cloth is pressed inside the mouth cavity which also creates pressure over the posterior wall of the fauces.

 Overlying

– Definition – in this condition young individuals (usually infants or very young children) die due to asphyxia, when they get compressed under the body of an intoxicated adult bed partner. This is purely accidental in nature.

   

Aspiration of large quantities of water results in overdistension of the pulmonary alveoli (emphysema aquosum) the alveolar septae are thinned and stretched with narrowing and compression of the capillaries. The appearances resemble pulmonary emphysema.