Table of Contents
Asphyxia
Definition: Asphyxia is derived from the Greek word meaning “pulselessness.” It refers to an acute shortage of oxygen in the body, coupled with the inability to eliminate carbon dioxide.
Stages of Asphyxia:
- Inspiratory Dyspnea: ~ Time duration- 1 minute. Breathlessness, heaviness in chest, ringing in ears, and high BP.
- Expiratory Dyspnea: Time duration 1–2 minutes. Victim becomes unconscious due to CO2 accumulation.
- Respiratory Failure: ~ Time duration- 2–3 minutes. Brain’s respiratory centers fail.
Types of Asphyxial Death: Hanging, Strangulation, Suffocation, Drowning
Hanging
Definition: Hanging is an asphyxial death where the neck is compressed by a ligature, obstructing respiration.
Types:
- Complete Hanging: Body is suspended with no ground contact.
- Partial Hanging: Some part of the body touches the ground.
External Examination of Hanging
- Cyanosis of lips and tongue
- Petechial hemorrhages on the face
- Bleeding from facial openings
- Dribbling of saliva from mouth
- Postmortem staining in suspended parts
- V or U-shaped ligature mark above thyroid cartilage
- Tardieu’s spots
Note: Tardieu’s spots are small pinpoint hemorrhages due to increased vascular pressure.
Internal Examination of Hanging
- Cyanosis of internal organs
- Neck tissue injuries
- Blood on larynx and possible carotid artery damage
Strangulation
Definition: Asphyxial death caused by compression of the neck without suspension.
Types:
- Ligature Strangulation (Garroting): With ligature, usually from behind
- Manual Strangulation (Throttling): By hands; may leave bruises and finger marks
- Mugging Strangulation: Using elbow bend to compress neck
- Bansdola Strangulation: Using sticks from both sides
External Examination of Strangulation
- General signs of asphyxia
- Dark blue postmortem staining
- Ligature mark below thyroid gland
- Multiple marks = repeated use
- Oblique marks = dragging
- Dark brown marks with abrasions
Internal Examination of Strangulation
- Cyanosis and pulmonary edema
- Crushed trachea/larynx/cartilage
- Hemorrhage in tissues
- Ruptured carotid artery
- Hemorrhage at base of tongue
Suffocation
Definition: Asphyxial death not due to drowning or neck compression.
Types:
- Smothering: Blocking of nose/mouth by hand or object
- Pale areas around nose/mouth
- Lip abrasions/lacerations
- Gagging: Obstruction of airway by gag material, swells with saliva
Medicolegal Aspects:
- Often homicidal
- May be accidental in unconscious individuals
Drowning
Definition: Asphyxial death due to submersion, obstructing airways with liquid.
Types of Drowning:
- Wet Drowning: Water enters lungs
- Dry Drowning: Laryngeal spasm prevents water entry
- Secondary Drowning: Death after initial survival, CNS injury common
- Immersion Drowning: Submersion causes respiratory impairment
Medicolegal Aspects:
- Confirm drowning as cause
- Identify site and duration of submersion
- Manner: accidental, suicidal, or homicidal
- Skin wrinkling within hours; cuticle separates in 48h
- Body floats in 24h (summer), 2–3 days (winter)
Diagnosis of Death by Drowning
External Signs:
- Wet, pale clothes and skin
- Position-based postmortem staining
- Petechial hemorrhages and cyanosis
- Dilated pupils
- Frothy, blood-tinged mouth discharge
- Skin wrinkling, cadaveric spasm, rigor mortis
Internal Signs:
- Hemorrhage in lower lung lobes
- Lungs appear red or gray
- Water-filled, swollen stomach
- Presence of diatoms in tissues
Diatom Analysis:
Diatoms are microscopic algae found in water. If inhaled during drowning, they reach lungs, bloodstream, and distant organs. Their presence in internal organs confirms antemortem drowning.
Final Thoughts
Understanding asphyxial deaths is crucial in forensic medicine. Each form—hanging, strangulation, suffocation, and drowning—has distinct signs that reveal the truth behind mysterious deaths. With this knowledge, forensic experts bring clarity, accuracy, and justice in cases of unnatural deaths.
