STRANGULATIONS

STRANGULATIONS

In strangulations also, death occurs due to constriction of the neck.

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 – According to the mode of causation, strangulations are of the following types –

1. Strangulation by ligature.
2. Throttling or strangulation by hands or manual strangulation.
3. Strangulation by means other than a ligature material or by hand or limbs.
4. Garrotting – actually a type of strangulation by ligature.
5. Mugging – Strangulation of the neck by compressing it in the knee bent or elbow bent.

STRANGULATION BY LIGATURE

STRANGULATIONSIn strangulation by ligature, the ligature material is tightly tied around the neck.

Ligature material – Anything which can be tied around the neck, can be used as the ligature material. This may be a rope, a napkin, a handkerchief, a scarf, a saree, an electric wire, a dupatta, a belt etc.

The knot – The knot may be an incomplete or half knot, or a full or double or multiple knot. Strangulation may be caused by just constricting the neck by a ligature without even placing a knot.

Causes of death due to strangulation by ligature –

1. In most cases, it is combination of apoplexy and asphyxia.
2. As a single cause, asphyxia is the most common one.
3. Apoplexy alone also may cause death but is not very frequent.
4. Vagal inhibition.
5. Fracture of the cervical vertebrae with injury to the spinal cord.

Post-mortem findings –

External appearance –

1. There will be a ligature mark around the neck. The ligature mark is at or below the level of the thyroid cartilage. It is circular, continuous, abraded and contused and sometimes parchmentised. The mark of the knot is usually in front but may be at any place. In many cases, the ligature material is left around the neck after death of the victim. There may be more than one turn of the ligature mark. It is more prominent when the ligature material is tough and narrow and is left in situ for some time, being tightly tied around the neck.

2. The face is highly congested and cyanosed. Eyes may be partly opened and the eyeballs and the tongue are protruded. Tardieu’s spots are more abundant than in case of hanging and are present on the forehead, temples, eyelids and under the conjunctiva. There may be wide areas of subconjunctival haemorrhage. There may be bleeding from the nose.

3. The post mortem staining is deep and prominent.

4. There may be involuntary discharge of urine and fecal matter. This is more common than in case of hanging.

5. In males, there may be seminal ejaculation. This is less common than in case of hanging.

6. Strangulation, being mostly homicidal, in most cases there may be presence of marks of resistance on the body. If any of the hands is found in a state of cadaveric spasm, then the grip may contain foreign hair or fabrics or button of a shirt belonging to the assailant or one of the assailants.

Internal findings –

1. As in case of hanging, the tongue may be protruded and bitten by teeth.
2. The most important internal findings lie in the neck. The subcutaneous tissue underneath is contused, often torn at a few places with gross extravasation. In case of strangulation by ligature, fracture of the superior horn of thyroid cartilage or sublaxation between the two sides may be expected.
3. Fracture of the hyoid bone is most uncommon in case of strangulation by ligature.
4. Fracture of the cricoid cartilage may occur rarely.
5. Fracture or injury to the tracheal rings does not occur generally but may be seen in a few rare occasions.
6. The mucus membrane of the larynx and trachea is congested with presence of petechial haemorrhagic spots.
7. Lungs are extremely congested with abundant haemorrhagic spots, extensively present at the interfaces of the lobes.
8. Brain and meninges are congested with frequent presence of minute haemorrhagic spots.
9. All the organs are congested.

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.

Causes of death –

Death in case of throttling is almost always exclusively due to asphyxia, though the chance of the death due to vagal shock cannot be ruled out. Apoplexy and cerebral anaemia is not likely to play any role to cause the death.

Postmortem findings –

External – Evidence of constriction of the neck with the help of fingers will be there in the form of nail scratches and bruises caused by nails and finger tips. When the assailant uses his right hand from the front of the victim, usually there should be one large oval shaped bruise on the upper part of the right side of the neck, on the outer margin of which there should be a cresentic nail scratch. On the left side of the neck, there will be multiple smaller bruises with smaller cresent shaped nail scratches, on the outer margins of the bruises. If both hands have been used, then on each side of the neck, there will be one large bruise with a big nail scratch and multiple smaller bruises with multiple nail scratch abrasions at the outer margins of the bruises. If the victim was attacked from the back or from one side, then according to the position of the fingers the position of the bruises and the abrasions will vary. The number of bruises and abrasions will also vary according to their number coming in forceful contact with the skin of the neck.

Internal findings –

There will be diffused extravasation in the soft tissue of the neck. The extravasation is more marked underneath the bruises and abrasions and the surrounding tissue. The diffusion is more likely to occur over the upper part of the neck. Usually, there is fracture of either or both side cornu of hyoid bone. Sometimes the fracture is over the midline. Thyroid cartilage is usually spared because the level of compression is high up and is usually just below the line of mandible. The oesophagus being compressed against the body of the cervical vertebrae, the posterior wall of oesophagus in particular may show congestion or even extravasation. There will be congestion and Tardieu’s spots under the mucus membrane of the lumen of the larynx and trachea. The level of constriction being high, there is no fracture of the tracheal rings.

The lungs are congested. There may be emphysematous appearance of the lungs. Tardieu’s spots may be numerous on the undersurface of the pleura. The organs are generally congested. Blood is dark in colour. Brain and meninges are congested with haemorrhagic spots in the substance of the brain and on the meninges.

STRANGULATION BY MEANS OTHER THAN LIGATURE OR THROTTLING

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.

POST MORTEM FINDINGS –

External findings –

There will be gross contusions and abrasions on those parts of the neck which are compressed by stick or by foot. Rest of the external findings are in the line of other forms of strangulations. If the victim is strangled in supine position, then extensive bruises or abrasions may be found on the back, particularly against the scapular region and the back of the shoulders.

Internal findings –

There will be gross extravasation of blood with contusion and even laceration of the soft tissue of the neck. There will be fracture of the thyroid cartilage and the tracheal rings. There will be contusion of larynx and trachea and also of oesophagus, particularly on the posterior wall, due to friction with the vertebrae. There may even be fracture dislocation of the cervical vertebrae with corresponding contusion and laceration of the spinal cord and the meninges. Rest of the internal findings will be similar as in case of other forms of strangulations.

PALMAR STRANGULATION is that form of strangulation, where the base of the palm is used to compress the front of the neck. Usually the base of the palm of one hand is used to compress the neck simultaneously closing the mouth and nasal openings with the fingers with reinforcement of strength of compression by the other hand.

In palmar strangulation, there may not be any external finding on the front of the neck, but there may be extravasation of blood in the soft tissue of the neck underneath and congestion and even haemorrhage in the trachea and posterior wall of the oesophagus. There may be fracture of the tracheal rings.

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, caused by a special method. This method is used in lonely places to kill travellers and rob their properties (as was adapted by the ‘Thagi’s in India in the past). This was the official method of execution of death sentence in Spain.

During postmortem examination, nothing more than a thin transverse circular ligature mark should be present externally around the neck. Internally, underneath the ligature mark there will be a line of contusion with diffusion of blood in the surrounding area. There need not be any sign of fracture of thyroid bone or the trachea rings. There will be other external and internal signs of asphyxia. But as there is no scope of any struggle, other signs of violence or resistance will be absent, both externally and internally.

In MUGGING, strangulation is caused by compressing the neck in the elbow bent or the knee bent.

Externally, there may be presence of signs of struggle along with signs of asphyxia, but in the neck, there may not be any sign of violence or strangulation, as the compression is affected by the soft muscles of the arm or the leg. Internally, there may not be any finding. But in some cases, there may be fracture dislocation of the cervical vertebrae with injury to the surrounding area. In some cases, there may be fracture of the hyoid bone at the midline. Other signs of asphyxia will be present.

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 or torn fibres of a cloth or a button. There may be homicidal wounds on the body. In one case, the victim was strangled with a rope and then his throat was cut across.

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 strangulation though not common, does occur. The following methods may be adapted for self strangulation –

1. A person may go on giving turns of the ligature material around his neck until he becomes unconscious. Then death occurs before the turns of the ligature material get untwisted to relax the constriction of the neck.

2. A person after encircling his neck with a rope may go on putting knots until he becomes unconscious.

3. By tying a stick at the free ends of‘the ligature material and then placing the rope around the neck the suicide goes on twisting the stick until he is unconscious due to constriction of the neck caused in this way. Once he is unconscious the stick is released from his hand. But it does not untwist because it gets fixed at the shoulder, and the constriction continues till and after death.

4. A person lying on the side of his bed ties a rope loosely around his neck and at the other end of the rope he may tie a weight. He then drops the weight down from the cot. The length of the rope being shorter than the height of the cot, he gets strangled due to the hanging weight.

Accidental strangulation by ligature –

1. A person may accidentally get strangled when his neck-tie gets fixed with a revolving machine.

2. Porters who carry loads on their back with a supportive belt around the forehead, may get accidentally strangled if the belt around the forehead slips down to the neck.

3. Death of a foetus due to asphyxia due to umbilical cord twisted around the neck, is another example of accidental strangulation death.

4. Masochistic practice to get sexual gratification by partial asphyxiation by arranged strangulation, may also lead to death due to strangulation when the victim fails to release the tie at the right moment.

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 freind. One case of suicidal throttling by an insane person was recorded in the text book Medical Jurisprudence and toxicology of Modi, but the description there in is not much convincing.

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.

Post-mortem strangulation – May be caused to bring a false charge of murder against one’s enemy. A dead body while being removed from water e.g., a well may be tied around neck and limbs and the marks caused by them may wrongly lead to the diagnosis of strangulation-death. The absence of other findings of antemortem strangulation will clear the position.

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.