Park, Ji MinSuñe, Therese Anne

Results primarily form the interference with the process of inspiration

Condition in which the supply of oxygen to the blood or tissues has been reduced

ANOXIC DEATHfailure of arterial blood to be normally saturated with O2

• atmosphere without or insufficient O2• obstruction from pressure outside• paralysis of respiratory center• mechanical interference of passage

ANEMIC ANOXIC DEATHdecreased capacity of blood to carry O2(severe hemorrhage, poisoning, low hgb)

STAGNANT ANOXIC DEATHfailure of circulation(heart failure, shock, arteriovenous obstruction)

HISTOLOGIC ANOXIC DEATHfailure of cellular oxidative process, O2 cannot be utilized properly(cyanide and alcohol)

1. DYSPNEIC PHASE• Lack of O2 and retention of CO2• Breathing rapid and deep• Pulse rate increases• Rise in blood pressure• Cyanosis

2. CONVULSIVE PHASE• Stimulation of CNS by CO2• Cyanosis more pronounced• Staring eyes and dilated pupils• Tardieu Spots – hemorrhage by ruptured

capillaries due to increased pressure• Usually unconscious

APNEIC PHASE• Paralysis of respiratory center of brain• Shallow breathing, gasping and slow• Heart later fails• Recovery is almost nil due to prolonged

cerebral anoxia

1. Hanging2. Strangulations

a. By ligatureb. Manual strangulation or throttlingc. Special forms (palmar strangulation,

garroting, muggling or yoking, compression of the neck with stick)

3. Suffocationa. Smothering or closing of the mouth and

nostrils by solid objectsb. Choking or closing of the air passage by

obstruction of the lumen4. Asphyxia by submersion or

drowning5. Asphyxia by pressure on the

chest6. Asphyxia by irrespirable gases

Suspension of body by a ligature which encircles the neck and the constricting forces is the weight of the body

1. As to LOCATION of ligature and knota. Typical – encircles the whole neckb. Atypical – ligature on one side of the neck

2. As to AMOUNT of constricting forcesa. Complete – body completely

suspended; constricting forces is the whole weight

b. Partial – body partially suspended

3. As to SYMMETRYa. Symmetrical – knot is at midlineb. Asymmetrical – not in midline, head tilts

to the opposite side of the knot

Ligature at the neck with a noose or knot and other end is fastened to an elevated object

Weight causes noose to tighten upon suspension pressure in the neck

Compression of sup. laryngeal nerve, carotid arteries, jugular veins = CEREBRAL ANOXIA

Protrusion of tongue outward – pressure is above the larynx and upward direction

Protrusion is kept inside buccal cavity – pressure is below the larynx

MATERIALS USED IN HANGINGthinner and tougher – mark more pronouncedsoft and broad – mark less pronounced

* In suicide – rolled beddings, leather belts, electric wires; rope is commonly used

NOOSEtightened after encircled as with metal buckle, ring or sliding noose

MODE OF APPLICATION OF THE LIGATUREsingle loop – one ligature furrowseveral loops – several intervening redness

between the furrows POSITION OF THE KNOT

hanging – ligature above thyroid cartilagestrangling – loop below the thyroid cartilage

COURSE OF THE LIGATURE AROUND THE NECKligature mark deepest opposite location of knot

1. Simple asphyxia2. Congestion of the venous blood

vessels in the brain3. Lack of arterial blood in the brain4. Syncope5. Spinal cord and column injury

1. Severity of the constricting factorswindpipe – death may be delayedvital blood supply – unconsciousness develops

immediately, death accelerated2. Point of application of the ligature

below larynx – death instantaneousabove larynx – death delayed 3-5 mins.knot at one side or below jaw – delay death

3. Other factorsa. Physical condition of the subjectb. Rate of consumption of O2 in blood and

tissues

1. Induce the natural acts of respiration

• ligature must be loosened• all obstacles in mouth must be removed• tongue must be pulled forward• body on back rest• place in free current fresh air• electrical stimulation of phrenic nerve• respiratory stimulation (e.g. ammonia)

2. Stimulate the heart to renew action if it ceases to beat

• apply heat at precordium• hypodermic injection of stimulants• administration of brandy

3. Maintain the natural body temperature

• cover body with blanket• place in warm room

EXTERNAL AND INTERNAL FINDINGS

Vital reaction – principal criterion for determination

Ante-mortem:• Redness at site of ligature• Ecchymosis of pharyxnx and epiglottis• Rupture of intima of carotid artery• Subpleural or subepicardial hemorrhages

Fold markings on the neck of an obese individual – marks are not continuous, removed on stretching the skin of the neck

Marks of tight neckwear

Homicidal hanging• Windows and doors opened used as an

escape by offender• Presence of signs and struggles (clothing,

furnitures,beddings)• Stains and bodily injuries, defense wounds

LYNCHING – homicidal hanging practiced by Americans against the Negros who commit crime against white Americans.

Suicidal Hanging• Place compatible with self-suspension• Absence of signs of struggle• Deep, congested and papyraceous

with abrasions in the furrow of ligature• Signs of previous ineffective suicide attempt• Suicide note• Easily accessible materials• History of reverses in life• No disturbance in place

Produced by compression of the neck by means of a ligature which is tightened by a force other than the weight of the body

soft material, smooth application – no visible mark after deathhard, rough ligature – extensive abrasion and contusion

Infanticide by umbilical cord strangulation

HANGINGSTRANGULATIO

N

Frequently injured Hyoid Bone Frequently spared

Inverted V-shape Apex site of knot

Direction of Ligature Mark

Horizontal Knot on same plane

Level of hyoid bone

Ligature Location

Below larynx

Deepest opposite of knot

Ligature GrooveUniform in depth in whole course

Frequently observed

Vertebral InjuryNot usually observed

1. Asphyxia due to occlusion of windpipe

2. Coma due to arrest of cerebral circulation

3. Shock or syncope4. Inhibition of respiratory center due

to pressure on vagus and sympathetic nerves

1. Removal of ligature2. Artificial respiration, tracheotomy3. Prevention of complications

a. Edema of glottisb. Pneumoniac. Abscess formation at site of injury

Homicidal• Most common• Aside from neck, evidence of struggle

marks of violence in other parts of bodyAccidental

• Rare• Ligature at neck and tightened by means

of twisting• Mostly children or epileptics

Constricting force applied in neck is the HAND

Garroting Mugging

Exclusion of air from the lungs by closure of air openings or obstruction of the air passageway from the external openings to the air sacs.

Closure of external respiratory orifices

Homicidal and accidental is frequent Suicidal smothering by means of his

own hands is NOT possible

Overlaying – most common in children (pressure of beddings and pillow)

Accidental smothering of epileptic Gagging

Plastic bag suffocation

Impaction of foreign body in the respiratory passage

Café coronary - restaurant patron has sudden heart attack, autopsy reveals large mass of food lodged in throat; accidental

Definition –nostrils and mouth has been submerged in any watery or pultaceous fluid for a time to prevent the free entrance of air into the air passage and lungs

“respiration de surprise” phase of resistance dyspneic phase with a

forceful respiratory movement. another apneic phase. terminal respiration, after which the

breathing stops permanently.

typical drowning – asphyxia atypical drowning

• cardiac inhibition• laryngeal spasm • submersion when

unconscious

person might have fallen into the water and his body strikes on a solid hard object

under the influence of alcohol or other depressants and incapable of helping himself

cramps shock due to fright or sudden exposure to

cold water could cause heart failure apoplexy or cardiac failure might have been dead and thrown into the

water

SCHAEFER’S METHOD prone position with face down. Operator kneels astride the body and exerts

pressure on the lower ribs at the rate of 12 to 15 times a minute.

SYLVESTER’S METHOD patient lying on his back, operator astriding

over the body swing the arms forward up and then

pressing the chest wall repeat every 3 to 5 seconds.

1. External findingsa. wet clothes, pale face with foreign bodies clinging on the

skinb. skin – puckered, pale, contracted in the form of “cutis

anserina” or “goose-skin” or “gooseflesh” especially body is submerged in the cold water.

c. “cutis anserine” – not diagnostic of drowningd. may appear before or after deathe. contracted penis and scrotumf. Washerwoman’s hand and feet – skin of hands and feet is

bleached, corrugated and sodden in appearance.g. Eyes are half-opened or closed, eyelids livid, conjunctivae

injected and pupils dilated.h. Mouth closed or half-opened, with protruding tonguei. Postmortem lividity mostly in the head, neck and chest.j. Presence of firmly clenched hands with objects as weeds,

stones, sand, etc..k. Physical injuriesl. In suicidal drowning, pieces of stone or other heavy objects

in pockets or clothing to facilitate submersion

2. internal findingsa. Respiratory

• “emphysema aquosum”.• “Edema aquosum”• “Champignon d’ocume” • Tracheo-bronchial lumina is congested and filled

with fine froth with foreign bodies• Blood-stained fluid inside the chest cavity due to

permeation of water trapped inside the air sacs.• Congested whole lung field• Presence of fluid with bloody froth in the lung

section

b. Heart• may be emptied or filled with blood• right side may be distended with blood

while left may be emptied on the account of the distention of the air sacs, thereby limiting the capillary flow

• if drowning in salty water, blood chloride content is greater in the left side than right side, but if it is fresh water, the result is opposite

c. Stomach• plenty of fluid and other foreign materials• absence of water shows that death is rapid or

submersion is made after death

d. Brain• congested and big blood vessels are engorged

e. Blood• blood becomes dark on account of the absorption of

all its available oxygen.• reduction of hemoglobin contents on account of

dilution• red blood cells may be crenated

f. Other Organs• liver – engorged with dark fluid blood• spleen and kidneys – dark in color and

congested• water in the middle ear due to violent

inspiration when the mouth is full of water.

materials or foreign bodies in the hands.

increase in volume (emphysema aquosum) and edema of the lungs (edema aquosum)

water and fluid in the stomach contents.

froth, foam or foreign bodies in the air passage

water in the middle ear.

within 24hours, decomposition causes the accumulation of gas in the body, the body floats.

floating of the body influenced by the weather, conditions of the fluid medium, presence of wearing apparel, age, sex and body built.

When body recovered, usually with flexed extremities

lividity more on the face “tete de negri” or bronze color of the head

and neck

1. Suicidal drowning• Heavy articles or weight may be found in the

pocket of clothing.• Presence of a suicidal note.• Determination of the strong reason for him to

commit suicide.• Mentality of the person• Study of the character and manner of the

person previous to the commission of suicide.• History of previous attempt to commit suicide.

2. Homicidal drowning• evidences of struggle like physical injuries and

destruction of the clothings• articles belonging to the assailant may be found

near the place• presence of a motive for the killing• presence of ligature on the hands or legs which

could not possibly be applied by the victim himself

• presence of physical injuries which could not have been self-inflicted, like gunshot wound at the back, severe injuries in the head, etc..

• testimony of witness

3. Accidental drowning• absence of mark of violence on the body

surface• condition and situation of the victim

immediately before death which may make one inclined to believe that it is accidental.

• exclusion of suicidal or homicidal nature of the drowning

• testimony of a witness or witnesses who saw the incident happened

free exchange of air in the lungs is prevented by the immobility of the chest and abdomen due to external pressure or crush injury.

1. homicidal case 2. accidental case 3. suicidal case – very rare

caused by buried under a pile

of sand under the rubble of

a collapsed building crushed in a

highway accident sudden fall of

materials in mines crushed in a crowd,

usually accidental

purplish-black cyanosis of the face and neck irregular pattern on the skin small subcutaneous petechial hemorrhages

on the skin of face, chest, shoulder and neck

congestion and petechial hemorrhages of the sclera and conjunctiva fracture of the ribs due to compression heart and big blood vessels engorged with dark fluid blood contusion with petechial hemorrhage

of the lungs other sings of physical injuries

hyper-expansion of the chest muscles and lungs – difficulty in breathing

exhaustion, or have his feet supported by tying or by a wood block

unconsciousness and death from asphyxia.

1. CARBON MONOXIDE (SILENT KILLER)• formed from incomplete combustion of carbon

fuel• burning of wood, oil, coal, kerosene and

charcoal used in cooking or heating or gasoline engines in cars

• colorless gas, insoluble in water and alcohol• limiting the oxygen carrying capacity• prevents release of oxygen from

oxyhemoglobin• accidental and suicidal death by carbon

monoxide poisoning is common• judicial death execution by gas chamber carbon

monoxide is utilized in US

2. CARBON DIOXIDE• gas blown out of the lungs during respiration.• Colorless, heavy gas mixed with carbon monoxide

and hydrogen sulfide• Often found in drainage pipes, deep wells, sewage

tanks and decomposing organic matters• Small amount of gas mixed with air(2%) -

tachypnea• Stronger concentration (10% or more) - ataxia, fall

of blood pressure. Loss of reflexes. Anesthesia, diminished respiration, dyspnea, discomfort and muscular weakness

• Greater concentration (60%) immediate loss of consciousness, with or without convulsion and death

3. HYDROGEN SULFIDE• decomposition process of organic substances

containing sulfur.• Large quantities in a sewer, septic tanks,

drainage pipes and deep wells• Colorless, transparent gas, sweetish taste and

emitting an odor similar to a rotten egg• Dilute solution produces irritation of the eyes,

nose, throat and air passages, followed by dizziness, headache, nausea, vomiting, abdominal pain, cyanosis, dilated pupils, cold extremities and labored breathing.

• Prolonged exposure may cause convulsion, delirium, coma and death

4. HYDROGEN CYANIDE• one of the most toxic and rapid acting gases• naturally found in leaves of cherry-laurel, in

kernels of common cherry, plum, peaches, in ordinary bamboo shoots, and in certain oil seed and beans.

• Smaller dose, patient can walk and speak or perform volitional acts before death takes place

• Average span of life after partaking the drug is 2 to 10 minutes.

• Only small quantity is needed to end one’s life, often used for suicidal purpose

5. SULFUR DIOXIDE• colorless gas, heavier than air and with

pungent odor.• Employed as disinfectant, as a bleaching

agent, a powerful reducing agent, and found in eruption of volcanoes

• Irritation of the respiratory passage causes sneezing, coughing, spasm of the glottis and suffocation

• Irritates the eyes and cause congestion and lacrimation

ESSENTIAL CHARACTERISTICS OF A SUBSTANCE

a. substance heavier than airb. spread rapidlyc. produce effect even in low concentration d. true gas, smoke volatilized liquid or finely divided solide. big quantity in a relatively cheap pricef. stable substance or not easily made non-toxic by rapid chemical reactiong. storage for an ample length of time

1. LACRIMATOR OR TEAR GAS• exposure can cause irritation with copious

flow of tears• cause severe lacrimation, spasm of the

eyelids, congestion of the conjunctivae and temporary blindness

• long time exposure can cause vomiting, nausea, bronchitis and blistering of skin

a. chloracetophenone (C.A.P)b. bromobenzyl cyanide (B.B.C)c. ethyl Iodoacetate (K.S.K

2. vesicant or blistering gas• contact with skin may

cause bleb or blister formation

a. mustard gas (Dichlordiethyl Sulfide, Yellow Cross, “Yperite”)

b. Lewisite (Chlorovinyl-dichlorarsine)

- cause erythema, vesicle with cloudy fluid

3. Lung Irritants (Asphyxiant or Choking Gas) cause dyspnea, tightness of chest and

coughing, varying degree of conjunctival irritation, vomiting, coma and death

treatment : removal of the victim from vitiated atmosphere, absolute rest, administration of oxygen and symptomatic approach

a. Chloride b. Phosgene c. Chloropicrin d. Diphosgene

4. Sernutator (Nasal Irritants or Vomiting Gases)

coryza, nausea, malaise, headache, vomiting, salivation and pain in the chest, and protraction

a. Diphenyl chlorarsine (D.A.)

b. Diphenylamine chlorarsine (D.M.)

c. Diphenyl cyanarsine (D.C.)

5. Parlysants (Nerve Gas) inactivation of cholinesterase and

consequent increase of acetylcholine causing paralysis at the myoneuronal junction

6. Blood Poisonsa. Hydrocyanic Acid (Hydrogen Cyanide or

Prussic Acid) – prevent the tissue from utilizing the oxygen of the blood

b. Hydrogen Sulfide (Sulphurated Hydrogen) – paralysis of respiratory center, nausea, abdominal pain and irregular heart action

c. Carbon Monoxide (Carbonic Oxide) – reduces the oxygen carrying capacity of the blood