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Park, Ji Min Sue, Therese Anne


primarily form the interference with the process of inspiration Condition in which the supply of oxygen to the blood or tissues has been reduced



failure 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



decreased capacity of blood to carry O2 (severe hemorrhage, poisoning, low hgb)


failure of circulation (heart failure, shock, arteriovenous obstruction)


failure of cellular oxidative process, O2 cannot be utilized properly (cyanide and alcohol)



Lack of O2 and retention of CO2 Breathing rapid and deep Pulse rate increases Rise in blood pressure Cyanosis



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



Paralysis of respiratory center of brain Shallow breathing, gasping and slow Heart later fails

Recovery is almost nil due to prolonged cerebral


1. 2.

Hanging Strangulations
a. By ligature b. Manual strangulation or throttling c.

Special forms (palmar strangulation, garroting, muggling or yoking, compression of the neck with stick)


a. Smothering or closing of the mouth and nostrils

by solid objects b. Choking or closing of the air passage by obstruction of the lumen
4. 5.


Asphyxia by submersion or drowning Asphyxia by pressure on the chest Asphyxia by irrespirable gases


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



As to LOCATION of ligature and knot a. Typical encircles the whole neck b. Atypical ligature on one side of the neck As to AMOUNT of constricting forces a. Complete body completely suspended; constricting forces is the whole weight b. Partial body partially suspended


a. Symmetrical knot is at midline b. Asymmetrical not in midline, head tilts to the

opposite side of the knot


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

of tongue outward pressure is above the larynx and upward direction Protrusion is kept inside buccal cavity pressure is below the larynx



thinner and tougher mark more pronounced soft and broad mark less pronounced * In suicide rolled beddings, leather belts, electric wires; rope is commonly used

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



single loop one ligature furrow several loops several intervening redness between the furrows


hanging ligature above thyroid cartilage strangling loop below the thyroid cartilage


ligature mark deepest opposite location of knot

1. 2. 3. 4. 5.

Simple asphyxia Congestion of the venous blood vessels in the brain Lack of arterial blood in the brain Syncope Spinal cord and column injury


Severity of the constricting factors

windpipe death may be delayed vital blood supply unconsciousness develops immediately, death accelerated


Point of application of the ligature

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


Other factors
a. b.

Physical condition of the subject Rate of consumption of O2 in blood and tissues


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)


Stimulate the heart to renew action if it ceases to beat

apply heat at precordium hypodermic injection of stimulants administration of brandy


Maintain the natural body temperature

cover body with blanket place in warm room



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


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.



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


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 death hard, rough ligature extensive abrasion and contusion

by umbilical cord strangulation

Frequently injured Inverted V-shape Apex site of knot Hyoid Bone Direction of Ligature Mark

Frequently spared Horizontal Knot on same plane

Level of hyoid bone Deepest opposite of knot Frequently observed

Ligature Location

Below larynx Uniform in depth in whole course Not usually observed

Ligature Groove
Vertebral Injury

1. 2. 3. 4.

Asphyxia due to occlusion of windpipe Coma due to arrest of cerebral circulation Shock or syncope Inhibition of respiratory center due to pressure on vagus and sympathetic nerves

1. 2. 3.

Removal of ligature Artificial respiration, tracheotomy Prevention of complications

a. Edema of glottis b. Pneumonia c.

Abscess formation at site of injury


Most common Aside from neck, evidence of struggle marks of violence in other parts of body Rare Ligature at neck and tightened by means of twisting Mostly children or epileptics


Constricting force applied in neck is the HAND




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


of external respiratory orifices Homicidal and accidental is frequent Suicidal smothering by means of his own hands is NOT possible

most common in children (pressure of beddings and pillow) Accidental smothering of epileptic Gagging


bag suffocation


of foreign body in the respiratory



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


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

SCHAEFERS 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.
SYLVESTERS 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.


External findings a. wet clothes, pale face with foreign bodies clinging on the skin b. 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 drowning d. may appear before or after death e. contracted penis and scrotum f. Washerwomans 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 tongue i. Postmortem lividity mostly in the head, neck and chest. j. Presence of firmly clenched hands with objects as weeds, stones, sand, etc.. k. Physical injuries l. In suicidal drowning, pieces of stone or other heavy objects in pockets or clothing to facilitate submersion

2. internal findings a. Respiratory

emphysema aquosum. Edema aquosum Champignon docume 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


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.


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

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

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 ones life, often used for suicidal purpose

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


a. substance heavier than air b. spread rapidly c. produce effect even in low concentration d. true gas, smoke volatilized liquid or finely divided solid e. big quantity in a relatively cheap price f. stable substance or not easily made non-toxic by rapid chemical reaction g. storage for an ample length of time


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

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

a. b.

2. vesicant or blistering gas

contact with skin may cause

bleb or blister formation



mustard gas (Dichlordiethyl Sulfide, Yellow Cross, Yperite) Lewisite (Chlorovinyldichlorarsine) 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 Poisons a. 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