Criminal Cases: Asphyxial Deaths

The term asphyxia means the absence of pulsation (pulselessness), though its usage in Forensic Medicine has generally come to mean a lack of oxygen.  Asphyxia is best described as an interference with respiration due to any cause – Mechanical, Environmental, or Toxic.

In forensic practice, violent mechanical asphyxia as the cause of death is a frequent and usual occurrence, notwithstanding whether it is murder, suicide, or accident. Yet sometimes death is caused by asphyxia which concerning the manner it has occurred is unusual and it requires a detailed analysis of the event and excluding other reasons for death.

Introduction

Asphyxia is a condition of the deficient supply of oxygen to the body that arises from abnormal breathing. An example of asphyxia is choking. Asphyxia causes generalized hypoxia, which affects primarily the tissues and organs.

In compression asphyxia, the respiration is prevented by external pressure on the body. It is usually due to external force compressing the trunk due to heavyweight over chest/abdomen and is associated with an internal injury. Most commonly this is accomplished by compression of upper air-ways such as in strangulation and hanging, occlusive blocking of the mouth and nose by smothering, penetrating trauma to the chest that can collapse the lungs, flooding of the lungs with fluid (drowning), and natural diseases such as tumours that press against the lungs.

In most instances, autopsy findings will be minimal. Nonspecific findings may include indentations or ‘pressure marks’ on the skin related to bedding or clothing. Because the autopsy is usually negative, it is difficult to sort out overlaying from other forms of suffocation (including intentional suffocation) or SIDS

Historical Development

Traditionally, the conditions leading to asphyxia have included breathing an oxygen-deficient atmosphere and/or interference with the act of breathing (i.e., inhaling and exhaling) and/or respiration (i.e., gas exchange and the utilization of oxygen). Conditions that historically were thought to involve airway compromise but are now recognized to involve restriction of blood flow (e.g., hanging, strangulation, and compression asphyxia) continue to be classified as asphyxia.

Violent deaths resulting from asphyxia include death due to hanging, strangulation, suffocation, and drowning. Hanging is usually suicidal, but accidental hanging can occur among children during playing or in toddlers by slipping of restraining straps, or among athletes who are in the habit of exhibiting hanging.

 Sometimes, it is not easy to state whether death is due to suffocation, it is therefore very essential to look for evidence of violence in the shape of external marks surrounding the mouth and nostrils or on the inside of the mucosal surface, or the chest. In northern parts of India, it is not uncommon to throw dead bodies into running streams, to avoid the detection of crime.

Stages

There are four stages where the transfer of oxygen can be compromised, i.e., oxygen reduction at the cellular level may be caused by

 (1) decreased amounts of oxygen in the environment,

 (2) reduced transfer from the air to the blood,

 (3) reduced transport from the lungs to the tissues, and

 (4) reduced transfer across cell membranes.

Categories

There are three generalized categories: Strangulation, Chemical Asphyxia, and Suffocation.  Most reported murders by asphyxia involve strangulation.  An inhaled substance interfering with the body’s ability to use oxygen [e.g. carbon monoxide, butane, and nitrous oxide] characterizes chemical asphyxia. 

Another term, ‘simple’ asphyxia, is sometimes used when oxygen is displaced by another gas. When water or another liquid fills the lungs causing asphyxia, this is called drowning.  There are several variations such as near-drowning, secondary drowning, and immersion syndrome.  In some cases, a coroner’s report may list a significant medical or pathological condition such as Chronic Obstructive Pulmonary Disease [COPD] as the cause of death rather than asphyxia during a drowning, further frustrating those who are unfamiliar with the terminology.  Autoerotic or ‘sexual asphyxia’ by self-strangulation, drowning, choking, and a variety of other means is increasingly reported, especially by the media.

Tolerance to ischemia and asphyxia vary with not only age and special adaptation but also with a past medical history and present state of health.  For example, those who have a history of the cardiovascular or pulmonary disease may be more susceptible [e.g. heart attack, asthma]. 

Post-mortem examinations, review of medical records, accident reports, and photos taken at the scene are used to analyse and classify asphyxial deaths. Blood vessels, usually small veins, are broken by high intravascular pressure.  They can occur in various parts of the body, such as over the surface of the heart and organs, in the eye, the skin and the scalp.

physical signs are non-specific to asphyxia, meaning they can be present after death from other causes.  Furthermore, a case may be complicated by pathology or injuries additional to asphyxia. This information is used by forensic scientists in combination with data describing the place and manner of death to perform analyses and form opinions. Reconstruction of asphyxial death often involves a combination of experts who may be clinicians, biomechanical experts, and automotive experts who perform accident reconstruction, and chemical or biological scientists.   Communicating the results of these studies and the terminology to attorneys, families and a jury can be a significant contribution to a successful case.  

These criteria essentially can be summarized in the following:

  1. Negative autopsy or some signs of asphyxia.
  2. The body position must interfere with normal gas exchange.
  3. It must be impossible for the subject to move to another position.
  4. Other causes of death (natural and unnatural) must be excluded.

Case Laws

Santosh and Anr. v. State of Kerala[1]

Blood clotting could be delayed in case of asphyxial death. presence of bloodstained fluid could cause profuse bleeding after death in case of asphyxial death. Death could have been rapid. 

Banambar Misra And Anr. v. State of Orissa[2]

It was opined that the deceased died an unnatural asphyxial death because of the ingestion of a massive dose of chloroquine and no disease leading natural asphyxial death.

 

Conclusion

Asphyxiation is a condition of the deficient supply of oxygen to the body that arises from abnormal breathing. An example of asphyxia is choking. Asphyxia causes generalized hypoxia, which affects primarily the tissues and organs.

In forensic practice, violent mechanical asphyxia as the cause of death is a frequent and usual occurrence, notwithstanding whether it is murder, suicide, or accident. Yet sometimes death is caused by asphyxia which regarding the manner it has occurred is unusual and it requires a detailed analysis of the event and excluding other reasons for death.

Suicidal deaths as a result of hanging and accidental deaths as a result of drowning seems to be the major contributing causes of asphyxia deaths. Both these manners of deaths, somehow, indicates frustration and carelessness on the part of the population which are preventable and needs to be rectified on an urgent basis. A well designed and comprehensive program is needed to identify the causative factors and prevention of suicidal behaviours. Measures to improve the socio-economic conditions through reforms in the fields of education, health, increase in employment opportunities are expected to lessen the existing stress and strain of the society. This in turn will help to decrease the incidence of suicidal, homicidal, or accidental cases of asphyxia. Drowning prevention strategies should be comprehensive and include engineering methods which help to remove the hazard, legislation to enforce prevention and assure decreased exposure, education for individuals and communities to build awareness of risk.

Q&A

Q.1 What Is Asphyxia?

A.1 Asphyxia is a condition of the deficient supply of oxygen to the body that arises from abnormal breathing.  Asphyxia is best described as an interference with respiration due to any cause – Mechanical, Environmental, or Toxic. In forensic practice, violent mechanical asphyxia as the cause of death is a frequent and usual occurrence, notwithstanding whether it is murder, suicide, or accident. Yet sometimes death is caused by asphyxia which regarding the manner it has occurred is unusual and it requires a detailed analysis of the event and excluding other reasons for death.

Q.2 Explain the Traditional Approach to Asphyxia.

A.2 Traditionally, the conditions leading to asphyxia have included breathing an oxygen-deficient atmosphere and/or interference with the act of breathing (i.e., inhaling and exhaling) and/or respiration (i.e., gas exchange and the utilization of oxygen). Conditions that historically were thought to involve airway compromise but are now recognized to involve restriction of blood flow (e.g., hanging, strangulation, and compression asphyxia) continue to be classified as asphyxia.

Q.3 What Are the Main Stages Where the Transfer of Oxygen Can Be Eliminated?

A.3 There are four stages where the transfer of oxygen can be compromised, i.e., oxygen reduction at the cellular level may be caused by

 (1) decreased amounts of oxygen in the environment,

 (2) reduced transfer from the air to the blood,

 (3) reduced transport from the lungs to the tissues, and

 (4) reduced transfer across cell membranes.

Q.4 Name the Categories Causing Asphyxia.

A.4 There are three generalized categories: Strangulation, Chemical Asphyxia, and Suffocation.  Most reported murders by asphyxia involve strangulation.  An inhaled substance interfering with the body’s ability to use oxygen [e.g. carbon monoxide, butane, and nitrous oxide] characterizes chemical asphyxia. 

Q.5 Summarize the Criteria of Asphyxia.

A.5 These criteria essentially can be summarized into the following:

  1. Negative autopsy or some signs of asphyxia.
  2. The body position must interfere with normal gas exchange.
  3. It must be impossible for the subject to move to another position.
  4. Other causes of death (natural and unnatural) must be excluded.

References

  1. https://indiankanoon.org/search/?formInput=cites:721996
  2. https://link.springer.com/referenceworkentry/10.1007%2F978-1-61779-058-4_15
  3. https://www.tasanet.com/Knowledge-Center/Articles/ArtMID/477/ArticleID/338920/Forensic-Analysis-of-Injury-and-Death-by-Asphyxiation
  4. https://www.researchgate.net/publication/273137172_UNUSUAL_ASPHYXIAL_DEATHS_-_Case_Reports
  5. Sudden deaths from positional asphyxia: A case report: Medicine

[1] 1991 CriLJ 570.

[2] I (2001) DMC 231.

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