Wednesday, November 3, 2010

Forensic Post: Asphyxial Death; Hanging

As a continuation to my previous forensic post, today im gonna talk about the second asphyxia death, hanging. I never seen autopsy on hanging also, another “cis…!” for that…Honestly, writing this post itself feels a bit creepy, but that's me, I'm not sure why I'm kinda attracted to these creepy stuff. But let this post be a lesson to us all, SUICIDE IS PAINFUL, NEVER TAKE YOUR OWN LIFE 

Death by Hanging

Is also a form of asphyxia death, where the body is wholly or partially suspended by a ligature around the neck. Simple eh? But you see, even thou someone might hang themselves; it’s not necessarily for them to actually die due to asphyxia. For all you know, it might be death due to cerebral congestion from the external jugular vein compression (4.4 lbs), cerebral anoxia from common carotid artery compression (11 lbs), vagal inhibition from vagus/carotid body compression causing cardiac arrest, fracture or dislocation of cervical vertebra or it could be a combination of both coma and asphyxia. Well, all of that sounds painful enough!

Of course, we should also think about the manner of death, in this case, natural can be rule out because it’s not likely someone found to be hanged would be dead naturally ( but if someone were to die naturally but then was hanged after their death to make it look like suicide, then it is possible right? But who would do such a thing? That would be so twisted, why am I thinking as such? Heh!). So the focus should be on suicidal, murder and well, accidental is also possible but would be quite rare.

What are the signs?

Externally you can see a ligature mark and it is the ONLY specific sign. This ligature mark depends on the nature if the ligature use and the types of knots.

A fixed knot is when we “ikat mati awal-awal”, so once the person is hanged, the knot won’t move. Because usually the knot will be loose, the ligature mark seen will be in V shape since the upper and “knot” part of the ligature is not in contact with the skin.

A running noose is the adjustable knot. Once pressure is exerted on the ligature, usually by the weight of the person, the knot adjusted to the neck and chokes the person to death. Thou it sounds terrible, some believe that it’s less painful compare to the fixed knot (but how can they know right? Hehe…). Due to the nature of the knot, a running noose ligature mark will be complete, circular and more horizontal and we may even see the knot impression mark.

That’s the first thing about ligatures, there are more things to observe at the ligature mark:
  • Where is the point of suspension?
  • What would the duration of suspension be? Longer duration even prominent ligature mark
  • What is the constriction force, complete or partial, complete hang? Or maybe just kneeling or sitting position
  • What is the texture of the ligature, diameter, single or double, shape and pattern? Help knowing the type of ligature used
  • Are there any scratch marks at the neck near the ligatures? This indicates struggling to be free, thou this does not rule out suicidal since hanging could be painful

Other important feature of hanging that can be observed is
  • the head, normally it would inclined to the opposite site of suspension,
  • the face will be congested, the tip of the tongue can be protruded and bitten,
  • the saliva might be dribbling from the mouth and see the eyes, it might be close, partially open or might have a serene look
  • the penis would be turgid, congested and semi erected
  • the nail is cyanosed
  • and the postmortem staining will depend on the parts of the suspended bodies. Since those who dies due to hanging normally is not lying on the ground, the usual post mortem staining at the back would be absent. Instead it may confined to the feet, if its full hanging, or at the legs, buttocks, hands and arm if the bodies were found to be in sitting position. Interesting isn’t it?
back to Allah, the One and Only True God

We always think of hanging as suicidal, and most of the time it is. Taking life with our own hands is consider as “major sin” and you don’t get to heaven if you do that. No matter what happen in our life, there is always a way to solve it. God don’t create problems for us so that we will be stuck for the rest of our life, thou sometime it may seem that way, but largely it depends on our own effort to actually do the right thing. To all problems from any aspects of life, the right thing to do is ALWAYS and ALWAYS to return to your beliefs. Seek the right way by diverting ourselves to the right path. After all the main reason for God to send a “big test” to us is to make us divert ourselves back to Him, beside testing our belief. So suicide is NEVER the way to get out from any sort of problems! There’s a lesson to be learn here kids! Till next time, thank you for reading! :D

Tuesday, November 2, 2010

Forensic Post: Asphyxial Death; Drowning

Not like my everyday post, today I like to talk about…. DEATH… More specifically, asphyxial death. Why? Because it’s a big and important topic, with many medico legal and interesting aspect and also because I never get the chance to actually observe one yet (cis..!).

Asphyxia is the condition of lack of oxygen arising from an obstruction to the air passage from within or out. Generally, those who died due to asphyxia might have cyanosis, general visceral congestion, venous congestion, increase venous back pressure, stasis of the blood, pulmonary edema, serous effusion, post mortem fluidity of blood, petechial hemorrhage, cardiac dilation, biochemical changes and pseudo-Rouleaux formation due to heamoconcentration in the blood.

Under asphyxia we have drowning, hanging, sexual asphyxia, strangulation, manual strangulation (or throttling) and last but not least, suffocation. Well they all sounds the same, but there are not actually. Since there are too many of it, maybe I talk about the others in my other post, today, we talk about, drowning. Death due to drowning…


Is when the air entry is prevented from entering the lungs by water or any form of fluid matter into which the head had fallen and remained in. Get it? You know, head in water, air prevented in, and cannot breath. Note here, it is the head that remained in, so if someone were to be push in a small bucket containing water (or even pasta sauce) just enough to immerse the head, and the person dies because of it,  it is already consider as drowning. (and I learn that from watching detective conan haha)

Before jumping to any conclusion, there are a few aspects of drowning to think about
Was death really due to drowning? What was the motive? I mean they might have died due to natural disease before falling in the water or suffer a natural disease while they are in the water. It could also be an injury before they fell or be thrown in the water or died from other effect of immersion other than drowning… so how can we tell? Before starting the autopsy, we have to answer a few questions where we go back to the basics, the 4 manner of death, accidental, suicidal, homicidal or natural… So the purpose is to rule out what’s not and rule in what it is. So lets go through…

Signs of Drowning

What are the post mortem signs of drowning? The signs could be further divided to external and internal signs which can further be subdivided to presumptive and specific. Basically, the presumptive external signs are bodies which are wet, covered in seaweeds, cyanosis, congested eyes, presence of “washerwoman’s skin”, “goose skin” or cutis anserine, and retraction of scrotum and penis. But more importantly are the specific external signs which are fine white, tenacious, lathery froth or foam like soap with blood oozing from the mouth and nostrils. This can be reproduced by exerting pressure to the chest. Another important sign is the cadaveric spasm, which is the clasping or grasping of objects found in the water. For the internal signs, the white tenacious foam can also be found in the air passages to the terminal bronchiole. There can also be logging and ballooning of the lungs.

Laboratory test

When there are drowning bodies, laboratory test of the pulmonary and blood is important to determine the possible cause of death and the actual place the drowning took place. An important key point in the lab test is the diatoms. These are microscopic unicellular algae that can be found in certain water. Since it is indestructible, we can determine whether the victim was alive or not before they were immersed in the water by looking for these diatoms in the lungs, blood, brain, liver, kidneys and bone marrow. If they are alive, these diatoms have time to circulate around throughout the body. By comparing the diatoms too, we can determine whether the alleged crime scene (locus of crime) was true or not.

Don’t forget about the blood! Since the bodies died in the water, we can also determine whether the water was salty or fresh water by looking at the blood. Is it crenated or are there burst spherocytes?

What about the pulmonary tissue? There will be two aquosum. The first one is emphysema aquosum, where the alveoli is filled with water, mucous and also air, the inter alvelolar septa is also ruptures. Another one is oedema aquosum where the inter-alveolar space is filled with water, the interalveolar membrane is widened due to edema and it may also rupture.

We should also do biochemical test to check the chloride content, magnesium and specific gravity of the blood.

Of course there are other things regarding drowning I didn’t cover here, but basically that’s about it. So, thank you for reading! See you again in the other forensic post! (^_^)