Throtting: Forensic Medical Report PDF

I would like to express my special thanks of gratitude to my teacher ***Dr. Trivesh Sharma,*** who gave the opportunity to do this project on the '***Manual Strangulation',*** who also helped me in completing my project. I came to know about so many things I am really thankful to them. Secondly, I...

I would like to express my special thanks of gratitude to my teacher ***Dr. Trivesh Sharma,*** who gave the opportunity to do this project on the '***Manual Strangulation',*** who also helped me in completing my project. I came to know about so many things I am really thankful to them. Secondly, I would also like to thank my parents and friends who helped me a lot in finalizing this project within time. Manita B.A.M.S 2^nd^ Proff. Reference ========= - ***Jason Payne-James, Richard Jonas, Steven B Karch, John Manlove's*** in ***Simpson's Forensic Medicine, 13^th^ edition published*** by ***Hodder Arnold,*** an imprint of ***Hooder Edu., UK,*** chapter 15 **Asphyxia** page no. 151 - ***S.K. Singhal*** in ***Singhal's Forensic Medicine & Jurisprudence, 4^th^ edition published*** by ***Raju Shah, The National Book Depot, Mumbai, India***, chapter 5 ***Violent Asphyxial Deaths*** page no. 124***.*** - ***Nageshkumar G Rao in Textbook Of Forensic Medicine & Toxicology, 2^nd^ edition published by Jaypee Brothers Medical Publishers (P) Ltd., Delhi, India, chapter 15 Violent Asphyxial Death page no. 194.*** - ***DiMaio, V.J.M., & DiMaio, D.(2001), Forensic Pathology, 2^nd^ edition, CRC Press.*** - ***Knight, B., & Saukko, P. (2010), Knight's Forensic Pathology, CRC Press.*** - ***Spitz, W. U. (2006), Spitz and Fisher's Medicolegal Investigation of Death: Guidelines for the Application of Pathology to Crime Investigation. Charles C Thomas Publisher.*** *INDEX* ======= ***S. NO.*** ***TOPIC NAME*** ***PAGE NO.*** ***SIGNATURE*** -------------- --------------------------------- ---------------- ----------------- ***1.*** ***Throttling :*** Introduction ***1*** ***2.*** ***Autopsy findings*** ***2 - 4*** ***3.*** ***Medico legal aspects*** ***5 -- 7*** ***4.*** ***Conclusion*** ***8*** ***5.*** ***Reference*** ***9*** ***THROTTLING*** - Asphyxia produced by compression of the neck by human hands is called Throttling. - The act of suffocating someone by constricting the windpipe with bare hands is throttling. - ***[Synonyms]*** : choking , strangling , strangulation - ***[Type of asphyxiation]*** : manual strangulation [ ] - The mechanism [ ] of death is by occlusion of the blood vessels supplying blood to the brain , i.e. the carotid arteries. - Occlusion of the airway probably plays a minor role, if any, in causing death. - Carotid sinus pressure, may result in vagus nerve stimulation resulting in cardiac arrest, vagal inhibition. - ***[Manual strangulation] :*** It is a type of death where the perpetrator uses his hands to encircle and compress the front and side of the neck. - It is a common method of homicide, most often encountered when the physical size and strength of the assailant exceeds the victim. - Usually victims are females, children, aged people and those cases where victim may be incapacitated due to drugs or caught unaware because of the suddenness of the act. - Throttling is a type of homicidal strangulation that cannot be self-inflicted and often occurs following assaults. It causes death by: cerebral anoxia, reflex cardiac asystole, asphyxia. AUTOPSY FINDINGS ================ Signs of asphyxia are present. On neck, there are injuries due to finger tip and nails. Injuries due to thumb are seen better as compared to fingers : I. ***Bruising on the neck :*** They are due to grasping of neck by the assailant these bruises are usually oval or circular, dark red or purplish in color and are about 1.5-2cm in diameter, contusions. These contusions are initially red and soft, but later become brown and hard. If the gripping fingers slide over the skin, bruises take up an elongated shape. No contusion may be seen, if- **a)**. A cloth is kept in between the hand and neck. **b)**. the compression with fingers is continued till beyond death (since after death, there will be no extra-vasation of blood ). II. ***Abrasions on the neck :*** the neck examination will show fingernail marks, which could be from both assailant as well as victim. Thus , the finger nail marks are helpful in interpretation of the case giving opinions. Injury produced may be abrasion or lacerations as it depends upon amount of force applied and length of nails -- **a)**. When the force applied is less or medium -- the injury is multiple linear abrasions. **b)**. When the force applied is moderate or more -- the injuries are semilunar lacerations, being relatively close to each other. **c)**. When the force applied is severe -- the individual lacerations overlap, so that a bleeding line is seen. **d)**. May be no injury, if gloves are worn. - During autopsy, scrapings from under the fingernails of deceased may be taken for DNA fingerprinting and compared with that of suspect. - ***Throttling with one hand*** If one hand is used, in a right handed assailant, injuries due to thumb are present on the right side of the neck and due to fingers are present on left side of the neck of victims. Injuries due to fingers are placed vertically one above another. - ***Throttling with both hands*** - When both hands are used to compress the neck, injuries depend upon the position of hands: a. Hands are placed opposite to each other i.e. one each on anterior and posterior parts of neck injuries due to both thumbs are present on right side of neck and due to all fingers are on left side of neck. b. Both hands are placed on anterior part of neck -- injuries due to thumb of right hand and four fingers of left hand are produced on right side of neck and vice versa. c. Both hands are placed on anterior side, one overlapping the other- there are multiple vague contusions on neck. d. If victim is lying -- both thumbs produce injuries on same side of neck and all the fingers on opposite / lateral side. - When both hands are used, thumbnail impression of both hands will be in middle with rest of four fingers nail marks seen on either side of neck. - However, if thumbs overlap then midline impressions would be absent. ***INTERNAL FINDINGS :*** - Bruises may be seen over the prominence of the larynx and at the level of cricoid cartilage. - If excessive force has been applied, bleeding from larynx may have occurred. - There are diffuse extravasations of blood in soft tissues. - Tissues of neck are often markedly contused. - Bleeding may be seen in the strap muscles or platysma. - Brain and meninges are congested. - Lungs, esophagus, epiglottis, pharynx and larynx are congested. - Trachea lacerated. - In the living victim, clinical evaluation may reveal pain on swallowing, hoarseness, stridor, neck- head or back pain. - Fracture of hyoid bone is very common in throttling- - More common in elderly. - Fracture is of adduction type (inward compression fracture). - Posterior end of hyoid are displaced inwards. - Fractures usually occurs in midline and involves greater cornu of hyoid. - Periosteum is torn on outer side of bone. - In Throttling, there is laceration of muscles. Hence, muscles are congested. - Effects of pressure on neck in manual strangulation: I. Carotid sinus pressure -- vagus nerve stimulation -- cardiac arrest II. Carotid artery blockage -- unconsciousness III. Jugular vein blockage -- congestion and haemorrhages IV. Airway blockage -- lack of oxygen MEDICO LEGAL ASPECTS ==================== - Determination Of Cause And Manner Of Death : -------------------------------------------- - ### Whether death is due to strangulation : - In case of death due to strangulation, there are injuries on neck, depending upon the types of strangulation and these injuries show features of inflammation and vital reaction. - Usually signs of struggle are present. - At times some other method of homicide may have also employed. - ### Whether strangulation is -- A. ***Suicidal manual strangulation --*** is never reported. Manual self strangulation is impossible, as pressure on neck depends on voluntary action, which is discontinued when power of decision is obliterated with loss of consciousness. B. ***Homicidal manual strangulation*** -- is common. There will be marks of violence, on other parts of body. - Females predominate as victims. According to studies reported by DiMaio, the most common motive for manual strangulation was rape, followed by domestic violence. - Thus if the victim is female, carefully look for evidence of sexual assault, as it is common for an assailant to molest/rape a girl then strangle her. Detailed examination of external and internal genital organs, including vaginal washings for chemical and microscopic examination is performed preferably. - Finger nail scrapings and pubic and scalp hair sample from deceased should be retained for possible examination later at forensic science laboratory. - Documentation and Evidence Collection : ======================================= A. ***Scene Documentation :*** - ***Photographs --*** capture the scene, the position of the body and the potential evidence around the victims. - ***Sketches --*** create detailed sketches of the scene, nothing the location of the body and relevant items. B. ***Body Documentation :*** - ***Photographs -*** take high resolution photos of neck, face and other areas visible injuries. - ***Injury description --*** document the type, size, location and pattern of external injuries such as bruises, abrasions and fingernail marks. - ***Petechiae --*** note the presence and distribution of petechiae in the eyes, faces and mucous membrane. C. ***Autopsy Report :*** - ***Comprehensive Report --*** compile a detailed autopsy report that includes the findings from the external and Internal examinations, histological analysis and ancillary tests. - ***Diagrams --*** includes diagrams of the injuries and their locations on the body. - ***EVIDENCES :*** A. ***DNA --*** collect swabs from the neck and fingernails to obtain DNA evidence that may identify the perpetrator. B. ***Toxicology --*** collect blood, urine and other fluids for toxicological analysis to rule out intoxication and incapacitation. C. ***Clothing and Nail Scrapping --*** collect victims cloths and obtain scrapings from victim's fingernails, which may contain traces of assailant. - ***Chain of Custody :*** - ***Secure Handling --*** ensure all evidence is collected, labeled and stored securely to maintain the chain of custody. - ***Documentation --*** record each transfer of evidence, detailing who handled it and when, to preserve its integrity for court proceedings. - ***Legal Considerations :*** - ***Expert Testimony --*** forensic pathologists may be called to testify in court, presenting the findings and explaining their significance in the context of the case. - ***Reports and Records --*** maintain thorough and accurate records to support the forensic conclusions and provide a clear basis for the expert testimony. *Conclusion* ============ - Manual strangulation is a critical aspect of forensic medical jurisprudence that requires meticulous investigation and analysis. - It involves deliberate pressure on neck, leading to asphyxia and potential fatal outcomes. Forensic examination of manual strangulation includes: 1. ***Identification of physical signs:*** Bruising, abrasions, petechiae and internal injuries to neck structures. 2. ***Autopsy and histological examination:*** Detailed dissection and microscopic analysis to reveal underlying tissue damage. 3. ***Legal determinations:*** Establishing the cause and manner of death, differentiating between homicide, suicideor accidental causes. 4. ***Expert Testimony:*** providing clear and precise medical findings in a legal context to aid in judicial process. - Throttling is a significant topic in forensic medicine due to its violent nature and potential lethality. - Accurate forensic evaluation is crucial for justice, ensuring a thorough understanding of the circumstances surrounding the death or injury and informing legal proceedings.