A Study on Asphyxial Death in Bilaspur District
Sushma Upadhyay*
Assistant Professor, Department of Forensic Science, Guru Ghasidas Vishwavidyalaya, Koni, Bilaspur (C.G.)
*Corresponding Author E-mail: sushmaupadhyay20@gmail.com
ABSTRACT:
This work is aimed to determine, the frequency of violent asphyxial deaths autopsied in Bilaspur district along with age and gender vulnerability. Causes patterns and type of asphyxia were noted. Important data is collected in predesigned proforma for study .Maximum no. of cases were from Road Traffic Accident i.e. 33.02 % whereas the minimum number of cases belongs to drowning incidence i.e, 4.58% .The incidence of Violent Asphyxial Death among total studied subjects (109 cases) were found 16.51%.Among gender wise frequency distribution of V.A.D. cases of male were found maximum in number The cause of death in most of the cases were either hanging or strangulation. Drowning cases were also noticed those were found 27.77%. Males and young age group population between 15–44 years are more vulnerable victims of violent asphyxial deaths. Suicidal deaths due to hanging and accidental death due to drowning seems to be the major contributing causes of asphyxial deaths.
KEYWORDS: Asphyxial Deaths, Suicide, Autopsy, Hanging, Drowning.
INTRODUCTION:
The word asphyxia is defined as suffocation as a result of physical blockage of the airway or inhalation of toxic gases, resulting in lack of oxygen and unconsciousness. The origin of the word asphyxia is early 18th century. Many case reports are available in literature about asphyxial deaths as they can be sometimes very challenging and reveal stunning results to the forensic experts 1-3. Suicide by asphyxia is extremely rare and has been proven in multiple studies worldwide as well as ours. In a study done in Brazil, high alcohol levels were associated with suicide by hanging 4 .Substance abuse in suicide was also reported in the United States 5. Another study in the United States associated suicide with depression and also found that self strangulation by ligature was very uncommon. This study used a sample of 33,300 (all were cases of suicide), out of which 7,491 were due to asphyxia6.
Simple asphyxiants merely displace oxygen from ambient air whereas chemical asphyxiants react in the human body to interrupt either the delivery or utilization of oxygen7 .When the concentration of any gases increase, the fraction of inspired oxygen (FiO2) tends to decrease, rendering to hypoxemia. Working in confined spaces are hazardous to workers.8 .The death is usually due to hypoxemia, secondary to gases inhalation9.In a chemical emergency that involves a mass exposure, the majority of the affected persons are likely to be exposed minimally and to remain ambulatory and therefore able to reach a hospital by their own efforts. Thus, hospitals and triage centres should make advance preparation for shower facilities.10,12,13 In scenarios for the treatment of mass casualties, the projected number of persons affected by stress often exceeds the number of persons affected physically, by ratios ranging from 5:1 to 16:1.10,11,14,15. Therefore, resources to provide psychological support must be available both for casualties and for emergency personnel.
METHODOLOGY:
A total of 109 medicos legal deaths were autopsied meticulously at Department of Forensic Medicine and Toxicology during the period i.e. January to March 2016.VAD Case are mainly collected to: Determine cause and manner of death. A pre designed proforma is used for this particular study .In this study those cases are included in which death could only be attributed to the direct effect of mechanical interference of the process of respiration leading to asphyxia and ultimately death.
The present work is aimed to determine, the frequency of violent asphyxial deaths autopsied in Bilaspur District along with age and gender vulnerability. In 2013 about 1.6 million cases of unintentional suffocation occurred.
The word asphyxia is from Ancient Greek a “without” and sphyxis, ”squeeze” (throb of heart).
Table 1: Distribution of total no. of subject (N=109)
Types of cases |
No. |
% |
RTA |
36 |
33.02 |
Poisoning |
28 |
25.68 |
Burn |
22 |
20.18 |
Hanging |
18 |
16.51 |
Drowning |
05 |
04.58 |
Total |
109 |
100 |
Table 2: Incidence of V.A.D. (n= 18)
Total no. of Autopsies Conducted |
Violent Asphyxial Death |
% of Asphyxial Death |
109 |
18 |
16.51 |
Table 3: Distribution of Frequency of V.A.D. in Relation to Age (n=18)
Age (in years) |
Hanging |
Strangulation |
Smothering |
Drowning |
Traumatic asphyxia |
Total |
% |
0-14 |
- |
01 |
01 |
01 |
- |
03 |
16.66 |
15-24 |
01 |
02 |
- |
02 |
- |
05 |
27.77 |
25-44 |
04 |
- |
- |
|
- |
04 |
22.22 |
45-64 |
- |
- |
- |
02 |
01 |
03 |
16.66 |
65 and above |
- |
02 |
01 |
|
- |
03 |
16.66 |
Total |
05 |
05 |
02 |
05 |
01 |
18 |
100 |
Table 4: Distribution of Frequency of V.A.D. in Relation to Gender (n=18)
Cause of Death |
Male |
Female |
Total |
|||
No. |
% |
No. |
% |
No. |
% |
|
Hanging |
2 |
20.00 |
3 |
37.50 |
5 |
27.77 |
Ligature Strangulation |
2 |
20.00 |
1 |
12.50 |
3 |
16.66 |
Manual Strangulation |
1 |
10.00 |
1 |
12.50 |
2 |
11.11 |
Smothering |
1 |
10.00 |
1 |
12.50 |
2 |
11.11 |
Drowning |
3 |
30.00 |
2 |
25.00 |
5 |
27.77 |
Traumatic Asphyxia |
1 |
10.00 |
- |
- |
1 |
05.55 |
Total |
10 |
100 |
8 |
100 |
18 |
100 |
Table-5: Distribution of Marital Status of the Subject (n=18)
Marital Status |
No. |
% |
Married |
13 |
72.22 |
Unmarried |
05 |
27.77 |
Total |
18 |
100 |
Table-6: Distribution of Place of Incidence of the Subject (n=18)
POI |
No. |
% |
Indoor |
13 |
72.22 |
Outdoor |
05 |
27.77 |
Total |
18 |
100 |
Table-7: Condition of Subject when Brought To Hospital (n=18)
Condition |
No. |
% |
Alive |
05 |
27.77 |
Dead |
11 |
61.11 |
Unconscious |
02 |
11.11 |
Total |
18 |
100 |
Table-8: Suicide Note Present or Not (n=18)
Suicide Note |
No. |
% |
Present |
06 |
33.33 |
Absent |
12 |
66.66 |
Total |
18 |
100 |
Table-9: Duration of Survival (n=18)
Survival |
No. |
% |
Spot |
11 |
61.11 |
1-7 days |
03 |
16.66 |
>7 days |
02 |
11.11 |
Within 24 hours |
02 |
11.11 |
Total |
18 |
100 |
Table 10: Distribution of Frequency of V.A.D. in Relation to Manner of Death (n=18)
Cause of Death |
Manner of Death |
|||
Accidental |
Homicidal |
Suicidal |
Total |
|
Hanging |
01 |
01 |
03 |
05 |
Ligature Strangulation |
- |
03 |
- |
03 |
Manual Strangulation |
- |
02 |
- |
02 |
Smothering |
- |
02 |
- |
02 |
Drowning |
02 |
01 |
02 |
05 |
Traumatic Asphyxia |
01 |
- |
- |
01 |
Table 11: Post-mortem finding on external examination in cases of hanging and strangulation
External Findings |
Hanging |
Strangulation |
||
|
No. |
% |
No. |
% |
Placement of Ligature Marks |
Oblique |
Transverse |
||
· Above Thyroid |
03 |
60.00 |
04 |
80.00 |
· at & above Thyroid |
02 |
40.00 |
03 |
60.00 |
· Below Thyroid |
04 |
80.00 |
00 |
00.00 |
Congestion of Face |
05 |
100 |
05 |
100 |
Dribbling of Saliva |
03 |
60.00 |
01 |
20.00 |
Discharge of Urine/Faeces |
04 |
80.00 |
03 |
60.00 |
Discharge of Semen |
02 |
40.00 |
01 |
20.00 |
Signs of Struggle |
03 |
60.00 |
02 |
40.00 |
Table 12: Post-mortem finding on internal examination in cases of hanging and strangulation
Internal Findings |
Hanging |
Strangulation |
Sub cutaneous Tissue |
05 |
05 |
Fracture of Thyroid |
09 |
07 |
Fracture of Hyoid |
01 |
00 |
Neck Muscle Contusion |
05 |
03 |
Fig-A:Shows oedema & Haemorrhage of Epiglottis
Fig-B: shows pink foamy liquid in bronchi
Fig-C: Shows Severe laryngeal congestion
Fig-D: Shows Severe laryngeal congestion
Fig-E: Shows Epiglottis abscess nodule
Measuring 1.6 cm × 1.3cm× 0.6cm (white arrow)
Fig-F: Shows Epiglottis abscess rupture measuring 0.5cm×0.1cm (white arrow)
RESULT AND DISCUSSION:
Among the total no. of subjects from Bilaspur district, maximum no. of cases were from Road Traffic Accident i.e. 33.02% followed by poisoning cases those were 28 in no. The third largest group was Born cases those were 20.18 whereas the minimum no. of were belongs to drowning incidence i.e, 4.58% of total studied subjects. The incidence of Violent Asphyxial Death among total studied subjects (i.e,109 cases) were found 16.51%.Among gender wise frequency distribution of V.A.D. cases of male were found maximum in no. those were found 10 cases as compared to female i.e,08 cases. The cause of death in most of the cases were either hanging or strangulation. Drowning cases were also noticed those were found 27.77%.V.A.D. as per age distribution it was noticed in most of the cases were from the age group 15-44 those were found 41.11%.Age group between 0-24 and 65 and above were found almost equal in no.i.e,3 cases each. As per the marital status of studied subject married were found maximum in no.i.e,13 cases as compared to unmarried those were found 27.77%.Regarding the place of incidence most of the incidence were took place indoor i.e., 72.22% were as outdoor were found 27.77% only. It was also observed maximum no. of the cases were brought to the hospital were found dead i.e., 61.11%.The subject were unconscious when brought to the hospital were 2 in no. It was noticed that only in 6 cases there was suicide note found among total studied subject of V.A.D. i.e., 18.It was noticed in 61.11% cases, the death was occur at spot at the place of incidence. The subjects those were survived for 20 hrs to 7 days were found 5 in no. whereas those were survived more than 7 days were only 11.11%.Among total studied V.A.D. cases, hanging and drowning was the major cause of death followed by strangulation i.e. ligature strangulation and manual strangulation. Those were found 3 and 2 cases respectively. Smothering was the least count of death in V.A.D. that was found in 2 cases. The external post mortem findings reveals that the location of ligature mark found oblique in case of hanging were as transverse in case of strangulation. The above region of thyroid was found rupture in 80% cases in case of strangulation and 16% cases in case of hanging respectively. The congestion of face was found equal in no. in both i.e. 5 cases in each. The sign of struggle was reported in 3 cases of hanging and 40% cases of strangulation respectively. In 9 cases of hanging and 7 cases of strangulation there were fracture of thyroid and hyoid were examined. Neck muscle contusion was observed in 5 cases if hanging and 3 cases of strangulation respectively. The subcutaneous tissue injuries were noticed in 5 cases of both hanging and strangulation.
The maximum no. of cases of Road Traffic Accident i.e. 33.02% and the minimum no. i.e. 4.58% of drowning incidence were reported among the total studied subjects from Bilaspur district. The incidence of VAD among total studied subjects was found 16.51%. Among gender wise frequency distribution of V.A.D. cases shows that the male were found maximum in no. as compared to female, those were 10 and 08 cases respectively and the cause of death in most of the cases were either hanging or strangulation.
The maximum no. of cases were covering the age group15-44 those were found 41.11% cases. It was also noticed that most of studied subjects were found maximum in no. those were 13 in no. Regarding the place of incidence most of the incidence were took place indoor i.e., 72.22% were as outdoor were found 27.77% only and most of the cases those were 61.11 were found dead when brought to the hospital. Suicide note were found only in 6 cases and the maximum no. of casualty has been taken place at spot at the place of incidence. Only six cases were survived for more than one week. Among studied subjects hanging was found the major cause of death.
The external post mortem findings reveals that the location of ligature mark found oblique in case of hanging were as transverse in case of strangulation. The above region of thyroid was found rupture in 80% cases in case of strangulation and 16% cases in case of hanging respectively. The congestion of face was found equal in no. in both i.e. 5 cases in each. The sign of struggle was reported in 3 cases of hanging and 40% cases of strangulation respectively. The fracture of thyroid and hyoid were examined in 9 cases of hanging and 7 cases of strangulation. The involvement of neck muscles contusion was observed in 5 cases in hanging and 3 cases of strangulation respectively. The injuries related to subcutaneous tissue were noticed in 5 cases of both hanging and strangulation.
CONCLUSION:
Males and young age group population between 15–44 years are more vulnerable victims of violent asphyxial deaths. Suicidal deaths as a result of hanging and accidental deaths as a result of drowning seem to be the major contributing causes of asphyxial deaths. Both these manner of deaths, somehow, indicates frustration and carelessness on the part of population which are preventable and needs to be rectified on urgent basis. More over these cases of suicide should serve as an eye opener for organizations working for socio economic justice in our country.
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Received on 27.04.2017 Modified on 24.07.2017
Accepted on 19.08.2017 © RJPT All right reserved
Research J. Pharm. and Tech. 2017; 10(8): 2538-2542.
DOI: 10.5958/0974-360X.2017.00449.8