Introduction
Smothering, i.e. the closure of mouth and nostrils along with or without strangulation, manual or by means of the ligature is frequently encountered in routine autopsy. Mostly young middle-aged females in cases of dowry death, rarely in infants on account of the victim being female in want of a male child and accidentally by inexperienced mothers, who press them too closely to the breast when suckling or pressure over neck during routine care while oil massaging, assaults for property and inheritance claim, etc. meticulous autopsy, a thorough search detailing scene for crime questioning of relatives in association with findings of internal organs leads to the conclusion of forcible smothering.1 In view of external injuries, a conclusion regarding the disease preposterous inference. Closure of mouth and nostrils by means of hand, bedclothes, soft pillows, or mud are common methods. Strangulation is defined as compression of the neck by force other than hanging, ligature strangulation is a violent form of strangulation that results from constricting the neck by means of a ligature or by any other means without suspending the body.2,3 When constriction is produced by the pressure of the fingers and palms upon the throat, it is called throttling. When strangulation is brought about by compression of the throat with a foot, knee, bend of the elbow, or some other substance it is known as mugging, (stranglehold). It is known as bansdola where a wooden stick is used to compress the neck. Garroting is another form of neck compression where a rope or a loin cloth and a wooden stick as a lever to tighten the ligation around the neck are used.2, 3 Accidental strangulation can arise in the course of a person’s occupation when a necktie or scarf is caught in a piece of moving machinery, or belts as in mill workers or in an epileptic or intoxicated person who may be helpless in extricating himself from such tight encirclement of the neck or in utero when the movements of the fetus cause the umbilical cord to wound round the neck.
We present a rare case of smothering with ligature strangulation of a student in a hostel whose body was found outside the hostel premises. Smothering and strangulation are usually homicidal, sometimes accidental, and rarely suicidal.
Case History & Autopsy Finding
A 17-year-old college student was found dead inside a car parked near his college hostel in the early morning. The dead body was brought with an alleged history of being killed by ligature strangulation.
The face was congested, moderately swollen, and cyanosed with subconjunctival hemorrhages. Features of asphyxia were also seen over the earlobes and fingertips. The mouth was partially open; lips were deeply cyanosed and bruised. There were mucosal lacerations on the inner aspect of the gums both upper and lower lips with blood clots. Blood oozed out from nostrils soiling the face at places (Figure 1).
A single abrasion of about 9 X 1.5 cm in size, which was reddish brown in color, was seen on the right side of the neck (Figure 2). This abrasion was consistent with the history of neck compression.
Internal examination showed a fracture of the superior horn of thyroid cartilage with extravasations of blood and blood clots. Trachea was congested. Both lungs were congested and edematous, with frothy blood on the cut section. Occipital and postero-lateral areas of the scalp showed extravasation of blood and cut sections showed oozing of dark red blood. There were patchy areas of subarachnoid hemorrhages. The brain matter was congested and edematous (Figure 3).
After considering all circumstantial evidence and post mortem findings the cause of death was given as smothering with neck compression and the manner of death being homicide.
Discussion
Smothering can be homicidal, accidental, or suicidal. However, they are usually homicidal, rarely suicidal and very rarely accidental in nature.4 It is possible when the victim is incapacitated by drinks or drugs, a weak child or old person’s ill health, and is unable to defend themselves.4, 5 Generally, most fatal smothering cases are accidental in nature. Singh O reported one unusual case of accidental smothering where a person got slipped & became unconscious during a response to a call of nature.6 The person remained lying unconscious for a long time and mud & sand got collected around his mouth and nostrils due to incessant rain. Siddhartha Das reported another unusual case of homicide by a combination of three different methods like manual strangulation, smothering and traumatic asphyxia.2
In ligature strangulation, there can be contusion of the strap muscles & fracture of thyroid cartilage.7 In the present case also we found contusions & fractures of thyroid cartilage. When a soft material is used the ligature mark may be not prominent. In the present case also the ligature mark was not so conspicuous & it was absent on the left side of the neck.
Conclusion
The case study emphasizes the role of careful and intelligent analysis of history and visits to the scene of crime in such cases and knowing how people perform such an act and distinguishing between criminals and legitimate factor users such as sleeping on a pillow. Institutional homicide mainly results due to some foul play or ragging in school or college, especially if indulgence of the victim or his colleagues is found in drug abuse or any antisocial activity. The institutions, anti-ragging committees, Government, and law enforcement agencies need to take necessary steps to prevent such episodes.
