THROTTLING OR MANUAL STRANGULATION
Asphyxia produced by compression of the neck by human hands is called throttling. Death may occur due to asphyxia, or the pressure may continue for sometime for asphyxia signs to appear, and then a change in grip may allow the fingers to press on the carotid structures and cause reflex cardiac arrest. Vagal inhibition is much more common in manual strangulation than with a ligature.

Medico-legal Questions:

- The usual diagnostic signs of death due to manual strangulation are:

1. Cutaneous bruising and abrasions.
2. Extensive bruising with or without rupture of the neck muscles.
3. Engorgement of the tissues at and above the level of compression.
4. Fracture of the larynx, thyroid cartilage, and hyoid bone.
5. Cricoid cartilage is almost exclusively fractured in throttling.
6. General signs of asphyxia.

When all the signs are present, the diagnosis is easy. In the absence of external signs, or when they are equivocal, care is necessary. The pressure must be applied for two minutes or more to cause death. fingernail abrasions are often produced due to the victim and assailant may indicate their origin. When a suspended body shows extensive injuries to the neck structures, there is a strong probability that the victim was first throttled and then suspended after death. In such case, signs of violence on the body, and sometimes of rape, if present are helpful. The discolourations produced in decomposing bruises are usually localized, but similar areas of decomposition may be found when decomposition affects localized ante-mortem intravascular collections of blood in the cervical tissues, or localized patches of post-mortem lividity. Hyoid bone fracture is strongly suggestive of throttling.

When throttling has been attempted at about the moment of death, one cannot be certain whether the deceased was alive or dead at the time. Nail marks will appear much the same whether produced just before or just after death, but contusions are only produced during life.

2) Whether the throttling was suicidal, homicidal or accidental?

- Suicidal Throttling: Suicide by throttling is not possible, because the compression of the windpipe produces rapid unconsciousness and the fingers are relaxed.

- Homicidal Throttling: Throttling is a common mode of homicide because the hand is immediately available. It is a method of choice in infants. The victims are usually infants, children or women. Adults can be throttled when under the influence of drugs or drink, or stunned or taken unawares. In an adult, signs of struggle are usually present, but if the throat is forcibly grasped and firmly compressed, the victim cannot struggle. The assailant may also sustain injury, especially scratches and bruising of the face and arms, or his hands and fingers may be bitten. The alleged assailant should be examined to correlate any injuries that may have been inflicted on him by the fingernails of the victim, such as scratches. The fingernail scrapings of the assailant should be taken to compare any debris found and the tissue types of the victim. Sometimes, it is preceded by rape or attempted rape. The victim may have been held down b the throat during intercourse or throttled to stop her cries. If contusions and fingernail abrasions are present on the neck, the presumption must be of homicide. The defense may allege that such marks have been produced due to fall by the deceased while his hand was passively applied to his neck, the marks being produced accidentally by the pressure of his own fingers. This is highly improbable. Sometimes, a person might bry to strangle himself with his hand, and upon failure might use a ligature. In such case, the degree to which the impressions exist will usually clear the doubt.

- Accidental  Throttling: A sudden application of one or both hands on other person’s throat as a demonstration of affection, in joke, as a part of physiological experiment, etc., may cause death from cardiac inhibition.

3) How much force could have been used by an assailant?

- If there is severe damage to neck structures, it indicates use of considerable force, and is indicative of intent to injure, if not to kill. If there is fracture of hyoid bone or larynx, it indicates the use of appreciable force and is homicidal in nature, for it cannot be an accidental touch or momentary grip. A brief and minor contact with the neck would be consistent with restraint, without intention of injuring and causing death. minor damage or absence of damage to the neck structures is presumptive of innocence, but sometimes deliberate interference with the neck structures can kill without producing much damage, e.g., the karate blow. If a only slight changes are seen in the neck structures, a guarded opinion should be given about the probable degree of force used.