Today I appeared before the High Court, to give evidence on an autopsy of a murder I did in 2005 at the Teaching Hospital Ragama.
The history given to me by the police was as follows.
The deceased was a 35-year-old female ‘living together’ with a man for a few years as husband and wife. One day the man brought the dead body of the deceased to the OPD of a district hospital in the night claiming that she had collapsed after complaining of a chest pain. Unsuspecting hospital staff took the possession of the body in view of an inquest on the following day morning. After preliminaries the Inquirer-in-to-sudden death requested the DMO to perform the autopsy and find out the cause of death. The DMO, being an experienced senior doctor, found suspicious ‘marks’ on her face and neck during the autopsy. Without completing the autopsy he referred the autopsy to the Teaching Hospital Ragama.
The body was received naked wrapped in a polythene sheet. Body cavities had been opened and organs eviscerated. However they were only partly dissected. Neck had been dissected but internal structures were un touched.
The body belonged to a small made, moderately nourished woman measuring 5’ 8” in length.
External Examination
On external examination there were florid ‘petechial haemorrhages’ in tarsal plates of both eyes. (Later I found that there were florid petechial haemorrhages under the scalp and a few in the inter-lobar fissures of both lungs)
On the right cheek were two oval bruises (around 1-2 cm in maximum dimension) and a ‘semi-lunar’ shape imprint abrasion measuring 0.5 cm. On the left cheek was another oval shape bruise measuring 1.5 cm x 1 cm. On the right upper neck was another semi-lunar imprint abrasion of approximately similar size. On the front of the neck was another bruise of approximately similar size.
On the back and front of the left upper arm were two oval bruises measuring around 1-2 cm in the maximum dimension. On the back of the right upper arm and forearm were two similar bruises.
This is how I described one injury in my Post-mortem Report “Situated on the right cheek(approximate site) is an oval (shape) bruise (type)measuring 2 cm x 1 cm (size) with the longest diameter lying horizontally, (disposition) centred 7 cm to the right from the point of chin and 2 cm above the lower border of the lower jaw” (exact site).
(Note: you should always write the injury description in the ‘present’tense even if you complete the Post-mortem Report later as your description of injuries need to be contemporaneous’.)
Neck
Both sterno-hyoid and sterno-thyroid muscles were bruised over the thyroid gland and thyroid cartilage. Hyoid bone and thyroid cartilage were intact. They were very ‘elastic’.Around the right ‘greater horn’ of the hyoid bone was a bruise of soft tissues. Inside the larynx below the vocal cords were many petechial haemorrhages.
Genitalia were unremarkable.
Dissection of other organs did not reveal any acute disease condition which could have contributed to or caused death.
I concluded the cause of death as‘manual strangulation.
Some of the relevant questions asked by the State Counsel during the ‘examination in chief’ were as follows.
1. Could you please tell the court how manual strangulation causes death?
Not only manual strangulation, any kind of pressure on the neck such as ligature strangulation, hanging, direct blow to the neck etc. cause death by four different mechanisms. They are reflex cardiac arrest (vaso-vagal inhibition), obstruction of venous drainage (jugular veins), bilateral cardiac compression and obstruction to airway (trachea and/or larynx). The commonest are the two former mechanisms.
2. How did you conclude that the cause of death was ‘manual strangulation’?
Firstly the external examination revealed florid petechial haemorrhages on the tarsal plates. Then the internal examination also revealed petechial haemorrhages under the scalp, in the larynx and in the inter-lobar fissures of the lungs. Presence of petechial haemorrhages, especially in the eyes, should always be considered as due to ‘mechanical asphyxia’ unless proven otherwise.
Secondly the presence of oval bruises on the cheek and front of the neck and semilunar shape imprint abrasions on the right cheek and upper neck. The size and shape of these bruises indicated that they were likely to have been caused by ‘finger tips’ as fingertip bruises are said to be ‘discoid’ in shape measuring 1-2 cm in diameter. The size and shape of the ‘semi-lunar’ imprint abrasions indicated that they were likely to have been caused by ‘finger nails’. It is known that finger nails cause ‘crescent’ shape imprint abrasions. (It is claimed that by the direction of the convexity of these abrasions the direction of the application of the finger pressure can be guessed (Bernard Knight). But some experts disputed this claim (Gordon and Shapiro).)
In addition to the size and shape the distribution of these bruises and imprint abrasions are indicative of manual strangulation.
Thirdly presence of the bruises on the strap muscles and around the right greater horn of the hyoid bones indicated that they were likely to have been caused by a pressure on the neck by finger tips.
3. What was the force and how long was it applied?
It is a very difficult question to answer. Some experts say that to produce petechial haemorrhages on the tarsal plates one needs to apply sustain pressure at least for 15-30 seconds (Bernard Knight). But he admits that this is purely a guess work and not proven scientifically. Since bruises had been produced on the face and in the neck the force should have been at least moderate if not severe, on the scale of mild, moderate and severe. If the hyoid bone and thyroid cartilage had been fractured this guessing could have been easier. They were not fractured because they were still elastic with not apparent ‘ossification’.
4. Had she resisted? And Was she able to shout?
Since she was a small made woman (moderately nourished, small made, 4’8” in length) a man of average built could have easily overcome her resistance. (In fact the accused was well-built man.)
The presence of ‘fingertip’ type bruises on the left and right upper arms and right forearm indicated the possibility of restraining her during the assault.
(Of course I explained these points to the court in very simple language without medical jargon so that the judge, lawyers and the public could understand.)
After he finished ‘examination in chief’ the defence was asked to cross examine. They declined the offer.
If you were the defence lawyer what kind of questions you would have asked me to get your client at least a mitigated sentence?
Priyanjith Perera
07 November 2012
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