Hanging
Hanging is that form of asphyxia which is caused by suspension of the body by a ligature which encircles the neck, the constricting force being the weight of the body. The
whole weight of the body is not necessary, and only a comparatively slight force is enough to produce death. In ‘partial hanging’ the bodies are partially suspended, the toes
or feet touching the ground, or are in a sitting, kneeling, lying down, prone or any other posture. The weight of the head (5 to 6 kg) acts as the constricting force. In typical
hanging, the knot is situated over the nape of the neck ligature runs form the midline above the thyroid cartilage symmetrically upward on both sides of the neck to the
occipital region other position of knot is called Atypical Hanging. When the body is completely suspended by a Ligature with full weight acting as constricting force it is
termed as Complete Hanging,when any part of the body is in contact with the ground it is termed as Partial Hanging.
Ligature: A suicide will use any article readily available for the purpose, like a rope, metallic chains and wires, leather strap, belt, bed sheet, scarf, dhoti, saree, turban,
sacred thread, etc. The doctor should note whether the mark on the neck corresponds with the material alleged to have been used in hanging and if it is strong enough to
bear the weight and the jerk of the body. He should also note its texture and length, to know whether it was sufficient to hang. Before removing the ligature from the neck, it
should be described as to the nature and composition, width, mode of application, location and type of knot. Sometimes, the rope will break or become detached and the
deceased will be found lying on the ground with a ligature around his neck.
Symptoms: The first symptoms are loss or power and subjective sensations, such as flashes of light and ringing and hissing noises in the ears. There is intense mental
confusion, all power of to logical thought is lost; the individual can do nothing to help himself even if it were possible. These are to followed by loss of consciousness, which is
so rapid, that it is regarded as a painless form of death. Then follows a stage of convulsions. The face is distorted and livid, eyes prominent, and there is violent struggling.
Respiration stops before the heart, which may continue to beat for about 10 to 15 minutes.
Causes of Death :
1. Asphyxia : The constricting force of the ligature, causes compressive narrowing of laryngeal and tracheal lumina, and forces up the root of the tongue against the
posterior wall of the pharynx, and folds the epiglottis over the entrance of the larynx to block the airway. A tension of 15 kg. on ligature blocks the trachea.
2. Venous congestion: The jugular veins are blocked by the compression of the ligature which results in stoppage of the cerebral circulation, and a rapid rise in venous
pressure in the head. This occurs if ligature is made up of broad and soft material, which cannot sink into tissue to any depth. The jugular veins are closed by a
tension in the rope of 2kg.
3. Combined asphyxia and venous congestion: This is the commonest cause.
4. Cerebral anaemia: Pressure on the large arteries on the neck produces cerebral anaemia and immediate coma. This occurs with ligature made of thin cord, which
sinks deeply into tissues. A tension of 4 to 5kg on ligature blocks carotid arteries, and 20 kg. the vertebral arteries.
5. Reflex vagal inhibition form pressure on the vagal sheath or carotid bodies.
6. Fracture or dislocation of the cervical vertebrae.
Delayed Death: Death delayed for several days is rare. Delayed deaths occur due to (1) aspiration pneumonia, (2) infections, (3) oedema of lungs, (4) oedema of larynx, (5)
hypoxic encephalopathy, (6) infarction of brain, (7) abscess of brain, (8) cerebral softening.
The secondary effects of hanging in persons who have recovered are sometimes hemiplegia, epileptiform convulsions, amnesia, dementia, cervical cellulitis, parotitis,
retropharyngeal abscess, amnesia, and dementia.
Fatal Period : Death occurs immediately if the cervical vertebrae are fractured, or if the heart is inhibited; rapidly if cause is asphyxia, and least rapidly if coma is
responsible. The usual period is 3 to 5 minutes.
Post-mortem Appearances :
External: The ligature mark in the neck is the most important and specific sign of death from hanging. Ligature mark on the neck depends on: 1) Composition of ligature:
The pattern and texture is produced upon the skin, e.g., if thick rope is used, its texture may be impressed in the form of superficial abrasion. 2) Width and multiplicity of
ligature : When ligature is narrow, a deep groove is made because much more force per sq. cm. Of ligature is directed inwards. A broad ligature will produce only a superficial
mark. If the ligature is passed twice round the neck, a double mark, one circular, and the other oblique may be seen. The ligature may have one, two or more layers. There
may be multiple congested areas where the skin has been caught between the various layers. 3) The weight of the body suspended and the degree f the suspension: Heavier
he body and greater the proportion of the body suspended, the more marked is the ligature impression. 4) The tightness of encircling ligature: The ligature impression is
deeper opposite the point of suspension, but it may tail off vary rapidly if ligature consists of loop rather than a noose. If the noose tightness completely around the neck, the
ligature mark will be seen completely encircling the neck. 5) The length of time body has been suspended: Longer the suspension, deeper is the groove. Even a soft, board
ligature can cause a clear-cut groove if suspended long. If the ligature is cut down within a short time and a soft broad ligature has been used, there may be no external mark.
6) Position of the knot: The main force applied to the neck b ligature is opposite to the point of suspension. If the point of suspension is in occipital region, front of the neck is
involved. If in front, the depth of the groove is limited posteriorly by cervical spine. 7) Slipping of ligature during suspension: Frequently, only the portion adjacent to the knot
moves. There is a tendency for the ligature to move upwards, this being limited by the jaws. The upward movement may produce double impression of ligature. The lower
mark is usually very superficial and is connected by fine abrasions, caused by the slipping ligature, to the mark made by ligature in its final position.
Knot: It is frequently in the form of a simple slip-knot to produce a running noose or fixed by granny or reef-knot; occasionally a simple loop is used. The knot is usually on
the right or left side of the neck, ligature usually rising behind the ear to the point of suspension. Sometimes, the knot is in the occipital region and rarely under the chin. After
suspension in hanging, the knot is at higher level than the remainder of ligature, the movement of knot being due to the act of suspension. The involvement of another party
may be suggested by certain types of knots and nooses. Removal of the noose from the neck is done by cutting the noose away from e knot and tying the cut ends with
string or wire.
Ligature Mark: The ligature produces a furrow or groove in the tussue which is pale in colour, but it later becomes yellowish or yellowbrown and hard like parchment, due
to the drying of the slightly abraded skin. The course of the groove depends on whether a fixed or running noose has been used, when the loop is arranged with a fixed knot,
the curse of the mark is deepest and nearly horizontal on the side opposite to knot, but as the arms of the ligature approach the knot the mark turns upwards towards it. This
produces an inverted ‘V’ at the site of the knot, the apex of the ‘V’ corresponding with the site of the knot. An impression from a knot any be found if the ligature is tight on
the skin, usually on one or other side of the back and occasionally beneath the chin. A slip-knot may cause the noose to tighten and squeeze the skin through the full
circumference of the neck. In the case of a fixed loop with a single knot in the midline at the back of the head, the mark is seen on both sides of the neck and is directed
obliquely upwards towards the position of the knot over the back of the neck. In the case of a fixed loop with a single knot in the midline under the chin, the mark is seen on
the back and both sides of the neck, and is directed obliquely forwards towards the position of the knot over the front of the neck. In the case of fixed loop with the knot in the
region of one ear, the mark differs on each side of the neck. On the side of the knot, the mark is directed obliquely upwards to the knot, and on the other side it is directed
transversely. If the ligature is in the form of a loop, the mark will be most prominent on the part of the neck to which the head has inclined and less marked over the region of
the open angle of the loop. When a running noose is applied, the weight of the body will cause the noose to tighten in a mainly horizontal position. The mark is seen on both
sides of the neck, and is usually directed transversely across the front of the neck resembling that of a ligature mark in strangulation, except that it is likely to be seen above
the level of thyroid cartilage. If a running noose fails to tighten, the mark may resemble one produced by a fixed loop. If the noose is a belt dig into the skin. In hanging from a
low point of suspension, the groove produced by the ligature is less well marked, and may be at about the level of the upper border of the larynx and more horizontal. In partial
hanging when the body leans forward, a horizontal ligature mark may be seen. The ligature mark usually encircles the entire neck except for the place where the knot was
located. The firmer muscular tissues at the back of the neck do not show clear and deep grooves, as are teen of the depression, a thin line of congestion or haemorrhage will
be seen above and below the groove at some point, usually the deepest, if not throughout its course. Ecchymoses alone have no significance as to whether hanging was
caused during life or not, but abrasions with haemorrhage are strongly suggestive of suspension taking place during life.
The mark is situated above the level of thyroid cartilage, between the larynx and the chin in 80 percent of cases. It may be at the level of the cartilage in about 15 percent,
and below the cartilage in about 5 percent cases, especially in partial suspension. The width of the groove is about, or slightly less than the width of the ligature. Any welldefined
pattern in the ligature is match of patterns. When fresh, the ligature mark is less clear, but becomes prominent after dying for several hours. A portion of skin and
deeper tissue in relation to ligature should be examined microscopically for evidence of tissue reaction, which if present indicated ante-mortem hanging. The absence of
tissue reaction does not exclude ante-mortem hanging (Gordon, et al). however, hanging may occur without visible marks on the victim’s neck. If there is a beard. Or if a
portion of clothing is caught between the ligature and the skin, no ligature mark any be found under it.
When a folded cloth has been used, there may be great difference between the appearance of the neck mar and the size of the ligature. When fabric is pulled tight, certain
parts of it become raised into ridges, which form the ligating surface, and only these may be reproduced on the skin. When nylon, silk or terylene fabrics are used, they may
leave a mark only 2 to 3 mm wide. A loop made of soft material e.g., towel, scarf, etc. may not produce a ligature mark, but the knot may produce an abrasion due o its
firmness. If there is no ligature, the mark should be taped, as it may pick up some fibers by the ligature and facilitate the identification of the material of which the ligature
was made. The ligature mark of hanging may be reproduced by dragging a body aong the ground with ligature passed round the neck soon after death. decomposition
obliterates the ligature mark. The ligature mark may disappear after several bourns following removal of the ligature.
In obese persons or infants, skin folds on the neck may resemble a ligature mark, especially after refrigeration of the body has caused coagulation of the subcutaneous fat.
When there is swelling of the neck tissues due to decomposition, marks may be produced by jewellery or clothing.
Partial Hanging: Hanging may occur simply by leaning against the noose secured to a chair or door knob, the leg of a table, a bedpost or rail, or the handrail of a
staircase, which is slightly higher than the position of the head, the deceased being in a kneeling position, or fall back or forward and lie prone with only the face and chest off
the ground. In these cases, the constricting face is less and congestive changes are more marked. Hanging may occur when pressure is applied only at the font of the neck,
e.g. by the arm of a chair, rung of a ladder, etc. in such case, the marks on the neck may be indistinct or absent.
Hanging is that form of asphyxia which is caused by suspension of the body by a ligature which encircles the neck, the constricting force being the weight of the body. The
whole weight of the body is not necessary, and only a comparatively slight force is enough to produce death. In ‘partial hanging’ the bodies are partially suspended, the toes
or feet touching the ground, or are in a sitting, kneeling, lying down, prone or any other posture. The weight of the head (5 to 6 kg) acts as the constricting force. In typical
hanging, the knot is situated over the nape of the neck ligature runs form the midline above the thyroid cartilage symmetrically upward on both sides of the neck to the
occipital region other position of knot is called Atypical Hanging. When the body is completely suspended by a Ligature with full weight acting as constricting force it is
termed as Complete Hanging,when any part of the body is in contact with the ground it is termed as Partial Hanging.
Ligature: A suicide will use any article readily available for the purpose, like a rope, metallic chains and wires, leather strap, belt, bed sheet, scarf, dhoti, saree, turban,
sacred thread, etc. The doctor should note whether the mark on the neck corresponds with the material alleged to have been used in hanging and if it is strong enough to
bear the weight and the jerk of the body. He should also note its texture and length, to know whether it was sufficient to hang. Before removing the ligature from the neck, it
should be described as to the nature and composition, width, mode of application, location and type of knot. Sometimes, the rope will break or become detached and the
deceased will be found lying on the ground with a ligature around his neck.
Symptoms: The first symptoms are loss or power and subjective sensations, such as flashes of light and ringing and hissing noises in the ears. There is intense mental
confusion, all power of to logical thought is lost; the individual can do nothing to help himself even if it were possible. These are to followed by loss of consciousness, which is
so rapid, that it is regarded as a painless form of death. Then follows a stage of convulsions. The face is distorted and livid, eyes prominent, and there is violent struggling.
Respiration stops before the heart, which may continue to beat for about 10 to 15 minutes.
Causes of Death :
1. Asphyxia : The constricting force of the ligature, causes compressive narrowing of laryngeal and tracheal lumina, and forces up the root of the tongue against the
posterior wall of the pharynx, and folds the epiglottis over the entrance of the larynx to block the airway. A tension of 15 kg. on ligature blocks the trachea.
2. Venous congestion: The jugular veins are blocked by the compression of the ligature which results in stoppage of the cerebral circulation, and a rapid rise in venous
pressure in the head. This occurs if ligature is made up of broad and soft material, which cannot sink into tissue to any depth. The jugular veins are closed by a
tension in the rope of 2kg.
3. Combined asphyxia and venous congestion: This is the commonest cause.
4. Cerebral anaemia: Pressure on the large arteries on the neck produces cerebral anaemia and immediate coma. This occurs with ligature made of thin cord, which
sinks deeply into tissues. A tension of 4 to 5kg on ligature blocks carotid arteries, and 20 kg. the vertebral arteries.
5. Reflex vagal inhibition form pressure on the vagal sheath or carotid bodies.
6. Fracture or dislocation of the cervical vertebrae.
Delayed Death: Death delayed for several days is rare. Delayed deaths occur due to (1) aspiration pneumonia, (2) infections, (3) oedema of lungs, (4) oedema of larynx, (5)
hypoxic encephalopathy, (6) infarction of brain, (7) abscess of brain, (8) cerebral softening.
The secondary effects of hanging in persons who have recovered are sometimes hemiplegia, epileptiform convulsions, amnesia, dementia, cervical cellulitis, parotitis,
retropharyngeal abscess, amnesia, and dementia.
Fatal Period : Death occurs immediately if the cervical vertebrae are fractured, or if the heart is inhibited; rapidly if cause is asphyxia, and least rapidly if coma is
responsible. The usual period is 3 to 5 minutes.
Post-mortem Appearances :
External: The ligature mark in the neck is the most important and specific sign of death from hanging. Ligature mark on the neck depends on: 1) Composition of ligature:
The pattern and texture is produced upon the skin, e.g., if thick rope is used, its texture may be impressed in the form of superficial abrasion. 2) Width and multiplicity of
ligature : When ligature is narrow, a deep groove is made because much more force per sq. cm. Of ligature is directed inwards. A broad ligature will produce only a superficial
mark. If the ligature is passed twice round the neck, a double mark, one circular, and the other oblique may be seen. The ligature may have one, two or more layers. There
may be multiple congested areas where the skin has been caught between the various layers. 3) The weight of the body suspended and the degree f the suspension: Heavier
he body and greater the proportion of the body suspended, the more marked is the ligature impression. 4) The tightness of encircling ligature: The ligature impression is
deeper opposite the point of suspension, but it may tail off vary rapidly if ligature consists of loop rather than a noose. If the noose tightness completely around the neck, the
ligature mark will be seen completely encircling the neck. 5) The length of time body has been suspended: Longer the suspension, deeper is the groove. Even a soft, board
ligature can cause a clear-cut groove if suspended long. If the ligature is cut down within a short time and a soft broad ligature has been used, there may be no external mark.
6) Position of the knot: The main force applied to the neck b ligature is opposite to the point of suspension. If the point of suspension is in occipital region, front of the neck is
involved. If in front, the depth of the groove is limited posteriorly by cervical spine. 7) Slipping of ligature during suspension: Frequently, only the portion adjacent to the knot
moves. There is a tendency for the ligature to move upwards, this being limited by the jaws. The upward movement may produce double impression of ligature. The lower
mark is usually very superficial and is connected by fine abrasions, caused by the slipping ligature, to the mark made by ligature in its final position.
Knot: It is frequently in the form of a simple slip-knot to produce a running noose or fixed by granny or reef-knot; occasionally a simple loop is used. The knot is usually on
the right or left side of the neck, ligature usually rising behind the ear to the point of suspension. Sometimes, the knot is in the occipital region and rarely under the chin. After
suspension in hanging, the knot is at higher level than the remainder of ligature, the movement of knot being due to the act of suspension. The involvement of another party
may be suggested by certain types of knots and nooses. Removal of the noose from the neck is done by cutting the noose away from e knot and tying the cut ends with
string or wire.
Ligature Mark: The ligature produces a furrow or groove in the tussue which is pale in colour, but it later becomes yellowish or yellowbrown and hard like parchment, due
to the drying of the slightly abraded skin. The course of the groove depends on whether a fixed or running noose has been used, when the loop is arranged with a fixed knot,
the curse of the mark is deepest and nearly horizontal on the side opposite to knot, but as the arms of the ligature approach the knot the mark turns upwards towards it. This
produces an inverted ‘V’ at the site of the knot, the apex of the ‘V’ corresponding with the site of the knot. An impression from a knot any be found if the ligature is tight on
the skin, usually on one or other side of the back and occasionally beneath the chin. A slip-knot may cause the noose to tighten and squeeze the skin through the full
circumference of the neck. In the case of a fixed loop with a single knot in the midline at the back of the head, the mark is seen on both sides of the neck and is directed
obliquely upwards towards the position of the knot over the back of the neck. In the case of a fixed loop with a single knot in the midline under the chin, the mark is seen on
the back and both sides of the neck, and is directed obliquely forwards towards the position of the knot over the front of the neck. In the case of fixed loop with the knot in the
region of one ear, the mark differs on each side of the neck. On the side of the knot, the mark is directed obliquely upwards to the knot, and on the other side it is directed
transversely. If the ligature is in the form of a loop, the mark will be most prominent on the part of the neck to which the head has inclined and less marked over the region of
the open angle of the loop. When a running noose is applied, the weight of the body will cause the noose to tighten in a mainly horizontal position. The mark is seen on both
sides of the neck, and is usually directed transversely across the front of the neck resembling that of a ligature mark in strangulation, except that it is likely to be seen above
the level of thyroid cartilage. If a running noose fails to tighten, the mark may resemble one produced by a fixed loop. If the noose is a belt dig into the skin. In hanging from a
low point of suspension, the groove produced by the ligature is less well marked, and may be at about the level of the upper border of the larynx and more horizontal. In partial
hanging when the body leans forward, a horizontal ligature mark may be seen. The ligature mark usually encircles the entire neck except for the place where the knot was
located. The firmer muscular tissues at the back of the neck do not show clear and deep grooves, as are teen of the depression, a thin line of congestion or haemorrhage will
be seen above and below the groove at some point, usually the deepest, if not throughout its course. Ecchymoses alone have no significance as to whether hanging was
caused during life or not, but abrasions with haemorrhage are strongly suggestive of suspension taking place during life.
The mark is situated above the level of thyroid cartilage, between the larynx and the chin in 80 percent of cases. It may be at the level of the cartilage in about 15 percent,
and below the cartilage in about 5 percent cases, especially in partial suspension. The width of the groove is about, or slightly less than the width of the ligature. Any welldefined
pattern in the ligature is match of patterns. When fresh, the ligature mark is less clear, but becomes prominent after dying for several hours. A portion of skin and
deeper tissue in relation to ligature should be examined microscopically for evidence of tissue reaction, which if present indicated ante-mortem hanging. The absence of
tissue reaction does not exclude ante-mortem hanging (Gordon, et al). however, hanging may occur without visible marks on the victim’s neck. If there is a beard. Or if a
portion of clothing is caught between the ligature and the skin, no ligature mark any be found under it.
When a folded cloth has been used, there may be great difference between the appearance of the neck mar and the size of the ligature. When fabric is pulled tight, certain
parts of it become raised into ridges, which form the ligating surface, and only these may be reproduced on the skin. When nylon, silk or terylene fabrics are used, they may
leave a mark only 2 to 3 mm wide. A loop made of soft material e.g., towel, scarf, etc. may not produce a ligature mark, but the knot may produce an abrasion due o its
firmness. If there is no ligature, the mark should be taped, as it may pick up some fibers by the ligature and facilitate the identification of the material of which the ligature
was made. The ligature mark of hanging may be reproduced by dragging a body aong the ground with ligature passed round the neck soon after death. decomposition
obliterates the ligature mark. The ligature mark may disappear after several bourns following removal of the ligature.
In obese persons or infants, skin folds on the neck may resemble a ligature mark, especially after refrigeration of the body has caused coagulation of the subcutaneous fat.
When there is swelling of the neck tissues due to decomposition, marks may be produced by jewellery or clothing.
Partial Hanging: Hanging may occur simply by leaning against the noose secured to a chair or door knob, the leg of a table, a bedpost or rail, or the handrail of a
staircase, which is slightly higher than the position of the head, the deceased being in a kneeling position, or fall back or forward and lie prone with only the face and chest off
the ground. In these cases, the constricting face is less and congestive changes are more marked. Hanging may occur when pressure is applied only at the font of the neck,
e.g. by the arm of a chair, rung of a ladder, etc. in such case, the marks on the neck may be indistinct or absent.
No comments:
Post a Comment