Hanging: Introduction,classification, causes of death

Introduction

• Hanging is that form of violent asphyxial deaths, which is caused by the suspension of the  body by a ligature which  encircles the neck, the constricting force being the weight of the body.

Classification:

• Depending on the degree of suspension:

Complete hanging: 

• When the whole body is suspended from the ligature material and no portion of the body is touching the ground.

Partial hanging: 

• As the name suggests, the body is partially suspended, the toe or feet or either part of the body touching the ground. 
• The deceased may be in kneeling down position, sitting position etc.
• the weight of the head is where the constricting force comes from.

Depending on position of the knot of ligature:

Typical hanging: 

• Where the ligature runs from the midline, above the thyroid cartilage.
• symmetrically upwards on both sides of the neck(judicial hanging), to the occipital region.
• The knot is placed over the central part of the back of neck.

Atypical hanging:  The knot is anywhere other than the central part of the back of neck. Most common

site of knot is near one side of mastoid process or angle of mandible.

Types of knot: Knot tied may be :

1. Fixed noose: Rope is knotted to form fixed knot. This is the most cotnmon pattern. ligature mark is in inverted V shape.
2. Running  noose: One  end  of  the  rope  is  passed  through  the  loop  made from  the  other end, ligature  mark is  horizontal.

Depending on the manner of hanging:

• Suicidal hanging.
• Homicidal hanging.
• Accidental hanging for e.g. autoerotic asphyxia.
• Judicial hanging.

Causes  of death

Death  may occur  from  :

• Cerebral ischemia and anoxia due to compression of carotid artery.
• It require 3-5 kg weight of suspension-
• Tear in  intima  of carotid  artery  is  known  as  Amussat’s sign.
• Cerebral  congestion  due to  compression  of jugular veins.  It  requires  only 2 kg weight.
• Asphyxia due to  compression  of  airways  (larynx  and  trachea).  It  requires  15 kg weight.
• Neurogenic shock/vagal  inhibition (due  to  pressure  on  vagus  nerve  or carotid  sinuses)
• Fracture  dislocation  of upper  cervical  vertebrae with damage  to  spinal  cord  and brainstem :  especially in  judicial hanging.
• Any  combination  of  the  above.

* Combined asphyxia  and cerebral  venous  congestion  is  the  most  common  cause  of death.

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