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Hanging- Types, Causes of Death, Postmortem Findings and Medicolegal Importance

Hanging

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

Types

Complete hanging.
Partial hanging.
Typical hanging.
Atypical hanging.

1.Complete hanging

When feet do not touch the ground and the weight of the body acts as a constricting force.

2. Partial hanging

When the weight of the head and not the whole body acts as a constricting force is known as partial hanging.

3.Typical hanging

The ligature is situated in the midline above the thyroid cartilage and runs symmetrically upwards on both sides of the neck to the occipital region.

4. Atypical hanging

Any variation of this standard position.
Most common site of knot is near one side of mastoid process or angle of mandible.

Ligature

Not particular,like ropes,chains,wire,leather straps,belts,scarf,dhoti,sarees etc.
Its important to match the ligature with the ligature mark and see if its strong enough to bear the weight and jerk of the body.
Cut the ligature away from the knot.
Pressure abrasion

Symptoms

So rapid that they are rarely observed.
Flashes of lights before the eyes,ringing in the ears.
Unconsciousness and death.
The individual can do nothing to help himself even if it were possible.
Respiration stops before the heart which may continue for 10-15min.

Causes of death

1. Asphyxia

Ligature forces the tongue up and occludes air,15kg tension occludes the trachea.

2. Cerebral congestion

Obstruction of jugular veins by compression with 2kg wt tension.

3. Cerebral anoxia

Carotid artery occludes with 4-5kgs tension
Vertebral artery with 20kgs tension.

4.Reflex vagal inhibition.

5. Fracture dislocation of cervical spine t the level of 2,3,and 4 vertebrae.

6. Combination of any of the above.

Postmortem appearance

External appearance.
Internal appearance.

External appearance

1. Above the ligature mark

Tilt of the head.
Protrusion of tongue.
Dribbling of saliva.
Le Facia Sympathique-
When ligature knot presses on cervical sympathetics the eye on the same side may remain open and its pupil dilated
Tardieu spots.
Congestion of the face.
Petecheal haemorrhages.
Middle ear haemorrhages.

2. Beneath the ligature

Fixed or running noose.
Position of the knot.
Course of the ligature.
Width and multiplicity.
Point of suspension.
Slipping of ligature.
Weight of the body.

3. Below the ligature

Postmortem lividity (Glove and Stocking)
Relaxation of sphincters.
Injury to legs.(partial hanging)

Internal appearance

Haemorrhages in the neck.
Dry,white and glistening.
Rupture of platysma and sternomastoid.
Transverse tear in the intima of carotid artery.
Fracture of hyoid,cricoid and thyroid cartilages.
Congestion of organs.
Petechial haemorrhages.

Diagnosis

Ligature mark around the neck.
Presence of abrasions,echymosis and redness around the ligature mark.
Trickling saliva from the mouth.
Echymosis of larynx and trachea.
Rupture of intima of carotids.
Signs of asphyxia.

Medicolegal Importance

Suicidal

Usually full suspension.
Ligature tied to beam,hook,fan,tree etc.
Suspension without any platform is unusual in suicide.
Occasional nail mark-may be self inflicted while trying to free him\herself.
Suicidal note.

Homicidal

Extremely rare,except in case of lynching.
Difficult,unless the victim is unconscious by injury or by drugs.
Marks of violence may be seen on the body.

Postmortem hanging\Suspension

Person murdered and the dead body suspended to simulate suicide.
Usually the rope is tied first to the neck and then around the beam\hook where beam shows evidence of rope being pulled from below upwards.
Ligature mark may be produced if the body is suspended within 2hrs after death.

Judicial hanging

‘Knot’ in judicial hanging is placed in side of neck.
Drop of 5-7meters.
Fracture dislocation at cervical 2-3 or 3-4.
Transection of spinal cord.
Transverse tear of intima of carotid artery.
Injury to pons and medulla

Exam Important

Hanging

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

Types

1.Complete hanging

2. Partial hanging

When the weight of the head and not the whole body acts as a constricting force is known as partial hanging.

3.Typical hanging

The ligature is situated in the midline above the thyroid cartilage and runs symmetrically upwards on both sides of the neck to the occipital region.

4. Atypical hanging

Any variation of this standard position.
Most common site of knot is near one side of mastoid process or angle of mandible.

Ligature

Cut the ligature away from the knot.
Pressure abrasion

Causes of death

1. Asphyxia

Ligature forces the tongue up and occludes air,15kg tension occludes the trachea.

2. Cerebral congestion

Obstruction of jugular veins by compression with 2kg wt tension.

3. Cerebral anoxia

Carotid artery occludes with 4-5kgs tension
Vertebral artery with 20kgs tension.

4.Reflex vagal inhibition.

5. Fracture dislocation of cervical spine t the level of 2,3,and 4 vertebrae.

6. Combination of any of the above.