Hanging

HANGING, the compression of the neck by a ligature tightened by the weight of the body. This type of violent death, excluding capital punishment by hanging, is in the vast majority of cases encountered as suicide and very rarely as an accident; sometimes hanging is also practiced for the purpose of murder. In the RSFSR, according to questionnaire data for 1920–24, 882 men (43.5% of all male suicide cases) and 479 women (39.6% of all female suicide cases) ended their lives by hanging. Usually, during hanging, one end of the rope is fixed somewhere motionless (to a crossbar, handle, nail, etc.), and the other, in the form of a loop, often a running noose, is placed on the neck. Quite rapidly, as a result of the compression of the neck by the loop, an unconscious state ensues, followed by death with phenomena of asphyxia. Initially, the loop in hanging shifts along the neck upwards until it settles under the horizontal branch of the lower jaw, where it finally tightens. Therefore, in typical cases, when the knot of the loop is on the back of the head, it is always located on the upper part of the neck and usually passes in front between the larynx and the hyoid bone. Only in exceptional cases can the loop be located on the larynx or even lower. This occurs 1) if the loop is tightly tightened before the body hangs, and also with a strong protrusion of the thyroid cartilage; 2) when a wide belt, towel, etc., is taken, or if the loop is placed not on the bare neck, but over a necktie or a thick beard. But most often, the low position of the loop is due to tumors of the neck. The closure of the airways during hanging only rarely depends on the compression of the larynx or trachea, and with a high position of the loop, which is the rule in typical cases, it occurs in another way. Observations and experiments on corpses have shown that from the pressure of the loop, the hyoid bone is displaced upward, and with it the root of the tongue, which plugs the pharynx, blocking access to air. In addition, the larynx itself, as a consequence of pressure on the hyalo-thyroid ligament (lig. hyo-thyreoideum med.), is more or less flattened and somewhat rotated around the transverse axis, which causes the protrusion of the cricoid cartilage. With an atypical position of the loop, for example when its knot is on the side, the airways are only narrowed, but not closed, although even this circumstance is sufficient for a slower onset of death. Similarly, cases of hanging are encountered when the compression of the neck by the loop is small due to the peculiar position of the body, which to a significant extent excludes the influence of its weight. Finally, sometimes during hanging, the airways do not undergo any significant narrowing at all. A case of hanging has been described relating to a tracheotomized person found dead in a loop placed on the neck above the tube. Furthermore, according to the observations of Misuraca, in the hanging of a tracheotomized animal, it still perishes, although more slowly. In view of this, it must be recognized that in the onset of death during hanging, apart from the closure of the airways, other factors also play a certain role. Research by a number of authors has clarified that with a typical placement of the loop, under the influence of body weight, it produces very great pressure on the lateral surfaces of the neck, where the neurovascular bundles are located; in particular, as experiments on corpses have shown, the passage of fluid through the carotid arteries becomes impossible. There is hardly any doubt that under such conditions the lumen of the jugular veins is closed even more easily. Due to the compression of the vessels, blood circulation in the brain is greatly impeded, and congestion phenomena develop. In addition, further studies (Haberda, Reiner) showed that during typical hanging—probably as a result of stretching and bending of the neck—the vertebral arteries between the first and second cervical vertebrae are also compressed. From this it is clear why consciousness is lost so rapidly (after a few moments) during hanging, especially since nerve tissue is very sensitive to any disruption of nutrition (oxygen starvation). The rapid onset of an unconscious state is confirmed first of all by the testimony of rescued persons, who unanimously state that immediately after the compression of the neck by the loop, consciousness disappeared. This is also supported by the fact that although in hanging the body very often does not hang freely, but rests its feet on the ground (floor), nevertheless not a single case is known where the suicide, under the influence of fear, pain, etc., stopped the intended action at the very moment of hanging; for this, it would only be necessary to stand on one's feet, and life would be saved, since the loop, often having no running knot, would hang loosely on the neck. It should also be noted that with an asymmetrical position of the loop, namely with the knot shifted forward, when the vessels of one side are compressed or the veins are pressed more strongly than the arteries, conditions are created for the formation of significant congestion (cyanosis of the face, etc.). Furthermore, it is believed that the compression of the vagus nerve and its branches plays a certain role in the onset of death during hanging. At first, pressure on the nerve acts as an irritation, and later as a transection of the trunk (decrease in the respiratory rate, acceleration and weakening of heart contractions). According to the research of Ignatovsky and Haberda, the matter boils down to mechanical irritation of the nerve with subsequent cardiac arrest in diastole. With a typical placement of the loop, this traumatic insult will be bilateral and all the more dangerous. The possibility of instantaneous death via a reflex on the heart is also admitted; in particular, the so-called Hering sinus-carotid reflex cannot be excluded. Finally, cases of death are known when hanging was not accompanied by the closure of the airways and any significant compression of the vessels and nerves of the neck: e.g., the loop passed through the teeth, between which it was pinched, and further horizontally through the back of the head. The onset of death in these cases is explained by the stretching of the spine during hanging, which is accompanied by vasomotor phenomena. In treatment by suspension according to the Charcot-Motsutkovsky method, dangerous phenomena have already been observed (superficial accelerated breathing, increased blood pressure, hyperemia of the brain and its membranes, and in experiments on animals even hemorrhages into the brain substance). In later times (1911), Gumprecht experimentally proved that during typical hanging, the second cervical vertebra is displaced, moves away from the atlas, and its odontoid process tilts into the lumen of the spinal canal, compressing the brain. It is easy to understand the significance of such pressure in the region of the medulla oblongata. Thus, the fatal outcome in hanging depends not only on the closure of the airways, but also on other conditions influencing to one degree or another in each specific case. The positions of the body during hanging are diverse: sitting and semi-sitting positions are not uncommon; hanging while lying down also occurs, with the loop being tightened by the weight of the head and partly the neck. In appearance, the corpses of persons who died from hanging, aside from local changes on the neck, have no special distinctions. The face is usually pale. Only in individual cases, especially with an asymmetrical position of the loop, is the skin of the face more or less cyanotic with ecchymoses scattered predominantly on the conjunctiva of the eyes. Occasionally, bleeding from the ears may also be observed due to subepidermal ruptures of vessels and the escape of blood through the thin, mostly macerated layer of the epidermis of the posterior part of the ear canal. Biting or pinching of the tongue between the teeth, its protrusion, sometimes noticeable in various types of asphyxia, is particularly common in hanging due to the existing favorable mechanical conditions. When the body is removed from the loop in the first hours after hanging, the distribution of cadaveric spots is the same as on corpses of persons who died from other causes. If, however, the dead body remained suspended for a longer period of time, the cadaveric spots are located in the lower half, mainly on the legs. Against the background of the spots, multiple ecchymoses are sometimes noted, forming either postmortem or during life, and then only increasing under the influence of blood accumulation. The finding of such cadaveric spots, retaining their position even after the removal of the body, indicates that the corpse hung for a relatively long time. This circumstance may have forensic significance. Traces of semen are frequent on the penis, with some explaining this as postmortem escape of semen from the seminal vesicles due to relaxation of the sphincters, while others view it as the result of seminal emission under the influence of nervous system irritation by asphyxial blood. Upon external examination of the corpse, a strangulation furrow is usually found on the neck. With a typical placement of the loop, the furrow passes anteriorly transversely—most often between the thyroid cartilage and the hyoid bone, then heads posteriorly, taking an ascending direction on the lateral parts of the neck, and on the back of the head its ends close, forming an angle with the apex pointing upwards (this happens with a running noose or with a loop tied in a knot). In other cases (e.g., with an open loop), the ends of the furrow do not converge, but only head toward each other, getting lost behind the mastoid processes or on the hairy part of the back of the head; sometimes the knot of the loop, fitting closely to the neck, leaves an imprint after itself.

Equally common is the asymmetrical position of the groove, when its ends converge not at the middle of the occiput, but somewhere on the side. In individual cases, the knot of the noose may lie at the chin; the strangulation groove will be located accordingly. The groove is sharply pronounced on the side of the neck opposite to the knot, i.e., where there is the greatest compression of the skin. Frequently in hanging, a rope folded in two or several times is used, then the groove is also double (and so on). A soft and vaguely demarcated groove, caused by handkerchiefs or towels, is often expressed very weakly, and its flat anaemic imprint upon the removal of the corpse may completely disappear. When determining the location of the groove on the anterior surface of the neck, it must be remembered that during the examination with the corpse in a horizontal position, it will always lie lower than in a vertical position, due to the displacement of the skin. In the deeper parts of the neck during hanging, the following injuries may be found: bruises, muscle tears, fractures of the cartilages and the hyoid bone, ruptures of the inner lining of the carotid arteries and (as an exception) dislocations and fractures of the spine. Hemorrhages are found corresponding to the course of the noose in the subcutaneous tissue, in the intermuscular connective tissue, etc.; on the other hand, a antemortem origin of fractures is possible in the absence of accompanying hemorrhages; it is believed that this depends on the rapid onset of death during hanging, as well as due to the almost complete cessation of blood circulation in many cases in connection with the compression of the neck vessels. Muscle tears—most often of the sternocleidomastoid—are located at the site of the passage of the groove, are encountered comparatively rarely, and are formed as a result of direct pressure on the tissues by a rigid noose. According to Hofmann, such tears often occur postmortem from other causes, for example during an autopsy, from rough straightening and turning of the stiffened neck. Fractures of the plates of the thyroid cartilage proper are very rare and are observed with a low position of the noose (on the larynx—especially if ossified). Often during hanging, cracks or fractures of the upper horns of the thyroid cartilage and the greater horns of the hyoid bone are found (according to Reuter, in 60% with a typical position of the groove), occurring in an indirect way, depending on the tension during hanging of the lateral thyrohyoid ligaments. Tears of the inner lining of the carotid arteries are not frequent (according to Hofmann, in 8%), have the appearance of small transverse slits with uneven and mostly bruised edges and are almost always located immediately below the site of division of the common carotid artery; they occur partly from the direct pressure of the noose, but are more naturally explained by the significant longitudinal tension of the vessels during hanging. Fractures and dislocations of the spine belong to very rare findings and can occur under exceptional conditions, for example in the English method of capital punishment by hanging, when the convict is dropped from a great height on a long rope. Other phenomena found at autopsy are characteristic of acute asphyxia in general (see Suffocation). To distinguish suicide from murder, the following is taken into consideration: suicides resort to hanging most frequently; only under exceptional conditions can one hang another without resistance on his part, e.g., a child or a person in an unconscious state; therefore, in the absence of indications of such circumstances, in the absence of traces of struggle and self-defense, there is usually no reason to think of murder. More often, the corpses of persons killed by another method are suspended to simulate suicide and conceal the traces of a crime. If death in such cases resulted from injuries, then recognition is relatively easy. Various kinds of injuries can occur before hanging and moreover both accidentally and intentionally—for the purpose of murder or during suicide attempts. It also seems possible that during the hanging itself, in the period of agony and convulsions, various minor injuries (abrasions, bruises) also arise as a result of the body hitting surrounding hard objects. Sometimes injuries are caused by careless handling of the dead body when removing it from the noose and are postmortem in nature. Significant difficulties for recognition are presented by cases when a given person was first strangled by another method, and then the corpse was suspended; in particular, attention should be paid to whether there are signs of struggle and self-defense and other special signs of violence observed during strangulation by a noose or hand. In general, the expert's opinion must be given in a cautious form even in the presence of signs seemingly typical for suicide (ascending position of the strangulation groove, absence of traces of struggle and self-defense, phenomena of asphyxia), since at the present time there are known (Minakov), albeit exceptionally rare, cases of hanging of adults, completely healthy people, who under special conditions were caught unawares and had no opportunity to resist. Nor should one neglect the examination of the strangulation groove itself, since signs indicating its antemortem origin may be discovered, which is important when deciding the question of whether a corpse or a living person was suspended. As for the phenomena observed in persons removed from the noose and restored to life, they are subdivided into local and general. The strangulation groove appears as an abraded or reddened and swollen strip due to reactive hyperemia, sometimes with bruises. Pains in the soft tissues of the neck, especially when swallowing, persist for a long time if there are injuries to the larynx or hyoid bone. Severe symptoms—inflammatory swelling, edema of the larynx—can be present as an exception. Consciousness in many cases returns quickly, while in others the unconscious state lasts for several hours and even days, and death may still ensue. After some time following removal from the noose and even before the return of consciousness, convulsions occur. In some cases, amnesia is observed relating to the period immediately preceding the hanging, as a result of which, for example, the fact of a suicide attempt is completely denied; finally, mental disorders in the strict sense of the word, paralyses, and anesthesias are observed. When examining the brain, capillary hemorrhages in the region of the basal ganglia were found.