SUBJECT FORENSIC SCIENCE

Paper No. and Title PAPER No.14: Forensic Medicine

Module No. and Title MODULE No.27: Asphyxial Death: Hanging

Module Tag FSC_P14_M27

FORENSIC SCIENCE PAPER NO.14 : Forensic Medicine

MODULE NO.27: Asphyxial Death: Hanging
 TABLE OF CONTENTS
1. Learning Outcomes

2. Introduction

3. Causes of death in hanging

4. Ligature Mark

5. Other Signs

6. Medico-legal aspects of hanging

7. Summary

FORENSIC SCIENCE PAPER NO.14 : Forensic Medicine

MODULE NO.27: Asphyxial Death: Hanging
 1. Learning Outcomes
After studying this module, you shall be able to-

 Know the definition of hanging

 Understand the classification of hanging
 Learn postmortem findings in case of hanging
 Learn about the Medico-legal aspects of hanging

2. 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:

A) Complete hanging: When the whole body is suspended from the ligature material
and no portion of the body is touching the ground.

B) 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. here the weight of the head is where the
constricting force comes from.

 Depending on position of the knot:

A) Typical hanging: Where the ligature runs from the midline, above the thyroid
cartilage, symmetrically upwards on both sides of the neck, to the occipital region and
the knot is placed over the central part of the back of neck.

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

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MODULE NO.27: Asphyxial Death: Hanging
  Depending on the manner of hanging:

A) Suicidal hanging.
B) Homicidal hanging.
C) Accidental hanging for e.g. autoerotic asphyxia.
D) Judicial hanging.

3. Causes of death in hanging

1) Asphyxia: The ligature material’s constricting force causes compressive narrowing of
the larynx and the trachea, and thereby 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. This obstruction of the airway causes air hunger and if entry of air in
the lungs is completely prevented, then death occurs rapidly with marked signs of
asphyxia. A tension of 15kg on ligature blocks the trachea.

2) Venous congestion: In cases, where the knot is situated in and around the chin area, the
venous flow is obstructed, but the arterial flow remains intact. The jugular veins are
involved, resulting in stoppage of the cerebral circulation and a rapid rise in venous
pressure in the head leading to unconsciousness. A tension of 2 to 3 kg is needed for such
kind of incident.

3) Combined effect of asphyxia and venous congestion: This is the commonest cause.

4) Cerebral anemia: If the rope is situated at the nape of the neck, then both arterial and
venous blood flow are cut off by the pressure of the noose on both sides of the neck.
Pressure on the large arteries produces cerebral anemia and immediate coma within a
short span of 10 to 15 seconds. A tension of 4 to 5 kg obliterates both the carotids and a
tension of 20 kg is needed for obliterating the vertebral arteries.

5) Reflex vagal inhibition: Due to pressure over the carotid bodies or vagal sheath.

6) Fracture and dislocation of the cervical vertebra: More commonly seen in judicial
hanging.

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MODULE NO.27: Asphyxial Death: Hanging
 Fatal Period:
1) If death occurs due to asphyxia, then the fatal period is within 5 to 10 minutes. In case
of death due to occlusion of blood vessels, it takes a bit longer time- 12 to 20 minutes.
2) In judicial hanging, death is instantaneous.
3) Delayed deaths: Delayed death by several days is rare and occurs due to- 1) aspiration
pneumonia, 2) infections, 3) odema of larynx or lungs, 4) infarction of brain, 5)
hypoxic encephalopathy, 6) brain abscess

Post Mortem Appearance:

Externally the appearance of the ligature mark is the most important finding and specific sign
of death by hanging. The ligature mark on the neck depends on

1) Composition of the ligature: That involves the pattern and texture of the ligature
mark produced upon the skin. If a nylon rope with patterns used as a ligature material,
then the same may be seen as a patterned abrasion over the neck. The pattern abrasion
may not be that visible, if a soft and broad material is being used as ligature.

2) Width and multiplicity of the ligature: Sometimes a single ligature mark may be
produced, and sometimes multiple turns of ligature may be produced if double turns
of ligature applied over the neck. If a narrow ligature material is used, then grooving
is more as much more force is used per square metre of the area, and if a soft broad
material is used, then only a superficial mark is being produced.

3) The weight of the body and the degree of suspension: The heavier the body, and
more the time of suspension, the more marked will be ligature mark.

4) Length of time the body has been suspended: As it suggests, the longer the body is
suspended, the more marked will be the ligature mark. Thus a broad ligature material
can also produce a marked ligature impression if the suspension time is more and a
thin ligature material may not produce a grooving, if the body is brought down within
a short period of time. Incidentally, if a soft and broad ligature material used, and
body is also brought down within a short span of time, then very faint external mark
may be produced.

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MODULE NO.27: Asphyxial Death: Hanging
 5) Position of the knot: It is important to comment upon the position of the knot, if it’s
present in situ. The main force applied is usually opposite to the point of suspension.

6) Slipping of the ligature mark: There is tendency of the ligature mark to slip
upwards, which may be limited by the jaws. This upward movement may produce
double impression of the ligature and in that case. The lower mark is very superficial
and is connected by abrasions produced during slipping movement.

7) Knot mark: The location and the type of the knot mark is being recorded. It has to be
noted whether the ligature is below the chin, below the ear or at the nape of the neck.
This produces an inverted “V” shaped ligature mark, corresponding to the site of the
knot. The knot may be a fixed type of knot or running type of knot.

8) Removal of the ligature material: The knot should never be opened for removing
the ligature material. The first step is to take photograph before removal of the
ligature material. The ligature is now cut opposite the knot and the two cut ends are
secured with a string.

4. Ligature Mark
The ligature mark is described as per the direction, whether continuous or not, color, width,
depth, ligature pattern if appreciated, the areas of neck involved and its local landmarks and
whether parchmentised or not (The furrow or groove in the tissue produced by the ligature,
which is initially pale in color but later becomes yellow-brown or dark brown in color and
hard like parchment due to drying of the slightly abraded skin.). It may run from the midpoint
of the neck to upwards, outwards and backwards (from either side of the neck) to reach
behind the neck where it becomes deficient. Ligature mark is the most specific sign of death
from hanging and is usually oblique and above the level of thyroid cartilage. The course of
the knot depends on whether fixed knot is being used or slipping type of knot is being used.
When a fixed knot is being used, it produces an inverted “V” shaped mark at the site of the
knot. It is deepest and nearly horizontal on the side opposite to the knot and as the arms of the
ligature approach the knot, the mark runs upwards towards it. Sometimes the impression of
the knot may be found if the ligature is too tight on the skin.

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MODULE NO.27: Asphyxial Death: Hanging
 In case of fixed loop, with knot on the midline of the back of the neck, the ligature marks are
seen on both sides of the neck directed obliquely upwards towards the position of the knot,
being symmetrical on both sides. In case of the knot in the midline under the chin, then the
mark is seen on the back side and symmetrically and obliquely directed forwards towards the
position of the knot. If the fixed loop is present in a region on one side of the neck, under
either of the ear, then the mark is directed obliquely, from left to right or from right to left,
upwards and non-continuous. If the ligature is loop type of ligature material, then the mark is
more prominent to the part of the neck where head is inclined more. When a running noose is
applied, the weight of the body causes the knot to tighten more. However, if a running noose
fails to tighten, then it may resemble fixed noose ligature mark. In partial hanging, when the
body leans forward, a horizontal ligature mark may be produced and should not be confused
with ligature strangulation. Although the ligature mark may look clean, some small
microscopic fibres may be sticking to it, which gets adhered from the ligature material and
helps later in corroborating with the ligature material used. These are collected from the neck
by stripping them off using a sticking tape. They are then secured on a glass slide and
examined under the microscope. If the ligature mark is absent in certain cases of hanging, it
doesn’t really rule out hanging. Cause ligature mark may be absent in cases where soft and
broad material is being used, or suspension time is less in cases where ligature material is soft
and broad or when a padding has been used in between the ligature material and the skin in
contact. Sometimes presence of hair or clothing or jewellery can also be a reason for absence
of ligature mark for a certain distance over the neck.

In infants and obese persons, the skin folds of the neck may look like a ligature mark. In
order to avoid such complicacies, the histological examination of the ligature mark is very
much necessary where the presence of vital reactions will prove ante mortem hanging.
Suspension peak: The junction of the noose and the vertical part of the rope is pulled upwards
and away from the skin due to weight of the body and no ligature mark is left on the back and
a triangle is formed whose apex is called the suspension peak or point. This is a
distinguishing feature from the strangulation. But such suspension point is typically absent
when the knot is present at the front of the neck just beneath the chin because of the
projecting chin, on which the knot leaves mark.

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 5. Other Signs
Post mortem staining: is seen on forearms, arms, legs, feet, soles and is known as “glove and
stocking like distribution” as they become the dependent areas due to suspension of the body.
Blood may extravasate in these areas and petechial hemorrhage may be found. The face
becomes congested with multiple petechial hemorrhages above the level of the constriction,
in cases of involvement of the great vessels. The face may be puffed up and bluish as well
due to asphyxiation. Bloody froth may be coming out from the mouth and the nostrils.
Dribbling of saliva (surest sign of ante mortem hanging) is seen coming out from the angle of
the mouth, opposite to the knot. This is mainly because of the act that, the pressure of the
knot causes stimulation of the pterygopalatine ganglion leading to direct stimulation of the
salivary glands. The tongue may be protruded and may also be bitten. If the knot presses
upon the cervical sympathetic ganglion, the eye on that same side remains open and the pupil
is dilated which is also a vital ante mortem feature and is referred to as “Le facie
sympathique”. The hands may be clenched. The penis is engorged with blood and may be
semi erect. The relaxation of the sphincters causes soiling of the cloth by urine and faeces.

Internal Findings
The neck is dissected at the end after removing the brain so that a blood less field can be
established. A modified Y shaped incision is given and the neck is opened. The tissues
underneath the ligature mark are usually pale and glistening. Usually no extravasation or a
very minimal extravasation of blood is seen in the surrounding neck structures. Strap muscles
may be torn and may show hemorrhages. Amussat’s sign: The intima of the carotid arteries
may show horizontal tear due to combined radial force of the ligature material and axial
traction of the weight of the body. The larynx and epiglottis may show petechial hemorrhages
and trachea may be congested.

The lungs may be congested, edematous and oozes bloody serum on cut section. There may
be presence of sub-pleural ecchymoses. The hyoid bone may show antero posterior fracture
of the greater cornu but are rare before the age of 30 years, as the apices of greater cornu are
cartilaginous before 30 years of age. The brain is edematous and middle ear hemorrhage may
be present.

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 Simon’s hemorrhage: In the vertebral column, hemorrhage may be seen beneath the area of
the anterior longitudinal ligament of the inter vertebral disc in the area of lower thoracic and
lumbar vertebra which looks like dark red to violet horizontal lines between the vertebral
bodies. This finding is more frequent in younger individuals, in complete hanging and in
individuals with minimal degenerative changes. This is mainly because of the overstretching
of the spine due to suspension of the body.

6. Medico-legal aspects of hanging

1) Hanging is invariably suicidal, until unless otherwise proved. In a suicidal hanging, any
material available at that moment of time can be used for the act. A foot stool may be
found at the scene of the death which is used for reaching the point of suspension. That
stool may be found in a turned down position as the person jumps of the stool after tying
the ligature.
2) Tragic cases of accidental hanging are also reported where children play dangerous
games including simulation of hanging.
3) Homicidal hanging: Homicidal hanging is very difficult to establish until unless the
person is under the influence of any drugs or alcohol or is a mere child or weak and
feeble individual. Lynching is a form of homicidal hanging where an accused of murder
or rape is hanged in a public square by a mob as a part of carrying out justice. The term
“lynching” is derived from Charles Lynch (1736-96) who administered rough justice in
Virginia. This was his system of punishment given to African-American (Negro) slaves
for rape or murder who were being lynched by angry white mob.
4) Judicial hanging: In some countries, including India, hanging is the mode of carrying
out capital punishment or legal execution of death sentence. The face of the person is
covered by a black mask and he is made to stand on a platform above trap doors, which
open downwards as the bolt is drawn. The rope is allowed to drop 5 to 7 metres
according to the height and weight of the person. The knot is placed under the angle of
the jaw. The sudden stoppage of the moving body with the violent jerking movement
causes fracture-dislocation usually at the level of second-third or third-fourth cervical
vertebrae. Bilateral fracture of the pedicle of the second-third or third-fourth cervical
vertebrae occurs which is called hangman’s fracture.

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 5) Less commonly, the dislocation of the atlanto occipital joint or the odontoid process of
the axis vertebra causes pulping of the spinal cord and transaction of the cervical cord.
There even can be rupture of the brain stem with proper judicial hanging. This results in
instantaneous and irreversible loss of consciousness and irreversible apnoea. Death is
almost always instantaneous and asphyxia signs are not seen markedly if proper judicial
hanging is being executed.
6) Postmortem hanging: Sometimes the victim may be murdered by some other means
and then hanged postmortem in order to mislead the police. In such cases the ligature
mark will not show the typical signs of ante mortem hanging like grooving, patterned
abrasion, parchmentisation neither any vital reactions will be present. More-over, by a
thorough and meticulous postmortem examination, the original cause of death can also
be established.

7. Summary
 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.
 The causes of death due to hanging include: Asphyxia, Venous congestion, Cerebral
anemia, Reflex vagal inhibition, Fracture and dislocation of the cervical vertebra.
 In case of post mortem appearance the appearance of the ligature mark is the most
important finding and specific sign of death by hanging.
 In infants and obese persons, the skin folds of the neck may look like a ligature mark.
 Post mortem staining: is seen on forearms, arms, legs, feet, soles and is known as
“glove and stocking like distribution” as they become the dependent areas due to
suspension of the body.
 Hanging is invariably suicidal, until unless otherwise proved. In a suicidal hanging,
any material available at that moment of time can be used for the act.
 Homicidal hanging is very difficult to establish until unless the person is under the
influence of any drugs or alcohol or is a mere child or weak and feeble individual.
 In some countries, including India, hanging is the mode of carrying out capital
punishment or legal execution of death sentence.

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