Journal of Forensic and Legal Medicine 33 (2015) 71e75

Contents lists available at ScienceDirect

Journal of Forensic and Legal Medicine

j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / j fl m

Case report

Homicide by hanging: A case report and its forensic-medical aspects

Fabio C. Monticelli*, Herwig Brandtner, Sebastian N. Kunz, Thomas Keller, Franz Neuhuber
€t, Ignaz-Harrer-Str. 79, 5020 Salzburg, Austria
IFFB für Gerichtsmedizin und Forensische Neuropsychiatrie, Paris Lodron Universita

a r t i c l e i n f o a b s t r a c t

Article history: We report a rare case of homicide by hanging. The postmortem examination resulted in a verdict of death
Received 2 February 2015 by suicidal hanging and the Public Prosecutor's Office released the body for burial. After intervention by
Received in revised form the relatives police investigations were resumed. Based on evidence impossible to reconcile with the
15 April 2015
results of the postmortem examination and requiring further clarification, an autopsy was ordered. The
Accepted 17 April 2015
Available online 30 April 2015
results of the postmortem could not be brought in line with a suicidal hanging and were further sub-
stantiated by DNA analysis. The scenario put forward by the defense claiming a secondary transfer of
trace evidence onto the ligature and the victim's clothes was excluded because of the distribution pattern
Keywords:
Homicide
and the trace evidence ratio. The defendant was sentenced to 20 years of prison for homicide. The verdict
Hanging was confirmed by the Supreme Court and commuted to 18 years.
Electric cable © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
Burking
Postmortem
Trace evidence

1. Introduction signs of a strangulation trauma on the one hand and indications of a

According to the current relevant literature, case reports on
homicides by hanging are relatively rare.1e10 They have to be
distinguished from cases where the body has been hanged post-
mortem, i.e. for the purpose of simulating a suicide. Some authors
suggest a decreasing frequency when reporting on such cases,11 and
general forensic experience indicates that actually only a compar-
atively small number of such cases are submitted for forensic
investigation. This assumption was confirmed by data from “Sta-
tistik Austria”. In view of the above, it is almost inevitable that
physicians commissioned with the postmortem examination show
decreased sensitivity, at least when confronted with a case of
hanging, unless they are professionally involved with Forensic
Medicine, have the relevant medico-legal experience or have
participated in medico-legal training.12 In addition, based on the
authors’ own experience and the findings of
Rothschild,12 postmortem examination often display considerable
shortcomings that may lead to serious misinterpretation.
However, an inquest in cases associated with hanging is
generally considered to be quite difficult, since vital morphological
* Corresponding author. IFFB Forensic Medicine and Neuropsychiatry, Paris
Lodron University Salzburg, Ignaz Harrer Str. 79, 5020 Salzburg, Austria. Tel.: þ43
662 8044 3808; fax: þ43 662 8044 3821.
E-mail address: fabio.monticelli@sbg.ac.at (F.C. Monticelli).
possible homicidal event on the other hand are often very subtle or
may even be lacking.2,13 To make matters worse, the vast majority
of hangings can be attributed to suicidal acts, whereas accidental
and especially homicidal hangings are quite rare. Based on this
experience, the physician consulted may, at least inadvertently,
develop some prejudice which in turn may lead to only superficial
examination of the body and the surrounding evidence, such as the
ligature including the knot and the point of suspension.
The incidence of homicide by hanging is widely discussed in the
literature. Whereas Neugebauer in 1937 considered murder by
hanging an “extreme rarity” that required a “great imbalance of
power” between victim and offender,14 Mayne remarked only five
years later that murder by hanging was “not at all uncommon” and
that physical superiority was quite often replaced by intellectual
superiority.15 Recent estimates suggest a ratio of homicide versus
suicide of 1:1900,16 1:10002 or even up to 1:100, taking into ac-
count a high number of unreported cases and at the same time a
low autopsy rate.11 Given the similarity of current conditions, these
estimates seem to be applicable also to the present situation.
Based on the statistical data collected by “Statistik Austria”, the
ratio of autopsies ordered by Austrian courts may be considered
relatively low for the validation group of hanging cases, with a
percentage between 4.01 and 8.08%. There have been no significant
fluctuations within the past 10 years and no discernible tendency
towards higher or lower ratios (Table 1).17 According to the
recommendation No. R (99) 3 of the Council of Europe,18 autopsies

http://dx.doi.org/10.1016/j.jflm.2015.04.006
1752-928X/© 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
72 F.C. Monticelli et al. / Journal of Forensic and Legal Medicine 33 (2015) 71e75

Table 1
Ratio of autopsies (by court order) in the validation group of hanging cases (“Statistik Austria”).17

should be carried out in “all obvious or suspected unnatural
deaths”, also including suicide or suspected suicide cases. Even
though from the medico-legal perspective this would be ideal, for
the prosecutor in Austria it is still mandatory to have at least hints
of a third party involvement in the case to decide on autopsy. For
this reason Austria does not follow the European recommenda-
tions, which have been established by the Council of Europe in
1999.
The following case report demonstrates that deaths by hanging
may be difficult to assess. We will call particular attention to po-
tential deficits observed in postmortem examination as well as to
the significance and especially the scope of further examinations.
showed “basically no indication of further acts of violence or
defensive wounds”, however “a few [ … ] spots of dry skin (small
hematoma?) [ … ] next to the ligature mark require clarification”.
Based on this new evidence, an official autopsy was finally ordered.
2.1. Autopsy findings
Four days after discovery of the body, an autopsy was performed
on a young woman in good general and nutritional condition. No
significant internal diseases could be discovered, which corre-
sponded with the previous anamnestic information. After the

2. Case

A 26 year old woman was found dead in her apartment in the

late afternoon hours, suspended from the external handle of the
open bathroom door by the power cable of a hair straightener, in
semi-recumbent position (Fig. 1).
The apartment was searched because the woman had not
shown up for her late shift. Approximately 45 min after the body
had been found, a general practitioner carried out the inquest and
gave “strangulation by hanging” as cause of death. Since no
concomitant injuries could be found, the Public Prosecutor saw no
immediate need to order an autopsy and released the body for
burial.
In the death certificate, the general practitioner stated that
death had occurred a good 4 h before the inquest. In the evening of
the same day, further investigations were initiated, after the
mother of the deceased had vehemently expressed her doubts that
her daughter had committed suicide. She also mentioned in this
context, that in the last months before her death her daughter
had increasingly closer contact with her ex-boyfriend, from whom
she had separated a few years earlier.
The subsequent criminal investigation found two independent
witnesses who had heard a loud dispute in the apartment of the
victim, approximately around midnight in the night before the
discovery of the body. A witness also reported a vehicle with a
particularly loud exhaust system leaving the residential area
around that time at great speed. According to the police protocol,
further examination of the body by crime scene investigators Fig. 1. Position of the victim at the crime scene.
 F.C. Monticelli et al. / Journal of Forensic and Legal Medicine 33 (2015) 71e75 73

ligature had been removed at the time of discovery, an asymmetric interposition of the victim's hair in the ligature knot (Fig. 3) as well
ligature groove was found almost completely encircling the throat as a trace of saliva above the left mandibular ramus. Police docu-
and neck with the apex projected at the right external auditory mentation further stated that the zip of the victim's biker jacket
canal (Fig. 2). In addition to the protruding tongue, numerous was fastened, with the turned-up jacket collar covering the neck
petechial hemorrhages in the facial skin, the areas behind both ears, and the encircling ligature almost completely, leaving the impres-
the conjunctiva, the eyelids and oral mucosa were present. Other sion that the jacket had been closed only after the ligature had been
findings included circumscribed hemorrhages in the skin and soft put in place.
tissues in the left mandibular ramus (Fig. 2) as well as extensive
blue-grey discoloration of the skin on the right front of the chest, 2.3. Instrumentality
immediately below the clavicle, with an approximate diameter of
5 cm. After appropriate preparation, these became apparent as The configuration of the ligature, especially the double wrap
recent subcutaneous hematoma, which could be confirmed by around the door handle without evidence of a knot e although also
histopathological examination. only discernible from photographs (Fig. 4) e appeared as if the
In addition, there were small hemorrhages no larger than a cable had been fastened in haste and without prior planning. At
fingertip in the skin and subcutaneous fatty tissue across the front least, there was no indication of any course of action consistent
of the left shoulder joint and across the extensor side of the met- with a planned suicide.
acarpophalangeal joint of the left thumb, some scattered fresh
hemorrhages about the size of a thumb on the extensor side of the
2.4. Additional forensic and molecular biological examination
left thigh and tibia, the outside of the right proximal tibia and
groups of punctiform extravasations on the extensor side of the left
DNA of the suspect could be detected in a total of 18 items
thigh. During the preparation of the rear parts of the body, skin and
containing biological evidence. All of them consisted of mixed
tissue hemorrhages in projection on the lower lumbar region,
traces from both suspect and victim. In detail, DNA material of the
extensive muscle hemorrhages on the right of the mid-back region
suspect was found on the adhesive lifted off both the palm and the
as well as in projection on the left scapula were found. The prep-
back of each hand as well as on both sides of the neck, on the biker
aration of the clavicles showed subperiostal bleeding on the right,
jacket worn by the victim (collar and cuff area of both sleeves, in
at the base of the sternocleidomastoid muscle. The laryngeal skel-
projection on the outside of neck and throat, respectively), on each
eton and the hyoid bone were resilient and intact. The neck muscles
finger of the right hand (abrasions), fingers I to III of the left hand
showed no relevant hemorrhage when prepared in situ. An internal
(abrasions) and the ligature itself (hair straightener, knot area).
ligature mark could not be detected. Toxicological analysis of the
In order to be able to anticipate a statement of the suspect
body fluids saved during the autopsy showed negative results.
regarding possible secondary transfer of trace evidence, the DNA
mixture ratios of suspect/victim were determined by peak-area
2.2. Evaluation calculation via electropherogram. They amounted to 1:5 for the
abrasions on the hair straightener (knot area) and 1,2:1 for the
Based on the autopsy results, it was determined that the victim abrasions on the victim's thumb.
had died of non-natural cause as a result of asphyxiation by violent
ligature strangulation. However, numerous findings were not
2.5. Trial
compatible with a suicidal hanging, such as the hemorrhages in the
skin and subcutaneous fatty tissue on front of the chest, across the
The defendant did not confess. From the forensic point of view
left mandibular ramus, the front of the left shoulder joint and
and based on the autopsy findings, it was concluded that the
across the extensor side of the metacarpophalangeal joint of the left
deceased had been the victim of violent asphyxiation by strangu-
thumb, the extensor side of the left thigh and tibia and the outside
lation and had died of a non-natural cause. Apart from the inter-
of right proximal tibia, the hemorrhages to back muscles and the
position of hair in the ligature knot, the numerous findings on the
groups of punctiform extravasation on the extensor side of the left
body were inconsistent with a suicidal event. The DNA results in
thigh.
particular pointed to a homicidal event. As a possible explanation of
Other conclusive findings e reconstructed from photographic
the multiple blunt force injuries on the victim's body, in particular
material and the relevant police documentation e include the

Fig. 2. Neck and conjunctival petechiae. Fig. 3. Interposition of hair in the ligature knot.
74 F.C. Monticelli et al. / Journal of Forensic and Legal Medicine 33 (2015) 71e75
Fig. 4. Door handle and point of suspension.
against the ventral thorax on the right, the left mandibular ramus
and the back, the expert discussed that breathing was probably
inhibited by the pressure of knees to the chest with the formation
of counter-pressure bruising together with a violent obstruction of
the respiratory tract, consistent with so-called Burking. However,
there was no ultimate proof for such a scenario.
In view of the DNA results, it was necessary to review the
alternative explanation pleaded by the suspect, regarding a sec-
ondary transfer of evidence. The male components of the trace
evidence could be attributed to the suspect beyond any biostatis-
tical doubt and was not disputed by the defense. Confronted with
the transfer of the suspect's traces onto the various evidence, the
defendant stated e contrary to his earlier statement that he had not
had any contact with the victim prior to her death e that he had
been in the victim's apartment 3 days before the body was
discovered, found the hair straightener in the bathroom sink,
picked it up, rolled up the cable and put it aside. In the course of this
activity, his DNA had probably been transferred to the straightener,
and subsequently, during the victim's suicide, from the straightener
to the 18 pieces of evidence, where they had finally been found.
From a forensic-molecular biological point of view, this scenario
could be excluded.
The large number of items showing DNA traces of the suspect
did not lend any credibility to this version. Nor did the positions of
individual traces fit such an explanation. The cable of the hair
straightener, for example, was found inside the jacket collar. The
suspect's DNA, however, had been detected on the outside of the
collar.
Another important criterion for assessment was the mixture
ratio of the traces found. Compared to that of the victim, only
relatively little of the suspect's DNA was found on the hair
straightener. The mixture ratio was determined via electrophero-
gram by peak area calculation, with a ratio for suspect to victim of
approximately 1:5. On the fingernails and jacket, respectively, the
calculated ratio was reversed (suspect to victim: 1,2 to 1). A shift of
the DNA mixture ratio in favor of the suspect's DNA was not
plausible in the context of secondary transfer. If the suspect's
version had been correct, the DNA mixture ratio would have shifted
to the suspect's disadvantage. In addition, material loss has to be
taken into account in the case of a secondary transfer. And finally,
already existing traces of the victim should have been found on the
pieces of evidence (fingernails and hands, the victim's jacket),
which would have shifted the mixture ratio in favor of the victim
rather than vice versa.
During the court hearing, the physician who had conducted the
inquest in the present case was questioned by the expert. Serious
flaws in the procedure became obvious. Apparently, the victim's
clothes had not been removed. The physician's statement led to the
conclusion that she had misconstrued the extravasations on the left
mandibular ramus found during the autopsy as livor mortis and
that she had not noticed the large hemorrhagic areas on the chest at
all. In addition, the ligature had not been taken off with appropriate
diligence so that its position could only be deduced retrospectively
from the photographic material.
With regard to the time of death, it turned out that the esti-
mated time of death e for which the suspect had an alibi e was
solely based on the fact that the deceased had worn her working
clothes and that the physician had assumed that the deceased had
already dressed for her upcoming late shift. According to the
criminal investigation, however, time of death at one point during
the night prior to discovery was much more likely, since it also
corresponded with the dispute overheard by the witnesses.
Because of the insufficient information regarding post mortal
changes to the body, a conclusive time of death could not be
determined. In the course of the trial, the physician had to admit
that she had inferred the time of death from external circumstances
alone.
A jury convicted the defendant of murder and sentenced him to
20 years in prison. After a nullity appeal by the defense, the sen-
tence was confirmed by the Supreme Court, however, the penalty
was reduced to 18 years.
3. Discussion
Homicides by hanging remain e at least according to the rele-
vant literature e rarely reported events.1e10 However, the esti-
mated ratio of homicide versus suicide is approximate
1:100,11 taking into account a constantly decreasing number of
autopsies and a considerable number of unreported events. For
these reasons it is system inherent that a decrease of knowledge
and experience obtained by the physicians commissioned with the
postmortem examination is inevitable, unless they have benefitted
from specific training. In fact, an accurate postmortem examina-
tion, especially in cases of death associated with hanging, is
generally considered to be quite challenging, when the physician is
forensically untrained. Experience shows that in those cases, in-
quests are frequently conducted only superficially and therefore
inadequately. It has also to be taken into account, that at least
inadvertently a prejudice may occur on the part of the physician,
based on the small hypothetical probability of a homicide in the
respective collective of cases. This may result in an insufficient
assessment of the ligature with respect to material, knot, ratio of
length, etc. as well as the particular circumstances, such as the
point of suspension or an inadequate assessment of the question,
whether or not the victim had been able to place the noose around
the neck him- or herself.
In the present case, findings that could not be reconciled with a
suicidal hanging, could only be collected as part of the autopsy.
Rather, they had to be regarded as typical results of multiple blunt
force injuries against body parts that are not normally associated
with a suicidal hanging. During the trial, it was suggested as a
 F.C. Monticelli et al. / Journal of Forensic and Legal Medicine 33 (2015) 71e75 75

possible scenario that breathing was inhibited to the point of un- In general, it would be our opinion that the autopsy itself should
consciousness by the pressure of knees to the chest, in combination be seen as a part of the death investigation. Therefore we recom-
with a violent obstruction of the mouth and nose, consistent with mend to perform an autopsy in all obvious or suspected unnatural
so-called Burking (named after the serial murderers William Burke deaths, for example according to the European guidelines (coe R99-
[1792e1829] and William Hare [1792e1859]). Burking is a special 3, 2 Feb. 1999).18
form of mechanical asphyxia, usually leaving little evidence and
therefore easily missed.19 Although such a scenario could not be Conflict of interest
substantiated in the present case, it at least offered a set-up that fit
the body of evidence. The authors declare that they have no conflict of interest.
Another indication that a third party had been involved was the
interposition of the victim's hair in the knot area of the ligature, a Acknowledgments
phenomenon found in the majority of homicidal hangings.2
Additional investigations subsequent to the autopsy resulted in No funding from any organization has been received.
important evidence further substantiating the defendant's
involvement in the crime. The defendant's statements could be
References
largely refuted only through the extensive forensic-molecular
biological investigation, including the calculations of the mixture 1. Bo€hmer K. To €tung durch Erha €ngen. Dtsch Z Gerichtl Med 1939/1940;32:
ratio of the suspect's and victim's respective trace evidence. 449e53.
The time of death estimated during the postmortem examina- 2. Püschel K, Holtz W, Hildebrand E, Naeve W, Brinkmann B. Erha €ngen. Suizid
oder To€ tungsdelikt? Arch Kriminol 1984;174:141e53.
tion proved to be medically untenable, as closer questioning of the 3. Paldauf E. Ein außergewo €hnlicher Todesfall durch Erha €ngen. Beitr Gerichtl Med
physician showed. In addition, findings on the body were obviously 1970;27:263e6.
either misinterpreted or remained unobserved. 4. Sauvageau A. True and simulated homicidal hangings: a six-year retrospective
study. Med Sci Law 2008;49:283e90.
According to the literature, prerequisites for homicidal hanging 5. Vieira DN, Pinto AE, Sa FO. Homicidal hanging. Am J Forensic Med Pathol 1988;9:
include either bodily or numerical superiority of the perpetrator or 287e9.
impairment of the victim's consciousness by CNS-active substances 6. Lew EO. Homicidal hanging in a dyadic death. Am J Forensic Med Pathol 1988;9:
283e6.
or other acts of violence.2 In some cases, only efficient planning and
7. Ruwanpura R, Ariyaratne C. A homicide by suspension. Med Sci Law 2010;50:
effective use of a moment of surprise lead to successful homicidal 224e7.
hanging.2 Such an approach should be considered particularly in 8. Wright RK, Davis J. Homicidal hanging masquerading as sexual asphyxia.
cases, where an inverse imbalance of power is probable. In the J Forensic Sci 1997;21:387e9.
9. Leth P, Vesterby A. Homicidal hanging masquerading as suicide. Forensic Sci Int
present case, toxicological analysis did not find any indication of 1997;85:65e71.
relevant impairment of the victim due to central nervous acting 10. Sharma L, Khanagwal VP, Paliwal PK. Homicidal hanging. Leg Med 2011;13:
substances. 259e61.
11. Brinkmann B. Erha €ngen. In: Brinkmann, Madea, editors. Handbuch gerichtliche
Medizin, Band I. Berlin: Springer; 2004. p. 774.
12. Rothschild MA. Probleme bei der a €rztlichen Leichenschau. Rechtsmedizin
3.1. Conclusion for practice 2009;19:407e12.
13. Mallach HJ. Über einen ungewo €hnlichen Strangulationsmechanismus im Kin-
desalter. Beitr Gerichtl Med 1962;22:213e8.
Still, postmortem examinations performed by forensically un- 14. Neugebauer W. Zur Frage Selbstmord oder Mord durch Erh€ angen. Dtsch Z
trained physicians, represent a weak point in death investigations. Gerichtl Med 1937;28:111e31.
15. Mayne H. Mord oder Selbstmord durch Erh€ angen. Ein Beitrag zu dieser Frage
It seems appropriate to call attention to the generally apparent €ngten. Beitr Gerichtl Med
unter besonderer Berücksichtigung der Lage des Erha
shortcomings of postmortem examinations, at least in the context 1942;16:80e99.
of hanging cases, and to the need for improved initial and 16. Naeve W. Anla €sse und Ergebnisse richterlicher Leicheno €ffnungen im Wandel
€
der Zeit. Hamb Artzebl 1976;30:149e53.
continued medico-legal training of physicians. It should be further
17. Statistik Austria. Communication about statistical analysis of hanging cases in
pointed out that in cases like this, the authorities need to initiate Austria. Unpublished results.
further examinations on a wide range and that close cooperation 18. Council of Europe, Committee of Ministers. Recommendation No. R (99) 3.
between Prosecution, Forensic Pathologists and Forensic Molecular http://www.coe.int/t/dg3/healthbioethic/Texts_and_documents/RecR(99)3.
pdf.
Biologists is essential in order to obtain the best extent of trace 19. Buschmann CT, Rosenbaum F, Tsokos M. Ein Fall von überlebter Thor-
analysis for constructive evaluation of the case in hand. axkompression durch Beknien -“Burking”. Arch Kriminol 2008;222:128e32.