Table of Contents
- ABSTRACT
- INTRODUCTION
- HANGING
- Types of Hanging
- Mode of Death
- AUTOPSY
- POST-MORTEM APPEARANCES
- Forensic Significance of Hanging
- CONCLUSION
- REFERENCES
ABSTRACT
Forensic medicine is a vast field in forensic sciences. It implicates a systematized procedure to proceed in any civil or criminal investigation. Forensic medicine includes medical examination, documentation and presentation in the court of law. It helps to examine the cause of death, time since death, injuries, age of injuries, and type of weapon used in homicide. Hanging is one of the most common and easily accessible modes of death, be it suicide or a homicide. Depression or mental stress is the most substantial reason people choose to commit suicide. It is also used as a legal punishment in the Indian legal system. Another most commonly occurring death is due to road traffic accidents. Instant death due to hemorrhagic shock or death during hospitalization is frequent. Homicide by stabbing, medical negligence, and electrocution are some other causes of death.
INTRODUCTION
HANGING
Definition: When a person is suspended in the air through a ligature material tied around the neck, a force is applied to the neck, causing blockage of the air passage.
It is a prevalent means of suicide opted by people, especially young adults, due to one or the other reason such as depression, financial crisis, or mental trauma.
Types of Hanging
1. By virtue of the position of the knot
A. Typical Hanging
- The ligature mark tends to run upwards, from the front of the neck, towards the back of the neck.
- The knot of the ligature is typically located at the back of the neck (occipital region).
- The ligature mark often appears as an inverted “V” shape.
Medico-legal Significance:
- A typical hanging is often associated with suicidal hangings.
- The characteristic ligature mark can help forensic pathologists differentiate hanging from other forms of asphyxia, such as strangulation.
B.) Atypical Hanging
- The primary distinguishing feature of an atypical hanging is the location of the ligature’s knot. In contrast to a typical hanging, where the knot is usually at the back of the neck (occipital region), in an atypical hanging, the knot can be situated:
- On the side of the neck.
- At the front of the neck.
- Ligature Mark:
- Consequently, the ligature mark on the neck may also deviate from the typical inverted “V” shape. Its direction and characteristics will vary depending on the knot’s position.
Medico-legal Significance:
- Differentiation:
- Recognizing an atypical hanging is essential for differentiating it from typical hangings and other forms of asphyxia, such as strangulation.
2. On the basis of the force of neck compression
A.) Complete Hanging
A “complete hanging” is defined by the suspension of the entire body weight from the ligature around the neck.
- Full Suspension:
- The key characteristic is that the body is entirely off the ground or any other supporting surface. This means that the full weight of the body is exerting downward force on the neck.
- Medico-legal Significance:
- Complete hangings are often associated with suicides, as they typically require a deliberate act to achieve full suspension.
- The degree of force applied to the neck in a complete hanging can lead to significant injuries, including fractures of the hyoid bone and thyroid cartilage.
- It is important to note that even if the feet are barely off the ground, that is still considered a complete hanging.
B.) Incomplete Hanging
An “incomplete hanging” occurs when the body is only partially suspended, meaning some part of the body is still in contact with the ground or another supporting surface. This partial contact reduces the amount of body weight exerting force on the neck.
- Partial Suspension:
- A portion of the body remains supported, such as the feet, knees, or buttocks touching the ground or a nearby object.
- Reduced Force:
- Because the body is not fully suspended, the force applied to the neck is less than in a complete hanging.
- Medico-legal Significance:
- Incomplete hangings can still result in death due to asphyxia, even with reduced force.
- They can occur in various situations, including accidental hangings or in cases where the individual was unable to achieve full suspension.
- It is possible to have an incomplete hanging and still have a complete closing of the airway.
Mode of Death
- Judicial
- Suicidal
- Homicidal
- Accidental
AUTOPSY
External Examination
Clothes are examined for mud, sand, blood, vomitus, faeces, semen or other biological substances to collect evidence for representation in the court of law.
They form a basis for circumstantial evidence evident for the location of the crime scene.
Starting from the head, a medical practitioner observes any head injury if present.
The neck is examined very carefully for ligature marks, abrasions on the neck due to the ligature material and cross-checking if the ligature mark and ligature material are the same or not. All the measurements of the ligature mark are vital.
Struggle marks are looked for, if any, for strangulation.
Then, coming to the face: eyes, lips and all other facial characteristics are noted for any type of external injury.
Internal examination
A modified “Y“- shaped incision is made starting from the neck to the abdomen to open the body cavity.
Another incision is made in the trachea and opened properly to show it to the doctor in charge for any occlusions around the neck and any blood in the tracheal cartilage.
“I” incision is made in cases other than hanging.
The stomach is opened for the last meal consumed, and if there is any poisonous material, alcohol or drugs present.
If there is any indication towards strangulation or homicide, viscera collection is mandatory.
A part of:
Liver, kidney, spleen, and small intestine and their contents are stored in clean glass jars with labelled information such as case number and investigating officer. Medical professional in charge, hospital’s address where the autopsy & viscera collection took place.
POST-MORTEM APPEARANCES
In case of suicidal hanging
● Cyanosis of lips and fingers or toe nails, petechial hemorrhage in the sclera and eyelids.
● Tongue protrusion is a very common finding.
● Hyoid bone fracture is also found in a few cases, and tear of the transverse intima of the common carotid artery is the rarest finding.
● No effusions are observed around the cartilages of the trachea, and the trachea gets devoid of any blood traces in all the cases, indicating a pure suicidal hanging.
In case of homicidal hanging or strangulation:
● Ligature mark will be uneven, unlike in suicidal hanging.
● Occlusions are present in the trachea, and traces of blood are visible inside the tracheal cavity
● Struggle marks are present.
● Petechia in the skin is observed.
● The epidermis, or the inner lining of the body cavity, might have the possibility of bruises or abrasions.
In case of Judicial Hanging
● As the ligature knot is placed at the angle of the jaw, this usually causes fracture-dislocation of the second-third or third-fourth cervical vertebrae.
● There may also be signs of fracture dislocation in the occipital joint, which leads to instantaneous and irreversible loss of consciousness.
● This fracture causes instant death, and no signs of asphyxia are markedly seen in judicial hanging.
Accidental hanging
● Conjunctiva hemorrhage & Petechial hemorrhages observed.
● Bruises, abrasions and defensive marks may also be present.
Forensic Significance of Hanging
Hanging is always considered suicidal, until it is proved to be homicidal. Circumstantial evidences play a crucial role in proving or disproving the hanging to be suicidal or homicidal. A foot stool, ladder, or any other material used to tie the ligature on the fan or ceiling may have fallen on the ground.
Homicidal hanging becomes challenging to establish in any case unless the person is an alcoholic or in the influence of any drug. In Western countries, it was also used as a mode of punishment; the person was hanged in public for any criminal offense.
Judicial hanging is practiced in India as a legal punishment for a death sentence.
Post mortem hanging
Hanging after murder can be done by an offender to disguise murder as suicide. Parchmentization, grooving in the neck, patterned abrasion or bruises will be absent.
Case study 1
1. A home maker (female)- Age- estimated between 35-40 years.
Found hanging in the bedroom of her own house. The door was locked from the inside.
The ligature mark was shallow and had fewer abrasions.
The tongue protruded outside, and the livor mortis was more in the distal portions of the limbs, indicating upright hanging.
Tracheal rings devoid of any blood, indicating it to be suicidal hanging.
2. A labourer on a contract basis (male)- Age: 33 years old. The police officer in charge reported that a person committed suicide at his workplace, in an under-construction building.
His co-workers informed the police about the case. It was about 28 hours after his death.
It was a complete suicidal hanging. Cyanosis, post mortem lividity was visible in the body, and decomposition had begun around his eyes and mouth.
3. A teenage girl- Age- estimated about 17-18 years.
She was found hanging in a bedroom in her own house.
No struggle marks or bruises were observed.
Her reason for suicide was not clear as she did not leave a suicide note, nor did her parents know anything about her death.
4. A male was found hanging in his house. The Age was about 35 years.
He used to work here in Delhi as a security guard at a private office.
The body was discovered 28 hours after his death.
His younger brother said that he was under stress due to the loan of about 5 lacs.
5. A pregnant woman- Age about 25 years.
She had run away from her home with her boyfriend about one year prior to her death.
She was six weeks pregnant as found in the post-mortem examination.
Out of a sudden, she committed suicide. His husband said that she was also undergoing depression and mental illness, and he denied being the biological father of that child in her womb.
The fetus was removed from her body for examination; it was a six-week-old fetus.
6. A male was found dead in his home, aged about 52 years.
He hung himself in the store room of his house. He lived with his son and daughter-in-law.
His son was not able to find him the following day.
Later that morning, the family members experienced some kind of awful smell, and then they searched the store room and found his body hanging in the store room.
In the post-mortem, it was found that the dead body had been hanging for 18 hours; he had committed suicide during the last night itself. The doctor found all evidence of suicidal hanging.
No struggle marks or fresh injuries, indicating any violence from his family members, were present.
Cause of death- hypoxia caused by blockage of the air passage and cerebral ischemia.
UNKNOWN DEAD BODIES
Unknown means, whose identity is not yet established. Forensic medicine, thus, helps in identifying a dead body, its age, time since death, location of death, and any peculiarities which are unique to a person, such as;
A birthmark or a tattoo- their likes and dislikes towards something, or favoring a group of people or a community.
Any kind of physical features are unique.
Bodies found unidentified on roads, near any water body, under a water body, people who died in a plane crash, mass explosions, riots, etc., come under the category of unknown dead bodies.
A dead body was found at the Delhi-Haryana border: a male was found dead in a car, as reported by the investigating officer. A trespasser informed police that the person was dead.
The doors of the car were locked from the inside.
The autopsy–
The stomach was opened to examine any kind of drugs or alcohol present. It was full of alcohol, and his liver was fatty, indicating chronic liver disease due to excessive intake of alcohol.
Cause of death- myocardial infarction.
A decomposed body was found at Dwarka Mor near a marshy inhabited area.
Autopsy was challenging to perform because of decomposition in its advanced stages.
Adipocere formation was observed clearly around the forearms and over the abdomen. A bloated belly due to microbial action forming gases, putrefaction was visible, and blabs in the epidermis were also visible.
Cause of death- unknown.
ROAD TRAFFIC ACCIDENT
Any type of tragic events that occur at any location, such as roads, public places, workplaces or under construction buildings, caused by a vehicular force or any other non-living object, such as boulders, rocks, or a sharp or blunt object.
Case Study 2
Road accident of a woman- Age- around 35 years.
She was reported to be travelling on a motorbike with her brother, and a truck hit the motorbike.
Injuries- She had minor abrasions on her shoulder, forearms, feet and buttocks.
Graze abrasion on the left hand.
A degloving injury was in the right hand’s medial region.
She was hospitalized immediately and had surgical sutures starting from the right thigh covering Mons pubis till the left side of the lower abdomen.
Cause of death- died within 16 hours of her hospitalization due to hemorrhagic shock.
A labor on a contract basis-
Age estimated at about 45 years.
Met with an accident with a big boulder at the construction site and got hit with a force. He accidentally hit with this stone while working on a building standing on a ladder and fell.
Injuries- minor abrasions on the feet and abdominal region. Major internal injury inside the head caused hemorrhagic shock.
One injury at the lateral side of the left chest.
Cause of death- hemorrhagic shock.
MEDICAL NEGLIGENCE
It is any kind of act performed by a medical professional, or a doctor, in handling a patient during their treatment or a surgery. This is often included under tort, meaning any reckless act causing harm to the patient.
Protected under the Consumer Protection Act, 1986.
Case study 3
A neonate – this was a case of a neonate that was in the process of being born. The doctor assisted this delivery, using some instruments to create a suction on the head of the baby as crowning was visible.
This injured the head of the baby, causing bleeding, and the neonate died during the delivery. It was reported as a case of medical negligence.
The autopsy was conducted- an inverted Y incision was made starting from the chest to the abdomen, protecting the umbilical region for examination. His large intestine had fecal matter.
Heart, lungs, kidney, spleen and liver were intact and showed no abnormalities.
The head was sectioned, and the hemorrhagic shock was visible.
Viscera was photographed and collected.
Cause of death- hemorrhagic shock.
ELECTROCUTION
Electrocution is derived from two words, electric meaning current, and cause meaning death due to electric current or shock.
In many cases, it is fatal, especially if the voltage of the current entering the body is high, causing Cardiac arrest and burns in the skin.
There is always a principle of electric current entering into the body, leaving a wound in the form of burns, and leaving the body at a specific location, forming an exit wound. The entry wound will always be there. However, the exit wound is sometimes not visible on the body.
Case study 4
An electrician, around 26 years old, died due to an electric shock while repairing some electrical faults at the pole of wires.
Autopsy- the heart was abnormal, showing cardiac arrest; other vital organs were intact. Entry and exit wounds were clearly visible in his left hand’s fingers.
The little finger had third-degree burns as his epidermis and dermal layers with muscles were burned, and 2nd second-degree burn was seen in the left hand’s index finger, showing entry and exit wounds respectively. The brain was intact, and no abnormalities were detected.
Cause of death- Cardiac failure and third-degree burn on the little finger.
CONCLUSION
Forensic medicine is a field in forensic science that implicates medical knowledge in law. Medicine is very important in terms of the examination of different cases of living or dead victims or suspects. The doctor’s examination and supervision are very important as the court of law accepts appropriate evidence produced by experienced professionals for their objectivity and authenticity. Medical professionals examine and analyze injuries in a live or a dead person, to know the weapon used for attacking a person in a homicide or attempted murder case, cause of death, time since death, location of death, by conducting an autopsy and transporting it to the forensic labs. In this report, a deep study of all the autopsies was conducted in a mortuary, in a hospital located at Hari Nagar, Delhi, the Deen Dayal Hospital.
REFERENCES
Content-
- https://zjfm.journals.ekb.eg/article_67608_730cf031241a347abc8aa24613591cb8.pdf
- YouTube channel StupireMed.: hanging in forensic medicine and toxicology by DR. Vishwajeet.
- Journal from Research Gate.
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779963/
Images-
- Figure 1: Google stock images- Quora digests “how does it feel to conduct a past mortem?”
- Figure 2: References in neurological disorders: The Lancet Neurology.
- Figure 3, 4,5,6,7,8, & 9: Image Captured by Isha Thakur (Article Author) at Deen Dayal Upadhyay Hospital, Clock Tower, Hari Nagar, Delhi-110064.
About The Author
This project work has been submitted by Isha Thakur, who is pursuing a B.SC. (H) Forensic Sciences (5th semester) from Amity Institute of Forensic Science, Amity University, Noida, Uttar Pradesh.
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