Hanging and Strangulation: Forensic Analysis and Medico-Legal Aspects
Hanging and Strangulation: Forensic Analysis
Cartilage and Vascular Rupture
Vascular rupture resulting from osteo-cartilaginous lesions, extracervical intravital internal suspension, hemorrhagic infiltrations, localized lumbar discs, and signs of vital reaction are significant findings.
Medico-Legal Issues
Two primary medico-legal issues arise: determining the cause of death and establishing the etiology.
Cause of Death
Lesions can indicate hanging. Hemorrhagic infiltration of various lesions is an important finding. Strangulation and suffocation due to occlusion of breathing passages must be ruled out.
Etiology
The deceased’s background, careful examination of the scene, and forensic autopsy will usually allow a reliable etiological diagnosis.
Background
Examine letters and their contents, family and socio-economic factors, and the clinical history (psychiatric and somatic) of the deceased. Examination of the scene, especially incomplete suspension, is fundamental. The body’s vestments and the presence of erotic photos may indicate the sexual variety of hanging, almost always accidental. Preserve the knot.
Blunt Injuries
Intentional blunt injuries and their possible impact on the level of consciousness must be considered for a possible homicide. Assess the possibility of fraudulent instigation (battery required) triggering suicidal behavior. In seizures following the scene, test for the presence of furniture and other objects near the body against which the body could have collided. Autopsy may reveal old or recent attempted suicide by other means, usually by firearm. Toxicological research is important, especially for ethyl alcohol and other depressants. It is rare to find other substances.
Strangulation by Loop
Mechanism
Constriction of the neck is achieved through a loop, a process different from hanging, which uses body weight.
Etiology
Strangulation is most frequently murderous, with women as victims. Suicide is a rarer mode, and accidental strangulation is infrequent. Cases are even more exceptional in young children and adults.
Mechanism of Death
Death occurs due to anoxic anoxia, cerebral anoxia, and cardiac arrest via an inhibitory reflex mechanism.
Histopathology
External Review
The fundamental lesion is the strangulation furrow on the neck. Characteristics include:
- Direction: Generally horizontal.
- Depth: Uniformly marked all around.
- Continuity: Completely surrounds the neck.
- Number: Often multiple.
- Situation: Usually at or below the thyroid cartilage.
- Appearance of the background: Nearly always soft.
In homicidal strangulation, look for small nail marks or bruising, various types of blunt injuries to other body areas, grazes, and congestion. The face is often sharp, and petechial hemorrhages are abundant.
Internal Review
Consists of hemorrhagic infiltration into soft tissue and osteo-cartilaginous breakdown. Osteo-cartilaginous lesions are more common than in hanging, with the thyroid cartilage affected. Considerable force may break through the layers of the thyroid and cricoid cartilage. Examine internal cartilage for blunt injuries, especially in the pericardium.
Medico-Legal Problems
Identification and asphyxial constriction injury of the neck are crucial, excluding all other possible causes of death.
Etiologic Diagnosis
Distinguish between strangulation suicide and homicide, considering the procedure used.