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Hanging and Strangulation: A medico-legal analysis

 

                                                                                                                           Chirag Goyal 


                                                                                                                          I.            Table of Contents

II.   Introduction: Handing & Strangulation. 2

A.   Hanging. 2

B.   Causes of death in hanging –. 2

C.   Types of Hanging. 3

III.      Difference between strangulation and hanging. 3

IV.      Steps of identification


                         II.            Introduction: Hanging & Strangulation

In the year 2019, 1,39,231 cases of suicide were reported in India and rate of suicide was 10.4[1], however it’s still suspicious how many cases out of these were actually of strangulation.

A.     Hanging

Hanging is defined as a method of violent asphyxial death in which the body is suspended completely or partially by a rope knotted around the neck and the weight of the person hanging is applied to the neck, resulting in complete or partial asphyxial death.[2]

On the basis of suspension, there are mainly two types of hanging[3]

Complete hanging - The body is totally hanged from the ceiling, with no portion of the body contacting the ground at any point.

Partial hanging - The body is partially suspended, with the toes or feet contacting the ground, or the body is sitting, kneeling, lying down, prone, or in any other position with only the head and chest touching the ground, or the body is partially suspended with the toes or feet touching the ground. The constricting force is exerted by the weight of the head (5 to 6 kg), the chest, and the arms. Although it is not essential to use the entire body weight, even a very small force is sufficient to bring about death.

On the basis of the types of knots, there are mainly two types of hanging[4]

Typical hanging: The ligature extends from the midline above the thyroid cartilage on both sides of the neck symmetrically upward to the occipital region, and the knot is over the centre section of the back of neck.

Atypical hanging: It refers to a situation in which the knot is not on the occiput, for example, on the right or left side of the neck or at the front of the neck. 

B.     Causes of death in hanging –

·         As a result of the compressive force of the ligature, the laryngeal and tracheal lumens become narrowed, resulting in hypoxia and death.

·         The ligature causes the jugular veins to get clogged, resulting in the cessation of cerebral circulation, it is called venous congestion

·         Reflex vagal inhibition can lead to sudden cardiac arrest.

·         Fracture of cervical vertebrae

C.     Types of Hanging

Hanging can be divided into suicidal, homicidal and postmortem

Suicidal hanging: In many countries, hanging is a common method of committing asphyxial suicide. Males are more likely than females to be between the ages of 10 and 80 years old. The victim is able to approach the point of suspension because it is still accessible. In nature, partial hanging is almost always considered suicidal. It is possible that a previous attempt has occurred, and the crime is generally committed in a secluded location (the victim's home is the most common location). It is possible that a suicide note has been left behind. There should be a compelling reason for someone to commit suicide. It is possible that fibres of ligature material are present in the clenched hand.[5]

Homicidal hanging: This is extremely rare. Unless the victim is intoxicated or rendered unconscious, or unless the victim is either a child or a disabled person, this is not normally possible in an adult victim. In the following situations, homicide should be suspected: a. There are signs of violence or disarray in the furniture b. Injuries, whether offensive or defensive.[6]

Accidental hanging: Hanging deaths in children under the age of six are almost always unintentional. It has been observed in children while "playing hanging" (e.g., pretending to be a cowboy) or "Lassoing" (getting suspended from playground equipment), and in adults (e.g., autoerotic hanging) in a variety of settings. When workers fall from scaffolding, they may become entangled in the ropes, which can cause them to be hanged. Keeping the neck from being jerked around by the steering wheel Falls from great heights or from trees, as well as slipping from a ladder, can result in being suspended from the neck to an object in between.[7]

                      III.   Difference between strangulation and hanging

1. Ligature mark is most important factor used in differentiating. At the site of ligature, there is a pressure mark on the neck that is visible. “A typical ligature mark is present in the upper half of the neck, above the thyroid, and is oblique bilaterally symmetrical, extending to the angles of the mandible, then to the mastoid, and finally to the occipital protruberance..[8]

When the knot is tied on the posterior part of the neck, it is possible to hang completely from the knot. “There will be no mark if the ligature is soft and it is cut down immediately after death, but there will be a slight mark if the ligature is intervened by a thick and long beard or clothing around the neck.[9] Abrasions and bruises of the skin may be visible at the site of the knot as well as in the groove's bottom bed. There may be areas of hyperaemia and, on rare occasions, a few ecchymoses along the edges of the wound.” It is possible to find fibres from the ligature adhering to the skin. For fixed knots, the ligature mark is formed as an inverted "V" shaped impression, with the apex of the V corresponding to the location of the knot. When using a slip knot, the running noose may tighten around the neck, leaving a mark all over the neck except where the knot is.[10]

When distinguishing between hanging and strangulation by a ligature, it is also important to consider the level at which the ligature mark is placed on the body. Strangulation is a type of death that occurs when the neck is constricted by something other than one's own body weight. When people die by hanging or strangulation, asphyxia is the most common cause of death. However, it is possible that it is caused by venous congestion, cerebral ischemia, shock, or a combination of more than two of these factors. It is possible to sustain a fracture-dislocation of the cervical vertebrae during a judicial hanging[11]

Some of the factors which may affect ligature are as follows –

·         Ligature composition: If a hard or thick and rough ligature is used, the mark may be more pronounced than usual. Use of soft materials may result in a barely visible mark on the surface of the skin.

·         Material width: Broad ligature material may leave a broad mark with less grooving, whereas thin ligature material may leave a deep, narrow grooved impression, depending on its thickness.

·         Weight of the body: The greater the weight of the body, the more prominent the mark will be.

·         Rescue hanging: If the person survives the hanging, the ligature mark becomes less visible and heals, eventually becoming a pale scar-like mark.

2. External appearance - The neck has been elongated. The head is tilted to the side, in the opposite direction of the knot. In most cases, the face is cyanosed, and cyanosis can be found on the lips, tongue, nose, ears, and nails.[12] Because of congestion, the eyes appear prominent, and the pupils are dilated.[13] The term for the eye that can remain open on the same side as the other is le facie sympathique. When the tongue is drawn in or protruded and bitten, this is referred to as.[14] It is typically swollen and blue in colour. Bloody froth may be seen at the corners of the mouth and around the nostrils, with saliva dripping from the angle of the mouth. Hands are clenched, especially in the case of a severe hanging. Due to the excessive congestion, it is possible to experience haemorrhage into the middle ears on occasion.[15]

Hypostasis causes engorgement of the penis with blood, which may be semierect and with semen at the tip of the penis. Because of the relaxation of the sphincter, urine and faeces may be released. It is common for post-mortem hypostasis to occur in the legs, feet, hands, and forearms after a body has been suspended for an extended period of time. The upper part of the body will appear pale after the body has been suspended for an extended period of time. Petechial haemorrhages can be discovered in the skin of the legs within two to four hours of the onset of the symptoms. It has been shown that if the body is removed from the scene within four hours of death and placed in the supine position, postmortem hypostasis in the limbs will fade and new areas of lividity will develop along the back and buttocks.[16]

3. Internal Appearance: The subcutaneous tissue beneath the ligature mark is dry, white, firm, and glistening, indicating that it has been ligated. Hemorrhages and ruptures of the platysma and sternomastoid are common in these structures. Hyoid bone fractures can occur in anyone, but they are more common in people over the age of 40.

The fracture is usually caused by a ligature pulling the hyoid bone backwards, resulting in increased divergence of the greater horns (anteroposterior compression fracture), but it can also be caused by traction pulling the hyoid bone backwards. Transverse carotid intimal tears, long drops, and posteriorly placed knots (Amussat's sign) are all signs of carotid artery disease in obese patients. It is possible to have a ruptured vertebral artery, an intimal tear, and subintimal haemorrhage (which is the most common). Congestion has developed in the larynx and trachea. It is possible to have a fracture of the superior horn of the larynx.[17] It is possible that the tracheal rings, thyroid cartilages, and costal cartilages will be fractured.

When the cut section is squeezed, bloody froth comes out of the congested lungs. The mucus in the respiratory passages is bloody froth. The right chamber of the heart and the pulmonary vena cava are both full of blood, while the left chambers are empty. The viscera of the abdomen are suffocating. The brain is usually pale and congested, but not always. The pleura, pericardium, meninges, brain, and abdominal viscera are all possible sites for petechial haemorrhages to occur.[18]

                              IV.            Steps of identification

Following the identification of the body, a thorough examination is performed to look for any external injuries, dribbling of saliva, signs of asphyxia such as bluish discoloration of fingernails, petechial haemorrhages, signs of sphincter relaxation, pattern and also any distribution of hypostasis, the extent of rigour mortis that has developed, and other factors. A thorough investigation of the Ligature mark is carried out. Last but not least, step-by-step dissection of the neck was performed in order to observe the neck tissues structures beneath the ligature mark after the thoracic organs and brain had been removed from the body. This allowed the blood in the neck to drain away, resulting in a cleaner dissection field and a more comfortable procedure.

In the case of Amar Iqbal Singh vs State Of Punjab[19] (2009), the court gave 10 differences between hanging and strangulation which were based on above-mentioned criteria

In the case of Sunil Duggal & Ors. v. State, Delhi High Court[20] held that hanging and strangulation are two very different causes of death and it should be differentiated on different medical factors.

                                 V.            Hanging v. Strangulation: Judicial probe

One of the most recent case of Mavjibhai Ramjibhai Taviyad v. State of Gujrat[21], the court was faced with the issue of differentiating between Hanging and Strangulation. The Court noted that the medical evidence is sure that death occurs by strangling. It can be suicidal, murderous or unintentional. There is a single curve around the neck with one or more knots in homicidal strangling. The same is true of the position in this scenario. There may, or may not be, signs of struggle depending on the facts, circumstances, and prior conditions of crime. It can therefore only be determined that the form of death was not homicidal because there is no injury and no acts of struggle by the deceased indicated.

The bench also refers to Modi's "Medical Jurisprudence and Toxicology (23rd edition of Lexis Nexis Butterworths),' where the difference in suspension and strangulation is explained by the medical emphasis on particular differences. Hanging differs in the following terms from strangulation:

1.      Mostly homicidal;

2.      Face-Congested, livid and marked with petechiae;

3.      Saliva-No dribbling out of the mouth down on the chin and chest;

4.      Neck-not stretched and elongated in fresh bodies;

5.      external signs of asphyxia, very well marked (minimal if death due to vasovagal and carotid sinus effect);

6.      Bleeding from the nose, mouth and ears may be found;

7.      Ligature mark-Horizontal or transverse continuous, round the neck, low down in the neck below the thyroid, the base of the groove or furrow being soft and reddish;

8.      Abrasions and ecchymoses round about the edged of the ligature mark, common;

9.      Subcutaneous tissues under the mark- Ecchymosed;

10.  Injury to the muscles of the neck-Common;

11.  Carotid arteries, internal coats ordinarily ruptured;

12.  Fracture of the larynx and trachea-Often found also hyoid bone;

13.  Fracture-dislocation of the cervical vertebrae-Rare;

14.  Scratches, abrasions fingernail marks and bruises on the face, neck and other parts of the body-Usually present;

15.  Sometimes evidence of sexual assault;

16.  Emphysematous bullae on the surface of the lungs-May be present”.

The above characteristics would not ordinarily be acquired where it is hanging. If the medical evidence discussed above is assessed on the basis of the above expert criteria for medical jurisprudence, it can be apparently observed that symptoms like congested face, ear bleeding, horizontal ligature in continuous circle, neck abrasions around ligature mark, hyoid bone fracture, cervical vertebrae dislocation, etc. have been detected. They prove that dying is a thorny act. As said, wound scars demonstrating struggle cannot always be present because it could happen that the deceased was not in a position to resist or throw was so brutal that the deceased was never able to demonstrate any resistance.

The position was similar to what was observed by the court in the case of Muniammal vs The Superintendent Of Police[22].  In this case, the court relied significantly on the medical reports of the forensic department. It observed that a conscientious assessment of the authorities in the field of 'medical jurisprudence' would indicate that there should be as many data as possible on the post-mortem certificate collected at the time of such an inspection. If the post mortem certificate lacks details or does not contain sufficient results, then it will cause the decision-making authority so many complications. The doctor cannot assume that any deceased's kith and family will come out with a version that suspects that the deceased will die. However, as advertised, the doctor must provide possible results in the post-mortem certificate in order to support the administration of criminal justice.

 

 



*Student of 5th Semester , B.A. LL.B.(Hons)  Jindal Global Law School , OP Jindal Global University, Sonipat

[1] https://ncrb.gov.in/sites/default/files/Chapter-2-Suicides_2019.pdf

[2] Nageshkumar G Rao, Textbook of Forensic Medicine and Toxicology, 2nd edition 2010, Jaypee brothers Medical Publisher, page no-195

[3] K.S. Narayan Reddy, The Essentials of Forensic Medicine and Toxicology, 34th edition -2017, jaypee Brothers Medical Publisher (P) Ltd New Delhi-110002, page no-315

[4] Id.

[5] Gautam Biswas , Review of Forensic Medicine and Toxicology, 2nd edition, Jaypee Brothers Medical Publisher(P) Ltd New Delhi-110002, page no-190.

[6] Id.

[7] .K.Singhal, Forensic medicine & jurisprudence, 5th edition2018, published by The National book depot Mumbai, page no-125.

[8] S.K.Singhal, Forensic medicine & jurisprudence, 5th edition2018, published by The National book depot Mumbai, page no-121.

[9] Ajay Kumar, Text Book of Forensic medicine (Medical Jurisprudence and Toxicology), 2nd edition-2016, Avichal Publishing company (P) Ltd New Delhi-110002, page no-159

[10] Parikh’s Textbook of Medical Jurisprudence, Forensic Medicine and Toxicology, 17th reprint edition -2017, CBS pulisher & Distributors P. Ltd New Delhi-110002, page no172.

[11] K.S. Narayan Reddy, The Essentials of Forensic Medicine and Toxicology, 34th edition -2017, jaypee Brothers Medical Publisher (P) Ltd New Delhi-110002, page no-321

[12] S.K.Singhal, Forensic medicine & jurisprudence, 5th edition 2018, published by The National book depot Mumbai400012, page no-12.

[13] Parikh’s Textbook of Medical Jurisprudence, Forensic Medicine and Toxicology, 17th reprint edition -2017, CBS pulisher & Distributors P. Ltd New Delhi-110002, page no 171.

[14] K.S. Narayan Reddy, The Essentials of Forensic Medicine and Toxicology, 34th edition -2017, Jaypee Brothers Medical Publisher (P) Ltd New Delhi-110002, page no-321.

[15] Ajay Kumar, Text Book of Forensic medicine (Medical Jurisprudence and Toxicology), 2nd edition-2016, Avichal Publishing company (P) Ltd New Delhi-110002, page no-161.

[17] Gautam Biswas, Review of Forensic Medicine and Toxicology, 2nd edition, Jaypee Brothers Medical Publisher(P) Ltd New Delhi-110002, page no-183.

[18] S.K.Singhal, Forensic medicine & jurisprudence, 5th edition2018, published by The National book depot Mumbai400012, page no-124.

[19] Amar Iqbal Singh v. State Of Punjab, Criminal Misc. No. M-30471 of 2009.

[20] Sunil Duggal & Ors. v. State, Delhi High Court, 2019.

[21] Mavjibhai Ramjibhai Taviyad v. State Of Gujrat.

[22] Muniammal v. The Superintendent Of Police, Criminal Original Petition No.12582 OF 2007.

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