Strangulation is almost always homicidal, hanging almost always

suicidal, and suffocation (limited) usually accidental, but also often

homicidal.

Strangulation may be admitted, therefore, as including all cases of

suffocation by pressure on the neck, whether by cords or the hand; but

excluding hanging.

It will facilitate the study of the subject if we use the word ligature

as a general term to cover the many forms of cords, ropes, etc., used

in strangulation and hanging.

The word GARROTING is often used to indicate the forcible compression

of the neck by the hands of thieves. The assault is usually made from

behind, and the victim is robbed while the throttling proceeds. The

brevity of the process explains why death is not more frequent. The

word garroting comes from the Spanish; criminal execution in Spain and

Italy is usually by means of the GARROTE, a steel collar which is

tightened on the neck of the condemned by a screw. The notorious thugs

of the East Indies used sometimes a soft loin-cloth, at others a lasso

or long thong with a running noose. In Turkey and some other Eastern

countries the bowstring is a common mode of execution.

An examination of the reported cases of strangulation and hanging

shows a great variety of forms of ligature: cords, ropes, thread,

thongs, lassos, flexible twigs, bamboos, leather straps, girdles,

turbans, fishing-nets, collars, cravats and other forms of neckwear,

bonnet strings, handkerchiefs, sheets, etc. Women have even strangled

themselves with their own hair (Case 34). Stones, sticks, coal, and

other hard substances have sometimes been inserted in the ligature to

increase the pressure (Cases 36, 38, 42, 43, 44). Drunken and otherwise

helpless persons have been strangled by falling forward with the neck

against a firm substance.

STRANGULATION.

SYMPTOMS AND TREATMENT.

The symptoms and post-mortem appearances in strangulation will vary,

according as the deprivation of air is sudden or gradual, partial

or complete; and whether there is coincident pressure on the great

arteries, veins, and nerves of the neck.

The deprivation of air disposes to asphyxia; pressure on the great

arteries by cutting off the supply of arterial blood to the brain

disposes to anæmia of the brain and syncope; pressure on the great

veins, by preventing the return of blood to the heart, to congestion of

the brain and coma; pressure on the great nerves, the pneumogastrics,

to syncope. Statistics of hanging show that in about seventy per cent

of cases death is by a mixture of asphyxia and coma. While it is

probable that the proportion is less in strangulation, yet it is also

probable that a mixed result frequently occurs.

Asphyxia is from _α_ priv. and _σφίξις_, pulse—absence of pulse.

Apnœa from _α_ priv. and _πνέω_, I breathe—absence of breathing.

Syncope, _συνκοπή_, a faint; suspended animation from sudden failure of

heart. Coma, _κῶμα_, deep sleep. Richardson[729] makes the following

distinction between asphyxia and apnœa: Asphyxia is difficulty of

taking in breath; apnœa is breathlessness. There is asphyxia when the

blood from the heart can go to the lungs, but there is no access of

air; apnœa, when there is access of air, but the blood fails to reach

the lungs. In asphyxia the lungs obstruct the circulation; in apnœa

the obstruction is in the heart. In asphyxia the air cannot reach the

blood; in apnœa the blood cannot reach the air.

Quinquaud[730] and Fredericq[731] conclude from experiments on

animals that asphyxia is due to the deficiency of oxygen, not to the

accumulation of carbon dioxide.

Page[732] divides the phenomena witnessed in an animal killed by simply

depriving it of air, without interfering with the blood-vessels of the

neck, into four stages:

First. A short stage. (In the human subject this stage could scarcely

last longer than fifty seconds, which is said to be the extreme limit

of the most expert divers. The breath can be held longest if a number

of deep breaths have previously been taken, so as to surcharge the

blood with oxygen.)

Second. The stage of “_besoin de réspirer_,” when the want of air

begins to be felt; the animal makes vigorous and violent efforts to

overcome the obstacle. This stage may continue for three to four

minutes.

Third. Unconsciousness supervenes with irregular and spasmodic

movements; efforts at respiration continue.

Fourth. Efforts at respiration cease, but the heart still beats. This

stage may last from two to four minutes. Hofmann[733] says that it may

last a half-hour. In new-born infants, asphyxiated, it may be quite

long.

The post-mortem appearances in such an animal were as follows: the

lungs were pale, reddish, not much distended; there were a few

dilated air-cells toward the anterior border; hemorrhages irregularly

dispersed over the surface of the lung, varying in number and size.

The right cavities of the heart contained dark fluid blood, the left

were empty. The pulmonary artery and systemic veins, even the smallest

branches, were gorged with dark blood. Page adds that when the great

vessels of the neck are interfered with death may occur “by coma,

syncope, and even asthenia.”

Colin[734] made twenty-five experiments on horses, and records three

of them as follows: they were all strangled with a hempen cord at the

middle of the neck. The _first_ was quiet till the second or third

minute, then there were violent movements and strong efforts to dilate

the chest; at four minutes, spasms; four and one-half minutes, quiet;

six minutes, pupils dilated, tongue hanging out, limbs flaccid; blood

black. _Second horse_: Carotid artery denuded to observe its action.

In fifteen seconds, blood nearly black; four and one-quarter minutes,

no pulsation in carotids; five and one-half minutes, no respiratory

movement; six minutes, heart-beat ceased, except feeble contraction of

auricles, which continued till twenty-first minute. _Third horse_: In

five minutes respiration ceased; tracheotomy performed, but there was

no attempt to breathe; eight minutes, heart ceased to beat. Similar

results were obtained in ruminants and in small animals, except that

the larger animals lived longer than the smaller.

Faure[735] made the following experiment on a large dog. He tied a

cord tightly round its neck; for fifty-five seconds it was quiet, then

suddenly it became agitated, threw itself against the wall, rolled on

the ground, twisted itself; bloody mucus escaped from the nose and

mouth; the teeth were ground together; urine and fæces were passed.

The efforts at respiration became very rapid. It fell dead at the end

of three and one-half minutes.

The symptoms of strangulation in the human subject resemble closely

those just described as occurring in the dog.

The FIRST or PRELIMINARY STAGE lasts a variable time, according to the

suddenness and completeness with which the access of air is prevented;

it lasts until there is a demand for the air. In a case of homicide,

injuries may be inflicted on the victim in this stage which may have an

important bearing on the cause of death. Blows on the head may cause

unconsciousness, or even apoplexy; upon the stomach, may cause syncope;

stab-wounds may tend to cause death from hemorrhage.

The SECOND STAGE begins with the demand for air and lasts till

unconsciousness supervenes. It is characterized by frantic efforts to

breathe, efforts in which the entire body takes part. If the subject is

conscious, he is intensely so; the expression of the face is intense;

the eyes may protrude, the hands be clinched; the memory is unusually

active, and the events of a lifetime may rapidly pass before the mind

in a few minutes. The tongue may be thrust between the clinched teeth

and bitten; and urine, fæces, and semen may be discharged.

The THIRD STAGE usually appears suddenly, and is characterized by

unconsciousness and irregular involuntary movements, _i.e._, spasms;

these may end in opisthotonos; the veins become turgid, and hemorrhages

may occur from the eyes, nose, mouth, throat, ears, and into the

connective tissues of the lungs, pleura, pericardium, etc. The

circulation of venous blood in the arteries is shown by the general

lividity, especially where the skin is thin, as the lips and tips

of fingers. Hofmann[736] states that coincident with the oncoming

of unconsciousness and convulsions the respiratory effort becomes

expiratory, followed still later by inspiratory efforts.

The FOURTH STAGE begins with the cessation of spasms and of efforts to

breathe. The subject is quiet, but the heart still beats. The stage

ends with the cessation of the heart-beat.

Discharges of semen, urine, and fæces may occur in the first and

second stages, from terror; in the second and third from the general

agitation, and in the third and fourth from paralysis.

Strangulation according to Bernard[737] causes a rise in temperature,

varying from one to two degrees (Cent.). He thinks that this is due to

the changes from arterial to venous blood, especially in the muscles.

Lukomsky[738] concluded from experiments that in asphyxia both

arterial and venous pressure is increased in the systemic circulation,

but diminished in the pulmonary artery. The highest degree of blood

pressure coincides with the strongest respiratory movements, especially

expiration. He also concluded that the Tardieu spots (subpleural

ecchymoses) directly depended on the efforts of breathing and blood

pressure.

Some writers, as Taylor and Tidy, think that death occurs sooner in the

human subject than in the lower animals; where the access of air is

suddenly and completely prevented death may be immediate. Tardieu says

that death follows pressure of the hand sooner than that of a ligature.

Fleischmann[739] placed cords round his own neck between hyoid bone

and chin, tied them tightly, sometimes at the side, sometimes at the

back, without respiration being interfered with, because there was no

pressure on the air passages. But his face grew red, eyes protruded

slightly, there was a feeling of great heat in the head, of weight,

commencing dizziness, and suddenly a hissing and rustling in his ears.

The experiment should stop at this point. The same symptoms occurred

from applying the cord over the larynx. The first experiment lasted

two minutes, the second a half-minute. The difference was due to the

different situation of the cord.

Dr. G. M. Hammond[740] gives an account of a personal experiment in

strangulation. He sat down; a towel was passed around his neck, and

the ends twisted together, making forcible compression of the neck.

At first he had a feeling of warmth and tingling, first in the feet,

then passing over the entire body; vision partly lost; his head felt

as if it would burst; there was confused roaring in ears, like the

sound heard on placing the ear to a shell; he remained conscious. In

one minute twenty seconds all sensibility was abolished. After a few

minutes’ rest a second similar trial was made, with similar results,

except that sensibility was lost in fifty-five seconds. A stab with a

knife drawing the blood caused no sensation.

Should the subject recover from the immediate effects of the

strangulation there may yet be serious secondary results. Among these

are convulsions and paralysis; extreme swelling of face, neck, and

chest; loss of voice; lesions of larynx and lungs; abscesses. Death may

occur suddenly and remotely from one of the sequelæ.[741]

In the =treatment= of strangulation the first indication obviously

is to remove the pressure from the neck. Artificial respiration will

probably be required, and may be aided by ammonia applied to the

nostrils, tickling of the fauces, and galvanism. Colin[742] states

that artificial respiration is useless after cessation of heart-beat.

(See the treatment by galvanism under “Suffocation.”) If the body is

cold, artificial heat by means of hot bottles, etc. Venesection may be

necessary. Colin strongly advises venesection to relieve the distention

of the heart. Stimulants and light food are often required.

Limousin[743] recommends the use of oxygen. Cobos[744] experimented on

animals by injecting oxygen hypodermically, as a means of artificial

respiration. His conclusions are that the oxygen is absorbed and carbon

dioxide eliminated in the same place. The oxygen thus introduced causes

no trouble. Testevin[745] cures asphyxia by hypodermic injection of

ether.

The after-treatment will depend on the after-conditions.

The =prognosis= is good if there is no serious injury to the neck and

treatment is promptly applied.

POST-MORTEM APPEARANCES.

The =post-mortem appearances= in strangulation are external and

internal.

The external appearances are of two kinds: those directly due to

violence and accident and those due to asphyxia.

=External Appearances Directly Due to Violence or Accident.=—The MARKS

on the neck. In some fatal cases there are either no marks at all or

they are but slight; this is more likely to be the case in suicides

than homicides, and is usually due to the ligature being soft and

yielding. The victim of a homicide may, however, first be stunned and

afterward strangled.

Marks are said to be plainer after the body has become cold and where

subjects have recovered from attempts at suicide.

The marks of the ligature in strangulation usually encircle the neck

more completely and more horizontally than in hanging. These conditions

may, however, be reversed, because a body may be dragged by the neck

after strangulation, and there have been suicides by hanging in whom

the mark of the cord was horizontal. As a rule, however, a horizontal

mark with the knot on the same level as the cord, especially if below

the larynx, suggests strangulation rather than hanging; and if there

are several marks the probability is even greater. In compression with

the fingers the marks are not in a horizontal but oblique line.

The mark of the ligature is usually circular, well defined, and

corresponds closely to the breadth of the ligature; rather depressed,

and usually below the larynx. As a rule this depression is not deep;

the skin at the bottom of the groove is usually very pale, while the

adjacent parts are red or livid. Sometimes the bottom of the groove

shows ecchymoses. Neyding[746] says that suggillations in the groove

made by the ligature on the neck are rare, but are oftener found in

strangulation than hanging, because the conditions favoring their

formation are oftener found in strangulation. In most cases the skin

and connective tissue of the groove and of the parts in the vicinity

show, microscopically, hyperæmias and hemorrhages. Liman[747] states

that when we find suggillation in the groove or its vicinity, we may

know that some other form of violence has been applied at the same time

as that of the ligature or hand. He had not seen suggillation in the

furrow either in strangulation or in hanging, except when the injured

persons had lived some time, and in cases of twisting of the umbilical

cord. The absence of suggillation and ecchymosis was due, he thought,

to the pressure on the capillaries. Bremme[748] says that in the

subcutaneous connective tissue of the mark of the ligature there is no

hemorrhage either in strangulation or hanging, if death occurs at once

and the cord is removed at once after death; but if the cord remains

for some time after death there may be hemorrhage, or if death does not

occur at once whether the ligature is removed or not. It is impossible

to distinguish ante-mortem from post-mortem hemorrhage.

The parchment skin seen in hanging is seldom seen in strangulation.

Neyding[749] says that the dryness and induration called parchment skin

depend mainly on the amount of excoriation of the skin, and this is

greater in hanging. Tardieu explains this frequency as being due to the

fact that the constriction in hanging lasts a longer time. Liman has

seen the parchment skin in those strangled.

The violence used may cause ecchymoses and abrasions of the skin of the

neck adjacent to the mark of the ligature.

The marks of very different constricting ligatures may be quite

similar. Taylor[750] mentions a case in which a soft silk handkerchief

was used, and the appearance was the same as that of a narrow cord, due

to the tightness with which it was tied.

Where a hard substance like a piece of coal or stone is inserted into

the ligature, usually then a soft cloth, and presses directly against

some part of the neck, there is usually a corresponding bruise.

Marks of pressure by the thumb and fingers are usually on the front

of the neck, and either just above or below the larynx. In many cases

these marks are only those of the finger-tips with some scratches.

These marks may show definitely the probable size of the assaulting

hand, and whether right or left.

Marks of strangulation may disappear rapidly after the removal of the

ligature. Assailants usually constrict the neck much more violently

than is sufficient to cause death. Marks of violence on the neck are,

therefore, greater in strangulation than in hanging.

A great variety of external injuries other than those on the neck

have been found in the different cases reported where other forms

of violence were used. With few exceptions such additional injuries

indicate homicide.

=External Appearances Due to Asphyxia.=—A few of these have already

been given under the caption “Symptoms.” If death occurs quickly

there may not be any signs of asphyxia. The general LIVIDITY which

comes on in the second stage usually remains after death. The face

varies in color from violet to black and may be swollen. Casper[751]

says that the face has the appearance of any other corpse. Liman[752]

found the face livid in only one of fourteen cases. Hofmann[753] says

that the cyanosis appears during the agony because of paralysis of

the circulation and gravitation of blood. The cyanosis of the face,

projection of the eyes, and congestion of the conjunctivæ are due to

the expiratory effort. These signs are also seen in fat persons who

do not die of strangulation. Tardieu[754] mentions a dotted redness

or minute ecchymosis of the conjunctivæ and skin of face, neck, and

chest as constant; but this cannot be considered characteristic,

because it has been seen, though not so well marked, in death from

other causes. It has been found in suffocation from compression of

the chest and belly; and also where there is respiratory interference

in the prolonged efforts of tedious labor and in convulsions.

Liman[755] found it in those who were hung. It is due, according to

Hofmann,[756] to increased blood pressure and consequent hemorrhages.

It is of importance as tending to show that there was stasis of blood

in the head and face during life. Liman[757] found cyanosis in the

conjunctivæ, lips, back of mouth, and in the muscles. Maschka[758]

in 234 cases of asphyxia found capillary hemorrhages of the eyes and

eyelids 87 times.

Dastre and Morat[759] claim that in asphyxia the cutaneous circulation

becomes more active than in the normal state, while at the same time

the vessels of the abdominal cavity are contracted. Laffont[760]

considers the mechanism of this peripheral dilatation.

POST-MORTEM STAININGS (hypostases) are usually darker in strangulation

than in other forms of death. They appear soon, as does also

putrefaction, because of the quantity and fluidity of the blood.

Signs of HEMORRHAGE from the nose, eyes, and mouth may be visible;

as also bloody froth from the mouth and nose. Chevers[761] never saw

bleeding from the ears in strangulation. Taylor[762] states that Dr.

Geoghegan informed him of a case of suicidal strangulation by a ribbon;

the violence was great, there was bleeding from the ear, and the drum

was found ruptured. In this case the mark on the neck, which was deep,

nearly disappeared after the ligature was removed. Taylor also says

Wilde, of Dublin, saw a case of rupture of drum and hemorrhage in

strangulation. Pellier[763] says that Littré mentions a case of rupture

of tympanic membrane in strangulation by a cord. Zoufal and Hofmann

have offered explanations of the occurrence (Case 35).

The FACE usually shows pain and suffering; although sometimes the

features are calm. In the latter case there may have been syncope.

The EYES are usually staring, prominent, and congested, and the pupils

dilated. Casper[764] doubts their prominence. Budin and Coyne[765]

state that in asphyxia the dilation of the pupil progresses to a

maximum and then convulsions occur. Ophthalmoscopic examination during

the dyspnœa of asphyxia shows a lessened fulness of the retinal vessels.

The TONGUE is often swollen, dark, protruding, and sometimes bitten.

Maschka[766] states that if the ligature lies above the hyoid bone, the

tongue will be drawn backward; if over or below the bone, the tip of

the tongue may appear more or less between the jaws.

The HANDS are usually clinched and may have in their grasp articles

which, under the circumstances, have a medico-legal value.

The EXTERNAL GENERATIVE ORGANS are sometimes congested; erection of

the penis may have taken place and persisted. The vagina may be moist.

Tardieu, Devergie, and Casper[767] deny that these appearances are

usual.

INVOLUNTARY DISCHARGES of urine, fæces, and seminal fluid may have

occurred. There is nothing characteristic in their appearance.

All the external appearances of asphyxia are usually more marked in

strangulation than in hanging.

=Internal Appearances.=—THE MARK. Usually there is hemorrhage into the

loose connective tissue under the mark and in the subjacent muscles;

in most cases isolated and circumscribed, but sometimes extending

beyond the line of the mark. Hemorrhage from compression by the fingers

is more marked than that from ligature.[768] Sometimes there is only

fulness of the subcutaneous veins.

The CAROTID ARTERIES may suffer rupture of their inner and middle

coats, especially in atheromatous subjects and when the compression

has been great. Friedberg[769] states that the injury of the carotid,

if there is hemorrhage into its middle and internal coats, is a proof

that the strangulation occurred during life, and probably from pressure

of the fingers on the neck, without any regard to any disease of the

artery. He reports two cases. The examiner should be careful not to

injure the artery with his forceps. The vessels may contain clots.

The NECK occasionally suffers extreme injury, and, owing to the

violence used, this occurs oftener in strangulation than in

hanging.[770] Occasionally the neck is broken.

The HYOID bone may be fractured (see Case 5). Maschka[771] saw one case

in eighteen of Erdrosselung and five cases in fifteen of Erwürgen.

The TRACHEA is sometimes torn, or may be folded on itself.

The cartilages of the LARYNX, especially if calcareous, may be

fractured. This is more likely to affect the thyroid than cricoid.

The fracture would appear to occur only as the result of enormous

force; especially in the young in whom the cartilages are so elastic.

The experiments of Keiller[772] on cadavers led him to conclude that

falls on the larynx, even from a height and with superadded force, are

unlikely to fracture that organ; that severe pressure or violent blows

against the larynx from before backward may cause fracture; but that

severe lateral pressure, as in ordinary throttling, is more likely than

other forms of violence to fracture the alæ of the thyroid or even the

cricoid cartilages and also the hyoid bone. Taylor[773] states that Dr.

Inman, of Liverpool, had informed him of a case of splitting of rings

of windpipe from pressure (see Cases 5, 13). Maschka[774] in fifteen

cases of choking found six fractures of the larynx.

Chailloux[775] has collected eight cases of fracture of larynx in

strangulation. They were all made with the fingers. The experiments

of Cavasse[776] seem to show that there is no great difficulty in

fracturing the thyroid in strangulation.

=Internal Appearances Due to Asphyxia.=—The VEINS of the entire body

are distended with very dark and very fluid blood, while the arteries,

especially in the young, are mostly empty. Experiments on the lower

animals have shown that the pulmonary artery and systemic veins to the

finest ramifications are distended with dark blood.[777]

THE HEART.—The right side, especially the auricle, is usually full

of dark fluid blood, due to the mechanical impediment to the passage

of blood through the lungs. If the heart continues to beat after the

respiration has ceased the right ventricle is commonly well contracted,

like the left cavities, and nearly empty, the lungs being much

congested. Sometimes the left cavities of the heart contain blood. This

would be most likely to occur if the heart should stop in the diastole.

Sometimes clots are found in the right ventricle. Maschka[778] found

clots in the heart 25 times in 234 cases of asphyxia.

The LUNGS are usually much congested, resembling red hepatization,

except that the blood is darker. Hemorrhages (apoplexies) into the

substance of the lungs are common. Tardieu found patches of emphysema

due to rupture of the surface air-vesicles, giving the surface of

the lung the appearance of a layer of white false membrane. Ogston

admits this occurrence in pure strangulation but to a less extent in

mixed cases. Liman[779] found the lung surface uneven, bosselated,

the prominences being of a clearer color and due to emphysema.

The lungs were in the same condition of congestion and emphysema

in strangulation, suffocation, and hanging. He failed to find the

apoplexies described.

The lungs are sometimes anæmic. In healthy young subjects, especially

children, the blood-vessels of the lungs often empty themselves

after the heart stops. The lungs may, therefore, be bloodless, but

emphysematous from the violent efforts to breathe. Page’s experiments

on the lower animals showed the lungs of a pale reddish color and

not much distended; a few dilated air-cells might be seen toward

their anterior borders, and there might be small hemorrhages over the

surface. His experiments appear to show that subpleural ecchymoses

occur as a result of violent and repeated efforts to breathe. Among

other experiments[780] he stopped the mouth and nostrils of a young

calf long enough to excite violent efforts at respiration; it was

then instantly killed by pithing. The lungs were found pale red,

not congested, but showed subpleural ecchymoses. Page believed

these were due to the changed relation between the capacity of the

thorax and volume of lungs. Liman found these ecchymoses in cases of

strangulation, hanging, drowning, poisoning, hemorrhage, and œdema of

brain, in the new-born, etc. He failed to find them in some cases of

suffocation. He believes them due to blood pressure from stasis in

the blood-vessels. Ssabinski[781] made many experiments on dogs and

cats to ascertain the presence or absence of subpleural ecchymoses in

strangulation, drowning, section of pneumogastrics, opening of pleural

sac, compression of chest and abdomen, closure of mouth and nose,

burial in pulverulent materials, etc. Similar hemorrhages may appear

on the mucous and serous membranes, as the respiratory, digestive, and

genito-urinary tracts, and pleuræ, pericardium, peritoneum, membranes

of brain, and the ependyma. These are sometimes minute and stellate,

at others irregular in shape; many are bright-colored. According

to Tardieu the punctiform ecchymoses are rarely present except in

suffocation. Maschka,[782] in 234 cases of asphyxia, found the lungs

congested 135 times, anæmic 10, and œdematous 42. He thinks the

subpleural ecchymoses valuable signs of asphyxia.

The BRONCHIAL TUBES are usually full of frothy, bloody mucus, and the

mucous membrane is much congested and shows abundant ecchymoses.

The lining membrane of the LARYNX and TRACHEA is always congested and

may be livid; the tube may contain bloody froth or blood alone.

Tidy comparing strangulation and hanging concludes that because

strangulation is usually homicidal, and greater violence is used,

therefore the external marks are more complete in strangulation and the

congestion of the air passages is invariably much greater.

Maschka found the PHARYNX cyanotic in 216 of 234 cases of asphyxia.

The other MUCOUS MEMBRANES are generally much congested. Serum is found

in the serous cavities.

Maschka[783] considers the rounded, pin-head ecchymoses of the inner

surface of the _scalp_ and pericranium valuable evidence of asphyxia.

The BRAIN and membranes are sometimes congested; occasionally

apoplectic. Maschka[784] found congestion of brain and membranes 48

times and anæmia 30 times in 234 cases of asphyxia.

The ABDOMINAL ORGANS are generally darkly congested, although Maschka

denies this for the liver and spleen in asphyxia.

The congestion of the viscera generally is doubtless due largely to the

prior congestion of lungs and engorgement of heart.

Page[785] experimented on six kittens, strangling three of them by

the hand, the other three by ligature. The results of the post-mortem

examinations were nearly similar: the veins were full of dark fluid

blood; the right cavities of the heart were similarly gorged, the left

empty; lungs pale red, not congested and not distended. Brain normal.

The differences were in the lungs; in the first series there were

many small, irregular, circumscribed, dark-red ecchymoses scattered

over the general surface; in the second, a small number of bright-red

ecchymoses, somewhat larger than a large pin-head.

Langreuter[786] made some experiments on a cadaver from which

enough of the posterior part had been removed to enable him to

view the throat. He saw that the lateral digital pressure on the

larynx closed the glottis; stronger pressure made the vocal cords

override each other. Similar pressure between the larynx and hyoid

bone caused apposition of the ary-epiglottic folds and occlusion of

the air-passages. He experimented on sixteen bodies to ascertain

the effect of blows and pressure on the larynx, with the following

results: In eight cases, women, the thyroid cartilage was injured

three times, the cricoid four; in eight, men, the thyroid eight and

cricoid five. Whence he concluded that the larynx is better protected

in women. In the sixteen cases the hyoid bone was fractured ten times.

THE PROOF OF DEATH BY STRANGULATION.

Tidy[787] says that “nothing short of distinct external marks would

justify the medical jurist in pronouncing death to be the result

of strangulation.” On the other hand, Taylor[788] considers the

condition of the lungs described as characteristic. Liman[789] did

not think there were any internal appearances which could distinguish

suffocation, strangulation, and hanging from each other.

In estimating the value of testimony it will be well to consider the

following facts:

A victim may be strangled without distinct marks being found. The

practice of the thugs shows that this may be done with a soft cloth and

carefully regulated pressure without making marks. Taylor,[790] while

admitting the possibility, states that this admission “scarcely applies

to those cases which require medico-legal investigation.”

The subject while intoxicated or in an epileptic or hysterical paroxysm

may grasp his neck in gasping for air, and leave finger-marks.

Different constricting agents may make quite similar marks. Marks may

be made on the neck within a limited time after death, similar to

those made during life. Tidy’s experiments led him to fix this limit

at three hours for ecchymoses and six hours for non-ecchymosed marks.

Taylor,[791] however, doubts if such marks could be made one hour

after death. He says that the period cannot be stated positively, and

probably varies according to the rapidity with which the body cools.

It is, however, unlikely in such post-mortem attempts at deception

that the other conditions usual in strangulation would be found—such

as lividity and swelling of face; prominence and congestion of eyes;

protrusion of tongue; rupture of surface air-vesicles and apoplexies in

the lung; congestion of larynx and trachea, etc.

No conclusion can be drawn from the presence or absence of any single

appearance.

A cord may be found near a body or even around its neck; there may even

be a mark around the neck. These may be attempts at deception.

Marks much like those of violence may be made by tight collars and

handkerchiefs remaining until the body is cold.

Cases are reported of bodies having been first strangled and then

burnt or hung to cover the crime; and of partial suffocation by gags,

followed by or coincident with strangulation (see Cases 18, 20, 24).

In apoplectics with short and full neck we may find at the borders of

the folds of skin in the neck one or more depressions, red or livid,

that bear some resemblance to the marks of a ligature; but on section

there are no ecchymoses.

Froth, tinged with blood, in the air-passages is considered by

Tardieu[792] one of the most constant signs of strangulation.

The marks of topical medical applications, as plasters, sinapisms,

etc., must not be confounded with marks of violence.

In strangulation by ligature the marks are usually horizontal; in

hanging, oblique. In hanging too they are usually dry and parchmenty.

Ecchymoses are more marked in strangulation.

The dotted markings of face, neck, and conjunctivæ described by Tardieu

are more characteristic of strangulation.

The principal distinctions between strangulation and suffocation would

be the absence in the latter of marks on the neck.

Taylor[793] quotes the case of Marguerite Dixblanc, in which the

question was raised whether she had strangled her mistress, Madame

Riel, or whether the body had been dragged by a rope around the neck.

The question was left unsettled by the medical evidence.

The only motive for attempting to simulate strangulation on a corpse

would seem to be to inculpate an innocent person.[794]

Both suicides and murderers are usually more violent than is necessary

to destroy life; murderers more than suicides.

Putrefaction may cause external marks to disappear.

All marks on a body should be carefully noted; the cavities of the

skull, thorax, and abdomen carefully examined; the possibility of death

having occurred from other causes, even in strangulation, must be

considered.

As Taylor well says, our judgment must not be swayed to the extent of

abandoning what is probable for what is merely possible.

In all cases the cord or strangulating ligature should be carefully

examined for marks of blood, for adherent hair or other substances.

The precise manner in which the cord has been tied should be noted.

STRANGULATION: ACCIDENTAL, SUICIDAL, HOMICIDAL, SIMULATED.

The question whether a case of strangulation is accidental, suicidal,

or homicidal is very difficult to answer.

ACCIDENTAL strangulation is rare. If the body has not been disturbed,

there is usually no difficulty in arriving at a conclusion; but if

disturbed a satisfactory conclusion may not be reached.

It is worthy of mention that the umbilical cord may be twisted around

the neck of a new-born infant and may have caused strangulation; the

mark may give the appearance of death by violence.

SUICIDAL strangulation is rare. The experiments of Fleischman (_supra_)

suggest that one may commit suicide by compressing his throat with his

fingers (see Case 48).

Where a ligature of any kind has been used it is important to notice

the number and position of the knots. In a general way a single knot

either in front or at the back of the neck might suggest suicide; more

than one would suggest homicide. There are, however, exceptions.

Suicide has been committed by mere pressure of a cord fixed at both

ends a short distance from the ground; by twisting a rope several times

around the neck and then tying it (the coils may continue to compress

even after death); by tightening the cord with a stick or other firm

substance; by tightening the cords or knots by means of the hands or

feet or some portion of the lower limbs; by the use of a woollen garter

passed twice around the neck and secured in front by two simple knots,

strongly tied one to another.

It is difficult to simulate suicide; requires great skill and

premeditation on the part of a murderer. “The attitude of the body,

the condition of the dress, the means of strangulation, the presence

of marks of violence or of blood on the person of the deceased, on his

clothes or the furniture of the room, or both, rope or ligature, are

circumstances from which, if observed at the time, important medical

inferences may be drawn.” The assassin either does too little or too

much. Taylor[795] cites a number of cases of simulation.

Strangulation is generally HOMICIDAL. The marks of fingers or of a

ligature on the neck suggest homicide. This is true even if the mark

is slight; because infants and weakly persons may be strangled by

the pressure of the hands on the throat. Even a strong man, suddenly

assaulted, may lose his presence of mind and, with that, his power of

resistance; with approaching insensibility his strength still further

diminishes. This is true even if his assailant is the less powerful. It

requires more address to place a ligature on the neck than to strangle

with the hand.

A victim may be made insensible by drugs or blows and then strangled by

a small amount of compression; or suffocation by gags and strangulation

may both be attempted.

The importance of considering the position and number of the knots in a

cord is mentioned under suicidal strangulation.

In homicide, in addition to the marks on the neck, there is likely to

be evidence of a struggle and marks of violence elsewhere on the body.

It is important, therefore, to notice any evidence of such a struggle.

The nature of the cord may assist in identifying the assailant.

It must be remembered that homicidal strangulation may be committed

without disturbing noise even when other persons are near.

=Simulation.=—False accusations of homicidal strangulation are on

record. Tardieu[796] states that a distinguished young woman (for

some political purpose) was found one evening at the door of her room

apparently in great trouble and unable to speak. She first indicated

by gestures and then by writing that she had been assaulted by a

man who tried to strangle her with his hand, and also struck her

twice in the breast with a dagger. She was absolutely mute—did not

even attempt to speak—quite contrary to what is always observed in

unfinished homicidal strangulation. On examination by Tardieu, no sign

of attempt to strangle was found, and the so-called dagger-openings

in her dress and corset did not correspond in position. She confessed

that she had attempted deception.

The celebrated Roux-Armand[797] case was another instance of

attempted deception. A servant named Roux was found on the ground

in the cellar of his employer Armand; his hands and legs were tied

and there was a cord around his neck. He was partly asphyxiated, but

after removal of the ligature from his neck he rapidly recovered,

except that he was weak and voiceless. He stated by gestures that he

had been struck by his employer on the back of the head with a stick

and then bound as described. The next day he could speak. Armand was

imprisoned. Tardieu examined carefully into the case and the results

may be stated as follows: The asphyxia was incipient, else he could

not have so rapidly recovered. The cord around his neck had not been

tied—simply wound around several times; the mark was slight and

there was no ecchymosis. Although the legs and hands were tied, the

hands behind the back, there was no doubt but that Roux could and did

tie them himself. He had stated that he had been eleven hours in the

cellar, in the situation in which he was found. This could not be

true, for a very much shorter time, an hour probably at the furthest,

would have caused death, in view of the condition of asphyxia in which

he was found. Again, if his limbs had been bound for so long, they

would have been swollen and discolored; but they were not. Again,

if the ligature had been around his neck so long as he said, the

impression of it would have been more marked. Again, if his stertorous

breathing had lasted long it would have been heard by neighbors. The

injury on the back of the head, said to be due to a blow, was believed

by Tardieu to be due to dragging him on the ground. He further

had stated that when he received the blow on the head he became

unconscious, and yet he also described how Armand bound him after

knocking him down. Again, he had made no outcry; but if he had been

strangled while partly unconscious and afterward recovered his senses,

he would have been unable to give an account of the matter; if,

however, he had been strangled while conscious, there was no reason

why he should not have cried out. His inability to speak the first

day was assumed, because what was a simulation of absolute mutism

should have been simply a loss of voice. The innocence of Armand was

ultimately established.

ILLUSTRATIVE CASES.

HOMICIDE.

1. _Cullingworth: Lancet, May 1st, 1875, p. 608_.—Woman. Believed to

have been intoxicated. Face, especially right side, swollen and livid;

a little blood had oozed from mouth, nose, and inner angle of each eye.

Immediately over (in front of?) larynx and on each side of middle line

were marks of irregular outline such as might be caused by pressure of

thumb and fingers. Several dark, bruise-like discolorations on flexor

surface of each forearm. Hands clinched. Elbows flexed. Discharge of

fæces by rectum. Necroscopy: Brain and membranes normal. Hyoid bone and

laryngeal cartilages uninjured. Mucous membrane of larynx and trachea

congested and covered with frothy mucus. Lungs intensely congested.

Several hemorrhages; masses of tissue of each lung, chiefly toward

base, were solidified by effused blood. All the heart cavities empty.

Stomach normal, empty. No congestion of abdominal viscera.

2. _Taylor: “Med. Jur.,” Am. Ed., 1892, p. 412._—Man and woman.

Strangled by cord, tied so tightly that there was hemorrhage from mouth

and nose.

3. _Harvey: Indian Med. Gaz., December_ 1st, 1875, _p. 312_.—Hindoo

woman, age 45. Strangled with the right hand. Necroscopy: Two

contusions and abrasions on temple. Neck discolored from right to left

jugulars; marks of thumb on right side and three fingers on left,

extending from jugulars to windpipe. Eyes half protruded. Tongue

discolored. Blood-vessels full of clots. Brain congested (?) and showed

external hemorrhages (?). Lungs normal. Heart empty. Liver ruptured to

the extent of four inches, with adherent blood-clot. Spleen, stomach,

and intestines normal. Muscles of chest, both sides, congested,

discolored, and there were clots of blood over and under them. First

six ribs of left side and first three of right fractured.

4. _Harris: Ibid., p. 313._—Boy, age 10. Abrasions over front of

neck, especially near left ear, probably from ligature; also abrasion

on upper part of chest, probably from forcible pressure. Underneath

these marks the veins were much distended. Trachea minutely congested;

contained much frothy fluid. Lungs showed rupture of some of the

air-vesicles; entire tissues distended with blood and frothy fluid.

Dark fluid blood in both sides of heart. Large quantity of fluid in

pericardium. Brain much congested. Eyes congested. Tip of tongue

between teeth. Other organs normal.

5. _Mackenzie: Ibid., February, 1889, p. 44._—Hindoo woman, age not

given, strangled by another, stronger woman. Necroscopy: Abrasion on

front and lower part of neck just above sternum and clavicles; four

inches long, three broad; five superficial lacerated wounds on sides

of neck, four on left, one on right, apparently nail scratches. Two

contusions below and behind lower jaw. Also contusions on thighs. No

spots of ecchymosis on neck. Contusion under skin of lower part of neck

and upper part of chest, eight inches long, four broad. Left greater

cornu of hyoid bone fractured. Both upper cornua of thyroid cartilage

fractured; cricoid fractured on each side. Larynx, trachea, and bronchi

contained pink frothy mucus; mucous membrane congested. Lungs much

congested; pink frothy mucus in bronchi; no emphysema nor apoplexies.

Right side of heart full of dark blood; left side empty. Liver, spleen,

and kidneys congested. Stomach and intestines normal. Bladder empty.

Internal genitals normal. Brain congested.

6. _Mackenzie: Ibid., August, 1888, p. 232._—Hindoo man, age about

30. Strangled by soft cloth cord. Necroscopy: Circular mark of cord,

one-fourth inch diameter around lower part of neck; indistinct in

front, but distinct at sides and back. Superficial abrasions of lips

and right cheek as from a gag. Faint marks of blisters on temples.

Fingers not clinched. Face livid, swollen. Eyes closed; conjunctivæ

congested; corneæ hazy; pupils normal. Tongue protruding and bitten;

not swollen. Fluid blood oozing from mouth and nose. Clotted blood

under scalp of left temple. Skin beneath cord had the color and

consistence of parchment. Muscles not torn. Hyoid, thyroid, and cricoid

not injured. Larynx, trachea, and bronchi empty; congested. Lungs much

congested. Some dark fluid blood in right side of heart; left side

empty. Liver, spleen, and kidneys congested. Small patch of congestion

in stomach. Intestines normal. Bladder normal, contained some urine.

Brain congested.

7. _Ibid., p. 234._—Hindoo woman, age about 40. Broad, circular,

depressed “parchment” mark, one inch broad, around the neck, between

hyoid bone and thyroid cartilage; made by two pieces of cloth, each

three feet seven inches long and one inch broad, twisted into a single

cord and tied tightly by three ordinary knots on right side of neck.

Superficial wound on left side of head above ear. Face turgid, swollen.

Eyes closed. Tongue between teeth and bitten; not swollen. Muscles of

neck uninjured. Trachea uninjured. Lungs congested. Right side of heart

full of dark fluid blood; left side empty. Liver and spleen congested.

Other organs, including brain, normal.

8. _Ibid., p. 235._—Hindoo woman, age about 25. Piece of cloth twisted

tightly twice around mouth. Double cord made of two twists of thin coir

rope tied tightly around middle of neck just below thyroid cartilage;

beneath the cord the skin was “parchment” like. No injury to muscles of

neck nor windpipe. Eyes closed. Face not flushed. Tongue not ruptured

nor bitten. Hands not clinched. Larynx, trachea, and lungs congested.

Right side of heart full of dark fluid blood; a little fluid blood in

left. Liver, spleen, and kidneys congested. Other organs, including

brain, normal. Dr. Mackenzie considered death to be due to “asphyxia or

suffocation.”

9. _Harvey: Ibid., January_ 1st, 1876, _p. 2_.—Hindoo woman, age 12

or 13. Faint mark on front of neck; none at back. Severe bruise on top

of head, under which was much clotted blood, but no fracture. Lungs

congested. Clots in right ventricle; left empty. Brain, larynx, and

trachea congested. The examiner believed that she had been stunned and

then suffocated by pressure of some soft substance against the neck.

10. _Ibid._—Hindoo man, age 20. Dead seven days; much decomposition

and discoloration. Wrists and ankles were bound. The two corners at one

end of a cotton _lungi_ (turban) were passed one on each side of the

neck and fastened in a knot under left angle of jaw. The _lungi_ was

then passed around the body under the arms, etc., so as to draw upon

the neck and be buried deeply in the swollen flesh. Under the bands

the skin was blanched; the tissues above the bands were black and much

swollen. Lungs, larynx, and trachea much congested. Heart empty.

11. _Ibid._—Cases of strangulation by sticks and other hard

substances. Boy, age 7 or 8. No external marks of violence. There was

hemorrhage from mouth and nose. Face swollen and crepitant. Congestion

of subcutaneous tissues and bruising of muscles of right side of neck.

Mucous membrane of larynx and trachea covered with blood. Lungs much

congested; blood in both pleural cavities. Heart empty; bloody serum in

pericardium. Brain congested; slight hemorrhage on surface. Abdominal

organs normal. Dr. Harvey states that the boy was no doubt strangled by

pressure of a _lathi_ on his neck.

12. _Ibid._—In another subject two sticks were tightly tied together,

one pressing on the front, the other on the back of the neck,

flattening larynx and other soft parts. In the following case some

hard substance, like a brick, had been wrapped in a cloth and used

for compression. Boy, age 15. Necroscopy: Large dark ecchymosis in

subcutaneous tissue of front of neck and upper part of chest. Also

marks of violence on chest and left side of face. Dissection of neck

showed blood-clot and also laceration of muscles. Trachea folded on

itself, showing that compression had lasted several minutes. Tongue

protruding and bitten. Eyes closed. Features calm. Trachea much

congested. Lungs congested. Great veins of heart and neck full of fluid

blood. Heart, dark fluid blood in both sides, mostly in right. Brain

and membranes much congested.

13. _Pemberton: Lancet, May_ 22d, 1869, _p. 707_.—Woman, age 60.

Found dead. Nose partly displaced and cartilages injured. Lips pale.

Mouth closed. Lividity of front of neck from jaw to sternum. Cricoid

cartilage ossified (cretified?) and broken on left side; hemorrhage in

surrounding tissues. Lungs and heart as usual in suffocation.

14. _Cullingworth: Med. Chron., Manchester, 1884-85, i., p.

577._—Woman, married, found dead. Bruise and ecchymosis beneath the

ear; effusion of blood in underlying tissue. Other bruises on face,

etc. Several bruises in mouth, on lips and tongue. Blood dark and

fluid. Brain and membranes much congested. No marks of injury on

throat. Lungs congested; surfaces emphysematous. Heart contained dark

fluid blood. Urine and fæces had been discharged.

15. _The Gouffé Case._—Murdered by Eyraud and Bompard in 1889. _Archiv

anthropologie criminelle, Paris, 1890, v., pp. 642-716; vi., 1891, pp.

17_ and _179_. Reports by Bernard, Lacassagne, and others. Gouffé was

decoyed into a room and strangled; afterward his body was tied up,

placed in a trunk, and taken some distance away. The murderers fled

to America; but eventually Bompard returned to France and Eyraud was

captured; both confessed. When found, the body was well advanced in

putrefaction; after a very careful examination was identified. He was

strangled by the pressure of fingers; the head was afterward wrapped

in a cloth which was held in place by five turns of a cord around the

neck; traces of the furrows made by these cords were found. Heart

empty; no blood in muscles of neck; hyoid bone intact but superior

thyroid cornua fractured at base.

16. _Horteloup: Ann. d’Hygiène, 1873, xxxix., pp. 408-416._—Man found

dead on some leaves in a fountain at bottom of staircase; skull and

spine fractured. The murderers stated that they had struck him on the

head with a crutch; then, believing him to be dead, carried him and

threw him into the fountain. When examined, his face was livid, tongue

between teeth and bitten nearly in two; and three parallel abrasions

on left side of neck and one on right; slight wounds about the face

in addition to the fractures mentioned. No report of examination of

lungs or larynx. Horteloup concluded that the man had been strangled to

death, and that when thrown into the fountain, alighting on his head,

the jaws were brought together and tongue bitten.

17. _Laennec: Journ. de med. l’ouest, 1878, xii., pp. 68-71._—Woman,

age 53; attempted strangulation by her husband. There were slight

ecchymoses on each side of neck under angle of jaw, most marked on

left side; when seen, she complained of lassitude and lively pain in

hypochondria and region of lower ribs antero-laterally; no sign of

lesion. She stated that she was awakened from sleep by pressure on neck

and chest and feeling of suffocation; she soon lost consciousness and

so remained for some hours. Her statements were corroborated by other

testimony. Laennec considered the case one of prolonged syncope from

pressure on carotids.

18. _Lancet, ii., 1841-42, p. 129._—Woman, found dead, her clothing

on fire and lower part of her body burnt. Necroscopy showed face and

neck swollen as low as thyroid cartilage, and purple; eyes prominent

and congested; mouth closed; tongue not noticed; front of neck below

swollen part showed two dark-brown hard marks and slight marks also of

pressure; on incision the vessels were engorged. Blood, fluid; brain,

congested. There were no vesications from the burns and no sign of

inflammation.

19. _Alguie: “Étude méd. and exp. de l’homicide réel ou simulé par

strangulation, relativement aux attentats dont Maurice Roux a été

l’objet,” Montpellier, 1864, p. 121._—This essay contains the reports

of many interesting experiments on animals and the cadaver. His

conclusions in this case were that the victim had first been struck on

the neck by a club; then a ligature was placed on the neck, with many

turns, tied tightly, but the knots did not remain tight. [The marks

were visible four months afterward.] The assailant then tied the limbs.

The victim recovered with temporary loss of voice, memory, etc.

20. _Gatscher: Mittheil. d. Wien. med. Doct. Colleg., 1878, iv., p.

45._—A man found hanging. The examiner declared that he had hung

himself. Eight years afterward, suspicion of violence. A commission

appointed. The protocol had shown the blood fluid; a red-brown dry

furrow around the neck; ecchymoses in connective tissues of same;

the entire back and posterior parts of limbs showed post-mortem

suggillation. The commission declared that the man had been strangled,

had lain for at least three hours on his back, and then been hung up.

The murderer confessed.

21. _Ibid., p. 46._—Woman, age 50, found dead in bed. Blood fluid; two

ecchymoses size of beans in crico-thyroid muscles of each side; patch

of hepatization size of fist, in lung; injury of body. The examiner

declared that she had been strangled by compression of larynx with two

fingers, but he could not say how long the pressure had continued, that

is, whether she had died of the strangulation or of the pneumonia. The

assailant stated that he had choked her and when she seemed to be dead,

had left her. The woman lived alone.

22. _Waidele: Memorabilien, 1873, xviii., pp. 161-167._—Husband and

wife quarrelled and fought; he stated that he choked her with her

neck handkerchief, and as she turned round toward him, then choked

her with his hand until she died. The examiner declared that she died

of asphyxia; there was a brownish-red dry streak on each side of the

neck in the laryngeal region corresponding to the handkerchief, and

also two small abrasions of skin which might have been made by the

hands; he concluded, however, that she had been choked to death by the

handkerchief, because there were no ecchymoses.

23. _Rehm: Friedreich’s Blätter f. ger. Med., 1883, xxxiv., pp.

325-332._—Woman, age 37. Choked by the hand on the neck, and at the

same time assailant’s knee pressed against her abdomen, pressing her

against a wall, causing hemorrhage around the pancreas. Death stated as

due to asphyxia.

24. _Schüppel: Vier. ger. öff. Med., xiii., 1870, pp. 140-156._—Woman,

just delivered of child, and boy ten years old, were burnt to death in

a fire which consumed their house. Examination of the bodies showed

upon the neck of the boy a groove, and his tongue protruded. The

husband was charged with murder, was imprisoned, and committed suicide.

25. _Weiss: Ibid., xxvii., 1877, pp. 239-244._—Woman strangulated by

the bands of her nightcap.

26. _Isnard and Dieu: Rev. cas jud., Paris, 1841, p. 101._—Man,

age 65. Marks of fingers on face and neck. Opinion that he had been

assaulted by two men. The two murderers confessed.

27. _Friedberg: Gericht. gutacht., 1875, pp. 211-224._—Woman found

hanging to branch of tree, but in half-lying position, feet on ground.

Opinion given that she had been strangled and then hung.

26. _Tardieu: “Pendaison,” p. 223._—New-born infant. Question whether

its death was due to asphyxia from compression of neck by the mother

with her hand to hasten delivery. He doubted the possibility of the

mother thus assisting her child. But the direction of the seven

excoriations on its face contradicted the mother’s statement. The

traces of finger-nails were distinct. The lungs and alimentary canal

showed that the child had lived. Opinion given, infanticide.

29. _Ibid., p. 219._—Woman, advanced in years, habits dissipated;

found strangled. Four excoriations on left side of larynx, one on

right; blood in subcutaneous tissue. Marks of nails and long scratches

on wrist. Injuries on face and left breast. She had been strangled by

one hand on her neck while the other was over her mouth and nose. Face

livid; eyes congested; frothy bloody liquid flowing from mouth and

nose; tongue behind teeth; bloody froth in larynx and trachea; lungs

large, much congested, splenized in places, surface emphysematous,

looking like white spots; black fluid blood in heart; brain somewhat

congested.

30. _Ibid., p. 216._—Wife of the celebrated painter Gurneray; found

dead in bed, where a fire had been placed and slowly burnt and charred

her lower limbs, belly, chest, and right hand. A running noose around

her neck. Injuries of head; face livid; tongue between teeth; brain

normal; mark of cord slight; subcutaneous tissue infiltrated with

blood. Marks of pressure on chest; bloody froth in trachea; lungs

congested; heart contained fluid blood. Opinion given that she had

been struck on head, causing unconsciousness; then partly stranded and

partly suffocated by pressure on neck and chest. Body afterward burnt

to cover up the crime.

31. _Ibid., p. 211._—Three murders by one man. All women. All injured

about the head and then strangled by both hand and ligature. Two died;

one had an odor of alcohol and had apparently not resisted. The third

was resuscitated. She was strong and stout, and resisted. Marks of

fingers and nails on neck. Afterward she had headaches and giddiness

for a long time.

SUICIDE.

32. _Francis: Med. Times and Gaz., December_ 2d, 1876, _p.

634_.—Hindoo lunatic, a giant, strangled himself. He passed two or

three coils of stout thread around his neck, attached the ends securely

to his wrists, and then extended his arms to their utmost limit. This

occurred during a ten-minute absence of his attendant, who, returning,

found the man had fallen to one side from a kneeling position, with his

back against a wall, quite dead. No reason to suspect homicide.

33. _Badahur: Indian Med. Gaz., December, 1882, p. 330._—Hindoo

woman, age about 17, strangled herself with the border of her _saree_.

Necroscopy: Circular depressed mark caused by the border of a band

of cloth, which she had passed in three coils around her neck, the

coils tightly overlapping each other; the short ends had been knotted

together with a “granny” knot at the back of the neck, like the native

women tie up their hair. The coils were so tight that they had to be

cut off. Face swollen, dark purple; conjunctivæ congested. Tongue

between the shut teeth; bloody froth issuing from mouth and nostrils

[the examination was in September, thirty hours after death]. Skin of

neck reddened in nearly a continuous line all around, both above and

below the band, about three-fourths inch wide, evidently caused by the

pressure of the three folds. Considerable ecchymosis above and below

the coils; the neck underneath the folds was swollen and red. Brain and

membranes much congested. Trachea, pharynx, and œsophagus congested.

Lungs congested. Right cavity (auricle?) of heart full, left empty.

Liver, spleen, and kidneys congested. Intestinal peritoneum congested.

Stomach contained half-digested food. Small intestines empty; fæces in

large intestine. Bladder empty. Uterus and appendages congested; no

evidence of catamenia.

34. _Harris: Ibid._—Woman; made a loop of her hair around her neck,

knelt down so as to put it on the stretch; when found, was nearly dead.

35. _Geoghegan: Taylor’s “Med. Jur.,” Am. Ed., 1892, p. 413._—Informed

Dr. Taylor of a suicidal strangulation by a ribbon. The mark on the

neck nearly disappeared after removing the ligature. There was bleeding

from one ear, from rupture of tympanic membrane. No froth from mouth or

nostrils; but little lividity or swelling of face.

36. _Taylor: “Med. Jur.,” Am. Ed., 1892, p. 418._—Boy: found dead with

handle of pitchfork under necktie; marks of strangulation on larynx;

eyes and tongue protruded; tongue livid and marked by teeth; brain

congested. Also man found dead with handkerchief tied around neck and

twisted by razor strop. Taylor considered both as suicides. Also a

third case (Amer. edit., 1880, p. 465). A man of unsound mind twisted

a fishing-net firmly around his neck several times; it remained secure

without the aid of a knot.

37. _Fargues: Rec. de mém. de méd., etc., Paris, 1869, xxii., pp.

443, 444._—Soldier, age 32, while drunk, strangled himself with his

handkerchief, wrapping many folds around his neck, making a deep furrow

without ecchymosis; face pale, eyes closed, lips partly closed.

38. _Borchard: Jour. de méd. de Bordeaux, 1860, v., p. 349 et

seq._—Collation of cases of suicide by strangulation: First, an

officer who placed his sabre scabbard under his cravat. Second, a

woman strangled herself with a silk cravat, tightly tied. Third, a man

tied the sleeve of his jacket around his neck and fastened the end to

a window, so that the strangulation was partly due to suspension.

Fourth, a woman strangled by a cord.

39. _Hofmann: Wien med. Presse, 1879, xx., p. 16, et seq. Also

Lehrbuch, p. 559._—Woman, age 20, found dead in bath-room, with a

thick thread passed three times around the neck, and tied tightly in

front at the second and third turns; so tightly that even after cutting

the cords the pressure continued. No signs of violence. (Illustration.)

40. _Zillner: Wien med. Woch., 1880, xxx., pp. 969, 999._—Woman, age

33; found dead on the floor; a neck-handkerchief tied in a firm knot in

front of the neck; and underneath, a cord passed twice around the neck

and knotted in front in the middle line between the larynx and hyoid

bone. Blood was flowing from the ears. No sign of violence or struggle.

41. _Bollinger: Friedreich’s Blätter f. ger. Med., 1889, xl., p.

3._—Man, age 48; melancholic; found dead. Had torn up part of a sheet,

fastened it around his neck and the ends around a bed-post, then placed

his feet against the farther post and pressed, tightening the ligature.

(Illustration.)

42. _Roth: Ibid., p. 9._—Man, age 68; melancholic; found dead in bed.

Had made loose ligature of cravat, tied into it a piece of wood; the

ligature lay in front of larynx. Had attempted suicide once before.

43. _Ibid._—Son-in-law at 36 years of age had committed suicide in the

same way.

44. _Ibid._—Man, age 63; found dead in his bed; cord around neck

inclosing piece of wood.

45. _Maschka: Vier. ger. öff. Med., 1883, xxxviii., pp. 71-77._—Woman,

age 45. A cloth was found wound tightly three times around her neck in

front of larynx, and tied in a simple knot. There were also injuries

of the head. At first it was thought that she had been murdered, but

Maschka concluded that she had committed suicide.

46. _Ibid._—Woman; supposed to have been murdered by her son. There

were marks on the neck and other injuries, and hemorrhage into the

brain. Maschka concluded that the marks on the neck were not due to

strangulation.

47. _Hackel: Dorpat Diss., 1891, p. 34._—Man, age 48; strangled

himself with part of a mattress. Was found lying on his back, dead,

holding the ends in his hand. There was a double mark of ligature.

48. _Binner: Zeitsch. f. Med-beamte, 1888, i., pp. 364-368._—Woman;

suicided by choking herself with her hands.

For other cases, see Tidy, “Med. Jur.,” Cases 20 to 65; Maschka,

“Handbuch,” p. 625.

ACCIDENT.

49. _Bédié: Rec. de mém. de Méd., etc., Paris, 1866, xvi., pp.

482-484._—Soldier, age 39, found dying, lying on his bed; had returned

to his room drunk and lay down in his uniform. Face much congested;

lips cyanosed; eyes closed. Skin of neck below thyroid cartilage showed

deep mark from pressure of collar of uniform where the collar was

fastened; had passed urine into his clothing. When examined after death

his face was pale yellow, lips cyanosed, eyes closed; large hypostatic

patches; traces of pressure on neck still visible; lungs congested;

larynx, above level of pressure, congested; below was normal. Fibrin

clots in both ventricles of heart. Liver, spleen, stomach, and

intestines congested. Brain somewhat congested. Bladder contained urine.

50. _Liégey: Jour. de Méd. chir. et pharm., Brussels, 1868, xlvi.,

pp. 339-342._—Infant, age 8 months, accidentally strangled; it had

been placed in its cradle; coverlet over it and held in place by a

cord passed across. Some time afterward it was found dead beside the

cradle, its head hanging with the right side pressing on the cord.

Liégey had the mother replace everything as it had been and satisfied

himself that the above statement was correct. When found, the face was

pale, eyes and mouth closed; transverse furrow on right side of neck,

level of larynx, 3.5 cm. long, one deep; muscles in vicinity congested.

Lungs congested. Right side of heart contained clotted blood; left

side nearly empty. He concluded that the case was one of accidental

strangulation.

51. _Friedberg: Gericht. gutacht., p. 240._—New-born child found dead

in closet. Mother stated that she had taken the child by the neck

and drew it into the world. Opinion given that the child had been

accidentally choked to death by the hand.

For other cases, see Tidy, “Med. Jur.,” Cases 15 to 19, 59, and 62;

Maschka, “Handbuch,” p. 623.

HANGING.

Hanging is a form of mechanical suffocation by ligature of the neck,

in which the constricting force is the weight of the body itself. The

French call it “Pendaison” or “Suspension,” preferably the former; the

Germans, “Erhängen.” The expression “incomplete hanging” is applied

to those cases in which the subject is partially supported; kneeling,

sitting, or otherwise. The same expression has also been used for cases

which did not prove fatal.

The pathological effects of hanging are partly those of strangulation,

to which must be added the effects of the weight or fall of the body,

sustained as it is only by some form of ligature around the neck. These

additional injuries will, of course, be proportioned to the weight of

the body, length of rope, and suddenness of the fall.

In some countries, as the United States, England, Germany, and

Austria, hanging is a mode of capital punishment. It is desirable

that for judicial purposes it should be divested, as far as possible,

of unnecessarily cruel features; the victim should quickly be made

insensible, and death be speedy. Many suggestions to this end have been

made, among which is that of Haughton. He recommended that the drop be

long, say ten feet, so that the cervical vertebræ may be dislocated.

He also advised that the knot be placed under the chin. Others advise

that it be placed under the left ear; and others yet, as Barker, of

Melbourne,[798] near the spine. In any event the rope should be “freely

elastic.” G. M. Hammond[799] thinks that the object in judicial hanging

should be strangulation, and that the criminal should be pulled up and

left to hang thirty minutes; the rope should be soft and flexible so

as to closely fit the neck; a weight should be attached to the feet of

persons under 150 pounds. Larimore[800] also advocates strangulation

instead of attempting dislocation of the vertebræ. Porter[801] suggests

that for dislocation the noose be drawn tightly around the neck at the

last moment, the knot being either at one side or, still better, in

front. Dislocation may be still further assured if a hollow wooden or

leaden ball be placed over the knot close to the neck, thus forming a

fulcrum to throw the spinal column out of the perpendicular line at the

point of pressure.

Hanging is a common mode of suicide, especially in insane asylums and

prisons. It is sometimes accidental, and rarely homicidal. It is said

to have been attempted for erotic purposes.

The compression of the neck acts in line with the axis of the body;

while in strangulation it acts perpendicularly to that axis.

The final cause of death will depend on: 1. The suddenness and

completeness of interference with the access of air; asphyxia. 2.

Pressure on the large veins of the neck, preventing the return of blood

from the head, causing congestion of brain and coma. 3. Pressure on the

large arteries of the neck, preventing access of blood to the brain;

causing anæmia of the brain and syncope. 4. Injury to spinal cord or

pneumogastric nerves or all of them; causing paralysis. A combination

of numbers 1 and 2 is usually found in suicidal hanging; and probably

all of them in homicidal and judicial hanging. The more protected the

air-passages are from pressure the greater part will coma or syncope

have in the cause of death.

Mackenzie,[802] as the result of examination of 130 suicidal hangings,

says that 119 died of asphyxia, 8 of asphyxia and apoplexy, 2 of

syncope, and 1 of apoplexy alone. Coutagne[803] thinks œdema of the

lungs, “œdema carminé,” has an important part in causing death.

The following conditions tend to produce asphyxia: a tight ligature,

or a loose ligature above the hyoid bone. To produce coma, a loose

ligature pressing against the hyoid bone or larynx, especially a

cretified larynx. To both asphyxia and congestion of brain, a ligature

just beneath the lower jaw, or around lower part of neck.

Hofmann[804] states that when the ligature is placed between the larynx

and hyoid bone, the base of the tongue is pushed upward against the

posterior wall of the pharynx, completely stopping respiration and

causing asphyxia. Taylor[805] states that if the rope presses on or

above the larynx, the air-passages are _not_ so completely closed as

when pressure is below the larynx. In the latter case death would be

immediate; in the former a slight amount of respiration might continue.

The instantaneous loss of consciousness is due, not to asphyxia alone,

but to compression of the large vessels, especially the carotids,

against the transverse processes of the vertebræ, causing rupture of

the middle and inner coats, and at the same time compression of the

jugular veins and pneumogastric nerves. Immediate unconsciousness will

almost certainly follow compression of the pneumogastrics. He also

believes that the loss of consciousness and of power of self-help

occur at the moment that the noose is tightened around the neck. There

is no record of any one who attempted suicide by hanging seeking to

recover himself, although no doubt some would have done so if the

speedy unconsciousness had not prevented. Hofmann mentions the case of

a man who was found hanging, and with a loaded revolver in his hand,

apparently having intended to shoot as well as hang himself, but lost

consciousness before he had time to discharge the revolver. According

to him the causes of death are three: occlusion of the air-passages,

interruption of passage of blood to brain, and compression of

pneumogastric nerves.

Von Buhl[806] experimented on cadavers and concluded that in hanging,

the epiglottis and arytenoids are pressed over the glottis, and the

tongue and the œsophagus against the vertebræ, causing death by

apnœa. When the trachea was isolated from the vessels and tied, the

air-passages below became dilated and the lungs emphysematous and

anæmic. The heart continued to beat and blood to circulate.

The vertebral arteries being much smaller than the carotids, the

circulatory disturbance in the brain is not adjusted with sufficient

promptness. Compression of the pneumogastrics, according to

Waller,[807] has caused subjects to fall to the ground as if struck by

lightning. He holds that the unconsciousness in hanging is the result

of the compression of the pneumogastric nerves and not of the arteries.

Thanhöfer[808] knew a student who had acquired a certain dexterity in

compressing these nerves. One day he compressed the two nerves, his

pulse stopped and he became unconscious. Thanhöfer[809] tried bilateral

compression of pneumogastrics in a young man sentenced to be executed.

The pulse fell at once and the heart soon stopped; the eyes were fixed

and glassy. It was some time before he regained consciousness and for

two days there was _malaise_.

Hofmann says that the compression irritates and, in a higher degree,

paralyzes the pneumogastric nerves and causes disturbance of the action

of the heart.

Faure[810] denies that the constriction of the vessels of the neck has

any effect in the production of symptoms[811].

Coutagne believes that the pressure on the pneumogastric nerve is a

factor in causing death. He hung two dogs; in one the pneumogastric

nerves were dissected out and placed in front of the ligature; this

dog (No. 1) lived a quarter of an hour and died of pure asphyxia with

efforts at inspiration continued to the end. The other dog (No. 2),

in which the nerves were compressed, died in five minutes. In both,

the abdominal organs were congested and the cavities of the heart

were full. The lungs of the first were dry and uniformly red; of the

second were resisting, crepitant, and quite œdematous. No subpleural

ecchymoses in either. The experiments on animals by Corin[812] led

him to conclude that pressure on the pneumogastrics caused increased

frequency of the heart-beat and slowing of respiration. Pellier[813]

considers the subject quite fully. It would appear that the pressure

on the pneumogastrics disposes to stop the action of the heart and

cause rapid, perhaps instant death. The pressure on the carotids

causes cerebral anæmia and is then only a secondary cause. Levy[814]

does not think the action of the pneumogastrics is sufficiently well

known.

Tidy states that a dog lived for three hours suspended by a rope placed

above an opening in the windpipe; and that Smith[815] mentions the case

of a criminal who was hung; Chovet tried to save the man by making an

opening in the trachea before the execution and introducing a small

tube. The man was alive forty-five minutes after the drop, but could

not be resuscitated, although the surgeon bled him.

In a small proportion of cases of hanging, homicidal and judicial,

death occurs by dislocation of the spine. This is said to have been

first noticed by the celebrated Louis, who states that the Paris

executioner was in the habit of giving a violent rotary movement to

the body of the convict as the trap was sprung, causing a dislocation

of the odontoid process and compression of the cord and almost instant

death. Taylor[816] says that for dislocation the body must be heavy and

the fall long and sudden. Devergie[817] found this to occur in about

two per cent of cases. It is said that the Paris hangman placed the

slip-knot under the chin in front, which is as Dr. Haughton suggests.

Death may occur from secondary causes after apparent recovery; from

congestion of brain and other lesions of the nervous system; these may

prove fatal at remote periods.

Fracture of the odontoid process according to M. de Fosse is more

common than dislocation, and the giving away of the intervertebral

substance more likely than either of the others. The phrenic and

other respiratory nerves are likely to be paralyzed; the vertebral and

carotid arteries may be ruptured. The medulla oblongata is also likely

to be fatally injured. Death may also occur from hemorrhage upon the

cord, causing pressure.

Besides the ropes used as ligatures in judicial hanging, almost every

conceivable article that could be made into the semblance of a cord has

been used by suicides; usually, however, some portion of the bedding

or clothing. When one resolves on suicide, all the precautions of the

managers of prisons and asylums fail to prevent.

The secondary effects in those who recover involve the respiratory

organs—dyspnœa, cough, bloody sputa, bronchial râles, and fever;

or the nervous system—aphonia, dysphagia, numbness, chilliness,

spasms, pains in neck, face, or shoulder; sometimes paralysis of

bladder and rectum, and loss of memory. The marks on the neck slowly

disappear.[818] Verse[819] collated a number of cases in which the

hanging was not completed and the subjects lived for varying periods

afterward. Wagner and Möbius[820] discuss the spasmodic seizures and

amnesia, which often appear after the restoration from hanging.

SYMPTOMS IN HANGING.

Obviously these will be in some respects identical with those of

strangulation. In considering the latter, some of the similarities

and dissimilarities of symptoms and post-mortem appearances of

strangulation and hanging were mentioned.

Death may be immediate and without symptoms.

There is, of course, no preliminary or “waiting” stage, as in

strangulation, except in those rare cases of suicide where the subject

inclines his body forward with his neck against the ligature, his

body being near the floor or ground. The absence of a drop makes this

condition very similar to ordinary strangulation. The body of a victim

of homicide might be similarly placed for the purpose of deception, and

also that of a subject previously made unconscious; in these cases the

symptoms and appearances would resemble those of strangulation.

In other words it is necessary that there should be a drop or fall,

or at least the weight of the body, to produce the characteristics of

hanging. The jerk of the fall or sudden dependence of the body upon

the ligature causes a much greater constriction of the ligature on the

neck, and in a different direction, than in strangulation; and also a

much greater pressure on the blood-vessels and nerves of the neck.

Tidy divides hanging into three stages:

First stage: Partial stupor lasting thirty seconds to three minutes,

according to the length of the drop, the weight of the body, and

tightness of the constriction. The testimony seems to be uniform that

there is no pain in this stage; indeed, that the feeling is rather one

of pleasure.[821] The subjective symptoms described are an intense heat

in the head, brilliant flashes of light in the eyes, deafening sounds

in the ears, and a heavy numb feeling in the lungs. Sometimes there

is a feeling of absence of weight. In many cases efforts to breathe

are made for a time after the air-passages are closed. It is doubtful

whether there are any voluptuous feelings, as has been suggested.

Chowne[822] reports the case of Hornshawor, “Monsieur Gouffé,” who was

in the habit of hanging himself for exhibition. He fixed the noose

with a knot that would not slip, sprang into it, the rope coming

behind the lower jaw and the two sides passing up behind the ears.

He would hang for ten to fifteen minutes, and in addition to his own

weight would sustain one hundred and fifty pounds. Three times the

rope slipped and he would have died but for the help of spectators. He

described his sensations as follows: He lost his senses all at once.

The instant the rope got in the wrong place he felt as if he could not

get his breath, as if some great weight was at his feet; and could not

move only to draw himself up; felt as if he wanted to loosen himself

but never thought of his hands. He said: “You cannot move your arms or

legs to save yourself; you cannot raise your arms; you cannot think.”

Taylor[823] mentions the case of Scott, the American diver, who was

in the habit of making public exhibitions of hanging. The last time

he hung for thirteen minutes, the spectators not suspecting that he

had died. It is supposed that the ligature had slipped. Taylor also

reports a case (from Dr. Elliott) of a boy, age 11, who, to frighten

his parents, tied a knot in a handkerchief and put it around a knob

and his neck in one continuous ligature. The pressure against the

trachea was so effective that he became unconscious and died before

he could relieve himself.

Second stage: The subject is unconscious and convulsions usually

occur. The convulsed face, however, is a part of the general agitation

and does not indicate pain. In judicial cases the face is covered

with a cap. Sometimes there are no spasms. Urine, fæces, and semen

may be discharged in any stage. Jaquemin, however, in forty-one

cases of hanging, noted discharge of urine and fæces only twice.

Semen has, however, been found in the urethra where none was ejected

externally.[824]

Third stage: All is quiet except the beating of the heart. As a rule,

the pulse may be felt for ten minutes.

Blankenship[825] reports an execution of a man by hanging. After

the rope was adjusted the pulse was 121; first minute after drop,

pulse 54; second minute 52; third 39; fourth 20; fifth 0; sixth 70;

seventh 73; eighth 0; ninth 34; not perceptible afterward. Died

from strangulation; neck not dislocated. The heart beat once in the

nineteenth minute; from the ninth to the nineteenth, only two or three

times. No priapism.

In judicial executions, however, the right auricle is found in action

when the subject is taken down at the end of the usual period of

suspension (see Case 89). Tardieu mentions a case where the heart

was beating 80 to the minute one and one-half hours after supposed

death. It is probable that in these cases the deprivation of air and

compression of the vessels has not been complete. In such cases life

may sometimes be restored. Cases are reported where restoration has

been possible within a period of a half-hour of suspension; although

the fatal period is usually five to eight minutes at most. If, however,

the tissues and especially the spinal cord are injured, or the ligature

has compressed below the larynx, the chance of recovery is very small,

even if the body is cut down at once. According to Faure, animals

experimented upon die in twelve to twenty minutes.

Many cases of “incomplete” hanging have been reported; where the feet

touch the floor, or would do so if the subject should choose to have it

so. Tardieu[826] collected 261 cases, in 168 of which the feet touched

the ground, in 42 the subject was on his knees, in 29 the body was

lying, in 29 sitting and in 3 squatting. Hackel,[827] in 67 cases of

hanging, found it incomplete in 34 per cent.

[Illustration: FIG. 22.—Suicide of Prince Condé. (See page 763.)]

In one of the experiments of Faure[828] a large dog was hung, his feet

touching the ground. For five minutes he was quiet, breathing without

difficulty. He then tried to release himself, but instead tightened

the knot; he made still greater efforts to release himself, became

comatose and fell, apparently dead, at the end of ten minutes; was

really dead in twenty-eight minutes.

In incomplete hanging the upper limbs may have any position; the lower

limbs are disposed according to the position of the body (Cases 1, 10,

18, 19, 20, 22, 24, 26, 28, 37, 43, 50, 56).

Faure[829] made many observations on dogs which he killed by hanging.

He describes the results as follows: The dog remains quiet usually

twenty to thirty seconds, sometimes eight to ten minutes; then becomes

violently agitated, the body being thrown forward and backward so

powerfully that it bounds to a great height; the head is in motion;

the jaws parted; the feet extended and flexed; sometimes brought up

to the mouth and neck, trying to remove the obstruction; the inside

of the mouth is violet-colored; tongue blackish, livid, may be

bitten, often falls backward; the teeth are ground together; the eyes

sometimes protrude; conjunctivæ congested; urine and fæces discharged.

The agitation lasts two to five minutes, and then the dog gradually

becomes quiet. Toward death, however, the agitation is renewed but in

a different way; the fore feet are raised and put forward, the tongue

often has a peculiar spasm, the chest is raised, the eyes drawn back

into the orbits, pupils contracted; all of this is over within two

seconds. Such paroxysms may be repeated half a dozen times. In dying,

the eye oscillates from side to side and the pupil dilates. The heart

beats some time longer.

Francis Bacon records that he knew a man who wanted to find out by

experience if there was any suffering in hanging. He placed the cord

around his neck and stepped off a bench, intending to step back again,

but became immediately unconscious and would have died but for the

opportune arrival of a friend. He said he saw a light before his eyes.

TREATMENT.

The first indications obviously are to let the subject down, and remove

all constriction of neck and chest. Artificial respiration should then

be used, and this may be assisted by the vapor of ammonia to the nose

and tickling the fauces. If the body is warm, cold affusions may be

applied to the head and chest, and galvanism may be used.

If the body is cold, apply warmth. Friction of the limbs aids in

restoring warmth. If the subject can swallow give stimulants; these may

also be used by rectum. Venesection may be required to relieve cerebral

congestion or distention of the right heart and pulmonary circulation.

The following cases illustrate what may be done to resuscitate one

who has been hanged: A man, age 35, in good health, weight one

hundred and sixty pounds, was executed with a drop of over six feet;

the rope slipped behind the mastoid process. After three minutes

his struggles ceased; the radial beat ceased at six and one-half

minutes; all signs of life at ten and one-half minutes, and the body

was blue. Fourteen and one-half minutes, body let down; mark about

one-fourth inch deep on neck; swelling above and below; no fracture

of vertebræ. Strong galvanism of the pneumogastrics after sixteen

or seventeen minutes at intervals of four seconds caused marked

respiratory efforts; sixty-six minutes, galvanism renewed; heart-beat

and radial pulse recognized; epiglottis swollen, requiring the tongue

to be drawn forward; a few ounces of blood removed; pupils contracted.

One hundred and four minutes, galvanism renewed; subject swallowed

a little brandy-and-water. One hundred and thirteen minutes, slight

muscular action; cornea sensible. One hundred and eighty-six minutes,

feet warm, carotid pulsation. Signs of life now increased till six

hours after drop, when pupils began to dilate again. Twelve to fifteen

ounces of blood were taken and pupils again contracted and pulse

beat strong and steady; breathing easy, more regular; eyes followed

movements of persons around the room. Died nine hours later, fifteen

hours after drop. The experiments were repeatedly interrupted by the

sheriff.[830] Taylor[831] reports a case of recovery. Woman, age 44;

found hanging from a clothes-line, thrown over a door and fastened to

a handle on the other side; her knees on the floor; white froth around

the mouth; tongue protruding and swollen; face dusky and swollen; lips

dark blue; brown parchment mark on neck; skin abraded over larynx;

conjunctiva insensible; pupils dilated and fixed; fingers clinched;

limbs flaccid; no reaction from tickling feet; no respiration; faint

heart-beat and fine thready pulse. Sylvester’s artificial respiration

method used at once and continued for four and one-half hours; tongue

held forward by forceps. One hundred and fifteen minutes after body

was first seen there was spontaneous movement of legs. One hundred and

forty-five minutes, conjunctivæ sensible. One hundred and seventy-five

minutes, retching. Two hundred and five minutes, free vomiting. She

recovered but remembered nothing of the hanging. Keen[832] reports the

results of experiments upon a criminal who was executed by hanging.

He was cut down about half an hour after the drop. Faradization

and galvanization of pneumogastric and recurrent laryngeal nerves

caused movements of left vocal cord, but not the right; there was no

reflex motion in the larynx. The left phrenic nerve made no response

to stimulus. The internal intercostal nerves caused the raising of

the cartilage below them (inspiratory), the external intercostals

depressed the upper seven ribs (expiratory), and raised the eighth.

The other four not examined. The muscles of the face retained their

contractility.

Very few, comparatively, however, have been restored after hanging. For

cases of recovery see _Medical Times and Gazette_, London, 1871,

Vol. I., p. 669 (Cases 12, 13, 42, 44, 47, 49, 66).

POST-MORTEM APPEARANCES.

The post-mortem appearances are external and internal.

The =external= appearances are those due to the action of the ligature

on the neck and to other violence, if any has been done, and those due

to asphyxia or syncope.

The MARKS of the ligature. If the suspension be very brief and the

ligature soft and supple, and the body instantly cut down after death,

there may be no mark. Allison[833] questions the value of the mark,

contending that it is post mortem, and reports cases; says it is

present only if the drop be considerable or the suspension continue

after death. Tidy says that the mark is, in a measure, independent of

the ligature and duration of suspension, and does not usually acquire

its color for some hours after death; sometimes, however, it has

occurred in a much shorter time. It may be slight because the ligature

has been placed over the clothing. The longer a body hangs after death,

the more the mark shows. It can be produced upon the cadaver.

Harvey[834] says: “The characteristic mark is sometimes found in

non-fatal cases.... In eight instances in the present returns (of

nearly 1,500 cases of hanging) there was a distinct mark.”

Coutagne,[835] in twenty-four necroscopies on subjects hung, found

only slight or doubtful lesions in five cases; but of these, one

was in a condition of advanced putrefaction, another was apparently

weakened by loss of blood from wounds, and in the other three there

were marks of violence. In seventeen cases the lesions of the neck

were plain; hemorrhage in connective tissue or muscle.

The direction of the mark is usually oblique, following the line of

the lower jaw upward and backward behind the mastoid processes; it

may, however, be horizontal. If the ligature encircles the neck more

than once, one mark may be circular, the other oblique. If a running

noose is used the mark may be circular, and be seen all the way around

the neck, looking like the mark of a strangulation. Taylor[836] states

that if the noose should be in front, the mark may be circular, the

jaw preventing the ligature from rising upward in front as much as it

does behind. If it encircles the neck but once, its continuity is apt

to be broken by the prominence of the hyoid bone, thyroid cartilage,

sterno-mastoid muscles, etc.

In four-fifths of the cases (117 out of 143, Tardieu) the mark is found

between the chin and larynx; in nearly all the remaining fifth, over

the larynx; in a very few below the larynx; the last position is due

to the protection of the neck by a handkerchief or beard, or where

there is some anatomical or pathological peculiarity which prevents the

ligature from going higher.

Hofmann[837] had seen two cases of tumor of neck; one in a woman,

where the cord was below the larynx; and in a man where it was over

the larynx. He quotes[838] as follows: Remer, above larynx, 38;

over larynx, 7; below larynx, 2. Devergie, above larynx, 20; over

larynx, 7; below larynx, 1. Casper, above larynx, 59; over larynx, 9.

Roth[839] in 49 cases found the ligature mark above the hyoid bone

in 5; between the bone and the larynx, 31; over the larynx, 8; below

the larynx, 1. Hackel found the ligature in forty per cent of cases

between hyoid bone and larynx; in sixty per cent lower down. The

ligature always appears lower after the body is laid down than it was

in suspension. Maschka found the furrow 147 times in 153 cases above

the larynx.

The mark will vary in character according to the kind of ligature used,

its mode of application, the vitality of the tissues, and the period

that has elapsed since death. The result is different according as the

knot or loop is single or double, a running or slip knot.

The mark may differ in character in one part of the neck from another.

The same furrow may be soft in one part and dry in another. The width

of the mark does not necessarily correspond to the diameter of the

ligature. A double mark usually means that the ligature has been twice

passed around the neck, although the marks may not be continuous or

parallel. Tardieu states that a large single leather thong pressing

on the neck only by its borders may make a double mark. The mark is

usually _depressed_. The depth of the depression, groove, or furrow,

as it is called, is greater the narrower and firmer the ligature, the

longer the suspension, and the greater the weight of the body. The

mark may be merely a slight depression, without color, or only a red

blush, if the subject is young, tissues healthy, and suspension brief.

Roth,[840] in 49 cases of hanging, found the furrow of the ligature was

brown in 40, red-brown in 6, and 3 times bluish.

In about two-thirds of the cases the bottom of the furrow, the

place of greatest pressure, is white, especially so where the knot

is tied; while the edges of the furrow are usually slightly raised

and red or livid. If the subject is very fat, there may be only a

slight depression. Harvey[841] says that this hard, white, shining,

translucent band from compression of the connective tissue is the first

stage of the parchment or vellum skin, and is chiefly noticed in fresh

bodies. The borders are swollen and œdematous, called by Lacassagne

“_bourrelet de sillon_.”

The skin beyond the furrow is usually violet. Authors differ as to

whether this is due to congestion or hemorrhage. Roth[842] in 49 cases

found swelling below the furrow 27 times. Hackel found ecchymoses above

the mark in thirty-five per cent of the cases of hanging. Hofmann

thinks that the lividity of the upper border of the furrow is due to

the stopping of the venous blood descending from the head.

The dry, hard, yellowish-brown, or reddish-brown “parchment” furrow,

described by writers, is said to be common. Ogston[843] found it in

one-third of his cases. It is found only when the body has remained

suspended for several hours after death; indeed, may be produced by

applying the ligature to the cadaver; is not at all, therefore, a proof

of suspension during life. Liman states that constriction by a ligature

even for some time does not necessarily cause a mummified or excoriated

furrow. He saw cases in which the mark was soft, flat, scarcely

colored, but little interrupted, and not parchmenty. The parchment skin

seems to depend very much upon a previous excoriation of the skin. Its

appearance can be prevented or delayed by examining a body soon after

death or by rehanging it; and after it has appeared it will disappear

on the application of some liquid. Taylor[844] compares this parchment

mark to the cutis from which the cuticle has been removed for two or

three days.

Slight abrasions and ecchymoses are sometimes found in the furrow.

Ecchymoses alone do not indicate whether suspension has been before or

after death; but abrasions with hemorrhage strongly suggest suspension

during life. Devergie regards ecchymoses of the neck as strongly

suggestive of homicide. Neyding[845] says that suggillation in the

groove is oftener found in strangulation than hanging. And Bremme[846]

that there is no hemorrhage in the subcutaneous tissue of the mark if

death occurs at once and the cord is removed at once after death; but

if the cord remains for some time after death there may be hemorrhage,

or if death does not occur at once, whether the ligature be removed or

not.

Roth[847] found ecchymoses or small bladders at the lower margin of

the furrow, 9 times in 49 cases. Riechke found only once in 30 cases a

hemorrhage beneath and on both sides of the mark. Chevers did not find

ecchymoses of the skin of the mark in cases of hanging. Casper found no

ecchymoses in 50 of 71 cases. Maschka has seen two cases where burns on

the neck resembled mark of ligature.

The furrow, when once distinct, remains constant for a long time after

death, even in putrefaction. Marks from soft substances, however,

disappear sooner than those from strong and uniform compression.

The NECK nearly always appears stretched. According to Roth the

mobility of the head is increased by this stretching. The HEAD is

always inclined to the opposite side to that of the knot. In suicides

the head is usually bent forward on the chest. The HANDS are often

clinched so tightly that the nails are driven into the palms. This

occurs more especially when the hanging has been done with violence.

When the feet touch the ground, as often occurs in suicide, the hands

may be stretched out. Roth found the hands and feet flexed in 44 of 49

cases. Taylor says that we may expect to find the hands clinched when

constriction of the neck is sudden and violent. The LEGS are usually

livid.

The FACE varies with the duration of the suspension; at first it is

pale, afterward livid; congested and swollen, if the subject has been

long suspended. Roth found the face pale in 43 of 49 cases. In about

one-half the cases the features are calm and placid (syncope). Maschka

found the lips bluish in 98 of 153 cases. The EYES are often prominent,

staring, and congested, and usually the pupils are dilated. Lacassagne

and Maschka[848] look upon ecchymoses of the eyelids and conjunctivæ,

“_piqueté scarlatin_,” as important as favoring the idea of hanging

or strangulation. Roth found in 49 cases the eyelids closed 28 times;

half open, 12; congested in 6; ecchymosed in 2. Pupils dilated in 31;

narrowed in 2. Dilated in 97½ per cent of Ogston’s cases (Cases 85,

86; rupture of crystalline lens). Harvey[849] says the blood was found

flowing from the EAR in 6 cases of nearly 1,500, but no details were

given. Ogston, one case. Hofmann saw a case in which there was bleeding

from the ears. He says this is not due, as has been supposed, to

rupture of the tympanic membrane, but to hemorrhage from subcutaneous

vessels (Case 27).

The TONGUE is usually livid and swollen, especially at the base.

According to Tidy, Dr. Guy looks on this as showing that suspension

took place very probably during life. In about one-third of the cases

the tongue is protruded and compressed between the teeth; sometimes

bitten. Some observers found it protruded only as a result of

putrefaction. The protrusion of the tongue is not believed to depend

on the position of the ligature. Hackel in 67 cases found the tongue

lying forward in all cases where the cord was between the larynx and

the hyoid; in 55 per cent in front of the teeth, in 18 per cent between

the teeth; where the ligature was lower down, the tongue was behind

the teeth. He found by experiment that in the spasmodic expiratory

effort the tongue was thrust forward; in the inspiratory movement,

drawn backward. He concluded that the forward movement was the result

of reflex action. Maschka[850] found the tongue between the teeth 58

times in 149 cases. Roth in 49 cases found the tongue projecting and

bitten in 22, the teeth shut in 15 others; in 15 the mouth was open;

the tongue was retracted in 30 cases.

Harvey, after examining reports of nearly fifteen hundred hangings,

says: “In the majority of instances immediately after death the

features were placid, the face pale, the eyes not unduly prominent,

the mouth closed or half open, the tongue pressed against the teeth

but not protruding; the superficial veins full, but the head, neck,

and trunk free from lividity. After a longer or shorter time, however,

and apparently after a very few hours, in India, all this is changed.

Livid patches appear about the chest, back, and shoulders; the face

and head become bloated and puffy, the tongue and eyes protrude.”

Bloody froth is sometimes seen at the nose and mouth.

SALIVA is invariably secreted and runs out of the mouth down on the

chin and chest. Its presence is considered as evidence that suspension

occurred during life. The URINE and FÆCES are sometimes found to have

been expelled. These discharges occur in all kinds of violent death.

Tardieu found them, however, but twice in 41 cases of hanging. Roth in

49 cases found discharges of fæces in 17 and urine in 4; in 15 cases

not noticed.

Harvey mentions a case where internal piles had burst, and there were

stains and clots of blood about the perineum and anus. In such cases

without careful examination there would naturally be a suspicion of

violence.

In about one-fourth of the cases the GENITAL ORGANS are congested.

The penis is large and more or less erect; seminal fluid, generally

prostatic, and sometimes mixed with blood, is often expelled. The fluid

may pass only into the urethra and it may be necessary to press the

urethra to secure it. The clitoris may be found erect, and there may be

a sort of menstrual flow. Orfila showed by experiment that swelling of

the sexual organs and emission of semen can be produced after death in

those who had been suspended during life. The flow of semen is found

in all kinds of death by violence. Roth in 39 cases of hanging of men

found the penis enlarged 18 times and ejaculation in 19. Hackel found

the penis swollen in 43 per cent of cases of asphyxia. Erection may

come on soon or late, even days after death.

=Internal Appearances.=—The CONNECTIVE TISSUE UNDER THE MARK is

usually white and condensed, the more so if the body has been long

suspended. This dryness or condensation was found by Hackel in 52 per

cent of hangings. Deeper-seated parts are injured only when the hanging

has been violently done. The MUSCLES, especially the sterno-mastoid,

are sometimes ruptured. Hofmann[851] reports several cases.

Lesser[852] in 50 hangings saw 11 ruptures of muscle. Maschka never saw

the rupture in suicides. The sterno-mastoid was ruptured in the case

of Wirtz (Case 96) and Guiteau (Case 95). Hackel in 67 cases failed to

find the muscle ruptured. Hofmann[853] believes that the rupture of the

muscle is sometimes post mortem. Coutagne[854] found the sterno-mastoid

muscle ruptured once in 24 cases (Cases 29, 89, 95, 96).

The LARYNX may be fractured or dislocated. These lesions are very

rare in suicide; more frequent in homicide and judicial hanging,

and in the old where the cartilages are calcareous. Remer found the

injury in but 1 case in 101 of suicidal hanging. Barker found the

larynx _lacerated_ in his judicial cases.[855] Harvey says that the

TRACHEA was reported lacerated 11 times in nearly 1,500 cases; twice

the laryngeal cartilages were separated from each other. In 5 these

cartilages were fractured, but there was nothing to show under what

conditions. Hemorrhage in vicinity of larynx, 43 times. Pellier[856]

reports 1 case, and adds that the existence of the lesion easily

escapes notice because of the mobility of the cornua. Roth in 49 cases

failed to find any fracture. Pellier found the cricoid was injured

oftener than the thyroid, which is the reverse of what is found in

strangulation. Cavasse[857] was unable to cause fracture of larynx by

hanging the cadaver. Chailloux[858] collected 6 cases of fracture of

larynx in hanging. He concluded that the fracture could not be produced

on the cadaver by hanging, and is, therefore, caused during life.

Coutagne[859] in 24 cases found fracture of thyroid cartilage 8 times

(Cases 9, 51, 82).

The HYOID BONE is rarely dislocated. Orfila mentions a case of

fracture. Barker found the bone usually fractured in judicial cases.

In the case of Wirtz (_supra_) the greater cornu was broken. Pellier

reports 2 cases. Hofmann[860] says the hyoid cornua are often

fractured, especially when the ligature is between the hyoid bone and

thyroid cartilage. Coutagne found fracture of hyoid bone 8 times in

24 cases. He attributed the fracture to pressure against the spine.

Pellier speaks of fracture of STYLOID PROCESS (Cases 51, 84, 88, 89,

95, 96).

Dr. Barker, of Melbourne,[861] states that in 50 cases of hanging by

the old method there was not one case of _fracture or dislocation of

vertebræ_. After adopting his suggestion to place the knot near the

spine, he found that dislocation occurred between the second and third

cervical vertebræ with fracture of the third and pressure on the spinal

cord. Death was sudden and complete. The drop in these cases was short,

three to four feet. Coutagne thinks that the ordinary mobility of the

head, axis, and atlas on each other have led reporters into the mistake

of supposing a dislocation of vertebræ. Roth failed to find fracture

of vertebræ in any of 49 cases. These injuries are especially rare in

suicide; but in violent hanging, dislocation or fracture may occur and

also rupture of the ligaments. Harvey gives 5 cases of dislocation of

vertebra and 4 of fracture of vertebra in suicides. Three of the latter

were doubtful. Tardieu says these fractures have no significance as

to the hanging having occurred during life. They can be produced on

the cadaver; but infiltration of clotted blood around injured vertebræ

shows that suspension occurred during life (Cases 5, 7, 8, 68, 76 to

79, 83, 84, 91, 92, 94).[862]

The CAROTID ARTERIES may be injured; usually the inner and middle

coats are torn; and hemorrhage may occur into the wall of the vessel.

The common carotids are the ones usually affected, and just below

the bifurcation, but the external is also occasionally injured. The

injury is said to be due to the stretching and squeezing of the artery,

stretching being the most effective since the rupture often occurs at

a distance from the mark of the ligature. Such injury of the artery

does not prove that hanging took place during life because it has been

produced on the cadaver; but hemorrhage into the wall of the vessel

or wound or rupture after death is very improbable. Maschka says the

lesion is very rare. Tardieu says that the injury to the carotid is

rare and therefore unimportant. Pellier reports 4 cases of rupture of

carotid in a total of 23. Levy records the experiments of Hofmann, of

Vienna, and Brouardel and himself, of Paris, 5 in number. He concluded

that compression of the carotid arteries, if it produces obliteration,

can cause rapid loss of consciousness and death; and explains why in

incomplete suicide the subject is unable to help himself. Coutagne

found rupture of carotids 10 times in 24 cases. He insists on the

importance of the lesion.

Hofmann[863] says the rupture is always transverse, may be simple

or multiple and may occur in suicides; more apt to occur when the

ligature is thin. Lesser[864] tabulated 50 fatal cases of suicidal

hanging; in 29, he was satisfied that the hanging occurred during

life. In 3 of these the skin of the neck alone showed any lesion;

there was a double mark, the skin being otherwise bloodless. In 5

the deeper soft parts were the only ones affected. In 3 the skin

showed lesions, the deeper soft parts none, but either the hyoid

bone, larynx, or vertebræ were involved. In 12 the skin showed no

mark, but the deeper soft parts and either the larynx or hyoid bone

were involved; and in 6 the hyoid bone only or the bone and larynx

were injured. In the remaining cases it was not possible to say that

the hanging occurred during life. In 2 cases there were no marks at

all; in 9 there were changes in the skin; in 4, changes in the skin

and deeper parts; in 2, changes in the skin, deeper parts, and hyoid

bone or larynx; in 3, changes in the skin and hyoid bone or larynx,

or both. In 14 of the 50 cases the hyoid bone was fractured; in 20

the larynx; and in 1 the vertebræ. The common carotid arteries were

injured in 6. The number and severity of the lesions bore no constant

relation to the thickness of the ligature, nor to the force used, but

rather to the position of the body.

Ecker[865] reported a case of suicidal hanging in a man, age 40, where

the soft palate was swollen and filled up the passage so that the air

evidently could not enter.

The LARYNX and the TRACHEA are usually deeply congested, of a red

color; a violet color indicates putrefaction. Ogston reports mucus but

not bloody froth 9 times in the pharynx, 6 in the trachea, and 4 in

the lungs, in a total of 40 cases. In one case there was a quantity

of blood in the larynx and pharynx. Taylor thinks that pinkish froth

in the trachea indicates incomplete obstruction; and Chevers that it

is due to spasmodic efforts to breathe when the obstruction is nearly

complete. Chevers always found clear mucus in the larynx and upper

part of trachea, each follicle being marked by a minute globule of

mucus. Harvey states that this was noted a few times in his reports.

Baraban[866] discusses the condition of the epithelium of the air

passages in hanging.

The condition of the lungs and heart varies according to whether death

is due to syncope or asphyxia. Ogston found, in 22 cases, the lungs

were expanded in 4 and collapsed in 2.

Harvey says the LUNGS are congested in over seven-eighths of the

cases; emphysematous in a few; and subpleural ecchymoses present in

a few. Patenko[867] experimented on dogs by hanging them. When the

constriction occurred after expiration the lungs were congested; when

after inspiration, not congested. In the first case (p. 223) the blood

flows from the periphery to the heart and thence to the lungs, but

cannot flow from the lungs because of the difficult circulation in the

dilated pulmonary vessels and deficiency of intrathoracic pressure.

There is in both cases cerebral congestion in the region of the bulb.

Tardieu holds that punctiform ecchymoses and apoplexies do not occur

in hanging unless suffocation has preceded. Pellier,[868] however,

found these ecchymoses 14 times in 22 cases. He says that the lesion is

not characteristic of suffocation, and quotes Lacassagne, Grosclaude,

Dechoudans, Vicq, Chassaing, and Legroux to the same purpose.

Hofmann[869] says that the ecchymoses are relatively rare in adults.

Maschka[870] found them 18 times in 153 cases.

Harvey states that the presence of serum in the PERICARDIUM seems more

a matter of time elapsed after death than anything else. Still the fact

is that it is found much oftener in strangulation than in hanging.

The difference is explained by the comparative slowness of death in

strangulation. Harvey finds that in about one-half of the cases, if

the body is fresh, the right side of the HEART, pulmonary artery, and

venæ cavæ are full of dark fluid blood, the lungs being also much

congested, and the signs of death by asphyxia well marked. When blood

is found in both sides of the heart, it is probable that death is due

to neuro-paralysis. When decomposition is advanced all the cavities are

often empty. Taylor says that if the examination is delayed for several

days, the distention may not be observed.

The STOMACH is often much congested, and this fact might sometimes

suggest the possibility of poisoning. The LIVER, SPLEEN, and KIDNEYS

are usually much congested. Hofmann[871] says that this occurs in the

kidney only when the body has been hung a long time.

The BRAIN is rarely much congested. In 101 cases Remer found hemorrhage

but once; and in 106 cases Casper failed to find it. Tardieu[872]

says the brain is oftenest anæmic. If, however, the body is cut down

and placed horizontally, the blood-vessels of the brain may fill up.

Evidence may be found in the brain suggesting insanity and therefore an

explanation of a probable suicide. Harvey says that hemorrhages in or

about the brain are found in a much larger proportion of cases in India

than in Europe in cases of hanging. “No common condition likely to

cause extravasation is apparent, only one man being noted as plethoric,

but in many the rope seems to have been very tight.” Champouillon[873]

reports a case of suicide in a man, age fifty-two; the rope broke and

the body fell. The physician who made the necroscopy reported a rupture

of the _pons Varolii_. Champouillon believed that the rupture must have

been made in removing the brain from the skull. Wilkie[874] reports

a judicial hanging in which a man age about twenty-five, fell about

three and one-half feet. A recent clot was found in the brain. The

experiments of Brouardel of hanging rabbits showed the brain anæmic.

The conjunction of the following appearances would suggest that the

hanging had been of some duration: lividity of face, congestion and

prominence of eyes, dryness of skin under the ligature, deep furrow,

congestion of sexual organs, swelling and lividity of lower limbs,

hypostatic congestion of lungs.

Page experimented on a young cat and young dog; both were hung in the

same way. Examination of the cat showed the veins generally engorged;

sublingual veins much engorged; tongue protruded slightly and much

swollen; no frothy mucus in bronchi. In the dog the tongue did not

protrude and was not swollen; right cavities of heart contained blood,

left empty; brain and other organs normal. In the cat, the lungs were

uniformly congested, dark red; no ecchymoses. In the dog, the lungs

were much distended, posterior borders mottled violet; emphysematous

patches on surface; no apoplectic effusions; subpleural ecchymoses

bright red, irregular, clearly defined in outer surface, most numerous

toward the roots and on the lower lobes.

Pellereau[875] gives an account of hanging as seen by him in warm

climates. He had not seen the elongation of the neck described nor the

erection of the penis, nor subconjunctival ecchymoses, nor fracture

of larynx, nor rupture of walls of carotid artery, nor subpleural

ecchymoses, nor fracture of vertebra. He always found a mark on the

neck; the left cavities of the heart always empty, the right always

full of black blood. Mackenzie says that in 130 cases of suicidal

hanging, the protrusion of the tongue between the teeth, the open and

protruding eyes, clinched hands, and blue nails were very frequent,

the tongue was found bitten many times, there were urethral and

rectal discharges and rupture of carotid artery. The penis was found

erect several times. The hyoid bone fractured 24 times in 93 cases.

In no case was the larynx or vertebra fractured. In 73 cases ropes

were used; in 30, portions of clothing. The marks of ropes were

always well defined, indented, and parchment-like; the marks of soft

ligatures faint and reddish. In no case were the muscles of the neck,

the larynx, trachea, or large bronchi injured, and in none was there

subcutaneous hemorrhage or blister.

PROOF OF DEATH BY HANGING.

As in strangulation, no single sign in any given case is sufficient of

itself to prove that death was caused by hanging. But the sum total of

the lesions found, viewed in the light of the surroundings of the body,

will suffice to lead to a definite conclusion.

The fact that a body has been found suspended does not of itself prove

that hanging caused the death, because the victim may have been killed

in some other way, and the body afterward hung up to avert suspicion.

Chevers records many cases of this kind.

The value of the presence or absence of marks on the neck and the

characters of the marks has been questioned. Orfila, Casper, and Vrolik

have shown by experiment that if a body is hanged within one or two

hours after death the furrow, parchment skin, lividity, and the density

of the connective tissue will appear just as is seen when suspension

has occurred during life; but ecchymoses and infiltration, clotted

blood in the skin, connective tissue, and muscles of the neck suggest

suspension during life.

If a cord is removed _immediately_ after death, there may be scarcely

any mark at all.

Tardieu collected 261 cases of suicide by hanging where the subject

was not entirely off the ground. In 168 the feet rested on the ground;

in 42 the subject was kneeling; in 29 lying down; in 19 sitting, and 3

were huddled up or squatting. Fatal hanging may, therefore, occur in

almost any position of body. He shows incomplete hangings by thirteen

plates. Taylor also collected reports of 11 cases in a few years; in 3

the subjects were nearly recumbent; in 4, in a kneeling position; in 4,

sitting. Remer in 101 cases of suicidal hanging found in 14 that the

body was either standing or kneeling; in 1, sitting. Duchesne published

58 cases of partial suspension, 26 of which were new. Some of these

failures of complete suspension were due to soft and elastic cords.[876]

Taylor says that “that which is difficult to a conscientious medical

jurist in confining himself to the medical facts is often easily

decided by a jury from these as well as the general evidence afforded

to them.”

The limbs may be secured by the suicide before hanging himself. Persons

even with some disability of the hand have suicided by hanging.

Blindness is no obstacle, nor age; a boy as young as nine and a man as

old as ninety-seven.

Burger[877] fully discusses the question whether the hanging is before

or after death.

HANGING—SUICIDAL, HOMICIDAL, OR ACCIDENTAL?

Hanging is usually =suicidal=. Lesser[878] states that for three

years, 1876-79, there were admitted to the Berlin morgue 274 bodies of

“hanged,” of which 272 were suicidal; 2 infants of three and eighteen

months, homicidal. One man had first tried to kill himself with

sulphate of copper; another by cutting his throat; a woman by cutting

her arm. The other cases were uncomplicated. Pellier states that the

number of suicides in France from 1876-1880 was 13,445, and nearly

all were by hanging. Taylor[879] states that 2,570 persons committed

suicide by hanging in England in five years, 1863-67; four-fifths of

these were males. Harvey[880] reports for three years 1,412 cases

of hanging in India, of which 2 were accidental, in 3 there was

presumption of homicide, the rest probably all suicidal.

Feebleness of body does not preclude subjects taking their lives in

this way. They sometimes also wound or poison themselves first and

hang themselves afterward. A subject being found suspended in a room

fastened on the inside, would be suggestive of suicide. The absence of

signs of struggling or of any marks of injury also favors the idea of

suicide.

The possibility of a suicide breaking a rope, being injured by the

fall, and rehanging himself successfully, must be admitted (Cases 57,

58). The possibility of blood flowing after death must not be forgotten.

It is worthy of note that after beating or other violence children and

women may commit suicide from shame. Again, as Tardieu says, many have

hung themselves while partially intoxicated, and it is likely that

some such have just previous to the suicide met with falls or other

accidents which have left marks like those of violence. He also records

the case of a woman who fastened a cord to a bed-post, put her head in

a noose while kneeling on the bed, and made a deep wound in her arm

with a razor. She closed the razor, laid it aside, and fainted from

loss of blood. She must then have fallen forward and died from the

pressure of the cord on her neck.[881]

=Homicidal= hanging is rare but does occur. Where the hands are tied

together; where the injuries produced by the cord are severe; where

there are contusions and well-marked ecchymoses; where the laryngeal

cartilages and hyoid bone are fractured or the cervical vertebræ

dislocated or fractured; or where the carotids are injured or there

is hemorrhage into their walls; where there are severe wounds, the

hemorrhage from which would be sufficient to threaten syncope; where

there are many marks of violence on the body; where there is evidence

of a severe struggle—in all these cases murder may be reasonably

suspected. The number, situation, extent, and direction of must

be carefully noted and weighed. If these are out of proportion to

the ligature, the suspension, etc., they strongly suggest homicide,

although they may occur in suicide (see Cases 4, 11, 18, 20, 28, 29,

44, 52, 55, 59, 66).

Homicidal hanging may be committed by an assailant who is strong on

a subject who is weak, on a child, a woman, an old person; on one

stupefied by liquor or narcotic poison; or by many combined against one

person.

Cases are reported where injuries were inflicted or poison given, and

the subject was afterward hanged to avert suspicion. Most of these

cases are those of murder either by strangulation or suffocation (Cases

64, 65, 67, 68, 69, 70, 74).

Sometimes hanging is =accidental=. Children and even older persons

play at hanging successfully. Taylor mentions the case of a boy who

witnessed a hanging and afterward tried the experiment himself to

ascertain the sensation, and caused his own death.

Tardieu[882] relates the case of a man, T., age 37, of small stature,

feeble constitution, very thin, of sinister face, eyes hollow but

lively, cunning nose and mouth, who meeting a man aged 81, learned

that he had some trouble with his leg and promised to cure him. The

old man lived alone. T. told him to buy a strong cord as thick as his

little finger and one and one-half yards long, and keep the whole

thing a secret. T. would see him at his room at 7 P.M. The old man

became suspicious and had T. arrested. The investigation showed that

already T. had made away with three old men by hanging, who were known

to be opposed to suicide. Their bodies showed no trace of violence.

Two others had escaped when the cord was passed around their necks.

Tardieu gives a number of cases of suicidal hanging which were falsely

attributed to criminal violence, in which the pressure of public

opinion joined to circumstances improperly explained by inexpert

physicians caused deplorable judicial errors.

ILLUSTRATIVE CASES.

SUICIDE.

1. _Harvey: Indian Med. Gaz., 1876, xi., p. 2._—Man, age 30. Found

hanging by turban to bars of cell door; slip-knot around neck; heart

beating feebly; died in about a minute after being cut down. “The point

of suspension was forty-seven inches from the ground, the position

of the noose twenty-eight inches, and the feet were forty-two inches

away from the door supported on the toes.” Experiment showed that the

turban could not have borne the full weight of the body. He died from

strangulation.

2. _Ibid., p. 3._—Insane man, age 60. Put his neck in a V-shaped fork

of a tree and let his body swing. A broad abrasion found on each side

of neck. Scalp, brain, and membranes much congested; reddish serum

in lateral ventricles; two ounces clear fluid in pericardium. Lungs

congested; all the heart cavities contained blood.

3. _Ibid., p. 5._—Woman, age 28. Two marks of ligature on neck; one

deep and circular passed up behind left ear; the other passed from the

circular mark behind, crossed it on either side under lower jaw, thence

up to chin. Appeared at first to be a case of strangulation following

hanging; but the two marks were finally explained, that after the body

was taken down it was ordered up again until the police should arrive.

4. _Ibid., p. 5._—Man, age 45; first cut his throat and then hung

himself. “He had probably only just had time to hang himself before

dying.”

5. _Ibid., p. 30._—Woman; hung herself with a twisted cloth. There

was much ecchymosis about the neck and upper part of chest; lungs much

congested; fibrin clot in left mitral orifice; liver, spleen, and

stomach congested; transverse ligament of atlas ruptured.

6. _Ibid._—Man, age 39. Distinct mark of cord around neck; no other

mark of violence; laceration of larynx and dislocation of odontoid

process; hands clinched; involuntary discharge of semen; thoracic and

abdominal organs normal.

7. _Ibid._—Man, age 70. Mark of cord around the neck, superficial

in front, deep behind; second cervical vertebra dislocated; tongue

slightly protruding; fingers clinched; meningeal vessels engorged;

lungs tubercular, congested; right heart contained a little coagulated

blood.

8. _Ibid._—Sex and age not given. Found hanging on a tree; usual

signs; odontoid process fractured; rope in a double noose without knot,

a common _dooree_, such as is used for drawing water.

9. _Ibid., p. 32._—Man, age 50. Face livid, eyes red and protruding;

teeth clinched; lower jaw retracted; tongue behind the teeth; hands and

feet contracted; anus covered with fæcal matter; circular depressed

mark of cord around neck, hard as parchment, slightly ecchymosed along

edges; some infiltration of blood in connective tissue beneath the

cord; some tearing of soft parts; laryngeal cartilage displaced. Brain

and membranes congested. Right cavities of heart distended with dark

blood. Trachea congested.

10. _Hurpy: Ann. d’ Hygiene, 1881, vi., pp. 359-367, with

illustration._—Woman, age 77, suicided by hanging in the following

way: a short cord was fastened by one end to a table leg; the

other end was around her neck; she lay on the floor, face downward,

clothing not disordered. The brain was congested; lungs congested and

emphysematous; left side of heart empty (see Fig. 23).

[Illustration: FIG. 23.—Suicide. The cord on the neck is 44 cent. from

the cord on the table leg; vertex of head 30 cent. from table leg. Case

reported by Hurpy (see p. 717, Case 10).]

11. _Champouillon: Same journal, 1876, xlvi., p. 129._—Man, age 62;

first tried to suffocate himself with charcoal smoke and then hung

himself, but the rope broke and the body fell. He lived two days.

12. _Pellier: Lyon thesis, 1883, No. 188, p. 72._—Boy, age 16, hung

himself; rope broke; he was resuscitated; reddish circular furrow on

neck, not like parchment; he had erection and ejaculation; buzzing in

his ears and flashes before his eyes.

13. _Lacassagne: Pellier thesis (supra), p. 71._—Man; hung himself;

was cut down and sent to hospital; was aphonic for four days; then

a severe bronchitis set in, and at the end of a week a gangrenous

expectoration. The mark of the cord lasted fifteen days.