391

HANGING-CAUSE OF DEATH.

HANGING.

CHAPTER XXXIX.

CAUSE OF DEATH.-DEATH FROM THE SECONDARY EFFECTS.-POST-MORTEM APPEARANCES. -MARK OF THE CORD OR LIGATURE.-WAS DEATH CAUSED BY HANGING?-HANGING AFTER DEATH.-SUMMARY OF MEDICAL EVIDENCE. MARKS OF VIOLENCE ON THE HANGED.-WAS THE HANGING THE RESULT OF ACCIDENT, SUICIDE, OR HOMICIDE ?—

THE POSITION OF THE BODY.

Cause of Death. Asphyxia.-By hanging we are to understand that kind of death in which the body is wholly or partially suspended by the neck and the constricting force is the weight of the body itself, while in strangulation the constricting force is due to some other cause. In both cases death commonly results from asphyxia (p. 64), although this must depend in a great measure upon the position of the ligature on the neck as well as on the degree of pressure produced. If the cord is loose, or applied to the upper part of the neck, a small quantity of air may still reach the lungs, and then the cerebral circulation may become interrupted by the compression of the great vessels of the neck. In this case apoplexy of the congestive kind is induced, and operates as the immediate cause of death. It is easy to conceive that there may be a mixed condition of asphyxia and apoplexy, and according to the observations of Casper and Remer, this is actually met with in a great number of cases of death from hanging. A man, æt. 57, committed suicide by hanging. After being suspended for an hour, he was cut down. As the doubled rope was slackened from the neck, air escaped through the larynx, and a prolonged, rather loud groan was heard. As an explanation, Holland suggests that the suicide, in hanging himself, drew in a deep breath, and the sudden and violent constriction of the neck retained the air in the chest until the ligature was removed. (Brit. Med. Jour., 1875, i. p. 575.)

In the execution of criminals, death takes place at different intervals of time after suspension. This difference is probably dependent on the greater or less degree of constriction produced by the ligature. If the rope should press upon the larynx or above this organ, the closure of the air-passages will not be so complete as if pressed upon the windpipe immediately below the cricoid cartilage. A slight degree of respiration might in the former case continue for a short interval, in which the life of a person would be prolonged, while, in the latter, death would be inmediate. If the windpipe is in part ossified, the pressure of the ligature is less perfect, and death will then take place more slowly. Louis found that an occasional cause of death in hanging was a displacement of the second vertebra of the neck, whereby the spinal marrow was suddenly compressed. As a general rule, this cause of death is only likely to be observed in corpulent or heavy persons, when a long drop is given, and when much violence has been at the same time employed by the executioner. Fractures of the vertebræ may occur, and prove fatal by com

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pressing the spinal marrow. Death may also be caused suddenly, by rebral congestion from pressure on the blood vessels or by the effusion blood on the spinal membranes. This is likely to happen when the Lead falls, or is bent suddenly backwards, so that the weight of the body is supported on the back of the neck.

Death from hanging appears to take place very rapidly and without asing any physical suffering to the person. It is observed that in those riminals who are executed, there are sometimes violent convulsions of limbs and trunk. There is no reason, however, to believe that the dividual suffers pain, any more than in the convulsions of an epileptic On recovery there is an entire loss of consciousness of pain in both 3. The circulation of dark-colored blood through the brain and spinal rd may account for these effects. Efforts to inspire are made for one or o minutes after the closure or compression of the windpipe. The aphragm and intercostal muscles act spasmodically, but no air enters lungs; and it is probable that in the act of hanging, part of the air tained in the organs is convulsively expelled. When the suspension of the body has continued only a few minutes, it has often been found possible to restore life; and indeed, the period at which resuscitation ay take place varies according to circumstances. Supposing the bangag to be unattended with violence to parts about the neck, some persons aight be resuscitated after five minutes' suspension or longer, but then it as been observed that they have subsequently died from secondary causes afting the brain and nervous system. Others, again, may not be reewered when they are cut down immediately after suspension-a fact which depends probably on the different degrees to which asphyxia or oplexy has extended. When the ligature is so placed as to press on the windpipe below the larynx, insensibility and death are almost instan

taneous.

Patenko has investigated asphyxia due to mechanical causes, and draws a clear distinction between the appearances met with according as the access of air is shut off at the end of an expiration or at the end of an aspiration. He shows that if a dog be hanged, the drop taking effect as expiration is completed, the efforts at inspiration result in engorgement of the lungs; whereas if the drop takes effect at the moment when inspiration is completed, the lungs are comparatively bloodless. (Ann. Hvg., 1885, t. 1, p. 209.)

Death from the Secondary Effects.-It by no means follows that, bese we have succeeded in restoring the respiratory process, a person is e. Death may take place by a fatal relapse at various periods after the lent. A case of this description was published by Brodie. A boy, 17, was found hanging. When cut down he was insensible, his face vid, his lips of a dark purple color, the pulse not perceptible, the pupils. Flated and motionless. Artificial respiration was used, and in a quarter of an hour the diaphragm began to act. He breathed at irregular intervals with stertor and with a rattling noise in the throat. The pulse became perceptible, but often flagging, and the surface of the body was cold. The atenance was still livid, but the pulse and breathing had improved. At the end of another hour an attempt was unsuccessfully made to take ne blood from the arm, and the patient was placed in a warm bath. The breathing was stertorous through the night, and in the morning Twelve ounces of blood were taken from the arm; but there was no relief. He continued insensible, and cold on the surface; there was frothing at the mouth, and he died twenty-four hours after he was cut down. The

396

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boy was carefully examined. The vessels of the brain were very full of blood: this was the only morbid appearance.

We learn from those who have been resuscitated, as well as from experiments performed by persons upon themselves, that the insensibility of asphyxia comes on in the most insidious manner in death from hanging, and that a slight constriction of the windpipe will speedily produce loss of consciousness and muscular power. (Devergie, 2, 370.) The only symptoms of which the hanged persons have been conscious were a hissing in the ears, a flash of light before the eyes, then darkness and oblivion. The only profitable inference, in a medico-legal view, which can be drawn from observations of this kind is that asphyxia is not only rapidly induced, but that it supervenes under circumstances where it would not be generally expected to occur-i.e. when the weight of the body is in great part supported. Fleischmann found that a cord might be placed round his neck between the chin and hyoid bone, and tightened either laterally or posteriorly without perceptibly interrupting respiration; but while the respiratory process was thus carried on, his face became red, his eyes prominent, and his head felt hot. These symptoms were followed by a sense of weight, a feeling of incipient stupefaction, and a hissing noise in the ears. On the occurrence of this last symptom, the experiment, he says, should be discontinued, or the consequences may be serious. His first experiment on himself lasted two minutes; but in the second, owing to the cord by its pressure more completely interrupting respiration, the noise in the ears appeared in half a minute. When the pressure was applied on the windpipe, the effect was instantaneous, but when on the cricoid cartilage it was not immediate. If it was applied between the hyoid bone and the thyroid cartilage, or on the hyoid bone itself, the period during which a person could breathe was extremely short; and this result was more striking when the act of expiration was performed at the moment of applying the presure.

The death of Scott, the American diver, in 1840, shows how readily asphyxia may be induced by a slight compression of the throat, even when a person might be supposed to have both the knowledge and the power to save himself. This man was in the habit of making public experiments on hanging, and had frequently before gone through them without danger; but on the last occasion it is probable that a slight shifting of the ligature from under the jawbone caused so much compression on the throat between the chin and larynx as speedily to produce asphyxia. No attempt was made to save him until it was too late, and he was not brought to a hospital until thirty-three minutes had elapsed. He was allowed to hang thirteen minutes, the spectators thinking that the deceased was only prolonging the experiment for their gratification. The very insidious and painless manner in which a person who is suspended passes from life into death is also well illustrated in the report of the case of Hornshaw. (Lancet, 1847, i. p. 404.) This man was on three occasions resuscitated from hanging-a feat which, like Scott, he had performed in London for public gratification. He stated that on the last occasion he lost his senses almost at once; it seemed as if he could not get his breath, and that some great weight was attached to his feet: he felt that he could not move his bands or legs to save himself, and that the power of thinking was gone. It is not improbable that many persons have thus lost their lives by privately attempting these experiments, and their cases have been wrongly set down to acts of suicide. There is reason to believe that boys have thus frequently but unintentionally destroyed themselves, from a strange principle of imitation or curiosity. In 1874, a boy, æt. 11, in order to

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Frighten his parents, tied a knot in his handkerchief and put one part of it over the knob of the upright at the foot of the staircase, and the other Gaderneath his chin, so that the ligature did not go round his neck. His dead body was found suspended in the loop, which had pressed against the windpipe and produced speedy unconsciousness.

Post-mortem Appearances.-The external appearances met with in the fanged have been generally taken by medico-legal writers from those seen it the bodies of criminals who have been executed, or those who have been violently hanged. Thus among them are the following: lividity and swelling of the face, especially of the lips, which appear distorted; the eyelids swollen, and a bluish color; the eyes red, projecting forwards, and sometimes partially forced out of their cavities; the tongue enlarged, vid, and either compressed between the teeth or sometimes protruded; the lower jaw retracted, and a bloody froth about the lips and nostrils. There is a deep and ecchymosed impression around the neck, indicating the course of the cord, the skin being occasionally excoriated; laceration of the muscles and ligaments in the hyoideal region; laceration or contuSon of the larynx, or of the upper part of the windpipe. There are also, monly, circumscribed patches of ecchymosis, varying in extent, about the upper part of the body and the upper and lower limbs, with a deep livid coloration of the hands; the fingers are generally much contracted or Ermly clenched, and the hands and nails, as well as the ears, are livid; the rine, feces, and spermatic or prostatic fluid are sometimes involuntarily expelled at the moment of death. Such appearances will rarely be found in those cases of suicidal hanging which are likely to come before a medial practitioner. In these, the face is generally pale, and the mark on the heck is a simple depression in the skin, usually without ecchymosis, and scquiring a horny or parchment color only after some time. Esquirol found, in one instance, that when the body was examined immediately after death the face was not livid, but it first began to assume a violet ue in eight or ten hours. He thought that when the cord was left round The neck the face would be livid, but if moved immediately after suspenon, pale. This view is not, however, borne out by observation. The tongue is not always protruded. Devergie found that there was protrusion of this organ in eleven out of twenty-seven cases. This protrusion was formerly supposed to depend upon the position of the ligature: thus it was said, when this was below the cricoid cartilage, the whole of the larynx was drawn upwards with it; while, when above the hyoid bone, the tongue was drawn backwards. The protrusion or non-protrusion of the tongue does not depend upon any mechanical effect of this kind, bat simply upon congestion; for it is occasionally met with thus protrudiaz in cases of drowning and suffocation. Besides, the protrusion has not been found to have any direct relation to the position of the ligature.

There is another appearance on which a remark may be made-namely, the state of the hands. As a general rule, in violent hanging or strangu lation, the hands are clinched. This appearance may not always be found, - it may exist and be destroyed before the body undergoes medical inspection. When the constriction of the neck is produced suddenly and with great violence, we may expect to meet with it. Thus it is found in the cases of executed criminals and in strangulation attended with great Violence, whether the act be due to homicide or suicide. In cases in which the constriction is gradually produced, the clenched state of the hands may not be found. Convulsions generally attend violent hanging or strangu ation. The influence of these on the attitude or dress may not appear unless the body is in a sitting position or lying down.

398

EXTERNAL AND INTERNAL APPEARANCES.

Internally, we meet with the appearances of asphyxia-i.e. engorgement of the lungs and venous system generally with dark-colored fluid blood; the lungs otherwise present no particular appearance. In the case of an executed criminal they were in a state of extreme collapse. (Lancet, 1867, ii. p. 576.) This is an unusual appearance. The right side of the heart, and the great vessels connected with it, are commonly distended with blood. But when the inspection has been delayed for several days this distention may not be observed. The mucous membrane of the windpipe is more or less congested, and is sometimes covered with a fine bloody mucous froth. This may be owing to imperfectly obstructed respiration, and to spasmodic efforts at breathing. The vessels of the brain are commonly found congested; and in some rare instances it is said extravasation of blood has been met with on the membranes or in the substance of the organ. Effusion of blood is, however, so rare that Bemer found this appearance described only once among one hundred and one cases; and in one hundred and six cases recorded by Casper it was found in a single instance. In one case Brodie found a large effusion of blood in the substance of the brain, and he refers to another case in which there was a considerable effusion between the membranes. (Lect. on Pathology, p. 58.) The venous congestion of the cerebral vessels is, however, rarely greater than in other cases of asphyxia, and is probably dependent on the degree in which the lungs have been engorged. In most instances there is increased redness of the substance of the brain, so that, on making a section of the hemispheres, a greater number of bloody points (puneta cruenta) then usual will appear. The kidneys have been found much congested. A more important circumstance has been noticed by Yellowlynamely, that in examining the stomachs of five criminals who had been hanged, he found great congestion in all, while there was blood coagulated upon the mucous membrane in two. Such an appearance might, it is obvious, be attributed in a suspicious case to the action of some irritant substance. (See p. 90, ante; Ann. d'Hyg., 1830, p. 166; 1835, p. 208; 1838, p. 471.) In the case of Good, who was executed, the stomach was found on inspection to present over its whole surface a well-marked redness, resembling the effect produced by an irritant poison. The redness was especially observed at the pyloric end, where it assumed a somewhat striated character. A drawing representing the appearance of the interior of the stomach is preserved in the Museum of Guy's Hospital. In another case the stomach and the intestines, especially the inner coat of the former, were much congested and inflamed, as if the man had died from poisoning. The contents of the stomach were analyzed, but no poison was found. Chevers, who quotes this case, states that he has more than once verified Yellowly's observation, and he found the mucous membrane of the stomach much congested in death from hanging. (Med. Jurispr. for India, p. 397.)

The most striking external appearance. however, is the mark produced on the neck by the cord or ligature. The skin is commonly depressed, and is sometimes ecchymosed, but rarely throughout its whole extent; it is frequently free from all traces of discoloration as the result of ecchymosis, the skin in the depression being then hard, brown, or of a parchment color and consistency; or there may be only a thin line of blue or livid color in the upper or lower border of the depression, and chiefly in front. The course of the mark is generally oblique, being lower in the forepart than behind, and it is often interrupted. It is most commonly above the larynx. If the noose should happen to be in front, the mark may be circular, the jaw preventing the ligature from rising upwards in the same