hanging-245345563367650765788665782.pptx

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1. Hanging Continue… Dr. Md. Iqbal Bahar Chowdhury Associate Professor SMAMC

2. Objectives After this class you will be able to know about- Postmortem findings of hanging Homicidal hanging Medicolegal opinion of hanging Sexual asphyxia Complex & complicated suicide

3. External findings: In the face- Cyanosed, swollen Protrusion of eye ball & tongue. Petechial hemorrhage. Presence of dried mark of dribbling of saliva from angle of the mouth(opposite to knot)( surest sign of ante-mortem hanging ) Bleeding per nose or mouth may present. Post mortem findings

4. Post-mortem findings

5. Dried mark of dribbling of saliva from the angel of the mouth opposite to knot. Because of pressure by the ligature on submandibular salivary gland causes irritation thereby excessive secretion & there is no deglutition causing escape of saliva from the mouth. Confirmatory sign of ante-mortem hanging

6. Dried mark of dribbling of saliva

7. In the neck- Ligature mark : O blique , non continuous & high up around the neck (above the thyroid cartilage) Tardieu’s spot may present just above the ligature. The skin in the ligature is grooved, parchmentised & abraded (pressure abrasion ) at place. Cont..

8. External findings

9. Cont.. Generalized sign- The hands may be clenched. Cyanosis present in fingertips & nailbeds . There may be involuntary discharge-urine, stool, semen etc. Bluish or purple colored post mortem staining.

10. Tardieu’s spot seminal fluid(glans)

11. Internal findings- In the neck- Sub cutaneous tissue beneath the ligature mark is dry, white, firm & glistening( Parchmentization ) The platysma & sternocleidomastoid muscle may show hemorrhage. The hyoid bone may be fractured. Cont..

12. Injury of the neck muscles

13. Fracture of hyoid bone

14. Internal organ- Larynx & trachea are congested. There may be sub plural & sub pericardial Petechial hemorrhage may found. Lungs & Liver are congested. Brain : congested. Cont..

15. Congestion of trachea

16. Composition of ligature material. Width and multiplicity of ligature. Tightness of encircling ligature Length of time the body has been suspended. Position of the knot. Ligature mark of hanging depends on

17. Hanging without visible ligature mark Beard Hair in case of female A portion of cloth between the ligature & skin Decomposition may obliterates the ligature mark

18. Le facie sympathique If the knot presses on cervical sympathetic, the eye on the same side may remain open and its pupil dilated. It is called L e facie sympathique . I t indicates ante-mortem hanging .

19. Le facie sympathique

20. Homicidal Hanging It is difficult for a single assailant to carry it out. T he victim becomes unconscious by- injury, by a drug, Victim may be- child or very weak person.

21. Homicidal Hanging Homicide should be suspected: It is mainly based on circumstantial evidence . Presence of mark of violence or disorder of furniture or other objects. Clothing may torn or disarrange Presence of injuries, either offensive or defensive.

22. The name is derived from captain William Lynch, who used to order hanging on the spot publicly without trial in USA, where a black rapist was used to be lynched by angry white mob with a view to teaching others a lesson for committing offence. It is Homicidal Hanging Lynching

23. Lynching

24. Differential diagnosis of ligature mark other than the hanging Pseudo-ligature mark: Skin fold in case of obese & fatty dead body Presence of gold chain or jewelry in the neck of the dead body for a long time. In case of infant, refrigeration of dead body causing coagulation of protein in the neck.

25. In my opinion, death was due to asphyxia as a result of hanging which was ante-mortem and suicidal in nature. Post-mortem opinion in case of suicidal hanging

26. Suicidal Homicidal : Judicial hanging & lynching Accidental : Children & sexual asphyxia Medico legal importance of hanging­

27. Some individual apply a makeshift noose( or Hangman’s knot) around the neck and stand so that they are partially suspended from the rope to which the noose is attached. By lowering the body slightly, the noose tightens and cerebral hypoxia results. Cerebral hypoxia may enhance orgasm Sexual asphyxia/Auto-erotic hanging/ Asphyxiophilia

28. This is done during masturbation in order to heighten the intensity of orgasm . If the hypoxia is allowed to be present for more than a few moment, the person become unconscious and will die if the suspending noose is not released by another person. This is associated with abnormal sexual behaviour, usually transvestism & masochism . Sexual asphyxia

29. Victims are almost always young male . The scene is usually victim’s own house: bedroom, bathroom are usually selected & the door is locked from inside. Such persons are usually found naked, partly naked or may wearing female dress . Erotic or pornographic literature or attractive female nude photos are spread out. Evidence of recent emission of semen . Diagnosis

30. Sexual asphyxia

31. Manila rope

32. Complex suicide When a person plans more than one method of suicide to make sure that death will occur it is called complex suicide, e .g : a person first try to kill himself by cutting of radial artery, later he stab himself by knife finally hanged himself.

33. Complex suicide

34. When during the original suicidal method, there is unintentional trauma occurs which leads to death is called complicated suicide, e.g : a person hanging himself from a branch of tree , the branch breaks and the person dies due to complication of fall. Complicated suicide

35. It occurs when an individual acquire a certain body position in which his breathing is impaired Often because of neck twisting with kinking or compression of the trachea and/or elevation of the tongue into the posterior hypo-pharynx. In addition , the normal venous return to the head may be impaired. Postural asphyxia/Positional asphyxia

36. Body is typically inverted(upside-down) and the weight of the abdominal contents press against the diaphragm pushing it upwards T hus compress the thoracic organ which combined with decreased respiratory movement leads to cardio-respiratory failure or death. It is commonly accidenta l Cont..

37. Postural Asphyxia

38. Summary Postmortem findings of hanging Homicidal hanging Medicolegal opinion of hanging Sexual asphyxia Complex & complicated suicide

39. Reference The Essentials Of Forensic Medicine And Toxicology by   Dr . K. S. Narayan Reddy Lecture from Sir Salimullah Medical College by Prof. Dr. T.C. Das

40. Thank u all