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Case reports of asphyxiation by hanging in two young children are presented along with a review of the literature to determine the incidence and manner of death by hanging in the younger pediatric population.
10 healthy male and female subjects spent 7 nights both with a quiet surrounding and defined noise of subsonic jet fly-overs in a sleep laboratory. During the last 4 nights they were medicated in a double-blind cross-over test design with the benzodiazepine 8-chloro-6-phenyl-4H-s-triazolo (4,3-a)-(1,4)benzodiazepine (estazolam, BAY k 4200) at a dosage of 2 mg and placebo. On each following morning they passed a tracking test and an apparative mental arithmetic calculation test in order to evaluate a potential hangover. Simultaneously heart rate was registered continuously. The results were as follows: About 10 h after medication significant hang-over effects of estazolam in psycho-physiological performance could still be seen. Statistically significant differences between the conditions with estazolam and placebo in the range of 5 to 15% were found. Hang-over is not restricted to tracking and mental performance but can also be seen in slightly lowered heart rate.
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STUDY OBJECTIVE: To determine the incidence, demographics, clinical indicators of survival, and frequency of cervical-spine fractures to define appropriate emergency airway management in hanging victims. DESIGN: Medical examiner records, paramedic reports, and emergency department and hospital medical records were reviewed retrospectively for the period January 1, 1978, to January 1, 1990. SETTING: Urban paramedic system with nine receiving hospitals. PARTICIPANTS: A total of 160,724 medical examiner and paramedic records were reviewed to identify a total study population of 306 hanging victims. One hundred eighty-two victims (59%) were found dead at the scene, and the emergency medical system was not notified. An additional 57 (19%) were seen by paramedics and declared dead at the scene. Sixty-seven (22%) were treated and transported to nine receiving EDs; 39 of these 67 received oral or nasal endotracheal intubation. RESULTS: The incidence of hanging was 0.19% of all medical examiner cases and paramedic runs during the 12-year study. Those hanging victims who survived to receive paramedic transport and treatment by physicians were typically male and attempted suicidal hanging in a public place (most frequently jail) with available bedding or clothes. No hanging victim treated and transported by paramedics had documentation of cervical-spine or spinal cord injury. CONCLUSION: In nonjudicial hanging victims seen by paramedics and transported to an ED, cervical-spine injury is rare. Cerebral hypoxia rather than spinal cord injury is the probable cause of death and should be the primary concern in treatment of this patient population. Following external stabilization of the neck, nasal or oral endotracheal intubation is appropriate emergency airway management in hanging victims.
This study examined the increase in the rate of suicide by hanging and an apparently simultaneous decrease in the rate of suicide by firearm as hypothetical evidence that Australian males have substituted one method of suicide for another. Trends in hanging and firearm suicide rates were examined from 1975 to 1998 for all Australian males and from 1971 to 1998 for a subset of Australian male youth, as well as a group of Australian males aged over 64 years at the time of their death. When the firearm suicide rate for Australian males declined the hanging rate increased simultaneously, with no statistical difference in the rate of change of the two methods. A similar pattern of simultaneous divergence in hanging and firearm suicide rates of a 15- to 24-year-old subgroup occurred at a not dissimilar rate over a longer time period. Rates of suicide by hanging were found to have begun increasing prior to the decline in firearm suicide. The declining rate of firearm suicide in the 15- to 24-year-old subgroup coincided with an increase in the overall suicide rate. Relationships between trends in hanging and firearm suicide differed between states and between urban and non-urban areas within Queensland, with the firearm suicide rate falling more rapidly in urban areas, especially following the introductions of restrictions to weapon purchases. Individual suicide method choice may be related to independent changes in the social acceptability of each method, as well as to an increasing prevalence of suicide in younger males, who are more likely to use the hanging method. The functioning and effect of social acceptability remains unclear, however. Intervention and prevention strategies should focus on challenging the social acceptability of hanging, especially among males aged 15 to 24 years.
In a prospective study of 204 unselected cases of suicidal hanging congestion bleedings of different degrees were found in 51%. In typical symmetrical hanging (n = 38) they occurred in 42% of cases, in atypical suspension (n = 152) in 53%. The difference had no statistical significance. Statistically, no connection could be secured between the outer congestion bleedings including those within the neck soft tissue on the one hand, and the form of hanging, the kind of loop or the breadth of the strangulation tool on the other. Only a slight dependence on the blood alcohol content was established. The brain weight of the hanged cases was higher in all age groups than in a clinical autopsy collective. Likewise, it showed statistically no relation to the degree of the outer congestion signs. In 36 cases the brain was histologically investigated. In 78% of cases hyperemia was found, concerning predominantly the supply tract of venules, but also the capillary part. It existed both in typical and in atypical hanging. Independent of outer congestion signs and of cerebral hyperemia, small bleedings into the cerebral perivascular space could be observed in 50% of cases. The increase in brain weight in association with histological signs of edema in hanging was put down to a definite terminal-postmortal brain swelling, as it is known in all forms of peracute death. There is no connection with the type of suspension and the existence or non-existence of congestion signs. Also in atypical forms of hanging no reference to a cerebral residual perfusion is given.
OBJECTIVE: To identify characteristics that could distinguish males who completed suicide by hanging from males who completed suicide by firearms and non-domestic gas, and to suggest suicide prevention strategies targeted at hanging. METHOD: Using the psychological autopsy design, males who used hanging, firearms and non-domestic gas were compared on a range of variables covering social, psychological, and health related factors and aspects of the suicide incident. The sample consisted of 950 males who completed suicide in Queensland, Australia, between 1994 and 1996. RESULTS: Compared with males who used firearms and non-domestic gas, males who used hanging were significantly younger, less likely to have left a suicide note, and more likely to have been diagnosed with a psychotic disorder. Compared with males who used firearms, males who used hanging were significantly more likely to have made prior suicide attempts and have had no physical illness. Compared with males who used non-domestic gas, males who used hanging were significantly more likely to have lived with others, have had prior legal trouble, and have completed suicide at their residence. CONCLUSIONS: The results are discussed in terms of the availability and socio-cultural acceptability of methods. The authors suggest a possible relationship between impulsive traits and method choice. This proposition requires further investigation using alternative methodologies. Some suicide prevention measures targeting hanging suicides are discussed in light of the results.
Suicide statistics for Britain (England and Wales) from 1950 to 1990 are analysed. A rising suicide rate among males, particularly the young, is associated with an increased use of hanging as a suicide method. The same trend is not seen among females. Death by hanging can seldom be concealed or regarded as other than suicide, so statistics for suicidal hanging are likely accurate. Increased suicidal hangings cannot be explained by changes in the availability or awareness of the method and must reflect change in choice of method. Hanging as a suicide method has been historically unpopular in Britain because of the dishonorable repute associated with its use for judicial execution. The abolition of judicial hanging in Britain in 1965 may have led to an increased acceptability of hanging as a suicide method. The resultant increased use of this highly lethal method may be one underlying cause of the increased numbers of completed suicides and the rise in the suicide rate.
The study is devoted to one of the numerous factors (namely, body posture), which determine the strength of the neck compression in hanging. Mathematical modeling method and achievements of biomechanics were used. Human body was supposed to consist of 16 freely joined hard parts. The possibility of ligature tension calculation in any position in incomplete hanging is shown. Weight ranges for hanging of male persons in different body positions are presented: in standing posture the ligature is stretched by more than 65% of the body weight, in kneeling position by 64-74%, in sitting by 17-32%, in recumbent posture by less than 18% of the body weight. The importance of the accurate recording of a corpse posture at the place of accident is emphasized, as well as the necessity of the corpse mass evaluation. Significance of the work for medico-legal practice is illustrated by the study of the neck organocomplex trauma in 108 cases of suicidal hanging. Injuries were revealed stereomicroscopically after the complete preparation of the hyoid bone and laryngeal cartilages, preliminary fixed in the formalin solution. Trauma to the neck complex (fractures, infractions, fissures) was found in more than 64% of cases, differences in many of the groups compared are significant, P<0.05. Vulnerability index hyoid bone/thyroid cartilage was 1.75 in complete hanging of the body, 0.88 in standing position, 0.63 in kneeling, 0.33 in sitting, 0.25 in recumbent posture. Results of the study may be used for investigation of dying processes and morphology of hanging.
OBJECTIVE: Fiji is a Pacific nation with roughly equal numbers of indigenous Fijians and Indians. Previous studies, using police and medical records, have suggested significant racial, regional, age and gender differences in suicidal behaviour. The objective of the present study is to use a unique data set (autopsy reports) in the evaluation of earlier reports and to identify groups at greater risk. METHOD: Hanging and poisoning autopsy reports from two distinct regions were examined. RESULTS: The rate of autopsy (per 100000 population per year) among Indians (19.5) is significantly greater (p < 0.0001) than among Fijians (1.53). In the north, among the Indians, there are more autopsies in females (21.2) than males (16.8), and hanging constitutes 85% of total suicides, while in the Central and Eastern Divisions hanging constitutes only 58% of the total. These are regional influences. Among Fijians, the rates of hanging autopsy are significantly greater (p < 0.001) in males (1.98) than females (0.40); however, among Indians there is no significant difference. This is a racial difference. Hanging remains the preferred option for all groups. The mean age at autopsy is 31.7. There is no significant difference between the mean ages of the races, the sexes or the regions. There is no significant difference between the mean age of poisoning (31.5) and hanging (31.8). CONCLUSION: There is a significant racial difference in rates of suicide but the influences of region, age and method are relatively slight.
The hang-back recession is a simple, safe alternative to conventional recession. We evaluated the surgical results in 23 consecutive patients undergoing bilateral hang-back lateral rectus recessions and 24 consecutive patients undergoing bilateral conventional lateral rectus recessions. The 6-week postoperative success rate was 78% in the hang-back group and 75% in the conventional group. At the time of the most recent follow-up, the success rate was 64% in the hang-back group and 85% in the conventional group. Dose-response curves were similar for both methods. There were more late overcorrections with the hang-back technique. We suggest modified surgical guidelines for the hang-back recession technique.
PURPOSE: To compare the results of hang-back and conventional recession surgery. METHODS: This randomized, double-blind, matched clinical trial comprised 30 patients with esotropia and 24 with exotropia. All ocular examinations before and at least 1.5 months after surgery were performed by an orthoptist who was unaware of the method of recession. All surgeries were performed by the same surgeon. RESULTS: In patients with esotropia, deviation improved from 31+/-9 prism diopters (delta) preoperatively to 7+/-6 delta postoperatively for hang-back recession (n=15) and from 41+/-14 delta to 6+/-6 delta for conventional recession (n=15). Postoperative horizontal deviation was >10 delta in 40% of patients who underwent hang-back recession and 20% of patients who underwent conventional recession (P<.8). In patients with exotropia, deviation improved from 28.9+/-9 delta preoperatively to 0.5+/-11 delta postoperatively for hang-back recession (n=12) and from 29+/-8 delta to 6+/-6 delta for conventional recession (n=12). Postoperative horizontal deviation was >10 delta in 24% of patients who underwent hang-back recession and 17% of patients who underwent conventional recession (P<.2). Mean follow-up was 7 months. CONCLUSION: Hang-back recession is an alternative to conventional rectus muscle recession, especially in children who have smaller globes and patients with myopia or collagen vascular diseases.
Since conjunctival petechial haemorrhage and froth can occur when the cervical arteries and air passage are not obstructed or incompletely obstructed, it is useful to know whether they are closed or not in a suspended body when we estimate the cause of its death being due to hanging or being a disguise after killed by strangulation. We discussed their obstruction in hanging after references, as summarized in tables. Arterial obstruction: Classical data on the arterial obstruction (Brouardel, 1897; Schwarzacher, 1928) have not been cited with a definite description that the data were obtained in experiments on typical hanging. In typical hanging, carotid arteries are directly closed with the compression by a ligature. There are three hypotheses on the mechanism of the obstruction of vertebral arteries: They are due to (1) the compression on the posterior and inferior region of the mastoid processes ("posterior compression"), (2) the backward and upward compression at the same time on the thyrohyoid membrane ("anterior compression") and (3) the vertical traction on the neck ("indirect obstruction"). In atypical hanging, carotid arteries can be indirectly closed in certain head positions. Vertebral arteries are not closed by the horizontal compression (hanging in a prone position). The "posterior compression" is effective. The "indirect obstruction" seems to be in existence. In the cases where ligatures do not run on the front of the necks but on the faces, it is advisable to consult the figures prepared by Rauschke (1957) and Brinkmann et al. (1981).(ABSTRACT TRUNCATED AT 250 WORDS)
Death by Hanging: Suicide or Homicide. Six cases of homicidal hanging and murder presented as suicidal hanging are recorded. Suspension followed strangulation by ligature or throttling and head injuries in 4 cases. Distinction between homicide and suicide was easy in 5 cases: two of the perpetrators gave themselves up to the police, one committed suicide immediately after he had hanged his 15 year old daughter; in two cases tracks of blood, heavy injuries of the victims, and traces of robbery were obvious. Unless the victim is an infant or an adult person incapacitated by drink, disease, or drugs, or unless there are several assailants murder is difficult to accomplish. Distinction between murder and suicide may be impossible by an examination of the body alone. Detailed investigation of the scene, reconstruction of the position of the suspended body, examination of the rope, the knots, the direction of the fibres on the rope may serve to discover homicidal hanging. - Compared to suicidal hanging homicide has a frequency of about 1% in our autopsy material. However, we cannot estimate the number of obscure cases.