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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 36  |  Issue : 1  |  Page : 26-31

Analysis of ligature marks in hanging: A retrospective study of autopsies in the mortuary of a tertiary health-care center in North East India from 2011 to 2019


Department of Forensic Medicine and Toxicology, Regional Institute of Medical Sciences, Imphal, Manipur, India

Date of Submission09-Dec-2021
Date of Decision12-Dec-2021
Date of Acceptance22-Dec-2021
Date of Web Publication02-Sep-2022

Correspondence Address:
Dr. Memchoubi Phanjoubam
Department of Forensic Medicine and Toxicology, Regional Institute of Medical Sciences, Imphal, Manipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jms.jms_142_21

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  Abstract 


Background: Many times, a ligature mark may be the only evidence available in cases of asphyxial deaths due either to hanging or strangulation. A thorough examination of the ligature mark and analysis of the information provided by it is, therefore, a must to confirm the death as due to hanging.
Materials and Methods: A retrospective study was conducted at the Department of Forensic Medicine and Toxicology, Regional Institute of Medical Sciences, Imphal, between 2011 and 2019 to assess the information provided by a ligature mark in such cases.
Results: We found that deaths due to hanging constituted 7.1% of the total unnatural deaths subjected to medicolegal autopsy. Rope (34.93%) was the most common ligature material used. Majority of the victims preferred slip knots (53.61%), followed by fixed knots (46.38%). In most of the cases, the mark was obliquely placed (83.73%) and above the larynx (77.1%). Imprint over the groove when present corresponded with the ligature material used in all the cases.
Conclusion: It was concluded that a thorough, scientific examination of the ligature mark, though not conclusive, is the most important part of the postmortem examination of deaths due to hanging.

Keywords: Hanging, ligature mark, rope


How to cite this article:
Singh SB, Devi SE, Phanjoubam M, Devi TM. Analysis of ligature marks in hanging: A retrospective study of autopsies in the mortuary of a tertiary health-care center in North East India from 2011 to 2019. J Med Soc 2022;36:26-31

How to cite this URL:
Singh SB, Devi SE, Phanjoubam M, Devi TM. Analysis of ligature marks in hanging: A retrospective study of autopsies in the mortuary of a tertiary health-care center in North East India from 2011 to 2019. J Med Soc [serial online] 2022 [cited 2022 Oct 4];36:26-31. Available from: https://www.jmedsoc.org/text.asp?2022/36/1/26/355577




  Introduction Top


Hanging is one of the most common methods of suicidal deaths in India. Virtually all hangings are suicides until proven otherwise.[1] It is a form of mechanical asphyxia which is caused by suspension of the body by a ligature which circles the neck, the constricting force being the weight of the body.[2] The ligature material can be any household substance. A single knot with a running noose, fixed knot by a granny, reef knot, or a simple loop is found in cases of hanging.[3] The nature of ligature mark depends upon the material and position of ligature used and the time of suspension of body after death. If the ligature material is soft and is removed immediately after death, the mark might be absent in such cases. Thick and long beard or clothes on neck may lead to formation of a dull and ill-formed ligature mark.

Thus, the ligature mark becomes a crucial aid in diagnosis and evaluation of the case. Hence, examination of ligature material and mark becomes an indispensable part of autopsy.


  Materials and Methods Top


The present study was carried out in the Department of Forensic Medicine and Toxicology, Regional Institute of Medical Sciences, Imphal, between 2011 and 2019. A total of 166 cases of asphyxial deaths due to hanging were studied from the autopsy reports. A thorough analysis of each case was done with regard to age, sex of individual, ligature mark, ligature material, impression, pattern, color (to evaluate time since death), course, type of knot, level of ligature, skin changes, etc. A note was also made regarding other external injuries if any.


  Results Top


The total number of autopsies conducted in the mortuary at the Department of Forensic Medicine and Toxicology, Regional Institute of Medical Sciences, Imphal, between 2011 and 2019 was 2311.

Among the above, 166 (7.1%) cases were due to hanging. All the cases were examined with emphasis on ligature marks. The year-wise percentage of hanging cases was estimated and it was highest in 2017 (13.85%) and least in 2011 (6.62%). The average number of cases per year was 18.4. In the present study, 88 (53.01%) male victims and 78 (46.98%) female victims were found [Figure 1].
Figure 1: Year- and sex-wise distribution of cases

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Majority of the cases were Meiteis (76%), followed by Tribals (10%) and Nepalese (5%) [Figure 2].
Figure 2: Caste-wise distribution of cases

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Majority of cases observed were young adults in the third decade, i.e., 21–30 years with 53 (31.9%), followed by individuals in second decade, i.e., 11–20 years – 38 (22.89%) [Table 1].
Table 1: Age-wise distribution of cases

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Most of the cases were unmarried, i.e., 91 (54.81%) and 72 (43.37%) were married. In 3 (1.8%), the marital status was not known [Figure 3].
Figure 3: Marital status of victims

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Most of the cases happened in the morning (44%), followed by evening (29%), night (195), and afternoon (8%) [Figure 4].
Figure 4: Time of occurrence

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The ligature material was found in all the cases examined. Rope was the most common ligature material used by victims in the present study – 58 (34.93%), followed by dupatta (scarf) in 51 (30.72%) and other materials such as khudei (traditional loincloth) and phanek (traditional wraparound) were also used [Figure 5].
Figure 5: Nature and composition of ligature material

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Ligature mark was present in all the cases. A single ligature mark was found in 131 (78.91%) and multiple turns in 35 (21.08%) cases [Figure 6].
Figure 6: Multiplicity of ligature mark around the neck

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Regarding the position of the knot, 6 cases (3.61%) were of typical hanging type and 160 (96.38%) cases were of atypical hanging type where the knot was situated on other parts of the neck and not in the occipital region [Figure 7].
Figure 7: Position of the knot

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In the present study, two types of knots were found. Slip knot was found in 89 (53.61%) and fixed knot in 77 (46.38%) cases [Table 2].
Table 2: Type of knot

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The mark was obliquely placed on the neck in 162 (97.59%) cases and transversely placed in 4 (2.4%) cases [Figure 8].
Figure 8: Obliquity of ligature mark

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The ligature mark was situated above thyroid cartilage in 128 (77.1%) cases, at the level of thyroid cartilage in 38 (22.89%) cases, and below thyroid cartilage in 10 (6.02%) cases [Figure 9].
Figure 9: Location of the ligature mark

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Regarding the direction of ligature mark, the mark was obliquely going upwards from right to left and in 88 cases (53.01%), oblique from left to right in 51 cases (30.72%), and transversely placed in 3 cases [Figure 10].
Figure 10: Direction of ligature mark

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Hyoid bone was fractured in 4 cases only (2.40%) [Figure 11].
Figure 11: Fracture of hyoid bone

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The intima of the internal carotid artery was intact in 159 (95.7%) cases and had transverse tears in 8 cases (4.81%) [Figure 12].
Figure 12: Carotid artery tear

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In the present study, it was observed that in 26 (15.6%) cases, there was extravasation on the neck tissue, there was no extravasation in 65 (39.15%), and in 75 cases (45.18%), the subcutaneous tissues were pale and glistening under the ligature mark [Table 3].
Table 3: Condition of tissue under the ligature mark

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  Discussion Top


The ligature mark in hanging needs detailed and extensive examination. The nature and texture of ligature material and type of hanging (complete/partial) also play a vital role in correlating the findings in respective cases. In majority of cases, partial examination or missing of some trivial but important findings leads to derivation of wrong and inconclusive evidences which in turn leads to confusion.[4]

In the present study, 7.1% of cases of hanging were recorded in a period of 9 years (January 2011 to December 2019). Cases were higher in the later part of the study period. The above statement clearly depicts that the number of cases of hanging is increasing, and there is a definite need for formulation of necessary steps to control this social evil.

Young adults in the third decade accounted for maximum number of cases – 31.9%, followed by the second decade – 22.89%. Similar findings were observed by various research workers and authors.[1],[4],[5],[6],[7]

Majority of cases were males – 53.01% and 46.98% of cases were females. The present findings are consistent with studies done by other authors.[4],[5],[6],[8],[9],[10]

The incidence of hanging was found to be more common in unmarried individuals (54.81%) and less in married individuals (43.37%). This finding is different from studies done in other places.[1] The possible element of stress and lack of direction and purpose in life can be some reasons regarding increase in the cases of unmarried people.

The authors tried to study in detail regarding ligature material used, and a comparative study was performed in order to assess the common material used during hanging by the victims in the Indian subcontinent. In all the studies done by various researchers, cloth material – chunni –was found to be the most common ligature material, followed by nylon rope and saree.[5],[6] The comparative results are tabulated in [Figure 3]. The rope was the most common ligature material used by victims in the present study – 58 (34.93%), followed closely by dupatta in 51 (30.72%) and other materials such as khudei and phanek were also used. Thus, it depicts that in majority of cases, the decision of committing suicide by hanging is an unplanned one under extreme psychological disturbances. In particular period of time, whatever material was available it has been used by the victims.

Numerous facts can be established by examining ligature material. It produces a particular pattern over the skin and the characteristics of the mark broadly depend on material used. The pattern of ligature marks was observed only in cases where rope (34.93%) and belt (4.21%) were used, whereas other studies[2] observed patterns in only 10%.

Single ligature marks were most commonly found (78.91%). Identical results were recorded by Sadikhusen et al.[5]

In majority of cases, slip knot (71.08%) was used, which is a contradictory finding compared to the findings of Sadikhusen et al.[6] where the fixed knot was observed in a maximum number of cases –58%. Thus, the fact is once again strengthened, that in majority of individuals, suicide by hanging is being practiced under extreme psychological stress where individual resorts to an easy knot.

In the present study, maximum number of cases (77.1%) showed ligature marks above thyroid cartilage which was also observed by others.[1],[11] In hanging, the ligature mark was normally situated higher in the neck above laryngeal prominence. The position of the mark in hanging depends on the way – the device was fixed and the suspension point.[12] According to Reddy KSN, the mark of hanging is situated above the level of thyroid cartilage in between larynx and chin in 80%, at the level of thyroid cartilage in 15%, and below the level of thyroid cartilage in about 5% cases, that too in case of partial hanging.[11] All the above facts are correlating with the observations in the present study.

In the present study, the incidence of fracture of hyoid bone was observed in 2.40%. In other studies also, the percentage of cases showing hyoid bone fracture was very less.

In the present study, there were no external injuries other than ligature marks. Similar observations were evident in studies done by Saisudheer and Nagaraja.[1]

Internal examination beneath the ligature mark revealed that in 26 (15.6%) cases, there was extravasation on the neck tissue, there was no extravasation in 65 (39.15%), and in 75 cases, (45.18%), the subcutaneous tissues were pale and glistening under the ligature mark. It is said that the ligature mark is mainly a postmortem phenomenon, any inner neck structure injury indicating ligature mark intravitality is to be identified to establish the antemortem hanging.[13]

All the observations were linked with respective subsequent findings such as absence or presence of other external or internal injuries to obtain an acceptable outcome regarding the mode and manner of death in the victim.


  Conclusion Top


The present study tries to emphasize that the ligature mark needs to be evaluated along with other external features and internal findings. Thus, if this procedure of linking all the findings is followed as a routine practice in cases of death due to hanging, the formulation of final opinion in doubtful cases will become easy. This, in turn, helps to distinguish ante mortem ligature mark with postmortem ligature mark and in establishing the cause and manner of death.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Saisudheer T, Nagaraja TV. A study of ligature mark in cases of hanging deaths. Int J Pharm Biomed Sci 2012;3:80-4.  Back to cited text no. 1
    
2.
Reddy KS. The Essential of Forensic Medicine & Toxicology. 19th ed. Hyderabad: Published by K. Suguna Devi; 2000. p. 283-95.  Back to cited text no. 2
    
3.
Mathiharan K, Patnaik AK. Death from asphyxia. In: Modi JP, editor. Modi's Medical Jurisprudence and Toxicology. 23rd ed. New Delhi, India: Lexis Nexis Butterworth; 2005. p. 565.  Back to cited text no. 3
    
4.
Yadav A, Gupta BM. Histopathological changes in skin and subcutaneous tissues at ligature site in cases of hanging and strangulation. J Indian Acad Forensic Med 2009;31:200-4.  Back to cited text no. 4
    
5.
Luke JL. Correlation of circumstances with pathological findings in asphyxial deaths by hanging. J Forensic Sci 1985;30:1140-7.  Back to cited text no. 5
    
6.
Sheikh MI, Agarwal SS. Medico-legal implications of hyoid bone fracture – A study paper. J Indian Acad Forensic Med 2001;23:61-3.  Back to cited text no. 6
    
7.
Rajeev J, Ashok C, Hakumal R. Incidence and medico-legal importance of autopsy study of fracture of neck structure in hanging and strangulation. Med Legal Update 2007;7:105-9.  Back to cited text no. 7
    
8.
Jani CB, Gupta BD. An autopsy study of parameter influencing injury to osteocartilaginous structures of neck in hanging. Int J Med Toxicol Legal Med 2002;5:4-7.  Back to cited text no. 8
    
9.
Modi JP. In: Subramanian BV, editor. Modi's Medical Jurisprudence & Toxicology. 22nd ed. India, New Delhi: Butterworth's; 1988. p. 251-72.  Back to cited text no. 9
    
10.
Nandy A. Principle of Forensic Medicine. 2nd ed. Calcutta: New Central Book Agency Pvt. Ltd; 2000. p. 315-23.  Back to cited text no. 10
    
11.
Jason PJ, Anthony B, William S. Forensic Medicine-Clinical and Pathological Aspects. 1st ed. London: Greenwich Medical Media Ltd; 2003. p. 266-9.  Back to cited text no. 11
    
12.
Samanta AK, Nayak SR. Newer trends in hanging death. J Indian Acad Forensic Med 2012;34:37-9.  Back to cited text no. 12
    
13.
Sharma BR, Singh VP, Harish D. Neck structure injuries in hanging – Comparing retrospective and prospective studies. Med Sci Law 2005;45:321-30.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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