POSITION OF THE BODY. 431 body was resting on the ground, suspended from a gaspipe about four feet high, by a neckerchief round her throat. In 1877, Spenser, a barrister, was found dead in his bedroom under the following circumstances: he was in a sitting position on the floor, with the bell-pull, attached to the bed-post, tied round his neck. There was no doubt that this was an act of suicide. In another case of suicide, the subject of an inquest in 1878, a man was found dead suspended by a handkerchief to a cupboard door. When standing upright he was as high as the cupboard door, but, after suspending himself, he had drawn up his legs behind him, and had died asphyxiated in this singular position. In 1874, a lunatic who had escaped from his keepers was found hanging in a wood near Highgate to a sapling oak by a pocket-handkerchief. The deceased was in a sitting posture, the tree being bent down by his weight. The reports of eleven cases of suicidal hanging or strangulation gave the following results: in three, the deceased were found nearly recumbent; in four, in a kneeling posture, the body being more or less supported by the legs; and in four, the persons were found sitting. In one case, the deceased, a prisoner, was found hanging to the iron bar of the window of his prison, which was so low that he was almost in a sitting posture. Remer found that among one hundred and one cases of suicidal hanging, in fourteen the body was either standing or kneeling, and in one instance it was in a sitting posture. Duchesne has published an account of fiftyeight cases in which the suspension of the body was partial-the feet or trunk being more or less supported. The reporter drew the conclusion that suicide by hanging is consistent with any posture of the body, even when resting upon the two feet. (Ann. d'Hyg., 1845, t. 2, pp. 141 and 346.) Further evidence need not be adduced to show how unfounded is that popular opinion which would attach the idea of homicidal interference to cases in which a body is loosely suspended, or in which the feet are in contact with any support. We ought rather to consider these facts as removing a suspicion of homicide; for there are probably few murderers who would suspend their victims, either living or dead, without taking care that the suspension was not partial, but complete. Besides, the facts of many of these cases are readily explicable: thus, if the ligature is formed of yielding materials, or if it is only loosely attached, it will yield to the weight of the body after death, and allow the feet to touch the floor, which they might not have done in the first instance. If there is reason to believe that the body has not altered its position after suspension, we must remember the suddenness with which insensibility comes on, and the rapidity with which death takes place in this form of asphyxia. Under very slight pressure on the windpipe a person is rendered utterly powerless to help himself or to move from his position. (See p. 433, post; also Lond. Med. Gaz., vol. xliv. p. 85.) In spite of these well-known facts, the most serious mistakes are still liable to be made. A case occurred in France, in 1872, in which a young man was charged with the murder of his brother and suspending his body after death. The only grounds for this strong medical opinion were that there was no deep ecchymosed depression round the neck of the deceased, and the body was found hanging nearly in a sitting posture. These conditions were considered to be inconsistent with death from hanging. The cause of death was ascribed to poisoning with phosphorus, in consequence of some alkaline phosphates and phosphoric acid being found in the stomach. On this series of medical assumptions and mistakes, the young man, who had accidentally discovered his brother hanging, was convicted of murder and sentenced to the galleys for twenty years. The ignorance displayed by the medical 432 SUICIDAL HANGING. witnesses who gave evidence on this occasion has been fully exposed by Boys de Loury, Chevallier, and Personne. (See Ann. d'Hyg, 1873.1.2, p. 113.) The Limbs secured in Suicidal Hanging.-One or two points are worthy of notice in relation to this medico-legal question. The hands or legs, but more commonly the former, have been found tied in cases of undoubted suicidal hanging (Ann. d'Hyg, 1832, t. 1, p. 419); and yet it has been gravely debated whether it was possible for a person to tie or bind up his hands and afterwards hang himself. It is unnecessary to ex amine the ingenious arguments which have been urged against the possi bility of an act of this kind being performed, since they are refuted by well-ascertained facts. (Lond Med. Gaz., vol. xlv. p. 388; and Guy's Hosp. Rep., 1851, p. 206.) It has also been a debated question whether corporeal infirmity, or some peculiarity affecting the hands, might not interfere with the power of an individual to suspend himself. This question can be decided only by reference to the special circumstances of the case. In the case of the Prince de Condé, it was alleged that he could not have hanged himself in consequence of a defect in the power of one hand; it was also said that he could not have made the knots in the handkerdhiefs by which he was suspended. Allegations of this kind appear to have been too hastily made in this and other instances. A determined purpose will often make up for a great degree of corporeal infirmity; and unless we make full allow ance for this in suicide, we shall always be exposed to error in drawing our conclusions. Blindness is no obstacle to this mode of perpetrating suicide; and in reference to age, suicide by hanging has been perpetrated by a boy of nine, and by a man of ninety-seven years of age. STRANGULATION-CAUSE OF DEATH. 433 STRANGULATION. CHAPTER XL. CAUSE OF DEATH.-APPEARANCES AFTER DEATH.-WAS DEATH CAUSED BY STRANGULATION, OR WAS THE CONSTRICTION APPLIED TO THE NECK AFTER DEATH-MARKS OF VIOLENCE. ACCIDENTAL, HOMICIDAL, AND SUICIDAL STRANGULATION. Cause of Death. Asphyxia.-Hanging and strangulation are usually treated together, and some medical jurists have admitted no distinction in the meaning of these terms. In hanging, the phenomena of asphyxia take place in consequence of the suspension of the body; while in strangulation, asphyxia may be induced, not only by the constriction produced by a ligature round the neck independently of suspension, but by the simple application of pressure, through the fingers or otherwise, on the windpipe. Tardieu considers that the two modes of death should be kept distinct. The external and internal appearances in some respects differ; and while the proof of death from hanging leads to the strongest presumption of suicide, the proof of death from strangulation is equally presumptive of murder. (Sur la Pendaison, la Strangulation et la Suffocation, p. 151.) This medical jurist defined " strangulation to be an act of violence, in which constriction is applied directly to the neck, either around it or in the forepart, so as to prevent the passage of air, and thereby suddenly suspending respiration and life." This definition obviously includes hanging, and every person who is hanged may be said to be strangled; but while there is only one method of producing death by hanging, there are various methods of producing death from strangulation. A person may be strangled by the use of a cord, band, or ligature drawn tightly round the neck, or by manual violence to the front of the neck, whereby respiration is prevented. The cause of death is asphyxia. The rapidity with which it takes place will depend on the degree and situation of the pressure and the completeness with which the act of breathing is obstructed. Faure applied a ligature forcibly and suddenly to the neck of a middlesized dog. For fifty-five seconds the animal did not appear to suffer; but suddenly became violently agitated, its body stiffened, and it rolled convulsively on the ground. A bloody froth issued from the nostrils and throat, and the animal made frequent and violent efforts to breathe. In three minutes and a half it was dead. In a second experiment an elastic tube was introduced into the windpipe, which admitted of being gradually closed by pressure. The animal could bear the pressure up to the reduction of one-half of the calibre of the tube; but beyond this it suffered greatly, and when the pressure was increased convulsions supervened. The dog died in great suffering before the tube was completely closed. (Ann. d'Hyg., 1859, t. 1, p. 122.) It is probable that human beings die more quickly than animals, especially from the effects of manual strangulation. A sudden and violent compression of the windpipe renders a per 434 POST-MORTEM APPEARANCES. son powerless to call for assistance and give alarm, and it causes almost immediate insensibility and death without convulsions. When a ligature or bandage is used, the pressure is not so complete, and death takes place more slowly with convulsive movements. The circulation of dark-colored blood continues for a short interval (about four minutes), as in other cases of asphyxia. Owing to this, the face and lips, in accidental strangulation, have been observed to acquire a dark leaden hue. This arises partly from the arrest of the current of venous blood as the result of compression of the vessels and partly from the circulation of unaërated blood. There is a fair chance of recovery if the cause of constriction is removed, and air is permitted to have access to the lungs within a period of five minutes; this is on the assumption that no great mechanical injury has been done to the neck. In the act of strangulation a much greater degree of violence is commonly employed than is necessary to cause death; and hence the marks produced on the neck will be, generally speaking, much more evident than in hanging, where the mere weight of the body is the medium by which the windpipe is compressed. Post-mortem Appearances.-The appearances after death are similar to those of hanging, but the injury done to the parts about the neck is commonly greater. Externally, if much force has been used in producing the constriction, the windpipe, with the muscles and vessels in the forepart of the neck, may be found cut or lacerated, and the vertebræ of the neck may be fractured. The face is commonly livid and swollen, the eyes wide open, prominent, and congested, and the pupils dilated. The tongue is swollen, dark-colored, and protruded; it is sometimes bitten by the teeth, and a bloody froth escapes from the mouth and nostrils. The principal external signs of strangulation are seen in the marks on the neck, produced either by a cord or manual pressure. Tardieu has described another appearance which might be overlooked. This consists in the presence of numerous small spots of ecchymosis upon the skin of the face, neck, and chest, as well as in the conjunctiva or membrane of the eyes. These parts present a dotted redness, which has, however, been met with in other cases besides death from strangulation. Internally, the chief signs are to be looked for in the lungs, which are sometimes congested, and at others normal. Tardieu describes patches of emphysema, and also effusions of blood into the substance of the organs (pulmonary apoplexy), varying in diameter from five-eighths of an inch to an inch and a half, and states that the internal punctiform ecchymoses of suffocation are rare in cases of strangulation. (De la Strangulation.) The mark on the neck when a ligature has been used is commonly described as a depression, wide but not deep, and corresponding in its characters to the form and thickness of the ligature and the mode in which it has been secured. Too much importance must not be attached to this supposed correspondence when the ligature is not forthcoming. In a case of accidental strangulation which the author saw in 1864, the mark round the neck presented the appearance which might be expected from the use of a narrow cord. But in this instance a soft silk neckerchief was the means of constriction, and the peculiar narrowness of the mark on one side was owing to the great tightness with which it had been drawn. The mark or impression produced by a ligature is generally circular, from the mode in which the pressure is produced. It may be situated at any part of the neck, but it is more commonly below the windpipe. In manual strangulation the marks of bruising and ecchymosis will generally be in the front of the neck, chiefly about the larynx and below it. In a case of homicidal strangulation (Reg. v. Shaw, Liverpool Ass., Nov. POST-MORTEM APPEARANCES. 435 1884), the following were the appearances noted, the strangulation of a woman having been effected by means of the fingers and thumb applied to the sides of the neck. There was a bruise, with extravasation of blood, immediately beneath the lobule of the left ear; and another, also with extravasation, three-quarters of an inch below the lobule of the right ear. Corresponding to this latter bruise, a second effusion of blood had taken place into the deeper tissues half an inch beneath the surface. There were other bruises over each eyebrow, at the back of the right wrist, over the knuckle of the left little finger, at the inner side of the left elbow, and at each angle of the mouth. Within the mouth was a contused and lacerated wound opposite the jagged stump of the canine tooth, and, exactly opposite to this, on the upper lip was a smaller bruise, with extravasation of blood. The tongue was bruised on the right side, as though it had been caught between the teeth. The left lateral upper incisor was loosened, and the tongue and effused blood showed that the wound was recent. The blood generally was dark and fluid. The brain and its membranes were intensely congested. There were no marks of injury to the throat. The lungs were congested, and emphysematous on the surface. The heart contained a quantity of dark fluid blood. The abdominal viscera were not noticeably congested. Urine and feces had escaped. (Med. Chron., i. p. 577.) The circular direction of a mark produced by the ligature is not an absolute indication that strangulation has taken place without suspension of the body, since cases of hanging have occurred in which a circular mark has been observed; and it is possible that some degree of obliquity may occasionally exist in the course of the depression produced by a ligature in strangulation. A medical jurist ought, therefere, to weigh all the facts connected with the position of the body and the nature and direction of the ligature, before he forms an opinion from the appearances presented by the mark on the neck, whether the person has been hanged or not. Greater importance is to be attached to the lividity, ecchymosis, and abrasion of the skin in the course of the ligature than to the circularity or obliquity of the depression produced by it. In the strangling of a living person by a cord, it is scarcely possible that a murderer can avoid producing on the neck marks of severe injury, and, in the existence of these, we have evidence of the violent manner in which death has taken place. In cases in which great violence has been used to the neck, blood may escape from the mouth and nose. It is a matter of popular belief that, if there is no open wound in the body, there can be no bleeding. In Reg. v. Millar (C. C. C., July, 1870), the prisoner was charged with the murder of a Mr. Huelin. One of the circumstances which led to the discovery of the crime was the large amount of blood which had escaped from the mouth and nose as a result of the act of strangulation. The evidence left it clear that the prisoner had murdered Huelin and his housekeeper, and had endeavored to conceal the dead bodies. He had packed the body of the housekeeper in a box, and requested a carrier to place a cord round it. The man observed that fluid blood was oozing from the box, and that there was a large stain of blood on the floor beneath. On opening the box the body of the woman was found inside. There was a cord tied tightly round the neck of the deceased, and blood had escaped from the mouth and nose and had run down the side of the box. The deceased had been strangled, and such an amount of force used in the tightening of the cord round the neck, as to lead to a copious effusion of blood from the mouth and In cases of asphyxia the blood, owing to its liquidity, continues to flow for some time after death from any lacerated wound or blood vessel. On the other hand, a person may be strangled, and yet the ligature, in nose. |