Research article Int J Pharm Biomed Sci 2012, 3(3), 80-84

ISSN No: 0976-5263

Research Drops
PharmaInterScience Publishers

A study of ligature mark in cases of hanging deaths

T. Saisudheer1*, Deaths by ligation constitutes a major chunk of asphyxia deaths and corporal
T.V. Nagaraja2 evidence in 99% of cases, speaks about suicidal origin. When any case is submitted
to autopsy pathologist, without any evidentiary escort and with a valley of
1
Department of Forensic Medicine & questions and allegations regarding the manner of death, it is doctor’s responsibility
Toxicology, Kurnool Medical Collage, to come out with a justifiable opinion regarding many questionnaires. Study aims at
Kurnool – 500002, Andhra Pradesh,
India.
avoiding the misinterpretation by keen observation of autopsy findings, careful
2
examination of scene of crime, getting reliable information from near and dear of
Department of Forensic Medicine & deceased and detailed study of literatures regarding this subject matter by eminent
Toxicology, Chalmada Ananda Rao
Institute of Medical Sciences, medico legal experts. Detailed study of 200 cases of asphyxia deaths due to ligature
Karimnagar-505001, Andhra Pradesh, pressure over neck was done in the Department of Forensic Medicine, Kurnool
India. Medical College, Andhra Pradesh, India for a period of two years [2010 &2011.
After detailed study of all two hundred cases of asphyxia deaths due to pressure
over neck by ligature, statistics were discussed in detail to reach justifiable
*Correspondence: conclusions which is explained in detail. Suicides by hanging are now becoming a
Dr. T. Saisudheer
Tel: +91 9849027417
preferential mode particularly in urban population and over taking other modalities
Email: drsaisudheerkmc@gmail.com like poisoning, burning and drowning. Reasons may be the availability of ligature
material, easy accessibility to the suspension point in domestic set up and deaths by
hanging are considered as painless deaths when compared to other modes. Many
victims are middle aged group and post marital deaths are more than before
marriage. Partial hanging type predominates over complete hanging and majority is
atypical hangings than typical one. In majority cases the ligature material is one of
the wearing cloths followed by ropes and wires or chains. Anatomical damage to
the internal neck structures is lesser in suicidal hangings when compared with
homicidal hangings and other deaths due to pressure over neck.
Key words: Asphyxia deaths, Deaths due to hanging, Forensic medicine, Ligature
mark, Ligature materials, Suicide

Received: 04 Jul 2012 / Revised: 08 Jul 2012 / Accepted: 09 Jul 2012 / Online publication: 12 Jul 2012

1. INTRODUCTION Depending upon the methods of suicide, hanging is one of

Deaths by ligation of neck are in practice from the time
immemorial and before advent of civilization. In uncivilized
societies, the application of ligation for taking away the life
of another person was one of the commonest practices which
were successfully carried out into the civilized societies.
Earliest it was a homicidal method as suicide was considered
as a heinous act. More over the impression was ligation leads
to wind pipe constriction for which manual violence is
needed. But with progression of civilization, ligation has
been adopted for self application also.
When compared to other modalities of unnatural deaths,
death by ligation has found world wide acceptance and is one
of the preferred method to take away the life.
the commonest modes of death. Virtually all hangings are
suicides until unless otherwise proved contrary.
As per expert opinion, suicidal hangings are less common
in females but now a day’s domestic problems, frustrations,
harassments and so many other stress related reasons leading
to increased fold of suicides in females when compared with
past. But still suicides by hanging are in higher percentage in
men than women. Children are victims in many occasions of
homicidal hangings when compared with other age group.
Many conditions like passion, disappointments, loss of
property, misfortune, financial losses, poverty, disgust with
life, physical and mental sufferings, religious mania, unhappy
love, failures in many aspects, marital problems, jealous,
unbearable fear and pain are some of the common known
reasons for an individual who were tempted to put an end to

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T. Saisudheer and T.V. Nagaraja, Int J Pharm Biomed Sci 2012, 3(3), 80-84 81

his or her life by suicide by hanging which is one mode of haemorrhages. Fractures of hyoid bone are rare below 40
self killing, after poisoning. years of age. Generally superior horns of thyroid are
Hanging is a form of asphyxia which is caused by fractured. The abdominal organs are congested, but brain
suspension of the body by a ligature, which encircles the may be pale or congested according to mode of death.
neck, the constricting force being weight of the body, where The term asphyxia means absence of pulsation
whole weight is not necessary. Weight of the head (5kg-6kg) (pulselessness) and it results from the interference with
is enough to act as constricting force. So death happens in uptake of oxygen due to any cause which may be mechanical,
partial hangings also, which are on toes, feet touching, environmental or toxic. The tissues of the body cannot
sitting, kneeling and lying down postures. Many deaths of function without oxygen. Hence many deaths are due to
sexual asphyxias are of partial hangings. A suicide will use inference of oxygen supply to tissues which is a result of
any article readily available for the purpose, from sacred hypoxia or anoxia.
thread to sari, dhoti, chunni, rope, towel to bed sheet, chains The classical signs of asphyxia are
and wires, like many whichever available for them. 1. Congestion due to decreased venous return.
Symptoms of hanging starts with loss of power and 2. Tardieu spots or Peticheal haemorrhages due to escape
subjective sensations, followed by flashes of light, ringing of red blood cells from ruptured capillaries leading to
and hissing of noises in the ears, mental confusion, loss of formation of small bleeding points.
consciousness, which is so rapid, thus it is regarded as 3. Cyanosis due to reduced haemoglobin in the blood
painless form of death. Stage of convulsions follow and face
is distorted and livid, eyes prominent and there is violent
struggling.
Causes of death in hanging are asphyxia, venous
congestion, cerebral anaemia, reflex vagal inhibition and
fracture or dislocation of cervical vertebrae. Delayed deaths
are rare, if occurs, are due to aspiration pneumonia,
infections, oedema of lungs, hypoxic encephalopathy, brain
infarction, brain abscess and cerebral softening. In persons
who survived, secondary effects like hemiplegia,
convulsions, amnesia, dementia, cervical cellulites, parotitis
and retro pharyngeal abscess are seen. Usual fatal period in
deaths due to hanging is between 3 & 5 minutes in majority
cases.
Ligature mark depends upon composition of ligature,
width and multiplicity of ligature, weight of the body
suspended, degree of suspension, tightening of the encircling Fig.1 Pathophysiology of asphyxia
ligature, duration of suspension, position and type of knot,
slipping of the ligature during suspension and height of
suspension.
Ligature produces a ligature mark as a furrow or groove
2. EXPERIMENTAL
in the tissue which is pale initially, turns to yellow or
yellowish brown and is dry, hard on touch, parchment like
This study is conducted in the department of Forensic
due to drying of slightly abraded skin oozing. In partial
medicine and Toxicology, Kurnool medical college, Kurnool,
hangings, constricting force is less and congestive changes
Andhra Pradesh. The period of analytical study of ligature
are more marked because only veins are occluded. When
mark in cases of deaths due to hanging is from January 2010
there is pressure over cervical sympathetic ganglia, the eye
to December 2011. The total number of autopsies on hanging
on the same side may remain open and its pupil is dilated.
done during 2010 and 2011 years are 205. A detailed study of
Dribbling of saliva from angles of the mouth results from
200 cases of deaths due to hanging are analysed with special
irritation of salivary glands due to compression by ligature
reference to ligature mark.
over glands.
1. History obtained from relatives
Neck should be examined by reflecting skin flaps by
2. Visit to the scene of crime in suspicious cases
modified Y shaped primary incision, After emptying three
3. Description of scene of crime, injuries over body, last
cavities i.e., cranial, thoracic and peritoneal cavities, neck
seen alive and first seen dead
region is examined at last to avoid artefacts and
4. Information from the inquest report
misinterpretations. Superficial small haemorrhages in the
5. Autopsy done in hanging cases personally in mortuary
underlying layers of skin are produced directly by ligature.
of Kurnool medical college
Vertebral arteries also shows tears and sub intimal
6. Finding of autopsies in the post mortem reports
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T. Saisudheer and T.V. Nagaraja, Int J Pharm Biomed Sci 2012, 3(3), 80-84
7. Suicide notes, if any, present
8. Study of case sheets, where death occurs in hospitals, as
a complication of hanging.
3. RESULTS
The total numbers of autopsies done in the mortuary of
Kurnool medical college, Kurnool between the periods of
2010 to 2011 were [1487+1385] 2872, out of which total
number of autopsies done on cases of hanging were 205. A
detailed study of 200 cases of death due to hanging are
analysed with special reference to ligature mark.
About identity of deceased, out of 200 cases of hanging,
victim identified cases were 194 (97%) and victim
unidentified cases were 06 (3%). The most common age
group of victim was fallen between 20 to 40 years. Out of
200 cases of hanging 136 (68%) were female victims and 64
(32%) were male victims and regarding marital status
incidence of hanging is more common in married persons i.e.
out of 200 cases of hanging in 164 cases (82%), the victim
were married and unmarried victims were 30 (15%) and in 6
cases (3%) the marital status was unknown.
Regarding socioeconomic status of the victims, out of 200
cases of hanging, the incidence is more common in middle
income group 156 (78%), next common is in lower income
group 34 (17%) and least common is in higher income group
04 (2%) and not known in 6 (3%) cases. Regarding motive
for committing the suicide in hanging, in males family
disputes were most common motive 36 (18%), next common
motive was ill health 18 (9%) and least common motive was
financial problems 10 (5%). In females the most common
motive was harassment particularly in married women 102
(51%), next common motive was family disputes 22 (11%)
and least common motive was ill health 12 (6%).
Regarding type of hanging, complete hanging cases were
about 128 (64%) and partial hanging cases were about 72
(36%). About posture of the body in partial hanging, feet
touching cases were 88 (44%), sitting posture cases were 4
(02%) and kneeling posture cases were 34 (17%) and in lying
posture are 02 cases(01%).
Regarding nature of ligature material, out of 200 cases
hanging, in 172 cases (86%) the ligature material was soft, in
16 cases (08%) it was firm, in 4 cases (02%) it was hard and
in 08 cases (4%) the nature of ligature material was not
known. Regarding level of the mark over the neck, out of 200
cases, in 176 cases (88%) the mark was present above thyroid
cartilage, in 20 cases (10%) it was present over the thyroid
cartilage and in 4 cases (2%) it was present below the thyroid
cartilage. Regarding grooving of the ligature over the skin of
neck, out of 200 cases, in 108 cases (54%) grooving was
present and in 92 cases (46%) it was not present. Regarding
position of the knot, out of 200 cases of hanging, in 122 cases
(61%) the knot was in left side of neck, in 56 cases (28%) it
was in right side of neck, in 22 cases (11%) it was on the
back of neck. Regarding encircling of the mark around the
neck, out of 200 cases, there was incomplete encircling of the
©2012 PharmaInterScience Publishers. All rights reserved.
82
mark in 164 cases (82%) and complete encircling of the mark
was present in 36 cases (18%). Regarding presence of pattern
of ligature over the skin, out of 200 cases, pattern was present
in 20 cases (10%) and absent in 180 cases (90%). Regarding
type of knot, out of 200 cases slip knot was present in 118
cases (59%), fixed knot was present in 64 cases (32%) and in
18 cases (09%) there was no particular type of knot.
Regarding presence of injuries other than ligature mark, out
of 200 cases, in 186 cases (96%) injuries were absent and in
14 cases (4%) injuries were present. Regarding fracture of
hyoid bone and thyroid cartilage, out of 200 cases, there were
no fractures in 192 cases (96%) and in 08 cases (4%)
fractures were present. Soft tissue injury of neck region is
observed in 56 cases (28%) on dissection.
4. DISCUSSION
Out of all cases, percentage of hanging cases is 12% in
cumulative total of PMEs in years 2010 and 2011. As an
assistant professor I personally observed about 200 cases of
deaths from hanging in the mortuary and studied in detail in
the above direction, to ascertain the positive and negative fall
outs and pit falls, possibilities of misinterpretations,
masquerades, artefacts etc., in the interest of administration
of justice.
In my study, establishment of the identity of deceased is
near total 97% in deaths. Majority of the deceased have fallen
in the age groups of 20-40 years where compromise and
adjustment to the then circumstances leads to more stress.
This is followed by the period of adolescence. Incidence of
female sex is more in adolescent age group; this may be due
to early physical and mental maturity with influence of
emotional factors, in female sex. The incidence of hanging
deaths is minimal in the extremes of age. In the early
childhood (below 10 years) the deaths are either homicidal or
accidental in nature as emotions have no important role to
play. In contrast, in other extreme of age i.e. old age, the low
incidence is due to comprise and acclimatization to the
factors leading to suicide.
In my study the incidence of hanging deaths are more
common after marriage comparative to premarital life and
clearly indicates the influence of marriage on human
behaviour and institution of family. The incidence of hanging
is more in female sex than male sex and in 82% cases female
victims were married. This clearly shows the increased
vulnerability of female sex after marriage.
In my study hanging deaths whether suicidal or homicidal
are rare in upper income group. This is accordance with the
general trend of criminal profile which originates from the
roots of environmental and psychological factors. This why,
the maximum incidence of the hanging deaths are seen in
middle income group, who never compromise or accept the
reality. In contrast, the lower income group shows the same
trend, but on a lesser scale, which indicates the incidence of
hanging deaths, more of psychological in origin.
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T. Saisudheer and T.V. Nagaraja, Int J Pharm Biomed Sci 2012, 3(3), 80-84
In this study, in 85% of cases of death, precipitatory
factors are attributed, which revolves around 3 ‘M’ – Money,
Mental illness and Mal treatment. In males family disputes
are leading cause, where as in females, harassment is the
leading cause, particularly in married women. Male sex is
more vulnerable to matters concerned with money, where as
it is least important for females sex. With regard to other
factors like personal affairs ill health and mental illness the
trend is same for the both sexes.
In my study, in hanging deaths, preferred mode is
complete hanging, compared to partial hanging. In case of
partial hanging in majority of cases, feet are seen touching
the ground followed by sitting position. Low point of
suspension is not a must for partial hanging because in
present study, in majority of cases where feet are touching
the ground, the point of suspension is high. Reasons for it are
faulty assessment by the deceased before the application of
noose around the neck, stretching of the of the ligature
material after suspension and stretching of the neck after
death. With regard to nature of ligature material, the
preferred choice is a soft material like cloth made followed
by firm materials like rope. Hard material likes iron wires,
cable wires, etc, are used very rarely and the victims are
almost always of male sex only. But considered sex wise in
case of males the choice for soft and firm materials for
ligation is almost same, in contrast, in females the choice of
material is a softy only, with an occasional firm material like
rope. The preferred soft material for married group is the
saree. In contrast in unmarried group, dhoti, door curtain, bed
sheets or chunni are the preferred softies for use.
In the present study, typical hangings are rare and 22
cases, which are brought with intact noose around the neck,
the knot is on left side in 122 cases, the knot is on right side
in 56 cases and in 22 cases the knot is seen on the back of
neck. Knot below the chin is very rare. The commonest type
of knot applied is slip knot or loop, followed by reef or
granny knot.
In this study, whenever a broad ligature material like a
cloth or thick rope is used for ligation, the noose is made with
a single round around the neck. In contrast, when thin
materials like cables, metallic wires are used, they are applied
around the neck with more than one round. With regard to
course of ligature, in 82% cases it is partial in nature with
interruption either over nape of the neck or on the side of the
knot. In 18% of cases, it is complete in nature around the
neck with knot of slip variety only.
In this study, usual position of the ligature mark is above
the thyroid cartilage (88%), whether it is complete or partial
hanging, followed by mark over thyroid (10%). Only in 2%
cases, it is seen below the thyroid cartilage. This contradicts
the misconception that in partial hangings the ligature mark is
seen at a lower level, compared to complete hanging. This is
due to the application of slip knot in majority of cases where
final tightening of ligature occurs after the noose reaches its
final destination, i.e. upper part of the neck.
©2012 PharmaInterScience Publishers. All rights reserved.
83
About pattern of ligature, which is observed in 10% of
cases of hanging deaths, even though a patterned ligature
material was used it is not a hard and fast rule that patterned
abrasion should be produced by a patterned ligature material.
Hence the presence of pattern indicates that a firm or hard
material is used for ligation, but absence of pattern cannot
exclude a firm material. Hence presence of pattern has
positive value but its absence has no negative value, because
the imprint of pattern over skin depends on a number of
factors like texture of material, design of pattern, area of
contact, time of suspension, type of hanging etc. grooving
was present over ligature mark in 54% of hanging cases.
In our study, clinching and protrusion of tongue is seen
50% of cases of hanging deaths whether it is complete
hanging or partial hanging. Apart from ligature mark over
neck, other body injuries are seen in 7% of cases of hanging
and they are sustained prior, during and later to actual act of
hanging and their magnitude is not enough to indicate the
struggle, resistance or incapacitation, thereby raising the
finger towards the possibility of a homicide. In this study
damage to the internal tissues of neck is minimal in hanging
cases. Soft tissue damage was observed with ante mortem
fractures of hyoid bone and thyroid cartilage, in 4% cases. In
74% of cases of hanging, the internal neck structures were
free from the evidence of trauma. The presence of underlying
tissue damage is not an indicator for the manner of death in
case of hanging. In the present study, 97% of hanging deaths
are suicidal in origin; the remaining 3% are either homicidal
or accidental in nature. In all the four cases of homicidal
hanging, the victims are children who were below 10 years
and the perpetrator are the parents, who subsequently
committed suicide by same mechanism. In the two cases of
accidental hanging the victims are children while playing and
an adult under the influence of alcohol.
5. CONCLUSIONS
In ligation deaths, suicide by hanging is fast developing
as a preferential mode, particularly in urban areas, over
taking other modalities like poisoning, burning and drowning
etc. as it is considered as a pain less death and can be
accomplished with minimal effect and ligature material is
readily available.
Ligation deaths from hanging are most common in middle
age group, the period of an emotional outlet and outburst, and
almost are suicidal in nature. In contrast, hanging deaths in
child hood are mostly accidental or homicidal in nature and
in old age is suicidal.
In ligation deaths by hanging, male preponderance is seen
but this does not confirm the increased suicidal tendency in
male sex because the preferred mode for female sex is
conflagration.
The abnormally high post marital incidence of hanging
deaths shows the tell – tale signs and influence of marriage
on human behaviour, but this is the only factor which cannot
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T. Saisudheer and T.V. Nagaraja, Int J Pharm Biomed Sci 2012, 3(3), 80-84
be overcome and which has to be bore as long as the
institution of marriage at stake.
The incidence of suicidal hanging deaths is more common
in middle income group as they are the fulcrum of the society
with wavering or oscillating mentality.
The leading predisposing factor for mortality is
harassments in case of females, family and financial
problems in case of males, leading to physical or mental
stress in both sexes.
Irrespective of sex, partial hanging is more common than
complete hanging where in majority cases are feet are
touching the ground.
Soft materials are the preferred choice for ligation,
particularly sari in married group. Bed sheets, dhotis and
chunnis in unmarried group. Hence the marital status of the
deceased and the nature of the ligature material can also be
used as indicator in arriving to the manner of death.
Atypical hangings are more particularly with knot on left
side. There by typical hangings with knot over the occipital
region or under the chin usually allow suspicion as it is a
deviation from normalcy.
The course of ligature mark over the neck is influenced
by the type of knot applied which itself has no medico legal
bearing. An interrupted ligature mark over and above thyroid
cartilage is diagnostic of hanging.
It is not customary to get an imprint of ligature mark with
a patterned ligature material. The presence of pattern over
ligature mark has a positive value but its absence has more
negative value.
The grooving of the skin produced by ligature material
depends more on its texture, pattern, weight of the body and
duration of suspension rather than the other influencing
factors. Symptoms like clinched teeth or protrusion of tongue
can be considered as indicator rather than specific for
hanging.
©2012 PharmaInterScience Publishers. All rights reserved.
84
The extent of the damage to the internal structures of the
neck are nil or minimal in case of hangings when compared
with other modes of asphyxia deaths.
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