The FACE varies with the duration of the suspension; at first it is pale, afterward livid; congested and swollen, if the subject has been long suspended. Roth found the face pale in 43 of 49 cases. In about one-half the cases the features are calm and placid (syncope). Maschka found the lips bluish in 98 of 153 cases. The EYES are often prominent, staring, and congested, and usually the pupils are dilated. Lacassagne and Maschka[848] look upon ecchymoses of the eyelids and conjunctivæ, “piqueté scarlatin,” as important as favoring the idea of hanging or strangulation. Roth found in 49 cases the eyelids closed 28 times; half open, 12; congested in 6; ecchymosed in 2. Pupils dilated in 31; narrowed in 2. Dilated in 97½ per cent of Ogston’s cases (Cases 85, 86; rupture of crystalline lens). Harvey[849] says the blood was found flowing from the EAR in 6 cases of nearly 1,500, but no details were given. Ogston, one case. Hofmann saw a case in which there was bleeding from the ears. He says this is not due, as has been supposed, to rupture of the tympanic membrane, but to hemorrhage from subcutaneous vessels (Case 27).
The TONGUE is usually livid and swollen, especially at the base. According to Tidy, Dr. Guy looks on this as showing that suspension took place very probably during life. In about one-third of the cases the tongue is protruded and compressed between the teeth; sometimes bitten. Some observers found it protruded only as a result of putrefaction. The protrusion of the tongue is not believed to depend on the position of the ligature. Hackel in 67 cases found the tongue lying forward in all cases where the cord was between the larynx and the hyoid; in 55 per cent in front of the teeth, in 18 per cent between the teeth; where the ligature was lower down, the tongue was behind the teeth. He found by experiment that in the spasmodic expiratory effort the tongue was thrust forward; in the inspiratory movement, drawn backward. He concluded that the forward movement was the result of reflex action. Maschka[850] found the tongue between the teeth 58 times in 149 cases. Roth in 49 cases found the tongue projecting and bitten in 22, the teeth shut in 15 others; in 15 the mouth was open; the tongue was retracted in 30 cases.
Harvey, after examining reports of nearly fifteen hundred hangings, says: “In the majority of instances immediately after death the features were placid, the face pale, the eyes not unduly prominent, the mouth closed or half open, the tongue pressed against the teeth but not protruding; the superficial veins full, but the head, neck, and trunk free from lividity. After a longer or shorter time, however, and apparently after a very few hours, in India, all this is changed. Livid patches appear about the chest, back, and shoulders; the face and head become bloated and puffy, the tongue and eyes protrude.”
Bloody froth is sometimes seen at the nose and mouth.
Saliva is invariably secreted and runs out of the mouth down on the chin and chest. Its presence is considered as evidence that suspension occurred during life. The URINE and FÆCES are sometimes found to have been expelled. These discharges occur in all kinds of violent death. Tardieu found them, however, but twice in 41 cases of hanging. Roth in 49 cases found discharges of fæces in 17 and urine in 4; in 15 cases not noticed.
Harvey mentions a case where internal piles had burst, and there were stains and clots of blood about the perineum and anus. In such cases without careful examination there would naturally be a suspicion of violence.
In about one-fourth of the cases the GENITAL ORGANS are congested. The penis is large and more or less erect; seminal fluid, generally prostatic, and sometimes mixed with blood, is often expelled. The fluid may pass only into the urethra and it may be necessary to press the urethra to secure it. The clitoris may be found erect, and there may be a sort of menstrual flow. Orfila showed by experiment that swelling of the sexual organs and emission of semen can be produced after death in those who had been suspended during life. The flow of semen is found in all kinds of death by violence. Roth in 39 cases of hanging of men found the penis enlarged 18 times and ejaculation in 19. Hackel found the penis swollen in 43 per cent of cases of asphyxia. Erection may come on soon or late, even days after death.
Internal Appearances.—The CONNECTIVE TISSUE UNDER THE MARK is usually white and condensed, the more so if the body has been long suspended. This dryness or condensation was found by Hackel in 52 per cent of hangings. Deeper-seated parts are injured only when the hanging has been violently done. The MUSCLES, especially the sterno-mastoid, are sometimes ruptured. Hofmann[851] reports several cases. Lesser[852] in 50 hangings saw 11 ruptures of muscle. Maschka never saw the rupture in suicides. The sterno-mastoid was ruptured in the case of Wirtz (Case 96) and Guiteau (Case 95). Hackel in 67 cases failed to find the muscle ruptured. Hofmann[853] believes that the rupture of the muscle is sometimes post mortem. Coutagne[854] found the sterno-mastoid muscle ruptured once in 24 cases (Cases 29, 89, 95, 96).
The LARYNX may be fractured or dislocated. These lesions are very rare in suicide; more frequent in homicide and judicial hanging, and in the old where the cartilages are calcareous. Remer found the injury in but 1 case in 101 of suicidal hanging. Barker found the larynx lacerated in his judicial cases.[855] Harvey says that the TRACHEA was reported lacerated 11 times in nearly 1,500 cases; twice the laryngeal cartilages were separated from each other. In 5 these cartilages were fractured, but there was nothing to show under what conditions. Hemorrhage in vicinity of larynx, 43 times. Pellier[856] reports 1 case, and adds that the existence of the lesion easily escapes notice because of the mobility of the cornua. Roth in 49 cases failed to find any fracture. Pellier found the cricoid was injured oftener than the thyroid, which is the reverse of what is found in strangulation. Cavasse[857] was unable to cause fracture of larynx by hanging the cadaver. Chailloux[858] collected 6 cases of fracture of larynx in hanging. He concluded that the fracture could not be produced on the cadaver by hanging, and is, therefore, caused during life. Coutagne[859] in 24 cases found fracture of thyroid cartilage 8 times (Cases 9, 51, 82).
The HYOID BONE is rarely dislocated. Orfila mentions a case of fracture. Barker found the bone usually fractured in judicial cases. In the case of Wirtz (supra) the greater cornu was broken. Pellier reports 2 cases. Hofmann[860] says the hyoid cornua are often fractured, especially when the ligature is between the hyoid bone and thyroid cartilage. Coutagne found fracture of hyoid bone 8 times in 24 cases. He attributed the fracture to pressure against the spine. Pellier speaks of fracture of STYLOID PROCESS (Cases 51, 84, 88, 89, 95, 96).