Dr. Barker, of Melbourne,[861] states that in 50 cases of hanging by the old method there was not one case of fracture or dislocation of vertebræ. After adopting his suggestion to place the knot near the spine, he found that dislocation occurred between the second and third cervical vertebræ with fracture of the third and pressure on the spinal cord. Death was sudden and complete. The drop in these cases was short, three to four feet. Coutagne thinks that the ordinary mobility of the head, axis, and atlas on each other have led reporters into the mistake of supposing a dislocation of vertebræ. Roth failed to find fracture of vertebræ in any of 49 cases. These injuries are especially rare in suicide; but in violent hanging, dislocation or fracture may occur and also rupture of the ligaments. Harvey gives 5 cases of dislocation of vertebra and 4 of fracture of vertebra in suicides. Three of the latter were doubtful. Tardieu says these fractures have no significance as to the hanging having occurred during life. They can be produced on the cadaver; but infiltration of clotted blood around injured vertebræ shows that suspension occurred during life (Cases 5, 7, 8, 68, 76 to 79, 83, 84, 91, 92, 94).[862]
The CAROTID ARTERIES may be injured; usually the inner and middle coats are torn; and hemorrhage may occur into the wall of the vessel. The common carotids are the ones usually affected, and just below the bifurcation, but the external is also occasionally injured. The injury is said to be due to the stretching and squeezing of the artery, stretching being the most effective since the rupture often occurs at a distance from the mark of the ligature. Such injury of the artery does not prove that hanging took place during life because it has been produced on the cadaver; but hemorrhage into the wall of the vessel or wound or rupture after death is very improbable. Maschka says the lesion is very rare. Tardieu says that the injury to the carotid is rare and therefore unimportant. Pellier reports 4 cases of rupture of carotid in a total of 23. Levy records the experiments of Hofmann, of Vienna, and Brouardel and himself, of Paris, 5 in number. He concluded that compression of the carotid arteries, if it produces obliteration, can cause rapid loss of consciousness and death; and explains why in incomplete suicide the subject is unable to help himself. Coutagne found rupture of carotids 10 times in 24 cases. He insists on the importance of the lesion.
Hofmann[863] says the rupture is always transverse, may be simple or multiple and may occur in suicides; more apt to occur when the ligature is thin. Lesser[864] tabulated 50 fatal cases of suicidal hanging; in 29, he was satisfied that the hanging occurred during life. In 3 of these the skin of the neck alone showed any lesion; there was a double mark, the skin being otherwise bloodless. In 5 the deeper soft parts were the only ones affected. In 3 the skin showed lesions, the deeper soft parts none, but either the hyoid bone, larynx, or vertebræ were involved. In 12 the skin showed no mark, but the deeper soft parts and either the larynx or hyoid bone were involved; and in 6 the hyoid bone only or the bone and larynx were injured. In the remaining cases it was not possible to say that the hanging occurred during life. In 2 cases there were no marks at all; in 9 there were changes in the skin; in 4, changes in the skin and deeper parts; in 2, changes in the skin, deeper parts, and hyoid bone or larynx; in 3, changes in the skin and hyoid bone or larynx, or both. In 14 of the 50 cases the hyoid bone was fractured; in 20 the larynx; and in 1 the vertebræ. The common carotid arteries were injured in 6. The number and severity of the lesions bore no constant relation to the thickness of the ligature, nor to the force used, but rather to the position of the body.
Ecker[865] reported a case of suicidal hanging in a man, age 40, where the soft palate was swollen and filled up the passage so that the air evidently could not enter.
The LARYNX and the TRACHEA are usually deeply congested, of a red color; a violet color indicates putrefaction. Ogston reports mucus but not bloody froth 9 times in the pharynx, 6 in the trachea, and 4 in the lungs, in a total of 40 cases. In one case there was a quantity of blood in the larynx and pharynx. Taylor thinks that pinkish froth in the trachea indicates incomplete obstruction; and Chevers that it is due to spasmodic efforts to breathe when the obstruction is nearly complete. Chevers always found clear mucus in the larynx and upper part of trachea, each follicle being marked by a minute globule of mucus. Harvey states that this was noted a few times in his reports. Baraban[866] discusses the condition of the epithelium of the air passages in hanging.
The condition of the lungs and heart varies according to whether death is due to syncope or asphyxia. Ogston found, in 22 cases, the lungs were expanded in 4 and collapsed in 2.
Harvey says the LUNGS are congested in over seven-eighths of the cases; emphysematous in a few; and subpleural ecchymoses present in a few. Patenko[867] experimented on dogs by hanging them. When the constriction occurred after expiration the lungs were congested; when after inspiration, not congested. In the first case (p. 223) the blood flows from the periphery to the heart and thence to the lungs, but cannot flow from the lungs because of the difficult circulation in the dilated pulmonary vessels and deficiency of intrathoracic pressure. There is in both cases cerebral congestion in the region of the bulb. Tardieu holds that punctiform ecchymoses and apoplexies do not occur in hanging unless suffocation has preceded. Pellier,[868] however, found these ecchymoses 14 times in 22 cases. He says that the lesion is not characteristic of suffocation, and quotes Lacassagne, Grosclaude, Dechoudans, Vicq, Chassaing, and Legroux to the same purpose. Hofmann[869] says that the ecchymoses are relatively rare in adults. Maschka[870] found them 18 times in 153 cases.
Harvey states that the presence of serum in the PERICARDIUM seems more a matter of time elapsed after death than anything else. Still the fact is that it is found much oftener in strangulation than in hanging. The difference is explained by the comparative slowness of death in strangulation. Harvey finds that in about one-half of the cases, if the body is fresh, the right side of the HEART, pulmonary artery, and venæ cavæ are full of dark fluid blood, the lungs being also much congested, and the signs of death by asphyxia well marked. When blood is found in both sides of the heart, it is probable that death is due to neuro-paralysis. When decomposition is advanced all the cavities are often empty. Taylor says that if the examination is delayed for several days, the distention may not be observed.
The STOMACH is often much congested, and this fact might sometimes suggest the possibility of poisoning. The LIVER, SPLEEN, and KIDNEYS are usually much congested. Hofmann[871] says that this occurs in the kidney only when the body has been hung a long time.