Crime and Clues

Ligature strangulation:
Not Very Common But Contested Too Often.

(One finding: many conclusions)

Abstract:

This paper discusses the difficulties in differentiating ligature strangulation from hanging during life and also after death. The cases shown are those cases of hanging, which appeared and were considered to be that of ligature strangulation or that of Post Mortem hanging till few weeks after the autopsy. These controversial homicides turned out to have been suicidal deaths due to hanging. The cases highlight the difficulty in differentiating hanging during life or immediately after death. The controversies in hanging are relevant because hanging being presented, as ligature strangulation and ligature strangulation being contested as hanging are not rare. The paper also discusses the possibility of mistaking ligature strangulation for hanging during life.

Keywords:

Introduction:

Hanging is one of the most popular suicidal options in this part of country. (1)(2). Yet, no other cause of death is so equivocal or raises so many questions. No other cause of death is so open to misinterpretation by forensic health professionals, let alone investigators, laymen and non-forensic doctors. (3) (4) (5) Talk to anyone who has handled enough cases of hanging and he will tell you that almost all cases were suicidal but that an average 50% of these were disputed. Some of these controversies are discussed in this case report.

It is known that the preference for the opinion of ligature strangulation or homicidal hanging is strong in some situations. A breakup of the controversies in hanging shows that the families of the victims are intolerant to the opinion of hanging, as indicated by the cases given below. Controversies are relevant because hanging being presented as ligature strangulation and ligature strangulation being contested as hanging are not rare. A case of death due to ligature strangulation had been brought and presented as that of hanging had been reported. (6) Homicidal hanging appearing to be suicide is very rare but does take place. (7) Presenting suicidal hanging as natural death is uncommon but is reported. (8) Suicidal hanging being misinterpreted as ligature strangulation is also reported. (9) Those who attend the controversy view the performance either as goof up or obfuscation or treachery or forgery etc. that makes the topic interesting.

The actual statistics of deaths with ligature marks was not available. Out of the approximately 390 asphyxial deaths brought to the mortuary during the last 10 years and 58 such controversial situations the author came across, homicidal reasons account for 1 (.22%).

Material:

The factual material upon which this communication is based is derived from actual cases.

A middle-aged man can be seen seated on the bedside stool in the photo (Fig. 1). The lower end of a rope is tied around his neck. A pool of blood on the floor on the sides and front of the body is seen. His face and front of the body can not be seen. To a viewer the photo created doubt of violence because of two reasons. First, presence of blood indicates there should have been some injury, which could have accounted for this collection of blood. The fatal or nonfatal injury whatever it was (stab or gunshot wound?) was on the front of the body. This could not be seen in the photo as the photo was taken from behind. Second, multiple railroad bruises were conspicuous over the back of the victim. One wonders why should there be so many injuries on a hanged victim?

This is the picture of the death of a man, who was found hanging in his own house. Autopsy opinion in this case was death due to hanging. In consideration of the circumstances and the autopsy opinion the police accepted the death as a suicide and filed the case.

A few months after the incident a suspicion of homicide was raised. The dismissal of the death as suicidal hanging appeared unjust because of the viewer’s impressions of the picture. An enquiry was ordered to fix accountability and identify the officers responsible. The autopsy report became the target of vicious comments, mainly because the autopsy report was silent over these injuries.  Autopsy opinion of hanging was disputed in favor of post-mortem hanging.

Police took this photo at the time of his being discovered dead. The photo of the deceased was the sole proof in the record to express the way the deceased was found. The photo was used to ascertain the truth and account for the lapses committed by the investigation, either negligently or due to incompetence or intoxication.

In their report of re-investigation, the police had cited several reasons on the basis of which the earlier autopsy report could be struck down.

• Autopsy report did not speak of any injury.
• They said that the autopsy opinion of “hanging” should be disbelieved because it was improbable for one to hang oneself in that position.
• Moreover the standard practice that anyone assigned to photograph a scene of this type will normally take more than one photograph, and will include views of both sides of the body. Could it be this body was a person other than the one in question? The identity of the deceased was being questioned. Either he was not the actual person or if he was then concealment of the actual identity and the injuries of the deceased appeared to be the motive. A theory of murder was so much on their minds that they nurtured a general notion that autopsy was fixed at the behest of the police.

In reply to allegations that he missed the injuries or that he deliberately omitted them from the report, the autopsy doctor had to explain that the body was in a state of decomposition. There were no injuries. The apparent injuries and the pool of blood were postmortem developments. This plea of artifacts could not satisfy the re-examiners. Apportioning blame on the autopsy for having failed to bring out the truth, critics alleged that there were bleeding injuries. Reasoning that hanging victims never bleed or show injuries supported criticism. Refuting impression of autopsy doctor, investigators maintained had it been hanging there would have been fracture of cervical spine and the deceased would not have been in the position as was in the picture. Their ultimate perception was that the deceased had suffered injuries. The injuries had been missed during autopsy. Rejecting the plea of artefactual bleeding, the re-examiners recommended registration of the case as homicide. The case was registered as homicide. It ultimately had to be cancelled.

It is commonly believed that normally any wife who saw her husband hanging from a ceiling fan would tell the truth about it. This did not happen in this case. If the wife of the deceased lies about having seen persons murder her husband, it is abundantly clear that the case of hanging can be presented as that of ligature strangulation.

In this case (9) the wife of the deceased revealed a well-witnessed story of killing.  She claimed to have witnessed the killers run after killing her husband. (Fig 2) At the time of autopsy police papers gave a clear-cut impression of the homicide. Majority therefore believed both investigator’s action and the autopsy report.

About two months after the incident there was public resentment against the arrest of two killers in the case. The follow up of the case on homicidal lines displeased many. Public rage at the arrest gained momentum. It was found that the death was by “hanging” not by strangulation. Hanging took place in one’s own surroundings. Twist in the story of homicide brought the need to revise autopsy opinion of strangulation.

Most of the policemen and lawyers wondered if a dead man with a sharp weapon injury on one side of the neck and without a clear-cut ligature mark could be a victim of hanging. In this case the death had taken place due to hanging in the deceased’s own house. But the deceased was declared dead in a nursing home. Neither the treating physicians nor the police or the autopsy doctor ever knew that there was a background story of hanging. Most of those concerned considered the death to be a homicide. A sharp weapon injury on one side of the neck and a blunt force impact injury on the front of the neck made almost everyone think of nothing but homicidal death. (Fig 4&5) The autopsy opinion being silent over a clear-cut cause of death was contrary to the general impression of homicide. It therefore appeared botched. (10).

The new facts came to light after a fortnight. The family members had seen the deceased hanging from a ceiling fan. After bringing him down they had shifted him to the nursing home. It was found that family members were aware of the fact that the deceased had committed suicide by hanging. They concealed the observed facts. They lied by misrepresenting the case. The relatives faked a story of natural death.

If one expects an autopsy diagnosis of “hanging” or “ligature strangulation” as it was, at least here is a case that singularly lacked it. Autopsy opinion in the death of this recently married woman (Fig 6 & 7) is an example of error in diagnosis of “hanging”. Neither the police nor the husband and his other relatives have expressed suspicion of “ligature strangulation”. The autopsy report in this case was of “strangulation”. It was not specified in the autopsy opinion whether the strangulation was of “manual” or by “ligature”. It was probably left optional and left to the user to derive the meaning oneself. Autopsy opinion of strangulation was clear. But the investigators were convinced that the young bride committed suicide by “hanging”. She was fed up with the persistent humiliation for bringing insufficient gifts and wealth at the time of her marriage. In view of the circumstances the trial began against the in laws for “abetment to suicide”.

Controversial aspect of the opinion was that had the investigators relied autopsy opinion the case would have reached the courts in a different form (i.e. causing death by strangulation by a ligature). Or had the prosecution side of counsels used this evidence at any stage after beginning of the trial the scene would have been different. The defense counsel resenting wrong autopsy opinion expressed fear of the consequences of misuse of this wrong autopsy opinion by the prosecution side at any stage in the trial.

The autopsy opinion of “strangulation” in this case was based on the ligature mark. The salient features of the ligature mark were – it was brown in color, grooved and was visible conspicuously. It was a common knowledge that grooving was caused when the constricting force around the neck is the weight of the body when suspended. The observation thus indicates that the dead body remained suspended for some time. It is commonly seen in death due to hanging. This easily noticeable ligature mark is placed in the uppermost part of the neck. (Fig 8) This location is quite common in hanging for the simple reason that the lower jaw obstructs the noose of ligature material. The direction of the ligature mark had been expressed as horizontal in the autopsy report. . “Horizontality” of the ligature mark appears doubtful if verified in the photo (Fig 8). A mark following the curvature of lower jaw on both sides has to be oblique but not horizontal. This observation of “horizontal” is therefore too difficult to be presumed to be true. The oblique, depressed, ligature mark placed in the uppermost part of the neck is suggestive of hanging. The observation of dribbling of saliva too supports interpretation of hanging. The case belies a general assumption that the opinion of those who had actually examined the body is to be considered better than those who are able to comment by looking at the photos of the deceased.

Discussion:

Public outrage against a particular line of investigation brings in re- investigations. Re-examinations sometimes are held in order to prevent situations of public outcry. Re-examiners can always make a case citing what went wrong during the previous investigation. We studied the reasons for wrongful autopsy opinions in some of the controversial deaths where there was a ligature mark around the neck. Idea was to examine flaws in the investigative system that might lead to wrongful autopsy opinions and how to prevent them. Those creating or hearing the dispute were aware that hanging and other variety of asphyxial deaths viz. ligature strangulation, homicidal hanging and Postmortem hanging, shared a similar finding on the neck. The finding was one but the perceptions were many.

Whether it was a suicide or a murder, even investigators sometimes find it tough to answer. From FIR to final judgment the autopsy opinion is often under focus almost at every stage of the justice system – at a time when police decide the section of the offence, court entertaining the bail application, evidence recording and during arguments in the trial. The aim of the autopsy examination in such deaths is to exclude homicidal kind of asphyxial deaths. Good screening can work miracles by preventing harassment and can be easily performed in the field without much difficulty.  Bad screening could target innocents.

In common medical parlance artifacts are a known cause for mistake in one’s opinion. An error in perception because of something that simulates something else is an artefactual perception. Case 1 is how the same class of people views artifacts differently on different occasions in the same case. Artefactual presentation was the cause for one’s failure to accept hanging in this case. The doubt that the autopsy opinion of “hanging” had been given with the intention to hush up the case prevailed. Outrage over the dismissal of a case as suicide by “hanging” succeeded in registering the case as that of homicide. Ultimately it failed before it could be prosecuted. Phenomenon of artefactual bleeding in cases of hanging has been reported recently. (11) Artefactual misinterpretation has thus the potential of harassment.

The bleeding at the scene of occurrence was thus interpreted differently by the investigators of two different times.  The initial forensic and police response to bleeding at the site was simply to ignore it.  To their counterparts after a period of 6 months same bleeding was considered to be from antemortem injuries, which either escaped attention of autopsy doctor or could even be a deliberate omission.

Case 1 poses a question that should fairness of autopsy opinion be questioned merely because it was against their perception. There is also the larger question is it easy to analyze photographic observations. One of the reasons of this paper is that the author wants the readers to have an accurate perception of the photograph.  It needs also to be understood that one is likely to be caught in controversy even though autopsy impression was right.

In the case 2 close reading of the autopsy report, made it appear that the deceased had been strangled. Public outrage against the impression of homicide had forced police to go in review of the autopsy opinion. The police were stunned to find that the autopsy opinion was contrary to the facts. The three points raised make a cogent and rather persuasive argument as to why the autopsy opinion was faulty:

• One, that after the wife’s scream at finding her husband dead, the brother of the deceased did not allow any of the neighbors to enter their house for about 15 minutes. It was during this time that the scene of the hanging was possibly changed.
• Two, the village headman had seen the family attempting to throw the body across the common wall in the courtyard of the house.(Fig 3)
• Three, that there was someone who had seen a rope hanging from a ceiling fan. A version which was not available on the day of the autopsy and which corroborates that there could have been a hanging.

The family in this case obviously wanted police to prosecute the case as homicide. This deliberate misrepresentation to acquire a particular opinion was the reason for mistake.

Who is infallible or who makes more or less mistakes is not the issue. The issue before the police was how to get the autopsy opinion revised. The prevalent legal assumption that how could an autopsy doer rectify his mistake even if he was convinced over one’s own error of judgment made the situation difficult. That how could anyone else who had not examined the body, could revise such an autopsy opinion and that too at that stage was another problem.

Family members were aware of the actual facts. They fudged the facts and deliberately misguided investigators.  That the wife had seen the accused fleeing the scene turned out to be untrue, and misled the investigators. The case highlights the practical difficulty in relation to the revision of the autopsy opinion especially in the light of legal presumptions. It needs to be understood that bringing about a revision in the expressed autopsy opinion needs expertise in the field of forensic medicine and that the time passed since the actual occurrence has no limit.

In the case 3 too, there was deliberate misleading. Interestingly here it was not to falsely implicate someone but to save family’s prestige. Such misrepresentation or concealment of the facts was the reason for erroneous perceptions in case 2 and 3. In the case 4 no one – neither police nor relatives of the wife or of the husband side spoke of strangulation. Opinion of “strangulation” was based on the perception of the autopsy doctor.

In case 2, 3 & 4 those who performed autopsy were experts in fields of medicine other than forensic medicine. These experts of medicine – ENT or Eye specialists had autopsy exposure during the undergraduate teaching of forensic medicine. Police brought none of these two cases (2 & 3) as victims of suicide. Interestingly at the stage of autopsy no one talked of hanging or of the use of ligature material. In the case 4 the deceased was female. She was brought as a hanging victim. Investigators either repented having used autopsy opinion of “strangulation” in these cases or considered it “unfit” to be used. There was thus a scope of non-forensic doctor’s keeping investigators from the truth. Misrepresentation and misinterpretation in hanging are reported in the literature. Ligature strangulation staged as suicidal hanging had been reported. (6) That the autopsy diagnosis of Ligature strangulation was missed inadvertently in certain circumstances can be seen in a study. (7) Suicidal and homicidal hanging look alike. Homicidal hanging is very rare but does take place. (8) Presenting a case of hanging as natural death is reported. (9) Suicidal hanging misrepresented as ligature strangulation too is reported. (10).

Many of the mistakes we see today can be described. For an error someone has said, “Most of us can’t find the right thing to say; many of us can’t say the right thing and some of us do not even want to say the right thing.” An attempt has been made to look at removing some of the factors that have tended to produce error, mistake and injustice. Relatives are finicky about their perceptions. They prefer to interview those who conduct the autopsy. Detailed inquiries are made to ensure that there was no goof up.  That the doctor was not under the influence and was not of questionable character.

References:

1. Pattern of suicide ideators, attempted suicide and completed suicide in a tertiary care teaching Hospital. http://medind.nic.in/imvw/imvw8106.html
2. Nafisa took the extreme step apparently because she was saddened, as her fiancée had called off their wedding. http://www.deccanherald.com/deccanherald/july312004/i4.asp
3. The Last Dance: A Novel of the 87th Precinct http://www.amazon.com/exec/obidos/tg/detail/-/0684855135/103-3144724-5795038?v=glance&st=*
4. Widow says shipman gave no indication of suicide, http://society.guardian.co.uk/nhsperformance/story/0,8150,1456905,00.html
5. A suspicious death of a man who was in custody of the police, http://www.ahrchk.net/ua/mainfile.php/2004/816/
6. A case of strangulation fabricated as Hanging: http://anil299.tripod.com/vol_002_no_002/papers/paper005.html
7. Sharma, SK. Homicidal Hanging - Case Report (Bias In Premise Of Hanging). http://www.geradts.com/anil/ij/vol_001_no_001/paper001.html
8. Saurabh Sharma, S.K. Sharma: Controversial Death- Change of Decision from Homicide to Suicide: A Review Opinion [page 17-20], http://www.geradts.com/anil/ij/vol_005_no_002/main.html
9. Saurabh Sharma, S.K. Sharma: Prospects of Hanging Being Interpreted as Ligature Strangulation are Real (Twist in the tale by a scene examination) [page 21-24]: http://www.geradts.com/anil/ij/vol_005_no_002/main.html & http://www.crimeandclues.com/special_special/CSI_edition.pdf

Citation: Sharma & Sharma, "Ligature strangulation: Not very common but contested too often.", Crime and Clues, http://www.crimeandclues.com/ligature_strangulation.htm, original post 5/29/2006.

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