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   Table of Contents      
ORIGINAL ARTICLE
Year : 2019  |  Volume : 5  |  Issue : 2  |  Page : 69-72

Analysis of Hanging Cases Brought to Mortuary of Lok Nayak Hospital, New Delhi: A 3-Year Retrospective Study


Department of Forensic Medicine, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India

Date of Web Publication20-Aug-2019

Correspondence Address:
Senior Resident Rohit Bharti
Department of Forensic Medicine, Maulana Azad Medical College, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mamcjms.mamcjms_24_19

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  Abstract 


The incidence of hanging as a means adopted for committing suicide has been on the rise. Hanging provides painless death so it is one of the commonly adopted methods for suicide. This retrospective study including 173 hanging cases was conducted with an objective to find the pattern of hanging cases as a method of suicide. Male victims constituted 72.8% with male:female ratio being 2.7:1. Young adults in the age group of 16 to 35 years were more involved. Rainy season recorded maximum cases of hanging, that is, 67 cases (38.7%), whereas winter season recorded the least number, that is, 42 cases (24.3%). Most commonly used ligature material in this study in 149 cases (86.1%) was sari/dupatta/bedsheet. Autopsy findings revealed dribbling of saliva in 129 cases (74.6%), cyanosis in 150 cases (86.7%), and petechial hemorrhages on lungs in 115 cases (66.5%). Ligature mark was above the level of thyroid cartilage and parchmentized in all the cases. Additional injuries were present in 1.2% of cases. Neck structures were normal in all the cases and cause of death was mechanical asphyxia in 169 cases (97.6%).

Keywords: Hanging, ligature materials, ligature marks


How to cite this article:
Buchade DD, Bharti R, Amarnath A, Mittal AK, Khanna SK. Analysis of Hanging Cases Brought to Mortuary of Lok Nayak Hospital, New Delhi: A 3-Year Retrospective Study. MAMC J Med Sci 2019;5:69-72

How to cite this URL:
Buchade DD, Bharti R, Amarnath A, Mittal AK, Khanna SK. Analysis of Hanging Cases Brought to Mortuary of Lok Nayak Hospital, New Delhi: A 3-Year Retrospective Study. MAMC J Med Sci [serial online] 2019 [cited 2019 Nov 12];5:69-72. Available from: http://www.mamcjms.in/text.asp?2019/5/2/69/264778




  Introduction Top


Hanging is a form of violent asphyxia death due to compression of neck structure by a ligature mark where the weight of the body acts as the constricting force.[1] It is the most common mode of death adopted by victims to commit suicide in India, constituting 45.6% of total suicidal deaths in 2015.[2] Hanging produces painless death for the victim and there is no costs involvement other than that of the ligature material.[3] Thin rope around neck causes unconsciousness in 15 seconds.[4] The pattern of age, sex distribution, ligature material used, and findings at autopsy varies from region to region based on the educational status, employment status, happiness index, and material commonly available. This study is aimed to understand the pattern of hanging cases in Delhi.


  Material and Methods Top


The present retrospective study was conducted in the Department of Forensic Medicine at Maulana Azad Medical College, New Delhi. The data of three calendar years from January 1, 2014 to December 31, 2016 was collected from postmortem reports of the deceased. The collected data were entered in Microsoft Excel and analyzed using Statistical Package for the Social Sciences (SPSS, IBM Corp., Armonk, NY), Version 20.


  Results Top


There were a total of 173 hanging cases in the three calendar years studied [Table 1],[Table 2],[Table 3],[Table 4],[Table 5],[Table 6],[Table 7],[Table 8],[Table 9]. Of the 173 cases, 126 (72.8%) were males giving a male:female ratio of 2.7:1.
Table 1 Gender-wise distribution of cases

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Table 2 Age group-wise distribution of cases

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Table 3 Marital status of the cases

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Table 4 Month-wise distribution of cases

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Table 5 Season-wise distribution of cases

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Table 6 Ligature material-wise distribution of cases

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Table 7 Dribbling of saliva in the victims

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Table 8 Nails in the victims

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Table 9 Presence of petechial hemorrhages in the victims

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Young adults in the age group of 16 to 35 years were most commonly involved contributing to 131 cases (75.5%) followed by age group of 36 to 55 years to contributing 36 cases (20.8%). Youngest victim of the present study was of 13 years and oldest victim was of 74 years.

Almost half the victims were married (49.7%). Maximum number of cases were distributed in the month of October consisting of 25 cases (14.5%) followed by month of March (12.1%), whereas lowest number of cases were found in the month of December (2.9%). Rainy season (July, August, September, October) recorded maximum cases of hanging (38.7%), whereas winter season (November, December, January, February) recorded least number of cases (24.3%). Across the week, Wednesday observed the highest incidence (20.2%) whereas lowest was on Saturday (10.4%).

Total 167 individuals (96.5%) hanged themselves at their residence whereas the remaining six cases (3.5%) were found hanging in place of custody, tempo, guest house, hotel, and factory. A total of 169 cases (97.6%) were declared brought dead on hospital arrival and remaining four cases (2.4%) had a period of up to 2 days of hospitalization.

Sari/dupatta/bedsheet was used as a ligature material in 149 cases (86.1%) and in remaining 24 cases (13.9%) rope/wire were used.

Dribbling of saliva was present in 129 cases (74.6%). Cyanosis of finger nails was found in 150 cases (86.7%). Petechial hemorrhages was most commonly found on the surface of lungs in 115 cases (66.5%). Ligature mark was above the level of the thyroid cartilage and was parchmentized in all 173 cases (100%). In this study, 171 cases (98.8%) had only ligature mark on the body and remaining two cases (1.2%) had additional injuries like multiple fresh tentative cut marks or contusion. In 171 cases (98.8%), hypostasis was found on the back, that is, supine position of the body, and in remaining two cases (1.2%), it was distributed in upper limbs and lower limbs indicating suspension of body for a period of time. On neck dissection, no extravasation of blood was present and thyroid cartilage, cricoid cartilage, cervical spine, and hyoid bone were intact.

Alleged manner of death in all 173 (100%) cases was suicidal hanging. The cause of death was mechanical asphyxia in 169 cases (97.6%) and hypoxic brain damage in remaining four cases (2.4%).


  Discussion Top


Each suicide is a personal tragedy that prematurely takes the life of an individual and has a continuing ripple effect, dramatically affecting the lives of families friends and communities. Means adopted for committing suicide depend on awareness, availability of resource, and effectiveness of the means.[2] The present study was conducted on hanging victims to study the distribution of sex, ligature material used, place of hanging, survival period after hanging, season, time of hanging, etc. The study showed that males are the more common victims as compared to females. The largest age group found to be affected was 16 to 35 years of age, followed by 36 to 55 years of the age. These findings were very much similar to the findings of the previous studies by Kumar et al.,[5] which showed that the largest group affected was 21 to 30 years of age. Previous studies by Yadav et al.,[6] Ahmad and Hossain,[3] Meera and Singh,[7] and Patel et al.[8] also reported the largest age group to be affected as 21 to 30 years.[3],[6],[7],[8] The above findings can be easily explained by the fact that 16 to 35 years of age group is most susceptible to many frustrating situations in life such as examination failure, study pressure, unemployment, marital discord, extramarital affair, and others. The range of age distribution was from 13 to 74 years.

In the study, it was found that 50.3% of victims were unmarried. The difference between married and unmarried victims was not significant. Majority of victims (86.1%) used soft ligature such as dupatta/sari/bedsheet as ligature material, followed by rope/wire that was used by 13.9% victims. The pattern of ligature material used was similar to the study done by Saiyed and Modi[9] in Ahmadabad and Meera and Singh[7] in Manipur, who also reported that the most common ligature material to be used was sari or dupatta, followed by wire/rope. However, study done in Ranchi by Kumar et al.[5] reported that hard ligature material such as rope was used most commonly.

In our study, all the cases showed ligature mark above the level of thyroid cartilage. This was comparable with the findings of the study done by Ballur,[10] who observed that in 83% of cases, ligature mark was above thyroid cartilage; the study done by Sudheer and Nagaraja,[11] who reported 88% cases having ligature marks above the thyroid cartilage. This finding was less observed in study conducted by Naik and Patil[12] and Kumar et al.[5] reporting 62% and 69% of cases having ligature marks above thyroid cartilage, respectively.

In all the cases, ligature mark was visible, comparable observations were observed by Sudheer and Nagaraja,[11] Ballur,[10] and Kumar et al.[5] Ligature mark was also found to be parchmentized and hardened.

In our study, maximum deaths due to hanging were found to be in the month of October, that is, 25 (14.5%) victims, followed by March with 21 (12.1%) victims, and December with least number of victims to be only five (2.9%) cases. Rainy season (July to October) constituted maximum number of cases, that is, 67 (38.7%); however, winter season (November to February) recorded least number of cases, that is, 42 (24.3%).

Highest number of hanging incidents occurred on Wednesday with 35 (20.2%) cases and lowest number of incidents occurred on Saturday with 18 (10.4%) cases. In 167 (96.5%) cases, place of hanging was the home of the deceased and two cases were custodial hanging, one victim was found hanged in a tempo, one victim in hostel, and one victim in factory. Home, offering privacy for the victims, happens to be the most preferred scene. Total of 169 (97.6%) cases were declared brought dead on arrival of hospital and four cases had the survival period of up to 4 days. This shows that hanging is an effective form of committing suicide. Significant postmortem findings were dribbling of saliva seen in 129 (74.6%) cases, cyanosis of nails seen in 150 (86.7%), and petechial hemorrhages found on lungs in 115 (66.5%) cases. In 171 (98.9%) cases, hypostasis was seen on the back of body indicating the early removal of the body from suspension.

In all 173 (100%) cases, hyoid bone was found to be intact; our findings were similar with the findings of the studies done by Patel et al.[8] and Naik and Patil.[12] The findings were also comparable with the study done by Kumar et al.,[5] Yadav et al.,[6] Sudheer and Nagaraja,[11] Ballur,[10] Jayaprakash and Sreekumari,[13] and Meera and Singh[7] who observed that only 5.2%, 1.6%, 4%, 4%, 2.7%, and 3.6% cases, respectively, showed hyoid bone fracture. In contrast studies by Ahmad and Hossain,[3] Charoonnate et al.,[14] and Uzun et al.[15] have reported higher incidence of hyoid bone fracture among hanging cases. Not even in a single case fracture of thyroid cartilage was found, similar to the study conducted by Kumar et al.[5] and Patel et al.[8] However, study conducted by Jayaprakash and Sreekumari[13] reported thyroid cartilage fracture in 5.3% of cases.

In all 97.6% cases, cause of death was found to be mechanical asphyxia and in 2.4% cases, death occurred due to hypoxic brain damage.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Aggrawal A. Textbook of Forensic Medicine and Toxicology, 1st ed. New Delhi, India: Avichal Publishing Company; 2014. pp. 366-92.  Back to cited text no. 1
    
2.
Accidental Death and Suicides in India 2015. Available at: http://ncrb.gov.in/StatPublications/ADSI/ADSI2015/adsi-2015-full-report.pdf. [Accessed February 27, 2019].  Back to cited text no. 2
    
3.
Ahmad M, Hossain MZ. Hanging as a method of suicide retrospective analysis of post-mortem cases. J Armed Forces Med Coll 2010;6:37-9.  Back to cited text no. 3
    
4.
Knight B, Pekka S. Knight’s Forensic Pathology, 3rd ed. London: Arnold 2004. pp. 352-80.  Back to cited text no. 4
    
5.
Kumar N, Sahoo N, Panda BB, Hansda MK. Fractures of hyoid bone and thyroid cartilage: an autopsy study. J Indian Acad Forensic Med 2016;38:393-6.  Back to cited text no. 5
    
6.
Yadav A, Kumath M, Tellewar S, Lohit Kumar R. Study of fracture of hyoid bone in hanging cases. J Indian Acad Forensic Med 2013;35:239-41.  Back to cited text no. 6
    
7.
Meera T, Singh MBK. Pattern of neck findings in suicidal hanging: a study in Manipur. J Indian Acad Forensic Med 2011;33:352-4.  Back to cited text no. 7
    
8.
Patel AP, Bansal A, Shah JV, Shah KA. Study of hanging cases at Ahmadabad region. J Indian Acad Forensic Med 2012;34:342-5.  Back to cited text no. 8
    
9.
Saiyed MZG, Modi KA. Retrospective study of post-mortem cases of ‘hanging’: a method of suicide. J Med Sci 2013;2:48-50.  Back to cited text no. 9
    
10.
Ballur MS. Analytical study of deaths due to hanging cases reported at Dr. B.R. Ambedkar medical college mortuary during 2010-2012 [Masters thesis]. Bangalore: Rajiv Gandhi University of Health Sciences, Karnataka; 2013.  Back to cited text no. 10
    
11.
Sudheer TS, Nagaraja TV. A study of ligature mark in cases of hanging deaths. Int J Pharm Biomed Sci 2012;3:80-4.  Back to cited text no. 11
    
12.
Naik SK, Patil DY. Fracture of hyoid bone in cases of asphyxia deaths resulting from constricting force round the neck. J Indian Acad Forensic Med 2005;27:149-53.  Back to cited text no. 12
    
13.
Jayaprakash S, Sreekumari K. Pattern of injuries to neck structures in hanging: a autopsy study. Am J Forensic Med Pathol 2012;33:395-9.  Back to cited text no. 13
    
14.
Charoonnate N, Narongchai P, Vongvaivet S. Fractures of hyoid bone and thyroid cartilage in suicidal hanging. J Med Assoc Thai 2010;93:1211-6.  Back to cited text no. 14
    
15.
Uzun I, Buyuk Y, Gurpinar K. Suicidal hanging: fatalities in Istanbul retrospective analysis of 761 autopsy cases. J Forensic Leg Med 2007;14:406-9.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]



 

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