Hanging Fatalities in Central Bangkok, Thailand: A 13-Year Retrospective Study

Abstract

Hanging is violent asphyxial death. The objective of this study is to assess the data of hanging cases. A descriptive-retrospective study was conducted. We studied 244 hanging cases autopsied in Forensic Division, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, between January 2001 and December 2013. The study included 197 men (80.7%) and 47 women (19.2%). Their age ranged from 14 to 93 years. Most of these cases were incomplete hanging (83.6%). Features of hanging victims, such as tongue protrusion; congestion of face; petechial hemorrhage of face, conjunctiva, and internal organs; and neck injuries, significantly correlated with complete hanging. The predominant occupation of hanging victims was in the service industry (63.1%). Suicides usually occurred in private homes or apartments (84.8%). A suicide note was found in 6.1% of cases. The most common ligature material used was nylon rope, found in 61.1% of cases. The most underlying diseases of the victims in hanging cases were tuberculosis and human immunodeficiency virus infection, 9 cases each. Blood ethanol levels of 29 cases (11.8%) were detected to be higher than 150 mg%. Methamphetamine and benzodiazepine were detected in 5.3% and 3.3% of cases, respectively. This study provides comprehensive baseline data of hanging cases in central Bangkok.

Distinguishing between homicide and suicide knots and ligatures: A comparative analysis of case and survey data

“…This finding agrees with published studies and case reports [1,2,13–20,22–73]. According to a sample of published data summarized in Table 8, full suspension in hanging suicides appears to be more prevalent than partial suspension in eastern cultures [48–64]. Most suicides in the current study, which occurred in North America, were found partially suspended by their neck ligatures, with their feet or knees touching the ground or nearby furniture.…”

“…A relatively consistent detail observed in this study was the tension of neck ligatures in the cases analyzed, which agrees with the forensic literature [22–70]. Knotted homicide strangulation ligatures were typically tighter than suicide ligatures used for hanging.…”

“…The literature data summarized in Table 9 indicate that neck ligatures are knotted more frequently at the back (typical) in external tying situations and more frequently at the front or on the sides of the neck (atypical) with self‐tying [49–54,57,61,65–69]. External and self‐tying knots can occur in various locations around the neck.…”

“…Two notable findings emerged from the survey data: wrist gaps and chirality consistency. Table 8, full suspension in hanging suicides appears to be more prevalent than partial suspension in eastern cultures [48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64].…”

“…The differences in many specific knot and ligature characteristics are unknown. Further, the knot data reported in the literature are inconsistent, and numerous details have not been examined in case reports and international retrospective studies [1–6,13–20,25–74]. Published knot and ligature data acquired from homicides are not abundant.…”