Deaths from hanging in the eastern province of Saudi Arabia

An analysis of cases of hanging in the Eastern Province of Saudi Arabia over a period of five years is presented. Of 61 victims investigated there was a high incidence of suicidal hanging among expatriate males of lower socio-economic classes especially Asians, and in particular, Indians. Two distinct patterns of suicidal hanging were observed in this series. The first used a seemingly popular plastic clothes line, with complete body suspension. This produced a narrow ligature mark, commonly deep and high up in the neck, often with internal cervical injuries. In the second, soft cotton cloth was used with partial suspension of the body, which produced a broad, low, ill-defined ligature mark with facial congestion and petechial haemorrhages, but minimal or absent deep neck injuries. Classical external injuries of asphyxial death (congestion of the face and petechial haemorrhages) were more common in cases of partial suspension than in complete suspension. While the mechanism of death in the majority of cases of partial suspension was apparently due to airways or vascular obstruction, death in cases of complete suspension appeared to result from, in addition to obstruction (airways or vascular), vagal stimulation or carotid sinus pressure, or a combination of these. No fracture of the hyoid bone, thyroid cartilage or cervical vertebrae was detected in any of the victims in this series.