The pathology of hanging deaths in Western Australia

We present here the results of a prospective study of the pathology of 233 fatalities due to hanging in Western Australia (WA). The deaths occurred during the 5 year period 1988-92. Post mortem examination of these cases was undertaken according to a standardised protocol by forensic pathologists of this office. Post mortem findings of a further 37 cases examined by medical practitioners in rural WA are also reviewed, making a useful comparison. Petechial hemorrhages, as a hallmark of asphyxiation, were present in 113 of the 233 cases (48%). An observable ligature mark to the skin of the neck was seen in 230 cases (99%). Injury to the tissues of the neck was identified in 122 cases (52%), more commonly with complete suspension of the body (62%) than incomplete suspension (46%). Neck injury was essentially equally prevalent with a slip-knot (58%) or a fixed knot (60%). Other fresh injuries besides the neck injury were present on the deceased's body in 80 cases (34%). In the 37 non-metropolitan cases, an observable ligature mark to the skin of the neck was recorded in 30 (81%). Petechial hemorrhages were described in 3 cases (8%). Internal neck injury was apparently observed in 10 cases (27%), although precise detail adequately identifying the site of injury was given in only 2 cases (5%).