J Forensic Sci, 2017

doi: 10.1111/1556-4029.13680
CASE REPORT Available online at: onlinelibrary.wiley.com

PATHOLOGY/BIOLOGY

Rajanikanta Swain,1 M.D.; Mantaran Singh Bakshi,2 M.D.; Shivani Dhaka,3 M.B.B.S.; Krishna Kumar
Singh,3 M.D.; and Asit Kumar Sikary,4 M.D.

Self-Strangulation Turning into Partial Hanging

for a Suicide Victim

ABSTRACT: Hanging is the most common asphyxial method of suicide, whereas suicide by strangulation is unusual. Here, we are reporting
a particular methodology of the asphyxial method of suicide in which a case of self-strangulation culminated into partial hanging. A 30-year-
old male wrapped one end of the cable wire around his neck. He then passed the other end over a curtain rod and tied that end around the right
hand. He pulled the hand down, using the curtain rod as a fulcrum, to tighten the noose around the neck in an attempt to strangulate himself.
However, he lost consciousness during the process and the body slipped down, pulling the right hand up which got stuck at the curtain rod.
This led the body hanged in the kneeling position. This bizarre scenario raised suspicion of homicide but the crime scene, autopsy and victim
characteristics were in favor of suicide.

KEYWORDS: forensic science, forensic pathology, double asphyxia, suicidal strangulation, partial hanging, death scene investigation, elec-
tric cable

The most common asphyxial method of suicide is hanging, in
which the constricting force over the neck is applied by the body
weight of the victim himself. Other asphyxial methods such as
choking, gagging, smothering and strangulation are rarely suici-
dal in nature. Among these, suicidal strangulation always draws
the attention of the scientific community because of unusual
mechanism and methods adopted by the victims, especially with
the ligature (1–6). In ligature strangulation, constricting force is
actively applied over neck through the ligature. These two
asphyxial methods, i.e. hanging and strangulation, are poles apart
from each other so much so that hanging deaths are considered
suicidal and strangulation deaths, homicidal until proved other-
wise. However, we are reporting a case of suicide in which a
bizarre mechanism led a case of self-strangulation culminating
into partial hanging.
Case Report
A 30-year-old male was found partially suspended by the neck
in kneeling position, with the help of an electrical cable inside
his hut (Fig. 1). One end of the cable was encircling the neck
with a half knot on the left lateral side of the neck while the
other end of the cable was wrapped around the right hand and
1
Department of Forensic Medicine, Andaman & Nicobar Island Institute of
Medical Sciences, Port Blair, Andaman & Nicobar Island 744101, India.
2
Clinical Fellow Orthopaedics, Southmead Hospital, Bristol BS10 5NB,
U.K.
3
Department of Forensic Medicine, All India Institute of Medical Sciences,
Ansari Nagar, New Delhi 110029, India.
4
Department of Forensic Medicine, ESIC Medical College and Hospital,
NH3, NIT3 Faridabad, Faridabad, Haryana 121001, India.
Received 7 Sept. 2017; and in revised form 7 Oct. 2017; accepted 9 Oct.
2017.
wrist of the deceased, after passing over a curtain-rod which was
the suspension point (Fig. 2). As per the history, he was a rick-
shaw puller and was depressed for last few months due to his
financial condition. On the day of the event, he chose not to go
for the work and when other family members left the hut for
their daily chores, he committed suicide.
At postmortem, a single turn of an electrical cable wire was
found around the neck with a half knot on the left lateral side of
the neck at the level of the mandibular shaft. The knot was
secured with the help of the plug at the end of the cord prevent-
ing from slipping under tension. The ligature mark completely
encircled the neck and was running obliquely upward in an
inverted ‘V’ form with the apex at the position of the knot.
There was no injury to the underlying neck structure. Face was
congested. Bluish discoloration (cyanosis) was present on the
lips, right hand and nails of the deceased. Tardieu spots were
present over the lower limbs. No struggle mark was present on
the body. All the internal organs showed non-specific congestion
with Tardieu spots on the surface of both the lungs and heart.
Discussion
Suicide by self-strangulation is unusual but not rare. Case
reports and case series have been published in the scientific liter-
ature (1–23). Our case is an interesting case of suicide by self-
strangulation, which culminated into partial hanging due to a
unique mechanism used for the process.
After careful analysis of the crime scene, it has been hypothe-
sized that the deceased first wrapped one end of the cable wire
around his neck with a half knot on the left side of the neck,
which was automatically secured by the attached plug at the
end. He then passed the other end over a curtain rod and tied
that end around the right hand. He pulled the hand down, using

© 2017 American Academy of Forensic Sciences 1

2 JOURNAL OF FORENSIC SCIENCES
FIG. 1––Partial hanging condition of the body at the scene.
FIG. 2––Close up view of the mechanism. The white arrow points at the
rod used as fulcrum but later became suspension point, the black arrow
points towards the inverted ‘V’ form of the ligature and the blue arrow
points towards the half-knot.
the curtain rod as a fulcrum, to tighten the noose around the
neck in an attempt to strangulate himself. However, during the
process, he became unconscious due to occlusion of the carotid
artery, a phenomenon which occurs in the usual course as
described by Sauvageau et al. in their works on video-filmed
hanging deaths. According to them, the agonal process includes
loss of consciousness after 8-18 sec of the initiation of hanging,
followed by decerebrate and decorticate rigidity, loss of muscle
tone after about 1.5–2 min and lastly some isolated body move-
ments (24,25). This unconsciousness, or less probably loss of
body tone, led the body collapsed down and pulled the right
hand, across the curtain rod, up which got stuck at the rod. In
this process, he got hanged by the neck in the kneeling position.
This two-way movement of the cable wire on the curtain rod
was established after the examination of the curtain rod and the
cable wire by the crime scene investigators.
This victim resorted to this mechanism because of common
belief among the general public that fatal compression of the
neck only occurs when force is applied on the ligature or when
the body is completely suspended. In this case, the height of the
curtain rod was not sufficient for complete suspension, so he
resorted to the mechanism of applying force on the ligature.
However, contrary to the public belief, Brouardel had demon-
strated that a force of 2 and 5 kg is needed to occlude the jugu-
lar veins and carotid arteries while a 15 and 30 kg force can
occlude the trachea and vertebral artery, respectively (26).
Asphyxia is possible in partial condition too, as in this case,
because a force about 20–40 kg is exerted even in a semi-reclin-
ing position with feet and buttocks on the surface, which is suf-
ficient to occlude neck vessels and even, trachea.
Analysis of various case reports and case series published on
self-strangulation (1–23) indicates that the victims of these types
of suicide are predominantly male and are above 30 years of
age. The ligature used in these cases are a twin, cable tie, hemp
rope, scarf, fabric belt, a sleeve of a shirt, nylon rope, dressing
gown cord, underpants elastic, telephone wire, pantyhose, wire
cloth hanger, rubber band, shoelace, elastic gymnastic bands and
waist belt. The knots used are mostly fixed knots, one to three
in numbers, while slip knot and no-knot cases are the least, that
too with multiple turns of the ligature. The position of the knot
is either on the front or on the sides of the neck, back of neck
position being the least. The turn of the ligature around the neck
varies from single or double turn for most of the ligature to 36
turns for the twin. Various elaborate mechanisms such as using
elastic bands over the ligature, binding the cord around the
hands or feet, using moving vehicle or weights to exert a force
on the cord encircling the neck are also used, albeit less com-
monly. Most of the victims are depressed for one or the other
reason; some of them being diagnosed case of depression under-
going treatment. Most of them commit the act in their home
environment, but a few of them committed the act in custody.
Self-strangulation was reported as a part of complex suicide
too. In a case reported by Nor and Das (27), a 16-year-old girl
first tried to strangulate herself but she had to stop when she felt
choked and difficulty in breathing. She then jumped from the
terrace of the 13th floor of a building.
Our case characteristics comply with the characteristics of the
other self-strangulation cases. The man was 30 years old and
was depressed due to his financial condition. He committed the
act in his hut using a single turn of the electric wire to compress
his neck with a half knot at the right side of the neck. He bound
the other end of the cord to his right hand to pull the cord using
a curtain rod as a fulcrum. He passed the cord over the rod,
bound it to his right hand and pulled the hand down to apply
force over the cord around the neck, which is an altogether dif-
ferent mechanism. However, he lost consciousness during the
process. The body gravitated down which in turn pulled the right
hand up but the hand got stuck at the rod. The person, conse-
quently, got hanged in a partially suspended condition. This
 SWAIN ET AL.
process led to a unique method of suicide, which started as self-
strangulation but culminated into partial hanging.
Crime scene examination and psychological history are impor-
tant in differentiating suicide from homicide in such unusual sce-
nario. The unusual mechanism of hanging, in this case, raised
suspicion about the manner of hanging as the cord was bound to
the right wrist and not to the curtain rod. However, the crime
scene examination showed no disturbance at the scene and the
door of the hut was bolted from inside. Furthermore, there was a
history of being depressed over his financial condition. These
facts were in coherence with other reported cases of self-strangu-
lation and pointed towards suicide.
At autopsy, the pattern of ligature mark, congestion of the
face, hemorrhage in the neck muscles, injuries over the hyoid
bone or larynx, and defense injuries are important autopsy find-
ings for differentiating homicide from suicide strangulation (2).
Extensive congestion of the face and head, no or insignificant
hemorrhage in neck structures, intact thyrohyoid complex or sin-
gle fracture to the thyroid horn, the absence of a clear ligature
mark, and absence of defense wound are characteristic autopsy
findings of suicidal strangulation. In this case, there was conges-
tion of the face but no injury to the neck structure or any other
part of the body which suggested suicidal manner. Tardieu spots
over the lower limbs were consistent with the position of the
body at the scene. However, the ligature mark pattern was differ-
ent in this case. Usually, the ligature mark of suicidal strangula-
tion is horizontal mark having no suspension point to pull the
ligature up. However, in this case, the ligature mark was running
obliquely upward towards the knot as there was a suspension
point which pulled the ligature up, as usually seen in a case of
hanging (28).
Conclusion
This case report presents an unusual case of self-strangulation
in which the victim used a curtain rod as a fulcrum to pull the
ligature down with his right hand after binding one end of the
ligature to the hand. This in turn exerted a force on the other
end of the ligature encircling the neck. However, he lost con-
sciousness during the process causing his body to gravitate
down. This in turn pulled his hand, on the other side of the rod,
up, but it got stuck at the rod – suspending the victim in the par-
tial hanging condition. The scenario in which the body was
recovered raised suspicion of homicide but crime scene analysis
and autopsy finding suggested the manner to be suicide. Victim
characteristics were too in accordance with the reported suicidal
strangulation cases.
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Additional information and reprint requests:
Asit Kumar Sikary, M.D.
Department of Forensic Medicine
ESIC Medical College and Hospital
NH3, NIT3 Faridabad
Haryana 121001
India
E-mail: asitsikary@gmail.com