A 50-year male has been found hanged in a bath-room along with incised wound on wrist, groin and cubital region. How will you establish cause of death and opine whether he has expired of hanging or injuries sustained ?

I. Initial Scene Investigation

The initial scene investigation is crucial. Documentation should include:

• Position of the body: Was the body fully suspended, or was there ground contact?
• Ligature material: Type of material used (rope, cloth, etc.), its strength, and condition.
• Ligature mark: Location, depth, and characteristics of the ligature mark on the neck.
• Wound examination: Detailed description of the incised wounds – location (wrist, groin, cubital region), size, depth, direction, and any evidence of hesitation marks.
• Surrounding environment: Any signs of struggle, presence of a stool or other object used for support, and any other relevant findings.

II. Post-Mortem Examination – External Examination

A meticulous external examination is essential:

• Ligature Mark: A complete circular or incomplete ligature mark is noted. The depth and elasticity of the mark are assessed.
• Incised Wounds: Each wound is examined individually. The angle of incision, sharpness of the edges, and presence of any defensive wounds are noted. The depth of the wounds is crucial – wounds that sever major blood vessels are more likely to contribute to rapid blood loss.
• Other Injuries: Any other injuries, such as abrasions or contusions, are documented.
• Pallor and Cyanosis: The presence and extent of pallor (paleness) and cyanosis (bluish discoloration) can provide clues about the time of death and the cause.

III. Post-Mortem Examination – Internal Examination

The internal examination focuses on identifying injuries consistent with hanging and assessing the effects of the incised wounds:

• Hyoid Bone and Thyroid Cartilage: Fractures of the hyoid bone or thyroid cartilage are often seen in hanging, but their absence does not rule out hanging.
• Spinal Cord: Examination for evidence of spinal cord injury.
• Lungs: Signs of congestion, edema, and petechial hemorrhages are common in hanging.
• Brain: Examination for cerebral edema and hemorrhages.
• Major Blood Vessels: The internal examination must meticulously assess the extent of damage to major blood vessels in the areas of the incised wounds. Evidence of significant blood loss is critical.
• Stomach Contents: Analysis of stomach contents can help estimate the time of death.

IV. Establishing the Cause of Death – Differentiating Hanging vs. Injuries

The following factors are considered to differentiate between death due to hanging and death due to the injuries:

• Sequence of Events: If the wounds are clearly inflicted *before* the hanging, it suggests a deliberate attempt to ensure death. If the wounds are inflicted *after* a failed hanging attempt, it suggests a change in intent.
• Severity of Wounds: If the incised wounds are deep enough to cause fatal hemorrhage, they could be the primary cause of death, with the hanging being a secondary event or an attempt to conceal suicide.
• Blood Loss: Significant blood loss from the incised wounds, confirmed by internal examination, strongly suggests the wounds contributed to or caused death.
• Ligature Mark Characteristics: Typical features of a suicidal hanging include a complete or nearly complete ligature mark, upward trajectory of the ligature, and absence of defensive wounds on the hands and arms.
• Pathological Findings: The presence of characteristic post-mortem changes associated with hanging (e.g., congestion of lungs, petechial hemorrhages) supports the diagnosis of hanging.

V. Opining on the Cause of Death

The forensic pathologist will opine based on the totality of the evidence. Possible opinions include:

• Death due to Hanging: If the ligature mark is typical, internal findings are consistent with hanging, and the wounds are superficial or do not explain the cause of death.
• Death due to Incised Wounds: If the wounds are deep and caused significant blood loss, and the hanging appears to be a secondary event.
• Combined Effect of Hanging and Incised Wounds: If both hanging and the wounds contributed to death, and it is difficult to determine which was the primary cause.
• Undetermined: If the evidence is insufficient to establish a definitive cause of death.