page_title: Hanging
section_title: Medical effects
hierarchical_section_title: Hanging / Medical effects
caption_attribution_description: English: Anoxic brain injury following a hanging. Note the loss of grey white matter differentiation and small ventricles due to brain swelling.
context_page_description: Hanging is the suspension of a person by a noose or ligature around the neck. The Oxford English Dictionary states that hanging in this sense is "specifically to put to death by suspension by the neck", though it formerly also referred to crucifixion and death by impalement in which the body would remain "hanging". Hanging has been a common method of capital punishment since medieval times, and is the primary execution method in numerous countries and regions. The first known account of execution by hanging was in Homer's Odyssey. In this specialised meaning of the common word hang, the past and past participle is hanged instead of hung.
  Hanging is a common method of suicide in which a person applies a ligature to the neck and brings about unconsciousness and then death by suspension or partial suspension.
context_section_description: A hanging may induce one or more of the following medical conditions, some leading to death:
  Closure of carotid arteries causing cerebral hypoxia
  Closure of the jugular veins
  Breaking of the neck (cervical fracture) causing traumatic spinal cord injury or even unintended decapitation
  Closure of the airway
  The cause of death in hanging depends on the conditions related to the event. When the body is released from a relatively high position, the major cause of death is severe trauma to the upper cervical spine. The injuries produced are highly variable. One study showed that only a small minority of a series of judicial hangings produced fractures to the cervical spine (6 out of 34 cases studied), with half of these fractures (3 out of 34) being the classic "hangman's fracture" (bilateral fractures of the pars interarticularis of the C2 vertebra). The location of the knot of the hanging rope is a major factor in determining the mechanics of cervical spine injury, with a submental knot (hangman's knot under the chin) being the only location capable of producing the sudden, straightforward hyperextension injury that causes the classic "hangman's fracture".
  According to Historical and biomechanical aspects of hangman's fracture, the phrase in the usual execution order, "hanged by the neck until dead," was necessary. By the late 19th century that methodical study enabled authorities to routinely employ hanging in ways that would predictably kill the victim quickly.
  The side, or subaural knot, has been shown to produce other, more complex injuries, with one thoroughly studied case producing only ligamentous injuries to the cervical spine and bilateral vertebral artery disruptions, but no major vertebral fractures or crush injuries to the spinal cord. Death from a "hangman's fracture" occurs mainly when the applied force is severe enough to also cause a severe subluxation of the C2 and C3 vertebra that crushes the spinal cord and/or disrupts the vertebral arteries. Hangman's fractures from other hyperextension injuries (the most common being unrestrained motor vehicle accidents and falls or diving injuries where the face or chin suddenly strike an immovable object) are frequently survivable if the applied force does not cause a severe subluxation of C2 on C3.
  In the absence of fracture and dislocation, occlusion of blood vessels becomes the major cause of death, rather than asphyxiation. Obstruction of venous drainage of the brain via occlusion of the internal jugular veins leads to cerebral oedema and then cerebral ischemia. The face will typically become engorged and cyanotic (turned blue through lack of oxygen). There will be the classic sign of strangulation, petechiae, little blood marks on the face and in the eyes from burst blood capillaries. The tongue may protrude.
  Compromise of the cerebral blood flow may occur by obstruction of the carotid arteries, even though their obstruction requires far more force than the obstruction of jugular veins, since they are seated deeper and they contain blood in much higher pressure compared to the jugular veins. Where death has occurred through carotid artery obstruction or cervical fracture, the face will typically be pale in colour and not show petechiae. Many reports and pictures exist of actual short-drop hangings that seem to show that the person died quickly, while others indicate a slow and agonising death by strangulation.
  When cerebral circulation is severely compromised by any mechanism, arterial or venous, death occurs over four or more minutes from cerebral hypoxia, although the heart may continue to beat for some period after the brain can no longer be resuscitated. The time of death in such cases is a matter of convention. In judicial hangings, death is pronounced at cardiac arrest, which may occur at times from several minutes up to 15 minutes or longer after hanging. During suspension, once the prisoner has lapsed into unconsciousness, rippling movements of the body and limbs may occur for some time which are usually attributed to nervous and muscular reflexes. In Brit
caption: Anoxic brain injury following a hanging. The loss of grey white matter differentiation and small ventricles due to brain swelling are visible.
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