66 year-old Jeffrey Epstein, who recently pleaded not guilty of sex trafficking charges, was found dead in his jail cell on August 10. He had recently been on suicide watch and reports initially suggested he had hung himself by his bed sheet.
However, results of the financier’s autopsy suggest he sustained trauma consistent with hanging (after preliminary reports suggested strangulation). How do forensic experts tell the difference?
With hanging, one drops from a height and suspends, incurring a fracture of a neck bone which in turn may sever the spinal cord.
A severe blood pressure drop can ensue and the victim may die within minutes
As seen above, a “hangman’s fracture” is seen with hyperextenstion injuries where the pars interarticularis on the pedicle of the C2 vertebrae becomes fractured. The distance of the drop is crucial in determining success of the execution. A drop to long could cause beheading, a drop too short could cause strangulation.
If they do strangulate….they asphyxiate (lose air flow), or lose blood flow from their carotid arteries being compromised.
From a capital punishment standpoint, hanging is one of the most common and barbaric ways to execute. Three states still have this form of execution as an option if lethal injection is not available (DE, NH, WA).
Strangulation occurs when one compresses the structures of the neck causing decrease air and blood flow. It could be executed using a ligature (scarf, sheet, cord) or by one’s hands. Moreover it can occur if a hanging drop is improperly calculated. Many times the hyoid bone is fractured (1/3 of all homicides) as its think U-shape is vulnerable to the forces of strangulation.
So injuries incurred can be similar in both strangulation and hanging, especially if the latter is done improperly and ineffectively severs the spinal cord.
However, since hanging causes a blood pressure drop and strangulation causes a back up of pressure into the head due to vessel constrictions, on autopsy one may find more signs of hemorrhage (retinal hemorrhages) and swelling (brain edema) during strangulation than accurate hanging.
Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.