External Examination

• Clothing and personal effects description.

• Evidence of other trauma; distribution of lividity.

• Is ligature available? In situ or removed? If in situ, note knot position, number of loops. Photograph ligature. If in situ, cut away from knot. Reconstruct circumference by joining cut ends with tape (Fig. 50). The ligature is evidence.

Fig. 50. Suicidal hanging. Ligature was removed from neck by cutting away from knots. Note reconstruction of ligature by tape (arrows).

• Ligature description: ° Type of material.

• Ocular or facial petechiae.

• Tongue protrusion between clenched teeth.

• Description of furrow or skin "mark" (62): ° Course (angled or canted up).

° Neck circumference at level of furrow (to determine degree of neck constriction;

noose circumference < neck circumference). ° Pattern.

° Transfer of ligature material. ° Associated skin changes or trauma. ° Relation to thyroid cartilage.

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