In an unofficial examination, a hanging death can be completely misinterpreted when the scene does not suggest a typical hanging situation or because the body has already been taken down without the prior knowledge of the medical examiner. The first situation can for example result if a very short ligature was used and the deceased is seated. In the second situation the examiner is then faced with the dilemma that suicide is perhaps abhorrent to family members and has as a result been covered up by them. The body is then taken down, made tidy, dressed in a high collared garment and laid in a bed. The attending doctor is often reluctant – especially if the family is well situated and a certain dependency exists - to disrobe again a body already dressed in burial garments and the ligature marks – often in a case of "white hanging” the only evidence of an unnatural incident – may be easily overlooked. The call for an independent examiner in such cases is of crucial importance.
Case examples of overlooked causes of death by hanging:
The elderly lady had hanged herself in her bedroom with a very short ligature attached to a door handle and adopted a crouching position. As her nightgown hid the position of the body, it appeared from a distance that she was sitting on a stool and leaning with her back to the door. The attending GP who examined her believed that his patient had died from a long standing heart condition and without closer inspection had attributed the death to natural causes. It was only discovered when the funeral director came to take away the corpse that she was in fact hanging from a door handle and not sitting on a stool.
The subject was found hanged in an upright position on a raised platform in a playground. The parents had taken him down, laid him on the grass and then called the emergency services to inform them that a corpse had been found. As certain sure signs of death had already become apparent, the attending doctor drew conclusions without any additional examination of the body and left the scene. A ligature and ligature marks were only discovered later as the body was taken away by a funeral director who informed the police.
The woman was found hanging by relatives. They did not want the suicide to be made public and were also worried that the police might investigate someone, so the body was taken down, dressed correctly with a high collared garment and laid in a bed. Since she had suffered with a serious heart condition for many years, it was hoped that the GP would register a death from natural causes, which he in fact did. It was only later that the funeral director noticed the unnatural condition of the neck and informed the police.
This case too is a prime example of how easily a hanging can be overlooked if sufficient care is not taken in an examination. The deceased was laid in the bed less than six hours after death so that the lividity had shifted and did not appear typical of a hanging. The ligature marks were not very obvious and were not noticeable at first glance. The small, scattered pale spots as shown in the illustration are in themselves not specific. The death was obviously caused by a reflexive incident as the deceased showed no signs of congestion which would have been present after suffocation.
However, the marked blanching of the corpse also did not indicate heart failure, which the attending doctor had documented.