KZ has had some excellent posts on this topic and Im not certain I can offer much more.
I dont see anything in the AR that would indicate the type of bruising linked with manual strangulation but its absence doesnt rule it out.
Fingernail marks are also common and absent here, but they would only be potentially present if the victim was conscious and able to move their hands
A broken hyoid bone, while common in manual strangulation, can be interpreted equivocally here because the furrow line indicates that it was just as likely to be broken as a result of the hanging.
Its easy to understand how the force of a constricting noose would be able to fracture bones and cartilage beneath it, and if it were to slip, anything in its path.
The injuries that are best explained by a long drop hanging are the injuries to the strap muscles. From the AR:
The left sternocleidomastoid muscle has a 4-3/4 x 1-3/4 inch area of hemorrhage extending from the clavicle with softening and abundant hemorrhage within the muscle. On the right there is similar hemorrhage measuring 2 x 1-1/4 inch at the clavicle. Along the medial edge of the right sternocleidomastoid muscle, there are a 1 x ¼ inch hemorrhage (inferior, near the clavicle) and a ¼ inch diameter hemorrhage (more superior.)
This is serious trauma to the left and right SCM muscles, and it indicates that there was a pulling force from above.
As the ligature tightened it would essentially grip the upper portion of the SCM (among other things,) then as the body jerked down and away from the ligature there would be a considerable stretch on that muscle group and would likely be the cause of that trauma.
The injuries that would be most readily explained by some sort of pre-hanging manual strangulation would be the fractures below the furrow line and there a number of fractures BELOW the ligature furrow with no indication that the rope was initially lower and slipped upward.
This would mean that some other force was responsible and manual strangulation would be the likely candidate.
The most suspicious injuries in Rzs neck, IMO are:
There is a ¼ inch diameter hemorrhage of the left cricothyroid muscle and corresponding purple discoloration of the tracheal mucosa. There is a corresponding left cricoid fracture anteriorly. It is curved, non-displaced, and is situated approximately 1/8 inch from the anterior midline.
I also find the very extensive nature of the petechiae to be suspicious if it was all as a result of long drop hanging. There should have been more than enough constricting force to close off venous and arterial blood flow to RNs head instantly. Petechiae are common and plentiful when only venous blood flow is constricted and arterial blood flow to the head continues.
The long drop hanging should have cut venous and arterial flow to RNs head instantly, preventing congestion and the formation of extensive petechiae.
It has been reported that a tension of 33 lb on the ligature will occlude the trachea, a tension of 4.4 lb will compress the jugular veins, a tension of 8- 10 lb will occlude the carotid arteries and tension of 60 lb will compress the vertebral arteries.
Textbook Of Forensic Medicine And Toxicology: Principles And Practice, Krishan Vij MD, page 161
Compare with:
there would have been 600 pounds of pressure when she hung there
http://archives.cnn.com/TRANSCRIPTS/1109/08/ddhln.01.html
What I dont see as a likely scenario is one where she was manually strangled and then hoisted up from above. The tearing and hemorrhaging in the strap muscles belie this scenario.
What had perplexed me from the early days of this case is that while some of the injuries are consistent with a long drop hanging it just didnt make any sense to me, whatsoever, that there were NO INJURIES to posteriorly to the neck structures.
After a spending a great deal of time looking at the force involved in a drop from that height, I realized that the way the rope was attached above would have the potential of moving this away from the realm of a long drop hanging.
I used to do some rock climbing and I do know that even falling in a comfortable harness at the end of rope that is designed to give is still something that can be a harsh experience if it involves any significant distance. But, I did know that I would not be injured unless the fall distance caused me to hit something on the way down.
The reason people dont suffer injury from falls involving bungee cords or climbing ropes is that they are designed to distribute force over time rather than stopping suddenly.
The worst case scenario would be a fall at the end of a wire rope.
RZ was found hanging on the end of a tow rope. These are not designed to be very elastic for obvious reasons and if that rope was attached directly to the railing I would suspect that there would have been horrific injuries to the spinal column.
I now believe that its possible that the movement of the 300 pound bed extended the time enough, and absorbed enough energy along with the rope, to account for the fact that RZ did not suffer the posterior neck injuries that would be typical in a long drop hanging.
Cynic,
thank you for the extensive time and effort you put into your posts and illustrations! A picture really is worth a thousand words in some cases. We are all so very fortunate to have someone with your talents and knowledge posting here! I wish I could quickly make the visual illustrations you can, but I'm still working on that skill.
(Warning- very long, esoteric post ahead! Skip if you like.)
I agree that it is very unlikely that Rebecca was strangled and then hoisted from below, although I know this is a common and popular theory. I strongly agree that a beating heart was necessary to achieve the hemorrhage within the muscle tearing, and other evidence seen at autopsy. She was alive when she went over the long drop, IMO, and the extensive muscle tearing was the precursor to decapitation, IMO. If she had been much heavier, I think she would have surely been decapitated by that long drop. I apologize for that graphic and gruesome description, but a brief search of hanging and decapitation would demonstrate that convincingly, IMO.
Id like to comment on a couple of things: the manual strangulation force and time necessary to achieve compliance from a victim, versus force and time necessary to kill them (ie, achieve aysytole, or a non-beating heart), and the natural fusion of the hyoid bone.
First, manual strangulation (using hands only) takes time, and sustained pressure that is unrelenting. If someone were to try a preview of how difficult this could be for an ordinary, non-murderous person to achieve, simply clench your hand into a fist. Can you sustain that for about 5-6 minutes, without releasing pressure? Most people cant. And if one factors a struggling, fully conscious, adult, and non-drugged victim into the equation, the task of manual strangulation until death becomes more difficult.
So, if one wanted to strangle a conscious, non-medicated adult, one would have to make the victim more compliant with the strangulation, right? That leaves things such as the element of surprise, physical overpowering and/ or restraint, and/ or imposed neurological impairment. Imposed neurological impairment from non-drugged/ poisoned sources could be from lack of oxygen (mechanical smothering or strangulation), or imposed head trauma, or both.
The force, and duration necessary to achieve compliance from constriction of the neck structures is far less than what is necessary to kill someone. This is especially true with an attacker who is much bigger than the victim (such as an adult perp and a child victim, or more than one adult perp overpowering an adult victim). For example, a #100 lb woman is widely considered very small, even if she is physically fit. A person who is reasonably fit weighing #150- #200 would be more likely to be able to overcome the #100 person, given the right set of circumstances.
For decades, Sellicks Manuever was a universal standard of care in emergency intubation. (Although since about 2010- 2011, it has fallen out of favor academically.) Before about 2010, if you didnt do this, and document it, and the patient aspirated stomach contents, youd better just write out the check for the civil damages. It was an absolute standard of care that was taught to everyone involved with critical care and emergency intubation. Sellicks Manuever (also called Cricoid Pressure and the BURP Manuever was widely taught to EMS and OR personnel. Basically, this is a manual fingers only compression of the cricoid cartilage during laryngoscopy and intubation that was felt to create a compression of the esophagus against the spine, and minimize the potential for aspiration. Im explaining this esoteric topic because it has relevance to how much pressure can occlude important structures in the anterior neck in a LIVING person.
It requires about 40-44 newtons of pressure to apply manual (fingers) cricoid pressure correctly. This is equal to the pressure that is required to cause blanching of the nail beds of the person applying pressure, or about 10-15 pounds of pressure. When teaching this procedure to nurses or students, it was necessary to make sure the practitioners fingers were correctly applied, as compression of the jugular veins bilaterally could be catastrophic in certain patient populations. So why am I belaboring this esoteric point?
If the noose and t-shirt were already in place on Rebeccas neck, it would not take much manual bilateral pressure OR time to create occlusion of the jugular veins sufficient to cause semi consciousness, or unconsciousness. (And that is separate from any potential head blows.) That is more than sufficient to cause the petechiae seen at Rebeccas AR, IMO. I have personally seen facial and eyelid petechiae from simply bucking and breath holding in intubated and semi-conscious, or conscious patients. (As well as negative pressure pulmonary edema, but Rebecca displayed none of that at autopsy.) So, if she was rendered semi conscious, or unconscious, and more compliant before being tossed to her death over the railing, I believe it happened VERY close in time to the tossing over the railing. As in, seconds to a minute or so. IMO.
The noose and t-shirt, if applied before any potential partial strangulation, IMO, is sufficient to both buffer, and prevent bruising from manual circumferential partial strangulation (hands around the neck), and yet allow for occlusion of the bilateral jugulars sufficient to cause partial or complete LOC, and occlusion of the airway. Which may translate to compliance with murderous hanging; ie, tossing off the balcony.
As far as the hyoid bone fracture, Rebecca did demonstrate hyoid fracture, which could be consistent with either strangulation or hanging. However, at her age (32), she is on the early edge of complete hyoid fusion. So, it is possible that her young age and small body habitus leant towards an incomplete fusion of the hyoid at age 32. That means it could be more likely to fracture with less pressure. But then, as Cynic points out, 600# of completely suspended hanging force is more than sufficient to fracture a hyoid, even in the absence of bony fracture of the spine.
The mean age of unilateral and bilateral fusion in females was 37.5 and 45 years, respectively. Fusion was not seen in ages below 20 years. Non-fusion has been found even after the age of 60 years.
http://www.researchgate.net/publica...in_the_hyoid_bone_usefulness_and_implications
A victim of compression of neck will more likely have fracture of hyoid bone if his hyoid bone is fused. Indian authors have reported that the fusion of hyoid bone occurs after 40 years of age.
Fusion in the hyoid bone is not related to the sex of the victim and there is no tendency towards early fusion on the left side compared with the right side. If the victim of pressure on the neck is aged over 38 years, the clinicians and forensic experts should expect fractured hyoids.
http://www.ncbi.nlm.nih.gov/pubmed/18442944
The long and short of this very long post, is that I think science demonstrates that it is possible that she was rendered unconscious or semiconscious if she was subjected to manual partial strangulation for a time and pressure less than what is necessary to kill. And that if she was already bound hand and foot, and already had the noose and t-shirt wrapped around her neck, those may have been enough to prevent the typical signs of any manual strangulation bruising.
I do believe her heart was beating when she went over the railing. I think the science is indisputable there, IMO.
