Posted in Psychology & Medicine


Hanging is one of the most popular methods of execution and suicide throughout the ages. It is typically performed by fashioning a noose (most commonly with the eponymous hangman’s knot), placing it around the victim’s (or own) neck. The person then falls from a short height (e.g. dropped from a stand or stepping off a stool), upon which the force of the body pulling down causes the noose to tighten. This can kill a person via two ways. Firstly, if the force of the drop and the knot is strong enough, the sheer force of the noose tightening and the person being suspended by their neck will cause their neck to break. This causes spinal cord injury at the cervical level, where the brainstem lies. When the brainstem is damaged, the person loses control of autonomic processes such as breathing, causing instant death. Secondly, if the neck does not break, the person will be strangulated by the noose. This will kill the person through either choking (from airway obstruction) or brain ischaemia (as the carotid arteries are cut off). Pressure on the carotid artery may also cause something called a carotid reflex, where powerful nervous signals cause the heart to beat so slowly that it stops.

It is said that whether a person dies a quick, clean death via neck fracture or a slow, painful death via strangulation depends on how good the knot is. A hangman’s knot is made up of a loop with a series of coils above it. The more coils there are, the more friction it adds to the knot, making the noose harder to pull closed. A true hangman’s knot is defined as thirteen coils, which provides enough resistance to cause a neck fracture when a person falls. If there are fewer knots than that, the knot will tighten too quickly around the neck and not provide enough resistance to cause a neck fracture. This leads to strangulation, which is far more excruciating and a very inhumane way to die. If there are too many knots, there will be too much resistance and there is a risk of decapitation, leading to a very messy situation.

In forensic medicine, there are certain signs that reveal a victim was hung. For example, the C2 spine (second vertebrae in the neck) will exhibit a hangman’s fracture, where there is fractures on both sides. Fracture of the hyoid bone (a small bone below the chin) is also a classic sign of hanging. There will also be bruises along where the noose was and every sphincter would be open (which leads to immediate voiding of the bowels and bladder at the time of death). If the person died of strangulation rather than neck fracture, they will show signs of asphyxiation, such as blue lips (cyanosis). Another interesting result of hanging is something called a death erection. As the name suggests, it is when a corpse is found with an erection, most likely due to hanging. This is probably caused by the noose crushing the cerebellum, causing a reflex erection. The same phenomenon has been observed in women as well.

Posted in Psychology & Medicine


When and what was the first surgery performed by mankind? Many would believe it to be a simple procedure such as suturing a wound. But would you believe that the earliest surgical procedure was brain surgery in 6500BC? Surprisingly, this is true.

Archaeologists have found a large amount of skulls with a large, round hole in them. Some of the oldest skulls with holes were found in France, where 40 skulls from the Neolithic era were excavated. Archaeologists believed these holes to be from a battle leading to a dent in the skull. However, these holes were actually the results of a surgery (signs of bone recovery can be seen around the edges of the hole, suggesting the patients were alive for some time even after the operation). These skulls all belonged to trepanation patients.

Trepanation is the surgical opening of the skull by drilling a hole in it. This is an ancient surgery that can be found throughout history. Hippocrates and Galen from ancient Greece both recorded detailed instructions on trepanation, ancient Incans performed the surgery and it was also common during the Middle Ages and the Renaissance in Europe. These surgeries were most likely indicated for skull fractures where fragments were embedded in the brain. During the Middle Ages when it was better known that the brain was the seat of the soul, trepanation was used for psychiatric treatments too. For example, in 15th century Netherlands, trepanation was used to excise a so-called stone of madness that was supposedly the cause of insanity. Like this, it was believed that trepanation could release the demons and insanity trapped in the skull.

Although this operation sounds hilariously misled, it is still used in modern medicine. Of course, it is not known to treat insanity, but rather to treat brain bleeds. Extradural and subdural haemorrhages occur when a rupture of an artery in the brain causes a collection of blood in the skull, compressing the brain. This is a dangerous situation which can lead to a stroke or even death. One treatment of this condition is trepanation, or a burr hole, where a small hole is drilled in the skull to relieve the pressure, lowering intracranial pressure and stabilising the patient. Trepanation is an excellent example of how we can learn from the past and how medical knowledge from ancient times is sometimes still valid.