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Scan          : Totmacher
Cut&Paste     : SpKIN

The information below is taken from the book "Suicide and Attempted Suicide"
by Geo Stone. 

Title         : Suicide and Attempted Suicide
Author        : Geo Stone
ISBN          : 0786704926

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TABLE OF CONTENTS

DROWNING
CUTTING AND STABBING
CYANIDE
CARBON MONOXIDE (CO)
GASES
ELECTROCUTION
GUNSHOT WOUNDS
HANGING AND STRANGULATION
HYPOTHERMIA
JUMPING

APPENDIX

ORIGINAL TABLE OF CONTENTS

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DROWNING

Drowning is an effective and quick means of suicide, usually taking
between four and ten minutes. Wether or not it is a low-trauma death,
as some have claimed, is in dispute. Drowning is responsible for only
1.3 percent of official suicides in the United States, land of the
handgun, but is much more common in many other parts of the world. It
is a distinctly poor choice for a suicidal gesture.


LETHAL INTENT: High
MORTALITY: High, 67 to 75 percent
PERMANENT INJURIES: Moderately likely
PROS AND CONS OF DROWNING AS A MEANS OF SUICIDE

Pros: -Requires no equipment or expertise
      -Is generally quick
      -May be low-trauma, especially if combined with drugs

Cons: -Difficult to use by someone confined to bed
      -Potential for lung and brain damage if interrupted
      -Possibility of revival for up to half hour in very cold water


PROGNOSIS FOR DROWNING: FACTORS DETERMINING SURVIVAL

The chances of surviving submersion depend mostly on how long someone
has been breathing water. Secondary factors are water temperature, age
of the victim, and wether the water is salt or fresh.


SURVIVAL TIME

Though the medical sources differ, they generally cite somewhere around
four to ten minutes as minimum-fatal and maximum-survivable times. Even
though the heart may continue to beat weakly for several more minutes,
there is little chance of recovery.


TEMPERATURE

People can swim much longer in warm than in cold water (see Hypothermia
chapter). However, very cold water substantially increases the time
during which a drowned person can be successfully revived. This is
because quick chilling of the body retards cellular damage and death.
This, in turn, is due to the fact that at lower temperatures all chemical
processes including metabolism and decay, are slowed. For example, at
20 degrees C (68 degrees F), metabolic rate, as measured by oxygen
consumption, drops to about one-fourth that of normal body temp (37
degrees C, 98.6 F).

Recoveries after as long as twenty to thirty minutes in very cold water
are not uncommon. The longest documented submersion without brain damage
is sixty-six minutes (body core temperature was 66 degrees F [19 degrees
C]). However, two-thirds of these recoveries are in children under eight
years of age though only 20 percent (about 865 out of 4200 in 1988) of
accidental drownings are in this age group.

The reasons for this high survival rate seem to be: (1) Children cool
more rapidly, since they are smaller; (2) they are protected by a 
phenomenon called the "mammalian diving reflex" which is stronger in kids
up to two to three years old. When such a child falls into water, more
blood is sent to her brain and heart, the heart just slows to just a few
beats per minute, and the glottis (vocal cords) closes, preventing water
(and air) from entering the lungs.


INJURY

Survival rates after near-drowning are around 90 percent. However, even
someone who seems to have been successfully resuscitated may have suffered
permanent or even fatal injury: Pneumonia can develop, especially from
contaminated water; temporary kidney failure sometimes occurs, caused
by the red blood cell destruction following massive absorption of fresh
water; heart failure and/or brain damage due to lack of oxygen may be seen.

The frequency of brain damage reported in near-drowning cases ranges from
2 percent to over 30 percent. If near-drowning is defined as having 
impaired consciousness on arriving at the hospital, the latter figure is
probably more realistic. Recovery may take weeks or months and may be
incomplete.


WHAT IS DROWNING?

The short answer is: Drowning consists of filling the lungs with liquid so
that oxygen cannot be absorbed. To the extent that this is the direct
cause of death, drowning is another form of asphyxia. Further, inhaling
water can cause the airway (larnyx) to spasm shut or the heart to suddenly
stop. In addition, both fresh and saltwater damage the blood, lungs, and
heart, though some medical consequences of drowning depend on wether salt-
water, fresh water, or some other liquid is inhaled.

Here's the long answer: Someone who is conscious can hold his breath until
carbon-dioxide buildup in his blood stimulates the brain's respiratory
center, which overrides any voluntary breath-holding and forces an 
inhalation: You can't not breathe. If the mouth and nose are under water
at this moment, water is inhaled. This in turn causes reflex coughing,
gagging, vomiting - and additional inhalation, often of more water. This
cycle continues until conscioussness is lost, generally within two to three
minutes, due to lack of oxygen. Convulsions and cessation of breathing
follow quickly, which is followed more slowly by heart failure. Brain
damage, then death, usually occurs within four to ten minutes.

Foam frequently comes from the mouth and nose of a drowning victim, but
sometimes this is not visible until pressure is applied to the chest in a
resuscitation attempt. The foam is usually white, but may be bloodstained
and may persist for several days (depending on temperature) on a corpse
in the water. It is produced by a mixture if air, water, mucous, and other
components, whipped into a froth by desperate respiratory activity. It may
be more frequent in accidental than in suicidal drowning, if in the latter
the person is less likely to struggle, but this is speculation based on
the fact that people who are already unconscious when they drown don't
produce this foam.

The more graphic description of drowning that follows came from observations
on dogs that were tied up and held under water until they were dead. The
first stage was described as "surprise" and lasted a few seconds. This was
followed by violent agitation in which the dog tried to escape its bonds
and reach the surface while holding its breath. This lasted about a minute.

The third stage, also about one minute long, consisted of deep inspirations
of water and expiration of white foam. Mouth and eyes were open, and body
movements decreased. In the fourth stage, breathing motions stopped, pupils
were dilated, and corneal reflexes disappeared; another minute. In the last
stage, lasting thirty seconds, there were three or four respiratory gasps
and a few spasms around the lips and jaws.

These observations were later confirmed when a man who had drowned his
pregnant wife gave a detailed description of her death in very similar terms.


SUMMARY

This is not a complicated means of suicide. Pretty much all that's needed
is some water and a few minutes without interruption. Reports from near-
drownings are contradictory concerning pain. To minimize it, one may take
enough alcohol or sedatives to become unconscious while swimming or bathing.
To decrease chances of unwanted resuscitation, avoid drowning in freezing
water.

Drowning is fairly quick and frequently lethal - two-thirds to three-quarters
of such attempts are fatal - means of suicide, usuallly taking between four
and ten minutes, but there is some danger of brain damage if you're rescued
after being unconscious. Drowning is a very poor choice for a suicidal
gesture.


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CUTTING AND STABBING

Relatively few people commit suicide by cutting or stabbing themselves.
However, around 10 to 15 percent of suicidal gestures/attempts are from
wrist cutting. Unlike all-or-nothing methods like hanging and drowning,
cutting and stabbing can be made about as lethal as you choose to make
it. Nevertheless, mistakes and accidents do happen.


LETHAL INTENT: Variable, mostly low
MORTALITY: Low, around 5 percent
PERMANET INJURIES: Low
PROS AND CONS OF CUTTING AND STABBING FOR SUICIDE

Pros: -Can be done as a fast (or slow), highly lethal method
      -Knives and razors are readily available

Cons: -Painful
      -Sometimes gory cadaver
      -Consciousness not immediately lost



THROAT

Cutting the throat is the fastest, most reliably lethal, and perhaps
most gruesome of suicidal cuts. However the method is not used as
often as formerly, probably because straight razors have been widely
replaced by safety razors and electric shavers.

The cut-throat wound usually starts high and (in right-handed persons)
on the left side of the neck, goes across the center,and ends lower
on the right side. (You might try this - with yor finger - to get a
better sense of it.) Since the "victim" generally throws his head back,
the skin will be under tension and the cut smooth and straight. This
may not be the case when the skin is too loose to be effectively
stretched tight, as in old age or after recent major weight loss. While
most cuts are by razor or knife blade, occaasionally broken glass or
some other irregular object is used. These also tend to leave jagged
rather than straight wounds.

More often than with other methods, the corpse is found in front of a
mirror. Perhaps mirrors are used to visually guide the hand. Shallow
cuts are often found near the beginning of the wound. These are one
piece of evidence a medical examiner will use to distinguish suicide
from murder. However, hesitation cuts are occasionally seen in murder,
and therefore are not definitve.


WRIST, ELBOW, ANKLE

Cuts on the wrist, and to much lesser extent elbow or ankle, are often
used to make a suicidal gesture. Such wrist cuts are generally shallow
and perpendicular to the long bones of the forearm. They tend to sever
the surface veins. Since these veins are not particulary large and do
not carry as much pressure as the arteries, such cuts are not usually
life-threatening because they can clot before a fatal quantity of
blood is lost.

Wrist cuts become more dangerous:

1.

If the cuts are more or less parallel to the long bones. In such a
case the blood vessels tend to be sliced lengthwise or diagonally,
making clotting more difficult and thus allowing more and faster
blood loss.

2.

If cuts are deeper and near the long bones of the forearm (the thumb-
side long bone is the radius; the other long bone is the ulna), they
may sever the radial artery or the ulnar artery. These pieces of 
plumbing are under high pressure and cutting them can be fatal unless
the bleeding is actively stanched.

There are claims that a single cut across a healthy wrist artery is
not dangerous, because the cut artery (which, unlike veins, has built-
in muscle) will contract and so limit blood loss. While this protective
mechanism does exist, it's not always sufficient: Four of the forty
Stockholm deaths due to cuts on the limbs were from just such an
injury.

You can find (or usually avoid) these arteries by checking various
points around your wrist for a pulse. Without a stethoscope you will
only detect one in a couple of spots, for example, where your wrist
and thumb come together. You can locate the radial artery fairly near
the surface there. The other major wrist artery, the ulnar, runs
parallel to the other forearm bone and can be felt near the heel of
the hand. Hyperextending the wrist is comon, but hides the radial
artery around the end of the radius (try feeling for the pulse), and
one may end up with only severed flextor tendons.

3.

If cuts are numerous. Multiple cuts of wrists, elbows, and ankles,
none individually dangerous, may cause enough blood loss to be fatal.

4.

If clotting is inhibited. This may be deliberately done by keeping the
cut under water. Another way to slow clotting is with drugs. Some drugs,
like heparin and coumarin-like compounds, are prescribed specifically
to decrease blood clotting in medical conditions like stroke. With other
drugs, the anticlotting ability is usually considered a side effect to
its intended therapeutic use. Aspirin, when taken for pain relief, is
the most common drug of this sort. Since many people are not aware of
these effects, use of such drugs may occasionally turn a suicidal
gesture into an accidental suicide.


FEMORAL ARTERY AND VEIN

The femorals are the main arteries and veins to and from the legs. As
you might expect, they carry a lot of blood, and an untreated cut to
either one is quickly fatal. In one case, a thirty-four-year-old man
bled to death from a 2 millimeter (less than 1/8 inch) nick to the
femoral vein - and the vein is the low-pressure half of the circuit.

They run next to each other, with the artery closer to the front of
the leg, and are nearest to the skin at the groin, which makes a
tourniquet hard to apply if that's the site of the cut.

While knives can be and often are used on impulse, one case showed
the benefits, however temporary, of planning and knowledge. A
physician applied a local anesthetic to his leg, and then neatly cut
his right femoral artery lengthwise. I estimate that he would have
lost a fatal amount of blood in about five minutes. He died quickly,
and, probably, painlessly.


STAB WOUNDS

Unlike most wrist cuts, self-inflicted stab wounds are generally 
intended to be lethal. They are usually aimed at the front of the
trunk, wiht the heart area being the most frequent target. Other sites
tend to be scattered near the centerline of the chest, from the neck
to the groin; they are almost never seen on the head, back or
extremities.

Death, when it occurs, is generally due to loss of blood if a major
vein or artery is cut, or to heart damage, if that vital organ is cut.

A heart injury, in turn, causes internal bleeding and/or an inability
to pump blood to other parts of the body. Even a relatively small heart
wound may be fatal if not promptly repaired, but the severity of a 
heart wound also depends on its location. If the cut is to the upper
chambers, the right ventricle, or the major blood vessels, death is
likely; a small cut to the left ventricle wall is sometimes survived,
since the thick muscle there may seal the wound when the heart contracts.
However, this is not something you should count on.


OTHER WOUNDS

There are occasional reports of unusual sites or methods. One woman
cut off her arm just below the shoulder, using a small kitchen knife
with a six-inch blade. Another held a knife to her back and ran back-
wards into a wall. One man stabbed himself in the chest with a chainsaw
while it was running.


CAUSE OF DEATH

A cut-throat wound most often causes death by hemorrhage, Severing either
of the two carotid arteries on the right side of the neck or the jugular
veins on the left will cause fatal blood loss within about five minutes.

Since blood flows into the head via the carotid, unconsciousness might
occur a couple of minutes after cutting it; perhaps a minute or two
longer if the jugular veins are sliced instead.

Since the trachea (windpipe) is usually also cut, blood may be inhaled,
making asphyxia a secondary factor. If the trachea is partially cut while
the carotid arteries and jugular veins are missed, inhalation of blood
(asphyxia) may be the actual cause of death, but this is unusual. In one
case of this sort, the victim died after about thirty minutes.

Very occasionally, the trachea is completely severed without major blood
vessel damage. This can cause the lower part of the trachea to fall into
the thorax (chest cavity), followed by unsupported soft parts of the neck.
This results in mechanical obstruction of the airway and subsequent asphyxia.

It's conceivable that an upside-down posture would permit breathing under
these circumstances, but this is mere speculation.

It's also possible, but rare, that when the external jugular vein is partly
cut and open to air, enough air gets into the damaged blood vessel to cause
a fatal air embolism: A large air bubble enters a major vein and is sent
to the heart, which isn't desgined to pump gases. It's a bit like getting
air in your car's brake lines, which is also designed to pump only liquids.

Injecting air into a vein has been suggested (and tried) as a suicide
method; it's not a good one. Since the output of the heart is around 70
milliliters per beat, you would probably want to inject at least twice
that volume of air to make sure your heart developed the cardiac equivalent
of vaporlock. This would require something like a bicycle pump and you
would be conscious for at least the first three to five minutes.


HOW LONG DOES IT TAKE TO BLEED TO DEATH FROM CUTS TO LIMBS?

When death occurs after wrist, ankle, or elbow cuts, it is almost always
from loss of blood and shock. How long does this take? Obviously, it 
varies, depending on which vessels are cut, at what angle they're cut,
and where your body is sending blood at the time. A very rough estimate
of blood loss would be: 2-3 ml/beat x 70 beats/min = 140-210 ml/min;
x 12-18 min = around 2500 ml, which is half your blood supply, and about
the limit of what you might survive without prompt medical help. Add
another five to twenty minutes to die, for a total of seventeen to
thirty-eight minutes; but this is just a ballpark figure and could easily
be off by a factor of two or more.

If avoiding discomfort is a priority, be aware that severe loss of blood
causes a physiological anxiety response.


CUT/STAB WOUNDS TO THE CHEST

With suicidal chest stabs, death is usually due to either (1) injury to
a major vein or artery leading to fatal blood loss or (2) injury to the
heart itself or to the sac surrounding it, the pericardium. If the heart
is sufficiently damaged, it will hemorrhage and be unable to pump blood.
But even if the heart itself is untouched, blood may fill the pericardium
faster than it can drain out (or a blood clot may block outflow). This
will eventually leave the heart with no room to expand, and thus keep it
from filling (and thus pumping) properly ("cardiac tamponade").

In one case a forty-four-year-old man stabbed himself six times in the
chest with a seven-inch-long kitchen knife. He then washed and returned
the knife. After changing his clothes a number of times, he had lunch
with his aunt who apparently didn't notice anything unusual. He collapsed
about two hours after stabbing himself and died shortly afer reaching the
hospital. The pericardial cavity was found to have 300 milliliters of
partly clotted blood; another 410 milliliters was in the chest cavity.
The heard muscle received cuts, but the cause of death was cardiac
tamponade.


SUICIDE, WRIST

Since you're trying to kill yourself by bleeding to death, your
preparations should be directed toward keeping your blood from clotting.
To this end you might eat a few (four to eight) apsirin about an hour
before the main event. Can't hurt, might help. It also might decrease
the pain a bit.

An excellent meal, hot bath and a glass or two of good wine - after all,
you won't get another chance - should be pleasant and relaxing. The
alcohol and hot bath will also have the effect of increasing your near-
the-skin blood flow. More importantly, since our blood has a hard time
clotting in water, keeping a slice wrist submerged increases blood loss.

Using a properly aimed spray of water from a shower head is even more
effective because the motion of the water and mechanical action of the
drops further interfere with clot formation. It also improves the visual
aesthetics, for whoever finds yor body, not to have a tub filled with 
blood. You may want to rig a "stand-off": something to keep your wrist
from falling against your body or the tub and thus slowing blood loss;
or use blood vessels in your ankle instead of, or in addition to, your
wrist.

Now, the best preparation in the world won't do the job if you don't
cut yourself adequately. To lose a lot of blood in a hurry you need to
either cut a good artery or two or several veins. As discussed im more
detail above, you can feel the arteries on the inside of the wrist near
the long forearm bones. Cutting them lengthwise is more effective, but
either way should work. If the blood spurts out you've hit a gusher of
an artery; if it flows, you got a vein. Cutting several times across the
underside of the wrist may well get you enough veins and small arteries
to do the trick, but if you want to be faster and more certain, go for
the radial or ulnar arteries.

On the other hand, maybe there's no hurry and you want to savor the 
slowly spreading pool of red in the tub. Fine. Just be aware that you
will eventually lose consciousness and that a bit later you will have a
"window of opportunity" for brain damage from lack of oxygen before you
die. That would not be a good time to be rescued. On the third hand,
it's entirely possible that you will slide underwater when you become
unconscious and thus drown before you can bleed to death. I suppose if
you wanted to make this more likely you could use an air pillow to
support your head above the water: You hold the air valve shut by hand;
when you lose consciousness your hand falls, the valve opens and lets
out the air. Or perhaps this is getting too complicated.

An alternative method has been suggested. It consists of running an IV
line into your favorite elbow vein, using a big-bore needle (say, 16
gauge) taping it into place, and letting it drip away. Call the Red
Cross for details, though they may suggest a better use for your blood.

I'm not aware of any cases using this technique. It would certainly be
slow, and probably subject to clotting, but I don't know this for a
fact.

The femoral arteries and veins, going through the groin to the legs
carry a lot more blood than does the wrist plumbing. Cutting them is
thus more quickly fatal. It also allows use of both hands and avoids
wrist tendons, but is hard to stanch or tourniquet should you change
your mind after the fact.


SUICIDE, THROAT

If you're going to cut your throat, the three major structures that
are commonly injured are the carotid artery, the jugular vein, and 
the windpipe. These are all accessible from the front of the neck,
but the major blood vessels are partly protected by the sterno-mastoid
muscles nearby. (Turn your head to the side and feel them.) The large
carotid is on the right side under the angle of the jaw (where you can
feel your pulse). It's most accessible by cutting in between the trachea
and the sterno-mastoid muscle. Completely severing it will cause un-
consciousness in a couple of minutes and death in about five. Not
pleasant, but fast. Throwing the head back moves the carotids under the
sterno-mastoid muscles and may require deeper cuts or limit damage to
trachea or larnyx.


SUICIDE, TRUNK

The only target worth aiming for is the heart: Single-stab injury to
other organs is too slowly fatal unless you happen to hit a major blood
vessel. The heart is somewhat protected by the cartilage and/or bone
structures of the chest and ribs. The ease of getting through varies a
lot from one location to the next. To most reliably reach the heart may
require either a strong thrust through the chest wall - falling onto a
knife will be more than enough - or an upward stab from between a pair
of ribs. In either case, it is easier to get through if the wide part
of the blade is held horizontally rather than vertically.

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CYANIDE

Cyanide is one of the fastest-acting poisons, though sources differ
with regard to just how long (mostly between one and fiteen minutes
in large (1500 mg) doses, longer with lower doses) it takes to kill.
The lethal dose is estimated to be 50 to 300 mg; however much larger
amounts have been survived with prompt medical attention.

The gaseous forms, hydrogen cyanide and cyanogen, are rarely used in
suicide, but should act more quickly than the oral poison; solid 
cyanide salts (potassium, sodium, and calcium cyanide) are the commonly
sold forms, but hydrogen cyanide gas can be easily made by mixing a 
solid cyanide and a liquid acid (for example, hydrochloric [muriatic]
acid); this is what is done in gas chambers.

Cyanide works by causing asphyxia at the cellular level; it binds to
iron ions found in some enzymes and makes them unavailable for cellular
respiration, essentially choking your cells. The cells try to survive
by switching to a non-oxygen requiring metabolic pathway (the same one
your muscles use when you're exercising faster than you can breath in
oxygen), but this quickly builds up lactic acid to toxic levels. The
fastest-metabolizing cells, brain an heart cells, are most quickly
affected; and if they die, so do you. Cyanide also has a direct
poisonous effect on the central nervous system and depresses breathing,
but this is overkill. As with carbon monoxide, some survivors have
permanent nervous-system injury, such as memory deficits and tremor.

If you use cyanide, it would be a thoughtful gesture to leave a
conspicuous note to that effect, because of possible hazard to rescuers
who might otherwise apply mouth-to-mouth resuscitation - some people
lack the ability to detect the almond-like smell of cyanide.


APPLE SEEDS

If you really can't get what you need, as a last resort you might
consider...apple seeds. If you crush a fresh apple leaf (or cherry,
plum, pear, and some others) between your fingers, you should be able
to detect the faint odor of almonds. This is the smell of cyanide.

Apple seeds average around 0.6 mg hydrogen cyanide (HCN) per gram of
dry seed. Since the lethal dose of HCN is estimated to be about 50 mg,
you need around 85 grams (3 ounces) of dry seeds. This is around half
a cup, which requires a lot of apples. However:

1.

Plants are variable; eat enough - at least three times the minimum dose:
Cyanide is not a drug on which to skimp, since it can cause brain 
damage in sublethal doses.

2.

The HCN must be liberated from the sugar it's chemically attached to.
This occurs when the moistened seed is crushed, releasing an enzyme,
emulsin, which does the job. Apparently this also occurs in the stomach,
due to the hydrochloric acid there. In any case, you need to crush and
eat these seeds fairly quickly, both to avoid evaporation of cyanide
from the crushed seeds, and so as not to lose consciousness before in-
gesting a lethal dose. A blender or coffee grinder would be a good way
to break up the seeds.

3.

There are around 150 plants known to contain cyanide (vegetarians note!).
Many of them have it in higher concentration than do apple seeds. For
example, bitter almond seeds average around 3 mg/grams (range 0.9 to 4.9),
or five times the apple seed concentration. Cassava root is also quite
poisonous unless processed to remove its cyanide.

4.

Cyanide, in the form of the alkali potassium salt is available as a metal
plating solution, for example "Cy-An-In"; the lethal dose of the sodium,
potassium, and calcium cyanide salts is estimated to be 200 to 300 mg
(0.07 to 0.11 ounce).

5.

The use of cyanide is controversial: Some claim it is painless and quick,
others that it is painful and quick. For what it's worth, cyanide is
commonly used by suicidal chemists but rarely by physicians. However,
this may reflect their respective easy access to different poisons rather
than any other basis for preference.


The German Euthanasia Society recommends 1.5 grams potassium cyanide -
about seven times the lethal dose - dissolved in a glass of cold water.
Don't use fruit juice or soft drinks; their acid releases HCN prematurely
(not that it will matter if you drink it quickly). Kool-Aid has been
recommended for those who don't like plain water.

The same folks suggest placing 1 gram of a cyanide salt into a gelatin
capsule and putting that inside a larger gelatin capsule. The idea is for
at least the inner capsule to reach the gut before dissolving and releasing
the cyanide. This is claimed to minimize stomach pain.

Sodium cyanide works every bit as well as the potassium salt; calcium
cyanide decomposes in water, but should do the job if used quickly.
Effects are fastest ifthe stomach is empty and gastric acidity high. With
minimally lethal doses, death may take up to an hour. Symptoms include
a bitter, burning taste; constriction or numbness of the throat; nausea
and vomiting; disorientation; irregular breathing; unconsciousness;
violent convulsions; protruding eyeballs; foam, often bloody, around the
mouth. All in all, not a particularly peaceful exit, it would seem.

6.

If you're in a hospital, and wired to monitoring devices, this (and most
drugs) won't work fast enough and you'll probably be "saved"; but, if
you're considered mentally competent, you can check yourself out
"against medical advice" (AMA) and take care of business at home.

7.

Unlike most drugs/poisons, cyanide has a reasonably specific set of anti-
dotes that are usually effective if administered quickly enough; amyl
nitrite by inhalation; sodium nitrite and sodium thiosulfate, intravenously.

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Carbon Monoxide (CO)

is colorless, odorless, and tasteless; it has one less oxygen atom
than carbon dioxide (CO2). It will be produced by any carbon-fueled
flame that doesn't get enough oxygen. If a flame is yellow or puts out
visible soot, you can be sure it's also generating carbon monoxide; if
a flame is blue, carbon dioxide is the principal carbon oxide. You may
have noticed that the outer part of a candle flame is blue, while the
inside is yellow. This is because the outer portion burns hotter due
to its greater oxygen supply.

Carbon monoxide's biological effects are mostly due to the fact that
it's 200 to 250 times more strongly attached to the oxygen-transporting
molecule in red blood cells, hemoglobin, than is oxygen. Thus a low
concentration of CO in the air can occupy a large fraction of your
hemoglobin. For example, 0.01, 0.02, 0.10 and 1.0 percent CO in the 
breathing mixture would tie up 11, 19, 54, and 92 percent,respectively,
of a person's hemoglobin at equilibrium.

Carbon monoxide is also directly toxic to cells by interfering with 
their ability to use oxygen, by binding to a number of iron-containing
enzymes and other proteins. Carbon monoxide causes blood to be a bright
cherry red, which produces a ruddy corpse. This unusual coloration can
be used for preliminary identification of CO poisoning.

The toxicity of carbon monoxide is shown by a case in which a car
accident victim was put on a stretcher, which was placed eight to ten
feet behind the tailpipe of an idling ambulance while antoher person
was attended to. Upon reaching the hospital,the first man was
discovered to be dead from carbon-monoxide poisoning. His other
injuries were minor.

Since smoldering tobacco contains about 4 percent carbon monoxide,
pack-a-day smokers have 5 to 6 percent of their hemoglobin tied up
by carbon monoxide. This level causes small, but measurable, impair-
ment of both physical and mental performance. Frequent cigar smokers
have peak carbon monoxide blood levels of around 20 perecent. A 50
percent carbon monoxide blood level is often fatal, but levels as low
as 15 percent may also kill those with heart or lung problems.

It takes about five and a half hours of breathing fresh air to remove
half the carbon monoxide from hemoglobin, another way of showing the
high affinity between the two; 100 percent oxygen reduces this to 80
minutes; 100 percent oxygen at three atmospheres pressure gets rid of
half the carbon monoxide in twenty-three minutes, but may cause
permanent eye damage. However, even twenty-three minutes is often to
long: A few minutes of asphyxia is enough to cause brain damage which
may be fatal, and has a good chance of being permanent.

These injuries include dementia, psychosis, paralysis, cortical blind-
ness, memory deficits, and Parkinsonism; the latter two are the most
common. The frequency of permanent injury from carbon monoxide overdose
ranges from 0.3 to 43 percent in various studies, even if high-pressure
oxygen used. "Some survive [in] a coma for weeks or months before
succumbing to infection.

Alcohol and other central nervous system depressants (for example, 
sedatives) may increase the toxic effects of carbon monoxide. A 0.20
percent blood-alcohol concentration combined with serious (but generally
not fatal in a healthy individual) 35 to 40 percent carbon-monoxide
saturation of the blood has been fatal. However, this is association is
controversial. Carbon monoxide is also hazardous to unprotected rescuers
and will explode if the concentration reaches 10 percent and there is
a spark or flame present. This concentration will not be reached from
combustion, but may be achieved from compressed CO (in tanks) or 
chemically generated CO.

Automotive carbon monoxide poisoning is becoming less frequent in the 
United States. The reason is that car engines are required to get
better gas mileage and produce fewer toxic emissions than in the recent
past. A new, well-tuned engine may emit 0.06 percent carbon monoxide,
compared to 6 to 9 percent from an engine of the 1960s, a hundredfold
decrease. As a result, it takes longer to kill yourself by filling a
garage with carbon monoxide from a tuned engine. It can be done, but is
no longer either fast or certain.

How long does this take? For a given-volume garage, it depends primarily
on the age, state-of-tune, and size of the engine. If a "clean" two
liter engine idles at 750 rpm, the it will take about an hour for 20 by
20 by 8 foot garage to reach 0.06 percent carbon monoxide. This is not
a reliably lethal concentration.

What would happen if the exhaust gases are piped directly into the car,
as is commonly done using a garden or vacuum-cleaner hose? It would
take about three minutes to reach 0.06 percent atmospheric carbon
monoxide. However, the atmospheric CO concentration can't be greater
than that of the exhaust mixture; it just takes less time to get there.
Once again, not reliably lethal.

If we had a "dirty" engine of the same size with 6 percent carbon
monoxide emissions (100x clean engine), it would take about thirty
five seconds for the garage to reach 0.06 percent carbon monoxide; 70
seconds for 0.12 percent, 140 seconds for 0.24 percent, and so on.

Thus, a lethal concentration of CO would be produced in a minute or two.
Death could occur in less than half an hour. Note that, while running
such exhaust into the car would generate lethal concentration of CO
within a few seconds, one would have to continue breathing it for a
fatal result.

Alternatively, one may be able to buy a small tank of carbon monoxide
from a chemical, science supply, or industrial gas supply company
(you will need a gas regulator/valve, too). Loosely sealing yourself
in a plastic tube tent, car, or functional equivalent, and releasing
the gas should be quickly (five to fifteen minutes) fatal.

A simple amd reliably lethal source of carbon monoxide is a charcoal
grill, hibachi, or other burner. If charcoal (or any other handy carbon
fuel, like wood or coal) is burned in one, a deadly CO concentration
will be quickly generated in any small, enclosed space, such as a tent.
Using this method inside a building is a bad idea, both due to fire
hazard and because of the CO danger to other people.

Dr. Kevorkian's current suicide apparatus consists of a gas mask attached
to a tank of carbon monoxide. The gas flow is controlled by a valve that
is opened by the patient, who is wearing the mask. Under these conditions
death should occur in less than five minutes. The advantage is that the
gas concentration will probably be higher than with a tent, with faster
results. The disadvantage is that the hookup is a bit more elaborate
and is correspondingly more likely to require someone else's help.


EFFECTS OF CARBON MONOXIDE

A century ago the eminent British scientist J. B. S. Haldane studied
the effects of carbon monoxide on himself - a time-honored, but some-
times hazardous, medical tradition. While sitting and takin notes, he
breathed a 0.21 percent carbon monoxide mixture for seventy-one minutes.
A summary of his observations follows: After twenty to thirty-four
minutes he has a slight feeling of fullness and a throbbing of the head;
17 percent of his blood hemoglobin was tied up by carbon monoxide as
carboxyhemoglobin. After forty to forty-five minutes the headache was
worse, his breathing was slightly fast and he felt abnormal (39 percent
carboxyhemoglobin). After fifty-nine to sixty-five minutes, he was 
breathing fast, looked pale, was starting to become confused, and couldn't
move in his chair without feeling worse (44.5 percent carboxyhemoglobin).
After seventy-one minutes his vision was dim, he couldn't get up without
help, and he stopped the experiment (49 percent carboxyhemoglobin). There
were no long-term ill effects.

As always, there is individual variability: In 7 perecent of fatal CO
poisonings, less than 40 percent of the victim's hemoglobin was tied up
by CO. Another study found that 0.32 percent CO for an hour caused
unconsciousness; 0.45 percent caused death.

In animal experiments, carbon monoxide is about as fast as intert gases:
unconsciousness occurs in one to two minutes and death after around five
minutes, using 4 to 8 percent CO. Death is preceded by convulsions and
muscle spasms, but the fact that there are frequent accidental carbon
monoxide poisonings among sleeping people shows that it doesn't cause
enough discomfort to reliably awaken someone. However, first taking
enough of a sedative (for example alcohol, opiate, barbiturate) to achieve
unconsciousness would probably result in an easier death.

If low concentration of CO is anticipated, such as from new car exhaust,
it may be useful to premedicate with antinausea (for example, some
antihistamines) and antiseizure (for example,Valium) drugs, but this is
speculative. Better is to avoid this situation: Don't use CO for a 
suicidal gesture and don't use low concentrations for suicide.
We close this section with a suicide note from Japan, written while a
car was filling with carbon monoxide. The first eleven items of the note
were personal messages and instructions for the disposal of assets. The
last entries are quoted below, in translation:

[At 6:15 p.m.] The inhalation of exhaust gases is begun.

[After seven minutes] My eyes and throat are slightly irritated. Put on
a bathing towel. There are tremendous water drops on the door glasses
[This is condensation of water vapor from the exhaust]. The tank is full
of gasoline.

[After eight and one-half minutes] Slight shortness of breath. Ha-ha-ha.
The powers of Nissan's engine are great!

[After ten minutes] Swallowed a cup of Japanese sake [rice wine]. I could
not control myself to stay in the cabin [of the minivan] at this level of
shortness-of-breath yesterday.

[After eleven minutes] To the mistress of a grocery store: "Yes, you were
right. The size of this hose, 30mm in outer diameter and 25mm in inner
diameter, fits the exhaust pipe perfectly.

[After twelve and one-half minutes] Swallowed another cup of sake. I wish
I could have a can of beer. I wonder what the concentration of carbon
monoxide is now.

[After fourteen minutes] Breathing can only be done by mouth.

[After fifteen minutes] Water is pouring out of the hose.

[After sixteen minutes] Good-bye, Mum and Papa!

[After seventeen minutes] Still I am living. It is asthmatic breathing.
Now, I will sleep.


-------------------------------------------------------------------------------

GASES

Many gases that are more or less nontoxic can cause asphyxia by
replacing oxygen from the breathing mixture. Some common ones
include avetylene, argon, butane, carbon dioxide, freon, helium,
hydrogen, liquified petroleum gas (LPG), methane, neon, nitrogen, and
propane. As a result, they are dangerous in enclosed areas or when
breathed through a gas mask, but not otherwise. People start showing
signs of asphyxia when the concentration of these gases is around 30
percent; severe symptoms at around 50 percent; death at around 75
percent.

In the above list, argon, butane, carbon dioxide, freon, and LP gas
are heavier than oxygen, and may displace it from the bottom of 
closed spaces, and, occasionally, even open spaces that are protected
from wind. Tunnels that are open only through manhole covers
occasionally contain lethal concentrations of carbon dioxide. Someone
entering such a location unknowingly would become unconscious within
a couple of minutes - perhaps within seconds - and would be dead after
five to ten minutes. A standard gas mask is useless under these
circumstances; supplemental oxygen is necessary.

However, for the purpose of suicide, carbon dioxide would be an un-
pleasant choice, since its presence stimulates both breathing reflexes
and the sensation of smothering.

The hydrocarbons methane, butane, liquified petroleum gas (LPG), and
propane, while readily available as fuel gases, are normally mixed
with badsmelling "warning" gases (mercapatans), related to skunk
scents.

Acetylene is used for gas welding and is easy to aquire, but contains
somewhat-toxic acetone. Don't bother making you own acetylene from
calcium carbid (formerly and still occasionally used in carbide
lanterns for caving), because it contains an ammonia-like contaminant,
phosphine (PH3).

The remaining gases - argon, helium, and nitrogen - are your best bets
in this category. They are all tasteless, odorless, nonirritating, and
under these conditions, chemically and physiologically inert. In fact,
nitrogen comprises about 80 percent and argon 1 percent of sea-level,
while roughly 90 percent helium to 10 percent oxygen mix (precise ratio
depends on dive depth) is used for deep-water diving (to avoid intoxic-
ating effects of high pressure nitrogen called "nitrogen narcosis" or,
more poetically, "rapture of the deep").

Since these inert gases are not poisonous and your lungs have something
to inhale, such asphyxias will be minimally traumatic. That is, they
will not cause feelings of suffocation (which are due to carbon dioxide
buildup, not the lack of oxygen) or hemorrhages (caused by high blood
pressure from blocked jugular vein or struggling to breathe against a
closed airway).

Most medical use of inert gases is for animal euthanasia, however there
have been human fatalities from them, too. For example, airline face
masks were mistakenly hooked up to inert gas cylinders instead of to
oxygen at least ten times during the 1980s in the United States. The
fact that these people died without attracting attention is consistent
with nontraumatic death.

Argon is commonly used for inert-gas electric welding and helium for
balloons. Nitrogen has a variety of uses and may be purchased either as
a gas or as a cold (-196 degrees C or -321 degrees F) liquid. All of
these are available from industrial gas suppliers. Helium can also be
found at party-supply stores, and argon at welding suppliers. None of
these gases are dangerous unless they displace oxygen from the breathing
mixture.

Probably the easiest way to use inert gases for suicide is to enter a
tube tent with a gas cylinder, flush the tent with any of the three
gases, and seal the ends of the tube. The volume of a tent is such that
you won't produce enough carbon dioxide to stimulate breathing reflexes
before dying. Since there's little or no residual oxygen in the breathing
mixture, minimal amounts of carbon dioxide ought to be exhaled, suggesting
that a large inert gas-filled plastic bag over the head should work as
well as the tube tent.

Only slightly more complicated method is to hook up a gas delivery mask
(available at military surplus or medical supply stores) to a cylinder
of compressed inert gas. This may, in fact, be the easiest method if
you're using supplemental oxygen, and have a gas delivery system already
in place.

The main hazard of this (and all) asphyxia is the possibility of brain
damage if the process is interrupted due to intervention, running out of
gas, or tearing or removing the gas mask, plastic bag, or tube tent
while unconscious. This can be minimized by using a high concentration
of the anoxic gas, which causes most rapid loss of consciousness. These
gases are not a danger to others in anything but a small, sealed space,
however it's important that a gas cylinder not be mislabeled, lest it
imperil subsequent users.

In experiments, animals (dogs, cats, rabbits, mink, chickens) show
little or no evidence of distress from inter gas asphyxia, become un-
conscious after one to two minutes, and die after about three to five
minutes. Thus, use of any of these three gases, combined with a plastic
bag, should be less traumatic than plastic bag asphyxia alone, since
there will be little discomfort from carbon dioxide buildup and
unconsciousness will be swift.

-------------------------------------------------------------------------------

ELECTROCUTION

Electrocution is an effective, but infrequently used, method of
commiting suicide. It is not a good choice for a suicidal gesture.
The potentially lethal effects of electricity on the body include
heart stoppage, respiratory failure, and burns.


LETHAL INTENT: High
MORTALITY: 40 to 90 percent
PERMANENT INJURIES: Moderately likely
PROS AND CONS OF SUICIDE BY ELECTROCUTION

Pros: -Not much physical strength or dexterity needed
      -High fatality rate
      -High (not household) voltage and current usually cause quick
       unconsciousness

Cons: -Scarcity of data on suicidal electrocution - most of our
       information is extrapolated from accidents
      -Frequent permanent injuries from high-voltage accidents
      -Electricity is mysterious to many people
      -May be hazardous to innocent bystanders or rescuers


HOW DANGEROUS IS ELECTRICITY?

This may semm a silly question, but electricity is usually invisible
and, for many people, mysterious. As a result, it't not widely known
that consequences of electric shock often depend on how quickly help
is available. This is because death is commonly due to the shock-
induced stoppage of heartbeat or breathing - which are frequently
reversible if there is prompt medical intervention, usually CPR (
cardio-pulmonary resuscitation).

The medical literature cites a wide range (5 to 50 percent) of mortality
rates in known electrical accidents, but since minor shocks are rarely
reported, the accuracy of even this figure is questionable. In one
recent study only 3 perecent of hospital patients admitted with injuries
from high voltage (greater than 1000 volts; found in high-power trans-
mission lines and some industrial uses) died. But this didn't include
those dead at the scene or dead on arrival.

There is about a 90 percent fatality rate in suicidal electrocution
attempts using household and high-voltage current. Use of electric
stunning devices is about 40 percent fatal.

The frequency of long-term injury is unknown with suicide attempts, but
occurs fairly often in accidents. Much depends on the type and duration
of electric shock. The three most common sorts of long-term injury are:

-burns, typically from high-voltage power transmission;
-direct neurological (brain/nervous system) damage, generally from
 lightning or high voltage power transmission;
-indirect brain damage resulting from breathing paralysis, which can
 be caused by high- or low-voltage power, or lightning


ELECTRICAL PATH

To achieve (if that's the right word) electrocution, the electrical
current pathway must go through organs that are both vital and 
suspectible to electrical disruption. The ones that best fit this
description are the brain, spinal column, heart, and respiratory
muscles in the diaphragm.

The electrical pathway is thus critical: Head-to-limb is always
dangerous because it goes through the brain, and, depending on which
limb, possibly the heart. Similarly, a right-hand-to-right-foot path-
way is less hazardous than a left-hand-to-left-food or a hand-to-hand
circuit, since the latter two are more likely to go through the heart.


HOUSEHOLD (A.C. OR ALTERNATING CURRENT) ELECTRICITY

The treshold for feeling household (60 cycle-per-second) alternating
current, is between 0.5 and 2.0 milliamps (mA), depending on individual
sensitivity. This minimal current feels like a tingle and causes no
direct, but may startle someone into losing balance or dropping an
electrified object into a more dangerous position, for example, into
the bathtub.

A little more current can cause numbness (2 mA), pain (1-4 mA), and
muscle spasms (5 mA). Somewhere between 6-22 mA, these muscle con-
tractions are uncontrollable and the victim cannot let go of a grasped
object, often the electrical conductor. The fundamental reason this
happens is that voluntary muscles, like those in your hand, normally
contract in response to small electrical signals transmitted through
the nervous system; the hundred-times-stronger external electrical
signal totally overwhelms the nervous system's control.

Since other muscles also go into involuntary contractions from electrical
overstimulation, people will die from inability to breathe (tetanic
asphyxia) if a low current path goes through the respiratory muscles
(head-to-leg, arm-to-arm, or arm-to-opposite-leg).

Thus, not being able to let go of an electrical conductor may well make
such relatively small current more dangerous than a larger current that
knocks you away from the conductor. In one instance a 21 volt A.C.
microphone electrocuted a pastor who was waist-deep in a water-filled
concrete baptismal fountain. Death was attributed to drowning,as a
result of electrical paralysis.

However the most common reason for death from low-voltage (household)
alternating current is ventricular fibrillation. This is caused by
somewhat higher current, starting around 100 mA for one-tenth of a
second, which will induce the different parts of the heart to beat out
of synch with each other, as normal nerve conduction within  the heart
is disrupted.

A 2000 mA (2 amps) or greater jolt can make the heart, basically, stop
(cardiac standstill). However, it will often restart spontaneously when
the current stops. Thus, higher amperage current, which can cause the
heart to stop, will be less dangerous than lower amperage, which sets
off fibrillation.

Fifteen amps of current passing through the diaphragm (muscles below
the lungs) can paralyze breathing (respiratory arrest), but paralysis
also depends on the electrical path; lesser current through the head
may have the same effect ny knocking out the respiratory center in the
brainstem. In both cardiac standstill and respiratory arrest, CPR has
a good chance of maintaining circulation long enough for breathing and
heart function to restart.


HIGH-VOLTAGE A.C. ELECTRICITY

"High voltage" is arbitrarily defined as more than 1000 volts. Power
lines into houses are generally 220/240 volts A.C.; high-power lines
in residential and industrial areas are often at 7620 volts A.C.;
power lines from generating plants sometimes carry over 70000 volts
A.C.

In high-voltage shocks (for example, from high-voltage transmission
lines or lightning) death is most often due to respiratory paralysis,
and/or heart stoppage, while ventricular fibrillation is infrequent.

Most characteristic of high-voltage electrocution is the presence of
burns: 96 percent (89 in 93) of high-voltage deaths in one study had
visible burns (compared to 57 percent of deaths from electrocution due
to less than 1000 volts). In the survivors, burn are often the most 
severe injury, especially with A.C. current.

Sometimes the temperature exceeds the flash point of muscle, which then
ignites and burns, rather like a piece of meat over hot charcoal fire.
As you might suspect, such electric current through the skull is parti-
cularly gruesome. In some cases, the skull splits open, and the eyes
are blown out of their sockets by the steam pressure from the boiling
brain.

The tetanic contraction can be so severe that it is capable of causing
bones to break and muscles to tear from their attachment points in bones.
The upper arm bone is most frequently broken.

Despite the above, the actual cause of death in the majority of high-
voltage electrocutions is paralysis of the respiratory center of the
brainstem, which keeps you from breathing on your own, and results in
asphyxia.


DIRECT CURRENT

Direct Current (D.C.) electricity occurs naturally in lightning, static
electricity and electric eels; somewhat less naturally in batteries,
capacitators, electric trains, and other human artifacts. Direct current
is less dangerous than A.C. for two reasons: (1) It does not cause
multiple tetanic muscle contractions; thus one can let go of a D.C.-
energized wire (though the single jolt it does cause can result in
broken bones from the force of the contraction, injury from falls, burns
cardiac standstill, or respiratory arrest); (2) It is less likely than
A.C. to cause ventricular fibrillation. As a result, D.C. current of
less than 80 mA is claimed to have no harmful physiological effects.


SUICIDE BY ELECTROCUTION

1.

Climbing a high-voltage pylon or pole and grabbing a high-voltage wire.
Typical injuries include burns, heart and/or respiratory stoppage, and
injuries from the fall. The intitial jolt causes unconsciousness, and
death is highly likely.

A variation on this is sometimes used by people who don't like heights:
Rather than climbing, they wrap a wire around some part of their body
(often around a wrist, but in at least one case, around the neck) attach
a weight to the other end of the wire and toss the weight over a high-
voltage line, which is an uninsulated, bare wire. In this situation
there is no fall from a height, but the electrical contact is prolonged.

Bare feet and damp soil are helpful but generally not necessary. Enough
heat is generated to often amputate the wire-wrapped part of the body.
A thin wire is at risk of melting before you do, so it's important to
use the thickest one you can handle.

There are occasional reports of people being electrocuted as a result
of urinating onto high-voltage electric train rail, though these are
probably not deliberate suicides.

Despite its high lethality, people sometimes survive high-voltage suicide
attempts with nothing but third-degree burns and permanent injuries to
show for their troubles.

2.

A simple electrocution  method using household current is to remove the
insulation from the end of an extension cord, plug in the extension
cord, and grasp the two bare wires, one in each hand. Alternatively, one
can hold one wire and touch a grounded item (for example, an exposed
metal pipe) to complete the circuit, This requires the black (hot) wire
to be held - if a polarized plug is used and the wiring has been installed
correctly. Or, if the circuit/outlet has an on/off switch, one can wrap
the bare ends of the extension cord around two different limbs (no chance
of letting go) and flip the switch.

There are many other ways to do this,limited only by your imagination.
But don't leave an electrically live (albeit biologically dead) corpse
for someone to blunder onto; to avoid this, you should incorporate a
timer into the circuit. You should also leave a prominent sign telling
people not to touch anything before turning off main fuse or circuit
breaker.

It might seem that this sort of electrocution would be an option for a
terminally ill person in a hospital. However, if the circuit is protected
by a "ground fault circuit interruptor," as it should be, this will not
work. In addition, resuscitation equipment is generally nearby, making
electrocution more difficult.

3.

Dropping a 120 volt electric appliance into a bathtub containing water
(and you) should do the job, especially if you're also touching metal,
for example, a spigot or drain. Even if the device is turned off, the 
terminal of its attached electric cord is still "live." Estimate of the
current involved: 120 volts/1000 ohms equals 0.12 amps (120 mA), which
is not enough to trip a standard fuse or cicuit breaker; however, you
should try it first with an unoccupied tub. Once again, if the device
is plugged into a circuit with a GFCI, this will not work; but obviously,
one could plug into a non-GFCI circuit.

-------------------------------------------------------------------------------

GUNSHOT WOUNDS

LETHAL INTENT: High
MORTALITY: High, around 80 percent
PERMANENT INJURIES: Likely
PROS AND CONS OF GUNS AS A MEANS OF SUICIDE

Pros: -Usually fatal
      -Often fast
      -Generally easy to obtain firearms (in United States)

Cons: -Easy to act on impulse/no chance to reconsider
      -Survivors often  have severe and permanent injury
      -Sometimes gruesome cadavers
      -Less reliable than one might expect, due to bad aim, bullet
       deflecting from bone, or defective gun/ammunation


Shooting yourself is a generally effective - 72 to 92 percent mortality
rates are reported - but frequently messy method of suicide. About 60
percent of the suicide in the United States are by means of gunshot;
four out of five of these are head injuries. Suicidal gun wounds to the
head tend to be quickly fatal: 70 to 90 percent of people with such
injuries die before getting to a hospital, but there is a 3 to 9 percent
survival rate, and these people often have brain damage or disfiguring
injuries. Wounds to other parts of the body are less likely to be lethal.
Gunshot is a method that can be, and all too often is, used impulsively,
as it doesn't require much planning or allow time to reflect on other
possibilities.


RESULTS: HOW AND WHY ARE GUNSHOT WOUNDS FATAL?

Obviously, gunshots can cause severe tissue and organ damage. Death,
when it occurs, usually results from loss of blood leading to irrever-
sible shock, or from injury to a vital organ(s), such as the brain or
heart.


SURVIVAL TIME AND MOBILITY AFTER INJURY

In most cases of fatal (nonfatal wounds will be discussed in the next
section) gunshot wounds to the head or heart, collapse is rapid but
death may not be. In one study of fatal brain gunshots, 98 percent of
victims found alive maintained vital functions (heartbeat, blood pressure,
breathing) long enough to reach a hospital and be evaluated.

In one case a Finnish man committed pistolshot-to-head suicide - in 
front of a movie camera he had set up. There was immediate collapse, but
just before the four-minute film ran out, he opened his eyes and raised
his head; how long he survived and his capabilities before dying are
unknown.

Specific regions of the brain control particular functions. For example,
the brain stem, at the base of the skull, is responsible for maintaining,
among other things, breathing, while the cerebral cortex, just behind
the forehead, is the seat of intellectual abilities. Thus, someone with
a wound that is limited to the cerebral cortex may well remain mobile
(and sometimes even coherent) for minutes or hours. Similarly, a bullet
that travels from temple to temple may miss the brain entirely, passing
beneath it, possibly cutting the optic nerves and causing blindness,
without producing immediate collapse. On the other hand, a shot to the
brain stem is quickly fatal.

"One-shot" targets are those where a bullet wound is instantaneously
incapacitating and quickly fatal. These are: brain stem, basal ganglia,
medulla oblongata, and spinal column in the neck.

"Rapidly fatal" targets allow ten to fifteen seconds of voluntary action
after a gunshot wound. These are the heart and the large blood vessel
above it, the aorta. Injury to other organs, though often lethal, allows
more time before incapacitation.

A gunshot to the front of the head may fall into any of these categories,
depending on the bullet's angle and how far it penetrates. Large caliber
and high-velocity bullets are most likely to be immediately disabling,
but there are no guarantees.


NONFATAL GUNSHOTS TO THE HEAD

Not all gunshot wounds to the head  are equally dangerous. Since the
"old" or "primitive" parts of the brain are responsible for maintaining
and regulating basic functions like breathing and temperature, injury
to these areas tends to be quickly fatal. It's not a coincidence that
many executions are carried out by a single shot to the base of the
skull. This part of the brain is located at the lower back of the head,
near where the spinal column meets the skull. Shots into the base of 
the skull damage this tissue (brainstem), as do shots straight through
the mouth from front to back.

Shots to the front of the head may cause unexpected problems:
The cerebral cortex, directly behind the forehead doesn't control any
vital functions, so injury there is not directly life-threatening, but
may well result in intellectual and personality deficits.

Firing a gun, especially a shotgun or rifle, with the muzzle under the
chin or aimed at the face, is somewhat less likely to be fatal than one
might expect. Apparently, people tend to flinch or tilt their head back
at the moment they pull the trigger, changing the direction of bullet
entrance and decreasing the chance of fatal brain damage while increasing
that of massive facial injury. This is generally not a problem when the
muzzle is in the mouth: Using 12-gauge shotguns in this manner caused
the head to burst open in 74 percent of cases; only 9 percent of such
wounds with a 20-gauge shotgun resulted in similar injury. Shotgun
wounds from a .410 were similar to 20-gauge; 16-gauge was in beween
12- and 20-gauge in its ability to rupture heads.


OUTCOMES OF NONFATAL WOUNDS TO THE HEAD

These are some of the most disfiguring of injuries. Quoting from a
typical case report:

This twenty-year-old man attempted suicide with a 12-gauge shotgun that
was placed under his chin and directed to the left side. He sustained
a large soft tissue loss [part of his face was blown off], facial nerve
injury, loss of vision, and mulitple fractures of the mandible [lower
jawbone], maxilla [upper jaw], nose, zygoma [cheekbone], and orbit [eye
socket]. The patient was treated with tracheostomy [breathing hole in
neck], wound debridement [dead tissue removal], and a neck flap.

Mandibular reconstruction with hip graft was complicated by osteomyelitis
[bone infection] and a nonunion [bones didn't join]. Two years later he
was referred for treatment of a severe facial deformity, facial paralysis,
depressed malar eminence [collapsed cheekbone], nonunion, and ankylosis
[inability of a joint to function] of the mandible. Inferior rectus
entrapment, [eyeball muscle stuck in the wrong place] visual loss, and
lacrymal disfunction [inability to produce enough tears to keep the eye
moist] were also present.


WEAPONS: WHAT TYPE OF GUN SHOULD YOU CHOOSE?

Not all firearms are equally lethal. Lethality depends on several
physical factors: (1) Speed of the bullet (we will include shotgun
pellets under the term "bullet"); (2) weight of the bullet; (3) type
of bullet; (4) size of the gun. In general, the order of most to least
lethal weapons in contact wounds is:

1. shotgun
2. high-velocity rifle
3. large or high-powered handgun (.45 caliber or .357 magnum)
4. small caliber (.22) rifle
5. small caliber (.22) handgun


MASS OF BULLET

Since doubling the mass of the bullet doubles its energy at any given
speed, a .45 caliber which has about twice the diameter of a .22 caliber
ought to pack four times the energy (volume of a cylinder is proportional
to the square of the diameter) if all else (velocity of bullet) were
equal. This is one of the reasons that lead is used for bullets: It
weighs about 1.5 times as much as does the same volume of steel. Also,
since lead is quite soft (you can scratch pure lead with a fingernail),
it does minimum mechanical damage to the bore of the gun, though it may
clof rifling grooves.


SPEED OF BULLET

The speed of sound is about 1100 feet (340 meters) per second (fps).
The muzzle velocity of high-velocity rifles is aroud 2400 to 4000 fps
(730 to 1200 meters); handguns are mostly 350 to 1500 fps (100 to 460
meters).

Low-velocity (less than speed of sound) bullets crush or push aside
tissue; the wound track is not much wider than the bullet (unless it
mushrooms or tumbles). High-velocity bullets are used in military-type
rifles and some semi-automatic pistols and have a lead core surrounded
by a harder copper-alloy jacket. They are desgined to not jam automatic
loading mechanisms common in military weapons, and to survive rough
field conditions; on striking a body, they are less likely than lead
to flatten and more likely to drill a clean hole. Quite sporting.

However, if jacketed bullets hit bone or develop a wobble while going
through flesh, they can cause extensive damage along the wound track.
High-speed bullets send a shock wave of compression ahead of the lacer-
ation track. This can tear and even shatter organs, both nearby and,
(transmitted through liquid, of which we are mostly composed) distant
ones.

High-velocity bullets also cause "cavitation." The bullet accelerates
tissue radially away from the wound track at a high rate of speed. This
generates a temporary cavity that can be much larger then the diameter
of the bullet. The resulting near-vacuum also sucks clothing fibers and
other sources of infection into the wound.

If a bullet exits the body at high speed, it has not transfered maximum
destructive energy. Thus, various attempts have been made to prevent the
bullet from leaving. Without going into the fine points, these methods
include:

1.

using a hollowed out bullet tip, which tends to mushroom upon hitting
tissue, and thus slows down;

2.

using a tip that is softer than the body or jacket of the bullet;

3.

using so-called "dum-dum" bullets with deformed tips, again intended
to cause mushrooming;

4.

using multiple small bullets, as with a non-rifled shotgun;

5.

using explosive-tipped bullets, which are supposed to detonate on
contact. Like mushrooming bullets, they were banned by the Hague
Convention of 1899.

-------------------------------------------------------------------------------


HANGING AND STRANGULATION

Hanging and strangulation are effective methods of suicide. Both can
be carried out by people with limited physical abilities. Hanging
doesn't require complete suspension. Death occurs within about five
to ten minutes after cutoff of oxygen or blockage of blood flow to
the brain (anoxia); however, convulsions are common and the noise may
attract attention. Pain can be minimized by protecting and padding
the front of the neck. Since finding the body will probably be
traumatic, care should be given to choosing a location. These are
highly lethal methods and cannot be done safely as a suicidal gesture.


LETHAL INTENT: High
MORTALITY: High, around 80 percent
PERMANENT INJURIES IN SURVIVORS: Moderately frequent
PROS AND CONS OF HANGING AS A MEANS OF SUICIDE

Pros: -Quick unconsciousness
      -Fairly quick death
      -Easily accomplished with materials found around the house
      -Can, if necessary, be done without leaving bed

Cons: -Possibility of brain damage if interrupted
      -Sometimes a gruesome cadaver, which may be upsetting for
       whoever discovers the body


Suspension hanging is often lumped (and confused) with judicial-type
("drop") hanging, suffocation, strangulation, and even choking. This
is entirely understandable, since the subject is confusing, but there
are some important, and sometime critical, differences between them.
Brief definitions of these terms may be helpful im making sense of 
what follows.


1. SUSPENSION HANGING

suspension by the neck, with little or no drop. Death is due to
compression of the airway (trachea, or windpipe) and/or the major
blood vessels connecting the heart and the brain. These latter are
the carotid and vertebral arteries, and the jugular vein. We will use
"hanging" to mean "suspension hanging" unless otherwise specified.


2. JUDICIAL-TYPE (DROP) HANGING

a several foot drop, with rope attached to the neck. If everything goes
right, death is due to a broken neck. While this is quicker than
suspension hanging, it may or may not be less traumatic.


3. STRANGULATION

manual compression of the airway and/or blood vessels to/from the
brain. In suicide, this generally requires a ligature (rope, wire,
cloth, etc.). In homicide, there may be a ligature or there may be
direct pressure from hands or forearm on the neck.


4. CHOKING

blockage of the airway by mechanical obstruction, for  example, a lump
of food.


5. SUFFOCATION OR ASPHYXATION

interference with the ability to take in or use oxygen; related to
choking, suspension hanging, and strangulation, in that oxygen is
prevented from reaching the brain in each case; however, there is no
direct pressure on the airway in suffocation or asphyxation. Examples
are, use of a plastic bag or carbon monoxide (see Asphyxia chapter).


PHYSIOLOGY: WHAT IS HANGING, AND HOW DOES IT KILL?

Hanging can kill by four distinct mechanisms: compression of the
carotid arteries, compression of the jugular veins, compression of
the airway (trachea), and breaking the neck. The first three can
result from suspension hanging; the last from drop hanging.


CAROTID ARTERY

On the right side of your neck, just under the side of the jaw, is
your carotid artery. Put your fingers there and gently feel your 
pulse. It should be quite strong. (If you can't find one, either
you're looking in the wrong place or you don't need this book.) The
carotid artery carries much of the blood to your brain, which uses
around 15 percent of the entire blood supply of your body. Anything
which interrupts that blod-flow for more than a few seconds will cause
loss of consciousness.


JUGULAR VEIN

On the other side of the neck, under the left side of the jaw is the
jugular vein, which carries "used" blood back to the heart. If the
jugular is blocked, blood backs up, much like water in a stream that 
has been dammed. The carotid and jugular can be compressed with just
a few pounds pressure; a moderately tightened rope will do nicely.
Death occurs within a few minutes. There does not need to be any
pressure on the airway (trachea, or windpipe), though there often is.


TRACHEA/AIRWAY

The airway, down the front-center of your neck, can be blocked
internally, (by inhaling a foreign object) or externally (by a
ligature). When the interference is internal, it is termed "choking"
In either case, obstruction of the airway takes a good deal longer
to produce unconsciousness than does carotid pressure, and is much
more painful. (Details are in the Asphyxia chapter.)


HANGING

Judicial (drop) hanging is quite a different kettle of worms from
supsension hanging. In a (properly done) judicial-type hanging, the
victim falls several feet before coming to an abrupt halt at the end
of a rope. Often, thisis the bitter end. Such a precipitous change in
velocity is supposed to cause a broken nekc and quick  unconsciousness
and death. However, exhumation of judicial hanging victims has shown
that a broken neck was frequently not the cause of death. An excessively
long drop can result in separation of head from body, and is considered
bad form by professional hangmen.

Suspension hanging can cause compression of the carotid, jugular, and/
or airway, depending on how it is carried out.

There are similarities between suspension-hanging and choking, as well
as previously mentioned differences. Your blood carries oxygen and 
nutrients to your brain. Enough pressure on the airway compresses it
and prevents oxygen from reaching the lungs. Your body has build-in
reflexes to keep this from happening: pressure against your trachea
causes quick pain, and you have irresistible urge to back away and cough;
one reflex (pain) gets your attention and moves you away from the
stimulus - say someone's thumbs - and the other reflex (cough) attempts
to clear the airway. If these attempts are unsuccesful, blood will
continue to be pumped to the brain (and elsewhere) by your heart, but
it won't carry enough oxygen and you will lose consciousness in a
couple of minutes.


TIME TO DEATH

As asphyxia proceeds, first temporary, then permanent brain damage from
lack of oxygen will occur. Death follows in five to ten minutes (ten to
twenty minutes, according to Polson; however, his number seems to be 
based on the fact that the heart may continue beating for up to twenty
minutes after judicial hanging, and ignores that the heart may continue
to beat after brain death. While human data are lacking, unanesthetized
dogs die after around eight minutes of asphyxia). On the other hand, it's
also true that unconsciousness and death will be delayed if blood flow
to/from the head in only partially obstructed, as is sometimes the case.


CAROTID REFLEXES

Curiously, you don't have the same protective reflexes along the carotid
artery, so that pressure sufficient to block the artery doesn't elicit
much in the way of defensive reaction. In fact, one of the reflexes that
is present may be counterproductive: Near where the carotids divide are
some nerve cells, the "carotid sinus". These nerve cells have the
normally useful function of maintaining blood pressure at a steady level.
They respond to a decrease in blood pressure (for example, when you stand
up) by constricting arteries and telling the heart to beat harder.

Without this, you might pass out every time you stood up suddenly, because
not enough blood was reaching your brain. (The dizziness many people feel
when they stand up suddenly is another way of appreciating how quickly
and exquisitely sensitive your brain is to absence of enough blood.)
Similary, the carotid sinus responds to an increase in blood pressure
by relaxing the arteries and inhibiting the heart.

So far, so good. The problem arises because these pressure-recpetor nerves
aren't smart enough to tell the difference between blood pressure and
externally applied pressure - for example a forearm or billy club across
the right-front side of the neck.


"SLEEPER" HOLD

Those of you who are wrestling (TV variety) fans are probably familiar
with the sleeper hold; it is nothing more than a forearm pushed against
the carotid artery, compressing it, and cutting off blood flow to the
brain (see Asphyxia chapter). This causes unconsciousness in about eight
to fifteen seconds.

The sleeper hold is forbidden in tournament wrestling and is faked in the
TV stuff. The reason is that the amount of pressure needed to compress
the artery is enough to cause the carotid sinus to kick into overdrive
and sned the heart a priority message to slow down, which is sometimes
enough to stop the heart altogether.


PRESSURE NEEDED TO COMPRESS THE CAROTID, JUGULAR, AIRWAY

carotid = 7 lb (3.2 kg) - 11 lb (5 kg)
jugular = 4.5 lb (2 kg)
airway  = 33 lb (15 kg)
vertebral = 66 lb (30 kg)

What this means, practically speaking, is that someone who wants - or
wants to avoid - a lethal result should be aware that full suspension
is quite unneccessary. Death will occur after only a few pounds of
pressure on a neck ligature; a sitting or semireclining position is
sufficient.


SUSPENSION HANGING

Hanging does not have a very good image. For example: "The discovery of
a grotesquely hanging corpse whose swollen, sometimes bitten tongue
protrudes from a bloated blue-gray face with hideously bulging eyes is
a nightmarish sight upon which only the most hardened can gaze without
revulsion." However, while some look livid, about 60 percent of hangers
have a "pale an placid" face. Some have small hemorrhages, caused by
capillaries leaking (due to high blood pressure in the abscence of
oxygen), on the face, eyelids, and/or scalp; others don't.

What accounts for these differences? Basically, it's a question of how
quickly and totally the ligature cuts off blood circulation to and from
the head. If suspension is fast and complete, the blood supply both to
and from the head will be cut off simultaneously, so there is no excess
blood or blood pressure in the head, and thus a more or less normal-
colored corpse. Similary, activation of the carotid sinus pressure
receptor would cause a decrease in blood flow to the head, leading to
paleness in the cadaver.

If, on the other hand, the pressure on the neck gradually increased as
consciousness was lost, it's probable that the jugular vein was shut
off before the carotid artery (and almost certainly before the hard-to-
clamp vertebral arteries), since it requires less pressure to do so.
Thus, in this case blood would continue flowing into the head while
having no way to leave it; hence engorgement and blue/purple color.

This is most likely when the suicide is in a sitting or lying position,
because there is less (and less sudden) pressure on the neck than when
completely suspended.


PLACEMENT OF THE LIGATURE

An additional variable is the placement of the ligature. The least
pressure corresponds to the location of the knot in the rope, since
that point is pulled up and away from the neck. Depending on the knot's
site, it is thus possible to miss the jugular (if the knot's on the
left), carotid (knot on right), or trachea (knot along the centerline
of the face).

Further complications arise because the noose can be placed high or low
on the neck, with potentially different intermediate results. When high,
it is less likely to compress the airway because some of the pressure
from the ligature may be transferred to the jaw or skull.


DO PEOPLE DIE FROM AIRWAY BLOCKAGE OR FROM CUT-OFF BLOOD CIRCULATION
TO THE BRAIN?

Bodies with little weight on the ligature, that is, which are prone or
seated, have a greater chance of death from asphyxia, according to a
standard forensic text. Since the jugular vein (blood out) is easier
to compress than the carotid artery (blood in), enough blood accu-
mulates in the head and neck to compress the airway, leading to
asphyxia.

Medical experts disagree about the frequency and importance of airway
blockage in hangings. For example, one says, "Occlusion of the air
passage by constriction on the neck is probably extremely rare if
existing at all. Others hedge their bets: "Suicidal hanging is ear-
marked characteristically as causing death by compression of the
anatomic airway and the blood vessels in the neck." Or cover all the
bases: "Reports in the forensic literature have stated that death may
be due to either asphyxiation, coma, carotid artery or jugular vein
injury, or any combination of the above." Certainly, airway blockage
is not essential to successful hanging. In one case a woman with a
tracheotomy killed herself despite attaching the ligature above the
site of the breathing hole. She would have continued breathing until
dying from lack of blood to her brain.
Airway blockage is more likely when:

1.

the ligature knot is toward the back of the neck. In this situation
the maximum pressure from the rope is then on the front of the neck,
where the airway is.

2.

the person is seated, semireclining, or prone. Due to little weight
on it, the rope tends not to slide up the neck. Were it to move up,
it would end up being partially supported by the chin, relieving
pressure on the airway.

3.

the ligature is thin or attached with a running noose. Such a ligature
tends to clamp in place.

4.

the ligature is placed low on the neck, where it tends not to slide
up high enough to be supported by the chin.


TYPE OF KNOT

Most common are the running noose (loop at one end, through which the
other end is pulled) and the fixed noose with a granny or reef knot.


POINT OF SUSPENSION

As with their indiscriminate choice of ligatures, suicidal people
suspend themselves from whatever site is handy. Stair rails are
popular, as is tying one end of the ligature to a doorknob and
tossing the other end over the top of the door. Hooks and nails are
useable, but may bend or pull out if not sturdy and firmly attached.
Often a chair that the victim stood on is nearby, but total suspension
is quite unnecessary; a majority of such suicides have their feet
touching the ground.


POSITION OF THE BODY

In one study, 37 percent (30 in 80) of hanging victims were completely
suspended; 63 percent (50 in 80) were in contact with the ground. This
is credible, since all it takes to carry out a standing hang is to bend
the knees enough to tighten the ligature. In 261 cases of incomplete
suspension, 64 percent (168) had both feed touching the ground, 16 
percent (42) were on their knees, 11 percent (29) were lying down, 7
percent (19) were sitting, and 1 percent (3) were huddled or squatting.


STRANGULATION

is defined as pressure applied to the neck without suspension of the
victim. It is uncommon in suicide, but not unknown. The physiology of
strangulation is essentially the same as that of suspension hanging
and needs  not to be treated separately. In self-strangulation, the 
ligature is applied more slowly and less tightly than in suspension
hanging. As a result, the jugular veins are more constricted than are
the carotid arteries, leading to a blue, swollen head. Neck injuries,
however, are rare. Because the ligature cannot slide up the neck or
be supported by the chin, compression of the airway is more likely than
in suspension hanging.


CONSEQUENCES: WHAT ARE THE EFFECTS OF HANGING?

There is not much information from survivors for two reasons: (1) There
are not many survivors, and (2) often, survivors have more or less
complete amnesia. In one case, a woman tried to hang herself from the 
foot of her bed, while in jail. She was saved by a fellow prisoner. She
later mentioned having had severe pain, followed by unconsciousness.
In another instance a public entertainer, who hung himself briefly as
part of his act, made a mistake of timing. He said (afterwards) that he
could not breathe - quite understandable, under the circumstances - and
felt as if a heavy weight was on his feet. He lost consciousness before
he could move his hands to release himself.

There is additional information from experimental hanging. In one description
the subject mentioned flashes of heat and light, and deafening sound.
Legs were numb and weak. Pain was not severe and unconsciousness was
sudden.

More detailed information came from another self-experimenter named
Minovici. With 5 kg (11 lb) pull on the ligature, loss of consciousness
was rapid. When he leaned on the rope (incomplete suspension), within five
or six seconds his eyes blurred, he heard whistling, and his face turned
red-violet. With the knot on the side instead of the back of the neck,
these effects took eight or nine seconds to appear.

When he tried complete suspension, as soon as he left the ground, he couldn't
breathe or hear his assistant. He experienced such severe pain that he 
immediately stopped the test. Within ten minutes, many small hemorrhages
could be seen near the site of the rope; these remained visible for eight
to eleven days. For ten to twelve days later he had watering eyes,
trouble swallowing, and a sore throat.

After unconsciousness, convulsions follow. In trashing around, the victim
may make enough noise to attract attention, wanted or unwanted.


HOW TO DO IT, SUSPENSION HANGING

(1) Can be done with a wide range of ligature materials - most anything
will work; (2) can be carried out by invalids, without leaving their room;
(3) is  fairly quick, probably not painless (but unconsciousness is rapid),
but may have severe consequences - brain damage - if interrupted;
(4) doesn't require much knowledge to accomplish.

To carry out a suspension hanging, you can simply tie one end of the ligature
to a fixed point (doorknob, hook, rafter, etc.) and the other end to your
neck. You can and should protect the airway from unnecessary compression and
pain by firmly padding the front quarter of the neck and (more important) by
placing the knot high and at the front of your face.

Complete suspension is unnecessary and is generally more painful than partial
suspension; however, standing on and kicking away a chair is sometimes done
in the same spirit as diving, rather than wading, into icy water.
Unconsciousness occurs quickly and without enough warning to count on time
to change your mind: This is a lethal method and is not suitable for a
"suicidal gesture."

You need an uninterrupted twenty minutes (half an hour to take into account
last-minute vicissitudes) to be sure that you won't be cut down and "saved"
with permanent brain damage. Since you may trash around while unconscious,
take into account the possibility of attracting unwanted intervention because
of the noise. Because the cadaver is sometimes gruesome and always shocking,
consider not hanging yourself where loved ones will find the body. If you use
a hotel or motel, leave a good tip for the cleaning person.


HOW TO DO IT, DROP HANGING

(1) Requires a strong, low-stretch rope. Manila (sisal) or hemp works;

(2) Requires a 5 to 15 foot drop (see drop table or calculations);

(3) is quick, possibly painless - nobody knows, and none of the 
questionaires have been returned - and generally cannot be interrupted
once set into motion; (4) requires detailed knowledge of how and where to
attach rope, how and how far to jump (down, but not out), and a place to
jump from. To execute a drop hanging, the drop distance can be estimated
as follows,

      drop in feet = 1260 / your weight in pounds

The type of knot is not important as long as it doesn't loosen. However,
its position is, unlike in suspension hanging, critcal, The knot should be
as near the chin as convenient, and in any case no further back than the
cheekbone. Note which way the knot rotates when pulled up, and adjust it to
the side of your head so that it will rotate toward the chin and snap the
head backwards. If it ends up behind the ear, it will be much less likely
to produce a cleanly broken neck, and may leave you to strangle unpleasantly.
The drop should ne as close to straight down as possible; don't take a 
running jump.

The rope should be at least an inch thick and must not be one intended to
stretch in order to ease a fall, for example moutain-climbing rope. Attach
the other end to something that won't break or come loose.
This method is harder to get the hang of than is suspension, and is not
recommended unless you're confident that you fully understand it. Mistakes
usually transpose into some unpleasant form of suspension hanging, unless
the rope breaks.


HOW TO DO IT, STRANGULATION

If, for some reason, there is no attachment point available for a ligature,
strangulation is a possibility. This method consists of wrapping a cord
around your neck and tightening it. The disadvantages are: (a) Depending on
the amount of tension applied, it may compress your airway as well as the
major blood vessels (carotid and/or jugular) unless you protect the front
of the neck; (b) since there is no weight on the ligature, it may loosen
when you become unconscious. Some methods to solve this latter problem
are:

-use a high-friction ligature that will stay in place;
-use a double knot;
-wrap thin cord, as many times as possible in five to ten seconds, around
your neck, relying on friction to maintain the tension. A slip knot is
helpful, but may loosen unless wrapped;
-make a loose loop around your neck. Insert a thin, rigid item, for example,
a wooden spoon or pen, between the neck and the loop, and twist the rod
until it tightens the ligature; then tuck the end of the rod between the
neck and the cord to keep it in place. If you use a bar that is around
8 inches (20 cm) long, there is a good chance that it will stay in place
under your chin even if not tucked in.

The most reliable of these methods is to buy a racheting "tie down." These
are available at auto, motorcycle, and some hardware stores for between
$5 and $10 and are generally used for attaching cargo. Once tight, a
spring-loaded cam release (or equivalent) must be pressed to remove tension.
Bending forward increases the diameter of the neck , and thus the
constrictive effect of the ligature.

-------------------------------------------------------------------------------

HYPOTHERMIA

Hypothermia. (hypo, low; thermia, temperature) is an effective, but
infrequent used suicide method. It is a poor choice for a suicidal
gesture, unless one is sure of timely intervention.


FATALITY RATE: More than 30 percent
PERMANENT INJURIES: Moderately likely
PROS AND CONS OF HYPOTHERMIA FOR SUICIDE

Pros: -Not severly painful
      -Often lethal in the absence of intervention
      -Requires no special equipment and minimal knowledge
      -Usually some time to change your mind, without ill effects

Cons: -Rate of hypothermia highly variable: dependent on one's
       physical fitness and body fat content as well as on temperature
       and weather conditions
      -Sometimes severe injury in survivors
      -Requires temperatures that are seasonally and geographically
       limited
      -May take a long time
      -Victims may be revivable even several hours after clinical death
      -Insidious: people often don't notice signs of hypothermia in
       themselves


WHAT IS HYPOTHERMIA?

The freezing point of water, under standard conditions, is 32 degrees F
(0 degrees C) and its boiling point is 212 degrees F (100 degrees C).
Normal human body temperature is around 98.6 degrees F (37 degrees C)
and is tightly regulated by a variety of physiological mechanisms. Even
a 3.6 degrees F (2 degrees C) change is significant; a 5.4 degrees F
(3 degrees C) fever is medical emergency.

Systematic hypothermia is generally defined as a body temperature below
95 degrees F (35 degrees C). Severity is rated by how low the core body
temperature falls: 89.6 to 95 degrees F (32-35 degrees C) is mild hypo-
thermia; 80.6 to 89.6 degrees F (27-32 degrees C) is moderate; below
80.6 degrees F (27 degrees C) is severe.

Hypothermia is also divided into "acute" and "chronic" categories. Acute
hypothermia occurs quickly, roughly within two or three hours; chronic
hypothermia takes longer. While the boundary is fuzzy, the distinction
is more than academic, since both treatment and prognosis differ between
the two.


WHAT CAUSES HYPOTHERMIA?

Hypothermia occurs when the quantity of body heat lost to the external
environment substantially exceeds the heat generated from metabolism.
This can be caused by a decrease in heat production, or in an increase
in heat loss, or both.


HEAT PRODUCTION

Low heat production is usually due to insufficient food, illness, injury,
or some drugs.

An average resting body gives off about 50 kilocalories (kcal) or "kitchen"
calories - the same calories you see on food labels - of heat per square
meter of skin per hour. Multiplied by the average person's 1.7 square
meters of skin and 24 hours, you lose around 2000 kcal per day to the out-
side world, which is about the amount that you generate at rest from the
food that you've eaten. This is called "basal metabolism."

If your muscles are working, metabolic heat production goes way up. For
example, while you're shivering, you generate roughly five time as much
heat as when sitting quietly; while exercising, ten times as much.
However, exercise is a two-edged sword in hypothermia. While it produces
heat. which is needed to keep body and mind functioning, it also increases
blood flow to your active muscles, ant thus heat loss from them. In addition,
it uses up energy stores quickly. The decision whether to exercise in a
potentially hypothermic situation depends on the circumstances: How long
the conditions are expected to last, availability of food and shelter, and
need for clear thinking.

To some degree there is no choice in the matter: shivering is a form of
involuntary exercise. It increases heat production by 200 to 700 percent,
but is accompanied by an increase in blood flow to/from muscles, resulting
in about a 25 percent increase in heat loss, too. Shivering is an effective
means of generating heat, until  muscles run low on energy.


HEAT LOSS

Excessive heat loss is due to cold surroundings or to a failure in the body's
temperature regulating mechanism. There are four physical mechanisms of heat
loss:

1. Convection:

heat loss by means of molecular transfer of energy via air or water currents.

2. Conduction:

heat loss by touching something that's colder tha you are. This is,
fundamentally the same process as convection, but mostly applies to solids.

3. Radiation:

heat loss from invisible infrared-wavelength energy you give off.

4. Evaporation:

heat loss from the cooling effect of changing a liquid into a gas.


Looking at these in more detail:


CONVECTION AND CONDUCTION

Most heat loss in hypothermia is from contact with cold air or cold water:
You're always generating a micro-environment of warm air (or water, if that's
where you are) around your body., but this is easily stripped away by air/
water currents or your own movements.

The rate of convective heat loss also depends on the density of the moving
substance (heat loss in water is much faster than  in air of the same
temperature) and the velocity of the moving substance (the faster the air/
water current, the faster the heat exchange).

Another variable in heat loss is surface area. The more surface are, the more
heat transfer. Curling up in the fetal positon minimizes heat exchange by
minimizing surface area, and thus evaporation, radiation, and convection.
It may also be comforting for atavistic reasons.


WIND

Wind speed is the cause of the often-misunderstood "wind-chill factor."
"Wind chill" is just a practical demonstration of air convection and involves
nothing more complicated than wind removing the warmed (by you) air molecules
from near your body and replacing them with cold ones. This results in your
body being hit by more cold air molecules per minute, and so being cooled
more. For example, 0 degrees F (-18 degrees C) with no wind causes heat loss
at the same rate as 30 degrees F (-1 degrees C) and 25 mph (40 kmh) breeze.
However, the latter case would not drop below 30 degrees F (-1 degrees C),
in the absence of evaporative effects.


EVAPORATION

A second consideration, which is not technically part of wind-chill factor
calculations but is biologically important, is that more wind will cause
faster evaporation of sweat. This will remove from your body around two
and a half kilocalories per teaspoon of evaporated sweat, and thus
additional cooling.

Evaporation cools you because energy (heat) is always required to change
a liquid into a gas. If the liquid is on or near your skin (sweat, water,
or wet clothing), the heat comes from you, leaving you cooler. This is
handy in the desert, but not so good if you're trying to keep from freezing.
Thus, a dry body will cool faster in the presence rather than in the absence
of wind ("wind-chill"), but it won't get below ambient temperature. A wet
body in the wind will cool both faster and furher, and may drop far below
ambient temperature.


CAUSE OF DEATH

Death  is generally from circulatory failure: The heart either goes into
ventricular fibrillation or slows down and stops altogether. In people
who have suvived the first couple of days after rescue, organ failure,
particulary of the pancreas, may lead to delayed death. A wide range of
oher organs also may show acute damage from cold, but these injuries,
while sometimes severe, are not usually fatal.


SIGNS AND SYMPTOMS OF HYPOTHERMIA

The following chart shows the body core temperature and corresponding
signs and symptoms.


99-97F (37-36C)
Normal temperature range, shivering may begin

97-95F (36-35C)
Cold sensation, goosebumps, unable to perform complex tasks with hands,
shivering mild to severe, skin numb

95-93F (35-34C)
Shivering intense, lack of muscle coordination becomes apparent, movements
slow and labored, stumbling pace, mild confusion, may appear alert,
uable to walk straight

93-90F (34-32C)
Violent shivering persists, difficulty speaking, sluggish thinking,
amnesia starts to appear and may be retrograde, gross muscle movements
sluggish, unable to use hands, stumbles frequently, difficulty speaking

90-86F (32-30C)
Shivering stops in chronic hypothermia, exposed skin blue or puffy,
muscle coordination very poor with inability to walk, confusion,
incoherent, irrational behavior, but may be able to maintain posture
and the appearance of awareness

86-82F (30-27.7C)
Muscles severely rigid, semiconscious, stupor, loss of awareness of
others, pulse and respiration slow, pupils can dilate

82-78F (27-25.5C)
Unconsciousness, heart beat and respiration erratic, pulse and heart
beat may be unobtainable, muscle tendon reflexes cease

78-75F (25-24C)
Pulmonary edema, failure of cardiac and respiratory centers, probable
death. Death may occur before this level


SOME RISK FACTORS: ALCOHOL, DRUGS, EXERCISE

The role of alcohol in hypothermia is controversial. On the one hand,
it predisposes to hypothermia by several mechanisms:

1.

It produces an increase in blood flow (and thus heat loss) near the skin
("cutaneous vasodilation"). Since the skin contains many temperature
receptors, drinking alcohol generates a sensation o f warmth, but this
comes at the expense of internal heat;

2.

Alcohol causes hypoglycemia (low blood sugar), which decreases the
body's ability to produce heat;

3.

As a central nervous system depressant, alcohol slows metabolism and
promotes sleepiness;

4.

And certainly alcohol impairs judgement, which may be critical under
adverse conditions.

Many hypothermia victims have blood alcohol concentrations (BAC)
ranging form 0.13 to 0.25 gm/100 ml blood. "Legally impaired" in most
of the United States is 0.08-0.10 gm/100 ml BAC. Since exercise also
increases blood flow to the skin, the combination of alcohol with
strenuous exercise would seem to cause maximum heat loss.

On the other hand, alcohol appears to protect the heart against
fibrillation (and has been used for that purpose during low-temperature
medical operations, at levels of 0.40 gm/100 ml blood.) Perhaps this
protective effect causes the observed higher survival rate in hype-
thermics who had been drinkin, compared to those who were sober.
In addition, alcohol protects limbs against frostbite (freezing) by
increasing the blood flow, but again, this is at expense of core
temperature.

Some other drugs that have central nervous system depressant effects
can also produce hypothermia, for example barbiturates opiates, and
the "major tranquilizer" chlorpromazine (Thorazin) and related compounds;
but also some nonsedatives like acetaminophen (Tylenol) and lithium
ion (used to treat manic-depressive behavior). These drugs interfere
with temperature regualtion at the hypothalamic regulatory center in
the brain, and may cause hypothermia even at room temperatures. Of 103
consecutive Intense Care Unit drug overdose admissions, twenty-seven
were hypothermic.


HOW LONG DO PEOPLE SURVIVE UNDER COLD STRESS?

In one recent study, eight of eleven people with deep hypothermia and
cardiac arrest were resuscitated. Five of the eleven had no heartbeat
and six had ventricular fibrillation. None were breathing and all were
clinically dead with wide, nonreactive pupils, and were supported by
external heart massage and ventilation (CPR). The average (mean) length
of exposure to the cold in the survivors was 4.4 hours, and average core
temperature was 72.5 degrees F (22.5 degrees C). All three of the
patients who died had also been asphyxiated (one in an avalanche, two
in drownings).


HOW TO DO IT, ON LAND

Make arrangements so you won't be looked for: for example, tell people
you're going away for a few days. Go to a cold, secluded spot where
you won't be seen. Drink alcohol and/or take sedatives. You can speed
up the process by removing clothing and/or getting wet. Obviously, the
ammount of time needed will also be very dependent on temperature and
wind conditions, and your size, weight, and fat content. These are too
many variables to make even rough time estimates.

Use of a home freezer has been recommended, but the air supply in such
freezers is so limited that asphyxia will occur long before hypothermia.
Commercial freezers are a possibility, but the risk of untimely discovery
must be considered.


HOW TO DO IT, IN WATER

Since heat loss in water is much faster than in air of the same
temperature, the amount of time that one is subject to being saved is
correspondingly diminished. The main concern will be to avoid being
seen, both to avoid unwanted rescue and to prevent risk to potential
rescuers. Depending on the temperature of the water and your physical
condition, fatal hypothermia can occur in as little as thirty minutes
or so; less after alcohol and/or sedatives. Be aware that unless the
water is very shallow (and even then if you end up facedown), you are
likely to actually die of drowning while insensible from cold, rather
than from hypothermia.

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JUMPING

LETHAL INTENT: High
FATALITIES: 40 to 60 percent
PERMANENT INJURIES: Frequent
PROS AND CONS OF JUMPING AS A SUICIDE METHOD

Pros: -Usually fatal, with a high enough jump site
      -Some contemplation time on the way down

Cons: -Can't do much about it once you're in the air
      -Not reliably lethal for jumps of less than 150 feet
      -High incidence of permanent injury
      -Risk for injuring others
      -Fear of heights is common


Jumps from higher than 150 feet (ten to twelve stories high) over
land and 250 feet over water are almost always fatal; however, most
suicide attempts are made from considerably lower heights. The
consequences of lower jumps are unpredictable. Permanent injuries,
including paralysis are common. Jumping is thus a particulary bad
choice for suicidal gesture. There is about a fifty-fifty chance of
surviving a one-story (12 foot) fall if you land on your head; three
to four stories if you land on your side; four to five stories if you
land on your feet.

The word "jumper" was apparently used in the Codebook of Federal
Security Agencies to describe someone attempting suicide by jumping
from a height. The term has commonly come to include accidental and
homicidal high falls, which is how we'll use it.
The two major questions a potential jumper might want answered are:

Is jumping a reliable way to kill yourself? The short answer is that
it's about 95 to 98 percent lethal if you fall more than 150 feet
(ten to twelve stories) over land - but sometimes a much shorter fall
is fatal (2.5 feet in one case).

What are the risks of long-term injury among those surviving a fall?
Short answer: quite high; more than half the survivors in one study
were either still hospitalized or permanently unable to work a year
after their jump.

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ORIGINAL TABLE OF CONTENTS

   Part I: Background

      Chapter 1: A Brief Overview of Suicide
      Chapter 2: History of Suicide
      Chapter 3: Three Ways to Study Suicide
      Chapter 4: Why People Attempt Suicide
      Chapter 5: Youth Suicide
      Chapter 6: Suicide in the Elderly and Other Groups
      Chapter 7: Some Frequently Asked Questions About Suicide
      Chapter 8: Is Suicide Appropriate? Is Intervention Appropriate? 

      Who Decides?

      Chapter 9: Assisted Suicide in Terminal Illness 
      Chapter 10: The Medical System in Terminal Illness
      Chapter 11: Pain Control and Hospice Care
      Chapter 12: Advance Directives: Living Will, Power of
   
      Attorney for Medical Decisions, and Do Not Resuscitate Orders

      Chapter 13: Some Practical Issues in Assisted Suicide
      Chapter 14: Euthanasia in the Netherlands
      Chapter 15: Euthanasia and Assisted Suicide in the United States
   
   Part II: SUICIDE METHODS
   
      Chapter 17: Asphyxia
      Chapter 18: Cutting and Stabbing
      Chapter 19: Drowning
      Chapter 20: Drugs, Chemicals, and Poisons
      Chapter 21: Electrocution
      Chapter 22: Gunshot Wounds
      Chapter 23: Hanging and Strangulation
      Chapter 24: Hypothermia
      Chapter 25: Jumping

   References, Suggested Reading, Afterward, Index

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