Citing anonymous law enforcement sources, the New York Post and TMZ.COM are reporting that convicted pedophile Jeffrey Epstein was found hanging in his Manhattan jail cell with a bedsheet wrapped around his neck and secured to the top of a bunk bed. According to the Post, Epstein, “who was 6 feet tall, apparently killed himself by kneeling toward the floor and strangling himself with the makeshift noose.”

TMZ.COM reports being told that “the bed sheets were tied to the top of a bunk bed and Epstein either hurled himself off the top bunk or had his feet to the ground and leaned forward to cut off his air supply.”

If true, does that prove that Epstein committed suicide by hanging or that he accidentally killed himself while engaging in autoerotic asphyxiation?  Or is it still possible that he was murdered?

Citing anonymous sources, the Washington Post reports that the autopsy of Epstein’s body by Barbara Sampson, New York’s Chief Medical Examiner, found that he had “sustained multiple breaks in his neck bones”.

According to the Washington Post  “Among the bones broken in Epstein’s neck was the hyoid bone, which in men is near the Adam’s apple. Such breaks can occur in those who hang themselves, particularly if they are older, according to forensics experts and studies on the subject. But they are more common in victims of homicide by strangulation, the experts said.”

Although the Medical Examiner completed the autopsy on Sunday, she has listed the cause of death as “pending”, meaning that her investigation is continuing.

So, what is the true significance of Epstein’s broken hyoid bone and what may we conclude at this point?

In Medicolegal Investigation of Death – Guidelines for the Application of Pathology to Crime Investigation (2d ed. 1980), Werner U. Spitz, M.D., Chief Medical Examiner of Wayne County (Detroit) Michigan, observes that  “[f]ractures of the larynx, including the hyoid bone and the thyroid and cricoid cartilages are frequently associated with manual strangulation. The hyoid bone is a horseshoe-shaped structure situated at the base of the tongue…The ends of the hyoid bone, also known as horns, and similar projections of the thyroid cartilage are the weak areas of these structures and consequently are more likely to fracture in cases of trauma. Strangulation is mostly responsible for these fractures, although fractures of the upper horns of the thyroid cartilage, particularly in an elderly individual with calcification of this cartilage, may sometimes occur as a result of a fall or forceful impact on the neck…The hyoid bone is well protected behind the mandible unless the head is extended. However, fracture of this bone as the result of a fall is sometimes seen.”

Further to this point, Dr. Spitz states that “the degree of calcification of the neck skeleton varies with age to the extent that in older individuals the hyoid bone and thyroid and cricoid cartilages become firm and unyielding. When pressure is applied to the neck of an elderly person, these structures break easily, much more easily than in a young individual. Consequently, the degree of calcification and fragility of the neck skeleton is (sic) of great significance and should be noted in autopsy reports of cases of manual strangulation.”

Dr. Spitz does not define “elderly” but other experts have opined that the referenced calcification can be complete by middle age. In other words, though apparently physically fit, Epstein, who was 66 years old, was past the age at which such calcification of the neck structures is complete. Of course, we won’t know the degree of calcification until the autopsy report is released.

In addition to the fractured hyoid, it is important to know if the autopsy showed other injuries associated with strangulation either by hand or application of the forearm (as in a choke hold). In that regard, the classic Legal Medicine and Toxicology by Gonzales, Vance and Halpern (1937) states that the “external marks on the neck vary. In a few cases the hand or the forearm does not leave visible external marks, even though the cartilages of the larynx are fractured. In other cases there is a profusion of indefinite abrasions and contusions on the neck and face, not characteristic of any particular type of violence. In many instances, however, striking and tell tale impressions are left on the front of the neck, generally in the form of small semilunar abrasions, or in the form of excoriations and scratches, presumably caused by the pressure of the thumb or the fingernails…These lesions occur laterally and at the level of the larynx, for the most part, but can occur anywhere on the front and sides of the neck and even on the back of the neck.

“Marks of violence are found often on the skin elsewhere on the body, as on the head, face, breast, arms and hands, and on the mucous membrane of the lips, mouth and tongue. When they occur, they usually indicate a struggle.”

Finally, the National Institutes of Health have republished a 2011 study appearing in Forensic Science International which analyzed the incidence of fractures of the neck structures in 206 cases of suicidal hanging. That study found that the incidence of fractured hyoid bones and thyroid cartilages increased with age and is significantly higher in male victims compared to female victims. It also found that the incidence of fractures varied significantly with the height, weight and body mass index of the victims and “did not vary significantly with the type of suspension (i.e. complete hanging with feet off the ground or incomplete hanging with body parts supporting the weight of the body) and the type of ligature (i.e. narrow vs wide). However, when taking the age of victims into account, a different picture was revealed: in individuals 40 years or more, victims with complete suspension of the body presented with a significantly higher incidence of fractures (63.2%) compared to victims with incomplete suspension (31.0%).”

Putting all of this together, Epstein’s neck fractures do not rule out that he died from hanging by tying his bedsheet to the top of his bunk bed, wrapping the rest of the bedsheet around his neck to form a noose and leaning into the noose with his feet on the floor. Moreover, unless there are signs of other injuries to his neck, face and elsewhere on his body indicating manual strangulation or a struggle, the likelihood of murder by manual compression of the neck is reduced.

In short, based on what is known so far, it appears that Epstein hung himself and the only question remaining is whether he intended to commit suicide or accidentally killed himself while engaging in autorerotic asphyxiation. Since the New York Post reports that “Epstein was confident he could fight the child sex trafficking charges against him and was in ‘great spirits’ just hours before his jailhouse death on Saturday morning” the probabilities indicate that, instead of suicide, he died the way he had lived: searching for the next mind blowing orgasm.

George Parry is a former federal and state prosecutor. He is a regular contributor to the Philadelphia Inquirer and blogs at knowledge is good.net. He may be reached by email at kignet1@gmail.com.