The question whether a case of strangulation is accidental, suicidal, or homicidal is very difficult to answer.
Accidental strangulation is rare. If the body has not been disturbed, there is usually no difficulty in arriving at a conclusion; but if disturbed a satisfactory conclusion may not be reached.
It is worthy of mention that the umbilical cord may be twisted around the neck of a new-born infant and may have caused strangulation; the mark may give the appearance of death by violence.
Suicidal strangulation is rare. The experiments of Fleischman (supra) suggest that one may commit suicide by compressing his throat with his fingers (see Case 48).
Where a ligature of any kind has been used it is important to notice the number and position of the knots. In a general way a single knot either in front or at the back of the neck might suggest suicide; more than one would suggest homicide. There are, however, exceptions.
Suicide has been committed by mere pressure of a cord fixed at both ends a short distance from the ground; by twisting a rope several times around the neck and then tying it (the coils may continue to compress even after death); by tightening the cord with a stick or other firm substance; by tightening the cords or knots by means of the hands or feet or some portion of the lower limbs; by the use of a woollen garter passed twice around the neck and secured in front by two simple knots, strongly tied one to another.
It is difficult to simulate suicide; requires great skill and premeditation on the part of a murderer. “The attitude of the body, the condition of the dress, the means of strangulation, the presence of marks of violence or of blood on the person of the deceased, on his clothes or the furniture of the room, or both, rope or ligature, are circumstances from which, if observed at the time, important medical inferences may be drawn.” The assassin either does too little or too much. Taylor[795] cites a number of cases of simulation.
Strangulation is generally HOMICIDAL. The marks of fingers or of a ligature on the neck suggest homicide. This is true even if the mark is slight; because infants and weakly persons may be strangled by the pressure of the hands on the throat. Even a strong man, suddenly assaulted, may lose his presence of mind and, with that, his power of resistance; with approaching insensibility his strength still further diminishes. This is true even if his assailant is the less powerful. It requires more address to place a ligature on the neck than to strangle with the hand.
A victim may be made insensible by drugs or blows and then strangled by a small amount of compression; or suffocation by gags and strangulation may both be attempted.
The importance of considering the position and number of the knots in a cord is mentioned under suicidal strangulation.