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Charing Cross Hospital and Westminster Medical School, London.
Self-strangulation by ligature is distinctly uncommon. It is distinct from self-suspension in cases of hanging, the latter being a far more common form of suicide. Self-strangulation must be separated from homicidal strangulation and from accidental sexual asphyxia. The ligature in suicidal strangulation may be knotted or tightened like a tourniquet. As the ligature is tightened the face and neck may become congested due to slow venous compression. Laryngeal fractures are rare and injuries are mild and often confined to the single ligature mark around the neck. The three cases discussed here were initially treated by the police as suspicious. Detailed examination of the scene and of the deceased person, along with investigation of the circumstances leading to the death, produced clear verdicts of suicide in all three cases.
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