STRANGULATION 159 Fig. 51.—Throttling: Effusion of blood in the epiglottis, larynx and soft tissues. 1. Whether Death was caused by Strangulation,—No inference should be drawn simply from a ligature mark, for it may be indistinct or absent, if a soft ligature like silk is used, and may be produced by the application of a ligature to the neck even after death. A similar mark may be pro- duced by a collar or neck band xvorn loosely round the neck when it com- presses the tissues which are swollen and distended by putrefaction. The natural folds of the skin especi- ally of a stout person rarely produce marks on the neck which may look like those found after strangulation. Abrasions and finger marks may be produced on the neck by a person gasping for air in an intoxicated condition or in an epileptic or hyste- rical fit. *Jp***eome to the conclusion that death was due to strangulation It is necessary, therefore, to note the effects of violence in the underlying tissues in addition to the ligature mark or bruise marks caused by the fingers or by the foot, knee, etc., and other appearances of death from asphyxia. At the same time the possibility of other causes of death should be excluded. 2. Whether the Stem- gulatibiT" was Suicidal, Homicidal or Accidental. —Suicidal strangulation is not very common, though sometimes met with. Jfo,, thfisg cases some contrivance is always made to keep the ligature tight after insensibility , supervenes. IJiis is done by twisting a cord several times round the neck and then tying a knot, which is usually single and in front or at the side or back of the neck, by twisting a cord tightly by means of a stick, stone or some ,other solid roate- rial, or by tightening the Fig. 52.—Natural folds of the skin simulating ligature marks on the neck. (From a photograph lent kindly by Dr. H. S.