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referred to by Metzger (Op. cit. p. 309), and another in Guy's Hosp. Rep.' 1851. There may be disease, such as paralysis or deformity in one or both of the arms, which may render it impossible for a person to tie a ligature around his own neck. The only caution here to be guarded against is that we do not push this doctrine of incapability too far. When there is a fixed resolution, many apparent impossibilities may be overcome by a person bent on suicide. The following case is instructive: -A middle-aged woman was brought into the Hôtel-Dieu, labouring under such a degree of mental excitement as almost to amount to insanity. Soon after her admission she destroyed herself by strangulation. The nurse, in going round the ward, saw her lying at the side of the bed with her head hanging out. Upon examination it was found that she was dead, and that there was a silk handkerchief around her neck. The handkerchief had been carried twice round the neck and then tied in front. The eyes and eyelids were strongly reddened and swollen. The marks of the ligature around the neck were deep, ecchymosed and partially excoriated: the brain, though a little congested, was healthy. The other organs presented no appearance calling for notice. (Ann. d'Hyg.' 1833, 2, 153.) It is worthy of remark that in this instance, in which there could be no doubt of suicidal strangulation, the deceased had lost four fingers of her right hand, so that this member had been from an early period of but little service to her; nevertheless she contrived to tie the cravat round her neck with great firmness and dexterity. It is easy to conceive that, had her body been found in a suspicious locality, a plausible opinion of homicidal strangulation might have been formed from the maimed condition of the hand. This case, then, will serve to convey a proper caution in drawing inferences as to acts which persons labouring under any corporeal infirmity are capable of performing when they make attempts on their own lives.

Although the cases just related show that suicidal strangulation may be effected under unexpected circumstances, yet in a case of murder by strangulation, it would not be easy to simulate suicide: it would at any rate require great skill and premeditated contrivance on the part of a murderer so to dispose the body of his victim, or to place it in such a relation to surrounding objects, as to render a suspicion of suicide even probable. Thus, if the cord or ligature should be found loose or detached, if the ecchymosis or mark in the neck should not accurately correspond to the points of greatest pressure,-if, moreover, the means of constriction were not evident when the body was first discovered and before it had been removed from its situation, there would be fair grounds for presuming that the act was homicidal. In cases in which strangulation has resulted from a compression of the windpipe by the fingers (throttling), and where there are fixed ecchymosed marks indicative of direct manual violence, we have the strongest presumptive evidence of murder; for neither accident nor suicide could be urged as affording a satisfactory explanation of their presence. For an instructive case of throttling of a new-born child, where the marks of a left hand were clearly recognizable on the neck, see ‘Ann. d'Hyg.' 1882, 7, p. 559.

Homicidal strangulation.-Strangulation occasionally comes before our Courts of law as a question of murder: and when a person has been tried upon a charge of this kind, the circumstances have been commonly so clear as to render the duty of a medical witness one of a simple nature. Difficulties, however, have occasionally arisen, as may be seen by reference to the cases of the Queen v. Taylor (York Lent Ass. 1842), the Queen v. Greek (Salisbury Lent Ass. 1842), the Queen v. Reynolds (C. C. C. Dec. 1842), the Queen v. Fowles (Stafford Lent Ass. 1841), and Reg. v. Jones (York Nov. Ass. 1882). In Reynolds' case it was left uncertain by the medical

evidence whether death was due to strangulation or malicious exposure to cold; and as the indictment only charged the former act, the prisoners were acquitted. For a full report of a case in which the question was whether the deceased had committed suicide by hanging, or had been strangled by her husband, the reader is referred to 'Cormack's Jour.' 1844, p. 344. The prisoner was acquitted on a verdict of 'not proven;' but there could be no medical doubt of his guilt. A case of alleged murder by strangulation (Commonwealth v. Flannagan) will be found reported in the 'Amer. Jour. of Med. Sci.' Oct. 1845, p. 389.

The body of a young woman was found lying upon the face, strangled, with a rope coiled three times round the lower part of her neck: the two inner coils (involving the windpipe) were tight, the outer coil loose, the end of the cord being placed loosely near the left hand of the deceased, which was raised towards it. The length of the free portion of cord was not sufficient to allow of the deceased grasping and tightening it to such a degree as to produce the great amount of violence found on the neck. The windpipe was flattened and its canal completely obstructed by the pressure of the two inner coils of rope. Admitting that a person could draw one coil so tightly, she could not retain the power of drawing a second with equal force, and after this a third. Fleischmann's experiments prove that pressure on the windpipe, sufficient to flatten it, is attended with instantaneous insensibility and loss of power (see p. 38, also case at p. 78). In Drory's case too much was done: one coil might have left the question of homicide doubtful-three coils, so drawn, were inconsistent with the theory of suicide. The evidence, medical and circumstantial, clearly traced the crime to the prisoner, and he was convicted. (Reg. v. Drory, Essex Lent Ass. 1851, Guy's Hosp. Rep.' 1851.)

6

In another case (Reg. v. Pinckard, Northampton Lent Ass. 1852), it was proved that deceased was found in a sitting posture in a corner of her room

Fig. 142.

on the floor, with a narrow tape round her neck, hung loosely and singly over a small brass hook about three feet above her head. Her clothes were placed smoothly under her, and her hands were open and stretched out by her side. The engraving, fig. 142, taken from a plan of the room, soon after the murder, will give an idea of the position of the body. There was a severe bruise over the right eye, and

there were marks of blood on the tape, as well as on the floor and wall of the room at a distance from the body. There was a stain of fresh blood on the knot of the tape where it passed over the hook, and there was no blood on the hands of the deceased. The windpipe for

about an inch and a half was lacerated longitudinally in its rings, and there was a deep circular mark round the neck in the course of the doubled tape, as if either from great pressure applied by some person, or from the weight of the suspended body. The later hypothesis, so far as the tape round the neck was concerned, was untenable. The body of the deceased

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did not weigh probably less than 120 pounds, while the tape found round her neck broke with a weight of 49 pounds: hence the deceased could not have been freely suspended by it. Apart from this the injuries to the parts about the neck, including the longitudinal fracture of the windpipe, were not such as the tape could have produced as a result of partial suspension in the position in which the deceased's body was found. The noose had been so placed that the greatest pressure was on the back of the neck, and the least in front, where the greatest amount of mechanical injury was actually done. The deceased had been strangled, probably by manual violence in the first instance, and afterwards by the use of a ligature drawn tightly by the hand. The body was then looped up with the double tape. These facts, taken in connection with the smooth arrangement of the clothes, the severe marks of violence on the body (inexplicable on the hypothesis of suicide), and the marks of blood and struggling in the room, proved that there had been homicide; and the crime was brought home to the prisoner by a series of moral and circumstantial proofs inconsistent with her innocence. In directing attention to the circumstantial evidence, it was suggested that the dress of the deceased might be torn or discomposed, a fact indicative of a violent struggle, and, cæteris paribus, incompatible with suicide; but it is proper to remark that evidence of murder, as in Pinckard's case, may be obtained by finding a smooth and undisturbed state of the dress, as well as attitude of the body. In fact, whoever attempts to imitate suicide under such a form of murder must fail in his object. The assassin either does too little, or he does too much. The woman who committed the murder in Pinckard's case had been a nurse in an infirmary, and accustomed to lay out dead bodies. After the murder she appears to have carried out, unthinkingly, her professional experience, by smoothing the clothes under the body, placing the legs at full length, the arms out straight by the side, and the hands open and laid out. Such a condition of the body was quite inexplicable on the supposition of suicide, considering the amount of violence which must have attended the act of strangulation. In the case of Drory, the criminal had attempted to make the death appear like an act of suicide by placing the lower end of the rope near the hand of the deceased: but he selected the left hand when the deceased was right-handed, and he did not leave enough rope free from the neck for either hand to grasp in order to produce the violent constriction of the neck caused by the two inner coils. Both of these criminals confessed their crimes before execution. Other reports of cases of alleged death from homicidal strangulation will be found in the Med. Gaz.' vol. 41, p. 295, and vol. 44, p. 1084.

It is proper to notice, in this place, the occurrence of what are called Garotte robberies.' The rigorous proof required of facts, which under these assaults can rarely admit of direct proof, confers much impunity on the assailants. The attack is made during darkness; the person is seized by the windpipe from behind, or a bandage is thrown around his neck; and this is suddenly tightened, while accomplices are engaged in perpetrating robbery. The nature of the assault by pressure on the windpipe, renders it impossible to give an alarm or call for assistance. The person assaulted, if he should recover, is seldom able to identify an assailant: he is attacked from behind, is rendered immediately senseless and powerless, and can rarely offer any resistance. Recovery or death in such cases depends on the lapse of a few seconds, more or less, during which the constriction of the neck is continued-on the degree of constriction, and the age, sex, and strength of constitution of the person assaulted. An attempt at strangulation, as in garotting, besides inflicting serious local injury to the windpipe and other parts near to it, may cause a state of insensibility which may continue for some hours. There is severe pain in

the throat, with difficulty of speaking and swallowing, and if the larynx is seriously injured there may be loss of voice. Dumbness, however, is not one of the secondary symptoms (p. 79): and loss of voice is usually only temporary during the pressure. By the 24th and 25th Vict., c. 100, s. 14, it is enacted, that whosoever shall attempt to drown, suffocate, or strangle any person, with intent to commit murder, shall, whether any bodily injury be effected or not, be guilty of felony; and being convicted thereof shall be liable, at the discretion of the Court, to be kept in penal servitude for life, or for any term not less than three years, . . . or to be imprisoned for any term not exceeding two years.' As the intent in these cases is too perpetrate robbery, and not murder, another section (21) has been framed, for the prevention of the crime of garotting: 'Whosoever shall, by any means whatsoever, attempt to choke, suffocate, or strangle any other person, or shall, by any means calculated to choke, suffocate, or strangle, attempt to render any other person insensible, unconscious, or incapable of resistance, with intent, in any of such cases, to enable himself, or any other person, to commit, or with intent in any of such cases thereby to assist any other person in committing, any indictable offence, shall be guilty of felony; and being convicted thereof shall be liable, at the discretion of the Court, to be kept in penal servitude for life, or for any term not less than three years, . . . or to be imprisoned for any term not exceeding two years,' &c.

Marks of violence.—It may be inquired whether marks of violence on the body, or blood-stains on the clothes, the furniture, or in the apartment, do not afford strong evidence of homicidal strangulation. The answer is-if the marks of violence are such that they could not have arisen from any accident before death, or that they could not have been self-inflicted, they afford the strongest evidence of murder. But the cases wherein so positive an answer can be returned are exceptions to the rule. It is not always in our power to distinguish accidental or self-inflicted from homicidal violence; and we are always bound to look to the probability of accident, or of previous attempts at suicide being the source of those personal injuries which may be evident on a strangled body.

In the following case the marks of injury to the neck clearly establish homicidal strangulation. The dead body of an old man, æt. 70, was found lying in a potato-field adjoining his house. His family consisted of a son, the son's wife, and a male servant-brother to the son's wife. The deceased had gone to gather potatoes for the servant, who was digging. On its being known to their neighbours that the body had been found in the field, suspicions were excited that his death had resulted from violence. On opening the skull a large quantity of dark fluid blood escaped, the membranes of the brain were greatly congested, the sinuses or large veins were gorged with blood, and the brain itself was also congested. Several clots of blood were observed in the lateral ventricles, and some over the surface of the brain. The lungs were filled with dark fluid blood, the air-cells were ruptured, and there was considerable emphysema. The right side of the heart was distended with dark blood. There was nothing remarkable in the abdominal viscera, but the lining membrane of the stomach, which was about half filled with potatoes, was congested. On the neck, over the left side of the thyroid cartilage, there was a slight mark of a crescentic form, with a corresponding though slighter mark on the opposite side. There was a large quantity of coagulated blood immediately beneath the marks, and in the substance of the muscles. On removing this, the left side of the cartilage, which was ossified, was found much depressed, and traversed by a fracture nearly an inch in length. From the general appearances presented by the body, together with the injury to the thyroid cartilage,

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an opinion was given that death had arisen from manual strangulation—and, from the particular form of the external marks over the neck, by a left hand. Several witnesses were examined, who proved that the deceased and the servant were on bad terms, the deceased having threatened to dismiss the servant, and that before they had gone to dig potatoes, the servant said he would be revenged of his master. The servant was committed for trial. One of the magistrates present desired that the prisoner might be requested to throw a stone, in order to ascertain if he was left-handed, which he did with the left hand. At the trial the sister of the prisoner swore that she saw her brother strangling the old man, and several witnesses proved that he had maltreated the deceased on many previous occasions. The jury, having some doubt as to the sister's veracity, acquitted him. For the account of another case, in which fracture of the larynx was properly regarded as a strong fact in favour of homicidal strangulation, see Edin. Med. Jour.' Dec. 1855, p. 527.

There may be several marks on the neck, but then the person may have tried to strangle himself more than once. The throat may be cut-there may be a deep-seated stab or gunshot wound, involving some of the important organs of the body-or poison may be found in the stomach; but in a purely medical point of view, how are we to know that the deceased did not actually make the marks, inflict the wounds, or take the poison before he succeeded in strangling himself? In the chapters on Drowning and Hanging, we have seen what suicides can do when they are bent on destroying themselves. Wounds and personal injuries often create serious difficulties to a medical jurist, which it requires the greatest caution and prudence on his part to meet and explain. Before a charge of murder by strangulation is raised against any person from marks or appearances found on a dead body, care should be taken that they admit of no other probable explanation than the direct application of violence. Even if marks indicative of strangulation are discovered, the question arises whether they may not have been produced by the deceased upon himself in an attempt at suicide which may have failed. If the body of a person is allowed to cool with a handkerchief, band, or tightly-fitting collar round the neck, a mark resembling that of strangulation may be produced. (See the cases of Byrne and Mahaig, vol. 1, pp. 114, 117; also cases at pp. 28, 29, ante.

On the dead bodies of infants and children, in whom the neck is short, a mark is occasionally seen which arises from the bending of the head; and in short-necked persons a similar mark or depression has been noticed after death, in front of the neck. These marks are then rendered more prominent by their assuming a livid appearance. They might, at first, be mistaken for marks produced by a ligature in attempted strangulation. In one case a death from apoplexy was attributed to homicidal strangulation from a cadaveric change of this kind. (Ann. d'Hyg.' 1859, 1, 139; and 26, 149.) Homicidal strangulation may be perpetrated on the weak and infirm without causing any noise or creating alarm. In the first place, if the throat is at once seized and firmly compressed, no cry can be made, nor any noise produced to excite the attention of those who are near. An aged woman was strangled in her shop by an apprentice in so short a time, and with such facility, that her husband, who was only separated from her by a slight partition, heard no noise or disturbance during the act. ('Ann. d'Hyg.' 1859, 1, 157.)

In contested questions of suicidal or homicidal strangulation, the Court must be greatly indebted to evidence founded on circumstances, as well as to moral presumptions. How far a medical jurist may be allowed to make use of these in the formation of an opinion it will be for the Court to determine. Generally speaking, his duty is rigorously confined to the