Introduction
Numerous distinctions exist between suicidal hanging and ligature strangulation within the domain of Medical Jurisprudence. It is imperative to recognize that these variances in the characteristics of these two types of causes of death serve as general indicators. Different scenarios can manifest, leading to variations in forensic experts' conclusions. Therefore, it is crucial to underscore that decisions in each situation must be made following a thorough and independent examination of the case.

Differences
Some potential differences between Suicidal Hanging and Ligature Strangulation are given below:

• A suicidal hanging occurs when a person decides to kill themselves while a ligature strangulation is where somebody causes another person's death.
• Suicidal people mostly initiate the hanging by taking control of the act. The death of the victim is often occasioned by the actions of somebody else in the case of ligature strangulation.
• Usually higher up the neck, ligature marks from suicidal hanging tend to be incomplete and above the thyroid cartilage. However, ligature strangulation is typically characterized by a transverse mark that completely encircles the neck and is typically below the thyroid cartilage.
• The preferred choice of knot for suicidal hangings tends to be a basic knot or noose formation. A more elaborate knot or several knots denote that it was a case of ligature strangulation.
• Typically, individuals who commit suicidal hanging show signs of having prepared themselves for their death or have had some emotional distress beforehand. On the other hand, ligature strangulation scenes may include signs that were characteristic of a struggle or a forced restraint.
• Ligature strangulation can cause some defensive injuries like bruises, abrasions, or fractures if they occur due to resistance to an attack. In cases of suicidal hanging, such injuries are usually lacking.
• Personal reasons such as depression, mental illnesses, and acute emotional distress are what mostly cause suicidal hangings. Most times ligature strangulation is done for a purpose just like revenge, killing a witness, or within the act of a crime.
• The method of suicidal hanging commonly occurs in private locations including bedrooms and bathrooms. Signs indicating a ligature strangulation can be seen at different places. There may be evidence of a struggle or forced binding in such cases.
• Suicidal hanging may leave the victim partially or fully clad. The ligature strangulation victim can be with full dress, undress, or even no dresses whatsoever.
• In instances of suicidal hanging, a victim's statement or a written note often serves as a definitive indicator of the intention to end one's life. Conversely, in cases of ligature strangulation, supporting evidence may come in the form of witness testimony and additional corroborating factors.
• Mental illnesses can be prevalent, and the victim might have attempted suicide in the past in suicidal hanging. For ligature strangulation, the victim could have been healthy, and the facts could have not matched up with suicide.
• The ligature in suicidal hanging is frequently similar to whatever is available for use near someone's surroundings like scarves, sari, belt, lungi, gamchha, dhoti etc. More complicated or rare type of ligature in ligature strangulation shows that the perpetrator planned his actions beforehand.
• The presence of drugs or substances in toxicology reports could conform to self-administration when investigating suicidal hanging. Ligature strangulation, however, can demonstrate unusual toxicology outcomes that are inconsistent with typical suicidal pattern of death.
• Autopsy finding can be consistent with suicidal hanging. Pathological findings in ligature strangulation may show anomalies that are inconsistent with suicidal hanging.
• In suicidal hanging there is a dribble of saliva through the mouth but that does not occur in ligature strangulation.
• Semen discharge occurs in suicidal hanging whereas in ligature strangulation it is not visible.
• Suicidal hanging does not include involuntary discharge of faeces and urine that may be observed in ligature strangulation.
• Fracture of the hyoid bone is common in suicidal hanging but the same is rare in ligature strangulation.
• Although bleeding from the nose, mouth, and ears tend to occur less frequently in suicidal hanging, it is a common occurrence with ligature strangulation.
• Fractures of the thyroid cartilage are rare in suicidal hanging, but common in ligature strangulation.
• Neck stretching and lengthening in suicidal hanging does not exist unlike ligature strangulation.
• In suicidal hanging, the face is pale and petechiae are not common, whereas in ligature strangulation, the face is livid, congested, and full of petechiae.
• Swelling and protruding of the tongue are not so common in the case of suicidal hanging; however, it is well marked in ligature strangulation.
• Suicidal hanging results in whitened hard and glistening subcutaneous tissues beneath the mark but in ligature strangulation, there is ecchymosis under the mark.
• The base in suicidal hanging is pale, hard, and parchment-like but, it is soft and red in ligature strangulation.
• Bleeding from the nose, mouth, and the ears are not common in suicidal hanging, but the same are common in ligature strangulation.
• There is no evidence of sexual assault in suicidal hanging; however, the same may be present in ligature strangulation.
• Injury to the muscles of the neck is rare in suicidal hanging, but the same is common in ligature strangulation.

The fact that the deceased has a double knotted ligature around their neck indicates that their death was not caused by themselves, but rather by another person's ligature strangulation. This was held in the case of Raghunath v. Emperor AIR 1926 Nag 119 and 26 Cr LJ 1380.

Conclusion
Differentiating suicide from ligature strangulation within medico-legal perspectives is highly difficult. In suicidal hanging most cases happen under restricted areas with specific ligature notches on self-tied, knots at the rear of the neck not leaving any marks of wounds of defence. Ligature strangulation, however, can occur in many places; present marks of fight; have weird ligatures; as well as bear evidence of defensive injuries.

However, such general markers will only provide an estimate and require thorough forensic examination for distinct differentiating. Scene analysis, ligature mark patterns, the position of ligature knot, presence of defensive injuries, and involvement of legal/forensic consultants help to achieve reasonable conclusion in every particular situation.

References:

• Medical Jurisprudence and Toxicology, HWV Cox, LexisNexis Butterworths