M.A.  S——­, aged fifty-three, was admitted into the Kent Lunatic Asylum at Chartham on Oct. 3, 1882, suffering from melancholia, the duration of which was stated to have been three months.  She had several times attempted suicide by drowning and strangulation.  She was on admission ordered a mixture containing morphia and ether thrice daily, to allay her distress.  On Oct. 10 she attempted suicide by tying a stocking, which she had secreted about her person, round her neck.  Shortly afterward, with similar intent, she threw herself downstairs.  On Jan. 4, 1883, she attempted to strangle herself with her apron.  On the 30th of November following, at 4 P.M. she evaded the attendants, and made her way to the bath-room of of No. 1 ward, the door of which had been left unfastened by an attendant.  She then suspended herself from a ladder there by means of portions of her dress and underclothing tied together.  A patient of No. 1 ward discovered her suspended from the ladder eight minutes after she had last seen her in the adjoining watercloset, and gave the alarm.

The woman was quickly cut down, and the medical officers summoned.  In the interval cold affusion was resorted to by the attendant in charge, but the patient was to all appearances dead.  The junior assistant medical officer, Mr. J. Reynolds Salter, M.B.  Lond., arrived after about three minutes, and at once resorted to artificial respiration by the Silvester method.  A minute or so later the medical superintendent and myself joined him.  At this time the condition of the patient was as follows:  The face presented the appearance known as facies hippocratica:  the eyeballs were prominent, the corneae glassy, the pupils widely dilated, not acting to light, and there was no reflex action of the conjunctivae; the lips were livid, the tongue tumefied, but pallid, the skin ashy pale, the cutaneous tissues apparently devoid of elasticity.  There was an oblique depressed mark on the neck, more evident on the left side; the small veins and capillaries of the surface of the body were turgid with coagulating blood the surface temperature was extremely low.  She was pulseless at the wrists and temples.  There was no definite beat of the heart recognizable by the stethoscope.

There was absolute cessation of all natural respiratory efforts, complete unconsciousness, total abolition of reflex action and motion, and galvanism with the ordinary magneto-electric machine failed to induce muscular contractions.  The urine and faeces had been passed involuntarily during or immediately subsequent to the act of suspension.  As the stethoscope revealed that but a small amount of air entered the lungs with each artificial inspiration, the tongue was at once drawn well forward, and retained in that position by an assistant, with the result that air then penetrated to the smaller bronchi.  Inspiration and expiration were artificially imitated about ten times to the minute.  In performing expiration the chest was thoroughly compressed.  The lower extremities were raised, and manual centripetal frictions freely applied.  In the intervals of these applications warmth to the extremities was resorted to.