Ingestion of pointed objects in a complex suicide

A 51-year-old woman with a psychiatric history of depression and drug abuse was found hanged in her bedroom. The ligature was a scarf attached to the door handle. The autopsy findings suggested that two methods of suicide had been used one after the other. In the first stage, numerous nails, pins and needles were swallowed; in the second stage, the suicide was completed by hanging.     

Alteration of the Death Scene After Self‐stabbing: A Case of Sharp Force Suicide Disguised by the Victim as a Homicide?

This paper reports a case of a 72‐year‐old woman who was found dead in her bedroom with a 4 cm vertical stab wound in the abdomen. A bloodstained knife was found in the top drawer of her bedside table. The clothes worn by the victim showed no damage. A bloodstained vest and a sweater with frontal incisions were found far from the victim, in the bathroom and in the bedroom respectively. Several bloodstains were found in every room of the apartment. The evidence found during the forensic examination and, in particular, the Bloodstain Pattern Analysis, led the investigators to determine the manner of death, being consistent with a suicide with a long‐lasting physical activity after self‐stabbing. This report describes an unusual case of “disguised suicide,” in which the victim tried to cover‐up the suicide by changing her clothes and concealing the weapon, in the last minutes of her life.     

Observed Characteristics of Suicidal Hangings: An 11-year Retrospective Review

Many studies have been published regarding suicidal hanging deaths, and most forensic pathologists and coroners are very familiar with such causes of death. Forensic pathologists are challenged over their rulings regarding manner of death in part because the general public has a limited scope of knowledge. One such challenge centers on the question of whether a hanging can be a suicide if the individual is not fully suspended. The authors designed a retrospective study to review suspension in hangings and to analyze other criteria used to help in deciding manner of death. We examined 229 suicidal hanging deaths over an 11-year period (1997 through early 2009) using the data from two separate jurisdictions in Ohio. In conclusion, we found that the vast majority (83.4%) of people who hanged themselves were found partially suspended. Among other criteria analyzed, only the presence of petechial hemorrhages and acute neck injury was statistically significant.     

Fatal accidental hanging by a high-chair waist strap in a 2-year-old girl

High chairs are commonly used to feed children after 6 months. Related injuries are oftentime minor and rarely leading to death. We describe a case of a 2-year-old female child who used to jump alone on her high chair and also had the habit to fasten the straps by herself. Her mother found her hanging by the waist straps. A thorough investigation showed that she climbed her high chair and fastened the waist straps but not the crotch one. The girl slid down into the seat, trapping her neck in the waist straps and thus resulting in hanging. In here, we concluded that the victim's death was caused by asphyxia, itself, caused by accidental hanging. The present case is of a special interest because of the rare similar cases reported. This case suggests that a correct restraint use and a close supervision would have prevented such a fatal issue.     

Planned Complex Occupation‐related Suicide by Captive‐bolt Gunshot and Hanging*

Abstract: Planned complex suicides are committed by using two or more previously planned methods simultaneously to make sure that death will occur even if one method fails. Herein, we presented a case of occupation‐related planned complex suicide, committed by captive‐bolt gunshot and hanging. A 29‐year‐old man, who worked as a butcher, was found dead in the stable, hanging by the neck with a captive‐bolt gun embedded in the forehead region of his head. The hanging was complete. Along the bolt canal were bone fragments, and at the end of the path was the punched‐out fragment of the skin and soft tissue. There were no fractures of the hyoid bone and laryngeal cartilages, and a superficial hemorrhage was present in the right sternocleidomastoid muscle. Our case underlines the utility of forensic autopsy and death scene investigation in reconstructing the mechanism of death, as well as the dynamics of the event.     

Hands Tied with Bag Full of Books in Suicidal Hanging

Hanging deaths associated with binding of limbs, masking of a face, and gagging are always suspicious. In suicidal hanging, the victim uses these added techniques to prevent him from backing out of his decision and to ensure death. However, binding of limbs and adding extra weight to the suspension in hanging are not reported. Herein, we report a case where the victim tied a bag containing books weighing 7 kg (15.4 lbs) to both his hands during hanging. The forensic specialist must be aware of the unusual presentation of suicidal hanging which may suggest foul play. The manner of death must be established after detailed analysis of circumstantial evidence, information obtained from the witnesses, complete autopsy, and toxicological examination.     

Jumping Together: A Fatal Suicide Pact

In suicide pact, two or more victims mutually agree and execute to end their lives together by predetermined method, preferably by hanging, drowning, gunshot, or poisoning. The victims are usually spouses, lovers, or friends, and the reasons behind such steps are various. In this reported suicide pact, husband–wife duo jumped from the terrace of a 12‐meter‐high building with their wrist bound to each other. Although they jumped together, the injury patterns were completely different. The man landed on head sustaining mainly craniocerebral injuries, and the wife landed on feet sustaining long bone injuries. They left a suicide note pointing out sudden demise of their only child as the reason for the suicide, and it was signed by both of them. Jumping from a height in suicide pact has not been reported in the scientific literature yet.     

Accidental Hanging Deaths in Children in Konya,Turkey Between 1998 and 2007*

Abstract: In general, hanging cases are the result of suicide, and accidental and homicidal hanging cases are rarely seen. This study retrospectively investigated 4571 death examinations and autopsies that were performed at The Konya Branch of the Forensic Medicine Council (Turkey) between 1998 and 2007; hanging was involved in 201 (6.5%) of the cases. There were a total of 13 accidental hanging cases, where 12 of these involved children. In seven of the cases, the accidental hanging involved a scarf that wraps around swing‐like cradles and is intended to prevent infants from falling down. It was concluded that accidental hanging deaths can be reduced by replacing swing‐like cradles with cribs that are designed for children, removing ropes in and around the house, and preventing children from reaching and/or playing with rope‐like objects.     

Autoerotic deaths in the literature from 1954 to 2004: a review

Autoerotic death by hanging or ligature is a method of autoeroticism well known by forensic pathologists. In order to analyze autoerotic deaths of nonclassic hanging or ligature type, this paper reviews all published cases of autoerotic deaths from 1954 to 2004, with the exclusion of homicide cases or cases in which the autoerotic activity was not solitary. These articles were obtained through a systematic Medline database search. A total of 408 cases of such deaths has been reported in 57 articles. For each case, the following characteristics are presented here: sex, age, race, method of autoerotic activity, cause of death, and location where the body was found. Autoerotic death practioners were predominantly Caucasian males. Victims were aged from 9 to 77 years and were mainly found in various indoor locations. Most cases were asphyxia by hanging, ligature, plastic bags, chemical substances, or a mixture of these. Still, atypical methods of autoerotic activity leading to death accounted for about 10.3% of cases in the literature and are classified here into five broad categories: electrocution (3.7%), overdressing/body wrapping (1.5%), foreign body insertion (1.2%), atypical asphyxia method (2.9%), and miscellaneous (1.0%). All these atypical methods are further discussed individually.     

Bleedings into the Anterior Aspect of the Intervertebral Disks in the Lumbar Region of the Spine as a Diagnostic Sign of Hanging

Abstract: Simon’s hemorrhages are ventral intervertebral hemorrhages located beneath the anterior longitudinal ligament that have been described in cases of hanging and tend to appear in the lumbar region of the spine. There are also reports of Simon’s hemorrhages in cases of blunt trauma, asphyxia, drowning, and putrefaction. In a prospective analysis of 2226 autopsies, we found Simon’s hemorrhages in 65 out of 178 cases of hanging and also in 17 cases in a group of 350 controls with various causes of death. The relative frequency of occurrence of Simon’s bleedings in cases of hanging was 37%. Simon’s hemorrhages can be considered an objective vital finding, which is not absolutely specific for hanging. The absence of hemorrhages in intervertebral disks does not exclude death by hanging. This study suggests that Simon’s bleedings in cases of hanging are more frequent in rather young individuals, in cases with free body suspension, and in individuals with minimal degenerative changes in the lumbosacral part of the spinal column.     

Child Suicide in the North of Portugal

Suicide in children is a rare finding and is probably motivated by acts of impulsiveness. This study aims to contribute to the characterization of child suicide in a forensic perspective in the Portuguese population. Data of forensic autopsies from 2004 to 2012 related to suicide victims under 18 years were reviewed. A total of 17 cases, with a male predominance (64.7%) and a mean age of 15.24 ± 1.348 for both genders, were registered. The leading suicide method was hanging (35.3%), and a suicide note was found in 41.2%. Psychological autopsy proved to be useful in promoting a better understanding of these incidents and their antecedents. This study also offers useful information, namely the implied risk factors, for future programs of suicide research and prevention.     

Amussat’s Sign in Hanging—A Prospective Autopsy Study

Abstract: Amussat’s sign is typically a transverse laceration of the intimal layer of carotid arteries described in cases of hanging. Subtotal laceration of the carotid artery is not strictly specific for hanging and can be also caused by blunt neck trauma, extreme overstretching, or whiplash‐injuries. In a prospective autopsy study of 178 cases of hanging, Amussat’s sign was found in 29 cases (a relative frequency of 16.1%). A statistically significant association between the occurrence of tears in the intimal layer of carotid arteries and the victims’ age was discovered in the cases studied (the frequency increased with age; p < 0.05). The occurrence of Amussat’s sign was independent of gender, weight, completeness of the victim’s body suspension, and position of the ligature knot on the neck. The study demonstrates the fact that the most probable cause of Amussat’s sign is a combination of direct compression of the artery by the rope and indirect stretching because of the gravitational drag produced by the weight of the body.     

Agonal sequences in a filmed suicidal hanging: analysis of respiratory and movement responses to asphyxia by hanging

The forensic literature on the pathophysiology of human hanging is still limited. Therefore, forensic pathologists often feel uncomfortable when confronted with related questions. Here presented is the filmed suicidal hanging of a 37-year-old man. This recording allows a unique analysis of agonal movement sequences: loss of consciousness (13 sec), convulsions (15 sec), decortication rigidity (21 sec), decerebration rigidity (46 sec), second decortication rigidity (1 min 11 sec), loss of muscle tone, (1 min 38 sec) and last isolated muscle movement (4 min 10 sec). As for respiratory responses, very deep respiratory attempts started at 20 sec. Respiratory movements progressively decreased and completely stopped at 2 min. Despite the fact that extending the presented data on all cases of hanging asphyxia would be a mistake, this case gives a very interesting insight into movement and respiratory response to asphyxia by hanging.     

Suicidal hanging on high-voltage line pylon

Hanging is one of the most frequent methods for suicides among young males. This report presents two cases of suicide by hanging on pylons carrying high-voltage power lines. The male victims suffered electrocution while committing suicide. Electrocution was the cause of death in both cases, however in one case blunt force injuries from hanging contributed to death. In these two cases hanging was the intentional method of suicide and it was followed by electrocution. The cases demonstrate that scene investigation, a detailed autopsy with histology, and amamnestic data are essential in the evaluation of suicides by hanging and that the determination of the cause of death remains a challenge in investigating such cases.     

Retrospective Analysis of Hanging Deaths in Ontario

Hanging deaths from investigation standpoint are rarely problematic. Unusual circumstances can on occasion raise suspicion of foul play. Associated neck injuries are reported in the literature with variable frequency (from 0% to 76.8%). This study retrospectively analyzed 755 hanging deaths in Ontario (Canada) to evaluate the demographic features and circumstances of hanging fatalities, and the frequency of hanging‐related neck injuries. A number of cases showed unusual/special circumstances (e.g., complex, double suicides, restraints). Among 632 cases with complete autopsies, hyoid and larynx fractures were present in 46 cases (7.3%) with the most common being isolated hyoid fractures. The incidence of cricoid fractures was 0.5% and cervical spine injuries, 1.1%. A higher incidence of neck injuries occurred among males, long drop hangings, and in cases with complete suspension. There was a tendency for the number of fractures to increase with increasing age and weight of the deceased.     

Experimental Results of a Residential House Fire Test on Tenability: Temperature,Smoke, and Gas Analyses

A fire experiment conducted in a British 1950s‐style house is described. Measurements of temperature, smoke, CO, CO₂, and O₂ were taken in the Lounge, stairwell, and front and back bedrooms. The front bedroom door was wedged open, while the door to the back bedroom was wedged closed. Contrary to expectations and despite the relatively small fire load, analysis and hazard calculations show permeation of toxic fire gases throughout the property with lethal concentrations of effluent being measured at each sampling point. A generally poor state of repair and missing carpets in the upper story contributed to a high degree of gas and smoke permeation. The available egress time was calculated as the time before the main escape route became impassable. Given known human responses to fire, such an incident could have caused fatalities to sleeping or otherwise immobile occupants.     

GC‐MS and GC‐MS/MS in PCI Mode Determination of Mescaline in Peyote Tea and in Biological Matrices

Peyote, a cactus containing the hallucinogen mescaline, is used to induce altered states of consciousness in religious ceremonies or for recreational purpose. This study reports a case of an underage boy suspected of mescaline abuse. For this purpose, we analyzed a dark green liquid sample found in the bedroom of the boy whose urine and hair samples were collected shortly after the drink was found. A method by gas chromatography‐mass spectrometry tandem mass spectrometry (GC‐MS/MS) in positive chemical ionization mode was developed and validated in terms of linearity, specificity, accuracy, and sensitivity for mescaline determination at the low concentrations present in hair. GC‐MS analysis of the liquid identified mescaline, while urine was negative; GC‐MS/MS segmental hair analysis identified mescaline in the proximal segment (root to 2 cm), while the distal segments were negative. Although peyote was uncommonly encountered, its use was confirmed by segmental hair analysis that can provide long‐term information about drugs use.     

Characteristic Features of Hanging: A Study in Rural District of Central India

The ligature mark is the most relevant feature of hanging. This study was undertaken with a view to determine the characteristic features of hanging and its association with ligature material or mode of suspension. Of a total medicolegal deaths reported at an Apex Medical Centre, hanging was noted in 4.1% cases, all suicidal with mortality rate of 1.5 per 100,000 population per year. The hanging was complete in 67.7% with nylon rope as the commonest type of ligature material used for ligation. The hanging mark was usually single, situated above thyroid cartilage, incomplete, prominent, and directed toward nape of neck. The mark of dribbling of saliva was seen in 11.8% cases. Facial congestion, petechial hemorrhage, and cyanosis were significantly seen in partial hanging. Though occasionally reported, the argent line was noted in 78.7% hanging deaths with neck muscle hemorrhage in 23.6% cases. Fracture of neck structure was predominant in complete hanging.     

The role of environmental factors in the causation of sudden death in infants: two cases of sudden unexpected death in two unrelated infants who were cared for by the same babysitter

We report two cases of sudden unexpected death in two unrelated African American female infants, 2 months and 4 months old. Both infants were attended to by the same babysitter in the same apartment and died 39 days apart in the same bed and in the same bedroom. The autopsy of the first infant revealed sudden unexplained death in an infant. Toxicologic analysis for carbon monoxide (CO) was not performed because it was not suspected. When the second infant died, investigation into the ambient air quality within the apartment revealed high levels of CO emanating from a poorly ventilated and defective hot water heater, which was located across a hallway from the bedroom where the two babies died. CO saturation levels in the postmortem blood samples of the two babies were elevated and were similar (13% and 14%). Nicotine and cotinine were not detected in the blood sample of the two infants. Cherry-red livor mortis was absent. Acute CO intoxication was determined to be the underlying cause of these two unexpected deaths. These two cases underscore the need to integrate ambient air analysis and postmortem CO analysis as routine components of the comprehensive death investigation of infants who die suddenly and unexpectedly.     

Pneumomediastinum and Soft Tissue Emphysema in Pediatric Hanging

Postmortem computed tomography (CT) is increasingly being used as a tool in forensic pathology. The exact value of postmortem imaging in detecting specific conditions has not yet been established, but in specific cases, it can be used as a diagnostic tool demonstrating findings that remain undetected during autopsy, as in this case. Pneumomediastinum and soft tissue emphysema were detected with postmortem CT in a 3‐year‐old girl after hanging. It was not found during autopsy. This radiological finding matches 3 adult cases previously described. It is assumed that in this case, the first reported in a child, hanging was the most likely cause as well. In the adult cases, it was interpreted as a vital sign; the person must have been alive to create a pressure gradient causing rupture of the alveoli. This case demonstrates one of the added values of postmortem imaging, the possibility of demonstrating findings that remain undetected during autopsy.