Suicide by air rifle and shotgun

We report the case of a 39-year old white male who committed suicide by shooting himself with an air rifle and a shotgun. The ballistics of air guns and rifles, with particular reference to the Sheridan air rifle, are reviewed. Only two cases of multiple firearm suicide have been reported; both involved simultaneously fired handguns. Ours is the first case, to our knowledge, of an air rifle and a shotgun used in sequence to commit suicide.     

Wrist slashing in a detention center. Case report and review of the literature

Suicides that occur in custody are rare and thus require extensive forensic analysis. Asphyxia by hanging is the most common means of suicide: at least 87.5% of successful suicides are committed in this way. A unique case of suicide in custody is presented in which a prisoner slashed his wrist with an eyeglass lens. The evidence and proceedings that led to this suicide are reviewed and the data are compared with known behavioral patterns. The world literature concerning suicide while incarcerated is reviewed.     

Suicidal incised wound of a fistula for hemodialysis access in an elderly woman: case report

A very rare case of suicide by stab wound of a fistula for hemodialysis access in an elderly woman is reported. The incidence of suicide attempts in people undergoing hemodialysis is well known. Nevertheless, suicide means do not usually include stab wounds of the arteriovenous access. Various pattern differences between homicidal and suicidal stab wounds, characteristics of suicide in the elderly, and approaches to the investigation of such cases are briefly discussed.     

Choking on toilet paper: an unusual case of suicide and a review of the literature on suicide by smothering, strangulation, and choking

While reports of suicide by smothering and strangulation are common, suicide by choking is far more rare. In addition to the act being difficult to carry out, suspected cases are not easily distinguished from accidental or homicidal deaths. Here, we present a case of suicide by choking on toilet paper in a patient with a long history of schizophrenia. The case was ruled a suicide based on the patient having been witnessed in a previous unsuccessful attempt of the same act.     

The psychiatrist's role in retrospective determination of suicide: an uncertain science

Psychiatrists have made significant contributions to our understanding of the phenomenon of suicide and are generally regarded as experts in all matters relating to suicide. When a legal determination must be made as to whether an individual has died as a result of suicide or by accidental (or any other) means, psychiatrists are often called upon to proffer their expert opinion to assist the courts to resolve the matter. Two case illustrations are presented and analyzed in which psychiatrists were called upon to make such retrospective determinations of suicide. The question is raised as to whether psychiatrists may sometimes exceed the limits of their scientific expertise in making such determinations.     

Suicide with associated acts of arson: two cases from Colorado

We report on two cases of suicide in which the victims started fires before their deaths. In one case the victim died of a single self-inflicted gunshot wound to the head after setting several fires in his residence. In the second case the victim hung himself after setting several fires in his residence and an adjoining building. In both cases, the victim's position was not near the origin of the fires suggesting that the arson was not a failsafe device to the primary mechanism of suicide. Neither victim showed a significant percentage of carboxyhemoglobin, or thermal damage from the fires. Both cases are remarkable in that, had the fire caused more damage to the remains and dwellings, a finding of suicide may not have been reached. We discuss similar aspects between the two reported cases and discuss differences observed with similar events such as complex suicide, suicide by self-immolation, and concealed homicide by burning. Similar cases should be reported to broaden our understanding of these complex events.     

Suicide by inhalation of carbon monoxide in a residential fire

Fire deaths are usually accidental, but atypical cases of homicide or suicide have been described. In suicide by fire, the only method reported by several authors consists of self-immolation. We present here the unusual case of an adult female who committed suicide by waiting in the living room after setting fire to her bedroom. The autopsy revealed smoke inhalation and the toxicological analysis revealed carboxyhemoglobin levels of 67%. Very few cases of suicide by fire not of the self-immolation type have been reported, and all have been anecdotal. A review of the literature is presented and a new term, "suicide by inhalation of carbon monoxide in a fire," is proposed for such cases.     

An Unusual Suicide Inside a Grave with Two Gunshot Wounds to the Head—The Psychological Approach

Abstract: In this report, the authors present a case of suicide committed by a 66-year-old man, inside a grave at the local cemetery, with two gunshot wounds to the head. A multiple-paged, handwritten suicide note was found in an army type bag inside the victim’s car, while a second one was found in his house. Medicolegal examination of the body revealed two typical contact gunshot entrance wounds and one exit wound to the head. Toxicological analysis of the femoral blood was negative for alcohol and drugs. The history, scene and autopsy findings, along with further police investigation, indicated an obvious case of suicide. The literature is reviewed and discussed. We report this case as the place of suicide is extremely uncommon and as there is no mention of a gunshot suicide inside a grave in the current literature.     

Suicide with two guns represents a special type of combined suicide

Suicide by simultaneous gunshots with two firearms is rare. The case of a 90-year-old man who killed himself with two 6.35 mm pistols fired at the temples at the same time is presented. The victim was found dead on the terrace of his home; two guns and two cartridges were present near the corpse. Cases of suicides with two guns published in the literature are compared, and the Italian cases are illustrated briefly. The authors describe the circumstances and autopsy findings that permitted the assertion that it was a case of suicide and to exclude an homicide and show, by figures, the three-dimensional reconstruction of cranial shooting injuries. The use of two guns is considered a representation of a special type of "combined suicide" or "planned complex suicide."     

Suicide by fire in a car trunk: a case with potential pitfalls

We present an unusual case in which an adult female committed suicide by fire while enclosed in the trunk of her vehicle. A finding of suicide was reached only because several key investigative facts were uncovered. Without these discoveries the case may still remain open as a suspicious death. Fire is rarely used as a mechanism of suicide in Western culture, and, as such, similar cases should be reported to advance our recognition of this phenomenon.     

Asphyxial suicide by inhalation of helium inside a plastic bag

Asphyxial suicide by placing a plastic bag over the head, especially in combination with inhalation of gases, is a rarely described method of committing suicide. This article reports a case of suicidal asphyxiation by inhaling the inert gas helium inside a plastic bag. A 64-year-old man probably followed the instructions described in an article about committing suicide written by a medical practitioner from Zürich. This form of suicide is recommended by right-to-die groups and in the internet as a certain, fast, and painless suicide method. Additionally, it leaves only seldom externally visible marks or pathomorphological findings on the body. If the plastic bag and other auxiliary means are removed by another person, the forensic death investigation of cause and manner of death may be very difficult. Therefore, the death scene investigation and the inquiry ordered in the environment of the deceased are very important.     

A review of nail gun suicides and an atypical case report

The nail gun was designed as a powerful industrial tool to drive nails into various hard surfaces with ease. Serious injuries associated with the tool are uncommon and deaths are rare. Unintentional injuries normally occur from misuse of the tool or from ricocheting nails. The intentional use of a nail gun to commit suicide is unusual. This paper will review successful and unsuccessful suicide attempts by use of a nail gun. We will present an atypical case of suicide committed with a nail gun by a 46-year-old depressed male investigated by the Allegheny County Coroner's Office in Allegheny County, Pennsylvania in April 2002. This case reports for the first time a unique pathological finding of a ring of bone traveling with the nail, which has not been seen in wounds of the head caused by other types of projectiles.     

Questioning the psycho-socio-cultural factors that contribute to the cases of suicide attempts: an investigation

Suicide attempts can be described to include all actions taken by an individual to end their life as a result of acute desperation. In parallel with the changes in the make-up of human societies both globally and in this country in recent years, suicide attempts are receiving attention in ever increasing proportions. The current study is aimed at investigating the psycho-socio-cultural factors that contribute to the known cases of suicide attempts. The study included 116 cases admitted to the Emergency Internal Medicine and Surgery Units of the University of Istanbul, Faculty of Medicine Hospital between 1 December 1998 and 31 May 1999. In only 47 cases, a 30-point questionnaire was used in several face-to-face interviews with the patients following the preparation of a clinical case study. In establishing the socio-demographic, socio-cultural and socio-economic attributes of each individual case, a range of contributing effective factors is questioned. Including the specific reasons for each suicide attempt, the emotional state of the individual prior to the suicide attempt, the type of suicide action chosen and reasons for this selection, immediate family structure, personal psychiatric antecedent, substance abuse. The results of our investigations are compared with the existing literature in a multi-faceted discussion.     

Suicidal asphyxiation by using pure helium gas: case report, review, and discussion of the influence of the internet

Suffocation by inhaled gases has been reported involving a variety of gases. We report a case of suicidal asphyxiation by forced replacement of oxygen with helium by using a complex homemade mask. In this case, a young woman researched suicide on the Internet and found an advocated method of suicide using helium. To our knowledge, there is only 1 previously reported case of suicidal asphyxia by using helium.     

Unusual suicides with band saws: Two case reports and a literature review

Suicides or suicide attempts with power saws (band, circular or chain saws) are rather rare events and only a few case reports exist in the forensic literature. The use of a band saw, in particular, has been extremely rare in cases of suicide.We report two cases of suicide that occurred in the same suburban area, three years apart. In each case, the victim was a carpenter and had a history of psychiatric disorder and/or of prior suicide attempts.We summarize the findings of the death scene investigations, the pertinent autopsy findings, and also summarize the world literature pertaining to suicide committed with power saws.     

Suicidal deaths using fireworks

The use of commercial explosives is an unusual method of commiting suicide, and only a few cases have been described in the medicolegal literature. In this paper, two cases of suicide are considered that reflect backgrounds of financial problems and psychological illnesses, respectively. Both individuals comitted suicide by detonating an explosive (fireworks). In the first case putting the explosive on his head and in the second case into his mouth. In both cases the cause of death was the destruction of the central nervous system. The following cases emphasize the importance of the forensic pathologist in the recognition of the scene, as well as the systematical collection of trace evidence of the explosion for their subsequent study in the laboratory and their correlation with the autopsy findings.     

Forensic Pathological Considerations of a Unique Case of “Complicated Suicide”*,†

In the forensic literature, peculiar and uncommon cases of suicides defined as “complicated” are reported. In these circumstances, the suicide method chosen by the victim fails, and death occurs due to a subsequent unforeseen accidental event defined as secondary trauma. Through retrospective examination of 25,512 autopsies in 27 years (1993–2019) at the Bureau of Legal Medicine of Milan, a unique case of complicated suicide was identified from a total of 4497 suicides. It concerns an elderly man who, after killing his wife by inflicting incised wounds to her neck, tried to hang himself by tying a rope to a heater and jumping from the window located over the heater itself. However, the rope suddenly snapped and the man fells to the ground causing fatal traumatic injuries. Death occurred because of an accidental event caused by the failure of the hanging mechanism. Therefore, a peculiar yet characteristic case of complicated suicide is described.     

The chain saw: an uncommon means of committing suicide

A suicide committed with a power saw is an uncommonly reported incident: and the use of a chain saw in particular has been extremely rare. We report two cases of suicide that were committed by using chain saws. In each case the victim had a history of depression or of a prior suicide attempt, and applied the chain saw to his neck to kill himself. We summarize the findings of the two death investigations and the world literature pertaining to suicide committed with power saws.     

Unusual hanging deaths

Four unrelated hanging deaths involving young white males, all in enlisted status in the United States military, are presented. Taken in a military context, one scene served as a suicide note equivalent with the unmistakable message of extreme defiance toward military regulations. In two cases, the elaborate attire of the decedents could have lead to the misclassification of the manner of death if investigative information had not been considered. Extensive background investigation and review of medical records in the fourth case disclosed that the victim had an eight- to ten-year history of compressing his neck to cause unconsciousness. He left an extensive suicide note in which he concluded that "hanging would be good." Each case has certain unique features, as a group, the cases all demonstrate a continuum from obvious suicide to cases where the manner of death is, at first, equivocal.     

Complex Suicide by Self‐stabbing and Drowning: A Case Report and a Review of Literature

Sharp force injuries and drowning are methods exceptionally combined in complex suicides. We report a challenging case of complex suicide by self‐stabbing and drowning that illustrates the difficulty in discriminating between homicide and suicide in such circumstances of death. The corpse of a young man was found submerged in a river, stabbed nine times with two wounds that had penetrated the thorax and had caused lung injuries and a hemopneumothorax. The postmortem and histological examinations were consistent with a death caused by drowning, but the manner of death still remained undetermined. Police investigation finally concluded to a suicide, although no suicide note had been left and the victim had no underlying diagnosed mental disorder. The parameters that may help distinguish suicide from homicide at the autopsy should be interpreted in light of a thorough forensic investigation to determine the exact manner of death in such a case.