An Unusual Method of Suicidal Ligature Strangulation

This article reports a case of suicidal strangulation by ligature of a 51‐year‐old woman with a psychiatric disorder. She had been suffering from depression with a history of previous suicidal attempt. The deceased accomplished self‐strangulation using two ligatures, with one placed above the other and consisting of a satin fabric and a shoelace. The underlying shoelace ligature was fastened by a secure fixed square knot at the back of the neck. The overlying fabric piece was tied with a half‐knot under the chin and was tightened around the neck manually. A detailed investigation and autopsy examination strongly suggests suicide. The case is of interest due to its rarity and uncommon method of execution.     

Double Hanging with Single Ligature: An Unusual Method in Suicide Pact

A married casual labor couple was found hanging in their makeshift bedroom with each end of a single chunni (a cloth worn around the neck by Indian women) spread across an iron bar below the roof. They left their two children, daughter, and son of 4 and 3 yrs age, respectively, with their grandmother living separately nearby, and went to attend cremation of one of their relatives. They returned late in the evening and found hanging in their bedroom next morning by neighbors.     

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.     

Self‐Strangulation Turning into Partial Hanging for a Suicide Victim

Hanging is the most common asphyxial method of suicide, whereas suicide by strangulation is unusual. Here, we are reporting a particular methodology of the asphyxial method of suicide in which a case of self‐strangulation culminated into partial hanging. A 30‐year‐old male wrapped one end of the cable wire around his neck. He then passed the other end over a curtain rod and tied that end around the right hand. He pulled the hand down, using the curtain rod as a fulcrum, to tighten the noose around the neck in an attempt to strangulate himself. However, he lost consciousness during the process and the body slipped down, pulling the right hand up which got stuck at the curtain rod. This led the body hanged in the kneeling position. This bizarre scenario raised suspicion of homicide but the crime scene, autopsy and victim characteristics were in favor of suicide.     

Self‐Strangulation Through A Sphygmomanometer: An Uncommon Suicide

Suicide by asphyxia is quite a common event in forensic practice and may be implemented in different ways. The authors report a unique case of a 16‐year‐old youth who committed suicide by means of a standard mercury sphygmomanometer. This manner of suicide has never been described in the literature reviewed. A complete forensic investigation led to the conclusion that the cause of death was mechanical asphyxia, ascribed to self‐strangulation by means of an atypical item. The victim suffered from attention‐deficit/hyperactivity disorder (ADHD) syndrome and was assisted by support teachers. He had a solitary and depressive personality. The exceptional nature of this case suggests that sphygmomanometers may be regarded as possible means of self‐strangulation. The case also highlights the importance of managing patients with psychiatric or cognitive disorders; indeed, particular caution is required to keep them away from objects that, although apparently harmless, can become lethal.     

Aqua-eroticum: an unusual autoerotic fatality in a lake involving a home-made diving apparatus

The term Aqua-eroticum was first introduced in 1984 by Sivaloganathan to describe the unusual autoerotic death of a man using submersion as an asphyxia method. This was the first case of that kind, and since then, no other case of autoerotic submersion has been reported, nor other autoerotic fatality in open water. Here we report the case of a 25-year-old man, nude under a home-made plastic body suit, overdressed for the season with winter clothes and restrained by complex bondage. He was submersed, tied underwater to a boat and was using a home-made diving apparatus for air supply. Death was ruled as accidental autoerotic asphyxia from rebreathing, caused by the faulty air-supply device.     

Six‐Year Retrospective Study of Suicidal Hangings: Determination of the Pattern of Limb Lesions Induced by Body Responses to Asphyxia by Hanging*

Abstract: The objective of the present study was to estimate the proportion of hanging victims presenting with limb lesions, to compare this rate between hanging in restraint spaces and in more open settings, and to describe the usual pattern of limb lesions associated with hanging. Two hundred and seven cases of suicidal hanging were retrospectively reviewed and compared to 45 homicidal nonhanging strangulation victims. Bruises incidence was significantly lower in hanging victims (19.8%) compared to homicidal strangulation victims (55.6%). Bruises were more commonly encountered in restraint areas such as closets and staircases (56.3% and 66.7%, respectively) than in more open settings such as barn, bridge, fence, and park. Limb bruises on hanging victims were generally located on the posterior upper limb or the anterior lower limbs, whereas strangulation victims did not display this preferential bruises concentration. Possible suspicion criteria for limb bruises distribution are discussed, in relation to physiopathology of human asphyxia by hanging.     

An Autopsy Case of Sudden Unexplained Death Caused by Malaria*

Abstract: Sudden unexplained deaths, especially those unwitnessed can lead to forensic issues and would necessitate the need for a meticulous and complete postmortem examination including ancillary investigations to discover the cause of death. We herein report a case of sudden unexplained death caused by malaria in an apparently healthy individual. This fatal case is presented to remind the forensic pathologist of the possibility of malaria as a cause of sudden unexplained death in malaria‐endemic regions. In the present case, histopathological examination demonstrated the presence of parasitized red blood cells with malarial pigment in the blood capillaries in the brain, myocardium, pericardium, lungs, kidneys, liver, and the spleen. Cerebral malaria with acute renal insufficiency or pulmonary edema with an acute respiratory distress syndrome might have been the cause of death.     

Deaths Due to Accidental Air Conditioner Compressor Explosion: A Case Series

In an air‐conditioning system, the compressor is a large electric pump that pressurizes the refrigerant gas as part of the process of turning it back into a liquid. The explosion of an air conditioner (AC) compressor is an uncommon event, and immediate death resulted from the blast effect is not reported in forensic literature. We report three such cases in which young AC mechanics were killed on the spot due to compressor blast, while repairing the domestic split AC unit. The autopsy findings, the circumstances leading to the explosion of the compressor, are discussed in this study.     

Comparison of handmarks in manual strangulation: an experimental study

A police case with a strangulated woman with fingermarks on the neck and two suspects identifying each other as the perpetrator set off a laboratory experiment. Twenty-one males participated in the study. Blue paint was applied to their fingers, after which they grasped a neck dummy and pressed hard as if strangulating someone. The imprint was removed from the dummy, and their hands were photographed. Five imprints were randomly chosen and superimposed on the hand photographs in blind trials. In no cases did we match an imprint to the correct hand. However, in four cases we matched the imprint with several hands, one of which was the correct one. This means we were able to exclude nonmatches in 4/5 cases. Overall, matching of hands and fingermarks is difficult and inconclusive. Objective criteria for matching are difficult to establish, and matching is probably best suited for cases with specific anatomical features.     

A Very Unusual Accidental Mechanical Asphyxia of Choking with a Whole Solea Solea

The case here reported involves a schizophrenic 19‐year‐old girl under treatment with clotiapine, which was well tolerated except for a moderate dry mouth. The woman ingested a whole sole (Solea solea), which caused a very rapid death by choking. A complete autopsy was performed 24 h later, as well as histological and toxicological analysis. At autopsy, the sole was wedged in the esophagus causing a choking ab extrinseco. The fish had a length of 18 cm and a maximum width of 6 cm, weighing 188.7 g. Toxicological analysis detected 0.57 mg/L of clotiapine in blood, which falls within the therapeutic range. The peculiarity of this case is represented by two factors: one is the choking by fish and the second was the adverse affect caused by clotiapine, which induced a condition of dry mouth making the act of swallowing even more difficult, thereby contributing to a very rapid mechanical asphyxia and the death of the young woman.     

Laryngeal Choking on Food and Acute Ethanol Intoxication in Adults—An Autopsy Study*

Abstract: The retrospective autopsy study included 98 adults who died because of laryngeal choking on a bolus of food: 67 men and 31 women (χ² = 6.843, p < 0.01), average age 58.61 ± 15.87 years (range 26–92 years). Most of the subjects had poor dentition (χ² = 34.327, p < 0.01). Twenty individuals died in medical institutions, and 78 were nonhospitalized individuals. More than a third of the nonhospitalized individuals were under the influence of ethanol at the moment of death: average blood concentration 8.3 g/dL (SD = 11.0), ranged from 5.0 to 36.0. Nonhospitalized persons were at the moment of event more often under influence of ethanol than the subjects in control group (χ² = 38.874, p < 0.01), and at the same time significantly more intoxicated (z = −7.126, p < 0.01). Our study pointed out that poor dentition and impairment of the swallowing reflex, as a consequence of ethanol intoxication in individuals without mental disorders, were the most important risk factors for bolus death.     

扼颈损伤的法医临床学鉴定21例分析

目的分析总结扼颈损伤的一般规律,归纳损伤程度鉴定的要点,为法医临床学司法鉴定实践及制定、修改相关鉴定标准的条款提供参考。方法对襄樊地区1963年1月—2004年1月因扼颈致伤的案例,按性质、症状、鉴定结论进行总结和分析。结果颈部扼伤加害者多为青壮年男性,加害者身上多有抵抗伤;被害人颈部多有扼痕反应,主要症状、体征以喉挫伤、眼部窒息征象表现为主。结论损伤程度以轻伤与轻微伤为主,现行鉴定标准有一定的不适应性。     

Agonal Sequences in Four Filmed Hangings: Analysis of Respiratory and Movement Responses to Asphyxia by Hanging*

Abstract: The human pathophysiology of asphyxia by hanging is still poorly understood, despite great advances in forensic science. In that context, filmed hangings may hold the key to answer questions regarding the sequence of events leading to death in human asphyxia. Four filmed hangings were analyzed. Rapid loss of consciousness was observed between 13 sec and 18 sec after onset of hanging, closely followed by convulsions (at 14–19 sec). A complex pattern of decerebration rigidity (19–21 sec in most cases), followed by a quick phase of decortication rigidity (1 min 00 sec–1 min 08 sec in most cases), an extended phase of decortication rigidity (1 min 04 sec–1 min 32 sec) and loss of muscle tone (1 min 38 sec–2 min 47 sec) was revealed. Very deep respiratory attempts started between 20 and 22 sec, the last respiratory attempt being detected between 2 min 00 sec and 2 min 04 sec. Despite differences in the types of hanging, this unique study reveals similarities that are further discussed.     

Accidental Trauma Mimicking Homicidal Violence

Homicide investigations represent an important function of death investigators. Although recognizing nonobvious homicides is crucial, an equally important role involves the identification of cases that initially present as possible homicides, but are ultimately discovered to not represent homicides. Failure to recognize such cases results in wasted time, squandered resources, false allegations, and potential life‐altering consequences. The authors review a series of cases wherein initial investigation suggested a possibility that the deaths represented homicides. By carefully considering additional information, including scene findings, history, and postmortem examination, each was determined to represent an accidental traumatic death. In addition to highlighting the importance of recognizing accidental traumatic deaths that initially present as homicides, the cases serve to highlight the fact that forensic pathology cannot be practiced without knowledge of appropriate ancillary information. Although guarding against cognitive bias is important in all forensic disciplines, including forensic pathology, access to vital case‐related ancillary information is an essential component of practicing medicine as a forensic pathologist.     

Distinguishing between homicide and suicide knots and ligatures: A comparative analysis of case and survey data

Distinguishing between suicide and homicide can be challenging owing to ambiguous and confusing case details. In particular, there is a paucity of useful information comparing homicide and suicide knots and ligatures in the literature. Multiple knot and ligature characteristics have not been recognized previously because complete and accurate information has been lacking. Ninety external tying cases (mainly homicide) and 56 cases involving self‐tying (mainly suicide) were reviewed to compare multiple knot and ligature characteristics. Additionally, 189 survey volunteers performed four standardized external tying tasks and two self‐tying tasks, yielding comparison data from more than 1500 knots. Using all available data, it was determined that the differences between external and self‐tying included types of knots, ligature configurations, ligature tensions, wrist gaps, wend lengths, knot access, external anchoring, and other indicators. These differences are presented in a proposed analysis checklist inspired by medical and psychiatric protocols. The checklist contains 14 potential characteristics for head and neck bindings, 14 potential characteristics for wrists and arms, nine ankle and leg characteristics, and four linkage details. The proposed checklist can be expanded and fine‐tuned as more data are accumulated. It offers experienced knot analysts an additional tool to assist in drawing conclusions, which then can be related to other case evidence by investigators.     

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.     

Positional Asphyxia without Active Restraint Following an Assault

Deaths due to positional asphyxia are most often accidental, associated with alcohol and/or drug intoxication. A 19‐year‐old male is reported who was assaulted and placed in a head‐down position in the back of a car were he was later found dead. Brush abrasions indicated that he had been dragged to the vehicle. The head and right shoulder were wedged into the foot well with the body uppermost. At autopsy, there was marked congestion of the face, neck, and upper chest with conjunctival ecchymoses, bruising of the face and scalp, focal subarachnoid hemorrhage, minor cerebral contusion, and diffuse cerebral swelling with early hypoxic ischemic encephalopathy (HIE). Toxicology was negative. Death was attributed to HIE resulting from the unusual positioning of the body. Cases of positional asphyxia involving others may not always include restraint, and when encountered should initiate a careful evaluation of the possible events and lethal pathophysiological processes.     

Autoerotic death: incidence and age of victims--a population-based study

Review of the Australian National Coronial Information System and the Swedish National Forensic Database was undertaken over a 7-year period from 2001 to 2007 for all cases where death had been attributed to autoerotic death or sexual asphyxia. In Australia, there were 44 cases (M:F = 42:2) with the majority of victims aged >30 years (77%)-a yearly national rate of approximately 0.3/million. In Sweden, there were nine cases (M:F = 9:0) with the majority of cases aged <30 years (55%)-a yearly national rate of approximately 0.14/million. The usual male predominance was present in both populations, although the Australian victims were older than is usually reported. Lethal sexual asphyxia is uncommon in both the Australian and Swedish populations, with a lower rate than has been cited for North America. Whether this is because of different kinds of paraphilic activities in different populations or of differences in methods of central data collection is uncertain.