Suicide by intravenous injection of cocaine. A report of three cases

Death as a consequence of cocaine abuse is continuing to increase in all parts of the United States. Cocaine use may cause the development of psychosis, with subsequent expression of suicidal ideations, and potentially even successful suicide. Cocaine dependence may also cause depression in the individual who is unable to control his or her craving for the drug, and suicide may be perceived as the only solution to a desperate problem. Despite the dramatic escalation of cocaine abuse and the potential toxicity of this drug, there have been no reports within the United States of cocaine being used as the agent to accomplish a suicide. Herewith are reported three cases in which depression and desperation over cocaine dependence were the motivations for successful suicide, which was accomplished through the intravenous injection of cocaine to the point of death. True cocaine suicide is probably only identified through the presence of objective scene information that unequivocally proves suicidal intent, such as notes or letters which contain information to this effect. A careful search of the scene of death in cocaine fatalities is mandatory, and diligent application of routine scene investigation principles may reveal that suicide through the use of cocaine is more widespread than first appearances would suggest.     

Two unusual cases of suicide by hanging

Two unusual cases of suicide by hanging are described, in the first case the deceased's left hand tied to the left thigh with the head and face covered by a heavy winter coat. In the second case the deceased's hands were tied behind his back.     

Suicide by xylene ingestion. A case report and review of literature

A 27-year-old male committed suicide by ingestion of a large quantity of xylene. The presence of xylene in the tissues of the victim was confirmed by chromatographic and spectrometric techniques. High levels of xylene were detected in blood (11 mg/dl), gastric contents (880 mg/dl), and duodenal contents (3,300 mg/dl). Histological examination of the lungs showed severe congestion and acute pulmonary edema. Review of the relevant literature is presented.     

Suicide by hara-kiri: a series of four cases.

The authors describe four cases of suicide by hara-kiri. This very painful form of suicide consists of self-inflicting a wound in the abdomen using a sharp instrument. It was first reported in 988 A.D. in the East but has now become rare in both the East and West. These four cases occurred over a 40-year period in the Trieste and Bari medicolegal area. In two of our cases the victims were afflicted with mental illness, whereas the other two suffered from depression. In cases of death by hara-kiri, it is important to establish a differential diagnosis between suicide and homicide; the presence of trial wounds (inflicted by the victim as a form of practice to overcome any hesitation before stabbing the abdomen with the cutting weapon) can prove very helpful.     

Jail suicides by hanging. An epidemiological review and recommendations for prevention

This article reviews 17 cases of jail suicide occurring in Oklahoma in calendar years 1981 through 1983. Significant variables are reviewed, and recommendations for prevention are presented.     

Suicide: a ten-year retrospective review of Kentucky medical examiner cases

Suicide, a manner of death, ranked as the eleventh leading cause of death in the United States and accounted for approximately 30,000 deaths in 2001. A host of biological and psychosocial components interplay in a suicide investigation. Precipitating factors may include domestic quarrels, loss of employment, financial difficulties, substance abuse, chronic disease, or mental illness. The authors conducted a ten-year (1993--2002) retrospective review of suicide from all Medical Examiners' Offices in Kentucky. There were 2,864 suicides ranging between 11 and 96 years (average age 42.0 years). The majority of victims were males (81.7%) and Caucasian (94.8%). African-American females comprised the smallest group, consisting of only 0.59%. The preferred mode of death was by firearm (67.5%), followed by hanging (13.7%), overdose (9.9%), and carbon monoxide poisoning (4.4%). This comprehensive study discusses the trends of suicide in the United States during the twentieth century and underscores the importance of a multidisciplinary approach to the investigation and prevention of suicide.     

Suicide by drowning: a 20-year review

Drowning as a method of suicide is known to occur, but has primarily been described in environments with readily available access to water, such as coastal regions. In this study, we describe and analyze a series of suicidal drownings occurring in a noncoastal area of Texas. Between 1977 and 1996, 52 cases of suicidal drowning were investigated at the Southwestern Institute of Forensic Sciences in Dallas, Texas. Such deaths accounted for only 0.85% of all suicides and 4% of all drowning deaths. In contrast. suicidal drownings reportedly account for 2.8 to 8.9% of all suicides in regions with easy access to water. As with other studies of suicidal drowning, the victims are usually sober white males over the age of 40 years. Our results also confirm that certain individuals who commit suicide by drowning use weights to facilitate the process. A detailed analysis of the cases is provided. as is a synopsis of several questions that may aid in determining the manner of death in suicidal drowning cases.     

Decapitation by hanging

This case report describes the most infrequently observed decapitation by the rope in the event of a suicidal hanging. Knowing the length of the drop, it was possible to estimate the loading of the neck of about 13 500 N. This value appears to applicable to indicate the upper limit of tolerance of the neck.     

Suicide by means of a charcoal grill. Casuistic report with review of the literature

Due to the conversion of the gas supply from city gas to CO-free natural gas and the introduction of the catalytic converter technology for motor vehicles the number of suicides by CO poisoning has decreased considerably. Nevertheless suicides by CO poisoning are still committed once in a while. In the described case from the autopsy material of the Institute of Legal Medicine at Münster, the suicide used a charcoal grill as the source of carbon monoxide.     

Suicide by cop among female subjects in officer-involved shooting cases

An analysis of suicide by cop (SBC) among female subjects in a large sample (n = 707) of officer-involved shootings (OIS) is reported. Women represented 3% of the total sample (n = 21) and 5% (n = 12) of the 256 SBC cases. Therefore, 57% of the women (n = 12) were classified as SBC, and 81% of the women (n = 17) behaviorally evidenced some suicidal motivation. The results underscore that when a female subject becomes involved in a situation leading to an OIS, there is a very high likelihood that she is motivated to be intentionally killed. She is almost guaranteed to have a diagnosed mental disorder, has been prescribed psychiatric medications, and is abusing a substance at the time, most likely alcohol. Nevertheless, she also poses a serious risk of injury to both police officers and civilians during the encounter and will possess a firearm half the time. The wish for suicide is often precipitated by serious relationship issues. Comparisons are made to the male subjects in our previous study.     

Macro- and microscopic findings of cord marks in 2 cases of delayed death by hanging

Two cases of delayed death after suicidal or accidental hanging are reported. Despite equally long survival times (33 and 27 days, respectively) and macroscopically very similar cord furrows, segmental granulation tissue was present histologically in one case (suicide) below the cord furrow, and in the other case there was a normal corium. The main cause for the divergent ultrastructural findings consists in the variable degree of strangulation.     

Asphyxiation by hanging in two young Hispanic children--homicide, suicide, or accidental deaths? A review of pediatric hangings

Case reports of asphyxiation by hanging in two young children are presented along with a review of the literature to determine the incidence and manner of death by hanging in the younger pediatric population.     

Suicide by explosion of natural gas: case report and review of literature

Natural gas (NG) is used as a home energy supply and, with or without ignition, is rarely misused to result in death. The authors report an unusual suicidal explosive death induced by NG. A huge explosion with resultant fire had blown out a bungalow, with destructive damage predominantly above the ground, resulting in only 1 exterior wall and the foundation still in place. The victim was transferred to the hospital, and on the way, he admitted to undoing the natural gas fitting and to igniting the source. He survived for a short interval of time in the hospital before all resuscitative efforts failed. During autopsy, a special attention was paid to victim's identification and search for other injuries, not related to the explosion, so as to exclude or document homicidal injuries disguised by the subsequent explosion. The forensic pathologist should be aware of the different kinds of inflammable substances and integrate the findings with the scene information and the impression of the investigators at the scene.     

Transfer of biological traces in cases of hanging and ligature strangulation

In hanging and ligature strangulation, the noose mostly causes a mark or groove which is formed partly by compression of the skin and partly by abrasion with loss of the upper epidermal layers. The horny scales abraded from the neck may be transferred to the strangulation device or to the interposed textiles where they are sometimes visible at stereomicroscopic examination or even to the naked eye as silver-grey particles. The morphologic features of the epidermal transfer due to hanging and ligature strangulation is demonstrated by 14 case examples. The biological traces may be sufficient for comparative DNA typing by means of PCR-based methods. In 9 out of the 14 cases, genomic DNA typing was successful. Analysis of mtDNA succeeded in another two cases, although genomic DNA could not be detected. Beside the accumulation of solid epidermic particles the paper describes deposition of serous and fatty tissue fluid at the ligature (mainly adjacent to skin ridges).     

Suicide by drowning

A study of suicidal drownings was performed by using the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, Florida, U.S.A., during 1980-1984. A total of 70 cases were collected and analyzed as to the age, race, sex, and cause of death of the victim, along with blood alcohol content, the drugs detected at postmortem examination, the geographic location of the terminal incident, the scene circumstances, the presence or absence of a suicide note, and the reason for the suicide. Essentially, one deals with an older white male population, although all age groups can be affected. Members of the population studied frequently died from drowning alone, rather than from additional contributory causes. Most were sober and frequently without drugs detected. Most incidents occurred at home or in a canal, with the victim just "found floating". A note was absent approximately half the time. The reason for the act was depression concerning poor health, death of a loved one, financial problems, chronic pain, or being "tired of life". A discussion ensues about the approach a forensic scientist should have concerning such cases.     

Suicide by self-immolation

In the Western world, self-incineration is a rare event compared with the Asian countries. The circumstances of death are often unusual, and differentiation from homicide is sometimes possible only after evaluating all the investigation results and findings. In many cases of self-cremation, a fire accelerant is used. In our study material at least 30% of the body surface were burned. Unaffected skin was predominantly found on the back of the body. The cases presented by us are inhomogenous as to the motive and differ from those reported in the literature with regard to gender distribution, scene, motivational situation and psychological constitution.     

Suicide by pencil

We report an unusual suicide, committed with a common pencil. A 72-year-old male inflicted himself a penetrating thoracic wound while being hospitalized for a hip prosthesis operation. Although the patient was immediately operated, the cardiac injury appeared to be fatal. Cases of suicidal penetrating wounds of the anterior chest wall are rare and they are mostly inflicted by knives, glass fragments, or other sharp instruments. The potential danger of a pencil should be taken into consideration, especially in psychiatric hospitals and imprisonment facilities. We examined the legislation in Italy and Finland concerning the regulation of privacy in special care institutions.     

Fractures of the axis caused by hanging

Prerequisities for fractures of the neural arch of the axis in the region of the isthmus (hangman's fracture) during hanging are considered to be a long drop and a submental knot. A case is presented showing that hangman's fracture arising in hanging can result from stretching of the neck combined with anteroflexion of the head.     

Suicide by self-immolation in Durban,South Africa: a five-year retrospective review

Self-immolation is an uncommon method of suicide, and its occurrence in South Africa is thus far unknown. This study aimed to determine the prevalence of self-immolation deaths and to establish a profile of these cases and the circumstances under which this condition occurs. A 5-year (1996-2000) retrospective review at a mortuary in Durban, South Africa, was conducted. Data were obtained from the Department of Forensic Medicine, the Medical Research Council's National Injury Mortality Surveillance System, and police and hospital records. During the study period, there were 12339 nonnatural deaths, of which 696 (5.6%) were suicides. Self-immolation accounted for 69 (0.6%) of all nonnatural deaths and 69 (9.9%) of all suicides. The subjects had a mean age of 31.2 years and were predominantly female (76.8%) and black (81.2%). The mean burn surface area was 63.3%, and the mean injury severity score was 36.9. Accelerant use was documented in 53 (76.8%) of cases, and paraffin was preferred. All cases occurred indoors. The proportion of suicides due to self-immolation in our study is excessive when compared with international studies that report figures between 0.9% and 2.2% of suicides. Additional studies are necessary to further elucidate the reasons for this discrepancy.