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.     

Methods of Choice in Completed Suicides: Gender Differences and Review of Literature

Abstract:  Suicide is an important public health hazard worldwide. A 4-year retrospective study from January 2000 to December 2003 was conducted to identify the favored methods in realized suicides among males and females in the west coastal region of India. During the study period, a total of 539 cases of suicidal deaths were autopsied. Males were predominantly affected (male: female—1.9:1). The age of the victims ranged from 13 to 90 years in males (mean = 40.1 years, median = 37.0 years) and 15 to 85 years in females (mean = 36.6 years, median = 32.0 years). Most favored method of suicide amongst males and females was hanging (36.9%, n  = 199) followed by poisoning (34.7%, n  = 187). Male dominance was apparent for each method of suicide except for self-immolation. Males were relatively more likely to use hanging and poisoning while females were more likely to prefer drowning and self-immolation as methods of suicide. Relatively younger females (mean   = 33.0 years, median = 32.0 years) preferred hanging as a method of suicide when compared to males (mean = 42.4 years, median = 40.0 years). Among females, significantly younger females resorted to hanging when compared to older females who preferred drowning. On investigating the various theories proposed for choice of suicide methods in males and females in different regions we conclude that preference of method of suicide in men and women is complexly determined. In this region, availability, accessibility, popularity, and socioacceptability seem to be the major determinants in the choice of methods among males and females rather than violence associated and lethality of the method. Females were as likely to use lethal and violent methods as males in this region.     

Death certification of "suicide by cop"

Death certification of "suicide by cop" is controversial among some medical examiners and coroners. We present five such deaths that were certified as suicides and discuss the medico-legal issues involved with these certifications. To certify such a death as a suicide, certain criteria should be met. Suicide by cop is a circumstance that involves competing intentional acts that may result in dichotomous determinations of the manner of death. Despite the absence of direct self-infliction, there is overwhelming evidence that these five individuals intended to end their own lives. Their use of an unusual method to accomplish this goal may inappropriately result in a reflexive certification of homicide. All of the decedents possessed weapons or a facsimile of a weapon. We present five instances of suicide by cop and contend that these types of deaths are best certified as suicides.     

Fatal Electrocution by a Support Metal Wire

Abstract: Electrocution is not an uncommon cause of death. A case of fatal electrocution by a metal wire that was used as a support for the insulated television cable wire is reported. Electric current flowed through the metal wire when it touched the residential power line. Electrical injury caused because of contact with the live metal wire is described with histopathological findings. This case reports the circumstances that led to accidental fatal electrocution in an outdoor setting during the rainy season. Significance of death scene investigation to confirm the cause and manner of death in cases of fatal electrocution is highlighted. Public awareness programs to lay emphasis on electrical safety in domestic environment need to be introduced to prevent fatalities resulting from ignorance and/or negligence.     

Why Do People Hang Themselves on Trees? An Evaluation of Suicidal Hangings on Trees in Konya,Turkey, between 2001 and 2008

Hanging is the most common method of suicide in the world, and many public places offer a means or opportunity to carry out the activity. Of 4,452 death examinations and autopsies, there were 378 (8.5%) suicides and suicide method was hanging in 185 (48.9%) cases. In 20 of these (10.8%), the suspension point was the branch of a tree. The incident location was the garden of the victim's house in nine cases, the woodlands in seven cases. The suicides were attributed to psychiatric disorders in nine cases, economic problems in six cases, and family problems in five cases. It is concluded that hanging on a tree as a suicide method is often committed by males and the underlying motive may be different in suicidal hangings on trees occurring at daytime and night. For preventional purposes, the reporting of such suicides in public places by the media may be restricted by local authorities.     

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.     

Usefulness of Systematic Histological Examination in Routine Forensic Autopsy*

Abstract: The forensic community does not agree on the need to perform histological examination at forensic autopsy. The aim of our study was to determine the usefulness of systematic standard histology in forensic autopsies. A prospective study was carried out on 428 autopsy cases for which standard histological examination was systematic. Mechanism of death not shown by gross anatomic findings was discovered by histology in about 40% of the cases. Cause of death was established by only histology in 8.4% of the cases. Microscopic findings affected the manner of death in 13% of the cases. Histology provided complementary information about prior medical condition of the deceased in about 49% of the cases. Traumatic lesions were better documented by histology in about 22% of the cases. According to the results of our study, systematic standard histology for the main organs should be used in routine forensic autopsies.     

Percentage of body recovered and its effect on identification rates and cause and manner of death determination

Anthropologists frequently encounter cases in which only partial human remains are recovered. This study reports how the percentage of the body recovered affects identification (ID) rates and cause and manner of death determination. A total of 773 cases involving anthropology consults were drawn from the New Mexico medical examiner's office (1974-2006). Results indicate a significant correlation between body percent recovered and ID rates, which ranged from 89% for complete bodies to 56% when less than half the body was present. Similar patterns were evident in cause/manner determination, which were the highest (83% and 79%, respectively) in complete bodies but declined to 40% when less than half the body was found. The absence of a skull also negatively impacted ID and ruling rates. Findings are compared with general autopsy ID rates (94-96%) and cause/manner determination rates (96-99%) as well as prior published rates for individual casework and mass death events.     

Characterization of lesions in hanging deaths

Hanging is a common method of committing suicide and a routine task in medico-legal autopsies. The hanging mark is the most relevant external sign and its characteristics are well known, but, for unknown reasons, there are major differences in reports on internal findings. We retrospectively studied 228 consecutive cases of hanging deaths. A complete standard autopsy was performed for every case. We investigated the association between the characteristics of the hanging mark and the frequency of bone, cartilage, soft tissue, and vascular injuries with the mode of suspension. Most cases (75.3%) presented some kind of bone or cartilage fracture, but these were unrelated to any of the variables studied. Vascular lesions are clearly more infrequent: intimal injuries were found in the carotid artery (9.1%), the jugular vein (2.2%), and ruptures of the carotid adventitial layer (21.7%). These could be partially associated with the use of a hard fixed noose and body weight.     

Alcohol ingestion and age of death in hanging suicides

Retrospective review of 100 consecutive, nondecomposed cases of suicide because of hanging was conducted at Forensic Science SA, Australia. Alcohol was detected in 38 cases (38%). The percentage of victims who had ingested alcohol significantly decreased with age (r(2)=0.81), with alcohol detected in 57.1% of those aged ≤24 years, compared to 28.5% of those aged between 55 and 64 years, and 0% of those aged ≥65 years. A similar linear relationship between alcohol ingestion and age was found for cases with blood alcohol levels >0.05 g/100 mL (r(2)=0.73). The mean ages of those with detectable alcohol (35.2 years) levels >0.05 g/100 mL (35.1 years) and levels >0.1 g/100 mL (37.2 years) were all significantly less than in those with no detectable alcohol (44.4 years) (p<0.005, <0.005, <0.05 respectively). A clear relationship between alcohol ingestion and younger age was shown in hanging suicides.     

Further observations on the speed of death in hanging

Given that most fatal hangings are suicidal and occur in locations that have been selected to conceal this activity (thus maximizing the chances of a lethal outcome), there has been very little corroboration of the speed with which unconsciousness and death may occur. A 35-year-old male is reported who committed suicide by hanging immediately after talking to his spouse. Police investigations confirmed her reliability as a witness indicating that lethal anoxia in this case had occurred within a very short time (most likely in less than 1 min) of suspension. The speed with which death may result from hanging not only gives an insight into fatal pathophysiological mechanisms, but also provides useful information for situations where a lethal outcome is to be avoided, or is not intended. For example, individuals at risk of suicide who are being monitored in institutional facilities need to be constantly under direct visual surveillance as significant hypoxia can be rapidly induced, parents and caregivers with infants and children in potentially unsafe sleeping environments need to realize how swiftly death or irreversible anoxic brain damage may occur from neck compression, and those who engage in recreational asphyxia should be informed just how quickly a fatal outcome may ensue.     

Suicidal Shotgun Wound Employing a Shotgun Barrel,a Shotgun Shell,and a BB*

Abstract: A vast majority of firearms‐related suicides involve the conventional use of a properly functioning, intact firearm. Occasionally, forensic investigators encounter a case wherein the firearm suicide victim employs some form of unconventional use of a weapon, or utilizes an unusual weapon type. In this case report, the authors present an unusual case in which a man committed suicide by using a shotgun shell, a shotgun barrel (separate from the rest of the gun), and a BB. Some confusion as to the cause and manner of death was present during the initial scene investigation. Examination at autopsy revealed the cause of death to be a shotgun wound of the chest and prompted further scene investigation. Therefore, this case serves as another example of the importance of cooperation between scene investigators and forensic pathologists when investigating a death. A review of suicidal firearm cases using unconventional means and/or firearms is presented.