Suicidal fire deaths revisited

A study of self-immolation or suicidal fire deaths was performed on the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, Florida, during the 8-year period from 1977 to 1984. A total of 24 cases, representing 0.96% of the suicides that occurred during this period, were collected and analyzed as to age, race, sex cause of death of the victim along with the blood alcohol content at autopsy, drugs detected at autopsy, and the terminal carboxyhemoglobin. Additionally, the scene circumstances, geographic location of the terminal incident, the reason for the suicide, whether or not there was a past suicide attempt, a past psychiatric history, how the fire was started, presence or absence of an outside example, time of occurrence, presence of hospitalization, and presence of a suicide note were also noted. Most of the victims were white women of over 50 years of age who died of thermal injuries. Half of the time the blood alcohol content was negative at autopsy, 1/3 of the time the drug screen was negative, and 1/3 of the time a small amount of carboxyhemoglobin was noted. Most fires originated at home, although motor vehicles were also common. Reasons for the suicide were varied. Of the cases 1/3 had a precious suicide attempt and approximately 1/2 of the cases had a psychiatric history. Commonly, the fire is started by pouring a flammable liquid on one-self as isopropyl (rubbing) alcohol or gasoline and igniting it. No outside media examples were noted. These events occurred more frequently in the afternoon or evening.(ABSTRACT TRUNCATED AT 250 WORDS)     

Suicidal buflomedil intoxication

A suicidal intoxication of a young woman following an overdose of buflomedil is reported. She died in a hospital 17 hours after ingestion. In various body fluids the following buflomedil concentrations were determined: heart blood 24.5 microg/ml, liquor 21.3 microg/ml, bile 39.1 mg/ml and urine 138.6 mg/ml. Additionally the results of autopsy and histology are presented. Anemia of the internal organs was conspicuous; this finding is attributed to the vasodilating effect of buflomedil on the peripheral vessels.     

Suicidal yew ingestion

A 41-year-old man was found dead, lying in prone position on the ground near a parking area, where the car of the person was parked. Remarkable were the spasm-like hands of the decedent, cause of death was unknown. Primary an epileptical attack was assumed. A medicolegal autopsy was performed followed by histological and forensic toxicological analysis. Furthermore a plant anatomical investigation was applied. Autopsy revealed fragments of greenish needle-like leaves in the stomach and the intestines, but not in the colon. Plant anatomical investigation indicated the presence of yew. Histological findings were in concordance with the literature, in addition the investigation of bone marrow was performed for the first time. Forensic toxicological analysis revealed the presence of 3,5-dimethoxyphenol, the marker for intoxication with taxus baccata.This case reports the importance of medicolegal examinations in order to avoid misdiagnosis. Here the suspection of an epileptical attack as a possible cause of death was excluded by an autopsy, in addition an intoxication by yew leaves was proved.     

Suicidal electrocution using timers. Case reports and review of the literature]

Suicidal electrocution using a time switch is relatively rare. Based on two cases from the authors' own forensic material and seven cases from literature peculiarities regarding the concomitant intake of medicines (benzodiazepines) and alcohol are discussed and comments are made how to proceed in the criminal and forensic investigation of such cases.     

Accurately assessing elderly fall deaths using hospital discharge and vital statistics data

Historically, fatal injury monitoring and surveillance have relied on mortality data derived from death certificates (DC). However, problems associated with utilizing DC have been well documented. Recently, access to and utilization of hospital discharge data (HDD) have offered a new and important secondary source of data regarding in-hospital deaths. However, studies have shown that discrepancies between the HDD and the corresponding DC often exist. This discrepancy was especially evident when comparing HDD to the vital statistics data (VSD) for deaths by falls among those aged 65 and over in 19 states.This was a retrospective forensic review of elderly (age 65 and over) fall-associated fatalities (E880-E888) identified from HDD and VSD in Allegheny County, Pennsylvania, between 1997 and 1998. Seventy-seven cases were identified, with the original manner of death listed as natural (34), suicide (1), and accidental (42) on the DC. Following a forensic review of the cases, the manner of the death on the DC should have been changed from natural to accidental in 28% (n = 12) of the cases, representing an undercount in the VSD. Undercounts were due to a failure of clinicians to account for the significance of a fall event that contributed to subsequent pathology and death. In addition, in that 22% (n = 17) of the HDD fall-associated deaths, the fall did not contribute directly or sequentially to the underlying cause of death, thereby representing an overcount in the HDD.Based on these findings we recommend (1) elderly fall surveillance systems should only count HDD E-coded falls that demonstrate a serious traumatic injury which directly or subsequently results in death, (2) all in-hospital fall-associated deaths should be reported to and reviewed by coroner/Medical Examiner offices for determination of the cause and manner of death, and (3) physicians should be better educated in properly completing death certificates.     

Suicidal electrocution in a bathtub

A case of suicidal electrocution in a filled bathtub is presented with a discussion of the mechanism of electrocution in water. A modern safety device, the Ground Fault Interruptor Circuit, is also described.     

Suicidal transurethral perforation of bladder

This case report describes a highly unusual way of committing suicide: the insertion of a cylindrical foreign body through the penile urethra, resulting in perforation of the urinary bladder and abdominal hemorrhage. The manner of death was determined by a psychological autopsy that successfully ruled out an autoerotic (accidental) death. The case is presented in order to alert medical examiners and psychiatrists that such a unique and painful method of taking one's life exists.     

Suicidal administration of elemental arsenic

A case of suicidal arsenic poisoning with predominantly gastrointestinal symptomatology is reported. According to his own statement, a student of chemistry had taken in 30 g of metallic arsenic. During the following period he suffered from frequent vomiting and excessive diarrhoea. Approximately 15 hours after the oral application he sought for medical help and was brought into a hospital. Despite of gastric lavage with carbo animalis, hemodialysis, and BAL as antidote the patient died after a survival time of altogether 48 hours. By means of x-ray fluorescence analysis and atomic absorption spectrometry 350 mg of arsenic could be detected in the gastric fluid of the corpse; x-ray diffractometric analysis actually proved the presence of elemental arsenic. Nevertheless it can't be excluded that the metallic form was contaminated with arsenic oxides. The paper presents the clinical course, the analytical data, and the postmortem findings.     

Suicidal decapitation using a tractor loader: a case report and review of the literature

In forensic practice, decapitated bodies are predominantly associated with decapitation by wheels of trains or with postmortem dismemberment following homicide. In the suicidal context, decapitation accounts for less than 1% of total suicide. Apart from decapitation by trains, other encountered methods involve suicidal hanging and vehicle-assisted ligature suicide. Reported here is a unique case of suicidal decapitation in a 45-year-old man using a tractor loader at the foot of a silo, on his farm. The head was recovered in the loader and there were several impact spots from the loader as well as blood on the silo wall. The autopsy revealed a complete decapitation wound with the severance plane located between the third and fourth cervical vertebra. A 1.5 cm wide abrasion on the anterior part of the neck and abrasions under the chin were noted. This very unique case of intentional suicidal decapitation is the first reported case of a planned system intended to create decapitation outside the unique case of homemade guillotine and the more common decapitation by train.     

Pregnancy-related maternal deaths

Pregnancy is a normal biologic process, but because of a variety of physiologic factors, it increases a woman's risk for death. Maternal deaths in pregnancy may be due to conditions unique to pregnancy, conditions associated with pregnancy, or conditions unrelated to but exacerbated by pregnancy. Death may occur during any trimester, during labor/birth, or postpartum. In this report, we present 45 cases of pregnancy-related maternal deaths that were investigated and autopsied at the Dallas County Medical Examiners office between 1977 and 1999, and we review the topic of pregnancy-related maternal death.     

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.     

Unusual hanging deaths

We describe the circumstances and medical findings of four unusual hanging deaths. In brief, the unusual features are tracheostomy, delayed death, self-mutilation combined with severe neck injury caused by lengthy drop, and homicidal hanging in a young girl.     

Suicidal drowning in south Florida.

Autopsy protocols at the office of the Chief Medical Examiner were reviewed with respect to suicidal drowning. Between July 1, 1994 and June 30, 1998, there were 267 drownings and 873 people committed suicide in Broward County, Florida. Of those, 25 were suicidal drownings, representing 2.86% of all suicides, and overall the 8th leading cause of suicidal death. When considering suicide in the age group of 65 years and older, (n = 239), which accounts for 19.8% of the population and 27.4%, of all suicides, drowning represents 6.7% of all suicidal deaths, and within females in this group represents the third most common form of suicidal death (13.8%). The presence of alcohol or other drugs is less usual in elderly suicide victims than younger victims. Of the 25 drowning suicides, there was a preference for swimming pools, canals, and lakes as the locations of choice. Additional drowning and suicide related criteria were evaluated including marital status, mental health, clothing worn, previous attempts or threats, suicide notes, and personal effects at the scene; with the intention of establishing a profile for drowning by suicide. Given the relative abundance of water, the suicidal drowning rate appears to be lower than what might otherwise be anticipated.     

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.     

Suicidal hanging within an automobile.

Accidental asphyxia related to cars has been described in different reports, but suicidal hanging in an automobile is very unusual. Two cases of suicidal hanging inside an automobile are described, illustrating an unusual form of hanging. In one case, the deceased used his belt as a ligature, and the point of attachment was the window of the car. The second victim used the safety belt of the passenger seat. In both cases, the automobile engine was turned off, all the windows were closed, and the door locks were blocked. The medicolegal cause of hanging was based on the scene of the investigation, police and witness reports, social history, autopsy findings, and toxicologic examinations.     

Evaluation of the role of abstinence in heroin overdose deaths using segmental hair analysis

In the body heroin is rapidly metabolized to 6-acetylmorphine and morphine. Victims of lethal heroin overdose often present with fairly low blood concentrations of morphine. Reduced tolerance due to abstinence has been proposed to account for this finding. The aim of the present study was to examine the role of abstinence in drug-related deaths by comparing recent and past exposure to opioids using segmental hair analysis with the postmortem blood morphine concentrations in deceased heroin users. The study included 60 deceased drug addicts in the Stockholm area, Sweden. In 32 cases, death was not related to heroin intake. In 18 of the 28 heroin fatalities, opioids were absent in the most recent hair segment, suggesting a reduced tolerance to opioids. However, the blood morphine levels were similar to those found in the 10 subjects that showed continuous opioid use. Hair and blood analysis disclosed an extensive use of additional drugs that directly or indirectly may influence the opioid system. The results suggest that abstinence is not a critical factor for heroin overdose death. Obviously tolerant subjects die after intake of similar doses. Other factors, particularly polydrug use, seem to be more causally important for these deaths.