Clinical forensic examination findings in assault cases among adolescents

Child and youth criminality has risen markedly over the past 25 years and causes increasing concern to the general public. The clinical forensic examination cases of youth violence victims examined at the Institute of Legal Medicine of the Hanover Medical School and its Oldenburg Branch between 1999 and 2008 were retrospectively analyzed. In all, 55 adolescents (37 females, 18 males; median age 15.5 years) were examined. In most cases the suspect was a close (40.0%) or passing (23.6%) acquaintance. 16 assaults were committed by two or more adolescents jointly. Most of the juveniles were victims of sexual assaults (56.4%). In 15 victims of sexual offences (51.7%) diagnostic findings were obtained on the basis of anogenital injuries and/or the presence of sperm. In summary, the analysis shows that adolescents frequently become victims of sexual assault. In addition, youth violence is often committed in a group.     

Child and elderly victims in forensic autopsy during a recent 5 year period in the southern half of Osaka city and surrounding areas

To outline the recent features of child and elderly victims from the medico-legal perspective with special reference to abuse and neglect, a retrospective investigation of forensic autopsy cases over a 5 year period (1994-1998) in the southern half of Osaka city and surrounding areas (a population of 1.57 million) was undertaken. Among 646 autopsy cases, there were 53 child cases (under the age of 15 years, about 80% below 6) and 121 elderly cases (65 years old and above). Nearly half of the child deaths and more than half of the elderly deaths were described as accidental. Fire and traffic victims were much more frequent in the elderly. Child victims included those of neonaticide/infanticide (n=6), physical abuse (n=10), unintentional fatal infliction (n=2), neglect (n=2), mutual suicide (n=2), suicide (n=1) and murder (n=3). Child abuse and neglect were domestic maltreatment by the parents. In this series, there was a comparable number of fatalities due to maltreatment in the elderly (n=13) and in children, and non-domestic violence was more frequent in the elderly than domestic violence. Elderly females tended to be battered by their sons or grandsons in domestic violence cases, whereas males were predominantly attacked by younger males in non-domestic violence. The other elderly victims included those of self-neglect (n=2), murder (n=7) and suicide (n=9). Non-domestic homicide of the elderly occurred mainly in the center of the city, whereas domestic maltreatment of children and the elderly was sporadic, although somewhat more frequent in the peripheral zone of the city and the surrounding areas. The above profile of child and elderly abuse suggests a substantial influence of social and familial backgrounds.     

Victim-related aspects of homicide of elderly persons in the catchment area of the Bonn Forensic Medicine Institute]

The present study examines the circumstances of 19 homicides involving 10 males and 9 females 60 years of age or older, which were submitted to the Bonn Institute of Forensic Medicine for autopsy. The incidence of these homicides sharply decreased by age. The causes of death were blunt force injuries alone or in combination in 8 cases and strangulation in 5 cases, thus reflecting the importance of the direct physical assault. Defense wounds were found in only 6 cases. The deceased unexceptionally suffered from diseases of the cardiovascular or respiratory system. Robbery or family/partner conflicts accounted for the vast majority of motives. Both, the most common location for homicide being in the victim's own residence and the high proportion of neighbours, acquaintances and relatives among the assailants underline that violence in the close social context endanger the elderly more than conventional violent street crimes. In the victims of homicide the elderly were represented in a smaller proportion than their percentage in the population at large. Over the 8 years of the present study there was no increasing tendency in the homicide rate in the elderly population.     

Injuries of the female genitalia in cases of sexual assault

Sexual violence is a global problem that particularly affects women and children. A retrospective analysis of 390 clinical-forensic examinations and 120 autopsies regarding injuries of the female genitalia in cases of sexual violence was performed. In the majority of cases no injuries of the female genitalia were found. Autopsy cases showed significantly more (and more serious) injuries of the genitalia than clinical forensic examinations (43 % vs. 25 %; p = 0.0004). Predominantly found were injuries of the external anogenital area, mostly tears or soft tissue lesions. In the current literature, data regarding the rate of injuries in victims of sexual violence vary strongly and their comparability is limited. Regarding the reconstruction of an offence, a forensic examination with an appropriate documentation of the injuries is evidently crucial.     

Homicide in the elderly. A study of homicide in the aged based on an Aachen autopsy sample of the 10-year period 1976-1985

Investigations on the peculiarities of homicides of the elderly are missing in the German literature up to the present date. Therefore we undertook an evaluation of the case files collected at the Aachen Institute of Forensic Medicine from the ten-year-period 1976-1985. Among 3736 autopsies we found 183 cases of homicide with 35 victims of 60 years and older. We collected peculiarities of modus operandi related to victim, suspect and offence and compared the data with such from police criminal statistics and partially with German population statistics. Two types of homicide of the elderly can be differentiated: One is independent of the victim's age whereas the other exploits the living conditions in the higher age (living alone, socially isolated, ailing, helpless etc.) For these latter cases the name "Gerontocide" is proposed. The paper deals with the peculiar difficulties of criminal investigation and clarification in such cases, resulting on the one hand from the lack of suspicion if elderly people die, on the other hand from the more difficult detection of causal relationship between offence and death--especially in the presence of severe illness of the victim.     

Child and adolescent victims in forensic autopsy: a 5-year retrospective study

Children of more than 3 years of age and adolescents have been largely overlooked in the forensic literature, especially the 4-9 age group. Thus, the present study was undertaken to address this particular issue of child and adolescent victims in forensic autopsies. On a 5-year period (2000-2004) in Quebec province (Canada), all forensic autopsy cases of children and adolescents from 4 to 19 years of age were retrospectively studied. A total of 223 cases of child and adolescent deaths (148 males, 75 females; 6.6% of all forensic autopsies) were reviewed. Age, gender, manner of death and cause of death were analyzed for all victims organized into three groups of age: 4-9, 10-14, and 15-19. Moreover, homicide cases (n = 54) are further analyzed in terms of method(s) used (firearm, sharp force, asphyxia, blunt force, intoxication). This 5-year retrospective study may contribute to a better understanding of typical deaths in the 4-19 group of age and therefore, bring a working basis for the forensic pathologist or medical examiner/coroner.     

Injuries due to deliberate violence in Chile

An analysis was made over a period of 6 months of the incidents involving deliberate violence as registered in 'Vicaria', the clinic for out-patients within the Cathedral of Santiago de Chile. A total of 236 victims of deliberate violence were observed. Men aged 15-24 years were found to be victims of deliberate violence most frequently. 'Under education' was the most frequently registered occupation for both sexes, and a large group of male victims were 'Unemployed'. 82% of the victims were men and 14% women, 1.5% were boys and 1.5% girls less than or equal to 14 years of age. None of the victims were alcohol intoxicated when arriving in the clinic. The incidents took place in streets for 81% of the male victims and 79% of the female victims, and in the majority of the cases the aggressor(s) was one (or several) police officer(s). Six percent of the female victims had been injured at home. There was no reporting of the aggressor being a relative or acquaintance. The most frequent type of violence was blunt violence from baton(s) (44%), while blunt violence without the use of instruments was reported less frequently (33%). The use of firearms was registered in 18% of the cases, and of sharp instruments, combustion, electro-shock and chain in 1.4%, 1.4%, 1.1% and 0.4% of the cases respectively. A total of 517 primary and secondary diagnoses were applied to the patients. Most of the victims (99%) had moderate or less serious lesions according to the Abbreviated Injury Scale (AIS) (score less than or equal to 2). Twenty-four percent of the victims had more than 4 lesions, and 7% more than 10 lesions. The head/neck region and the trunk were affected with equal frequency, the frequency of injuries of the head/neck region being comparable with that observed among torture victims and in contrast to the pronounced predominance of injuries of the head/neck region observed in a Danish emergency ward study of deliberate violence.     

Multiple homicides--forensic and criminologic aspects

The interpretation of medicolegal findings in homicide is an important tool of case profiling (so-called "operative case analysis"). In 17 cases of "multiple homicides" involving 22 offenders (21 males, 1 female; mean age 33 years) and 45 victims (21 males, 24 females; mean age 35 years; 41 fatalities, 4 survivors), the autopsy reports and the prosecution authorities' files were retrospectively analysed with regard to individual characteristics of perpetrators and victims, circumstances, and mode of commitment in order to comprehensively characterise relevant forensic and criminologic aspects. 31 victims were found to belong to the close social environment of the perpetrator, and 32 killings were committed in the victim's, perpetrator's or the joint flat. The main motives included greed (n = 7), personal conflicts (n = 5) and concealing of a crime (n = 9). The relevant injuries were attributable to gunshot wounds (n = 13), sharp force (n = 11), blunt force (n = 3), ligature strangulation (n = 3), smothering (n = 6), fire/carbon monoxide (n = 2) and combined impacts (n = 7). In 12 victims, defense injuries were found. The blood alcohol concentration exceeded 1.5 g/l in 5 victims. In 5 offenders, a psychiatric impairment of juridical responsibility was assessed (and 20 German criminal code, n = 1, psychosis; and 21 German criminal code, n = 4; acute alcohol intoxication). As far as data were available, 16 crimes were judged as murder, 12 as manslaughter and one as physical injury with fatal outcome.     

Twenty years of femicide in Milan: A retrospective medicolegal analysis

Femicide constitutes a leading cause of premature deaths for women, yet it has been the subject of limited research until recently. Enhanced data collection and analysis on killings of women and girls are necessary to understand and address this unrelenting phenomenon. This study examines all cases of female homicide encountered at the Institute of Legal Medicine of Milan (Italy) spanning from 1999 to 2019; data from 2020/2021 were shown separately given the bias that the forced cohabitation and stay at home during the lockdowns of the SARS-CoV-2 pandemic may represent regarding violence against women and femicide. In this study, specific factors were considered, including the age and nationality of the victims, the place of recovery of the bodies, the victim’s relationship to the perpetrator and the injuries they suffered. As a result, 200 female killings were found among the over 15,000 autopsies and 535 homicides investigated at the Institute of Legal Medicine of Milan from 1999 to 2019, representing an average of 9.5 femicides yearly. The majority of victims were Italian (74%) and half were aged between 18 and 49 years old. The killings were overwhelmingly committed in the domestic setting (78.5%) by male perpetrators (at least 85%), related to the victims as intimate or ex-intimate partners and members of the family (73.5%). The homicides were mainly perpetrated with sharp (32%) or blunt instruments (21.5%), shooting (18.5%) and asphyxiation (16.5%). This study is part of a growing effort to enhance data collection and analysis on femicide. Studying and monitoring the rates of femicide (or “femicide watch”) will permit to better understand, reduce, and finally end femicide globally.     

Stranger and acquaintance sexual assault of adult males

This study examined victim and assault characteristics and the nature and extent of coercion, violence, and physical injuries among adult male victims of sexual assaults. Client records of three groups presenting to a sexual assault care center were included: males assaulted by a stranger (n = 64), males assaulted by an acquaintance (n = 81), and females assaulted by an acquaintance (n = 106). Study results revealed that male victims of sexual assault tended to be young, single men who reported high rates of vulnerabilities such as homelessness and physical, psychiatric, and cognitive disabilities. Male stranger assailant victims were more likely to experience assaults involving weapons and physical violence. Injuries sustained by victims and services delivered at the sexual assault care center were similar for both male and female clients. The results of this study reveal new information about violence in male sexual assaults and the vulnerability of the male victims.     

The Social Construction of Roles in Intimate Partner Violence: Is the Victim/Perpetrator Model the only Viable one?

An ongoing discussion in the partner violence (PV) literature exists concerning the respective roles of perpetrator and victim. Most of it is gender based. The classical feminist argument is that women are victims of the violence and this is sustained by the social perception of them as victims. More recently increased recognition of mutual violence has taken place, calling into question the gender-based victim/perpetrator model. Recent research further calls into question this role differentiation through findings indicating that a majority of the protagonists in the PV drama view themselves as victims. A corollary to this controversy is that whether a man or a woman is the victim, the principal client in conventional intervention with PV is the woman. This paper will argue that the relevancy of gender-based role differentiation for most PV cases is not supported by recent data, and that incorporating an interactive perspective enables a more complex view than the classical victim/perpetrator one, and may improve our practice with PV populations.     

Adolescent homicides in Finland: offence and offender characteristics

Approximately 9% of the homicides in Finland are committed by adolescents under 20 years of age. The purpose of this study was to investigate the offence and offender characteristics in homicidal adolescents. Forensic psychiatric evaluation statements of adolescent offenders accused of a homicide during 1990-2001 were reviewed retrospectively (n=57). In 38% of the cases, there were multiple offenders. In 58% of the cases, the victim was an acquaintance, in 25% a stranger, in 12% a family member and in 5% of the cases an (ex)intimate partner. Sixty-nine percent of the offenders were intoxicated and 21% under the influence of drugs at the time of the killing. The most frequent motives were an argument (25%) and a robbery (25%). Sixty-four percent of the offenders had developmental problems and 42% had a crime history. Approximately half were diagnosed as having a conduct or a personality disorder, but 32% of the offenders were considered not to suffer from a mental illness or substance abuse. For 63%, the level of intellectual functioning was average or above average. There were signs of more than one form of violence in 54% of the cases and 28% of the cases contained excessive violence. The use of multiple and excessive violence was significantly related to the offender age, multiple offenders, offender-victim relationship and substance abuse, but not related to having developmental problems, crime history or mental illness.     

Forensic case profiling aspects on multiple homicides from the Cologne-Bonn metropolitan area 1985-2000

The medicolegal and subsequent criminologic interpretation of forensic and pathological findings in cases of homicide makes up an important tool of case profiling. In a retrospective study of 26 cases of "multiple homicides" involving 31 perpetrators (30 males, 1 female, mean age 33.5 years) and 73 victims (33 males, 40 females, mean age 36 years, 68 fatalities, 5 survivors), autopsy reports and prosecution authorities' files were investigated with regard to individual characteristics of victims and offenders, circumstances as well as mode of commitment. The major aim of this study was to comprehensively elucidate and characterise relevant forensic and criminologic features, which may gain importance for forensic case profiling. Forty-six victims were found in the close social environment of the perpetrator and 45 homicides were committed either in the victim's, the perpetrator's or the shared domicile. The main motives included concealment of a crime (n=13), personal conflicts/domestic arguments (n=7) and greed (n=12). The relevant injuries with regard to the cause of death were attributable to sharp force (n=13), blunt force (n=7), gunshot wounds (n=24), ligature strangulation (n=3), smothering (n=5), fire/carbon monoxide (n=4) and combined impacts (n=11). In 15 cases, so called defence injuries were found. In 5 victims a post-mortem blood alcohol concentration >1.5 g/l was determined. In six perpetrators, a severe psychiatric impairment of juridical responsibility was ascertained (Section 20 German criminal code, n=2, psychosis; Section 21 German criminal code, n=4, acute alcohol intoxication). As far as conviction data were available, 27 crimes were juridically assessed as murder, 12 as manslaughter and one as bodily harm with fatal consequences.     

Mountaineering fatalities on Mount Rainier, Washington, 1977-1997: autopsy and investigative findings.

Mountain climbing is a popular recreational activity with a growing number of participants and associated fatalities. To define the characteristics of these fatal incidents and the typical autopsy findings in the victims, we reviewed the autopsy and investigative findings of all fatalities that occurred on Mount Rainier from 1977 through 1997. A total of 50 deaths occurred in 29 separate incidents. Fifty-eight percent of accident victims died as the result of a fall; another 34% died as a result of an avalanche. The incidents leading to death occurred at an average altitude of 3652 m (11,977 feet); range, 2073 to 4389 m (6800-14,400 feet). The average age of the victims was 31.2 years (range, 17-55 years), and 47 of the 50 were men (94%). Bodies were not recovered in 13 cases (26%). Autopsies were performed in 30 of the remaining 37 cases. At autopsy, the cause of death was ascribed to multiple injuries in 12 cases (40%), isolated head and neck injuries in 7 cases (23%), and chest injuries in 1 case (3%). Asphyxia and hypothermia were the cause of death in 8 cases (27%) and 2 cases (7%), respectively. The frequency of specific injuries is presented by anatomic region. The unique autopsy and investigative features of mountaineering deaths are discussed.     

Victims of Intimate Partner Violence. The Physician’s Intervention in the Portuguese National Health Service

This study intends to characterize the current situation in Portugal regarding intimate partner violence (IPV) disclosure by the victims and its detection and report by the National Health Service (NHS) professionals, in order to promote the health and protection of the former. We interviewed 101 adult victims of IPV who sought care in the NHS. The results reveal that a relevant number of victims did not disclose the abuse to NHS physicians (18.8 %). According to the victims, in 57.9 % of the cases, physicians did not suspect IPV. In cases where there actually was suspicion (based on specific evidence and markers) or where there was no concealment of such type of violence, 52.3 % of the physicians did not inform the victims about the risks this situation posed to them, 89.8 % did not mention their obligation to denounce the case (as it is foreseen by the Portuguese law), and the number of injuries they described was lower than the one described in the forensic medical reports.     

Examination reports on survived strangulation cases

Clinical-forensic examination of strangulation victims is an increasing part of the routine of many forensic pathology institutes. The cases examined between 2004 and 2008 at the Institute of Legal Medicine of the Hanover Medical School were retrospectively analysed. In total, the study material comprised 218 victims (175 females and 43 males). In 80.7 %, the clinical-forensic examination was performed within 24 hours after the incident. In the overwhelming number of cases, the alleged perpetrator was no stranger. 128 victims (58.7 %) had strangulation marks, 32 victims (14.7 %) ligature marks and 65 victims (29.8 %) nail marks. Four victims showed injuries of the laryngeal and pharyngeal structures (reddening, hematomas, swelling and in one case a fracture of the cricoid cartilage on both sides). Extensive petechiae were predominantly seen in the conjunctivae, the buccal mucosa and the skin of the face in cases where the victims suffered a loss of consciousness. 87 cases (39.9% were classified as potentially life-threatening and 30 cases (13.8 %) as acute life-threatening events. This classification is of legal relevance for the penalty. In addition, 60 victims experienced sexual violence. These results suggest that early clinical-forensic examination is crucial for documenting forensic evidence in support of police investigations and may deliver significant details relevant in court.     

Blame attributions and rape: Effects of belief in a just world and relationship level

Purpose. The blaming of rape victims can cause secondary victimization. It is of importance to investigate factor that might lead to victim blaming. This study investigated the effect of belief in a just world (BJW), gender of participant, and level of relationship closeness between victim and perpetrator on attributions of both victim and perpetrator blame. Methods. In a between‐subjects experiment, a community sample (N= 166) answered questions of victim blame and perpetrator blame after reading one of four scenarios, each depicting a different level of relationship between the victim and the perpetrator (strangers, acquaintances, dating, or married). Results. Overall, high levels of perpetrator blame and low levels of victim blame were found. Contrary to previous research, the victim of a stranger rape was blamed more than when the perpetrator was known to the victim. Furthermore, participants high on BJW attributed higher levels of victim blame and lower levels of perpetrator blame. Specifically, female participants high on BJW attributed most blame to a victim of stranger rape. Conclusions. In conclusion, BJW was a significant predictor of blame attributions, and relationship type is a variable that merits further research.     

Gender-Role Stereotypes and Perceptions of Heterosexual,Gay and Lesbian Domestic Violence

Although domestic violence occurs in all types of relationships, non-prototypical cases (e.g., gay male, lesbian, female-against-male) are often overlooked. We replicated and extended previous research demonstrating that perceptions of heterosexual and same-sex domestic violence are generally consistent with gender-role stereotypes. Male and female undergraduates read one of four domestic abuse cases varying by victim and perpetrator sex and sexual orientation. Victim sex, ratherthan sexual orientation, was the most potent predictor of responses, although male-against-female violence was considered the most serious and deserving of active intervention. Domestic violence perpetrated by men or against women was judged more serious than violence perpetrated by women or against men. Perceptions that male perpetrators were more capable of injuring victims, and female victims were more likely to suffer serious injury were consistent with gender-role stereotypes.