Fictitious ambush following an attempted "extended" suicide

An unusual case of a 31-year-old-woman who was found near a forest road with self-inflicted injuries and burns is reported. The woman claimed to have been attacked by a man with a knife who then tried to burn her in her car. While she managed to escape, her cat died in the car. The examination of the wounds showed multiple superficial cuts in body regions easily accessible to her own hand. Gas chromatography of skin samples from the cat proved that it had been in in contact with a fire accelerant. On the basis of the examination findings, differential diagnostic aspects with regard to the motivation of the woman for simulating an offence are discussed. In all probability, the woman intended to commit suicide together with the cat through self-immolation, but did not complete the plan.     

Putrefaction and wound dehiscence: a potentially confusing postmortem phenomenon

The decomposed body of a 49-year-old man was found at his home address. At autopsy, 3 incised wounds of the lower abdomen and groins were identified, raising the possibility of some form of inflicted injury. Further dissection revealed that the wounds were healing surgical incisions that had been forced open by putrefactive tissue breakdown, swelling, and gas formation. Death was due to ischemic heart disease. Putrefaction is a common problem encountered in forensic practice that may result in considerable distortion and modification of tissues. Unusual skin lesions caused by the disruption and dehiscence of healing surgical wounds may be created by decomposition. This possibility should be considered when symmetrical, cleanly incised wounds are identified.     

Secondary combined suicide viewed by the wife]

A 47-year-old man was found dead at the bottom of a wall outward the door of the cellar of his house. Preliminary physical examination at the scene of the death revealed a laceration of the scalp, an incised wound in front of the neck and several stab wounds in the left chest penetrating through the clothing. Questioned by the police his wife told that her husband who suffered from severe depression had inflicted the incised and the stab wounds himself, had made an unsuccessful attempt at self-strangulation and had finally jumped down from the wall beside the stairs declining to the cellar of their house. As the circumstances of the scenario were suspicious and as the pattern of injuries arose doubts concerning self-infliction homicide was taken into consideration as well. Autopsy showed additional hesitation marks adjacent to the left end of the incised wound in front of the neck. The stab wounds of the chest were restricted to the region of the heart and displayed only minimal penetration of the chest-wall, findings characteristic of self-infliction. As a consequence the manner of death could be determined as prolonged suicide, and exact reconstruction was possible with the help of the wife's testimony.     

Sharp injury fatalities in New York City

We reviewed the case records of all fatalities due to sharp injuries in New York City in 1999. The epidemiological profile, circumstances, toxicology results, location, and injuries were examined. There were 120 deaths: 101 homicides, 17 suicides, and 2 accidents. The causes of death included: 112 due to stab(s) with or without incised wounds and 8 pure incised wound fatalities of which 5 were suicides. The detection of ethanol and/or illicit drugs was 61% in the homicide and 12% in the suicide groups. "Defense wounds" were reported in 49% of the homicides and "hesitation" wounds were found in 65% of the suicides. There were no self-inflicted sharp injuries of the face. Deaths due to a single stab wound occurred in 34% (34/101) of the homicides and 24% (4/17) of the suicides. Of these 38 deaths, 58% were of the anterior thorax (chest) and 71% injured the heart and/or great vessels. The remaining deaths with single stab wounds involved the femoral artery, abdominal organs, or head. There were no sharp injury suicides by Hispanics, Asians, or anyone under the age of 18 years. Over half of the suicides at home occurred in the bathroom and 78% of these occurred in the bathtub. Suicide notes were found in 24% of suicides, and an additional 24% verbally expressed a plan to commit suicide.     

A Case of Extreme Sexual Self-Mutilation

Abstract:  We report on a case of extreme sexual self-mutilation in which the subject inflicted severe trauma to his genitalia and then falsely reported a sexual assault. The 30-year-old white male did not report the incident for 10 days and then checked into a hospital. The hospital called the Westminster Police Department after the subject reported that he was the victim of a sexual assault in our city. This case is unusual in that the subject's initial behavior and story did not indicate deception. It was not until the subject's computer was searched that investigators determined that the injuries were self-inflicted. Without this critical information the case might still remain open as a sexual assault. This case is reported to broaden our understanding of this behavior and inform investigators of the potential for this type of self-inflicted injury.     

Pathologic features of fatal shark attacks

To examine the pattern of injuries in cases of fatal shark attack in South Australian waters, the authors examined the files of their institution for all cases of shark attack in which full autopsies had been performed over the past 25 years, from 1974 to 1998. Of the seven deaths attributed to shark attack during this period, full autopsies were performed in only two cases. In the remaining five cases, bodies either had not been found or were incomplete. Case 1 was a 27-year-old male surfer who had been attacked by a shark. At autopsy, the main areas of injury involved the right thigh, which displayed characteristic teeth marks, extensive soft tissue damage, and incision of the femoral artery. There were also incised wounds of the right wrist. Bony injury was minimal, and no shark teeth were recovered. Case 2 was a 26-year-old male diver who had been attacked by a shark. At autopsy, the main areas of injury involved the left thigh and lower leg, which displayed characteristic teeth marks, extensive soft tissue damage, and incised wounds of the femoral artery and vein. There was also soft tissue trauma to the left wrist, with transection of the radial artery and vein. Bony injury was minimal, and no shark teeth were recovered. In both cases, death resulted from exsanguination following a similar pattern of soft tissue and vascular damage to a leg and arm. This type of injury is in keeping with predator attack from underneath or behind, with the most severe injuries involving one leg. Less severe injuries to the arms may have occurred during the ensuing struggle. Reconstruction of the damaged limb in case 2 by sewing together skin, soft tissue, and muscle bundles not only revealed that no soft tissue was missing but also gave a clearer picture of the pattern of teeth marks, direction of the attack, and species of predator.     

Fatal Eurasian Brown Bear Attacks—Two Swedish Fatalities in Modern Times

Fatal bear attacks on humans are uncommon with only one reported case in Sweden since 1902. The bear population is, however, growing and the frequency of confrontations is likely to increase. Case I-A 40-year-old hunter and his dog were found dead near a bear's den. Autopsy showed that a large portion of the face, facial skeleton, and anterior portion of the brain was missing. Autopsy of the bear showed two nonfatal gunshot wounds. Case II-A 61-year-old man and his dog were found dead outside a hunting lodge. Autopsy revealed numerous wounds, including partial evisceration of the intestines. The victim's blood ethanol concentration was 0.27%. These cases confirm the presence of risk factors identified by the Scandinavian Brown Bear Research Project, that is, provocation by a dog, encountering an injured bear, and appearing close to its den. An additional possible factor in case II was ethanol intoxication.     

The 'break enter and die' syndrome may involve significant injury to major neck vessels

Death from incised wounds of major vessels may occur during illegal entry of premises. Wounds are often relatively unimpressive having been caused by thin shards of glass. Alcohol and/or drugs have often been taken that have impaired coordination and contributed to a failure to take appropriate action. A 37-year-old man slipped and fell while attempting to enter a house through a window that he had just broken. He was found dead surrounded by a large amount of blood. At autopsy, a single horizontal, deeply incised wound of the anterior neck was present with transection of the internal jugular veins bilaterally and the right common carotid artery. Toxicological studies were negative for alcohol and common drugs. Death was due to exsanguination and air embolism. This case demonstrates that the injuries sustained during such activities may be quite extensive and involve major neck vessels. Alcohol and drug intoxication are not necessarily involved.     

Evaluation of atypical stab and incision wounds in a case of combined suicidal injuries

A fatal case of stabbing and cutting is reported which involved a 37-year-old male who suffered from depressive disorder and had already attempted suicide in the past. The postmortem examination revealed 12 lacerations of the scalp, 5 deep incised wounds on the flexor surface of the right forearm, 3 stab wounds of the back of the head, 12 stab wounds of the chest (with cutting of ribs but no injury of heart and lungs), 35 stab wounds of the abdomen and deep incised wounds of both sides of the neck with hesitation marks and incision of the left internal jugular vein. The significance of criteria to properly establish the manner of death like localization, axis and pattern of the wounds, hesitation marks, defense wounds, pulling aside the clothing to expose the target area, sustained capacity of physical activity and potential lethal effects of the single injuries as well as conclusions from the scene of death are discussed.     

An unusual case of thermal injuries with a hot glue gun: Deliberate self-harm or maltreatment?

Assessing injuries in forensic medicine casework, examiners are often confronted with the question of self-infliction versus third parties' influence, respectively, deliberate self-harm versus maltreatment. We report the case of a 40-year-old male who presented with numerous partially healed thermal injuries of different age. These burns were shaped like capital letters and little circles, which were arranged in lines in a regular form. The lesions were found on the whole body with exclusion of face, genitals, hands and feet. Furthermore, four bitemarks at the right shoulder were noted. Investigations revealed that the man had been abused by his 25-year-old wife (presumably a borderline personality disorder patient) for at least 1 year. In addition to another series of abuses, the woman may have inflicted the shaped burns with a hot glue gun as punishment for breaking certain "rules" she had established. When assessing injuries of patients in forensic medicine, several considerations regarding etiology have to be taken into account. In principle, the victim's testimony, the anamnesis, the police investigation results and the findings from the forensic physical examination have to be balanced against each other. The injury pattern in the present case showed contradictory single characteristics both of deliberate self-harm and of maltreatment. After forensic analysis, it was assessed as injuries inflicted by an assistant with the patient's consent.     

Unusual self-electrocution simulating judicial electrocution by an adolescent

Electrocution is one of the rarest modes of suicide. In this case, one school going adolescent committed suicide by electrocution using bare electric wire. This is a rare case of suicidal death by applying live wires around the wrists, simulating the act of judicial electrocution. He positioned himself on armed chair and placed the nude wire loops from a cable around both wrists and switched on the current by plugging in to nearest socket by foot. There were linear electric contact wounds completely encircling around the both wrists. In addition to these linear electric burns all around wrists, there were electrical burns over both hands. This death highlights the need of supervision and close watch on children for self-destructing activities and behavior. This case also highlights unusual method adopted by adolescent to end his life.     

Case reports of suicide with an electric drill

In this report, three cases of suicide by an electric power drill are described. In the first case, a man aged 51 was found with four penetrating wounds of the head and chest. The second case involves a 56-year-old man who suffered a penetrating craniocerebral injury and the third case involves a 53-year-old man who suffered one head injury and two chest injuries. In the first two cases, the victims were found dead. In the third case, the victim survived his injuries for 28 hours. The case histories and the post-mortem examinations revealed no evidence of homicide.     

Symmetrical fracturing of the skull from midline contact gunshot wounds: reconstruction of individual death histories from skeletonized human remains

This paper reports a bilaterally symmetrical cranio-facial fracture pattern that is observed in self-inflicted, midline gunshot wounds. Five cases of self-inflicted gunshots wounds are presented as follows: two high-powered rifle cases, two shotgun cases, and one handgun case. In all five cases the remains were either decomposing or skeletonized and submitted to forensic anthropologists. Following identification, the main focus of the anthropological examination was the analysis of perimortem trauma to the skeleton. In each case, the skull was submitted in a highly fragmented state. Nevertheless, by focusing on the pattern of perimortem cranio-facial fractures, the anthropologists contributed key information regarding the circumstances of death. The observed symmetrical cranio-facial fracture patterns in the above cases are described in detail and interpreted. The specific location of the linear fractures is discussed, as well as the theoretical rationale behind the location in terms of skeletal architecture, such as buttresses, struts, and sutures. The interpretive framework provided by this paper may prove helpful to others who are faced with similar cases of cranio-facial fracturing.     

Clinicopathologic features of fatal self-inflicted incised and stab wounds: a 20-year study

The files of the Forensic Science Center in Adelaide, South Australia, were examined for all cases listed as suicide in which death had been caused by the use of a sharp instrument during the 20-year period from January 1981 to December 2000. Fifty-one cases were identified, consisting of 35 men and 16 women. The age range was 23 to 83 years (mean 49 years) representing 1.6% of total suicides (513182). Fatal injuries included incised wounds to the arms in 51.4% of men (n = 1835) compared with 87.5% of women (n = 1416), incised and stab wounds to the neck in 40% of men (n = 1435) and 25% of women (n = 416), and stab wounds to the chest or abdomen in 28.6% of men (n = 1035) and 12.5% of women (n = 216). In 8 cases, multiple sites were involved. The use of sharp instruments in suicide was favored by older, rather than younger, individuals, with a tendency for women to incise their wrists. Hesitation marks were present in 23 cases (54%) and scarring of the wrists from previous suicide attempts in 5 cases. Although this study demonstrated a higher number of men than women committing suicide by using sharp objects, this method of suicide remains uncommon.     

Fatal suicidal injury of a radiocephalic arteriovenous fistula

A 59-year-old man was found dead in his living room. His body was covered with blood, but the only injury found was a 31-mm-long, transverse incision on the radial surface of the left forearm. Autopsy revealed that the injured vessel was an enlarged cephalic vein from a radiocephalic arteriovenous fistula (RC-AVF) that had been created 23 years before for hemodialysis. Cephalic vein injury is usually not fatal, but circumstantial evidence, autopsy, and histological findings suggested that hemorrhagic shock and death occurred within a short time after the self-inflicted incised wound. This may be explained by the blood flow rate in the RC-AVF, which can reach 12 ml/s; this is 25 times higher than the normal cephalic vein blood flow.     

Suspected suicide and suicide attempt with mysterious concomitant circumstances

Two cases of suicide and attempted suicide, respectively, are presented. A 15-year old boy suffering from diabetes died of hyperglycemia after continuous drinking of large amounts of sugared tea. He concealed his disease from the teachers as well as from the doctor. A 52-year old woman was found with multiple blunt force injuries and stab wounds. The suspicion of homicide attempt could be clarified, as all of the injuries were self-inflicted.     

Occupation-specific mode of self injury within the scope of a fictitious assault]

In typical cases self-inflicted injuries in fictitious offences show a characteristic pattern of findings with multiple, uniform, and mostly superficial skin lesions. If the actors possess special experiences, knowledge or instruments--particularly in the field of medicine--the injuries inflicted by themselves may have an appearance whose autoaggressive origin is less obvious. The case of a 43-year-old nurse is reported who was admitted for surgical treatment with two cuts in the abdomen extending into the subcutis; she pretended to have been attacked by 2 masked men who stabbed her for xenophobic motives. In reality she had inflicted the cuts upon herself after applying a local anaesthetic. The necessary equipment (Scandicain, disposable syringes, stitch cutter) was taken from her place of work. Self-inflicted injuries specific to medical professions, as well as fictitious offences with atypical cut- and stab-wounds and the insinuated motives of the alleged offenders are discussed.     

Extensive Petechiae in Attempted Self-Strangulation

Abstract:  A 29-year-old Korean man reported to have been robbed, bound, and gagged by a stranger in his apartment. Clinical findings included extensive petechiae to his face and tramline patterned abrasions and ligature furrows to his neck and face as well as his wrists. Initially, no other leads in the investigation existed and a robbery was assumed to have taken place. The man eventually confessed to fabricating the story and to having self-induced the ligature marks by subluxating his jaw at the temporomandibular joint and hooking the rope closest to the back of his neck on the corner of table. The man demonstrated this unsuspected ability to law enforcement officers. As a motive for his unconventional behavior, he confessed to engaging in autoaggressive behavior as punishment for "losing face" after his ex-girlfriend terminated her pregnancy. This case demonstrates that petechiae due to neck compression also may occur in the living and are due to vascular compression and not lethal hypoxia.     

Fatal and Nonfatal Rip Saw Injuries

This paper deals with a fatal stab wound suffered by a 29-year-old man and nonfatal injuries of 35-year-old and 67-year-old saw operators. Rip saw is a machine that is specially designed for making a rip cut, a cut made parallel to the direction of the wood grain. Rip-saw-related injuries mostly occur when a person is struck by the cutting material, which usually involves splinters of irregular shape and diameter. When the splinter strikes the body diagonally, the injuries may include abrasions, lacerations, and cut wounds; in situations where the victim is struck directly, the most common injuries are oval- or star-shaped stab wounds with a varying width of abrasions around the wounds. Therefore, such injuries may come across as injuries produced by a knife-like instrument, which is an added difficulty in the interpretation of such injuries.     

Homicide with postmortem opening of the thoracic and abdominal cavity--morphological, criminological and forensic-psychiatric aspects

During a walk a man found the partially unclothed body of a 16-year-old girl in a field near a village in South Baden. The body showed numerous injuries caused by sharp force. Several stab wounds were discernible on the neck, the chest, the genital region, the back and the right thigh. Postmortem, the anterior wall of the trunk had been severed with one long cut reaching from the mons pubis to the jugular fossa. The injuries and the scene suggested homicide with a sexual motive. Already on the next day a male suspect was ascertained. Blood traces of the victim could be demonstrated on his car. The man confessed the homicide, but did not describe the course of events in detail. He denied a sexual motive for the homicide. The psychiatric examination did not furnish any clues to internal, neurological or psychiatric disorders. The perpetrator did not claim intoxication for the time of the offence, which might have been relevant for the question of criminal responsibility. Psychodiagnostically, it was found that he had a narcissistic personality structure with a pronounced lack of self-esteem, deficits in affect processing and control as well as anxiety and aggression problems. The man was sentenced to life imprisonment for murder.