B. Karger

Autopsy features relevant for discrimination between suicidal and homicidal gunshot injuries

Abstract. A total of 624 consecutive gunshot autopsies from the Institutes of Legal Medicine in Münster and Hamburg was investigated retrospectively. In a subsample of 284 suicides and 293 homicides (n=577), a large variety of features such as firearm, ammunition, number and site of entrance wounds, shooting distance and direction of the internal bullet path were recorded and binary logistic regression analysis performed in the case of bullet paths. Females constituted 26.3% of the homicide victims and 10.6% of the suicides. Short-barrelled firearms outnumbered long arms in homicides by 6:1 and in suicides by 2:1. More than 1 gunshot injury was found in 5.6% of the suicides (maximum 5 gunshots) and in 53.9% of the homicides (maximum 23 gunshots). The suicidal gunshots were fired from contact or near contact range in 89% while this was the case in only 7.5% of the homicides. The typical entrance wound sites in suicides were the temple (36%), mouth (20%), forehead (11%) and left chest (15%) but uncommon entrance wound sites such as the eye, ear, and back of the neck and head were also encountered. In suicidal gunshots to the right temple (n=107), only 6% of the bullet paths were directed downwards and only 4% were directed from back-to-front. In gunshots to the left chest (n=130), bullet paths running right-to-left or parallel occurred frequently in suicides (75%) and infrequently in homicide victims (19%). From 61 suicides who fired the gun inside their mouth, only 1 pointed the gun downwards. Consequently, some bullet path directions cannot be considered indicative of suicide: downwards and back-to-front in gunshots to the temple, left-to-right in gunshots to the left chest and downwards in mouth shots. The isolated autopsy findings can only be indicative of suicide or homicide but the combined analysis of several findings can be associated with a high probability.

Suicides by sharp force: typical and atypical features

Abstract A total of 65 consecutive cases of suicide by sharp force were investigated by evaluating the autopsy and prosecution department records. Suicides constituted 17% of all fatalities from sharp force autopsied between 1967 and 1996. Young males and persons with a psychiatric history predominated among the persons who chose this “hard” method of suicide. The most common implements used were knives (62%) and razor blades (15%). Cutting injuries in isolation were present in 26, stab injuries in isolation in 24 and a combination of both in 15 fatalities. The number of injuries per case varied from 1 to 37 but 1/3 showed one injury. More than 85% of the cutting injuries were located at the wrist, elbow crease or neck whereas 79% of the stab injuries involved the ventral aspect of the trunk. Perforation of clothing was present in ¶16 (52%) out of 31 stab injuries to the trunk. Injuries to more than one body region were observed in 34 (52%) cases. Tentative marks were present in 50 (77%) fatalities and the number varied from 1 to 60 per case. Superficial incisions of the fingers were found in 15% with razor blades constituting the weapon in half of these cases. Deviations from these typical patterns occurred not infrequently. The utter determination of the victim to carry it through or the use of unusual weapons resulted in a few bizarre cases which are outlined briefly.

Ketoacidosis and lactic acidosis – frequent causes of death in chronic alcoholics?

Abstract In clinical medicine, severe keto- or lactic adicosis associated with vomiting, nausea, abdominal pain, tachycardia or pathological respiration, has been described in chronic alcoholics. This study reports on fatalities of chronic alcoholics where the cause of death could not be determined by thorough autopsy, histology and toxicology including determination of alcohol concentration. In a first series, acetone was determined in the blood of such chronic alcoholics (n = 24), diabetics with metabolic decompensation (n = 7), cases of hypothermia (n = 7) and controls (n = 218). Among the 24 chronic alcoholics where the cause of death was unknown, 9 cases showed very high levels of acetone (74–400 mg/l). These comprised 6 cases without additional findings and 3 cases where a second patho-mechanism such as intoxication possibly contributed to the cause of death. In a second series, the sum values according to Traub (lactate/glucose) were determined in cerebrospinal liquor of chronic alcoholics with undetermined cause of death (n = 45), diabetics (n = 6) and controls (n = 39). Among the 45 alcoholics, 17 cases showed very high sum values (294–594 mg/dl) including 8 cases where non-lethal intoxications may have contributed to the final outcome. Other causes of a ketoacidosis or lactic acidosis (e.g. diabetes) were excluded in both groups of alcoholics. Consequently, ketoacidosis and lactic acidosis can be the cause of death of chronic alcoholics in a considerable number of cases where no pathomorphological or toxicological changes are present. A scheme for medical and laboratory examination is described.

Experimental Arrow Wounds: Ballistics and Traumatology

OBJECTIVE To provide information on the ballistics and the wounding potential of different arrows or bolts fired from different weapons and to investigate the suitability of simulant media for experimental arrow wounds. METHODS A longbow, a compound bow, and a crossbow were used to fire a variety of modern and ancient arrows. Fresh corpses of four adult pigs (47 shots) and blocks of gelatin and soap (48 shots) were used as target media, and the resulting wound tracts were examined. The range of fire was 8 m and the velocity was recorded at a distance of 3 m (and 16 m in additional shots) by light screen devices. RESULTS The mean velocities recorded ranged from 45 m/s (longbow) to 67 m/s (compound bow). The excellent exterior ballistics of arrows results in only a small initial decrease in velocity of O.10 to 0.18 m x s(-1) x m(-1). The penetration depths were reproducible for the same arrowhead fired into the same simulant medium but differed considerably when compared with those in soft tissue. In nonbone tissue, the penetration depth was substantial (17-60 cm) and depended on velocity and especially on the type of arrowhead. All arrows penetrated deeply into the large body cavities and injured organs as long as no thick bone had to be perforated. Flat bones such as ribs were always perforated. Extraction of arrowheads from thick bone proved to be difficult in some cases. The wounding mechanism was a combination of incision and puncture, which facilitated deep penetration of tissue and produced clean-cut wounds. CONCLUSION Gelatin and soap are not suitable for experimental arrow wounds. Every arrow wound carries a lethal potential. The severity of the wound depends primarily on the target area and the type of arrowhead. Extraction of arrowheads from thick bone has to be performed carefully.

Multiple gunshot suicides: potential for physical activity and medico-legal aspects

Abstract Out of 138 clearly defined gunshot suicides which were autopsied, 11 persons (8%) fired two or more gunshots to the body. From these 11, 5 cases involved 2 gunshots to the head where the bullets fired first had missed the brain. The trajectories were restricted to the chest in three cases and a combination of gunshots to the head and chest including two perforating heart wounds without immediate incapacitation occurred in three more cases. Reliable incapacitation is based on physiological effects (tissue disruption) and can only be achieved by decreasing the functioning capability of the CNS. This can be accomplished by direct disruption of brain tissue or indirectly by cerebral hypoxemia from massive bleeding. Targets of immediate incapacitation are restricted to certain CNS areas and targets of rapid incapacitation include the heart, the (thoracic) aorta and the pulmonary artery. Other major blood vessels and major organs (lungs, kidneys, liver, spleen) constitute targets of delayed incapacitation. This general classification can be derived from the literature and is illustrated by the cases presented. A thorough post mortem can exclude or quantify the potential for physical activity. Typical features of single gunshot suicides such as contact shots, classical entrance wound sites and soot/backspatter on a hand also occur in multiple gunshot suicides.

Backspatter from experimental close-range shots to the head. II. Microbackspatter and the morphology of bloodstains.

Backspatter is the ejection of biological material from a gunshot entrance wound against the line of fire. Backspatter of blood was investigated experimentally in transverse gunshots to the heads of calves (n=9) from shooting distances of 0–10 cm. The resulting bloodstains were documented on white paper placed horizontally 60 cm below the impact site. The morphology of bloodstains and the distribution of microstains (diameter <0.5 mm) is reported. The number of microbackspatter stains per gunshot varied between 39 and 262 and the maximum travelling distance was 69cm while the vast majority of microdroplets accumulated between 0 and 40cm. The direction a single droplet can take comprises every possible angle between the most tangential ones to the skin surface. Microstains exclusively were circular to slightly oval. The morphology of macrobackspatter stains (diameter >0.5 mm) varied from round to elongated with circular, drop-like and stains in the form of exclamation marks predominating. Small macrostains (0.5–4 mm) made up more than 90% of the macrostains and no systematic relationship between distance travelled and size of the stains could be established. The necessity of appropriate lighting and magnification in the investigation of surfaces for backspatter is stressed because many microstains are located in the proximity of the entrance wound where the firearm and the shooting hand are located in cases of close-range shots.

Suicide by more than 90 stab wounds including perforation of the skull.

Abstract A man committed suicide in his bathroom using a small pocket knife. At the autopsy a total of 92 stab wounds on the forehead, in both temples, the anterior aspect of the neck, the back of the neck, the chest and the sides of the trunk were found. In addition, repeated stabbing had caused a large soft tissue defect on the forehead. The frontal bone showed 3 perforations but no brain injury was present and two ribs were severed in the bony part, one of which carried a star-like pattern from repeated stabbing. No major vessels were injured and the cause of death was exsanguination after a considerable survival time. The large number of stab wounds, the perforation of bone and some injury sites, especially the head and back of the neck, are extraordinary findings in suicides which were probably favoured by insufficient anatomical knowledge and the use of a short-bladed knife. A psychiatric history could not be verified.

Morphological findings in the brain after experimental gunshots using radiology, pathology and histology

Abstract The tissue disruption inside the brain after experimental gunshots to the head was investigated with special reference to secondary bone missiles and intracranial pressure effects such as cortical contusion and deep intracerebral haemorrhages. The evidential value of various examination methods is compared. 9 mm Parabellum ammunition was fired to the temporal region of calves (n = 10) from a distance of 0–10 cm. Plain film radiography, CT, MRI, visual inspection and histology were performed on every brain. The tissue disruption of the permanent tract is delineated best by artefact-free MRI. Cortical contusions and deep intracerebral haemorrhages were detected infrequently by visual inspection and imaging techniques although they were present in every brain as verified by histology. These injuries remote from the tract increase cerebral wounding compared to non-confined tissue. In particular, the brain stem and central areas were frequent sites of haemorrhages, which can be expected to have serious and immediate consequences. Ectopic bone fragments were found in all brains using CT scans. Bone fragments were located inside clearly enlarged permanent tracts or were driven into brain tissue. In the latter cases, secondary shot channels up to 4 cm in length could be verified by histology. Cortical contusions and intracerebral haemorrhages can only be detected reliably by histology. The localization of bone fragments requires CT scans. Therefore, a detailed examination is accomplished best by a combination of the methods applied in this study.

Analysis of 155 consecutive forensic exhumations with emphasis on undetected homicides

A total of 155 consecutive forensic exhumations performed in Münster, Germany from 1967 to 2001 were evaluated retrospectively on the basis of the autopsy report, the police report and the death certificate. Histology and toxicology were performed in most cases. The postmortem intervals varied from 8 days to 8 years. Compared to other countries, the autopsy rate was low (1.2–1.4%) and the exhumation rate high (0.016%): principle of reciprocity. The cause of death could be clearly determined in 103 cases (66.5%) and histology or toxicology were decisive in 40%. Some findings were discernable using immunohistochemistry after considerable postmortem intervals, such as acute myocardial infarction after 1 year and pneumonia after 2 years and a diazepam intoxication was determined after 4.5 years. Major deviations between the cause of death as stated on the death certificate and as diagnosed after autopsy existed in 57 cases (37%). A more detailed analysis revealed five subgroups. 1. primary suspicion of intoxication (n=18) confirmed in 6 cases including 3 homicides (with parathion, clozapin, diazepam) which are described in more detail. 2. primary suspicion of homicide other than poisoning (n=51) confirmed in 19 cases. There was a serial killing of 15 patients by injection of air. In the remaining 4 cases, a shaken infant, craniocerebral injuries from blows with beer bottles, a craniocerebral gunshot and a multiplicity of blunt force injuries were diagnosed. The latter two cases are described in more detail. Superficial external examinations and the low autopsy rate were 2 common reasons for the occurrence of “buried homicides” (n=22)—not a single forensic autopsy had been performed directly after the death of the victims. 3. primary suspicion of medical malpractice (n=39). 4. accidents including traffic accidents (n=30). 5. clarification of the cause of death, circumstances or identity (n=17). Exhumations were frequently successful for recovering evidence which should better have been collected immediately after the death of an individual. Exhumations can also be regarded as an instrument to evaluate the quality of death certificates and death investigations.

Experimental bloodstains on fabric from contact and from droplets

Abstract The differentiation between contact bloodstains and stains produced by projected droplets on fabric can be crucial in crime scene reconstruction since suspects can explain bloodstains on their clothing by contact with the victim post mortem. Experimental smear and contact pressure stains on three different types of fabric were compared with stains produced by falling and projected droplets (“dynamic” stains) of equivalent size. The morphology of the small stains (0.1–10 μl) was investigated with a macroscope. Characteristic for “dynamic” stains are symmetry and rhythmicity (secondary droplets) of the stain and a zonal drying pattern. Contact stains lack the characteristic features of “dynamic” stains and show a clear impregnation of the material resulting in a blood-soaked reverse side of cambric and cotton and in a paler overall colour. The mode of formation of microstains (blood volume 1 < μl) on irregular surfaces (e.g. terry cloth) can be difficult to determine since the rough surface structure and the small blood volume reduce the characteristics of dynamic stains. In these cases, comparison with experimental stains on the same surface material is recommended.