Karen J. Heath

The symmetry of self mutilation and the chess board pattern

The assessment of injury patterns in forensic practice sometimes requires separation of self inflicted injuries from those that have been inflicted by another, as the medicolegal significance of each is entirely different. Certain repetitive features are found in self inflicted injuries that may assist in identifying these cases. Non-lethal self inflicted injuries are usually incised, and are located in areas of the body that are accessible. Common areas include the forearms, anterior thighs, forehead, cheeks, upper chest and abdomen [1]. The lesions tend to occur on the opposite side to the dominant hand and are not found in sensitive areas such as the eyelids, genitalia or nipples, unless there is a serious underlying psychiatric disturbance. Typically the clothing has been carefully lifted before the wounds are inflicted in contrast to assaults where stab and slash wounds often cut through overlying fabric [2, 3]. The wounds also tend to have characteristic pathological features, occurring in clusters of superficial incised lesions of similar depth [4]. Healed scars from self infliction may also serve as an indication of previous self harming actions and may record the pattern of the original injury. One of the most telling features is symmetry, with similar lesions sometimes being cut into opposite limbs. Fig. 1 illustrates this symmetry with a series of faint paired scars on the anterior aspect of the lower leg. The lesions are uniformly spaced and parallel, similar to a second case where the scars were found in an orderly pattern on the anterior thigh (Fig. 2). On occasion, words or designs may be cut into the skin with the intention of focussing blame on a particular individual or group. For example, incised swastikas have been used by individuals pretending to be victims of right wing violence [5]. A case of a teenage girl has also been reported, who alleged that she had been assaulted and had the word ‘‘whore’’ cut into her arm and forehead. Careful examination of the letters on the forehead revealed that they were reversed as they had been cut by the victim using a mirror [6]. Another very distinctive feature of self inflicted incised wounds is the so-called ‘‘chess board’’ pattern [4]. This refers to clusters of incised wounds that run parallel and at right angles to each other, creating a series of ‘‘squares.’’ Again, this is a feature that is very strongly suggestive of self infliction, as movement of a victim who is frightened and in pain from a knife attack means that individual lesions are rarely so controlled, unless the victim has been incapacitated in some way, or is already unconscious or dead. Figure 3 demonstrates a typical chess board pattern, in this case formed by a series of uniformly spaced horizontal incisions across a forearm, intersected by parallel longitudinal cuts. In Fig. 4 a series of fine closely spaced incisions on the wrist and hand demonstrate a more subtle chess board effect. In the case of deeper incisions, healing may result in scarification. This is shown in Fig. 5 where scarring of a forearm following self inflicted wounding acts as a record of the original chess board pattern revealing squares of varying sizes. R. W. Byard (&) Discipline of Anatomy and Pathology, Level 3 Medical School North Building, The University of Adelaide, Frome Road, Adelaide, SA 5005, Australia e-mail: roger.byard@sa.gov.au

Head impalement - An unusual form of suicide

An 80-year-old man with pancreatic adenocarcinoma and depression was found with his head impaled on a bolt that had been screwed into a hole that had been drilled in the floor of a shed at his home address. Once the bolt was in place the decedent had winched a heavy weight above it, using a pulley that he had attached to the metal roof frame, and the front fork of a bicycle frame. The latter had been bolted to a nearby work bench as a winching device. After the weight had been positioned, he had placed his head over the bolt and cut the rope with a kitchen knife. The impact of the falling weight had forced his head onto the bolt with penetration of the cranial cavity. The complexity of the design of the suicide apparatus is exceedingly rare in our experience and the time taken to set up the device indicated that there had been a considerable degree of premeditation. The finding of complex apparatus at a death scene may provide useful information in ascertaining the manner of death and also in providing some indication as to the decedents level of determination to succeed.

Murder-Suicide or Murder-Accident? Difficulties with the Analysis of Cases

Abstract:  Homicide where a perpetrator is found dead adjacent to the victim usually represents murder–suicide. Two incidents are reported to demonstrate characteristic features in one, and alternative features in the other, that indicate differences in the manner of death. (i) A 37‐year‐old mother was found dead in a burnt out house with her two young sons in an adjacent bedroom. Deaths were due to incineration and inhalation of products of combustion. (ii) A 39‐year‐old woman was found stabbed to death in a burnt out house with her 39‐year‐old de facto partner deceased from the combined effects of incineration and inhalation of products of combustion. The first incident represented a typical murder–suicide, however, in the second incident, the perpetrator had tried to escape through a window and had then sought refuge in a bathroom under a running shower. Murder–accident rather than murder–suicide may therefore be a more accurate designation for such cases.

Circumstances of Death and Diagnostic Difficulties in Brushfire Fatalities

Abstract:  The deaths of 10 bushfire (brushfire) victims (aged 2–59 years; M/F 1:1) from the files of Forensic Science SA in Adelaide, South Australia, over an 8‐year period (January 2002 to December 2009) are reported. Nine of the victims were found in or near motor vehicles. Death was attributed to incineration (N = 5), trauma from bushfire‐related vehicle crashes (N = 2), inhalation of products of combustion with hyperthermia (N = 1), inhalation of products of combustion (N = 1), and undetermined (N = 1). Death scenes covered large areas and involved many victims. Loss of infrastructure and closure of local roads owing to debris limited access and made the finding of bodies difficult. Bodies in such fires may be exposed to the damaging effects of weather and animal predation. Heat damage hindered pathological assessment with resultant delays in identification. Assessment of antemortem injuries and determination of causes of death were also complicated by the condition of some of the bodies.

Patterned postmortem ant abrasions outlining clothing and body position after death

Analysis of a series of cases where post mortem lesions had been caused by ant activity demonstrated two types of specific lesions, the first associated with clothing, and the second with the position of the body of the decedent. The first type of injury consisted of areas of abraded parchmented skin with well-defined straight edges that marked the perimeter of clothing. The second lesion consisted of circular abraded injuries that outlined the junction between the body and the surface that it was resting on, essentially tracing the outline of the point of contact. In both situations ants had been unable to gain access to skin beneath elasticized clothing or parts of the body pressed against the floor or ground. This had resulted in a visual record of the edge of clothing and the position of parts of the body after death. This information may be important if clothing has been removed prior to autopsy or if lividity is minimal. These unique lesions also show that not all insect predation on bodies obscures information.

Potential dangers of accelerant use in arson

Accelerant-enhanced combustion often characterizes a fire that has been deliberately set to disguise a murder scene or to destroy property for insurance purposes. The intensity and rapidity of spread of fires where accelerants have been used are often underestimated by perpetrators who may sustain heat-related injuries. The case of a 49-year-old male who was using gasoline (petrol) as an accelerant is reported to demonstrate another danger of this type of activity. After ignition, an explosion occurred that destroyed the building and caused the death of the victim who was crushed beneath a rear wall of the commercial premises. Gasoline vapour/air mixtures are extremely volatile and may cause significant explosions if exposed to flame. Given the potential danger of explosion, arsonists using accelerants do so at significant risk to themselves and to others in the vicinity.

Heat-related deaths in Adelaide, South Australia: Review of the literature and case findings – An Australian perspective

Heat waves are not uncommon in Australia, but the event of 2009 was particularly severe and ranks third of the 21 recorded heat wave events in south-eastern Australia in terms of the resulting mortality and morbidity. This is a review of Coronial autopsy findings in South Australia (which has an area of nearly 1 million square kilometres with a population of 1.6 million that predominantly resides within the region of the capital: Adelaide) during the period of the 2009 heat wave. Fifty-four post-mortem examinations were performed on cases in which exposure to high ambient temperature was regarded as having caused or significantly contributed to the death. The findings (including results of toxicological and biochemical analyses, where available) are reviewed and compared with the post-mortem examination findings in 22 deaths over the same period not attributed to the effects of heat. There were no specific autopsy findings that distinguished heat-related from non heat-related deaths. The lack of specific post-mortem findings increases the reliance on scene investigation in order to be able to categorise a death as being heat-related. A checklist for scene investigators is proposed in order to assist with collection of relevant data to assist the Coronial investigation process.

Forensic features of pharmacobezoars.

Three cases of pharmacobezoars are reported to demonstrate typical autopsy findings and potential lethal mechanisms: (i) A 32‐year‐old woman died following an overdose of prescription medications. A gelatinous pharmacobezoar was found forming a cast of her bronchial tree. (ii) A 24‐year‐old woman also died following an overdose of prescription medications. At autopsy, two pharmacobezoars were present, one within the larynx and another occluding the right main bronchus. Deaths in both cases were attributed to airway occlusion by pharmacobezoars complicating mixed drug toxicity. (iii) A 79‐year‐old man was found dead in a car. Death was attributed to the combined effects of carbon monoxide and drug toxicity with a large pharmacobezoar lodged within the esophagus. Pharmacobezoars are specific types of bezoars that occur when pharmaceutical materials, such as tablets, suspensions, and/or drug delivery devices, aggregate and contribute to death by occluding airways with tenacious material or by eluting drugs.

Sudden death and the forensic evaluation of neurocutaneous syndromes

On occasion the forensic evaluation of individuals who have died suddenly and unexpectedly may reveal intracranial vascular abnormalities such as capillary, venous- and arteriovenous malformations. Such vascular abnormalities may form part of a heterogeneous group of disorders called neurocutaneous syndromes and involve the skin, nervous system and other organ systems. These unusual conditions include Sturge-Weber, Osler-Weber-Rendu, Klippel-Trenaunay, Von Hippel-Lindau, Proteus and Wyburn-Mason syndromes in addition to ataxia telangiectasia. Causes and mechanisms of unexpected death include epileptic seizures, intracranial haemorrhage and thromboses. Differentiating these conditions at autopsy is important because of variable inheritance patterns and occasionally inaccurate clinical classifications. The autopsy evaluation requires review of the medical and family histories, and full external and internal examinations with photographic documentation and histologic sampling of lesions. Formal neuropathology, storage of blood and tissues for molecular studies if required, and liaison with a medical geneticist should be considered.

Ant activity as a source of postmortem bleeding

The body of a 57-year-old man was found lying on his right side slumped against an ice chest outside a liquor store beside a major city road. Attending ambulance officers noted a considerable amount of blood under the body with linear abrasions suggesting to them that the body had been dragged away from the road. They considered that the most likely scenario was a ‘‘hit and run’’ accident. Police set up a crime scene area and blocked off all lanes of the road. The pathologist who subsequently attended the scene confirmed that the fully clothed body was lying in a pool of blood, but also noted that there were numerous ants crawling over the body and that the ‘‘brush abrasions’’ were more typical of postmortem ant activity (Fig. 1). At autopsy there was no evidence of acute injury, although there were extensive areas of yellow, parchmented, superficial abrasions with serpigenous margins and adherent ants. These had the typical appearance of postmortem ant predation (Fig. 2). The lesions on the left (upper) side of the body had a typical yellow dried appearance, contrasting with the lesions on the right (lowermost) side, in the areas of dependent lividity, which were congested and hemorrhagic (Fig. 3). The blood at the scene had oozed from these lesions, which were still seeping at the time of autopsy. Other findings at autopsy were of hepatic cirrhosis and old traumatic injury to the frontal and temporal lobes of the brain. Toxicology revealed a blood alcohol level of 0.392 % and a vitreous alcohol level of 0.45 %. No other injuries or underlying medical conditions were present which could have caused or contributed to death, which was therefore attributed to acute alcohol toxicity. Subsequent information revealed that the decedent had a history of alcoholism, epilepsy and previous traumatic head injuries. He had been drinking at the liquor store the day before death and had been noted by staff to be lying against the ice chest, where he was found in an unchanged position the next morning.