Homicidal and suicidal sharp force fatalities in Stockholm, Sweden.: Orientation of entrance wounds in stabs gives information in the classification

https://doi.org/10.1016/S0379-0738(98)00025-5Get rights and content

Abstract

A comparative study of 174 homicidal and 105 suicidal sharp force deaths in the Stockholm area is presented in order to identify variables of importance in the differentiation between homicides and suicides. In homicides, a significantly (p<0.05) higher number of cut and stab wounds were seen in the head, upper and lower extremities and a significantly higher number of vertical stab wounds were found in the chest. Lower numbers were seen in the wrist and the crook of the arm. When counting the injured areas, irrespective of the number of injuries, abdominal wounds and horizontal chest stab wounds were also significantly more often found in victims of homicide. Injuries to the back and to the genitals were not seen in suicides. The suicide victims were significantly older and had significantly lower blood alcohol levels. A new variable pointing at a statistically significant difference between homicides and suicides was found: In homicides, stab wounds with a horizontal axis of entrance wound in the chest was found to be less common than those with a vertical axis. Other variables studied were prevalence of defence and tentative wounds, farewell notes and suicidal ideation, earlier parasuicides, venue, gender of the victims and the types of sharp objects used.

Introduction

The differentiation of homicide and suicide is a difficult and central issue in forensic medicine. Over the centuries, experience in this field has been collected by members of the medicolegal profession. This knowledge has, however, often been gathered in different societies and in different periods of time. Most of the earlier studies were centred on either homicides 1, 2, 3, 4or suicides 5, 6, 7, 8, 9; fewer authors have compared the two groups 10, 11.

The aim of this study is to focus on practical variables that are observable on the body at the scene of death (before formal postmortem examination) that will assist in the differentiation of homicidal and suicidal manners of death.

Death due to sharp force violence is the most common cause of homicidal deaths in Sweden 1, 2, 3and in many other countries in Europe 4, 10, 11, Africa [12]and Asia 13, 14. In the United States, sharp force violence occurred in 30% of fatal as well as non-fatal family assaults [15]. Differences in the anatomical localisation and patterns of sharp force injuries between homicidal and suicidal violence 10, 11, 16, 17, 18have been described.

The deaths in the present study were classified as suicides or homicides according to the results of the combined police and medicolegal investigations. On this basis, numbers and topographical localisation of cuts and stab wounds (hereafter, if not specified, called “wound”) in these two groups will be shown. In addition, suicide victims will be compared with homicide victims with respect to age, gender, toxicological findings, setting of incident, types of sharp objects used and the occurrence of tentative and defence injuries.

Section snippets

Methods

Wounds inflicted by cutting or stabbing with a sharp tool (knife), weapon (bayonet) or sharp piece of equipment were, in this context, regarded as sharp force injuries. Cuts by axes or cutting weapons did not occur as solitary sharp injuries in this series. Only wounds that transected the dermis were included.

All homicidal and suicidal deaths due to sharp force violence examined at the Department of Forensic Medicine in Stockholm, Sweden, in the ten-year period, 1983–1992, were included in the

Results

Of 105 suicide victims, 82 (78%) were males (male/female ratio, 3.6). The mean age among males was 51.5 years [standard deviation (SD)=17.07, range 20–90) and among females, it was 46.0 years (SD=17.42, range 25–83). Of 174 homicide victims in the same time period and area, 133 (76%) were males, yielding a male/female ratio of 3.2. The mean age among males was 37.1 years (SD=14.38), with a range of 4–77 years and for females, it was 33.8 years (SD=12.05), with a range of 3–56 years.

Differences

Discussion

Variables of importance in the differentiation between homicide and suicide are described in classic [17]and modern [18]textbooks of forensic medicine. Also, recent reports regarding sharp force injuries [10]have confirmed classic notions that injuries to the flexor side of the wrist are seen predominantly in suicides and that injuries to the head, back, genitals and the upper extremity, except for the wrist and the crook of the arm, are seldom seen in that situation. The present series

Acknowledgements

The author is grateful for the financial support given by the Swedish National Board of Forensic Medicine.

References (33)

  • T. Karlsson et al.

    Patterns in sharp force fatalities — a comprehensive forensic medical study: Part 2. Suicidal sharp force injury in the Stockholm area 1972–1984

    J. Forensic Sci.

    (1988)
  • G. Isacsson et al.

    Use of antidepressants among people committing suicide in Sweden

    Br. Med. J.

    (1994)
  • A. Jegesy et al.

    A detailed study on suicides in Baranya County (Hungary)

    Int. J Leg. Med.

    (1995)
  • A. Ohberg et al.

    Trends and availability of suicide methods in Finland. Proposals for restrictive measures.

    Br. J. Psychiatry

    (1995)
  • T. Bajanowski et al.

    Tod durch scharfe Gewalt

    Arch. Kriminol.

    (1991)
  • D.A. Rouse

    Patterns of stab wounds: a six year study

    Med. Sci. Law

    (1994)
  • Cited by (130)

    • Homicidal sharp force cases: An 11-year autopsy-based study

      2022, Journal of Forensic and Legal Medicine
    • Approach to blunt, sharp, and transportation deaths

      2022, Principles of Forensic Pathology: From Investigation to Certification
    View all citing articles on Scopus
    View full text