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