Suicidal head impalement with a hydraulic press machine – occupation-related suicide in a psychiatric patient

A 63-year-old mechanic, diagnosed with schizophrenia, was found next to a hydraulic press used for removing car wheel bearings. He was in a sitting position, bent towards the machine, with his head placed between the piston and the pressing plate. His flexed left arm was resting on the lever beneath the machine pedestal, and on the right side there was a power switch that was still in the “on” position. His right arm was beside his body, but away from the machine. On the pressing plate, beneath the decedents head, was a piece of bloody cloth. Blood spatters were present on the left hand and left trouser leg. At autopsy there was a gaping laceration in the right temporal area extending to the right ear lobe, where a piece of helix was missing. This missing tissue was found on the inner surface of the left temporal bone. The temporal lobes and brain-stem were destroyed along the wound trajectory but there were no brain contusions present. There was blood aspiration in both lungs, but all other findings were unremarkable. Death was attributed to the fatal head injury that resulted from the low-velocity penetration of the hydraulic press piston. While the cause of death was self-evident and undoubted, the manner of death required medico-legal investigation. The protective cloth that had been placed on the pressing plate, a medical history of schizophrenia, and the absence of any defensive injuries, all led to the conclusion that this was a case of a rather unusual suicide, which could be regarded as related to the decedents occupation.