Suicide by self-stabbing

89

Forensie Science International, 56 (1992) 89 - 94 Elsevier Scientitk Publishers Ireland Ltd.

SUICIDE BY SELF-STABBING

R.D. START, C.M. MILROY and M.A. GREEN Sh&ï.eld Unive-mity Departnwnt Sheffield Ss YES (UK)

of Forens& Pathhgy,

!l’h.eMedko-Legal Centre, Watey

Street,

(Received June 5th, 1992) (Accepted June 14th, 1992)

Summary A series of 28 deaths from suicidal stabbing has been analysed for the age, sex and psychiatrie history of the victim, the place and time of death, the multiplicity and site of wounds, the incidence and distribution of other injuries and the implements used. Key words: Self-infliction;

Stab wounds; Forensic pathology

Introduction

Although stabbing is the most frequent way of committing homicide in the United Kingdom [l], self-stabbing is an uncommon method of suicide. In 1990 the Registrar Genera1 recorded 70 deaths in England and Wales from selfinflicted injuries by cutting and piercing instruments [2]. NO distinction is made between incised and stab wounds but together these forms of suicide were stil1 less common than al1 other conventional methods with the exception of electrocution. Most publications relating to self-stabbing have been single case studies [3 - 41 and apart from one study involving the assessment of tentative injuries in such cases [5] we are unaware of any other reports based on large series. The present series of 28 suicides resulting from sell-stabbing was compiled over a 16-year period in Yorkshire and Humberside. Results

A total of 273 suspicious deaths involving cutting and piercing instruments were investigated in Yorkshire and Humberside between 1975 and 1991 (Table 1). Fifty-one (19%) cases represented suicides and 28 (10%) cases represented self-stabbings. Correspondence to: C.M. Milroy, Sheffield University Department Medico-Legal Centre, Watery Street, Sheffield S3 7ES, UK. 0379-0738/921$05.00

0 1992 Elsevier Scientific Publishers Printed and Published in Ireland

Ireland Ltd.

of Forensic

Pathology,

The

90

TABLE 1 NUMBER OF CASES INVOLVING CUTTING OR PIERCING IMPLEMENTS IN YORKSHIRE AND HUMBERSIDE 1975 - 19918 Percentage cases in parentheses. Type of wound

SUieide

H@??GidX?

Total

Incised Stab

23 (9) 28 (10)

6 (2) 215 (79)

29 (11) 243 (89)

51 (19)

221 (81)

272 (100)

‘Excluding 1 case resulting from an industrial accident.

Profik?

ofvicti??a

Twenty-six (93%) victims were white Caucasians and the male to female ratio was 3:l (Table 2). A history of mental disorder was established in 16 (57%) cases and 8 of these victims had attempted suicide on at least one previous occasion. Only 2 victims left suicide notes. Blood alcohol and toxicology screens were negative in al1 22 (79%) cases in which such information was available. Circumstances

of akath

Most (69%) of the self-inflicted stabbings occurred at night or in the early hours of the morning (Table 3). Twenty-two (79%) cases occurred at the home of the victim (Table 4). In 14 (50%) cases a close relative or friend was also present within the building, but the stabbings were actually witnessed in only 2 (7%) cases. Eight (29%) victims moved to a different room or location after the initial stabbing. The commonest implement used was a kitchen knife (Table 5). Only one victim purchased the implement especially for the purpose of suicide. In 11(39%) cases the implement was located within the victim’s body and in al1of the remaining cases the implement was found near the victim. More than one implement was used in 5 (18%) cases.

TABLE 2 AGE AND SEX DISTRIBUTIONS OF SUICIDAL STABBINGS (n) Percentage cases in parentheses. SeZ

Age (years) <25

Male Female

26-50

51-75

>76

Total

5 (18) 0

7 (25) 4 (14)

8 (28) 3 (11)

1 (4) 0

21 (75) 7 (25)

5 (18)

11 (39)

11 (39)

1 (4)

28 (100)

91 TABLE 3 DISTRIBUTION OF TIMES OF SUICIDAL STABBINGS Percentage

cases in parentheses.

Mwrning (h) 06:OO- 12:oo

Ajtmon

Evening (h)

Night (h)

12:00-18:OO

18:OO - 2.4:OO

24:OO - 06:OO

8 (2%

6 GW

3 (11)

11 (39)

(h)

TABLE 4 LOCATION OF VICTIMS AFTER SUICIDAL STABBINGS Percentage

cases in parentheses. Number of tictims

Location Home of victim Bathroom Bedroom Kitchen Living room Garden Home of relative Workplace Other

3 (11) 9 (32) 6 (21) 3 (11) 1 (4) 2 (6) 1 (4) 3 (11) 28 (100)

Total

TABLE 5 IMPLEMENTS Percentage

USED FOR SUICIDAL STABBINGSa

cases in parentheses.

Kitchen knife Folding knife Stanley knife/blade Scissors Fragment of glass Garden fork

24 4 2 2 I I

Total

34 (100)

aMore than 1 implement was used in 5 cases.

(70) (12) (6) (6) (3) (3)

Total

28 (100)

92

TABLE 6 NUMBER OF STAB WOUNDS FOUND IN SUICIDAL STABBINGS Percentage

cases in parentheses.

Number of wounds 2-5

6-10

11-19

>20

Total

18 (64)

6 (21)

1 (4)

1 (4)

2 (7)

28 (100)

Dìstrîbutìon

and multìplìcity

1

of stab w0und.s

Single wounds to the left side of the chest and the abdomen were the commonest fata1 injuries (Tables 6 and 7). The maximum number of self-inflicted stab wounds was 85. In 16 (57%) cases stab wounds occurred after clothing had been purposely moved aside but wounds occurred through clothing in 8 (28%) cases. Multiple stab wounds were inflicted through a single external wound in 3 cases. The commonest wound track in chest wounds was through the heart and into the left lung. The implement usually passed through the left lobe of the liver through the heart and into the left lung in abdominal wounds. Associatìons

with tentative marks and ether ìnjwries

Tentative marks were present in 18 (64%) cases and these injuries were usually in close proximity to the fatal wound (Table 8). There appeared to be no difficulty in distinguishing these injuries from defence wounds seen in homicidal stabbings. Incised wounds were also present in 7 (25%) cases and multiple sites were involved in 4 cases. The commonest sites for these incised wounds were throat (5 cases), wrist (5 cases) and arms (2 cases). One victim had attempted hanging before self-inflicting a fatal stab wound.

TABLE 7 DISTRIBUTION OF STAB WOUNDS IN SUICIDAL STABBINGS’ Percentage

cases in parentheses.

Site

Number of cases

Left side of chest Abdomen Leglthigh Neck Arms Wrists

17 (51) 10 (29) 2 (6) 2 (6) 1 (4) 1 (4)

Total

33 (100)

84 cases involved multiple sites.

93

TABLE 8 DISTRIBUTION

OF TENTATIVE

Figures in parentheses Site of fatal wound

Chest Abdomen Neck Legíthigh Total

MARKS IN SUICIDAL STABBINGS

are the average number of tentative Number of cases with tentative Local to fatal wound

marks.

marks

Distant to fatal wound

Total

6 (3) 4 (3) I (1) 1 (4)

2 (1) 3 (4) I (4) 0

8 7 2 1

12 (3)

6 (3)

18

Discussion Self-stabbings represented 10% of al1 deaths from cutting and piercing instruments in Yorkshire and Humberside between 1975 and 1991.. Self-stabbing appears to be more common than suicide by incised wounds but some deaths from incised wounds may have been examined by local hospita1 pathologists and so would not have appeared in this department’s records. The incidence and circumstances of self-stabbing are largely unknown because of a lack of comparable studies. In this series the typical victim of self-stabbing was male, 25 to 75 years of age and often had a known psychiatrie history. The suicide was most likely to occur at home despite the presence of a close relative who rarely witnessed the stabbing. The implement used was usually a kitchen knife and wounds were generally inflicted after clothing had been moved aside. The stab wounds were usually single with several tentative marks in close proximity to the fatal wound. The commonest sites were the left side of the chest and abdomen. The decision that stabbing was self-inflicted was not difficult in most instances. As wlth so many aspects of forensic pathology a degree of caution is required before drawing conclusions in cases of death by stabbing. The assessment of selfinfliction was frequently complicated by the movement of the bleeding victim before death, stabbing through clothing and the presence of stab wounds and tentative marks at sites distant from the fata1 injury. In these circumstances the nature and distribution of wounds and their relationship to the handedness of the victim usually clarified the situation after further careful appraisal of al1 available information. The ages of self-stabbing victims in this series were generally greater than those reported for homicide victims and there was a larger proportion of males [ll. Similar ranges of implements were used in these suicides compared with cases of homicide; the only exception was the sheath knife which did not feature

94

in our series. The distribution and multiplicity of stab wounds were also similar between the two groups. The observed character, distribution and incidence of tentative injuries compared favourably with the only previous analysis of such injuries and their absente should not exclude self-wounding [5]. Suicide by self-stabbing is uncommon and its distinction from homicide can be difficult even with previous experience of such cases. In this study many of the factors reputedly indicative of self-infliction were frequently absent; others more typical of homicide were regularly present. Our observations may assist more objective conclusions in future cases of possible self-stabbing. References 1 2 3 4 5

A.C. Hunt and R.J. Cowling, Murder by stabbing. Forensic Sci. Int., 52 (1991) 107- 112. OBce of Population Censuses and Surveys, Mortality Statidcs England and Wales Series DH2, HMSO, London, 1990, No. 16. J.F. Fekete and A.D. Fox, Succes& suicide by self-inflicted multiple stab wounds of the skull, abdomen and chest. J. Fwmnsic Sci., 25 (1980) 634 - 7. H. Hasekura, H. Fukushima, 1. Yonemura and M. Ota, A rare suicidal case of a ten-year old child stabbing himself in the throat. J. ForM Sci., 30 (1985) 1269-71. P.V. Vanezis and I.E. West, Tentative injuries in self stabbing. Fomwìc Sci Int., 21 (1983) 65-70.