Death Scene Research Articles

Infant death from accidental suffocation and strangulation in bed in England and Wales: rare or unrecognised events?

BackgroundMandatory joint police and healthcare investigations of sudden unexpected death in infancy (SUDI) have been in place since 2008 in England. These include death scene examination with cause of death...

Multiple suicidal gunshot wounds. Case reports and mini-review of literature.

To determine the manner of death (MOD) and, there-fore, to classify the event as natural, suicidal, homicidal, or accidental is an essential and routine task in forensic medicine. The evaluation of MOD presents numerous difficulties due to unusual anamnestic and circumstantial data, in addition to autopsy findings and postmortem findings. A mini review of the literature on the topic was performed. Here we report two cases of uncommon self-inflicted multiple GWs (SMGWs) to the head and thorax, suspected of killing. The presence of more than one gunshot wound is suggestive of homi-cide, especially when they involve the head. A review of the literature on the topic was performed on PubMed's database, showing, although considered infrequent, cases documenting SMGWs are not rare. In the cases reported, the initial suspicion of involvement of third persons was excluded through the examination of the death scene, post-mortem (CT and autopsy) findings and clinical-circumstantial data. The analysis derived from the review of the related literature allowed us to highlight the presence of common findings which should be considered in the evaluation of such cases.

A 15-year review of lightning deaths in Germany—with a focus on pathognomonic findings

Lethal accidents caused by lightning are divided into observed and unobserved events. Pathognomonic or characteristic findings are often overlooked during external postmortem examination. Classical mistakes may be made which may often lead to an incorrect diagnosis. An analysis of 270 fatalities was performed on a historical collection of the Committee for Lightning Conductor Construction for the United Economic Area e. V. (ABBW) on lethal accidents due to lightning that occurred in Germany for the period 1951–1965. Furthermore, a selective literature research was carried out. The aim of the study was to analyze the death scene, the clothing, and the victim. The authors focused on chief findings which were relevant to the correct diagnosis of “death by lightning.” Both Lichtenberg figures and singed body hair were considered pathognomonic for a lightning strike. The question arose as to whether Lichtenberg figures, for example, represented the finding that most often led to the correct diagnosis. Of the 270 lightning-struck victims from the case collection, 129 (47.8%) had singed body hair and 25 (9.3%) had Lichtenberg figures. A comparison of the frequency of the two reported findings, singed body hair versus Lichtenberg figures, has only been performed in the literature for case numbers below 40. This study is the first evaluation of a relatively large number of lethal accidents due to lightning. Singed body hair was reported more frequently in lightning-struck victims than Lichtenberg figures. This study showed that singed body hair is probably more diagnostically important than Lichtenberg figures.

Exploring death scenes and circumstances in fatal opioid poisonings: Insights for preventive strategies using forensic autopsy cases in Western Denmark

IntroductionFatal opioid poisoning is a growing global issue. This study aims to describe circumstances surrounding fatal opioid poisonings by examining death scenes, demographics, and information from bystanders with the goal of informing prevention efforts. MethodsWe extracted data from the autopsy reports of 327 forensic autopsy cases with fatal poisoning involving methadone and/or morphine from 2013–2020. ResultsFatal opioid poisonings occurred in both rural and urban areas. Death scene was the decedent’s own home and a relative’s or friend’s home in 62% and 21%, respectively. The decedent died alone in 64% of the cases while other people were staying at the same address while death occurred in 30%. Decedents aged 15–34 years were more likely to die with other people staying at the same address than persons aged > 44 years (OR±SD: 2.3 ± 0.9, p = 0.005), and had lower postmortem blood methadone concentrations compared to persons > 34 years (Median [interquartile range]: 0.36 [0.23–0.62] vs 0.63 [0.28–1.2] mg/kg, p = 0.002). Female sex was more prevalent, and persons using illegal drugs were less prevalent in decedents aged > 44 years compared to those with age 15–44 years (29% vs 20%, p = 0.05% and 67% vs 89%, p < 0.001, respectively). Other psychoactive drugs were detected in 97% of decedents, mainly benzodiazepines (80%). ConclusionsPreventive strategies based on our findings include the need for harm reduction initiatives in both urban and rural areas, recognizing symptoms of fatal poisoning, and awareness of low tolerance among younger age groups. Urgent attention should be given to avoiding opioid use alone, particularly among older individuals, including women using prescribed opioids. Conveying the risks of polydrug use to all age groups is essential, especially co-use of sedative drugs.

Medicolegal Implications of Deaths due to Agricultural Accidents.

Agriculture encompasses a variety of activities that carry with them a variety of different risks. The unsafe use of vehicles, machinery, and tools as well as animal husbandry, working at heights, and exposure to chemical, biological, and weather events may result in the deaths of agricultural workers. Inexperienced operators and/or their inappropriate conduct may lead to avoidable fatalities. Forensic pathologists operating with the support of agricultural engineers or other professionals must evaluate the death scene, the case background and circumstances, the autopsy findings, and the toxicological data to establish the factors and dynamics responsible for such accidents and deaths.The aim of this review is to focus on the diagnostic approach required, by means of an interdisciplinary approach, to identify the cause of some typical agricultural fatalities, to confirm that death was accidental, and to help exclude the possibility of homicide or suicide.

“Morbid spectacle”: allegorical dialectics of mammonism, humanity, and necropower inSquid Game(2021)

AbstractThis article uses Mbembe's concept of necropolitics as an analytical category to examine the representations of necropower in Squid Game. In the global “organ economy,” organ sellers decide to supply, and brokers then mediate between them and buyers. In contrast, South Korean loan sharks commodify delinquent debtors' organs by forcing them to sign a body waiver as collateral. Recent South Korean dramas have thematized this distinctive systemization of the black economy. Borrowing Lowenstein's “allegorical moment” concept, this article aims to illuminate representations of fluid necropower through children's games as a hinge between reality and the imaginary that invites viewers to dialectically evaluate death problems. The contestations of money and humanity synthetically emerge as necropower constantly moves among different entities: VIPs, a frontman, players, game rules, and money. This article claims that viewers process numerous allegorical moments created by the iconography of necropower and synthetically realize necropolitics and corporeality in Squid Game. Organ extractions and trade in episode two in particular represent “morbid spectacle” and the culmination of mammonism. This article analyzes scenes of death, games, the technique of killing, and esthetics to connect historical examples of the necropolitics that Mbembe draws on and to discuss representations of the organ trade in this recent Korean drama.

Флобер у Достоевского: роль и образ “Madame Bovary” в «Идиоте»

The article examines the role of G. Flaubert’s novel Madame Bovary in the artistic space of F.M. Dostoevsky’s Idiot and the philosophical and ideological ideas of the French writer, which formed the basis of his work. The research demonstrates that for Flaubert, the image of a woman captured by her fantasies and passions was a symbol of the spiritual state of his modern society, which, according to the writer, had lost its spiritual guidelines and was completely focused on itself and the satisfaction of momentary desires, while the true needs remained unsatisfied. The article shows that for the correct interpretation of the role of Madame Bovary, it is necessary to correctly take into account the time of her reading by the heroine of Dostoevsky since she did not read it before her wedding, as is commonly believed in research literature, but at the time of her departure from Pavlovsk, when she “forever” left the prince for the sake of his happiness with Aglaya. Thus, the article suggests that the image of Emma and the world that she symbolizes is primarily associated with the young Epanchina, and not with Nastasia Filippovna. The article also analyzes the death scenes of the two female characters.

Structural Bias in the Completeness of Death Investigations for Sudden Unexpected Infant Deaths (SUIDs).

To assess sudden unexpected infant death (SUID) investigations for structural inequities by race/ethnicity and geography. The SUID Case Registry compiles data on death investigations. We analyzed cases from 2015 to 2018 (N = 3847) to examine likelihood of an incomplete death investigation, defined as missing autopsy, missing scene investigation, or missing detailed information about where and how the body was found. We also analyzed which specific components of death investigations led to the greatest number of incomplete investigations. Twenty-four percent of SUIDs had incomplete death investigations. Death scenes in rural places had 1.51 times the odds of incomplete death investigations (95% confidence interval [CI], 1.19-1.92) compared with urban areas. Scene investigations led by law enforcement were more likely to result in incomplete death investigations (odds ratio [OR] = 1.49; 95% CI, 1.18-1.88) than those led by medical examiners. American Indian/Alaska Native SUIDs were more likely than other racial groups to have an incomplete investigation (OR = 1.49; 95% CI, 0.92-2.42), more likely to occur in rural places ( P = .055), and more likely to be investigated by law enforcement ( P < .001). If doll reenactments had been performed, 358 additional cases would have had complete investigations, and if SUID investigation forms had been performed, 243 additional cases would have had complete investigations. American Indian/Alaska Native SUIDs were also more likely to be missing specific components of death investigations. To produce equitable public health surveillance data used in prevention efforts, it is crucial to improve SUID investigations, especially in rural areas and among American Indian/Alaska Native babies.

Ayurvedic pandemic perspective: A narrative review

The human race has been under the onslaught of the COVID-19 pandemic for the past several months. The frequency, magnitude and unprecedented nature of the pandemic have imposed global chaos. The traditional lessons procured from the epidemic approach have converged to the delta of trained in capacity in tackling the grave issue, eventually opening the door to Ayurveda for experiential and experimental knowledge. To explore and draw a narrative review on the conceptual framework of Janapadhodhwamsa (Epidemics), eliciting causative factors, alarming signs, and nature and providing a guideline of remedial measures for such engulfing catastrophes. Materials and methods include a review on the concepts of Janapadhodhwamsa and Kalaja Vyadhi (seasonal diseases) in classical Ayurveda texts of Charaka and Susrutha, followed by a PubMed search using keywords such as COVID-19, disease transmission, climate change, socioeconomic impact, and pandemic risk. A scheme comprising a compilation, in-depth study, contemplation and coding of the relevant literature was employed. Ayurveda portrays the meaningful concept of Janapadhodhwamsa, the tragic scene of death, disease, and the resultant devastation of a large population spread over geographical entities, countries or the world as whole. Hence, it effortlessly justifies a vivid description of COVID-19. The paper intends to contribute to understanding and contributing to tackling the current pandemic by incorporating Ayurvedic principles with a focus on Janapadhodhwamsa.

A Swedish nationwide forensic study of the manner of death in single stab injuries to the trunk

IntroductionForensic pathologists are frequently confronted with questions about whether an injury is likely to have been inflicted by an assault or be self-inflicted. However, little is known of the epidemiological variables that might be applicable to differentiate between homicides and suicides in deaths caused by single stab injuries to the trunk. MethodUsing the Swedish forensic autopsy register, we identified 94 homicides and 45 suicides between 2010 and 2021 in which death followed a single stab injury to the trunk. We extracted characteristics from the cases and performed statistical analyses using the Mann-Whitney U test, Chi-square test and logistic regression model. ResultsVictims of homicides were younger than suicide victims (median age 33 years vs. 52 years, p < 0.05), and males were in the majority in both groups (93% vs. 82%). In numerous homicide victims, stab wounds were placed in the back and in axillar regions, unlike in suicides victims in which the stabs were all placed on the medial part of the anterior trunk. Vertical entrance wounds in the skin combined with a medially running injury channel (n = 13) showed a positive predictive value of 100% (95% CI 75.3–100) for homicide, although the sensitivity was low. Homicides were conclusively associated with an outdoor death scene (OR 19.0, 95% CI 7.6–47.1), injury to thoracic bone/cartilage (OR 3.8, 95% CI 1.6–9.0), influence of alcohol (OR 7.1, 95% Cl 2.9–17.7) and illicit drugs (OR 4.3, 95% CI 1.5–11.9). Discussion and conclusionThe observed forensic characteristics of stab injuries could be used as a tool when assessing the manner of death in single stabs. Further research on variables associated with manner of death are needed and we suggest also including characteristics of surviving victims in such analyses.

The Good Death of a Christian Through the Eyes of Sophie de Ségur (1799–1874)

This paper attempts to analyse how Sophie de Ségur (1799–1874) performed the mission of spreading the Catholic faith through children’s literature. The biography of this Russian woman who converted to Catholicism is presented at the beginning, together with her connections with the Ultramontane environment being active in nineteenth-century France. This is to prove that de Ségur’s writing activities were part of a planned programme aimed at shaping society in the spirit of Catholicism. The analysis is carried out on the examples of how she presented scenes of a good Catholic death in three novels for children: "Les vacances, Jean qui grogne et Jean qui rit and La sœur Gribouille". The study is divided into three parts: the death of the mother, the death of the child, and the death of the sinner, according to the criterion whose death was described. It is shown that in de Ségur’s perspective, a good death is a reward for a good and pious life. The social aspect of death and good preparation for it are also important.

A case of complex asphyxia sheds light on problems in the classification of asphyxias

Death from positional asphyxia is often an accidental event occurring when the victim’s body assumes a position which can compromise an effective respiration. Its diagnosis is usually not simple, because it needs to know the exact circumstance in which the body was found and the original positioning of all the body segments. In this case, a 41-year-old man with a history of opioid drugs abuse was found dead in a knee-chest position; the head was down on the floor with the face resting on a plastic bag. Pictures of the scene of death was taken while the body was still in its original position. At first, the main suspicion was that of a fatal overdose. Following the autopsy examination, completed by histological and toxicological examinations, the cause of death was determined as postural asphyxia secondary to intoxication by methadone, in the presence of ischemic heart disease. Some features, moreover, were typical of the death in head down position, and the prolonged knee-chest position was also associated with the obstruction of mouth and nose by the plastic bag, which may have contributed to the asphyxiation. These cases of “combined” asphyxia represent a challenge for the current classifications of asphyxia, which are very variable and not standardized, as we observe from a brief review of the literature. The elaboration of new systems of classification for asphyxias, which must be clear, simple and shareable, is necessary to avoid confusion in categorizing cases that present overlapping between several types of asphyxiation modalities.

Suspending ekphrasis: Christopher Marlowe’s ‘Brazen World’ in Part 2 of Tamburlaine the Great and its influence

I argue that Part 2 of Christopher Marlowe’s Tamburlaine the Great (1587; published 1590) upends the narrative operations of ekphrasis at work in Part 1 to expose Sir Philip Sidney’s ‘brazen world’ progressively. I track Part 2’s descent into this world through rhetorical insufficiencies that generate flawed ekphrases, which lack the requisite enargeia (vivid description) to be seen in the mind’s eye. Particular attention is paid to Zenocrate’s death scene as well as Tamburlaine’s preservation of her body in a gold-lined coffin. I argue that the coffin is a symbol of Tamburlaine’s rhetorical inadequacy and an aesthetic time capsule in which Marlowe suspends ekphrasis. This suspension complicates the ways in which audiences ‘see’, and is the site of a contest between ‘poetic’ (ekphrastic) and ‘dramatic’ (spectacular) ways of seeing. Through the ekphrastic interaction between the Tamburlaine plays, Marlowe challenges dramatists to revive the operations of ekphrasis in new ways. I examine William Shakespeare’s response to this challenge in The Winter’s Tale (1611; published 1623), arguing that he reconciles the poetic and dramatic ways of seeing to create a stage-picture of the revival of ekphrasis in the coming to life of Hermione’s statue.

The Sound of Good and Evil in Final Fantasy VII

Since its release in 1997, Square’s Final Fantasy VII has captivated audiences with its science fiction plot and rich characters. Like many video games, it presents a story about the forces of good and evil, played out through the protagonists and antagonists of the game. Throughout the story, musical character themes reinforce and enhance the struggle between good and evil taking place in the narrative. Drawing on Peter Brian Barry’s theory of evil known as the mirror thesis, this article views the character themes associated with Aerith and Sephiroth as representative of the moral extremes of good and evil, respectively. After framing the narrative and characters through the lens of the mirror thesis, I perform a close reading of Sephiroth and Aerith’s musical themes and backstories. The analysis demonstrates how Sephiroth represents the moral extreme of evil personhood, while Aerith represents the extreme of moral sainthood. The article concludes with a discussion of how these musical themes occur in relation to each other during significant moments of narrative conflict, particularly during Aerith’s death scene and the final cinematics of the game.

Ethnoracial Disparities in Rates of Non-Natural Causes of Death After the 2020 COVID-19 Outbreak in New York State

COVID-19 was associated with increases in non-natural cause mortality in the U.S., including deaths due to drug overdose, homicide, and motor vehicle crashes. Initial reports indicated higher rates of non-natural mortality among ethnoracial minority groups. This report aims to clarify these disparities by documenting trends in non-natural mortality across ethnoracial groups during the 2020 COVID-19 surge in New York State. We report monthly trends in non-natural cause mortality (overall and stratified by ethnoracial status) in New York State from January 2019 through December 2020, which included the COVID-19 onset in March 2020. Total mean monthly unintentional overdose rates per 100,000 increased from 17.45 (before surge: January 2019-February 2020) to 23.19 (after surge: March 2020-December 2020) (mean difference=5.73, 95% CI=3.82, 7.65; p<0.001).Mean monthly homicide death rates increased from 2.34 before surge to 3.55 after surge (mean difference=1.20, 95% CI=0.60, 1.81; p<0.001), with the increase seen primarily in the non-Latinx Black population. Although increasing unintentional overdose death rates before surge equally affected non-Latinx White, Latinx, and non-Latinx Black persons, they remained high for non-Latinx Black persons but dropped for the other 2 groups after the pandemic onset. None of the ethnoracial subgroups showed significant increases in suicide or motor vehicle crash death rates. Non-Latinx Black persons showed disproportionately high and sustained increased rates of unintentional overdose and homicide death rates after the 2020 COVID-19 surge in New York State. Fatality review and death scene investigation research is needed to better understand these disparities.

Crushed, uncooked egg in the oropharynx: a café coronary?

BackgroundObstruction of the upper respiratory airway can terminate in fatal asphyxia. Autopsy findings in asphyxial deaths as described in literature are not necessarily pathognomonic. A complete autopsy with ancillary studies is necessary to establish the cause, time, and manner of death.Case presentationThe authors present a 44-year-old male who was found dead in his car. He had been remanded in prison for drug trafficking 1 year prior to his death. No other history or death scene findings were provided by the police. Autopsy revealed a crushed, uncooked egg in his oropharynx. Postmortem radiology and toxicology were not done due to nonavailability of the required facilities. Death was ascribed to asphyxia due to a crushed, uncooked egg in the oropharynx.The manner of death could not be ascertained because pertinent information regarding the deceased’s medical records, locus report, and other ancillary investigations was not available.ConclusionsThis report presents an unusual cause of mechanical upper airway obstruction that has never been documented and discusses some of the deficiencies of autopsy practice in resource-limited countries.

Medicolegal Death Investigation of Railroad-Related Fatalities.

Railroad-related fatalities in the United States are increasing. A paucity of literature exists regarding the medicolegal death investigation of railroad-related deaths. We report on a subset of deaths in western Michigan, propose protocols for investigating train-related deaths, and propose a stepwise approach for the medicolegal investigation of railroad-related fatalities. Fourteen railroad-related fatalities from 2015 to 2019 were reviewed. Each case was analyzed for demographics, investigative components, train variables, and death certification. The average age was 32 years. Nine decedents involved pedestrians versus trains, and 5 involved motor vehicles versus trains. Male victims were more common, and 50% of the cases were associated with mental illness or recent stressors. Accident was the most common manner of death. With the exception of basic weather conditions, the remaining investigative variables were rarely reported. Image and audio recordings were taken in 3 cases, but railroad companies refused to allow the recordings to be viewed by the medical examiner. We conclude that in addition to a thorough medicolegal death scene investigation and postmortem examination, audio/video recordings are crucial components of death certification in railroad-related fatalities and advocate that medical examiners/coroners be given the legal right to view and retain them.

Bike stunt gone wrong – Fatal Impalement by Liquor Bottle, landing into the death

Sharp force injuries are the leading cause of death worldwide. Accidental deaths due to sharp force wounds are extremely rare compared to homicide and suicide cases. Therefore, their exact incidence or prevalence is not accurately known. This paper presents an accidental death due to massive blood loss resulting from the sharp cutting of the left femoral artery by glass fragments that impaled the left groin region of a young male. He was allegedly performing a bike stunt under the influence of alcohol. The body was found in a pool of blood, surrounded by multiple glass fragments from a broken alcohol bottle that was lying shattered next to the body. The autopsy revealed a near-total transection of the left femoral artery and significant glass injuries to the skin. Evidence of self-mutilation and scarification in multiple body regions highlighted risky behavior. To determine the circumstances of death in cases of accidental glass injuries, a thorough medico legal investigation, including details of the death scene, post-mortem examination, and chemical analysis of viscera for any intoxicants or stupefying agents, is always necessary.

Medical examiner response to the drug overdose epidemic in King County Washington: "Real-time" surveillance, data science, and applied forensic epidemiology.

As the overdose epidemic overwhelmed medicolegal death investigation offices and toxicology laboratories, the King County Medical Examiner's Office responded with "real-time" fatal overdose surveillance to expedite death certification and information dissemination through assembling a team including a dedicated medicolegal death investigator, an information coordinator, and student interns. In-house testing of blood, urine, and drug evidence from scenes was performed using equipment and supplies purchased for surveillance. Collaboration with state laboratories allowed validation. Applied forensic epidemiology accelerated data dissemination. From 2010 to 2022, the epidemic claimed 5815 lives in King County; the last 4 years accounted for 47% of those deaths. After initiating the surveillance project, in-house testing was performed on blood from 2836 decedents, urine from 2807, and 4238 drug evidence items from 1775 death scenes. Time to complete death certificates decreased from weeks to months to hours to days. Overdose-specific information was distributed weekly to a network of law enforcement and public health agencies. As the surveillance project tracked the epidemic, fentanyl and methamphetamine became dominant and were associated with other indicators of social deterioration. In 2022, fentanyl was involved in 68% of 1021 overdose deaths. Homeless deaths increased sixfold; in 2022, 67% of 311 homeless deaths were due to overdose; fentanyl was involved in 49% and methamphetamine in 44%. Homicides increased 250%; in 2021, methamphetamine was positive in 35% of 149 homicides. The results are relevant to the value of rapid surveillance, its impact on standard operations, selection of cases requiring autopsy, and collaboration with other agencies in overdose prevention.

Suicidal sodium nitrite intoxication: a case report focusing on the postmortem findings and toxicological analyses-review of the literature.

Sodium nitrite (NaNO2) is an inorganic compound that is commonly used as a preservative (E250) in the fish and meat industry. When ingested, sodium nitrite will lead to methemoglobinemia, hypotension, and arrhythmias. An increasing trend in the use of sodium nitrite as a suicide agent has been reported. In Belgium however it remains a rare phenomenon. The ingestion of sodium nitrite is not always apparent from the death scene investigation, especially in cases of covert administration or accidental ingestion. Hence, the forensic pathologist must be aware of this trend and the postmortem changes related to the ingestion of sodium nitrite to effectively identify these cases and determine the cause and manner of death. We describe a case of fatal self-poisoning following the oral ingestion of sodium nitrite with suicidal intent. Postmortem investigations showed signs of methemoglobinemia, such as a gray-brown discoloration of lividity and a chocolate brown discoloration of the blood. Postmortem toxicological investigation revealed methemoglobinemia (35%) in cardiac blood, hypernatremia (159.6mmol/L) in vitreous humor, and the presence of nitrite in gastric contents (1.15g/L) and, for the first time in a forensic case, in serum (38µg/mL). A review of the existing literature regarding cases of sodium nitrite intoxications was performed to correlate these findings.