From an investigative point of view, it is imperative that detectives have a practical understanding of the manner, means, and mode of several kinds of death. (See "Purpose of the Autopsy" in Chapter 18.) During the course of basic death investigations, various situations and types of death will confront the investigator. Because this chapter cannot conceivably cover all of the possibilities involved, it will address the more common methods of death:

Gunshot wounds Poisons

Cutting wounds Asphyxia deaths

Stabbing wounds Autoerotic deaths

Blunt force injuries Arson and fire deaths

In order to provide only the basic knowledge necessary to conduct an intelligent investigation, I have purposely avoided a technical and in-depth discussion of the pathology of wounds, injuries, and forms of death.

Gunshot Wounds

Gunshot wounds may resemble stab wounds in external appearance. However, certain physical characteristics of gunshot wounds will assist the investigator in differentiating stab wounds from wounds caused by firearms. In addition, certain wounds will provide the investigator with a clue to the circumstances under which they occurred.

In order to appreciate the nature of gunshot wounds, one must first understand what takes place as a bullet is fired from a weapon and what happens to the body as this projectile or bullet strikes it.

Basically, when a firearm is discharged, four things occur:

1. Fire or flame is emitted from the barrel.

2. Smoke then follows this flame.

315

Figure 12.1 CLOSE SHOT — FARTHER AWAY FROM THE SKIN THAN INDICATED IN

FIGURE 12.2. Unburned powder grains but no smoke deposits in the zone of blackening. (Courtesy of Medical Legal Art. Illustration copyright 2005, Medical Legal Art, www.doereport.com.)

Figure 12.2 CLOSE SHOT — SHORTER DISTANCE. Unburned powder grains and smoke deposits in the zone of blackening. (Courtesy of Medical Legal Art. Illustration copyright 2005, Medical Legal Art, www.doereport.com.)

3. The bullet emerges from the barrel.

4. Additional smoke and grains of burned and unburned gunpowder follow the bullet out of the barrel.

As this material exits the barrel, it spreads out like a funnel. As the distance from the barrel increases, the density of the pattern decreases, i.e., the flame does not go very far, the smoke goes a little further, the powder grains travel different distances depending upon individual factors, and the bullet travels the greatest distance of all.

Figure 12.3 ENTRANCE WOUND — .357 CALIBER. Suicide. Contact wound under throat. Observe the entrance wound of the bullet. Note the contusion and smudge ring around the collar of the wound. (Courtesy of Chief Deputy Doug Richardson, Coffee County, Tennessee, Sheriff's Office.)

Figure 12.4 ENTRANCE WOUND — SMALL CALIBER BULLET. Observe the small entrance wound in the head of the victim from a .22 caliber semiautomatic. The wound was hardly visible in the hairline, which the ME has shaved to expose the wound. (From the author's

files.)

Depending on the material present on the body or clothing and the degree of density, it may be possible to determine the distance involved. To make this determination, it is necessary to conduct test firings with similar ammunition.

Figure 12.5 DIAGRAM OF BULLET PENETRATING THE SKIN. The skin is pressed inward, stretched, and perforated in the stretched condition, after which it returns to its original position. The entry opening is smaller than the diameter of the bullet. Immediately around the opening is a contusion ring because the bullet rubs against this part of the skin and scrapes off the external layer of epithelial cells. (Courtesy of Medical Legal Art. Illustration copyright 2005, Medical Legal Art, www.doereport.com.)

The Projectile Striking the Body

There are two basic types of wounds:

1. The entrance wound

a. Generally smaller than an exit wound

b. Typically round, neat hole with an abrasion collar, and a gray or blackring around the edges

c. Comparatively small amounts of blood

2. The exit wound

a. Generally larger than an entrance wound

b. Ragged and torn in appearance, shreds of tissue extruding

c. Generally a greater escape of blood than from entrance wounds andpossibly profuse bleeding

The Nature and Extent of Gunshot Wounds

A number of factors will affect the characteristics of the wound and change its appearance, for example:

The distance Passage through clothing

Ricocheting The type of weapon

Type of ammunition used The part of the body affected Passage through the body

The homicide investigator should have a working knowledge of the pathology of wounds and the effect of a firearms discharge on the human body. Human skin

Figure 12.6 EXIT WOUND. This type of wound is usually larger than the entrance wound. It is jagged and torn in appearance. (From the author's files.)

Figure 12.7 DIAGRAM OF WOUND DYNAMICS. Typical characteristics of in and out wounds, which follow a general configuration. There are many exceptions. (Courtesy of Medical

Legal Art. Illustration copyright 2005, Medical Legal Art, www.doereport.com.)

Figure 12.8 CONTACT WOUND. Contact wound to head over bony surface. Note the contusion ring and large deposit of gunpowder in the wound. (Courtesy of Dr. Dominick J. DiMaio, former chief medical examiner, City of New York.)

is very elastic and resistant. When a projectile or bullet strikes the skin, it causes an indentation. As the bullet perforates the skin and bores through, it causes a circular perforation and an abrasion collar, which is caused by the damage to the skin as a result of the friction between the bullet and the stretched, indented skin. In addition to this perforation and abrasion collar, there will be a blackening effect around the wound's edges caused by the discharge of lubricants, smoke particles, and grime from the barrel of the weapon onto the bullet. The skin actually wipes this residue off the bullet as the bullet enters the tissue.

The skin, which has been stretched by the bullet, then returns to its normal or former position. This will make the wound appear smaller than the projectile which has passed through it. The resistance of the skin is evidenced by the fact that many times a bullet will go clear through the body only to be stopped by the skin on the opposite side.

A bullet usually travels in a straight line as it passes through the soft tissue of the body. However, if the bullet hits bones, its direction is unpredictable and will be determined by the velocity of the bullet, the size and shape of the bone, and the angle at which the bullet strikes the bone. In some instances, the bone may be shattered, creating additional projectiles of bone fragments, which cause even further tissue destruction. The exit wound will be large and ragged as this impacted tissue and the bullet push their way through.

As mentioned earlier, a bullet hitting a bone may deflect. Often a bullet fired into the chest cavity or skull will be deflected because of angle and, instead of entering straight into the body, may travel under the skin, sometimes encircling the entire chest or head of the victim.

Figure 12.9 WOUND INTO CHEST THROUGH CLOTHING. This photo depicts a wound that resembles a bullet entry that had gone through the victim's clothing. (Courtesy of Dr. Dominick J. DiMaio, former chief medical examiner, City of New York.)

Figure 12.10 WOUND EVALUATION. This wound was actually a puncture wound from an ice pick, which had been plunged into the victim's chest through the clothing. The drying wound resembled a gunshot entry wound. Medical examination determined it to be a stab wound. (Courtesy of Dr. Dominick J. DiMaio, former chief medical examiner, City of New York.)

Figure 12.11 CLOSE-CONTACT WOUND. A close-contact type wound with a clustered tattooing around the entrance wound (results from the gun's muzzle pressed directly to the victim's chest through light clothing). The wound is a perforating type with the bullet exiting the victim's back. The muzzle blast caused the tattooing. (From the author's files.)

Figure 12.12 X-RAY DEPICTING LODGED BULLET IN CHEST. (Courtesy of Medical Legal

Art. Illustration copyright 2005, Medical Legal Art, www.doereport.com.)

Figure 12.13 EXAMPLE OF GUNSHOT RESIDUE DISTRIBUTION. This revolver discharge demonstrates how gunshot residue particles fall on a shooter's hand during firing. The crime lab can perform analysis on these particles if they are collected in an appropriate manner. Also note the cloud of discharge materials following the bullet from the muzzle. This soot and the particles can be detected on clothing and/or skin. The muzzle/bullet impact site distance can be estimated from the spread of materials (see Figure 12.1 and Figure 12.2). (Photograph courtesy of the Federal Bureau of Investigation.)

Smudging or Smoke

1. Smoke and soot are deposited around the wound.

2. The wound has a dirty and grimy appearance.

3. This is easily wiped off the skin.

4. This indicates that the gun was held close to the victim, but was not in actual contact.

5. Clothes should be held for examination.

Searing

Searing is a yellow singed effect due to the discharge of flame from the barrel.

Tattooing or Stippling

1. Pinpoint hemorrhages due to the discharge of burned powder can be seen.

2. Unburned powder or pieces of metal of the bullet from the blast are driven into the skin.

3. Unlike "smudging," this cannot be wiped off the skin.

Reentry

If the bullet has already passed through another part of the body and reenters, an irregular wound will result which may appear as an exit perforation.

Figure 12.14 TATTOOING OR STIPPLING. The bullet entrance is surrounded by pinpoint hemorrhages due to the discharge of burned powder and fragments, which have been driven into the skin. This is the result of a close shot. (Courtesy of Dr. Dominick J. DiMaio, former chief medical examiner, City of New York.)

Figure 12.15 EFFECT OF HIGH-VELOCITY AMMUNITION. Homicide. This woman was

hit in the face at close range with a bullet from a 30.06 rifle. (From the author's files.)

Figure 12.16 EFFECT OF HIGH-VELOCITY WEAPON. Suicide. This man committed suicide by firing a shotgun into his mouth. This high-powered weapon combined with the shotgun load obliterated the man's face and head. (Courtesy of Detective Mark Reynolds, Harris County, Texas, Sheriff's Department.)

Ricocheting

Similarly, if a bullet has struck another object before entering the body, the entry wound will be irregular.

Shotgun Wounds

The shotgun, specifically the 12-gauge, is the most common weapon confronting law enforcement, and it is the most deadly.

1. Massive tissue destruction occurs.

2. Wadding is usually embedded in the wound if the shotgun is fired within 10 feet of the victim.

3. Wadding can provide the investigator with (1) the type of shot, (2) the gauge of the gun, and (3) possible evidence to identify the gun used.

Contact Wounds

1. The muzzle of gun is held directly against the skin at discharge.

2. The shape is a result of penetration of the bullet and escape of the flame and expanding gases.

3. The perforation will be larger than the diameter of the bullet.

4. The wound is dirty looking.

5. Skin edges are ragged and torn.

Figure 12.19 INTERMEDIATE RANGE SHOTGUN WOUND. This photo shows a close-up and intermediate-range shotgun blast to the neck of the victim. Note the spinal cord seen beneath the displaced tissue. (Courtesy of Dr. Dominick J. DiMaio, former chief medical examiner, City of New York.)

Figure 12.20 DIAGRAM REPRESENTATION OF A CONTACT WOUND. The weapon is pressed against the head or body in an area overlying bone surfaces. Subsequently, the gases from the explosion expand between the skin and the underlying bone surfaces producing a bursting effect with a ragged entrance wound. (Courtesy of Medical Legal Art. Illustration copyright 2005, Medical Legal Art, www.doereport.com.)

6. Charring of skin tissue occurs due to tremendous heat from the muzzle blast.

7. Particularly large and marked tissue destruction occurs when the contact wound is in the head or over bones. There will be a characteristic crossshaped or star-shaped wound, sometimes referred to as stellate. Due to the force of the explosion and the gases against the skull, there is an expansion under the scalp, producing a ragged and torn wound that is much larger than an exit wound.

Figure 12.21 CONTACT WOUND TO SIDE OF HEAD. Particularly large and marked tissue destruction is evident, characterized by a cross-shaped or star-shaped wound referred to as a stellate-type wound. (From the author's files.)

Figure 12.22 MUZZLE STAMP. Contact gunshot wound to the neck under chin demonstrating muzzle/slide/slide guide rod impression. (Courtesy of Westchester County Medical Examiner's Office.)

Figure 12.23 TWO BULLET ENTRY WOUNDS IN HEAD. The medical examiner has shaved the hair from the area of the entrance wounds into the victim's head. (From the author's files.)

It should be noted that the contact wound is the exception to the general configuration of entrance and exit wounds.

In some instances, the muzzle of the gun may be in contact with the skin and the underlying organs allow for the expansion of gases. The result will be a muzzle stamp or brand whereby the muzzle of the gun causes an abrasion on the body outlining the muzzle of the barrel and front sight. In this situation, the wound will not be ragged, but rather clean and round, because the charring and destruction take place under the skin. This is the exception in contact wounds.

Bullet Track

The bullet track is the path of the bullet or projectile as it passes through the body. In certain instances, the on-scene examination may readily indicate the direction of fire if the classic entrance/exit wounds are present. The bullet track is usually straight but may be bent, changed, or erratic, depending on any number of factors. The most common cause for change of track is when the bullet or projectile has hit or been deflected by bone. However, keep in mind that outer garments may deflect the path of the bullet, or the wounded person may have fallen and been hit again. Other factors that may affect bullet tracks include the following.

1. The velocity of the bullet (high or low) will determine the direction of track.

2. The type of bullet (lead or copper jacket) will determine how far the projectile traveled.

Figure 12.24 X-RAY OF VICTIM'S HEAD. The x-ray indicated the location where the two bullets are embedded in the victim's head. (From the author's files.)

(A) (B)

Figure 12.25 BULLET TRACK. Observe the skull cavity. (A) Two separate probes inserted into the entrance wounds of the projectile. (B) The direction of the bullet through the brain. Both (A) and (B) indicate the bullet track of the projectile. The pathologist will be able to make a determination of the direction and travel based on this procedure. (From the author's files.)

3. The ricochet factor — increasing size and number of projectiles — can give a wrong impression as to size and number of wounds.

Remember to note your observations, but be prepared to re-evaluate your thinking in light of additional information.

The bullet track is important in ascertaining the direction of fire. However, this determination must be made by the forensic pathologist, who can properly evaluate entrance and exit wounds through microscopic and physiological methods conducted during the autopsy.

Cutting Wounds

An incision or cut-type wound is caused by a sharp instrument or weapon and is generally longer than it is deep. The cut or incised wound is deepest where the weapon was first applied to the skin. If the cutting is done parallel to the lines of cleavage, the edges of the wound will remain together. If the cutting is across the lines of cleavage, the wound will be gaping or open.

The incised wound usually involves the skin and underlying tissue, but may be deep enough to slice bones or organs. It is difficult to determine whether cutting wounds are antemortem or postmortem; therefore, only the pathologist should attempt to make this determination.

Figure 12.26 LINES OF CLEAVAGE. Body and head. (Courtesy of Medical Legal Art. Illustration copyright 2005, Medical Legal Art, www.doereport.com.)

Figure 12.27 INCISED NECK WOUND. (Courtesy of Dr. Dominick J. DiMaio, former chief medical examiner, City of New York.)

Figure 12.28 SLASHING OF THE THROAT — SEXUAL ASSAULT. The victim's throat was slashed by her assailant during a sexual assault and murder. Her larynx was severed, preventing her from screaming for help. (Courtesy of Detective Sergeant Alan Patton, Grand Prairie, Texas, Police Department.)

Characteristics of cutting wounds include the following:

Clean and sharp edges

Minimum bruising

Longer than deep

No bridging of skin

Freely bleeding

It should be noted that it is extremely difficult to make any determination of the type of instrument or weapon used.

Stabbing Wounds

Stabbing wounds are piercing wounds, which may extend through the tissue and bone into the vital organs. They are caused by relatively sharp pointed instruments such as knives, screwdrivers, ice picks, daggers, scissors, or pieces of glass.

Figure 12.29 STABBING INTO BACK — LARGE KNIFE. This photo depicts stab wounds into female victim's back made with a large-bladed knife. (Courtesy of Dr. Leslie I. Lukash, former chief medical examiner, Nassau County, New York.)

Figure 12.30 STABBING INTO CHEST — KNIFE IN WOUND. Suicide. This photo depicts stab wounds into a female victim's chest with the knife left in one of the wounds. Many times the medical examiner will be able to state that a wound is consistent with a particular weapon. In this case, the weapon used by the victim is still in the victim. (Courtesy of Dr. Leslie I. Lukash, former chief medical examiner, Nassau County, New York.)

Stab wounds vary according to the type of weapon employed and how it was used in the attack (thrust, pulled out, twisted, etc.) The principle involving lines of cleavage (Langer's lines) is also applicable to stab wounds. The stabbing wounds can appear open and gaping or tight and narrow depending on whether the wound runs parallel to the lines of cleavage or against them. The shape of the stab wound may indicate what type of weapon or blade was used. However, like a bullet wound, the stab wound will be smaller than the blade which caused it due to the elasticity of the skin. The type of wound is, therefore, determined by estimates of minimum and maximum size. Sometimes the knife hilt may bruise the skin and leave an identifiable mark.

Characteristics of stabbing wounds are

Deeper than wide

Possible damage to vital organs beneath skin and bone

Internal bleeding with little or no external blood

Possible indication of type of weapon used

The pathologist will examine the wound track and can determine the position of the deceased when he or she was stabbed. In addition, if the victim fought with the assailant, there will be evidence of defense wounds on the hands and arms and between the fingers. Many times, the victim will have grabbed the knife only to have it pulled away by the assailant. This will leave a deep gash in the palm or on the undersurface of the fingers.

Figure 12.31 DEFENSE WOUNDS TO THE HAND. This photo depicts defense wounds to the victim's hand from a bladed instrument. There is also a foreign hair in the deceased's hand that can be used for DNA comparison. (Courtesy of Dr. Dominick J. DiMaio, former chief medical examiner, City of New York.)

Figure 12.32 INCISED WOUNDS — STRAIGHT RAZOR. Homicide. This photo depicts homicidal injuries inflicted with a straight razor. Note that the wounds are longer than deep and will bleed profusely. These types of injuries cut across the lines of cleavage and usually result in permanent scaring for victims who survive assault. (Courtesy of Dr. Dominick J. DiMaio, former chief medical examiner, City of New York.)

Figure 12.33 OVERKILL — STAB WOUNDS INTO CHEST. This photo depicts "overkill" injuries in which the offender stabbed the woman 94 times. These types of injuries usually occur when an offender is expressing rage, anger, or lust. (From the author's files.)

The type of weapon, the direction of injury, and the position of the victim are all factors which can be ascertained by a careful examination of the stab wound. However, estimating the length of a knife from the depth of a wound can be problematic because different parts of the body have different degrees of elasticity. For example, a knife can be driven into the abdomen further than into a person's chest due to the ribs and sternum. The clothing of the victim should always be obtained for later inspection to determine the position of the deceased during the attack and to correlate injuries to the body with tears or rips in the clothing.

Blunt Force Injuries

Blunt force injuries are evident by outward signs such as lacerations and bruising. However, lack of external injuries does not mean that blunt force was not applied. In many instances, internal damage to organs occurs without any external sign of violence.

Lacerations

A laceration is a tear in the tissue, which may be external (on the skin) or internal (such as a torn spleen). The torn edges of the skin will be ragged and bruised, and bridges of connective tissue may be stretched across the gap.

Figure 12.34 LACERATIONS IN SCALP — BLUNT TRAUMA. This photo depicts patter lacerations in the scalp from a hammer. The medical examiner has shaved the area of trauma to expose the external wounds, which are consistent with the hammer used. (Courtesy of Dr. Leslie I. Lukash, former chief medical examiner, Nassau County, New York.)

Figure 12.35 BLUNT TRAUMA — SKULL FRACTURES. This photo depicts the skull fractures beneath the lacerations seen in the previous photo. Note the extreme depressed skull fractures consistent with a hammer attack. (Courtesy of Dr. Leslie I. Lukash, former chief medical examiner, Nassau County, New York.)

Figure 12.36 DEPRESSED SKULL — CHOPPING WOUNDS. This photo depicts a depressed skull with multiple contusions. The weapon used was an axe wielded in a chopping fashion. (Courtesy of Dr. Dominick J. DiMaio, former chief medical examiner, City of New York.)

Figure 12.37 PATTERN INJURY — BLUNT FORCE TRAUMA. These photos depict blunt force injury to the head. Note how the pattern of the weapon used to inflict the injury matches that of the wound. (Courtesy of Dr. Dominick J. DiMaio, former chief medical examiner, City of New York.)

Chopping Wounds

These wounds are caused by a heavy object which has an edge, e.g., an axe. A wound produced by an axe will not only cut into the skin, but also cause contusions and structural damage to the body parts beneath. There will be a deep gaping wound, with contusions and structural damage.

Blunt force injuries are usually directed at the head of the victim. The evidence of injury to the head is evident in the lacerations of the scalp or the blackening of

Figure 12.38 INTERNAL VIEW — SKULL FRACTURES. This photo depicts the internal effect of massive blunt force trauma to the head with multiple fractures of the skull. (Courtesy of Dr. Dominick J. DiMaio, former chief medical examiner, City of New York.) the eyes. However, a severe injury to the head need not be accompanied by evidence of laceration or eye trauma. A person may receive a blow to the head and appear to be all right, only to die later as a result of an internal hemorrhage.

Injuries to the brain in the back of the head are more likely to be fatal than injuries to the brain in the front part of the skull. This information must be well known in the underworld because in many execution-type murders, the victim is found face down and shot through the back of the head.

Blunt force injuries to the abdominopelvic cavity, which contains many organs, can cause severe internal bleeding and death. The most common injury within this area is a torn spleen. However, damage to the liver, intestines, and bladder is relatively easy to cause when blunt force is directed to the body.

Bone injuries also result from the use of blunt force. In a fractured skull, the direction of the cracks or fractures may make it possible to determine the direction of force.

Deaths by Asphyxia

Death by asphyxia can occur through any number of circumstances. The most common, however, are

Strangulation (manual or ligature)

Hanging

Drowning

Figure 12.39 ASPHYXIATION — MANUAL STRANGULATION. Observe the marks on the throat area of the victim, which were caused by the fingernails of the assailant. (From the author's files.)

Figure 12.40 PETECHIAL HEMORRHAGE. Minute (pin-like) hemorrhages that occur at points beneath the skin. Usually observed in the conjunctivae (the mucous membrane lining the inner surface of the eyelids and anterior part of the sclera). (From the author's files.)

Inhalation of poison gases

Suffocation

In fact, any death in which air is cut off from the victim is considered to be asphyxial in nature. This would also include those classified as sexual asphyxia and autoerotic deaths, which are discussed later in this chapter.

Strangulation

Direct strangulation involves the choking of a person manually (by the hands) or mechanically (using a ligature). However, strangulation can also occur through such means as judo moves, use of forearms or legs (as in yoking), and use of instruments employed in combat to restrict air flow or to render an assailant unconscious by cutting off the supply of oxygen to the body. In manual strangulation deaths, there may be fractures of the hyoid bone or thyroid cartilage accompanied with hemorrhage. The fracture of the hyoid bone in ligature strangulation is found in less than 1% of cases.

In ligature-type homicides, any number of instruments can be employed, such as ropes, wires, and pieces of clothing. Any type of material or action which causes a person to stop breathing is considered to be asphyxial.

A cord, wire, or similar instrument will leave an obvious groove on the victim's throat, which resembles the mark on a hanging victim. The pathologist can often tell the investigator whether the marks left on the throat by the assailant's fingernails during the attack took place from the rear or the front of the victim.

Strangulation homicides will cause damage to the interior structures of the neck, throat, and larynx, which will be evident to the forensic pathologist who performs the autopsy.

Investigative Considerations

The investigator can make certain observations at the scene which may enable him or her to determine the manner of death, for example,

1. The presence of new abrasions, bruises, or fingernail marks on the throat of the victim may indicate a strangulation.

2. The presence of petechial hemorrhages (minute blood clots which appear as small red dots) in the conjunctivae (the mucous membrane lining the inner surface of the eyelids) or in the sclerae (tough, inelastic, opaque membrane of the eyeball) are presumptive evidence of strangulation.

3. Evidence of trauma to the tongue may be found. Many times persons who are asphyxiated will bite their tongues.

Hanging

Incidents of hanging are usually suicidal or accidental, as in autoerotic deaths. However, the investigator must be alert to incidents in which a hanging may have

Figure 12.41 ASPHYXIAL DEATH — HANGING. Note the reddened groove mark on the neck of the victim, indicating hemorrhage of the underlying tissues. (Courtesy of Dr. Dominick J. DiMaio, former chief medical examiner, City of New York.)

Figure 12.42 REMOVING NOOSE FROM AROUND NECK. The knots should not be disturbed or loosened. (A) A fixed noose should be cut off and the ends immediately tied together with a string or wire. (B) With a running noose, the position of the knot on the standard part is fixed, after which the noose is cut off. If the noose consists of a number of parts, they should be cut and the ends tied together with a string or wire. (Courtesy of Medical Legal Art. Illustration copyright 2005, Medical Legal Art, www.doereport.com.)

been purposely staged in order to cover up another crime, thereby making a homicide appear to be suicide.

Hanging deaths must be thoroughly investigated by the detective as well as the medical examiner/coroner. Practically speaking, the homicide investigator should be aware of certain characteristics of hanging deaths:

1. A body need not be completely suspended in order to suffer asphyxia. If a suicide has fastened a rope, noose, or other type of material around his or her neck, attached the other end to a door-knob, towel rack, or other hooktype object, and then allowed his or her throat to be contracted, asphyxia will take place, whether or not other portions of the body are in contact with the floor. A majority of the body weight supported by the ligature will effect the required result.

2. If the material used is small or ropelike, there will be a deep groove across the neck, usually high up.

3. Minute areas of bleeding due to the rupture of small blood vessels in the skin will cause small black-and-blue marks to appear within the area of the groove line. This type of rupture indicates that the person was alive when the hanging took place.

4. Persons who have died as a result of asphyxia may expel urine or feces.

5. Postmortem lividity will be pronounced in the head, above the ligature, and in the arms and lower legs due to gravity.

It should be noted that if the body is obviously dead and immediate lifesaving methods do not need to be employed, nothing should be touched, handled, or otherwise disturbed until the body and scene have been photographed. If the material around the neck must be removed, the knot or tie should not be touched. Instead, the material should be cut in an area which does not disturb the knot. When the noose is cut, the ends should be tied together with string to show the original position.

This procedure is usually performed by the pathologist who performs the autopsy. There is no need to remove the noose from the person at the scene unless it is possible that the victim is still alive.

Drowning

This type of asphyxia is the direct result of liquid entering the breathing passages and preventing air from going to the lungs. Practically speaking, a person need not be submerged to drown. As long as the mouth and nose are submerged in any type of liquid, drowning will occur. The sequences of events in drowning are breath holding, involuntary inspiration and gasping for air at the breaking point, loss of consciousness, and death. The mechanism of death in acute drowning is irreversible cerebral anoxia.

Figure 12.44 HEMORRHAGIC EDEMA FLUID. The white frothy fluid in the mouth and nostrils of the deceased is hemorrhagic edema fluid, commonly found in drowning victims. (Courtesy of Dr. Leslie I. Lukash, former chief medical examiner, Nassau County, New York.)

I remember one case in which a crew (violent urban youth gang) had forced their way into the victim's apartment. They proceeded to torture the man and then tied his hands and feet together. He was then carried to the bathroom, where one of the youths had filled the tub. The victim was placed facedown into the half-filled tub. They held his face under the water until he stopped squirming. The cause of death was drowning.

The most indicative characteristic of drowning is the white foam (hemorrhagic edema) which forms as a result of the mucus in the body mixing with water. The presence of this white lathery foam in the mouth and windpipe prevents air from entering and contributes to the asphyxia.

Bodies in the water for long periods of time are subject to additional damage or injury unrelated to the actual drowning. (See "External Agents of Change" in Chapter 9.) Most bodies will sink upon drowning, only to rise later when the gases from putrefaction begin to inflate the body, causing it to rise to the surface. The amount of time before this occurs depends upon water temperature, the condition of the body (fat or thin), and other variables such as currents. The victim of a drowning will often be found grasping objects such as mud, grass, or other material found in the water.

Inhalation of Poison Gases

The most common type of asphyxia results from the breathing in of certain chemicals, such as carbon monoxide. These deaths are best determined after toxicological testings are made of the blood. Carbon monoxide (CO) attacks the red blood cells of

(A)

(B)

Figure 12.45 FLOATERS. The term "floaters" is applied to describe bodies which show the effect of submersion and drowning asphyxia. (A) This is a photo of the body of a homicide victim recovered from the waters with his hands still cuffed behind his back. (B) This photo is a close-up of the same floater's face. (Courtesy of Dr. Leslie I. Lukash, former chief medical examiner, Nassau County, New York.)

Figure 12.46 SMOTHERING. This photo depicts a victim who has smothered. She committed suicide by placing a plastic bag over her head and tying it around her neck. (Courtesy of Dr. Dominick J. DiMaio, former chief medical examiner, City of New York.)

the body. It combines with the hemoglobin of the red blood cells, becoming cherry red, which creates a pinkish discoloration of the skin of the victim. At the scene, examinations sometimes will indicate the possibility of carbon monoxide poisoning if the lividity is cherry red. However, this is only a rough gauge, and before attributing the death to carbon monoxide, the investigator should await the results of the autopsy.

Suffocation

Suffocation or smothering occurs when the passage of air through the mouth and nose is blocked. The mechanisms necessary to accomplish this suffocation vary. Deaths from suffocation are a direct result of oxygen failing to reach the blood.

General Forms of Suffocation

• Smothering

• Choking

• Inhalation of suffocating gases

• Mechanical asphyxia

• Entrapment/environmental suffocation

• Mechanical asphyxia combined with smothering

If the smothering is homicidal, hands may be placed over the mouth and nose, a pillow forcibly compressed over the face, or a plastic bag, gag, or other obstruction forced into the mouth. When the suffocation is done with the hands, there may be evidence of scratches on the face.

Homicidal deaths occur when a victim chokes on a gag or when someone places an object in a newborn's mouth. Most deaths due to choking are accidental. In children, this usually involves the aspiration of a small object into the larynx with occlusion of the airway.

Deaths by Fire

Deaths caused by fire generally result from the inhalation of noxious gases and fumes created by the fire. The victim is usually dead prior to any burning or charring of the flesh. The pathologist will be able to determine the critical question of whether the victim was alive at the time of the fire. In burns due to flames, there is actual contact of flame with the body with singeing of the hair and scorching of the skin, which progresses to charring. Contact burns involve physical contact between the body and a hot object. Scalding burns are due to contact with hot liquids, the most common being scalding water.

Severity of Burn Injuries

Burns are described as first, second, third, and fourth degree.

First-degree burns are superficial types of burns, with redness of the skin usually associated with sunburn type injuries and subsequent peeling of the skin.

Second-degree burns can be superficial or deep. The burns are moist, red, and blistered with lesions. In deep second-degree burns the epidermis is disrupted.

Third-degree burns are full thickness burns with destruction of tissue and charring. This wound can heal but there will be scaring.

Fourth-degree burns are incinerating injuries extending deeper than the skin.

Investigative Considerations

If the body was alive at the time, it will evidence the following:

• Smoke stains will be found around the nostrils, in the nose, and in the air passages.

• Blood will have elevated levels of carbon monoxide.

• Blistering and marginal reddening of the skin will occur.

(A)

(B)

Figure 12.47 BURNED BODY. The classic pugilistic attitude is assumed by the body as a result of the coagulation of the muscles due to extreme heat. (A) The deceased had doused himself with gasoline and run until he collapsed. The gas-soaked clothing was burned off his body. (B) Note the severe burning and positions of the arms on the body after it has been turned over. Self-immolation is extremely rare. (From the author's files.)

Figure 12.48 FOURTH-DEGREE INCINERATING INJURY. (Courtesy of Dr. Leslie I. Lukash, former chief medical examiner, Nassau County, New York.)

• Burned bodies often assume a distorted position referred to as the "pugilistic attitude." This is caused by the contraction of the muscles due to heat.

• The skin may "crack," giving the impression of wounds.

Scalding Burns

There are three types of scalding burns:

• Immersion — accidental or deliberate

• Splash or spill — usually accidental burns

• Steam — exposure to superheated steam

Hot water accounts for most of the immersion and splash burns and, although most splash burns are usually accidental due to a spill, they can be homicidal as in domestic homicides and child abuse. Scalding of children is a common form of child abuse and homicide. The investigator should look for patterns of burns indicating immersion.

Arson

It should be noted that acts of arson to commit homicide and to cover up homicides have become very common. Therefore, homicide investigators should have some basic knowledge of arson-type fires and be familiar with the effects of fire on the human body, in order to interpret events at the scene properly.

Figure 12.49 SCALDING BURNS. The photo depicts the body of a woman who was scalded to death in her shower. A defective water heater had heated the water to a temperature of approximately 200°F. The woman crawled from the bathroom to the living room, where she collapsed. The body has been rolled over by the EMTs. (From the author's files.)

Figure 12.50 SCALDING — CHILD ABUSE. This photo depicts the body of a child dipped in scalding water. Note the lower extremities and even distribution of scald. (Courtesy of Dr. Leslie I. Lukash, former chief medical examiner, Nassau County, New York.)

Figure 12.51 SOOT IN TRACHEA. This photo depicts soot in the trachea, indicating that the victim was alive during the fire and breathed in smoke and carbon monoxide. (Courtesy of Dr. Frederick T. Zugibe, chief medical examiner, Rockland County, New York.)

Practically speaking, the average investigator lacks the expertise to investigate crimes of arson thoroughly. However, most arson-related homicides are very amateurish, and it will be obvious to the investigator that something is wrong. The presence of flammable liquids, several points of origin of the fire, and intensity of the blaze are examples of clues which may indicate arson. Meaningful interpretations of these clues, however, must be left to the experts because arson investigation is highly technical and complex. Therefore, death investigations in which arson is the cause of the death or has been employed by the killer to cover up the crime require that the homicide detective team up with the arson investigator.

The discovery of a body or bodies in a burned-out building or vehicle presents additional investigative problems. The mode of death could be natural, suicidal, accidental, or homicidal. The body may be too badly burned even to recognize whether it is male or female, or there may be evidence of gross injury and dismemberment. The investigators will have to rely on the pathologist to interpret these injuries. The pathologist will be able to make certain determinations regarding cause of death. Despite the tissue damage done by the fire, the examination at autopsy will reveal the wounds or injuries that actually caused the death.

Most incidents of arson are perpetrated to destroy evidence or conceal the crime by destroying the body. However, the body does not burn as easily as most people believe. Instead, it resists the destructive forces of the fire with amazing durability, allowing the pathologist to make determinations from the remains.

Poisons

Practically speaking, murder by poisoning is extremely rare. Investigators are usually confronted with cases in which the victim has committed suicide by taking an overdose of pills or ingesting something dangerous in order to cause death. Other cases of poisoning are usually accidental and involve narcotic overdoses or the inadvertent taking of the wrong medication. In some cases in medical facilities, a mix-up has occurred and a patient has been given the wrong medication or too high a dosage; if death occurs, it is assumed to be natural. In some instances, health care workers may have intentionally given overdoses to patients in a misguided effort to "end their suffering." Serial killer Donald Harvey, who worked as a nurse's aide, ultimately confessed to the murders of over 50 persons whom he killed by injecting them with mixtures of cyanide and arsenic or, in some cases, by disconnecting life-support equipment.

In December 2003, Charles Cullen, a former nurse, was arrested. Cullen claimed to have killed up to 40 patients during his nursing career in New Jersey and Pennsylvania. He pled guilty to killing 13 Somerset Medical patients and attempting to kill two others by injecting them with various medications. That plea was entered

Figure 12.52 OVERDOSE — SECONAL STAINS ON LIPS. (Courtesy of Dr. Dominick J.

DiMaio, former chief medical examiner, City of New York.)

as part of an agreement in which he promised to cooperate with authorities if they did not seek the death penalty. Cullen also pled guilty to the homicides he committed in Pennsylvania. Other deaths still are under review in both states.

The examination at the scene and the intelligent questioning of witnesses, members of the family, and others is of paramount importance in determining whether the mode of death was a homicide, suicide, or accident.

Many times, the initial investigation at the scene will reveal the presence of a suspected material or fluid. This material should be retrieved by the detective for later toxicological analysis. Any glasses, cups, or other containers from which the deceased may have been drinking, as well as a sample of the fluid or material believed to have been ingested by the deceased, must also be obtained. Any liquid evidence should be placed in a sterile container, sealed, and delivered to the medical examiner/coroner. Any residue or solid material should be placed in a clean paper bag for similar disposition.

In certain cases, it will be obvious to the police that the death was due to the introduction of some poisonous substance. Drug overdoses are the most common. Any drug paraphernalia or residue found at the scene, including hypodermic needles or syringes, should be collected and forwarded to the pathologist. It is important to secure any needles in order to prevent injury or infection to others. A cork placed on the end of the needle will be sufficient to prevent the needlepoint from scratching or cutting anyone during transportation.

In some instances, corrosion or burning around the mouth may be present. This usually indicates the consumption of some sort of caustic substance. If a person is desperate, as are most suicides, he or she may ingest a corrosive chemical such as lye or one of the common household cleaners. However, any number of chemicals or substances can be introduced into the human body to cause death. The investigator must be alert to the presence of any material found near the body.

The most important fact to keep in mind is that the scene examination and investigation into the events leading to the death must be thorough and complete. The medicolegal autopsy will determine the type and quantity of the poisonous substance involved. However, determination of the mode of death will be based on the police investigation at the scene.

Deaths Caused by Injection

Insulin is the most common drug used by persons who commit homicide because the death will appear to be natural, and if there is an autopsy, the medical examiner will ordinarily not be looking for injection sites or high levels of insulin in an ordinary toxicology screen.

I remember acting as a consultant for CBS News involving a series of cases assigned to an incompetent investigator. I had determined that the cases I had reviewed were inadequately investigated and consisted of a series of pervasive police errors and omissions. There was also official malfeasance involved in these events, which was referred to the state authorities for investigation. The investigator subsequently was fired for his actions.

One of the cases involved a murder where the former husband killed his wife with an insulin injection. The victim, who was not living with her husband, was discovered in her home. She was found nude from the waist down and her blouse had been pulled up over breasts. A bloody rag was by her head and a telephone answering machine was between her legs. The family considered her husband a suspect and advised the detective of their concerns.

There had been a history of domestic violence. The wife had confided in friends that her husband was going to kill her. The family ascertained that the husband had taken out a large insurance policy on his wife totaling over $300,000.

When the detective was informed of this information, he stated that he did not think that this information was relevant. The detective never processed the scene for fingerprints. He never had the bloody rag tested. He did not request tests for sexual activity and disregarded the fact that husband's drivers license was found next to his wife's body.

The medical examiner did conduct a sexual assault exam and provided swabs to detective. However, the detective never brought them to state lab and the evidence became contaminated.

I learned that an informant had revealed that the husband was planning on killing his wife for the insurance money. The informant had reported this to the neighboring police department and to the victim. When the victim's body was found, the informant told the assigned detective that the husband was planning on using an insulin injection to kill his wife.

However, the detective never advised the medical examiner. Toxicology was not performed for the presence of insulin and the medical examiner was not afforded an opportunity to locate the injection site. The death was ruled "undetermined" and the suspect got away with murder.

Case History1

Dr. Charles Friedgood, a general thoracic surgeon who had a practice in Brooklyn, New York, lived with his wife Sophie in the Great Neck section of Kensington, Long Island. The couple had five grown children and reportedly a stormy marriage due to Dr. Friedgood's affair with a medical assistant, who had borne him two children. The woman, who was 14 years younger than the doctor's wife, had recently moved back to her native Denmark.

Case Facts. On Tuesday evening, June 17, the doctor and his wife had dinner at a fish restaurant about 8:00 P.M. and returned home at 11:00 P.M. On Wednesday morning, June 18, the doctor stated that he had spoken to his wife before going to work in Brooklyn at about 9:00 A.M.

At approximately 10 to 11 A.M., the doctor called the housekeeper to see how his wife was and was informed by the housekeeper that Sophie could not be awakened. Dr. Friedgood called a local ambulance company. Police and ambulance responded. The EMT refused to take the body without a death certificate.

When Dr. Friedgood arrived, he examined his wife's body and verified death. He called some doctor colleagues who lived in the area, but none was available to sign a death certificate. Dr. Friedgood signed a death certificate that he had with him indicating that the cause of death was a cerebral vascular accident. Dr. Friedgood explained to the police officer and EMT that his wife had suffered an extreme stroke 15 years earlier.

Dr. Friedgood arranged for a funeral home to pick up his wife's body and then have it taken to Hazelton, Pennsylvania, where her family had a burial plot. He cited his family's Orthodox Jewish beliefs that burial should take place within 24 hours of death and that autopsies were to be avoided.

On Thursday morning, June 19, the Kensington police chief, who was suspicious of the circumstances — especially that the doctor had signed his own wife's death certificate, notified the Nassau County District Attorney and Medical Examiner's offices.

Nassau County authorities requested Dr. Friedgood to allow them to conduct an autopsy, but he refused citing religious reasons. However, under family pressure, he agreed to an autopsy to be conducted in Pennsylvania by Dr. Hudock, who was a pathologist and part-time medical examiner. On June 19, Dr. Hudock performed an autopsy. His opinion was that the death was inconclusive as to cause but was definitely not caused by cerebral vascular accident. Dr. Leslie Lukash, Nassau County's chief medical examiner, spoke to Dr. Hudock during the autopsy and offered his lab's toxicology services.

On Friday, Dr. Lukash sent a police helicopter to Pennsylvania to retrieve the specimens, which consisted of blood, bile, urine, brain, liver, kidney, and stomach contents.

On Saturday the preliminary toxicology studies indicated 15 mg of meperidine in the liver tissue, which was a toxic dose. Stomach contents also indicated trace amounts of Demerol.

The following Wednesday, June 25, Dr. Lukash went to Pennsylvania to discuss the high levels of meperidine with Pennsylvania authorities. He informed the authorities that Sophie Freidgood had died from Demerol intoxication by injection not ingestion.

On June 28, family members called the Nassau County District Attorney to alert the office that Dr. Friedgood was leaving the country on an international flight out of JFK airport. The plane was told to return 20 minutes into flight. Dr. Friedgood, who had a one-way ticket to London, was escorted off the plane. He had $600,000 in negotiable bonds and jewelry worth $37,000.

On June 30, the following Monday, Dr. Lukash advised the Nassau County District Attorney that the deceased had died from Demerol intoxication. Dr. Lukash wanted to have the body exhumed to determine the injection sites. This meant convincing Pennsylvania authorities for the need to get a court order for exhumation. Dr. Lukash also wanted further testing done by an outside laboratory. Dr. Leo DalCortivo, Suffolk County toxicologist, confirmed the Nassau County findings and, in one sample, found 225 mg in the liver, indicating that the injection occurred in the agonal or dying state.

Dr. Lukash subsequently testified at an exhumation court hearing in Pennsylvania that the deceased had died from Demerol intoxication by injection. In order to determine whether it was a homicide or suicide, an autopsy would be necessary to seek the sites of injection.

Dr. Lukash further testified that based upon the last consumption of food at 8:00 P.M. on June 17 and the amount of food found in the stomach (6 to 8 oz), it was his opinion that the deceased died during the early morning hours of June 18. This contradicted the statement by Dr. Friedgood that he had spoken to his wife on June 18 at 9:00 before going to work.

On July 11, Dr. Lukash and Dr. Hudock performed an autopsy for the purposes of detecting sites and bruised tissue, which were removed and analyzed. Four of the six injection sites showed the presence of Demerol.

Figure 12.53 LOCATION OF INJECTION SITE. The medical examiner located various injection sites on the exhumed body of the victim. This injection site was in the thigh. (Courtesy of Dr. Leslie I. Lukash, former chief medical examiner, Nassau County, New York.)

Figure 12.54 TISSUE SPECIMENS. This photo depicts a slide of the tissue injection sites. Four of the six injection sites showed the presence of meperidine, which is Demerol. In one sample, toxicology revealed 225 mg in the liver, indicating that the injection occurred in the agonal or dying state. Dr. Lukash proved that the victim was killed by lethal injection. (Courtesy of Dr. Leslie I. Lukash, former chief medical examiner, Nassau County, New York.)

Dr. Friedgood had a criminal history. The doctor had been indicted in Brooklyn for an illegal abortion that resulted in the death of a woman. However, the charges had been dismissed because of an illegal wiretap. A few years later, Dr. Friedgood was convicted on three federal income tax evasion charges and had been sentenced to 2 years' probation. In addition, his business partner in some real estate transactions charged that Dr. Friedgood had him kidnapped and drugged. The partner claimed that the doctor was trying to force him to sign a $510,000 promissory note. The case was dismissed because of lack of evidence. At the time of his wife's death, Dr. Friedgood was one of 13 doctors under investigation for fraud involving Medicaid benefits. This information was subsequently ruled inadmissible in his murder trial.

Dr. Charles Friedgood went to trial in October and was convicted in December of the murder of his wife and sentenced to 25 years to life in prison.

Sexual Asphyxia: The Phenomenon of Autoerotic Fatalities

Introduction

Sex-related deaths due to solo sex-related activities involving asphyxia are generally known as autoerotic fatalities. These manners of death are not prevalent. Nonetheless, police and medical examiners as well as coroners in various jurisdictions have recorded a sufficient number of cases to make this phenomenon a concern in the accurate determination of manner of death. Therefore, the homicide investigator should be aware of them. The mechanism of death may be asphyxia or some other physiological derangement caused by strangulation or suffocation. Based on first observation, the manner of death may be classified as suicide or homicide, when in fact it is an accident that occurred during a dangerous autoerotic act.

Most of the literature on the subject of autoeroticism analyzes the involvement of teenage boys, and older men who obtain some sort of sexual gratification through certain ritualistic activities. The male victims have been discovered nude, attired in female clothing, wearing a piece of female lingerie, or in normal attire. It should be noted that there are documented cases of female participants who have been discovered nude, seminude, or in bondage, as well as in normal attire.

The investigator confronted with a female victim found under these circumstances is cautioned to assess carefully all of the information available before jumping to any conclusions. In some cases, evidence indicates self-abuse and other masochistic activities. Contraptions or ligatures with padding, to prevent visible marks of this activity, are often used to cause hypoxia.

Hypoxia is defined as "an inadequate reduced tension of cellular oxygen characterized by cyanosis, tachycardia, hypertension, peripheral vasoconstriction, dizziness or mental confusion."2 Dr. H.L.P. Resnick, an author and researcher in this field, states that "a disruption of the arterial blood supply resulting in a diminished oxygenation of the brain ... will heighten sensations through diminished ego controls that will be subjectively perceived as giddiness, light-headedness, and exhilaration. This reinforces masturbatory sensations."3

Figure 12.56 AUTOEROTIC CASE INVOLVING FEMALE. This case involved a female who was into bondage. She was discovered in this position on her bed. (From the author's files.)

A combination of ritualistic behavior, oxygen deprivation, danger, and fantasy appears to bring about sexual gratification for these people. According to Robert R. Hazelwood, a retired supervisory special agent, "Death during such activity may result from: (1) a failure with the physiological mechanism; (2) a failure in the selfrescue device; (3) a failure on the part of the victim's judgment and ability to control a self-endangering fantasy scenario."4

The results of some 150 cases were the basis for an in-depth study and subsequent textbook, Autoerotic Fatalities,5 by retired Supervisory Special Agent R. Hazelwood; Dr. Park Elliot Dietz, M.D., M.P.H., professor of law, behavioral medicine and psychiatry at the University of Virginia; and Ann Wolbert Burgess, R.N., D.N.Sc., associate director of nursing research, Department of Health and Hospitals, Boston, Massachusetts. In my opinion, their text is one of the most thorough and comprehensive studies to date on the subject of autoerotic fatalities.

According to their text, approximately 500 to 1000 people die from autoerotic asphyxiation each year in the United States. Many times this type of case has been misclassified or gone unrecognized due to lack of knowledge, misinformation, or misguided efforts on the part of the surviving family to cover up what is perceived to be an embarrassing situation.

I have investigated and assessed over 200 of these situations. Often, during a class presentation on the subject of autoerotic deaths, one of the participants will remark how his department had a case like the ones presented and that the death had been classified as a suicide or homicide. In most instances, I have been afforded an opportunity to view the crime scene photographs and case reports which the investigators have supplied for my review.

I also have a number of videotapes which graphically portray the dangers of autoerotic hangings and how quickly the hypoxia affects the victim's ability to

Figure 12.57 TYPICAL AUTOEROTIC DEATH BY HANGING. Asphyxial death due to hanging. Note the "heavy leather" outfit as well as the ladder in place. The victim's pants were open and his genitals were exposed. (Courtesy of retired Supervisory Special Agent Robert R. Hazelwood, Behavioral Science Unit, FBI Academy, Quantico, Virginia.)

control the onset of fatal cerebral anoxia. Cerebral anoxia is defined as "a condition in which oxygen is deficient in brain tissues caused by a circulatory failure. It can exist for no more than 4 to 6 minutes before the onset of irreversible brain damage."2 Therefore, the person who practices this sort of activity is certainly at high risk for sudden death.

I became involved in one particular case after reading a New York Daily News article that described the suicidal death of a 17-year-old. Based upon my professional experience in the investigation of this type of death, I immediately recognized the possibility of an accidental autoerotic fatality. The following day, I called the detective commander of the local jurisdiction with whom I had grown up and whom I felt would be open to my speculations. He filled me in on the details of his investigation, which further assured me that this alleged suicide was in fact a tragic accident.

In this incident, the crime scene had been changed. The brother of the deceased had discovered the body, removed the ligature from his brother's neck, and out of embarrassment, dressed him. I learned that the detective supervisor had never heard of autoerotic fatalities. After I provided him with the necessary information, the case was properly reclassified. More importantly, the surviving family was made aware of the actual circumstances of their son's death. The family, who had been blaming themselves, could not understand why their son would commit suicide. We enlisted the services of a family priest to assist in explaining what had happened to their son. Although at first they were astonished and embarrassed (a typical response in this type of case), they were greatly relieved to learn that their son had not taken his life due to some unknown personal or family problem, but had died accidentally. In fact, this family actually wanted to go public to warn other parents of this phenomenon. I counseled them against going public, but advised them they could work anonymously to accomplish the same objective without exposing their family to any further trauma.

Periodically, a story in the local newspaper focuses on one or more deaths believed to be teenage suicides. I remember one particular story in my area that made reference to a "teenage suicide epidemic." The series of stories that followed these initial events was directed toward warning the public about this devastating public health problem. There was a call for a renewed effort in bringing suicide prevention programs into the schools as public health officials sought a solution for what was perceived to be the contagious effect of suicide among teenagers. Parents, teachers, and public health officials were mobilized in an effort to identify a motive for these unexplained deaths. Ironically, it was discovered that half of the reported suicides were actually autoerotic fatalities. However, the focus of attention on this issue, although initially misinterpreted, was instrumental in identifying other potential problems and issues of concern regarding suicide.

Some syndicated publications have reported on the phenomenon of autoerotic fatality quite accurately. Stories with headlines such as "Answers Sought in Unusual Deaths," "Six Deaths in Past Year Stir Warning," and "Medical Examiner Concerned about Bizarre Fatal Accidents" actually provide a genuine insight into these types of deaths. Of course, there is always the possibility that publicity about this phenomenon may actually increase incidents. I believe, however, that persons predisposed to this type of behavior will be neither encouraged nor discouraged by the presentation of information on sexual asphyxia. Instead, I believe that certain details need to be made public for the purposes of alerting people to the dangers of this potentially lethal practice. As a result, I agreed to an interview with the Associated Press entitled, "Autoerotic Deaths — Shocking Practice Often Mistaken for Teen Suicide."6

Parents, who have the responsibility of raising their children, as well as educators and others responsible for the public welfare of society, have a right to information and need to be educated about this phenomenon. I have investigated and consulted on a number of autoerotic deaths involving teenage boys. Teenagers, who are going through a period of sexual experimentation, are extremely vulnerable to peer suggestions. They have traditionally developed their own lifestyles, which involve pleasures, amusements, and pastimes different from those of their parents. They have their own slang, music, expressions, dancing, TV programs, movies, etc. Often parents are not even aware of their children's socialization into the teen culture. They are certainly not privy to their secret conversations, social groups, and/or risktaking ventures, which explains their total shock, horror, and disbelief when advised of this phenomenon.

I supervised one investigation where a 16-year-old boy's mother showed him an article about autoerotic deaths in a newspaper so that he would be aware of the dangers. He offhandedly remarked to his mother, "Those kids are stupid. They don't know what they're doing." His mother missed the significance of the remark. Her son was engaged in such activities himself and he was found dead 2 weeks later, the victim of an autoerotic fatality.

In most of the cases in which I have been involved, the teenage victim was made aware of the practice through word of mouth. There have been cases, especially those involving adult practitioners, where the victim learned of this activity through pornographic magazines, X-rated movies, underground publications, the media, and even novels.

Preliminary Investigation at the Scene

Every autoerotic fatality is unique because the circumstances surrounding this activity are based upon the person's fantasy and perception of what is considered sexually stimulating. The death scene will vary according to the victim's age, resources, and/or sexual interests. However, some common denominators do suggest that the death may be accidental.

There are five criteria for determining death during dangerous autoerotic practices:

1. Evidence of a physiological mechanism for obtaining or enhancing sexual arousal that provides a self-rescue mechanism or allows the victim to discontinue its effect voluntarily

2. Evidence of solo sexual activity

3. Evidence of sexual fantasy aids

4. Evidence of prior dangerous autoerotic practice

5. No apparent suicidal intent4

The most common method practiced during this type of activity is neck compression or hanging, with some sort of padding between the neck and the ligature to prevent any markings from being left by the tightening noose or rope. However, more elaborate and exotic methods such as chest compression, airway obstruction, and oxygen exclusion with gas or chemical replacement have been found.

Atypical Autoerotic Deaths

It should be noted that all autoerotic deaths are not attributed to sexual asphyxia. Some of the participants in autoerotic practice have devised some interesting and unique devices, which may or may not involve asphyxia. I am aware of one

Figure 12.58 BONDAGE FANTASY. The victim had used the blow-end of a vacuum cleaner to inflate a plastic bag, which was inside a canvas laundry bag secured with a rope around his neck. However, when the bag inflated, he had no way of letting the air out. He suffocated from chest compression. (From the author's files.)

particular case where the victim had constructed a long ceramic cone in the base of his "play toilet," which extended above the rim of the toilet seat. Over the toilet the subject had constructed a pulley system. He had affixed a wooden seat with a hole in the bottom that fit over the ceramic cone, which was lubricated with Vaseline. He pulled himself up and down with the ropes on the pulleys. As the man lowered himself down over the toilet seat, the ceramic cone would go into his anal cavity. The victim apparently did not keep up with his maintenance on his system, and one day one of the ropes, which had worn, broke. The subject was impaled on this device when discovered.

In a number of other cases of which I am aware, subjects have resorted to mechanical equipment to stimulate themselves or have employed electricity with some devastating results. One such case involved a 16-year-old male, who was found with a cow's heart attached to his genitals. Wires had been attached and plugged into a wall socket. The boy died from electrocution and he was charred. Detectives found several pornographic magazines in the scene. One of the magazines described a sexual toy that can be made from the fresh heart of a cow. Practitioners use a simple electrical circuit and some batteries to get the heart to beat and use the beating organ for sexual stimulation.

In one autoerotic death, the subject used a commercial vacuum on his penis to simulate fellatio and died a horrible death. Another subject hooked up electricity to shock his genitals and inadvertently stood in a puddle of water, resulting in electrocution. In another bizarre case, a man, who was discovered nude, had strapped himself into a harness and lowered himself into a septic tank. He died from inhaling the methane gases. This case was classified an autoerotic fatality based on his prior history and an examination of the crime scene.

Asphyxial Deaths — The Pathology of Autoerotic Death

Asphyxiation is the end stage of significant interference with the exchange of oxygen and carbon dioxide. According to Drs. Dominick J. DiMaio and Vincent J. DiMaio, nationally renowned forensic pathologists, "Asphyxial deaths are caused by the failure of the cells to receive and/or utilize oxygen. This deprivation of oxygen may be partial (hypoxia) or total (anoxia)."7 Fatal cerebral anoxia is an inadequate oxygen supply to the brain with consequent disturbance of bodily functions. The person loses muscle control and goes into spasm, resulting in convulsions, which are sudden violent involuntary contractions of a group of muscles; the person experiences seizure-like activity.

Asphyxial deaths can be grouped into three categories: suffocation, strangulation, and chemical asphyxia. The most common form of asphyxial death in autoerotic fatalities is strangulation, which is characterized by the closure of the blood vessels and air passages of the neck from hanging or ligature. This results in vasoconstriction, which causes tachycardia, during which the heart beats more than 100 beats a minute to increase the oxygen to the cells of the body. Bradycardia develops because the heart muscle becomes anoxic and cannot maintain the pace. The person succumbs to fatal cerebral anoxia.

The suspension of the body may be complete or incomplete. In sexual asphyxia cases, the body is usually in touch with the ground. There may be elaborate bindings of the body and hands of the victim. However, an analysis of these bindings will reveal that the victim was capable of binding himself or herself.

Suffocation is the second most frequently occurring form of autoerotic death. This may result from covering the mouth and nose with a plastic bag or mask, or from what is described as proximal or positional asphyxia, such as in chest compression.

Chemical asphyxia takes place when oxygen is excluded by inhaling noxious gases. The most common chemical asphyxial deaths involving autoerotic activities are with nitrous oxide.

The practitioners of this activity often are aware of the possibility of death and may even have taken precautions against a fatal act, but die as a result of a miscalculation. It would appear that the victim, who may be intent upon achieving an orgasm, misjudges the existent hypoxia already present and the time required to reach orgasm by masturbation. The victim loses consciousness and succumbs to the fatal cerebral anoxia.

The Reality of Asphyxial Death — Videotaped Cases

In my Sex-Related Homicide and Death Investigation textbook, I included the description of four videotape cases to indicate how suddenly one can lose his or her ability to survive such a dangerous game as sexual asphyxia. My review of these particular videotapes validated all of my research into the dynamics of sexual asphyxia and the reality of fatal cerebral anoxia.8

Equivocal Death Investigations

Equivocal death investigations are those inquiries that are open to interpretation. There may be two or more meanings and the case may present as either a homicide or a suicide depending upon the circumstances. The facts are purposefully vague or misleading as in the case of a "staged crime scene." Or, the death is suspicious or questionable based upon what is presented to the authorities. The deaths may resemble homicides or suicides, accidents or naturals. They are open to interpretation pending further information of the facts, the victimology and the circumstances of the event.9

Videotape Case History

I had the opportunity to review a case in which the victim, a white male, 38 years of age, had set up a video camera to record his autoerotic fantasy. The victim, who was married with children, had selected an area inside the garage of the family home to create some sort of execution scenario for his fantasy. He had placed a large sheet over the furnishings in the room to create a background for the camera. The entire scene was recorded on the videotape.

At 4:00 P.M., the victim was discovered hanging in the garage by his mother, who had gone to the house with one of her grandchildren to get a key to enter the house. She reported to police that earlier that day she had tried to call her son at 10:30 A.M. but there was no answer. When they entered the garage, they encountered the body. They then ran down the street to her residence where she informed her husband, the father of the victim. The victim's father ran to the house, which was only four houses away, and discovered his son hanging with a pair of blue panties completely over his head. The father quickly removed the panties from his son's head and checked for life and found none. He then called an ambulance. The father reported that he had also observed a VHS video camera near the overhead garage which was aimed towards the body. He took the camera down and placed it on a table. The father was asked whether there had been any problems. He stated that his son was not depressed, did not have any business problems, did not have any enemies, and as far as he was concerned, everything was going great for his son, who was happily married and had three children.

The responding officers saw a man's body hanging from a rope, which had been placed over a beam running east and west, the second beam from the wall. This rope had been placed over a rafter beam and was tied to an adjustable post, which ran in the center support beams and had been further tightened with the use of a screwdriver.

The victim was wearing a red, long-sleeved sweatshirt with red short pants. He had a wristwatch on his left wrist and there was lividity present. The body was also cool to the touch. Upon closer examination, a red cloth-type belt was observed protruding through the zipper fly of the victim. This cloth belt had been tied around the waist and the penis of the victim.

The investigators also noted a pair of blue slippers on the floor and a small wooden stool beneath where the victim was hanging. A screwdriver was on the floor where the father stated he had knocked it down checking his son, and a camera tripod, which had held the video camera, was near the garage door. The investigators located a box of pornographic periodicals in the living room along with certain hand-drawn sketches depicting sexual hanging scenes. This box also contained handwritten literature in reference to sexual-hanging types of actions.

Review of the Videotape. A hangman's noose was secured over a rafter in the ceiling and was tied off to the side. Directly below the hanging noose was a small wooden stool, which the subject could stand on to place the noose over his head and around his neck. The subject was observed walking into the camera's view wearing a pair of women's panties over his head. In the background, a large white sheet covered the wall and workbench. He looked in the direction of the camera and placed the noose over his head and around his neck. In order to secure the rope around his neck, he had to stand on his toes. He then stood with his hands behind his back. The hypoxia began to take effect immediately because the noose had begun to restrict the blood flow to the head. He suddenly lost his balance and the noose became tightened around his neck. At this point, he could have saved himself by simply standing back onto the stool.

However, he was not aware of the impending danger and again placed his hands behind his back and continued with the fantasy. In less than 15 seconds, he lost consciousness and went into fatal cerebral anoxia. He attempted to escape; however, it was too late. He lost muscle coordination and began to convulse. He went into seizure-like activity. He attempted to raise his arms, but they were in spasm and his fingers took on the classic claw-like spasm consistent with oxygen deprivation. He went into full convulsion and spasm until finally his heart stopped and he was no longer breathing. This asphyxial death occurred while his feet were touching the floor. His video production had gone from fantasy to reality in less than 4 minutes. This was also an extremely dramatic portrayal of the reality of sexual asphyxia.

Sexual Asphyxia — the Psychosexual Aspects of Autoerotic Activity

The purpose of this section is to acquaint the investigator with some of the clinical terminology used to define bizarre and deviant human sexuality. The psychopathology of this phenomenon is better left to the clinicians and other professionals trained in the fields of medicine and psychiatry. I refer the reader to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV),10 Abnormal Psychology and Modern Life,11 and Chapter 5 of Autoerotic Fatalities.5

The investigative interpretation of the psychosexual aspects of autoerotic activities can be found in a group of persistent sexual arousal patterns defined in DSMIV as paraphilias. The essential feature of disorders in this subclass is that unusual

(A)

Figure 12.59 FANTASY DRAWINGS. (A) The victim has drawn a woman, who is actually him, dressed in "LaFemme" undergarments. His fantasy involved cross-dressing. (B) Here a female victim has supposedly hanged herself with her bra. In both drawings, the victim has created a fantasy that involves urophilia. Approximately 20 of these drawings were found at the death scene. Additionally, the victim had taken Polaroid photos of himself dressed in female attire acting out similar events. (From the author's files.)

or bizarre imagery or acts are necessary for sexual excitement. Such imagery or acts tend to be insistently and involuntarily repetitive and generally involve (1) preference for use of a nonhuman object for sexual arousal, (2) repetitive sexual activity with humans involving real or simulated suffering or humiliation, or (3) repetitive sexual activity with nonconsenting partners. In other classifications, these disorders are referred to as sexual deviations. The term paraphilia is preferable because it correctly emphasizes that the deviation (para) is in that to which the individual is attracted (philia).

Because paraphiliac imagery is necessary for erotic arousal, it must be included in masturbatory or coital fantasies, if not actually acted out alone or with a partner and supporting cast or paraphernalia. In the absence of paraphiliac imagery, nonerotic tension is not relieved and sexual excitement or orgasm is not attained. The imagery in a paraphiliac fantasy or the object of sexual excitement in a paraphilia

(B)

Figure 12.59 Continued.

is frequently the stimulus for sexual excitement in individuals without a psychosexual disorder. For example, women's undergarments and imagery of sexual coercion are sexually exciting for many men; they are paraphiliac only when they become necessary for sexual excitement.10

According to DSM-IV, there are nine paraphilias. These are listed in Chapter 14, this volume, with a brief definition. However, for further information, see Diagnostic Manual of Mental Disorders IV and Abnormal Psychology and Modern Life:

1. Exhibitionism (302.4): Exposing the genitals to an unsuspecting stranger for the purpose of obtaining sexual excitement

2. Fetishism (302.81): Use of nonliving objects for sexual arousal (female undergarments, panties, shoes, etc.)

3. Frotteurism (302.89): A sexual attraction to rubbing against the genitalia or body of another

4. Pedophilia (302.2): Engaging in sexual activity with prepubertal children

5. Sexual masochism (302.83): Getting pleasure from being humiliated, bound, beaten, or otherwise made to suffer for sexual arousal (considered a chronic disorder)

6. Sexual sadism (302.84): The infliction of physical or psychological pain on another person in order to achieve sexual excitement (considered a chronic and progressive disorder)

7. Transvestic fetishism (302.3): Cross-dressing by a heterosexual male for sexual excitement (ranges from solitary wearing of female clothes to extensive involvement in a transvestite subculture)

8. Voyeurism (302.82): Repetitive looking at unsuspecting people who are naked, in the act of disrobing, or engaging in sexual activity (the Peeping Tom)

9. Paraphilia not otherwise specified (302.9): This category is included for coding paraphilias that do not meet the criteria for any of the specific categories:

Telephone scatolgia: A sexual attraction to making obscene telephone calls (lewdness)

Necrophilia: A sexual attraction to dead bodies; having intercourse with a dead body

Partialism: An exclusive focus on a part of the human body, a breast, leg, penis, etc.

Zoophilia: Use of animals for sexual arousal (includes intercourse with animals as well as training the animal to lick or rub the human partner)

Coprophilia: A sexual attraction to feces

Klismaphilia: A sexual attraction to the giving or receiving of enemas

Urophilia: A sexual attraction to urine

Mysophilia: A sexual attraction to filth10

Case Histories

Hanging. A white male in his late 40s, never married and living at home with his mother and sister, was found hanging in his basement workshop. He was wearing street clothing, which covered women's undergarments — a bra stuffed with padding and women's panties, women's boots, and leather gloves. A mask, which he had apparently been wearing, was found on the floor beneath him. He was hanging by a rope affixed to a hook in the ceiling. There was a Polaroid camera positioned on the workbench and a number of photographs of the deceased participating in this conduct. A number of pornographic magazines depicting female bondage, lesbian conduct, and sadomasochistic behavior were found in his room.

In addition to these commercial products, police discovered sadomasochistic drawings depicting the deceased dressed as a woman. In these drawings, this "woman" is observed with an erect penis, threatening and abusing other women. There were also a number of these sexually explicit drawings of nude and seminude women urinating. These fantasy drawings were further illustrated with words indicating that the deceased was actually verbalizing his sadomasochistic fantasies. Also discovered were two legal-size sheets of paper listing approximately 200 pieces of women's apparel and undergarments that the deceased had purchased. The victim had listed these items by number, description, price, and the name of the store from which the item was purchased. He then had a separate column, which indicated whether or not he had photographed himself in the item. This individual's total sex life was involved with solo sexual activities. His drawings further suggested paraphilias of transvestism, sadism, and masochism with fantasies of necrophilia and urophilia.

Suffocation. A white male, 66 years of age, was discovered lying upon his bed by police who had been called to the man's apartment. The deceased was wearing women's clothing, which consisted of a gray turtleneck sweater with crotch snaps and red panty hose. The

Figure 12.60 AUTOEROTIC DEATH SEQUENCE. A male had dressed in female attire with a discipline mask over his head. His eyes were covered with duct tape, his mouth stuffed with foam rubber, small rubber balls were in each ear, and he had a headband around the ears. The victim was wearing pantyhose and female undergarments beneath this outfit. All of the chains and binds were interconnected. A copper loop of wire between his legs had been connected to an electrical apparatus with a timer, which sent intermittent shocks to the victim's genital area. The victim was a 66-year-old male. (Courtesy of Detective Lieutenant Raymond Krolak, commanding officer (retired), Investigations Division, Colonie, New York, Police Department.) Continued.

Figure 12.60 Continued.

upper torso was bound with straps and chains, which were interconnected by a series of locks. A rubber mask covered his face and the mask was connected to the bed board by rope. An electrical apparatus consisting of a timer and two wires was attached to a hook in the ceiling. This equipment was plugged into a wall socket. One of the wires extended down to the crotch area of the victim. A copper wire loop had been fitted beneath the snaps of the turtleneck sweater and this could be connected to the electrical device. In the man's room, police investigators discovered three suitcases full of women's undergarments, wigs, and "falsies," as well as other sexual paraphernalia consisting of dildos, discipline masks, and pornographic materials. When the body was examined, the victim was found to be wearing women's undergarments. Under the head mask, duct tape covered his eyes, foam rubber was stuffed in his mouth, and a headband held a small rubber ball in each ear. He was totally in the dark and could not hear a thing, but all of the bindings and chains were within his grasp.

His escape mechanism was a single lock, which secured all of the chains wrapped around his body. The deceased had held the keys for this lock in his right hand. He had apparently dropped his keys on the floor, where the police discovered them. The duct tape and rubber balls in his ears certainly shut out any possibility of seeing the keys or hearing them drop to the floor. He had been bound to the bed in such a manner that he would not have been able to reach down to the floor even if he had heard the keys drop. The cause of death was suffocation. The police supervisor as well as the detective investigating this case had been to one of my Practical Homicide Investigation lectures. They immediately recognized the death to be an autoerotic fatality based on the preceding information. However, when the medical examiner of the jurisdiction arrived at the scene, he told the detectives it appeared to be a homicide related to "biker-gang" activity. He obviously was not familiar with such cases and based his conclusion of homicide on the bizarre binding of the body.

Chest compression. The author reviewed a case involving a male who had constructed a device that would cause chest compression. The victim had used the blow-end of a vacuum cleaner to inflate a plastic bag, which he had placed inside a canvas bag. The victim, who was wearing his wife's teddy and nothing else, had apparently crawled into the bag and was able to secure the contraption by pulling a rope around his neck. He then rolled over to the vacuum and turned it on with his nose. The vacuum filled the plastic bag with air, which in turn caused the canvas bag to tighten around the subject's chest. The only problem with this device was that the victim had no way to turn off the vacuum once the canvas bag had become inflated. He suffocated to death during his autoerotic activity.

Oxygen exclusion. A deceased male was discovered lying on a bed in a rental cabin with a plastic bag over his head. This male had rented the summer cabin during the off-season. The proprietor, who was checking on the rental, made the discovery when he entered the premises and noticed the nude body of the deceased on the bed. Police were called to the location and discovered an array of pornographic magazines opened to the centerfolds on the floor next to the bed. Also next to the bed was a canister of nitrous oxide. The investigators learned that the man, who had been involved with this activity in the past, had been sniffing the pure nitrous oxide by releasing the gas into the plastic bag from the tank. He would then write down his sexual fantasies on a pad while viewing the pictures of the nude models in the magazines next to the bed. When he placed the plastic bag over his head, the oxygen was excluded and the victim was asphyxiated.

Female Victims of Autoerotic Fatality

Although most of the cases of autoerotic death involve males, it is important to realize that this type of practice is not limited to males. For example, what may appear to be a sex slaying involving the bondage and suffocation of a female victim may in fact be the accidental death of a female practitioner of autoerotic activities.

One of the earlier such cases was reported by retired Special Agent Frank Sass of the FBI. A 35-year-old female divorcee was discovered dead by her 9-year-old daughter. The woman was nude and lying on a small shelved space in the rear of a closet in her bedroom. She was on her stomach and an electric vibrator with a hard rubber massaging head was between her thighs and in contact with her vulva. The vibrator was operating when the victim was discovered. Attached to the nipple of her right breast was a spring-type clothespin compressing her nipple. Immediately below her left breast another clothespin was found. Around the victim's neck was a hand towel; a nylon stocking went over the towel in loop fashion and was fastened to a shelf bracket above her head. The lower portion of the body was supported by the shelf and the victim's upper body rested on her arms, which were extended downward from her body in a push-up position. The clothespins were used to cause discomfort, the vibrator was used in a masturbatory exercise, and the ligature reduced oxygen flow. She obviously intended to support her upper body weight with her arms, but she lost consciousness and the weight of her body, hanging from the nylon stocking, caused her to strangle.12

It should be noted that the female victim of an autoerotic fatality who has involved herself in binding and some sort of sadomasochistic scenario presents authorities with circumstances actually resembling a sex-related homicide.

Hazelwood et al. cite the following case. A 23-year-old black woman was found dead in her bathroom. The victim's upper torso rested on the edge of the bathtub, her face was in the water, and her knees were on the floor. The faucets were turned on, and the water had filled the tub, spilled on the floor, and run throughout the house. There was vomitus in the tub water. A piece of rope had been doubled and looped around her on the left side of her neck, with the loose ends coming across and over her right shoulder. Her wrists were wrapped together in front of her body and the end of the rope securing them rested in her right hand. The decedent was nude, and a 9 1/2-inch bolt was on the floor beside the body. There was a bruise on the left side of her forehead and drops of blood were found on the edge and side of the tub. Autopsy revealed the cause of death to be aspiration of vomitus.5

This case was investigated initially as a suicide, based upon statements by a relative and friend of the victim. It was also investigated as a possible homicide, with the boyfriend, who had discovered the body, as a primary suspect. This case had enough factors to support both possibilities. In actuality, the case was eventually classified as an autoerotic fatality. According to the authors,

A theory that accounts for all of the facts in this case is that the victim had been drawing a bath while asphyxiating herself with the rope, intending to use the bolt for manual masturbation or already having done so. Through asphyxiation, she lost consciousness, struck her head on the bathtub, and aspirated vomitus...5

I present additional case histories involving female participants in my other textbook, Sex-Related Homicide and Death Investigation: Practical and Clinical Perspectives.

Figure 12.61 FEMALE VICTIM — ATYPICAL AUTOEROTIC. A metal bolt had been inserted into the victim's vagina from the rear. There was a rope secured around the victim's neck and she was bent over the water-filled tub. At first, the case appeared to be a sex-related homicide. However, upon closer examination, it was revealed that the rope was loosely placed around the neck and the deceased could control the pressure by pulling the end, which was in the front of her body. She apparently lost consciousness and her face went into the water. The actual cause of death was drowning. (Courtesy of retired Supervisory Special Agent Robert R. Hazelwood, Behavioral Science Unit, FBI Academy, Quantico, Virginia.)

Equivocal Death Investigation

Many times while I am conducting homicide programs, participants will provide me with cases in order to get my opinion. One such case involved the reported suicide of a 17-year-old black female. The detective who brought this case to my attention was concerned that the medical examiner and other detectives had classified this case as suicide. Based on his investigation into the background of the victim and what he observed at the scene, he felt that the death might have been an autoerotic fatality. He was concerned that the family were blaming themselves for the daughter's death. I reviewed his case file and crime scene photos and provided the detective with a full report, which included the following information, which he could bring to his superiors and the medical examiner for review.

Crime Scene

The location of the incident was in the basement of a single-family home occupied by the deceased and her family. The victim was home alone at the time of the incident. The area that the victim selected was secluded from the rest of the home.

(A) (B)

Figure 12.62 FEMALE VICTIM — EQUIVOCAL DEATH. (A) This victim reported as a suicide was actually an autoerotic fatality. She had been standing on a plastic bucket, which slipped out from under her feet. She was found hanging from an electrical wire fastened into a noose. CLOSE-UP SHOWING PADDING. (B) The presence of the padding was a crucial factor in the analysis of this case, coupled with the victimology. (Courtesy of Detectives Steven Little and Edward Dahlman, Columbus, Ohio, Police Department.)

There was no evidence of any break-in or entry. The victim's brother found her hanging from a wire noose, which had been affixed to a rusty metal clothes rod. There was a white towel wrapped around the victim's neck, which would have formed a padding between the wire and her neck. She was nude from the waist up and was wearing a pair of black sweat pants. A white T-shirt was observed approximately 6 feet away and appeared to have been discarded by the deceased. A white 5-gallon bucket was observed lying on its side near the area where the deceased was found. Forensic examination of this bucket revealed latent prints, which were later identified as belonging to the right foot of the deceased. The material on the deceased's hands turned out to be rust from the metal pipe to which the wire had been affixed.

The Victim

The deceased was a healthy and apparently happy 17-year-old young woman. The investigation disclosed that she came from a good family background where the mother and stepfather provided parental guidance and support. The family consisted of the 17-year-old victim, her 19-year-old brother, her mother, and her stepfather. In addition, the inquiry into the victim's background indicated that the victim maintained good social relationships with peers and was performing well in school. The interview of the deceased's best friend indicated that the victim was popular and well liked. The victim had two boyfriends and was sexually promiscuous with a young man. There was no indication in the reports that the deceased was depressed or suicidal. In fact, from all indications, she was functioning physically and socially as well as any typical 17-year-old teenager.

Investigative Considerations

A teenage female victim was found partially nude in a secluded area of the house when no one was home. The location that the victim selected afforded her an opportunity to engage in a private fantasy. The most common method practiced in sexual asphyxia is neck compression or hanging with some sort of padding between the neck and ligature to prevent any markings. The suspension point was within the reach of the deceased (rust on hands) until the plastic bucket was knocked over. It is a known fact that most victims of suicide are not found partially or fully nude. In this case, the victim's breasts were exposed.

Remember: This is an investigative theory. Do not get bogged down in theory and hypothetical speculation. In death investigations there are no absolutes.

Opinion

In my professional opinion, the victim died as a result of a tragic accident involving sexual asphyxia. The bases for this conclusion are twofold: (1) the indicators present at the scene and enunciated here and (2) the lack of suicidal intent on the part of the victim. This fact was supported by the thorough police investigation into the background of the deceased. I recommended that the authorities confer with the medical examiner to reclassify this death as an autoerotic fatality.

Results

The detective took this report and conferred with his superiors and the medical examiner. Reportedly, the medical examiner's initial concern about classifying this case as accidental was that the deceased did not fit the stereotypical profile of a practitioner of autoeroticism because she was a black female. However, the professional in-depth investigation undertaken by the detective provided enough factual basis to have this case reclassified. My consultative report simply validated the detective's hypothesis. The important point here is that the detective's dedication to classify this case properly as accidental provided a measure of consolation to the surviving family. The family was advised that their daughter did not commit suicide.

Notifying and Advising the Surviving Family of the Mode of Death

Advising surviving family members of the circumstances and nature of this type of death can be quite stressful and difficult. The tragedy is often compounded by survivor reactions, which range from guilt, shame, and humiliation to anger and rage.

As professional investigators, we are entrusted with a profound duty and responsibility, not only to the deceased, but also to the surviving family. It is imperative that we do all in our power to assist the surviving family by our professionalism. The official explanation of the circumstances of the death is best undertaken with the assistance of clergy or a professional practitioner after considering the family's ability to cope with the facts of the case. However, it is important to note that each case and set of circumstances will dictate the proper course of action. In some instances, I believe investigators who recognize what has happened may make a conscious decision to spare the family and allow them to believe the death to be an accident. Under certain circumstances, this action might be an entirely appropriate alternative. I offer this advice as a veteran homicide cop: whatever course of action you decide, just make sure you do the right thing.

Investigative Considerations

Although each autoerotic death scene may be unique, there are many common factors for the investigator to consider in determining the mode of death. I have listed some of these considerations within this section.

Victim profile. Research has indicated that most victims of this activity are white males ranging from 13 years of age to their late 30s. White females in their early 20s follow this group; then black males 20 to 40 years of age; and one reported black female was in her late 20s. The victims are considered to be basically moral people, successful in their respective occupations. They may be considered shy by friends because they are not sexually or romantically active. However, they may be married or involved with a significant other person. Interviews and investigations do not disclose any indications of depression or suicidal tendencies.

Location. The location selected is usually secluded or isolated and affords the practitioner the opportunity to become involved in a private fantasy. Some examples are locked rooms at home, attics, basements, garages or workshops, motel rooms, places of employment during nonbusiness hours, summer houses, or outdoor locations.

Nudity. Most victims of suicide are not found in the nude. Although this is not a conclusive indicator, the discovery of a nude victim should alert the investigator to the possibility of an autoerotic fatality if other indicators, such as those listed next, are present.

Determining the Involvement of Sexual Asphyxia: Autoerotic Checklist

In determining whether a death is related to autoerotic activity, the investigator should consider certain questions:

1. Is the victim nude, sexually exposed, or if a male, dressed in articles of feminine attire: transvestism, make-up, and wigs?

2. Is there evidence of masturbatory activity: tissues, towels, or hanky in hand or in shorts to catch semen? Seminal fluids?

3. Is there evidence of infibulations: piercing or causing pain to the genitalia, self-torture, masochism, pins in penis, etc.?

4. Are sexually stimulating paraphernalia present: vibrators, dildos, sex aids, pornographic magazines, butt plugs, etc.?

5. Is bondage present: ropes, chains, blindfolds, gags, etc.? Are any constrictive devices present: corset, plastic wrap, belts, ropes, vacuum cleaner hoses around the body, or chest constraints?

6. Is there protective padding between the ligature and the neck: towels, rags, or cloth to prevent rope burns or discomfort?

7. Are the restraints interconnected? Do the ropes and ties come together or are they connected? Are the chains interconnected through one another? Is the victim tied to himself so that, by putting pressure on one of the limbs, the restraints are tightened?

8. Are mirrors or other reflective devices present? Are they positioned so that the victim can view his or her activities?

9. Is there evidence of fantasy (diaries, erotic literature, etc.) or fetishism (women's panties, bras, girdles, leather, rubber, latex, high-heel shoes, etc.)?

10. Is the suspension point within reach of the victim or is there an escape mechanism (keys, lock, slip knot, etc.)?

11. Is there evidence of prior such activities (abrasions or rope burns on suspension point), unexplained secretive behavior, or long stays in isolated areas?

12. Does the victim possess literature dealing with bondage, escapology, or knots?

13. Is there a positioned camera? (Check film and/or videotapes. Look for photos and view any videotapes in the camera.)

Although not all such deaths will involve the preceding characteristics, their presence will certainly alert the investigator to the possibility of death occurring as the result of sexual misadventure.

Summary

The investigation of sexual asphyxia and the appropriate determination of mode of death require that the investigator conduct a knowledgeable scene examination. This obviously means that the investigator should have an understanding of clues that may be present at the scene and in the background of the deceased. The psychological autopsy can be helpful in resolving those cases in which it is not clear whether the motivational intent was suicidal or autoerotic in nature. As further information on this mode of death becomes available through research, the investigator will be afforded additional assistance in making this determination and properly classifying these cases.

References

1. Lukash, L., M.D. Personal interview, September, 2004.

2. Mosby's Medical & Nursing Dictionary, 2nd ed. St. Louis, MO: C.V. Mosby Co., 1986, pp. 212, 562.

3. Resnick, H.L.P. "Eroticized Repetitive Hangings — A Form of Self-Destruction." American Journal of Psychotherapy, January 10, 1972.

4. Hazelwood, R.R., A.W. Burgess, and N. Groth. "Death during Dangerous Autoerotic Practice." In Social Science and Medicine. Elmsford, NY: Pergamon Press, Ltd, 1981, 2, pp. 129–133.

5. Hazelwood, R.R., P.E. Dietz, and A.W. Burgess. Autoerotic Fatalities. Lexington, MA: Lexington Books, 1983, pp. 136–138.

6. Raeburn, P. "Autoerotic Deaths — Shocking Practice Often Mistaken for Teen Suicide."Sunday Journal News, December 2, 1984.

7. DiMaio, D.J. and V.J. DiMaio. Practical Aspects of Forensic Pathology, 2nd ed. Boca Raton, FL: CRC Press, 2001.

8. Geberth, V.J. Sex-Related Homicide and Death Investigation: Practical and Clinical Perspectives. Boca Raton, FL: CRC Press, 2003.

9. Geberth, V.J. Practical Homicide Investigation: Tactics, Procedures, and Forensic Techniques, 3rd ed. Boca Raton, FL: CRC Press, 1996, p. 20.

10. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 4th ed. Washington, D.C.: Author, 1994, pp. 522–532.

11. Coleman, J.C., J.N. Butcher, and R.C. Carson. Abnormal Psychology and Modern Life, 7th ed. Glenview, IL: Scott, Foresman and Company, 1984.

12. Sass, F. "Sexual Asphyxia in the Female." Journal of Forensic Science, 20, 1973; also in Psychiatric Nursing in the Hospital and the Community, 3rd ed. A.W. Burgess (Ed.) Englewood Cliffs, NJ: Prentice Hall, Inc., 1981, pp. 316–319.

Selected Reading

Adelson, L. The Pathology of Homicide. Springfield, IL: Charles C Thomas, 1974.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-III). Washington, D.C.: Author, 1980.

Burgess, A.W. Psychiatric Nursing in the Hospital and the Community, 3rd ed. Englewood Cliffs, NJ: Prentice Hall, Inc., 1981.

DiMaio, D.J. and V.J. DiMaio. Practical Aspects of Forensic Pathology, 2nd ed. Boca Raton, FL:. CRC Press, 2001.

Geberth, V.J. "Sexual Asphyxia and the Phenomenon of Autoerotic Fatalities." Law and Order Magazine, 37, 1989.

Geberth, V.J. Practical Homicide Investigation: Tactics Procedures, and Forensic Techniques, 3rd ed. Boca Raton, FL: CRC Press, LLC, 1996.

Harris, R.I. Outline of Death Investigation. Springfield, IL: Charles C Thomas, 1962.

Hazelwood, R.R., A. W. Burgess, and N. Groth. "Death during Dangerous Autoerotic Practice." In Social Science and Medicine. Elmsford, NY: Pergamon Press, Ltd., 1981.

Hazelwood, R.R., P.E. Dietz, and A. W. Burgess. Autoerotic Fatalities. Lexington, MA: D.C. Heath & Company, 1983.

Hughes, D.J. Homicide Investigative Techniques. Springfield, IL: Charles C Thomas, 1974.

O'Hara, C.E. Fundamentals of Criminal Investigation. 5th ed. Springfield, IL: Charles C Thomas, 1980.

Raeburn, P. "Autoerotic Deaths — Shocking Practice Often Mistaken for Teen Suicide." New York Sunday Journal News, December 2, 1984.

Resnick, H.L.P. "Eroticized Repetitive Hangings — A Form of Self-Destruction." American Journal of Psychotherapy, January, 1972.

Sass, F. "Sexual Asphyxia in the Female." Journal of Forensic Science, 20, 1973.

Snyder, L. Homicide Investigation, 3rd ed. Springfield, IL: Charles C Thomas, 1977.

Spitz, W.U. and R.S. Fisher. Medicolegal Investigation of Death: Guidelines for the Application of Pathology to Crime Investigation. Springfield, IL: Charles C Thomas, 1973.