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Suicides among children and youths are tragic events. The suicide cases of children, youths and young adults examined between 1995 and 2009 at the Institute of Legal Medicine of the Hanover Medical School were retrospectively analyzed. Altogether, 54 suicides among children, youths and young adults (37 males, 17 females; median age 17.5 years) were evaluated. The suicide victims were predominantly male (68.5%). The vast majority used "hard" methods such as hanging, jumping from a height or being run over by a train. In seven cases (13.0%) psychiatric disorders were known. Seven victims (13.0%) left a suicide note. Suicide was most frequently (40.7%) committed in the open air (40.7%). In addition, the evaluation shows that at the time of committing suicide more than 40% of the youths and adolescents, in whom a chemical toxicological examination was performed, were under the influence of alcohol, medical and/or illegal drugs.

A 42-year-old man evidently had died from an intoxication. On the basis of the findings at scene it was primarily assumed that the man had ingested a larger quantity of an ethylene glycol-containing antifreeze for suicidal purposes. The man was said to have had an alcohol problem and did not only consume drinking alcohol, but also other alcoholic liquids. At autopsy, a bluish liquid with an aromatic smell was found in the oesophagus and stomach. However, toxicological analyses did not furnish evidence of ethylene glycol--as expected--but a potentially fatal concentration of ethanol (blood alcohol concentration 4.01 per mille). The blue colour (patent blue C.I.42051) came from a liquid used in the wind-screen washer system in winter, which now contains ethanol (denatured with 2-butanone) instead of ethylene glycol. The results of the toxicological findings including the analysis of congener alcohols and the differential diagnostics of blue-coloured stomach contents are discussed.

Explosion injuries in civilians are rare. An uncommon case of suicide with a manipulated hand grenade is presented. The findings at the scene and on the body (i.a. massive soot blackening of the skin, singeing, size and number of splinters) gave reason to doubt the use of trinitrotoluene (TNT), the usual explosive charge in hand grenades. Further investigations showed that parts of several hand grenades and black powder from standard fire-crackers commercially available without legal restriction had been used as propelling charge. The victim, who was in a sitting position, held the hand grenade in the left hand and triggered it with the right. He bled to death due to a fracture of the right femur and lacerations of the liver. The chronological course and total circumstances of the case suggested suicide in a strongly intoxicated condition (BAC 2.5 per mille). In the flat, a larger number of unlicensed weapons and weapon parts were found.

There are no verified statistics about deaths occurring in hotels, and only a few cases have been described in the literature. A recent case induced us to conduct a systematic search for deaths in hotels in the autopsy reports of the Institute of Legal Medicine in Giessen for the period from 1968 to 2009. This search yielded 22 evaluable cases in which persons had been found dead or had died in hotels. Data evaluated in the study were sex and age of the deceased, reason for the stay in the hotel and cause of death. Among the deaths, 18 were males and 4 females and the average age was 41 and 40 years respectively. 6 of the male guests had died from a natural and 10 from a non-natural cause. In the remaining two cases, the cause of death could not be determined, but as there was no evidence that another party had been involved, the cases were not further investigated. Of the 4 female guests, 3 had died of a natural cause; in one case, the cause of death remained unclear even after morphological and toxicological investigations. Surprisingly, a third of the men were found to be temporarily living in hotels due to social circumstances. This was not true for any of the women. Our retrospective analysis is based on a comparatively small number of deaths in what were mostly hotels in small to medium-sized towns. Interestingly, the gender ratio of 18:4 for deceased men and women was significantly higher than the usual gender ratio of 2:1 found for forensic autopsies. To be able to draw further conclusions, a greater number of cases would have to be analysed, for example by recruiting additional case files from other institutes of legal medicine. This would also open up the option of investigating possible regional variations.

Self-inflicted impalement is a rarity in forensic autopsies. The case of a 32-year-old man, who was found dead lying on a suburban street, is reported and compared with the relevant literature. A 5-cm-thick wooden stick with blood traces protruded from the oral cavity. At autopsy, it was found that the wooden post, which had a total length of 28 cm, filled the entire oral cavity with the pointed end being located at the entrance of the larynx with lacerations of the posterior wall of the pharynx. There were no signs of asphyxia or involvement of another party. As secondary findings, fresh hesitation cuts could be demonstrated on the right forearm. Death was assumed to have been caused by reflectory cardiac or respiratory arrest similar to bolus death. The police investigations showed that the man had suffered from paranoid hallucinatory schizophrenia for 12 years with 3 previous attempts to commit suicide and had been discharged from inpatient treatment in a psychiatric institution only 4 days before his death. The pattern of injuries is described and an attempt is made to reconstruct the course of events on the basis of the results of the police investigations and the psychiatric documentation. The rare case of self-inflicted fatal impalement is compared with other reports in the literature.

Since Werkgartner described and correctly interpreted the muzzle imprint mark around the gunshot entrance wound in 1922, this finding has been generally accepted as a sign of a contact shot. In further studies, it could finally be clarified that the muzzle imprint mark is caused by the expansive power of the powder gases with pressure on and abrasion of the skin at the muzzle (weapon imprint). Its shape depends on the firearm, the ammunition and the anatomical conditions, but does not require a bullet. Examinations under a magnifying glass microscope and histological investigations can complete the macroscopic findings. Occasionally, the muzzle imprint mark requires a certain "drying period" in order to become clearly visible. In rare cases, muzzle imprint marks also form on textiles perforated by the projectile. Characteristically shaped muzzled imprint marks can provide clues to the type of the firearm and its position at the time of discharge.

This paper presents statistical data on medico-legal autopsies at the three Berlin institutes from 1999 to 2003. With an autopsy frequency of 6.5% in 1999, Berlin was ranking at the top in Germany. The relatively high autopsy rate--compared to other German institutes--led to a higher share of women, a higher mean age of the examined bodies and a higher percentage of cases of natural death. In accordance with studies from other major cities, there were more cases with an unknown cause of death and a higher number of drug victims than in rural areas. The negative consequences of a far too low autopsy rate in Germany regarding legal certainty, the quality of medical care and the validity of the statistics of causes of death are discussed in connection with possible measures to increase the frequency of autopsies.

Based on a case of self-strangulation committed with two connected cable ties, criteria for the differentiation of homicidal and suicidal ligature strangulation are discussed. Differentiation may be difficult and demands close cooperation between the police and the forensic experts. Apart from the history and general circumstances of the case, not only the kind of strangulation, but also the presence of any concomitant injuries, the degree of congestion and any internal injuries are of relevance for the criminalistic evaluation. As self-strangulations are rare, these cases demand special attention.

Suicide is an important health hazard worldwide. Hanging is one of the preferred means of committing suicide in India. The current research is aimed to describe the victimologic profile and find the gender differences in suicidal hanging in Manipal, South India. A 10-year retrospective review of medicolegal autopsy records was conducted at the Department of Forensic Medicine and Toxicology, Kasturba Medical College, Manipal. A total of 70 cases of suicidal hanging autopsied during the study period spanning from January 1997 to December 2006 were identified. Data on suicidal hanging was obtained, analysed and compared for males and females using Microsoft Excel and Statistical Package for Social Sciences (SPSS) for Windows, version 10.0. Males were predominantly affected (male:female - 2:1). Maximum victims of suicidal hanging were Hindus in their 3rd decade of life. Mean age for males and females was 40.62 years and 29.96 years respectively. Maximum mortalities were noted during summer months. Identification of target population is the prime issue before the process of prevention and health promotion is initiated. A difference in pattern of suicidal hanging exists among males and females. Thus, psychosocial correlates should be addressed separately for males and females in epidemiological studies for identification of population at risk and strategies for prevention.

Due to the increasing prescription there are more and more cases of abuse and accidents related to fentanyl patches. The use of fentanyl patches (e.g. Durogesic) for committing suicide is rare, however. In our case, we describe a suicide with an amount of fentanyl patches never mentioned in the literature before. A depressive 63-year-old man was found dead in his apartment. On the body of the decedent 20 nearly symmetrically arranged fentanyl patches (Durogesic) of different strength with a total dose of 1350 microg/h were found. According to the results of the police the fentanyl patches were part of the pain therapy of his late wife, who had died one year before. Neither the autopsy nor the histological examinations revealed a cause of death. The chemical-toxicological investigation showed the following fentanyl concentrations: 94.9 ng/g (femoral vein blood), 45.9 ng/g (blood of the left heart), 74.8 ng/g (blood of the right heart), 101 ng/mL (urine), 468 ng/mL (bile), 745 ng/mL (stomach contents), 78.4 ng/mL (cerebrospinal fluid), 133 ng/mL (vitreous humor). The blood concentrations were in the upper range of the concentrations found in similar cases published. Hints for a postmortem increase of the fentanyl concentration because of the long postmortem interval of nearly 8 days were found.

The number of fatal carbon monoxide poisonings has significantly decreased since the introduction of natural gas. Apart from their occurrence during house fires, accidental and suicidal carbon monoxide poisonings are only rarely seen nowadays. We report on 7 cases of unintentional and intentional fatal carbon monoxide poisoning (CO-Hb concentrations between 56.4% and 74%) due to improper handling of charcoal fires in closed spaces. Autopsy findings and results of the toxicological analysis are presented and discussed.

Complex suicides are defined as suicides using more than one method, which may sometimes suggest homicide. We present the case of a 27-year-old man who killed himself by using four different methods. The man was known as a loner and sufferd from bipolar psychosis. An eyewitness saw him afire and falling out of a window on the 4th floor of a hotel. He was wearing a judo dress with the belt wound twice around his neck. He died in a hospital about two hours later. The autopsy showed signs of neck compression typical of (self)-strangulation, several stab and cut wounds in the thoracic and abdominal region from sharp force, extensive first- to third-degree burns caused by the effect of heat, contusions of internal organs, serial rib fractures and several bone fractures of the extremities as signs of blunt force. The CO-Hb value in the blood amounted to 7%; the other toxicological tests were negative. Death was found to be due to exsanguination from a deep stab wound in the abdomen and multiple trauma caused by the fall from a great height in the course of a suicide. Homicide could be excluded due to the circumstances of the case, which demonstrated again that both the medical findings and the investigation results of the police are indispensable for the differentiation between suicide and homicide.

The article describes a shortly survived suicide with a powder-actuated tool. A 51-year-old man shot all through his head from the right to the left temple. The pin produced an extensive area of destruction in the brain tissue, but neither in the hospital nor during the autopsy was any projectile found. Finally the pin was detected in a metal fitting of the bed in which the man had killed himself. The suicide instrument was a powder-actuated tool firing a metal pin after igniting a cartridge. Unlike a nail gun using compressed air, pins fired by means of a propellant reach a velocity of up to 150 m/s thus developing a higher destructive potential.

Due to the conversion of the gas supply from city gas to CO-free natural gas and the introduction of the catalytic converter technology for motor vehicles the number of suicides by CO poisoning has decreased considerably. Nevertheless suicides by CO poisoning are still committed once in a while. In the described case from the autopsy material of the Institute of Legal Medicine at Münster, the suicide used a charcoal grill as the source of carbon monoxide.

A 55-year-old man was found dead on the bed lying on his side in a pool of blood with a bullet entrance hole in the nape. Behind his body, a semi-automatic rifle Remington Nylon, cal. .22 LR, was detected. As the gunshot entrance site was rather unusual for suicide, a forensic autopsy was performed, which showed a contact shot to the nape with the bullet path running upward to the left frontal area. The man had been treated with citalopram for delusional depression, so that a suicidal act seemed plausible, and the autopsy and criminalistic findings were also compatible with this assumption. A remarkable fact of the present case is that a long firearm had been used. Reports on suicidal shots to the nape are comparatively rare in the medicolegal literature and usually refer to pistols or revolvers.

When the situation at a death scene is unusual, this may suggest the involvement of another person. On the other hand, one also has to consider the possibility of a conscious or unconscious behavior in connection with extreme stress situations or suicidal acts. The forensic findings and criminalistic reconstruction of two cases of suicidal burrowing behavior are presented and discussed.

In the Western world, self-incineration is a rare event compared with the Asian countries. The circumstances of death are often unusual, and differentiation from homicide is sometimes possible only after evaluating all the investigation results and findings. In many cases of self-cremation, a fire accelerant is used. In our study material at least 30% of the body surface were burned. Unaffected skin was predominantly found on the back of the body. The cases presented by us are inhomogenous as to the motive and differ from those reported in the literature with regard to gender distribution, scene, motivational situation and psychological constitution.

A 7-year-old boy was killed by his father by manual strangulation during a murder-suicide. After the killing of the son, the father showed typical "undoing" behaviour: He changed the boy's clothes and laid him down on the bed. Then he placed candles around his head, put pictures of the parents' wedding around him and a crucifix and a picture of the family into his hands. He broke off a rose in a vase next to the bed, lit the candles and took photographs of his dead son. Later he called his wife, threatened to kill the son and finally called the police to confess the murder and to announce his forthcoming suicide.

A 78-year-old hunter was found dead beside his raised hide with a gunshot wound to his chest. In the present case, the reconstruction of the shooting event revealed an accident. Disregarding all safety rules, the hunter had placed his superposed rifle-shotgun on the chair and pulled the barrels of the cocked gun towards his body. One of the triggers interlocked with the button of a camping chair's cushion and a shot was fired. Furthermore the morphology of wounds from shotgun slugs is discussed on the basis of the autopsy findngs.

The authors report on a suicide of a 41-year-old man with acetylsalicylic acid. According to his own statement the man had taken about 200 tablets of Aspirin (65 g acetylsalicylic acid) and initially showed no symptoms of intoxication. 4-5 hours after ingestion he vomited twice, but clear intoxication symptoms like convulsions and cardiac arrhythmia occurred not earlier than 11 hours after ingestion. Resuscitation by the emergency physician was not successful. The chemical-toxicological analysis (HPLC-DAD) of blood samples taken in the hospital approximately 12 h after ingestion showed salicylate in concentrations of 475 mg/L to 557 mg/L. The post-mortem concentrations of salicylate were within the lethal-toxic range, i.e. 762 mg/L in heart blood and 215 mg/L in femoral blood. All tested organs contained equally lethal salicylate levels (e.g. 503 mg/L in the liver and 251 mg/L in the brain).

A severe traffic accident occurred on the German autobahn. According to eye witnesses, the car had changed from the left to the right lane at 160 km/h before crashing into a thicket at full speed. In the car, a sports pistol was found in the footwell of the driver's side. The emergency doctor who performed the external examination of the victim's body found a gunshot wound in the region of the driver's right lower jaw. As the prosecutor released the body without further examination, the family of the suicide asked for an autopsy, which demonstrated a lethal suicidal gunshot to the head; toxicological tests proved a previous consumption of cocaine.

A retrospective autopsy study of fatal deliberate self harm (FDSH) was undertaken in the mortuary of Kasturba Hospital, Manipal, Southern India over a period of 12 years (1993-2004). Out of 1917 cases autopsied, 21.2% were deaths due to deliberate self harm (DSH). The male sex (66.1%) and victims in the third decade of life (35.9%) predominated. More than two-thirds of the decedents were married. More fatalities were observed during the winter season (35.8%) and in the day time (62.2%). Dispair with life (61.9%) was the most common motive for FDSH. The majority of fatalities were due to poisoning (73.5%), where organophosphorous compounds topped the list (71.9%). About one-third of the victims survived for 18 to 24 hours after DSH.

The psychological autopsy is an important assessment tool used to identify aspects of a person's life that explain any lingering mystery that shrouds their death. In addition to answering questions of the past, the psychological autopsy has significant implications for the future. Statistics obtained from mortality data affect the course of health care research, the flow of resources, and ultimately public health policy. From a public health perspective, the misclassification of suicides as accidents or deaths from natural causes can negatively affect research funding and policy development related to suicide prevention efforts, making a standardized and accurate procedure imperative. Although the psychological autopsy was developed initially as a tool to assist the coroner in clarifying the cause of death, this procedure has transcended the confines of forensic science and has applications in the many arenas of litigation and public health policy.

The stellate bullet entrance wound is one of the facultative features of a contact shot. For the formation of a star-shaped wound two factors are of special importance: first, an extensive bony support underlying the skin in the entrance region, and second, a strong propellant charge of the cartridge fired. Contact shots to the precordial region usually do not cause stellate entrance wounds, even if high-powered rifle ammunition is used. In the reported case, an injury pattern was observed that was not in line with normal findings and seemed confusing at first. Following a suicidal gunshot to the chest from a sawed-off carbine 98a (cal. 8 x 57 Js), a 4.5 cm wide, gaping bullet entrance wound with radiating tears was found. Instead of the usual pocket, the anterior thoracic wall showed a fist-sized area of destruction with extensive undermining of the subcutis. Not far from the entrance hole, a rib fragment had become displaced retrogradely thus perforating the skin from the inside out. The unusual pattern of findings could be explained by the fact that the barrel had been sawed off: as a result of this manipulation, a considerable part of the propellant charge had been converted outside the barrel, i.e. in the initial section of the bullet path.

Objective: To test the hypothesis that selective serotonin reuptake inhibitor (SSRI) antidepressants may have a suicide emergent effect, particularly in children and adolescents., Method: Detections of different antidepressants in the forensic toxicological screening of 14 857 suicides were compared with those in 26,422 cases of deaths by accident or natural causes in Sweden 1992-2000., Results: There were 3411 detections of antidepressants in the suicides and 1538 in the controls. SSRIs had lower odds ratios than the other antidepressants. In the 52 suicides under 15 years, no SSRIs were detected. In 15-19-year age group, SSRIs had lower relative risk in suicides compared with non-SSRIs., Conclusion: The hypothesis that treatment of depressed individuals with SSRIs leads to an increased risk of suicide was not supported by this analysis of the total suicidal outcome of the nationwide use of SSRIs in Sweden over a period of 9 years, either in adults or in children or adolescents.

In cases of suicidal gunshots, the capacity to act may be preserved for a certain period of time, so that the suicide may be completed with another method. In the presented case a 74-year-old man was found hanged on the first floor of his house with two gunshot wounds in the chest. Both on the ground and the upper floor traces of suicidal acts were detected. As shots to the precordial region suggest rapid incapacitation, a suicide extending over two floors seemed almost impossible without knowledge of the cause of death and evaluation of the ability to act. The autopsy findings confirmed vital signs of hanging. Moreover, a through-and-through gunshot wound of the chest and abdomen affecting the spleen and a shot lodged in the body without injuring the lung were found. The injury findings thus sufficiently explained the preserved ability to act. The presented case shows characteristics of a complex suicide not yet described so far, but could be clearly classified as suicide in congruity with the pertinent literature.

The second part of the paper on suicides by gunshots to the head in the presence of witnesses focuses on relevant morphological autopsy findings such as entrance site, signs of close range or contact shots, bullet path etc. and also discusses selected aspects of ascertaining gunshot residues. For the identification of the shooter an integral medicolegal assessment of all the facts including the investigation results and the autopsy findings is essential. However, the morphological findings alone do not allow safe diagnosis, as for example in a homicide the temporal region, which was affected in all our cases, may have been deliberately chosen by the perpetrator as a localization typical of suicide. Thus methods to ascertain gunshot residues on the firing hand (by means of adhesive films and the polyvinyl-alcohol collection method--PVAL) are of great practical importance. In seven cases adhesive films and/or the polyvinyl-alcohol collection method were used. In one case the gunshot residues (GSR) were analysed by means of tape lifts and subsequent scanning electron microscopy (SEM). It was found that especially the combined application of topographical (adhesive tape/PVAL) and cumulative (SEM) methods allowed for the doubtless identification of the shooter, thus usually confirming the suicide. By the example of one case it is demonstrated that without the immediate collection of evidence at the scene objective reconstruction of the event becomes impossible. On the basis of the reported cases recommendations are finally given for a differentiated approach in the medicolegal evaluation of alleged witnessed suicide by gunshot (to the head).

Fatal monointoxications with benzodiazepines, for instance with a suicidal intention, are exceptional findings. We report the autopsy case of an 82-year-old woman who died due to a suicidal monointoxication with Rohypnol 1 mg film tablets (therapeutical agent: flunitrazepam). 0.065 mg/L flunitrazepam and 0.34 mg/L 7-aminoflunitrazepam were detected in a postmortem heart blood sample and toxicological analysis revealed the metabolite 7-aminoflunitrazepam in gastric contents, too. At external examination, a bluish-turquoise coloration was seen around the woman's right nostril and within the oral cavity. At autopsy, similar coloration phenomena were seen on the mucosa of the distal esophagus and the stomach. Formerly, bluish stains on mouth and nostrils were considered indicative of intoxications with organophosphates such as parathion (E 605). More recently, case reports accumulate where an intoxication with Rohypnol 1 film tablets (containing the coloring agent indigocarmine in its core) have to be considered as a potential differential diagnosis of such coloration phenomena.

At the Department of Legal Medicine in Giessen all forensic autopsies from the years 1990 until 2001 were investigated under the aspect of "death in preschool and school age between 3 and 16 years of age." Out of 69 deaths 19% were due to a natural and 81% to an unnatural cause of death. Both groups (3 to 6 and 7 to 16 years of age) were analyzed retrospectively with regard to age and circumstances of death and compared with the literature. The purpose of the differentiating evaluation is to furnish ideas how to prevent violent deaths of children.

The term "complex suicide" stands for suicides committed by using more than one method. A distinction can be made between planned and unplanned complex suicides (primary/secondary combinations). In planned complex suicides 2 or more methods are applied simultaneously in order to make sure that death will occur even if one method fails. In unplanned complex suicides the mode of performance is changed after the first method chosen failed or was working too slow or proved to be too painful. In planned complex suicides typically two of the generally common methods of suicide (e.g. ingestion of medicines, hanging, use of firearms, drowning, fall from a height) are combined. But also unusual combinations have been described such as the simultaneous firing of two guns, self-immolation in combination with other suicide methods or shooting oneself while driving a car. In unplanned complex suicides self-inflicted injuries by sharp force, especially cuts of the wrists, are often found as the primary act of suicide. In some cases the suicide switches from cuts to stabs (mostly to the heart region). Other methods often used after the first phase of suicide are hanging and jump from a height. In the literature the use of up to 5 suicidal methods applied one after the other have been described.

The article reports on findings after a suicide committed by being run over by the driving unit of an ICE train in a railway station. After recovering the body a fresh abrasion was found on the right upper abdomen with a minor laceration. Some hours later a circular abrasion mark and zones of contusion were discernible on the trunk. Whereas the integument was largely intact, the spine was severed and inner organs of the trunk were ruptured.

Electric knives, due to the double blades swinging in opposite directions, have a high injury potential. Tissues such as skin can be cut smoothly without cutting motion and with only little pressure. Authors report on the case of a woman of 47 years who cut herself deeply on both sides of her neck with an electric knife, slightly carving a notch into the larynx and a cervical vertebra and opening large blood vessels. With respect to the extent of injuries the capacity to act had to be questioned. However, considering the absence of venous air embolism and the peculiarity of the tool it had to be assumed that the capacity to act lasted for a short time.

Under forensic differential diagnostic aspects postmortem findings of adhesive tape in the face suggest either suicide, an autoerotic accident or homicide, in which case the adhesive tape could have been used for sealing the mouth or as a means to commit the homicide itself. 9 autopsy cases are described as examples with this constellation and discussed under criminological aspects.

In this report, three cases of suicide by an electric power drill are described. In the first case, a man aged 51 was found with four penetrating wounds of the head and chest. The second case involves a 56-year-old man who suffered a penetrating craniocerebral injury and the third case involves a 53-year-old man who suffered one head injury and two chest injuries. In the first two cases, the victims were found dead. In the third case, the victim survived his injuries for 28 hours. The case histories and the post-mortem examinations revealed no evidence of homicide.

The report presents the case of an alleged double homicide or a homicide followed by suicide of a couple, in which the court-ordered autopsy of both victims revealed that the homicide had been committed by the husband immediately before he died himself from cardiac failure. The article gives a short summary of the pathophysiological relations between emotional tension (stress) and physical strain and the effects on the cardiovascular system. The case report describes a homicide by strangulation immediately followed by the perpetuator's death from a natural cause.

In the medicolegal literature reports on homicides followed by suicide, especially in elderly people, are rare. In the present case, the victim, a 79-year-old woman, showed a rather unusual injury pattern: 3 gunshots to the head (with only 2 entrance wounds and 3 intracranial projectiles) and 2 stabs from a knife. The tools used for inflicting the stab wounds (a hunting knife and a double-edged dagger) were left in the victim's body after the offense. The 89-year-old husband hanged himself with an aerial cable after killing his wife. The police investigations and the autopsy findings suggested a combined homicide-suicide. The motive for the offense could be a so-called delusion of poverty associated with symptoms of depression.

Already the Celts and ancient Germanic peoples knew about the poisonousness of the yew, which played an important part in the mythology of these civilizations. For hunting, the arrows were made poisonous with yew juice, and yew leaves were used for homicide and suicide. In modern times taxine is rarely used with suicidal intent, although this method is actually recommended on the respective Websites. After a 14-year-old boy had intensively studied poisonous plants and methods of suicide on various Websites, he cut leaves from a yew tree (taxus baccata) in his parents' garden, crushed and ingested them and died soon afterwards. At the forensic autopsy pieces of the partially crushed, partially completely preserved yew leaves were found in the stomach. The histological findings were unspecific, e.g. marked general blood congestion of the internal organs and pronounced cerebral and pulmonary edema. When the tree leaves found in the stomach were viewed under the light microscope, a stoma typical of taxus was observed; chemical-toxicological investigations revealed 3,5-dimethoxyphenol in the gastric content, which is considered a marker for the ingestion of taxus.

Death cases--suicides as well as homicides--within the context of satanism are meanwhile becoming routine casework for forensic pathologists. Therefore the investigators should be aware of satanic signs and items associated with the occult to identify a satanic background. Based on two suicides of young persons, satanic signs helpful for classification are pointed out.

A fatal case of stabbing and cutting is reported which involved a 37-year-old male who suffered from depressive disorder and had already attempted suicide in the past. The postmortem examination revealed 12 lacerations of the scalp, 5 deep incised wounds on the flexor surface of the right forearm, 3 stab wounds of the back of the head, 12 stab wounds of the chest (with cutting of ribs but no injury of heart and lungs), 35 stab wounds of the abdomen and deep incised wounds of both sides of the neck with hesitation marks and incision of the left internal jugular vein. The significance of criteria to properly establish the manner of death like localization, axis and pattern of the wounds, hesitation marks, defense wounds, pulling aside the clothing to expose the target area, sustained capacity of physical activity and potential lethal effects of the single injuries as well as conclusions from the scene of death are discussed.

The authors report on three autopsy cases in which the findings at the death scene gave rise to the suspect of non-natural, in two cases even violent causes of death. The medico-legal and criminalistic investigations led to surprising results: Death was due to acute intoxication with narcotics, supposed delirium tremens and a suicide attempt in the presence of bronchopneumonia. External force was ruled out in all three fatalities by cooperative work of police investigators and forensic medicine.

On a wintry day a 29-year-old woman was found dead beside her car showing head injuries and signs of hypothermia. Several empty packets of sedative and hypnotic drugs were lying inside the car. Toxicological analysis revealed the presence of flunitrazepam (heart blood of the left and right chamber 0.033 mg/L each), norflunitrazepam (left heart blood 0.029 mg/L, right heart blood 0.027 mg/L), 7-amino-flunitrazepam (left heart blood 0.090 mg/L, right heart blood 0.104 mg/L), diazepam (left heart blood 0.395 mg/L, right heart blood 0.386 mg/L), nordazepam (left heart blood 0.112 mg/L, right heart blood 0.115 mg/L) and temazepam (left heart blood 0.034 mg/L, right heart blood 0.033 mg/L). Neither alcohol nor other drugs were found. It was concluded that benzodiazepine intake led to a disturbance of consciousness. Whether the woman died in this situation due to the icy temperature as a result of hypothermia or whether she died or would have died solely due to benzodiazepine overdosage could not be clarified.

Hanging is one of the most frequent types of suicide. Descriptions of unusual ligatures can be read about again and again. The paper reports the suicide of a 41-year-old electrician, who, using an electric winch, hung himself in nearly free suspension. The winch that was secured to the timberwork of the attic had been programmed by an electric time clock, the toggle switch of the remote control was fixed in the on-position using adhesive tape. The man had handcuffed his hands behind his back against any attempts to save himself. The noose was partly cushioned with a bike tube with the obvious aim of reducing the pain. Due to the state, in which he was found and the results of the post-mortem examination, a third party responsibility was excluded. The case shows that not only certain types of knots and nooses can be associated with various occupational groups, but the choice of a special strangulation device can possibly also come from the occupational sphere. As a modern variation of hanging, the presented casuistry can partly complete the familiar documentation of historical cases with the use of block and tackle and similar constructions.

So-called exit bags are voluminous, transparent plastic bags, each with a collar to go round the neck, and a Velcro fastening. In conjunction with the consumption of sleeping pills, the bags are recommended as an aid to commit suicide by organizations in favour of "humane death". It is reported on four such suicides by elderly people between 79 and 87 years of age. In two of these cases, there was assistance in committing suicide, one corresponding to a suicide protocol from the Swiss organization for euthanasia, EXIT. In two cases, detailed instructions for committing suicide were found. The morphological findings were not very specific in any of the cases. If the plastic bags are removed by a third party, this type of suicide may remain undetected even after performance of an autopsy. Exit bags tend to be used by older people with either real or feared life-threatening illnesses, in suicides which have usually been planned for some time. From the criminological point of view, the possible active participation of other persons in pulling the covering over the head can often not be proved. Assisting a suicide, in the sense of giving instructions on how to accomplish it, is not punishable in German law.

Suicidal deaths caused by pipe bombs are rare. An 18-year-old man was found dead in a forest by hikers. In immediate proximity to the body, a crater was located obviously induced by a detonation. The postmortem examination revealed severe damage of the head, upper-body and both arms and hands along with the extensive presence of soot and dirt. Particularly noticeable were numerous "entry wounds" and the presence of five bullet like pieces of metal in the body. The young man had a history of drug abuse and psychiatric problems. On the basis of autopsy findings, the conclusions of the police investigation and psychopathological considerations regarding the victim's case-history, discussion centers upon the differentiation between suicide by self-explosion, homicide by explosion or death as a consequence of numerous bullet wounds followed by an attempt to burn the body. Also considered is the possibility of paranoid psychosis induced by cannabis use as a cause of suicide.

In order to study the conditions for the formation of so-called rustmarks on the skin after contact with weapon steel tests to provoke rustmarks were performed on corpses and living bodies. These tests were only successful under the condition of a firm contact with the weapon steel and a certain minimum contact time between the weapon and the skin. The experiments showed that the critical parameters for the appearance of rustmarks are, first, the humidity of the skin and the environment, respectively, as well as the contact time, and second, the state of the weapon surface (greased or ungreased). Both the ambient temperature and the pH value of the skin (alkaline or acid) are irrelevant to the formation of rust. The longest time period until rustmarks appeared was observed on dry skin in contact with a greased weapon, namely 22 hours on a corpse and 170 min on a living subject. When using a greased gun humidity accelerated the formation of rust. An ungreased surface of the weapon also resulted in faster rust formation. The minimum time necessary for the formation of rust determined under the most favourable circumstances was 135 min for a corpse and 27 min for a living person. During the early postmortal interval the rustmark may therefore be another piece in the jigsaw towards determining the time of death on suicides committed with firearms.

A case of pretending a homicide to conceal a child suicide is reported in which characteristic findings of the postmortem examination and conclusions from the analysis of forensic autopsy series provided substantial support for the police investigation. In the late night hours of a spring day the police authorities were informed that a 10-year-old girl had been found dead on a playground near its parents' house. As injuries of the neck were recognized by the police officers a homicide investigation was initiated. The post mortem examination showed a furrow symmetrically slanting from the front to the nape of the neck, discrete punctate haemorrhages of the skin of the face and numerous 'tram-line' bruises of the back, buttocks and extremities. These findings indicated as cause and manner of death suicidal hanging following corporal punishment. Confronted with these conclusions the mother immediately made a corresponding confession.

An intoxication following administration of morphine, tramadol and atracurium in a suicide case is reported. The route of administration and the amount of the particular drug were known from the investigation of the death scene and the findings of the postmortem examination. Tramadol was present in the gastric contents as well as in blood, liver, kidney and brain samples, whereas the drug could not be detected in muscle. All body fluids and tissues investigated contained morphine as well as its 3- and 6-glucuronides with the exception of muscle tissue. The concentrations of morphine and its glucuronide metabolites were determined by LC/MS following solid phase extraction. Interestingly, the concentration of M6G in brain, liver and kidney were close to the concentration of M3G in the particular tissue. This phenomenon might be explained by a preferential hydrolysis of M3G or by a preferential formation of M6G postmortem. Measurement of morphine and M6G in femoral blood and cerebrospinal fluid may be a useful indicator in rapid deaths.

A 35 year-old male was found dead within a vast collection of garbage in his parent's house with 13 stab wounds of the thorax. 6 years before death he had suffered from a severe cerebral trauma with intracranial hemorrhage, after which an organic psychosis had ensued. At autopsy besides the stab wounds measuring 1-3.5 cm in length and partly exhibiting a so-called "fish-tail" formation a piece of wood was detected, having penetrated the fourth intercostal space along the sternal border and lacerated the pericardium, right pulmonary hilum and the pleura parietalis at the paravertebral line between the eight and ninth rib. There the leading part of the tool had apparently broken and bent to the left in a nearly 90 degrees angle, thus penetrating the left pleural cavity with a slight laceration of the lower lobe of the lung. From the forensic pathologist's point of view this case of multiple stabbing and additional impalement was at least remarkable and at first sight might have raised a suspicion of homicide due to the extent of the rib penetrations and especially the intrusion of the wooden device, which had been pushed by substantial force into an already existing wound. The police presupposed a suicide based on the personal history and situation at the site, where no traces suggesting an activity of somebody else could be ascertained. Reconstruction of the case and resulting differential diagnostic considerations are to be discussed.

Cases of combined suicide are infrequent findings, especially cases in which each method can be lethal. In interpretation of cases with a multitude of serious injuries it might be impossible to discover minor injuries which had occurred in the course of a preceding confrontation, because they may be masked by the general traumatization. In two cases of suicidal fall from a height neck injuries and petechial bleedings were found. The first case (woman 53 years) was a combination suicide (strangulation by ligature, deep incisions into her wrists, jump out of the window). The intensive petechial bleedings in the face could be explained as a result of ligature strangulation and the fracture of a lower thyroid horn as an indirect fracture resulting of the head traumatization. In the second case (girl, 14 years) petechial bleedings in the face were found. Furthermore the victim had marks on her neck-skin, consisting of well-lined bleedings and scratches, presenting a clear pattern, which could be related to a necklace. An explanation of these injuries as a result of a direct impact could not be given. Something must have happened prior the fall. Informations concerning the last hours before her suicide could not be obtained but a strangulation-attempt (by herself? by others?) must be ascertained. The histological investigation of the skin of this region arised a negative vital reaction, therefore a very short interval between that event and the death was assumed.