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Journal of Forensic and Legal Medicine 45 (2017) 17e20

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Journal of Forensic and Legal Medicine

j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / j fl m

Short communication

An unusual case of murderesuicide: The importance of studying knots

Cristian D'Ovidio*, Enrica Rosato, Aldo Carnevale
Section of Legal Medicine, Department of Medicine and Aging Sciences, G. d'Annunzio University of ChietiePescara, Via dei Vestini, 31, 66100 Chieti, Italy

a r t i c l e i n f o a b s t r a c t

Article history: An atypical murder-suicide that involved a married couple over 80 years of age was investigated at the
Received 19 February 2016 Institute of Legal Medicine of the University of Chieti-Pescara and is presented and discussed here. The
Received in revised form whole story allows us to confront the difculties involved in the discovery of a dead body in water when
20 May 2016
the circumstantial evidence does not allow any unique interpretation of the facts. The atypical and
Accepted 7 October 2016
Available online 8 October 2016
misleading element appeared to be how the body of the man was tied, with the interpretation inclined
towards a homicidal manner of death. It was only by combining the contributions of each of the ndings
that emerged during the course of the autopsy with the circumstantial evidence from the site inspection
that it was possible to reach resolution of this case, which was then identied as a murder-suicide.
Bondage 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
Forensic investigation

1. Introduction river.
The man was fully dressed in sportswear typical of a cyclist, and
The moment that a dead body is extracted from water marks the he was immobilised by several cords tied together. The aspect that
beginning of the real diagnostic challenge for the forensic pathol- posed serious interpretative uncertainties concerning the criminal
ogist, where the attention and efforts must be directed towards the nature of the event was represented by the atypical mode in which
denition of the causes, means, and ways in which the death the body appeared to be tied: the system of ropes was so intricate
occurred. The challenge, therefore, arises from the need to identify, that it was easy to believe that self-ligature was not possible. This
analyse and interpret correctly all of the aspects and every element resulted in the feeling that there had been participation of a third
that emerges, to be able to reconstruct the nature of a death that is person, and thus the initial hypothesis recognized this as a homi-
certainly suspect. cide or incitement to suicide.
However, the circumstances that might appear at initial obser-
vation are not always the reality, and this was what happened in 3. Forensic investigations
the case that is presented here.
After conducting various and relevant examinations to the place
of discovery, the body was taken for forensic investigations. First,
2. Case report
the body underwent a post-mortem thoraxeabdomen computed
tomography scan, which identied the presence of pulmonary
This case concerns an 89-year-old man, whose lifeless body was
ground-glass opacities bilaterally, with the distal trachea and main
found hanging from ropes in the waters of a river, from where it
bronchi lled by watery uid material. Material of the same
was recovered. The stretch of river was located near a carpark of a
density was observed even in the medio-distal oesophagus and
large shopping centre with access through a gate, and with a nar-
stomach, and in the rst duodenal portion.
row path that connected this square to the river. The depth of the
river at that point was not known, but the banks of the river were
3.1. Autopsy and histological ndings
steep, with a drop of about 1.5 m (Fig. 1). Also, it was a slow owing
An autopsy was performed 48 h later. The external examination
* Corresponding author.
revealed the presence of cyanosis of the face and lips with reddish-
E-mail addresses: (C. D'Ovidio), pink mantle hypostasis, and conjunctival hyperaemia with small
(E. Rosato), (A. Carnevale). punctiform haemorrhages. There were no obvious signs of
1752-928X/ 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
18 C. D'Ovidio et al. / Journal of Forensic and Legal Medicine 45 (2017) 17e20

subarachnoid haemorrhage spread through the left hemisphere

with contusion injury even to the left cerebellar lobe. The section of
the brain parenchyma showed widespread and multiple intra-
parenchymal haemorrhagic areas, with haemorrhage of the
lateral ventricle.
Thus according to the autopsy and the results of the histological
examinations, the death was caused by cardio-respiratory arrest
due to massive head injury.
Along with the presumed murder weapon (the long-handled
hammer), during the inspection of the house, some lengths of
white rope, a letter, a sum of money (V 1600.00), and the pension
books of the married couple were found on a table.

4. Description of the bondage

The descriptive report of the reconstruction is the result of

scrupulous investigations carried out during the judicial inspection
Fig. 1. The site where the man was pulled from the water and the system of ropes on
the tree.
and autopsy. The entire framework of the ropes was divided into
two inter-related systems, as a component tied to the body of the
victim that kept the upper limbs immobilised, and a second
putrefaction or of traumatic injury or self-defence. component that ensured the anchoring of the body to the place of
In the internal examination, the main ndings included venous discovery, to avoid the body being dragged away by the river
stasis with distention of the jugular and subclavian veins, and the current.
lungs were expanded and oedematous, with evidence of a sub- The body of the victim appeared to be tied with two different
pleural bleeding point (bleeding of Paltauf). The laryngotracheal types of rope. A black and white piece of rope was closely tied
mucosa appeared congested, with evidence of serum- around the waist, the shorter end of which then passed between
haemorrhagic liquid even in the peripheral bronchial ramica- the legs along the right inguinal fold, where it appeared to be
tions. White opalescent liquid was also present, with a residual of strongly tied with another rope of a different manufacture that was
ora from the river adhering to the mucosal surface of the stomach, tied to the right wrist. The other end of the rope that was tied at the
and liquid with the same characteristics even within the loops of waist had a free length of about 2 m (from the abdomen).
the small intestine, beyond the Ligament of Treitz. On histological Lengths of white rope were tied to each wrist, at about 77 cm
examination, the widespread presence in both lung elds of air- long for the right wrist, and about 54 cm long for the left wrist.
spaces dilated with aqueous content was assumed to be of partic- These were arranged so as to create a small loop around each of the
ular relevance, as well as the presence of the drowning liquid in a wrists while keeping the rest of the ropes free. The two sections of
large tract of the tenuous intestine. free rope were tied together with a tight knot that held the upper
limbs blocked along the sides of the body.
The site inspection showed that the other free end of the rope
3.2. Biological ndings
tied at the waist was tied to another white rope after about 2 m.
This new rope had a length of about 3 m that went up about 1.5 m
Biological tests were also carried out, with the implementation
towards the trunk of a tree, where it was wrapped around a sturdy
of qualitative and quantitative comparative analyses between tis-
branch of about 6 cme8 cm in diameter. From here, the next length
sue samples and the drowning uid. Plankton (diatoms) were
of the rope stretched about another 10 m, with its end wrapped
discovered in the lung parenchyma and in the organs perfused by
around and tied to a metal pole that was rmly embedded in the
the great circle (i.e., the liver and kidneys), as well as in the bone

5. Discussion
3.3. Toxicological ndings
Not all bodies recovered from water have drowning recognized
The routine toxicological analyses were negative for the pres- as the cause of death. Similarly, it is not always easy to immediately
ence of drugs or psychotropic agents. trace back to the manner in which a death occurred, as it might
Thus, according to the autopsy and the results of the histological have been an accidental, homicidal or suicidal event.1,2
examinations and biological tests, the hypothesis of asphyxial The nal judgment has to come from interpretation of the au-
death by drowning in fresh water was conrmed. topsy, histological and biological ndings, within the circumstantial
context in which individual factors of the victim and the environ-
3.4. Sites inspection mental factors are involved in the denition of the true
During the inspection in the house where the man had lived, the In the case presented here, while on the one hand the diagnosis
body of a woman was found on a bed, with a long-handled hammer of death by drowning was conrmed, serious doubts emerged
left on the nightstand. An autopsy of this woman was performed about the way in which this had occurred, with the strong suspicion
48 h later. The external examination revealed the presence of of the participation of a third person.
serious head injury involving the left hemisphere, with multiple Indeed, the post-mortem diagnosis of drowning was arrived at
lacerations of the scalp, a crushed skull, and brain disintegration. in a simple way. The autopsy documented all of the classic forensic
The body also showed evidence of passive defence injuries to the signs of wet drowning, including liquid aspiration, pulmonary
hands. oedema, sub-pleural Paltauf haemorrhage, distension of the
In the internal examination, the main ndings included stomach, and the duodenum containing drowning liquid. Also, the
C. D'Ovidio et al. / Journal of Forensic and Legal Medicine 45 (2017) 17e20 19

histological examinations of the lung parenchyma with

haematoxylin-eosin showed the classic acute watery emphysema
that was characterised by obvious dilatation of the alveolar spaces
with water content.1,6e8 These were also associated to the classic
radiological ndings that are commonly described in cases of
drowning.9e11 The positivity of the biological tests (for diatoms)
also supported the hypothesis of the death as drowning.1 This test
provided evidence on the effectiveness of the cardiovascular ac-
tivity when the respiratory tract was ooded.12
Although the combination of these factors correctly supported
the strong suspicion of drowning, it was impossible to dene with
the same certainty the circumstances of the death, as a suicide or as
a simulated suicide (i.e., murder) due to the nature and character-
istics of the devices put in place to tie the body.
In typical forms of suicide, it is usual to observe heavy objects
attached to the body to obstruct and prevent any attempt at Fig. 2. The system of ropes and knots.
instinctive reactions. The same reasoning can be applied to the
immobilisation of the hands and/or feet, and therefore it was
important to analyse the characteristics of the bindings, to deter- Indeed, there were also notes and drawings depicting the scaffold
mine whether these could have been prepared by the victim rope that the elderly man had then reproduced by the river.
himself.1 Through analysis of the various notes and drawings that appeared
The system of ropes and knots were relatively atypical to depict the presumed suicide, and by careful evaluation of the
compared to a suicidal death by drowning with self-tying. Indeed, system of ropes and ligatures, it was possible to deduce how in
victims can often be particularly resourceful in nding or designing reality his self-construction of the whole scaffold of ropes had been
lethal systems of self-ligation in cases of self-strangulation, where possible.
they also often use rare and unusual methods.13e15 Self-tying is a As shown in outline, the whole procedure was reconstructed
practice commonly used also in suicide by hanging,16 and in com- according to the followed main steps:
plex suicides characterised by combinations of different meth-
ods.17e19 Also hanging or self-tying with ropes around the neck and - The initial process for the construction of the system was to x
limbs is a typical mode of autoerotic practices.20 the stick that was sunk into the ground for the tying of the rst
In the present case, the complexity of the entire system of ropes rope. This rope then stretched for about 10 m, to reach the steep
that was so atypical, although particularly effective, plus the system bank, with it also passing around a thick branch of a tree.
of nooses with which the upper limbs were immobilised along the - Preparation of the loops of rope around each wrist, with
body, made the idea of self-tying remote. another rope passing round the waist by tying the longer end
Cases of murder carried out by drowning are very rare.21 Despite (about 2 m) to the previous rope. At rst, a continuum was
this, all of the elements in our possession led to the strong suspicion created between the ropes tied round the wrists, and then this
of atypical homicidal mode, with incaprettamento (binding of the was tied to the end of the rope passing round the waist (see
body), or potentially mediated by participation in the form of details in Fig. 2).
incitement to suicide.
Even if the autopsy was negative for typical signs of active or Finally, this was all conrmed by the nal words that he had
passive defence that would have indicated a possible scufe and/or written on a piece of paper left on the table in the house, where he
resistance by the victim, this did not specically exclude the stated his reasons for the act that he was to carry out, and the
occurrence of a murder due to the possible physical inferiority of specic instructions to nd his body.
the victim, as dictated by his age and body type. This was thus a typical case of murderesuicide that was moti-
With the case directed in this way, the resolution then took on a vated by altruistic reasons, a motive recognized with older cou-
decidedly different turn. Once the victim was identied and his ples, especially when one or both are suffering from a terminal
home situation was further investigated, there was an amazing illness.23,29e33
discovery. Still in a pool of blood in her bed, the corpse of a woman
was discovered. This was the lifeless body of the wife of the elderly
man, who had been his life partner. She was also an octogenarian,
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