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Not murder most foul
Suspicious circumstances and inexplicable wounds do not a murder make

Source: http://www.mja.com.au/public/issues/175_12_171201/cala/cala.html]

[This version of the report has been edited by Dr Robert N Moles
Underlining where it occurs is for editorial emphasis]

Alan D Cala and Christopher H Lawrence

These two unusual forensic cases highlight the value of the autopsy in defining cases of murder. Circumstantial evidence pointed towards foul play and murder investigations were initiated, but correlation of the autopsy findings with the scene of the "crime" showed that one was a death from natural causes, and the other was an accident.

Break and enter and fatal assault?

An 87-year-old, 54 kg man who lived alone was found dead at his home in Sydney after he failed to maintain regular contact with relatives. The house was locked, and a relative forced entry by smashing a side window. The man was found lying on his back in the lounge room, wearing only a singlet, a flannelette shirt and short socks. It was mid-winter, with a temperature range that day of 5º-15ºC. No working heater was found in the house.

The relative called the police, who suspected foul play in view of the scene they witnessed: a deceased, partially dressed man with bruises on his head, trunk and limbs, surrounded by upturned furniture, pulled-out drawers and scattered papers, suggestive of a struggle. The house, however, was secure (apart from the window smashed by the relative) and a wallet containing cash was found near the body (an unusual finding in a "break and enter / robbery").

The man had clearly been dead for many hours: the body was cold to touch, and there was very firm rigor mortis with dependent lividity. He had had a myocardial infarction in 1997, but recently had been well and was not taking any regular medication.

At autopsy, 10 separate injuries were found on the body: abrasions on the right cheek, right ear, and right lower chest, and bruises and abrasions on the posterior aspect of both upper arms. A very large abrasion (240 x 110 mm) was noted on the right lateral upper thigh, with other abrasions around both knees.

The heart weighed 640 g. The pericardial sac was obliterated by fibrous adhesions. The left ventricular wall thickness was 13 mm (reduced to 6 mm in the affected area by an anteroseptal scar), and the right ventricular wall thickness was 2 mm. The coronary arteries were severely narrowed by calcific atherosclerosis. The aorta and branches also showed severe atherosclerosis. The severe coronary atherosclerosis and left ventricular scarring were indicative of past and possibly recent myocardial ischaemia / infarction, but there was no evidence of an acute myocardial infarction. There were bilateral apical emphysematous changes in the lungs.

The stomach lining had numerous superficial jet-black erosions, 2-10 mm in diameter, in the body and antrum. About 20 ml of altered blood was found in the stomach in association with these erosions. Toxicological analysis was negative for alcohol or other drugs. Neuropathological examination showed age-related neurofibrillary changes in the brain and a scar in the putamen.

The cause of death was determined to be the combined effects of fatal hypothermia and ischaemic heart disease.

Discussion

Hypothermia, in which the core body temperature falls to below 35ºC, [1] is rare as a cause of death in a temperate city such as Sydney. Those most at risk are thin, elderly people who live alone in poorly heated premises. They have low fat reserves, may be nutritionally and calorically deficient and usually have other significant medical problems. Poor family and social networks may lead to isolation, which can exacerbate the situation by failure to obtain timely medical assistance.

Quite often, the scene findings in cases of fatal hypothermia show evidence suggesting a struggle. The premises may be in disarray, and affected individuals may be found under newspapers or furniture. Presumably, once hypothermia has set in, they become confused and disoriented, and attempt to seek warmth in unusual places. They also suffer from "paradoxical undressing", or "hide-and-die" behaviour, thought to be due to a disturbance of the temperature-regulating function of the hypothalamus that causes a feeling of overheating (and resultant attempts to cool down such as undressing) as the body's core temperature drops.

The most significant finding at autopsy was the presence of gastric erosions. Although not diagnostic for hypothermia (and not present in all cases), such multiple, superficial, variable-sized ulcers or erosions, found particularly in the body of the stomach, are often seen in cases in which hypothermia is believed to be either the sole cause of death or a contributing factor to death. They are thus highly suggestive of the diagnosis. They may also be seen in cases of "stress" from any cause, for example postoperatively, or following myocardial or cerebral infarction. Other autopsy findings that have been described in fatal hypothermia are pancreatic haemorrhage or necrosis, and cherry-pink lividity, but these are not specific. [2]

Assault with a steel bar?

In a second case, a 37-year-old, 99 kg man with no significant past medical history was found by his wife at about 8:45 am, lying in the back yard of his residence, with a penetrating injury to his right eye. This unusual injury was immediately designated as suspicious by the police, who arranged for a forensic pathologist to attend the scene.

The man's usual practice had been to water the garden each morning before leaving for work at 5:30 am. The garden hose was found still running on the ground, and the man's body was almost submerged by the water collecting around him. He was lying on his back with his legs folded underneath him, on the edge of a garden bed. Several sandstone rocks were around the body, and nearby was an 18 mm diameter octagonal steel post that was upright but loose in the ground.

The autopsy was conducted later that day. The main abnormality was a complex, patterned, roughly square injury on the right cheek and eye, which was covered with blood and fragments of brain tissue. On the right cheek, close to the nose, was a curved 26 mm full-thickness laceration running obliquely and medially. Two parallel lines of abrasion / laceration, 20-45 mm in length, extended upwards and laterally away from this laceration. On the lower right eyelid was a 'V'-shaped laceration.

Dissection of this complex injury showed a 70 mm long haemorrhagic wound track directed upwards, left to right, and front to back. The injury had perforated the posterior wall of the orbit, superficially bruising the lateral wall of the right orbit. The globe of the right eye remained substantially intact, despite the severe injury. There was a penetrating injury to the right inferior frontal region of the brain to a depth of 35 mm, resulting in a wound defect in the brain of 18 mm diameter. Within the wound were several small pieces of dark material, possibly representing corroded metal. The left orbit was fractured, and 300 ml of blood from a subdural haemorrhage was in the anterior right middle cranial fossa.

Detailed neuropathological examination also showed evidence of brain swelling, resulting in midline shift of structures from right to left, transtentorial herniation on the right side, and flattening of gyri over the area of the subdural haemorrhage. Duret haemorrhages, indicative of raised intracranial pressure, were present in the pons and midbrain, with some minor haemorrhage in the right uncus.

Other injuries, consisting mainly of abrasions, were present on the forearms and thighs.

The time of death was estimated to be between 5:00 and 6:00 am that morning, given the degree of rigor mortis, the rectal temperature and degree of skin slippage present. The rest of the autopsy showed no notable abnormalities.

Examination of the metal post under a dissecting microscope revealed small strands of tissue and one small hair, possibly from the lower eyelid of the deceased. DNA analysis confirmed that the material on the post was from the body of the deceased.

The cause of death was determined to be an accidental penetrating injury of the right orbit and brain by a steel post, with no evidence that the injury was inflicted by another person.

Discussion

Fatal penetrating injuries to the head are uncommon, [3] and mostly due to gunshot rather than stab wounds. Initially, investigating police believed the injury must have been caused by some other person. Suicide was considered highly unlikely. Although the metal post was the obvious weapon to have caused the injury, it was not immediately clear what had transpired to lead to the injury. There was even speculation about the possibility of a tangential gunshot wound.

Foul play was discounted after x-rays and autopsy revealed the true nature of the injury and "weapon". The most probable scenario is that while the deceased was watering his garden, he tripped on the hose, fell onto the post, sustained the penetrating injury and died a short time later.

References

[1] Harrison's textbook of internal medicine. 14th ed. New York: McGraw-Hill, 1998: 97-99.

[2] Knight B. Forensic pathology. New York: Oxford University Press, 1991: 380-384.

[3] Adams JH, Graham DI. Introduction to neuropathology. 2nd ed. Edinburgh: Churchill Livingstone, 1994: 133-155.

Authors' details

NSW Institute of Forensic Medicine, Glebe, NSW.
Allan D Cala, FRCPA, Forensic Pathologist;
Christopher H Lawrence, FRCPA, Forensic Pathologist.

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