Foremic Sciace Internotkmol, 56 (1992) 59,- 64 Elsevier Scientific Publishers Ireland Ltd.
59
FIREARM FATALITIES
DAVID ROUSE and LOUISE DUNN aDepartmmt of Fmmsie Medicine, Th Lmdm Hospita1 Medical College, Turner Street, Lonhn, EI MD, and bUniversity of Glasgow, Glasgow, (UK) (Received April 29th, 1992) (Accepted June lOth, 1992)
Summary One hundred and twenty eight cases of shooting fatalities were investigated during an 11-year period. Of these 57% were homicidal shootings with 34% suicidal in nature. Only two suicidal fatalities were female. Analysis of the sites of entrance wounds confirmed the ‘sites of election’ in suicidal shootings, whilst homicidal wounds showed a much wider distribution. Multiple entrance wounds were seen in 42% of homicidal shootings. Injuries to hands were seen in 7 homicidal fatalities. Kq worok Shooting fatalities;
Suicide; Homicide; Defence wounds
Introduction
There have been a number of series in the recent literature [l-21 concentrating on firearm fatalities. A similar series was undertaken to investigate whether firearm fatalities in England differed from other countries and form part of a review of this Department’s work. Methods and Materials
We analysed al1 cases of firearm fatalities during an ll-year period (1981- 1991 inclusive) in the area covered by the Department of Forensic Medicine at The London Hospital Medical College. This area covers parts of East and South East London and surrounding rural areas (approximate population of 5 million). Results
One hundred and thirty cases were identified from Departmental records of which 2 were unsuitable for inclusion in this study. Al1 the cases had a full auCowespmdmce to: David Rouse, Department of Forensic Medicine, The London Hospital Medical College, Turner Street, London, El 2AD, UK. 0379-0738/921$05.00
0 1992 Elsevier Scientific Publishers Frinted and Published in Ireland
Ireland Ltd.
Fig. 1 Incidence of 128 cases of shooting from departmental
records.
topsy. The annual incidence is shown in Fig. 1. The average was ll.6 fatalities/year, with no significant increase in the number of fatalities within the laat 8 years. Homicidal shootings formed a large proportion of the cases (57%) whilst suicidal shootings had a lower incidence at 34% (Table 1). Table 2 shows the distribution by age and sex for homicidal shootings with suicidal shootings in men occurring in an older age group than in homicidal cases. Although this trend is not evident in women, it would seem likely to be related to the differing sample size. TABLE 1 MANNER OF SHOOTING
Homicidal Suicidal Accidental Lawful killing Not known
Incidence
(% of total)
73 43 3 2 6
57 34 2 2 5
TABLE
2
MEAN AGE AND SEX DISTRIBUTION No. in each group in parentheses.
MaIe Female
FOR HOMICIDAL
AND SUICIDAL
SHOOTINGS
Five ages not known.
HOmiCidd
SUiCidd
36.2 (55) 48 (13)
42 (41) 31 (2)
Tables 3 and 4 compares the main features of suicidal shootings to homicidal cases. Women are comparatively rare victims of firearm fatalities and in only two cases were they suicidal in nature. In both these cases there was relatively easy access to firearms. Shot guns in this series account for 58% of cases in the suicidal group and 55% in the homicidal group. Most fatalities arise from a single discharge with only one suicide case having two gun-shot wounds. Thirty-one cases of homicidal shootings had more than one wound. Detailed analysis of the entrance site confirms the presence of sites of election for suicidal shooting, with the vast majority of such entrance wounds being to the temple, forehead, mouth, chin, neck and the chest. Homicidal shootings show a much greater divergente of entrance sites
TABLE
3
COMPARISON OF AGE, SEX AND WEAPON OF SHOOTING
TYPE IN SUICIDAL
AND HOMICIDAL
SUicide
HG??&&3
M:F
41:2
56:17
Weapon Shotgun Handgun Rifle Home made
25 12 2 1
40 21 7 -
3
5
3 12 6 10 4 4 3
6 19 12 12 9 8 -
1
9
Not known
4s
0-19 20-29 30-39 40-49 50-59 60-69 70+ Not known
CASES
62 TABLE 4 COMPARISON OF ENTRANCE SITES AND NUMBER OF WOUNDS IN SUICIDAL AND HOMICIDAL CASES OF SHOOTING SUicidf? Site of wounds Temple Forehead Mouth Chin Neck Elsewhere to head Chest Not definable Left chest Right chest Abdomen Multiple sites Limbs Back
8 4 12 1 3 4
Hf.?WiCi&
-
4 3
1 4 17
-
1 4 12 1 24 1 1
42 1 -
42 19 3 9
8 2 1
No.of wounds 1 2 3 3+
with involvement of the head away from sites of election and the right side of the chest. Analysis of single-shot fatalities (Table 5) shows that the majority of suicidal wounds involve the head (69%) whilst for homicidal shootings this variation in wounds sites is not so obvious. In 7 cases of homicidal shooting there was evidente of fire-arm discharge passing through the hands or arms. Comparison with other types of weapon would indicate that this represents a defensive action - i.e, trying to ward off the weapon.
TABLE 5 DISTRIBUTION OF SINGLE SHOT ENTRANCE SITES Regh
of entrance
Head Neck Chest Abdomen Extremities
sutio?e(%)
Hom&&
26 (68) 3 (7) 3 (19) 2 (5) -
20 (47.6) 1 (2.4) 19 (45.2) 1 (2.4) l(2.5)
(%)
63
Discussion The very high incidence of homicidal shootings in this series must relate to the nature of the Department. Most suicidal shootings occurring in rural distr& covered by the Department, where there is no element of suspicion, would have a post mortem performed by the local Coroner’s pathologist, rather than by a member of this Department. This may explain the shift to homicidal cases. In some series the vast majority of shooting fatalities are suicidal: 86% in Thomsen and Albrektsen from Denmark [l] and 71% in Selway from Australia [Z]. However in American series there is a marked trend towards homicidal shootings [3]. Examination of the homicidal and suicidal cases show results comparable to other series. Most suicides are carried out by men, with a very low incidence of female suicides (4.6%). In both these two cases both women had easy access to guns. Suicidal shootings by women are extremely uncommon with only 2.6% of al1 suicides in Denmark [l] and 3.2% in Australia [2] involving women. Some authors have taken the view that a shooting of a woman is homicidal until proven otherwise. One suicidal case in this current series, had multiple entrance wounds. However, one discharge passed harmlessly through the check with a second, fatal, intraoral wound. This multiplicity of discharges is not exceptional - Eisele et al. [4] provides three cases, Introna et al. [5] have presented a series of nine such cases, whilst Mabbe et al. [6] records a suicidal case of nine entrance wounds. A case of suicide by simultaneous discharge of two weapons has even been recorded [7]. There are wel1 recognised sites for election of a suicidal gun shot wound with most suicides reputedly shooting themselves in either the temple, the chest or through the mouth or front of the neck. Occasionally however, suicidal wounds may be elsewhere. Some authors believe that deviation from these sites should raise suspicions of homicide. In this series, the head is the dominant region in suicidal shootings. Shots fired into the mouth at 29% predominated but there was a high incidence of shots fired into the temple, (lg%), forehead (10%) and under the chin. This is similar to the findings of Thomsen [ll. In Eisele’s series [4] the temple was the commonest entrance area at 39%, but this may reflect the very high usage of hand guns. In this series 19% of suicides had entry wounds in the left chest. This is directly comparable with Eisele’s findings of 18% suicidal wounds in the chest [4], Thomsen’s of 17% with chest wounds [l] and 22.5% in Al Ragheb’s series [9]. With long-barrelled weapons the site of election wil1 be limited by the ability to reach the trigger, so that the common sites wil1 be the mouth, front of the head or thorax. Homicidal wounds do not show this distribution of wounds. In this series of single-shot fatalities 45.7% were to the head and 45.2% to the chest. Of those shot to the head, the vast majority were in sites not associated with those sites of election for suicidal shootings. In the Thompsen et al. series [l] the distribution was relatively equal amongst entrance wounds to the head (34%), chest (23%) and abdomen (21%). Analysis of the head wounds showed that the frontal
64
region was commonest at 33% with the left (29%) and the right temple (19%) being frequently involved. Gonzales [lO] found that in 30% of homicidal shootings there were multiple wounds. In this series multiple entrance wounds occurred in 42% of cases, whilst in Al Ragheb’s series [9] multiple wounds occurred in 54% of cases. In 9.6% of homicidal shootings the discharge had passed through the hands. We would propose that such injuries represent so-called ‘defence injuries’ similar to those seen in attacks with knives. Hunt et al. [ll] found such injuries in 39%. The relative paucity of such ‘defence injuries’ in homicidal shootings may in part relate to the increased distance between attacker and the victim. This series demonstrated the considerable similarity between shooting fatalities in England and elsewhere in the World; despite the restricted availability of firearms in this country. Acknowledgements
We would like to thank the members of the Department of Forensic Medicine and the Coroners for allowing USto use their material. References 1 2 3 4 5 6 7 8
9 10 11
J.L. Thomsen and S.B. Albrektsen, An Investigation of the pattern of firearms fatalities before and after the introduction of new legislation in Denmark. Med. Sci. Law., 31(1991) 162 - 166. R. Selway, Firearm Fatahties in Victoria, Austraha 1988. Med. Sci. Law., 31 (1991) 167-74. C.S. Hirsch, N.B. Rushforth, A.B. Ford and L. Achelson, Homicide and suicide in a metropolitan country. J. Am. Med. Assoc., 223 (1973) 900 - 905. J.W. Eisele, D.T. Reay and A. Cook, Sites of suicidal gunshot wounds. J. Forensic Sci., 26 (1981) 480 - 485. F. Introna and J.E. SmiaIek, Suicide from multiple gunshot wounds. Am. J. Forensic Med. Pathol., 10 (1989) 275 - 284. D. Habbe, G.E. Thomas and J. GouId, Nine gunshot suicide. Am. J. Forensic Med. Pathol., 10 (1989) 335 - 337. D.R. Rogers, Simultaneous temporal and frontal suicidal gunshots. Am. J. Forensic Med. Pathol., 10 (1989) 338 - 339. 1. West, Firearm suicide in a female. Med. Sci. Law., 20 (1980) 192-193. S.Y. Abu Ai Ragheb, Firearm fatalities in Jordan. Med. Sci. Law., 24 (1984) 213-221. T.A. Gonzales, M. Vance, M. HaIpern and C.J. Urnberger, Legal Medieine, 2nd edn., AppletonCentury Crofts Inc., New York, 1954. A.C. Hunt and R.S. Cowling, Murder by stabbing. Forensic Sci. Int., 52 (1991) 107- 112.
59
FIREARM FATALITIES
DAVID ROUSE and LOUISE DUNN aDepartmmt of Fmmsie Medicine, Th Lmdm Hospita1 Medical College, Turner Street, Lonhn, EI MD, and bUniversity of Glasgow, Glasgow, (UK) (Received April 29th, 1992) (Accepted June lOth, 1992)
Summary One hundred and twenty eight cases of shooting fatalities were investigated during an 11-year period. Of these 57% were homicidal shootings with 34% suicidal in nature. Only two suicidal fatalities were female. Analysis of the sites of entrance wounds confirmed the ‘sites of election’ in suicidal shootings, whilst homicidal wounds showed a much wider distribution. Multiple entrance wounds were seen in 42% of homicidal shootings. Injuries to hands were seen in 7 homicidal fatalities. Kq worok Shooting fatalities;
Suicide; Homicide; Defence wounds
Introduction
There have been a number of series in the recent literature [l-21 concentrating on firearm fatalities. A similar series was undertaken to investigate whether firearm fatalities in England differed from other countries and form part of a review of this Department’s work. Methods and Materials
We analysed al1 cases of firearm fatalities during an ll-year period (1981- 1991 inclusive) in the area covered by the Department of Forensic Medicine at The London Hospital Medical College. This area covers parts of East and South East London and surrounding rural areas (approximate population of 5 million). Results
One hundred and thirty cases were identified from Departmental records of which 2 were unsuitable for inclusion in this study. Al1 the cases had a full auCowespmdmce to: David Rouse, Department of Forensic Medicine, The London Hospital Medical College, Turner Street, London, El 2AD, UK. 0379-0738/921$05.00
0 1992 Elsevier Scientific Publishers Frinted and Published in Ireland
Ireland Ltd.
Fig. 1 Incidence of 128 cases of shooting from departmental
records.
topsy. The annual incidence is shown in Fig. 1. The average was ll.6 fatalities/year, with no significant increase in the number of fatalities within the laat 8 years. Homicidal shootings formed a large proportion of the cases (57%) whilst suicidal shootings had a lower incidence at 34% (Table 1). Table 2 shows the distribution by age and sex for homicidal shootings with suicidal shootings in men occurring in an older age group than in homicidal cases. Although this trend is not evident in women, it would seem likely to be related to the differing sample size. TABLE 1 MANNER OF SHOOTING
Homicidal Suicidal Accidental Lawful killing Not known
Incidence
(% of total)
73 43 3 2 6
57 34 2 2 5
TABLE
2
MEAN AGE AND SEX DISTRIBUTION No. in each group in parentheses.
MaIe Female
FOR HOMICIDAL
AND SUICIDAL
SHOOTINGS
Five ages not known.
HOmiCidd
SUiCidd
36.2 (55) 48 (13)
42 (41) 31 (2)
Tables 3 and 4 compares the main features of suicidal shootings to homicidal cases. Women are comparatively rare victims of firearm fatalities and in only two cases were they suicidal in nature. In both these cases there was relatively easy access to firearms. Shot guns in this series account for 58% of cases in the suicidal group and 55% in the homicidal group. Most fatalities arise from a single discharge with only one suicide case having two gun-shot wounds. Thirty-one cases of homicidal shootings had more than one wound. Detailed analysis of the entrance site confirms the presence of sites of election for suicidal shooting, with the vast majority of such entrance wounds being to the temple, forehead, mouth, chin, neck and the chest. Homicidal shootings show a much greater divergente of entrance sites
TABLE
3
COMPARISON OF AGE, SEX AND WEAPON OF SHOOTING
TYPE IN SUICIDAL
AND HOMICIDAL
SUicide
HG??&&3
M:F
41:2
56:17
Weapon Shotgun Handgun Rifle Home made
25 12 2 1
40 21 7 -
3
5
3 12 6 10 4 4 3
6 19 12 12 9 8 -
1
9
Not known
4s
0-19 20-29 30-39 40-49 50-59 60-69 70+ Not known
CASES
62 TABLE 4 COMPARISON OF ENTRANCE SITES AND NUMBER OF WOUNDS IN SUICIDAL AND HOMICIDAL CASES OF SHOOTING SUicidf? Site of wounds Temple Forehead Mouth Chin Neck Elsewhere to head Chest Not definable Left chest Right chest Abdomen Multiple sites Limbs Back
8 4 12 1 3 4
Hf.?WiCi&
-
4 3
1 4 17
-
1 4 12 1 24 1 1
42 1 -
42 19 3 9
8 2 1
No.of wounds 1 2 3 3+
with involvement of the head away from sites of election and the right side of the chest. Analysis of single-shot fatalities (Table 5) shows that the majority of suicidal wounds involve the head (69%) whilst for homicidal shootings this variation in wounds sites is not so obvious. In 7 cases of homicidal shooting there was evidente of fire-arm discharge passing through the hands or arms. Comparison with other types of weapon would indicate that this represents a defensive action - i.e, trying to ward off the weapon.
TABLE 5 DISTRIBUTION OF SINGLE SHOT ENTRANCE SITES Regh
of entrance
Head Neck Chest Abdomen Extremities
sutio?e(%)
Hom&&
26 (68) 3 (7) 3 (19) 2 (5) -
20 (47.6) 1 (2.4) 19 (45.2) 1 (2.4) l(2.5)
(%)
63
Discussion The very high incidence of homicidal shootings in this series must relate to the nature of the Department. Most suicidal shootings occurring in rural distr& covered by the Department, where there is no element of suspicion, would have a post mortem performed by the local Coroner’s pathologist, rather than by a member of this Department. This may explain the shift to homicidal cases. In some series the vast majority of shooting fatalities are suicidal: 86% in Thomsen and Albrektsen from Denmark [l] and 71% in Selway from Australia [Z]. However in American series there is a marked trend towards homicidal shootings [3]. Examination of the homicidal and suicidal cases show results comparable to other series. Most suicides are carried out by men, with a very low incidence of female suicides (4.6%). In both these two cases both women had easy access to guns. Suicidal shootings by women are extremely uncommon with only 2.6% of al1 suicides in Denmark [l] and 3.2% in Australia [2] involving women. Some authors have taken the view that a shooting of a woman is homicidal until proven otherwise. One suicidal case in this current series, had multiple entrance wounds. However, one discharge passed harmlessly through the check with a second, fatal, intraoral wound. This multiplicity of discharges is not exceptional - Eisele et al. [4] provides three cases, Introna et al. [5] have presented a series of nine such cases, whilst Mabbe et al. [6] records a suicidal case of nine entrance wounds. A case of suicide by simultaneous discharge of two weapons has even been recorded [7]. There are wel1 recognised sites for election of a suicidal gun shot wound with most suicides reputedly shooting themselves in either the temple, the chest or through the mouth or front of the neck. Occasionally however, suicidal wounds may be elsewhere. Some authors believe that deviation from these sites should raise suspicions of homicide. In this series, the head is the dominant region in suicidal shootings. Shots fired into the mouth at 29% predominated but there was a high incidence of shots fired into the temple, (lg%), forehead (10%) and under the chin. This is similar to the findings of Thomsen [ll. In Eisele’s series [4] the temple was the commonest entrance area at 39%, but this may reflect the very high usage of hand guns. In this series 19% of suicides had entry wounds in the left chest. This is directly comparable with Eisele’s findings of 18% suicidal wounds in the chest [4], Thomsen’s of 17% with chest wounds [l] and 22.5% in Al Ragheb’s series [9]. With long-barrelled weapons the site of election wil1 be limited by the ability to reach the trigger, so that the common sites wil1 be the mouth, front of the head or thorax. Homicidal wounds do not show this distribution of wounds. In this series of single-shot fatalities 45.7% were to the head and 45.2% to the chest. Of those shot to the head, the vast majority were in sites not associated with those sites of election for suicidal shootings. In the Thompsen et al. series [l] the distribution was relatively equal amongst entrance wounds to the head (34%), chest (23%) and abdomen (21%). Analysis of the head wounds showed that the frontal
64
region was commonest at 33% with the left (29%) and the right temple (19%) being frequently involved. Gonzales [lO] found that in 30% of homicidal shootings there were multiple wounds. In this series multiple entrance wounds occurred in 42% of cases, whilst in Al Ragheb’s series [9] multiple wounds occurred in 54% of cases. In 9.6% of homicidal shootings the discharge had passed through the hands. We would propose that such injuries represent so-called ‘defence injuries’ similar to those seen in attacks with knives. Hunt et al. [ll] found such injuries in 39%. The relative paucity of such ‘defence injuries’ in homicidal shootings may in part relate to the increased distance between attacker and the victim. This series demonstrated the considerable similarity between shooting fatalities in England and elsewhere in the World; despite the restricted availability of firearms in this country. Acknowledgements
We would like to thank the members of the Department of Forensic Medicine and the Coroners for allowing USto use their material. References 1 2 3 4 5 6 7 8
9 10 11
J.L. Thomsen and S.B. Albrektsen, An Investigation of the pattern of firearms fatalities before and after the introduction of new legislation in Denmark. Med. Sci. Law., 31(1991) 162 - 166. R. Selway, Firearm Fatahties in Victoria, Austraha 1988. Med. Sci. Law., 31 (1991) 167-74. C.S. Hirsch, N.B. Rushforth, A.B. Ford and L. Achelson, Homicide and suicide in a metropolitan country. J. Am. Med. Assoc., 223 (1973) 900 - 905. J.W. Eisele, D.T. Reay and A. Cook, Sites of suicidal gunshot wounds. J. Forensic Sci., 26 (1981) 480 - 485. F. Introna and J.E. SmiaIek, Suicide from multiple gunshot wounds. Am. J. Forensic Med. Pathol., 10 (1989) 275 - 284. D. Habbe, G.E. Thomas and J. GouId, Nine gunshot suicide. Am. J. Forensic Med. Pathol., 10 (1989) 335 - 337. D.R. Rogers, Simultaneous temporal and frontal suicidal gunshots. Am. J. Forensic Med. Pathol., 10 (1989) 338 - 339. 1. West, Firearm suicide in a female. Med. Sci. Law., 20 (1980) 192-193. S.Y. Abu Ai Ragheb, Firearm fatalities in Jordan. Med. Sci. Law., 24 (1984) 213-221. T.A. Gonzales, M. Vance, M. HaIpern and C.J. Urnberger, Legal Medieine, 2nd edn., AppletonCentury Crofts Inc., New York, 1954. A.C. Hunt and R.S. Cowling, Murder by stabbing. Forensic Sci. Int., 52 (1991) 107- 112.
