Characterization of five cases of suspected bathtub suicide☆
Introduction
Cases of sudden death occurring in a bathtub are extremely common in Japan, where bathing generally involves the use of a deep bath filled with very hot water. In 2005, the Tokyo Medical Examiner’s Office reported 1040 cases of sudden bathtub death, with an estimated mortality ratio of 12 deaths per 100,000 persons [1]. The prevalence of such sudden death is an important issue in Japan in view of the increasing proportion of the elderly population, and the fact that bathtub deaths are more frequent among those aged more than 70 years. Satoh et al. retrospectively reviewed 268 victims found unconscious or dead apparently during bathing, and demonstrated drowning due to water inhalation in 193 (72%) of them, the manner of death being judged as natural causes in 191 cases (71%) and accidental drowning in 63 (23%) [2]. However, it remains controversial to conclude whether bathtub deaths occur mainly as a result of natural diseases or accidental drowning, since the etiology often remains unclear. Thus, delivering an accurate verdict of bathtub death continues to be problematic. Recently, in 2014, the Japanese Society of Legal Medicine published a retrospective analysis of bathtub death in which age, sex, season, and diagnosis of death were analyzed based on a review of 1441 autopsy cases that included 24 cases of suicide (1.6%) [3]. However, the details of the individual suicide cases were not reported, and the investigation by Satoh et al. excluded cases of homicide and suicide. Although a few retrospective analyses of bathtub suicide in countries outside of Japan have been reported [4], to our knowledge such cases have not been well characterized in Japan. In the present study, we investigated in detail five cases of bathtub death that were suspected to be suicide, and analyzed the significant features of these cases that helped to judge the manner of death as suicide.
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Materials and methods
From the autopsies performed during the period between April 2006 and March 2015 at our department, we retrospectively reviewed the records of 27 individuals who had been found dead in a bathtub. Four experienced forensic pathologists had determined the cause and manner of death in each case through comprehensive postmortem investigations of autopsy findings and police reports which provided detailed descriptions of each scene, statements from witnesses, and the individual medical histories. In
Case reports
Our review of the autopsy cases revealed five cases in which a verdict of suicide had been reached on the basis of the comprehensive investigations of circumstances and autopsy findings. The immediate cause of death in all cases was determined to be drowning on the basis of macropathological findings such as frothy fluid in the airways or overinflation of the lungs as well as histological findings obtained at autopsy. There were no signs to indicate electrocution or sharp injury, which are
Discussion
In the present study, we investigated five cases of suspected suicide that involved bathtub deaths. These investigations revealed several characteristics that are often common to such suicide cases, and which might be potentially useful when attempting to determine the manner of death. First, the most critical information for judgement of suicide was provided by a witness, as described in Cases 1 and 2. Second, a farewell letter was also informative in this respect, as seen in Cases 1, 3 and 4.
Acknowledgment
This work was supported in part by Grant-in-Aid from the Japan Society for the Promotion of Science (25860486 to Y.T., 25460861 to T.N., 26293161 to Y.K.).
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All procedures of this study were approved by the Ethics Committees at Gunma University Graduate School of Medicine.