Elsevier

Legal Medicine

Volume 17, Issue 6, November 2015, Pages 576-578
Legal Medicine

Characterization of five cases of suspected bathtub suicide

https://doi.org/10.1016/j.legalmed.2015.07.005Get rights and content

Highlights

  • We investigated five autopsy cases of bathtub suicide.

  • There were several features that are often common to such suicide cases.

  • Wearing clothes might be a significant characteristic pointing to bathtub suicide.

  • Suicide cases should be carefully distinguished from accidental or natural death.

Abstract

We reviewed five autopsy cases of suspected bathtub suicide. 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. We suspected that the manner of death in those cases was suicide based on comprehensive postmortem investigations of statements from witnesses, the presence of a farewell letter, the fact that clothes had been worn, additional means to ensure suicide, and results of drug tests, as well as autopsy findings. Cases of bathtub suicide should be investigated carefully to distinguish them from accidental or natural death.

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.

Section snippets

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.).

References (7)

  • Available at:...
  • F. Satoh et al.

    “Dead in hot bathtub” phenomenon accidental drowning or natural disease?

    Am. J. Forensic Med. Pathol.

    (2013)
  • Available at:...
There are more references available in the full text version of this article.

Cited by (10)

  • Development of 18S rRNA gene arrays for forensic detection of diatoms

    2020, Forensic Science International
    Citation Excerpt :

    Forensic diagnosis of the cause of dead bodies recovered from water has been a challenge [1–3]. The question is to distinguish whether the victim is drowned in water or has been dead before entering the water [4–9]. In the latter case, it could point to a suspected crime.

  • Forensic pathological study of complex and complicated suicides: A twelve-year case series in Genoa (Italy)

    2019, Journal of Forensic and Legal Medicine
    Citation Excerpt :

    Toxicological analyses for possible substance abuse or drugs are also important. Of course, it is crucial to carefully review police reports for any mentions of trespassing or breaking and entering, the identities of those at the scenes as well as the accounts of eyewitnesses and family members.14 The Coroner also has the burden of comprehending the chronology of the lesions by determining if the victim was capable of performing subsequent actions following the first suicide attempt and establishing which wound was ultimately the fatal one.7

  • When bathing leads to drowning in older adults

    2019, Journal of Safety Research
  • Postmortem computed tomography findings in cases of bath-related death: Applicability and limitation in forensic practice

    2018, Forensic Science International
    Citation Excerpt :

    Although cultural practices related to baths vary across countries, baths are overall considered a mode of relaxation worldwide [1]. Unfortunately, many cases of sudden deaths during bathing have been reported thus far [2–14]. In most cases, death occurs in a bathtub, and victims are found unresponsive with their faces immersed or completely submerged under water [1].

  • Planned and unplanned complex suicides: Casuistry of the Institute of Legal Medicine of Parma (Italy)

    2017, Legal Medicine
    Citation Excerpt :

    Complex suicides represent indeed a real challenge for forensic pathologist, who has to document very thoroughly all lesions on the corpse, evaluating after their compatibility of self-inflicted ones. Obviously the Police’s inspection report, the crime scene evaluation, along with the autopsy report and psychiatric history of the victim are all fundamental to understand the cause of death and explain the reason that led the victim to the extreme gesture [2,11,20]. In the cases presented, all the provided elements have been necessary and crucial to count them as suicides and were consistent with literature regarding the connection between the psychiatric pathology and suicidal behaviour (case 1, 3 and 4) [11,13,20].

View all citing articles on Scopus

All procedures of this study were approved by the Ethics Committees at Gunma University Graduate School of Medicine.

View full text