Gun shot wounds in the cases of suicide are usually inflicted by using
of a single fire arm, most often by sole bullet. In the cases of suicide
head, chest, and abdominal wall are among the dominant localisation of
entrance wound. Research conducted in the Institute of Forensic Medicine
in Belgrade (Savic, 1992) failed to determine using of multiple fire arms
in the cases of suicide where the full post-mortem were performed. On the
other hand, analyse perform by Hadson P. (1981), based on 3,522 suicide
cases revealed multiple gEn shot wound in 1.6%. Multiple self-inflicted
gunshot wounds of the head are uncommon. In the case of multiple self-inflicted
gunshot wounds involved head and brain the question of physical activity
capables may arise. In such case determination of the manner of death must
be based on detailed history, scene investigation, autopsy findings and
consideration of ballistics.
We report the case of atypical self-inflicted bullet wounds of
the head of a 71-year-old male. On the scene, in the bathroom of the deceased
apartment, two hand guns ("Zastava", cal. 9 mm and AKTGES, cal. 6.35 mm)
where found. There was no eyewitness, but the deceased’s spouse, who was
in the kitchen at that moment, reported as a earwithness a single discharge
of a firearm. The suicide victim wrote on the day before a letter to his
family explaining in details how they should live after his death, giving
them instructions for his funeral, etc.The victim was admitted to the Neurosurgery
department in deep coma. The CT scan of head and brain was performed and
the patient was transferred to the intensive care unite where he died a
few hours later. No surgery was performed, except wound toilette and suture.
On the autopsy, the two near contact entrance wounds were found. One
was located in the right temple region, and it’s trajectory extends through
right frontal lobe, falx, and left frontal lobe to the exit wound in the
left frontotemple region. Slightly below the exit wound, mentioned above,
there was another entrance wound. In the subcutaneous tissue of the left
temple region, and in the left temple muscle heavily distorted bullet was
found. At that point cranial vault was fractured and slightly impressed,
dura lacerated, and some bone fragments were found impressed in the lacerated
brain tissue.
Reconstruction of the case disclosed that both shut were fired almost
simultaneously. This was supported by the findings of the powder residue
on the skin of both victims hands, trace evidence et the scene, and at
last regard by the earwithness statement. Reported case may be important
in different ways. First of all, in the cases of multiple gunshot wounds,
especially when there are proofs for using of more than one fire arms,
the question of the manner of death may arise. Those cases are always suspected
to be of homicidal origin. Such dilemma may be resolved only by thorough
investigation starting on the scene, and in the cases of fatalities, ending
with full post-mortem examination. Puzzling manner of death is usually
explained by putting together all medical, as well as non-medical facts
in a reasonable story. Also, in the cases of the multiple gun shot wound
to the head the crucial question is how does a bullet stop the physical
activity of the person it strikes? Reliable incapacitation may be due to
direct disruption and/or indirect elimination of the CNS activity by cerebral
hypoxemia from bleeding. Albeit "nerve shock" may be considered as a possible
mechanism of incapacitation, experimental studies failed to proof it.
Key terms: Gunshot Wounds, Multiple Gunshot Suicides, Head, Case Report