Journal of Forensic and Legal Medicine 45 (2017) 17e20

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Journal of Forensic and Legal Medicine

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An unusual case of murderesuicide: The importance of studying knots

Cristian D'Ovidio*, Enrica Rosato, Aldo Carnevale
Section of Legal Medicine, Department of Medicine and Aging Sciences, G. d'Annunzio University of ChietiePescara, Via dei Vestini, 31, 66100 Chieti, Italy

a r t i c l e i n f o a b s t r a c t

Article history: An atypical murder-suicide that involved a married couple over 80 years of age was investigated at the
Received 19 February 2016 Institute of Legal Medicine of the University of Chieti-Pescara and is presented and discussed here. The
Received in revised form whole story allows us to confront the difculties involved in the discovery of a dead body in water when
20 May 2016
the circumstantial evidence does not allow any unique interpretation of the facts. The atypical and
Accepted 7 October 2016
Available online 8 October 2016
misleading element appeared to be how the body of the man was tied, with the interpretation inclined
towards a homicidal manner of death. It was only by combining the contributions of each of the ndings
that emerged during the course of the autopsy with the circumstantial evidence from the site inspection
Keywords:
Drowning
that it was possible to reach resolution of this case, which was then identied as a murder-suicide.
Bondage 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
Murder-suicide
Asphyxia
Forensic investigation

1. Introduction
The moment that a dead body is extracted from water marks the
beginning of the real diagnostic challenge for the forensic pathol-
ogist, where the attention and efforts must be directed towards the
denition of the causes, means, and ways in which the death
occurred. The challenge, therefore, arises from the need to identify,
analyse and interpret correctly all of the aspects and every element
that emerges, to be able to reconstruct the nature of a death that is
certainly suspect.
However, the circumstances that might appear at initial obser-
vation are not always the reality, and this was what happened in
the case that is presented here.
2. Case report
This case concerns an 89-year-old man, whose lifeless body was
found hanging from ropes in the waters of a river, from where it
was recovered. The stretch of river was located near a carpark of a
large shopping centre with access through a gate, and with a nar-
row path that connected this square to the river. The depth of the
river at that point was not known, but the banks of the river were
steep, with a drop of about 1.5 m (Fig. 1). Also, it was a slow owing
* Corresponding author.
E-mail addresses: cridov@yahoo.it (C. D'Ovidio), enrica.rosato85@gmail.com
(E. Rosato), carneval@unich.it (A. Carnevale).
river.
The man was fully dressed in sportswear typical of a cyclist, and
he was immobilised by several cords tied together. The aspect that
posed serious interpretative uncertainties concerning the criminal
nature of the event was represented by the atypical mode in which
the body appeared to be tied: the system of ropes was so intricate
that it was easy to believe that self-ligature was not possible. This
resulted in the feeling that there had been participation of a third
person, and thus the initial hypothesis recognized this as a homi-
cide or incitement to suicide.
3. Forensic investigations
After conducting various and relevant examinations to the place
of discovery, the body was taken for forensic investigations. First,
the body underwent a post-mortem thoraxeabdomen computed
tomography scan, which identied the presence of pulmonary
ground-glass opacities bilaterally, with the distal trachea and main
bronchi lled by watery uid material. Material of the same
density was observed even in the medio-distal oesophagus and
stomach, and in the rst duodenal portion.
3.1. Autopsy and histological ndings
An autopsy was performed 48 h later. The external examination
revealed the presence of cyanosis of the face and lips with reddish-
pink mantle hypostasis, and conjunctival hyperaemia with small
punctiform haemorrhages. There were no obvious signs of

http://dx.doi.org/10.1016/j.jm.2016.10.004
1752-928X/ 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
18 C. D'Ovidio et al. / Journal of Forensic and Legal Medicine 45 (2017) 17e20
Fig. 1. The site where the man was pulled from the water and the system of ropes on
the tree.
putrefaction or of traumatic injury or self-defence.
In the internal examination, the main ndings included venous
stasis with distention of the jugular and subclavian veins, and the
lungs were expanded and oedematous, with evidence of a sub-
pleural bleeding point (bleeding of Paltauf). The laryngotracheal
mucosa appeared congested, with evidence of serum-
haemorrhagic liquid even in the peripheral bronchial ramica-
tions. White opalescent liquid was also present, with a residual of
ora from the river adhering to the mucosal surface of the stomach,
and liquid with the same characteristics even within the loops of
the small intestine, beyond the Ligament of Treitz. On histological
examination, the widespread presence in both lung elds of air-
spaces dilated with aqueous content was assumed to be of partic-
ular relevance, as well as the presence of the drowning liquid in a
large tract of the tenuous intestine.
3.2. Biological ndings
Biological tests were also carried out, with the implementation
of qualitative and quantitative comparative analyses between tis-
sue samples and the drowning uid. Plankton (diatoms) were
discovered in the lung parenchyma and in the organs perfused by
the great circle (i.e., the liver and kidneys), as well as in the bone
marrow.
3.3. Toxicological ndings
The routine toxicological analyses were negative for the pres-
ence of drugs or psychotropic agents.
Thus, according to the autopsy and the results of the histological
examinations and biological tests, the hypothesis of asphyxial
death by drowning in fresh water was conrmed.
3.4. Sites inspection
During the inspection in the house where the man had lived, the
body of a woman was found on a bed, with a long-handled hammer
left on the nightstand. An autopsy of this woman was performed
48 h later. The external examination revealed the presence of
serious head injury involving the left hemisphere, with multiple
lacerations of the scalp, a crushed skull, and brain disintegration.
The body also showed evidence of passive defence injuries to the
hands.
In the internal examination, the main ndings included
subarachnoid haemorrhage spread through the left hemisphere
with contusion injury even to the left cerebellar lobe. The section of
the brain parenchyma showed widespread and multiple intra-
parenchymal haemorrhagic areas, with haemorrhage of the
lateral ventricle.
Thus according to the autopsy and the results of the histological
examinations, the death was caused by cardio-respiratory arrest
due to massive head injury.
Along with the presumed murder weapon (the long-handled
hammer), during the inspection of the house, some lengths of
white rope, a letter, a sum of money (V 1600.00), and the pension
books of the married couple were found on a table.
4. Description of the bondage
The descriptive report of the reconstruction is the result of
scrupulous investigations carried out during the judicial inspection
and autopsy. The entire framework of the ropes was divided into
two inter-related systems, as a component tied to the body of the
victim that kept the upper limbs immobilised, and a second
component that ensured the anchoring of the body to the place of
discovery, to avoid the body being dragged away by the river
current.
The body of the victim appeared to be tied with two different
types of rope. A black and white piece of rope was closely tied
around the waist, the shorter end of which then passed between
the legs along the right inguinal fold, where it appeared to be
strongly tied with another rope of a different manufacture that was
tied to the right wrist. The other end of the rope that was tied at the
waist had a free length of about 2 m (from the abdomen).
Lengths of white rope were tied to each wrist, at about 77 cm
long for the right wrist, and about 54 cm long for the left wrist.
These were arranged so as to create a small loop around each of the
wrists while keeping the rest of the ropes free. The two sections of
free rope were tied together with a tight knot that held the upper
limbs blocked along the sides of the body.
The site inspection showed that the other free end of the rope
tied at the waist was tied to another white rope after about 2 m.
This new rope had a length of about 3 m that went up about 1.5 m
towards the trunk of a tree, where it was wrapped around a sturdy
branch of about 6 cme8 cm in diameter. From here, the next length
of the rope stretched about another 10 m, with its end wrapped
around and tied to a metal pole that was rmly embedded in the
ground.
5. Discussion
Not all bodies recovered from water have drowning recognized
as the cause of death. Similarly, it is not always easy to immediately
trace back to the manner in which a death occurred, as it might
have been an accidental, homicidal or suicidal event.1,2
The nal judgment has to come from interpretation of the au-
topsy, histological and biological ndings, within the circumstantial
context in which individual factors of the victim and the environ-
mental factors are involved in the denition of the true
circumstances.1e5
In the case presented here, while on the one hand the diagnosis
of death by drowning was conrmed, serious doubts emerged
about the way in which this had occurred, with the strong suspicion
of the participation of a third person.
Indeed, the post-mortem diagnosis of drowning was arrived at
in a simple way. The autopsy documented all of the classic forensic
signs of wet drowning, including liquid aspiration, pulmonary
oedema, sub-pleural Paltauf haemorrhage, distension of the
stomach, and the duodenum containing drowning liquid. Also, the
 C. D'Ovidio et al. / Journal of Forensic and Legal Medicine 45 (2017) 17e20
histological examinations of the lung parenchyma with
haematoxylin-eosin showed the classic acute watery emphysema
that was characterised by obvious dilatation of the alveolar spaces
with water content.1,6e8 These were also associated to the classic
radiological ndings that are commonly described in cases of
drowning.9e11 The positivity of the biological tests (for diatoms)
also supported the hypothesis of the death as drowning.1 This test
provided evidence on the effectiveness of the cardiovascular ac-
tivity when the respiratory tract was ooded.12
Although the combination of these factors correctly supported
the strong suspicion of drowning, it was impossible to dene with
the same certainty the circumstances of the death, as a suicide or as
a simulated suicide (i.e., murder) due to the nature and character-
istics of the devices put in place to tie the body.
In typical forms of suicide, it is usual to observe heavy objects
attached to the body to obstruct and prevent any attempt at
instinctive reactions. The same reasoning can be applied to the
immobilisation of the hands and/or feet, and therefore it was
important to analyse the characteristics of the bindings, to deter-
mine whether these could have been prepared by the victim
himself.1
The system of ropes and knots were relatively atypical
compared to a suicidal death by drowning with self-tying. Indeed,
victims can often be particularly resourceful in nding or designing
lethal systems of self-ligation in cases of self-strangulation, where
they also often use rare and unusual methods.13e15 Self-tying is a
practice commonly used also in suicide by hanging,16 and in com-
plex suicides characterised by combinations of different meth-
ods.17e19 Also hanging or self-tying with ropes around the neck and
limbs is a typical mode of autoerotic practices.20
In the present case, the complexity of the entire system of ropes
that was so atypical, although particularly effective, plus the system
of nooses with which the upper limbs were immobilised along the
body, made the idea of self-tying remote.
Cases of murder carried out by drowning are very rare.21 Despite
this, all of the elements in our possession led to the strong suspicion
of atypical homicidal mode, with incaprettamento (binding of the
body), or potentially mediated by participation in the form of
incitement to suicide.
Even if the autopsy was negative for typical signs of active or
passive defence that would have indicated a possible scufe and/or
resistance by the victim, this did not specically exclude the
occurrence of a murder due to the possible physical inferiority of
the victim, as dictated by his age and body type.
With the case directed in this way, the resolution then took on a
decidedly different turn. Once the victim was identied and his
home situation was further investigated, there was an amazing
discovery. Still in a pool of blood in her bed, the corpse of a woman
was discovered. This was the lifeless body of the wife of the elderly
man, who had been his life partner. She was also an octogenarian,
and had been suffering from a severe neurodegenerative disorder,
according to the ndings from further investigations. This discov-
ery opened a new and different chapter in the investigation, in
which the elderly man became the executioner or author of a
murder, with his subsequent suicide.
The term homicideesuicide is generally used to indicate an act
of extreme violence that is committed by an individual who thus
commits murder before committing suicide by acting without the
consent or against the will of the victim.22e28
By the overall assessment of the ndings traced in the double
crime scene, it was possible to classify the event as a murder-
esuicide. Certainly, one of the elements that suggested this hy-
pothesis was the discovery of the lifeless body of the man's wife.
Other ndings that emerged were the presence of some rope
samples that were of the same manufacture as those used at river.
19
Fig. 2. The system of ropes and knots.
Indeed, there were also notes and drawings depicting the scaffold
rope that the elderly man had then reproduced by the river.
Through analysis of the various notes and drawings that appeared
to depict the presumed suicide, and by careful evaluation of the
system of ropes and ligatures, it was possible to deduce how in
reality his self-construction of the whole scaffold of ropes had been
possible.
As shown in outline, the whole procedure was reconstructed
according to the followed main steps:
- The initial process for the construction of the system was to x
the stick that was sunk into the ground for the tying of the rst
rope. This rope then stretched for about 10 m, to reach the steep
bank, with it also passing around a thick branch of a tree.
- Preparation of the loops of rope around each wrist, with
another rope passing round the waist by tying the longer end
(about 2 m) to the previous rope. At rst, a continuum was
created between the ropes tied round the wrists, and then this
was tied to the end of the rope passing round the waist (see
details in Fig. 2).
Finally, this was all conrmed by the nal words that he had
written on a piece of paper left on the table in the house, where he
stated his reasons for the act that he was to carry out, and the
specic instructions to nd his body.
This was thus a typical case of murderesuicide that was moti-
vated by altruistic reasons, a motive recognized with older cou-
ples, especially when one or both are suffering from a terminal
illness.23,29e33
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