Written by Peter Vanezis
AN EXCERPT FROMPathology of Sharp Force Trauma
A SCENE IN WHICH THE DECEASED IS DISCOVERED and has
sustained sharp force wounds is usually associated with significant blood on
and around the body and requires careful assessment of the quantity and the
distribution of the blood together with other scene findings to assist in
attempting to reconstruct the events leading to death. It is therefore vital
that the scene and/or scenes be identified and protected to allow uninterrupted
examination by the investigating team and prevent or minimize contamination by
As part of the multidisciplinary forensic team, the
pathologist will work alongside colleagues to assess the body and its
environment as well as assisting in the collection of evidence. Reconstructing
the circumstances in which a person has died when they are discovered at a
scene requires a number of important initial questions which need to be
addressed. They include, whether or not the deceased died at the location in
which they were found, and how (the manner) the deceased came to their death—in
other words, is it a case of homicide, suicide, or accident?
In a number of instances, although the police are very
anxious for some initial guidance by the pathologist to assist them with their
investigation, it is not always possible to give any clear answers in a
specific way regarding the manner of death or the type of weapon used. I have
experienced cases where, because there had been a large amount of blood and
sometimes clothing and other material covering the wound sites, it had made difficult
any differentiation between different types of wounds such as stab or firearm
injuries, or even masked the wound completely. Since the scene is not the place
for the pathologist to carry out a detailed examination, for obvious reasons of
contamination, the safest approach is to keep one’s own counsel until the
post-mortem examination in the mortuary has been carried out.
Scenes are so varied that one can only categorize them in
very broad terms. The examination of each type of scene frequently requires a
different approach, with the attendance of appropriate forensic expertise. When
assessing a scene, the senior investigator will decide on the approach and the
various types of experts that might be required. This will depend on the
location, type of incident, number of deceased, health and safety aspects,
urgency of examination, and climatic conditions.
Location of a Body
The location may be in a building or enclosed within a
structure, such as a residence or workplace. It is essential to understand the
connection, if any, between the location and the deceased, i.e. if the location
is the deceased’s residence.
Domestic disputes are a common cause of fatal stabbings; and
in some series stabbing occurs, most commonly, in the victim’s own home. Rogde
et al. (2000), from a series of 141 homicides from two Scandinavian capitals—Oslo
and Copenhagen—found that 78% of all females were killed in their own home,
while this was the case for 49% of males. This is hardly surprising as many of
the victims are known to their assailants; and knives in a household,
particularly from the kitchen drawer, are close at hand to be used as weapons.
Among the victims killed in their own home, 51% of the females and 35% of the
males shared this home with the offender (most often their spouse) (Figure 1).
By contrast, 21% of males were killed outdoors compared to only 6% of females.
In a case example, the male victim was found collapsed
outside the entrance to an address which was close to where he lived. There was
a trail of blood from his flat to where he collapsed. Resuscitation attempts
were carried out, including a clamshell thoracotomy, but the deceased died from
a stab wound to the neck and had also suffered a number of other injuries
An outdoor scene may be either an urban or countryside
environment and in a number of situations involves some degree of concealment,
particularly in homicide cases where there has been an attempt to dispose of
the body. Occasionally a body is disposed of by burial and there may well be
the need to locate the deceased.
The author was part of a team which investigated the case of
a fully clothed body of a woman that was discovered in a shallow grave next to
a lime tree (Figure 3). She had been missing for five years. Her identification
was based on medical records including the use of facial superimposition. The
length of internment in the grave was calculated from the lime tree root
lengths and their rings growing through her. It is believed that this was one
of the first cases where this technique was employed. The botanist was accurate
to within one season from the five years from when she had been missing. Since
then, there have been a number of publications in the forensic literature which
have demonstrated the usefulness of examination of tree roots and other
associated plant growth as a means of estimating the length of internment
(Quatrehomme et al., 1997; Margiotta et al., 2015).
The cause of her death was established by close examination
of her clothing and skeletal remains. Examination of her lace blouse,
particularly on the inner aspect, clearly demonstrated two tears, although more
were suspected, that appeared to have been caused by a knife. Examination of
her rib cage confirmed a fracture to the fourth left rib anteriorly, fifth rib
below showing complete severance, and a small cut on the inner aspect of the
sixth rib. All were in line and were typical of a thrust of a sharp implement
such as a knife into the chest (Figures 4 and 5). From the damage seen to the
fourth rib, it was reasonable to assume that the knife used had entered up to
the hilt with the assailant’s hand also making contact against the chest,
delivering the blow as if by a hard punch. The skeletonized chest was devoid of
soft tissues but this did not deter the court from making the correct
assumption that vital organs would have been seriously injured (Vanezis et al.
A further case seen by the author which illustrates the
importance of a thorough scene examination is that involving a missing
14-year-old schoolgirl who had been abducted and murdered by her stepfather
(Vanezis 1996b). He had been sexually abusing her since she was an 8-year-old
child. He was convicted of her murder before her body was found. Whilst in
prison, and from conversations with other prisoners, it emerged that she did
not die in a car crusher, as he had originally asserted, but he had killed her
by other means and had deposited her body in a disused Victorian cemetery in
North London. Most of her remains were eventually found, partially covered by
dense vegetation after they had been scattered by predators to different parts
of the periphery of the cemetery (Figures 6, 7, and 8). Identification was
confirmed by her mother from her clothing found separately but nearby
(cardigan, skirt, and shoe) as well as a ring, watch, and necklace. Assessment
of the remains by an anatomist and dentist found her age to be consistent with
that of the missing girl. In addition, examination of clothing and skeletal
remains by a forensic scientist and myself revealed findings demonstrating that
she had been stabbed, which included a diagonal clean cut on a portion of one
of the left ribs. On her cardigan there were five tears typical of having been
caused by a knife, as well as a number caused by animal teeth. The knife tears
were to the front left part of the cardigan. A further six tears were seen on
the left sleeve, indicating that she had tried to defend herself.
A body found in, or near, water begs the question, in cases
of sharp force and other types of injury, whether or not the individual had
been killed and deposited into a river, sea, or other body of water. The
injuries need to be assessed as to whether they are antemortem or post-mortem.
If they are ante-mortem were they responsible for causing death or did the deceased,
despite suffering injuries before death, die from drowning or some other cause
associated with water. Such cases may well provide serious challenges for the
A number of issues need to be resolved such as where the
deceased entered the water in relation to where they were found. The use of
diatomaceous examination may provide some insight into this aspect of the
investigation, although results should be treated with caution (Coelho et al.
2016). They emphasize the importance of the creation of a diatom database at
different regions and at different seasons to assist the investigator with
identifying potential points of entry into water.
A number of complex suicides have been reported using more
than one method of self-injury including, very rarely, self-stabbing followed
by drowning. The first complex suicide involving multiple stab wounds followed
by drowning was reported by Kaliszan et al. 2013. The victim, a young man, was
seen walking into the sea partially submerged. He had at some stage stabbed
himself in the chest and abdomen a number of times before disappearing under
the water. A post-mortem examination revealed emphysema aquosum which is
typical of drowning. He left some of his personal belongings on the beach.
Suicide was clearly determined on the basis of the circumstantial evidence
prior to death, where he was found, and the distribution of the wounds on his
trunk. Peyron et al. (2018) report a case of a man found in a river with 18
stab wounds, which presented a serious challenge in assessing whether the
deceased had died from his wounds or from drowning and whether or not they were
self-inflicted or homicidal. He had been stabbed in the chest and was found to
have a haemothorax and lung injuries. However, the post-mortem and histological
examination revealed that the death was consistent with a death caused by
drowning. They were not certain of the manner of death, although a police
investigation concluded that the death was a suicide.
In the case of a deceased found by the seashore—or indeed
close to any body of water, such as a riverbank—the question will arise as to
whether the person died at the site of discovery or had been previously in
water. This is not always an easy question to answer and will depend very much
on the investigation of the circumstances and post-mortem findings.
Such a question arose when a 60-year-old man was found
partly covered by seaweed by some rocks close to a harbor wall. Initially it
was not known whether he had entered the water from one of the ships just
outside the confines of the harbor or fallen over from the harbor wall. The
post-mortem examination revealed a stab wound to his left upper arm and an
incised wound to the back of his head and to the palm of his right hand. There
were superficial friction marks, indicative of contact with stones from the
harbor wall near where he had been found. Following local enquiries, it was
established that a man, later identified as the deceased, had been involved in
a knife fight with two men. During the fight, he had lost his balance, fallen
over the harbor wall and drowned.
In addition to some of the locations discussed above, there
are many other types of locations such as the street, commonly seen in cases of
gang violence, or in other public places including bars, night clubs, and
Position of the Body
The position of the body may be of assistance in many cases
to resolve both the manner of death (whether homicide accident or suicide) and
help reconstruct the scenario and ascertain the locus where wounding had
occurred and whether or not the deceased had died in the same area where
injured, or had moved elsewhere, either when still alive by the victim moving
themselves after injury, or being moved after death. It is crucial for the pathologist
to document the position of body and ascertain whether it had been moved prior
to his/her attendance at the scene and reasons for doing so. There are a number
of legitimate reasons why a body may be moved from its initial position:
The handling of the scene, the blood distribution and the
collection of trace evidence are, on the whole, tasks that are addressed by
forensic scientists and police personnel, although with respect to blood
distribution there are some areas of shared expertise between the biologist and
the pathologist. In one case seen by the author, the blood on the blade of the
knife was wiped from the blade onto a shirt which had been covering a radiator,
giving an impression of the width of the blade and sharpness of its tip (Figure
The appearance of blood needs to be assessed in relation to
the position of the body and in particular to any wounds that are found. The
pattern of distribution of such blood stains may indicate whether they were
produced during life or after death. Care must be taken to assess the
distribution and quantity of blood with regard to whether or not movement of
the body has taken place prior to carrying out scene examination, for example
for resuscitation. Such movement may cause large quantities of blood to flow
from major stab wounds. The blood in these cases originates from within the
body cavity and, particularly with chest wounds, large quantities may spill out
on to the floor on turning the body over.
Examination of the bloodstain patterns at the scene gives an
insight into the actions and activities of victim and assailant and may be of
particular value in assessing the direction of travel of blood spots, their
velocity on impact, and distance travelled (Figure 10). Forensic scientists,
experienced in blood distribution patterns, will use their experience, together
with experimental testing and published work, to interpret different patterns
in order to estimate site of attack and number of impacts. The size and
orientation of stains, from spots to splashes, is indicative of the type and
location of the attack. By the very nature of many sharp weapons, most cases of
homicidal sharp force injury require close contact between the perpetrator and
the victim. As such, important trace evidence (hairs, fibers, fluids) that
might potentially link a suspect to the crime might be present on the victim or
at the scene. If the attacker sustains injuries during the attack, the suspect’s
blood and/or hair may also be present at the scene. With certain sharp force
homicides, a sexual assault may have preceded or coincided with the sharp force
attack. An examination of the scene may be helpful in identifying seminal fluid
or other trace evidence.
Tissue damage to a body, which may be of a very extensive
nature, can be produced by pets with no other access to food when acting as
predators and locked in a house with their owner (Rossi et al. 1994). At first
sight, such injuries may resemble incised or puncture wounds.
About the Author
Peter Vanezis OBE is Professor Emeritus of Forensic Medical
Sciences at the William Harvey Research Institute, Queen Mary University of
London. He began his career in forensic medicine at the London Hospital Medical
College in 1974 in the department headed by Professor James Cameron. He became Reader
and Head of the Forensic Department at the Charing Cross and Westminster
Medical School in 1990, following which he was appointed Regius Professor of
Forensic Medicine and Science in 1993 at the University of Glasgow. He was
awarded the OBE in 2000 for leading the British Forensic team in the
investigation of mass graves in Kosovo. After establishing a forensic pathology
unit at the Forensic Science Service in 2003, he was appointed to the new chair
of Forensic Medical Sciences at Queen Mary University of London where he
pursued academic activities until his retirement in 2018. He continues his
interest in forensic medical education and research through his Academy of
Forensic Medical Sciences.
S., P. Ramos, C. Ribeiro, J. Marques, A. Santos. 2016. Contribution to the
determination of the place of death by drowning - A study of diatoms'
biodiversity in Douro River estuary. J Forensic Leg Med. 1(41):58–64.
M., K. Karnecki, E. Tomczak, T. Gos, Z. Jankowski. 2013. Complex suicide by
self-stabbing with subsequent drowning in the sea. J Forensic Sci.
G., G. Bacaro, E. Carnevali, S. Severini, M. Bacci, M. Gabbrielli. 2015.
Forensic botany as a useful tool in the crime scene: Report of a case. J
Forensic Leg Med. 34:24–28.
A., T. Casper, O. Mathieu, Y. Musizzano, E. Baccino. 2018. Complex suicide by
self-stabbing and drowning: a case report and a review of literature. J
Forensic Sci. 63:598–601.
G., A. Lacoste, P. Bailet, G. Gr.vin, A. Ollier. 1997. Contribution of
microscopic plant anatomy to postmortem bone dating. J Forensic Sci.
H. P. Hougen, K. Poulsen. 2000. Homicide by sharp force in two Scandinavian
Capitals. Forensic Sci Int. 109:135–145.
M.L., A. W. Shahrom, R. C. Chapman, P. Vanezis. 1994. Post-mortem injuries by
indoor pets. Am J For Med and Path. 15:105–109.
P. 1996b. Scene location and associated problems, Chapter 5, p. 77, in Suspicious
Death Scene Investigation, Eds. P. Vanezis and A. Busuttil. Arnold: London.
P., B. G. Sims, J. Grant. 1978. Medical and scientific investigations of an
exhumation in unhallowed ground. Med Sci Law. 18:209–221.