Maiese, Aniello MD; Gitto, Lorenzo MD; dell’Aquila, Massimiliano MD; Bolino, Giorgio MD
From the Department of Anatomy, Histology, Forensic Medicine and Orthopedics, “Sapienza” University of Rome, Rome, Italy.
Manuscript received December 5, 2012; accepted March 28, 2013.
The authors report no conflicts of interest.
Reprints: Aniello Maiese, MD, Department of Anatomy, Histology, Forensic Medicine and Orthopedics, “Sapienza” University of Rome, Viale Regina Elena, 336-00161 Rome, Italy. E-mail: firstname.lastname@example.org.
In 2008, there were 782,000 suicides worldwide, representing 1.4% of total mortality and 15% of mortality due to injuries, with an estimate rate of 11.6 per 100,000 people.1,2 The incidence and pattern of suicide vary from country to country where cultural, religious, and social values play some role in this regard.3 Familial troubles, psychiatric illness, psychological stress, and poverty are the triggering factors in suicidal attempt.4
A geographic and genre breakdown assembled by the World Health Organization has revealed the incidence of suicide among men has risen in Lithuania, Russia, and Belarus. Among women, on the other hand, the incidence of suicide is highest in South Korea, China, and Japan. The highest male-female ratio is in Europe (4:0), whereas it is lower in the east Mediterranean area (1:1).2
In the past, self-infliction of sharp force was a classic form of suicide, whereas in modern times it is quite rare, constituting only 2% to 3% of all self-inflicted deaths.5–8 Among suicides committed using sharp weapons, those carried out according to rituals are a very small percentage, and the literature contains very few descriptions of “ritual acts” characterized by a clear and deep cut to the neck. One example of such a ritual act is the jigai, a traditional suicide method for Japanese women, in which the jugular vein is cut using a tantō knife (15- to 30-cm blade) or kaiken (15-cm blade).
The jigai ritual is the feminine counterpart of seppuku (well-known as harakiri), the ritual suicide of samurai warriors, which was carried out by a deep slash into the abdomen. In contrast to seppuku, jigai can be performed without assistance, which was fundamental for seppuku. Before proceeding with the jigai ritual, women often tied together their knees so that their bodies would be found in a decorous position, and their honor would be preserved.
In the following, we describe a peculiar and rare case of suicide, in which the victim was a male devotee of Japanese culture and weapons. He was found dead in his bathtub with a deep slash in the right lateral-cervical area, having cut only the internal jugular vein with a tantō knife, exactly as specified by the jigai ritual.
A 58-year-old man was found dead in his bathtub, with a clearly visible slash in the right lateral-cervical area. On the bathtub rim, there was a steel weapon, a knife of the tantō variety (Fig. 1), whose blade was 30 cm in length. Further inspection of the house discovered 2 katana swords and some kaiken knives placed on a rail, in addition to several books describing Japanese culture and traditions.
The external examination of the body revealed on the right lateral-cervical region a deep slash (4 cm), with no interruption, which affected the skin and soft tissue below (Fig. 2).
The autopsy of the neck revealed that the aforementioned uninterrupted slash became even deeper, ultimately causing a partial severing of the internal jugular vein, although the arterial vascular structures remained intact (Fig. 3).
Inspection of the heart revealed a vast whitish pale area, affecting the posterolateral wall of the left ventricle at the level of the third lower average. The appearance of this area was consistent with previous infarct episodes (Fig. 4). The coronary arteries showed significant luminal narrowing of two thirds at the level of the anterior descending and circumflex, whereas the posterior coronary artery was completely occluded.
The examination of the remaining organs appeared devoid of elements worthy of note with the exception of a visceral diffuse pallor, compatible with a framework of hemorrhagic shock as well as the rest of the scarcity of phenomenology hypostatic. The toxicological examination was completely negative.
Considering all the data revealed by the postmortem examination, it was possible to attest that death was caused by critical hemorrhagic shock in a subject with reduced coronary reserve.
In modern society, hanging, poisoning, and drowning are the most common methods of suicide.9 As noted above, suicides carried out with steel weapons are unusual; consequently, in some cases, the main problem for investigators is the differential diagnosis between suicide and homicide,5,10–12 which relies on the direction, deepness, location, and number of the wounds as well as the presence of testing cuts,13 as well as anamnestic/circumstantial elements and chemical/toxicological confirmation. In Western cultures, there is a strong and extremely negative conception of suicide, and it is considered a crime and/or a sin in many communities and religions (including Judaism, Islam, and Christianity). By contrast, in Eastern cultures, especially in Japan, suicide is still considered an honorable method for removing oneself from a disgraceful or hopeless situation.14 Therefore, it is not surprising that members or devotees of these cultures have resorted to suicide to “free their souls,” enacting their suicides through secular rituals.
In fact, there is an existing literature about ritual suicides in Japan, dating from 988 bc.15 It is worth clarifying, however, that in modern times such suicides are rare, even in Japan, where just 0.2% of suicides are carried out in this way.16 Furthermore, whereas the literature contains several descriptions of cases of seppuku (or harakiri), there are no references to specific cases of jigai (the female equivalent).
The 2 procedures differ in how they are performed: seppuku or harakiri is carried out using a katana sword (30- to 60-cm blade), which cuts the abdominal wall without damaging the internal organs. By contrast, in the jigai ritual, a tantō knife is used (15- to 30-cm blade) to cut the jugular vein, without severing the carotid and other neck structures.
Another main difference is that in jigai, in contrast to seppuku, no assistance is provided by any other person. Indeed, seppuku is very painful and usually entails a slow agony before death occurs. This is why the presence of another person (the kaishakunin) is necessary: before the ritual, these people promise to intervene and shorten agony by damaging vital structures with a single-bladed weapon stroke (often severing the arteries of the neck).
The case we examine here concerns a man who was a devotee of Japanese culture and weapons, as revealed by the discovery in his house of several books about Japanese culture, in addition to Japanese swords and a knife.
This person, probably because of long-term depression, decided to take his own life by a ritual act. The investigative inspection deduced that the subject, sitting in the bathtub in his apartment, self-inflicted a deep slash in the right lateral-cervical region using a tantō knife, 30 cm in length; the weapon was found on the rim of the bath tub. The cut, deepening into the soft tissue, almost completely severed the right jugular vein, not including the carotid or the other structures of the neck, exactly as the ritual procedure specifies.
The element that makes this case unusual is the use of the jigai ritual by a man: in Japanese culture, this ritual is traditionally the exclusive prerogative of women.
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