Potential forensic implications of kerokan therapy - a traditional Indonesian therapy associated with neck bruising.

Kerokan is a traditional Indonesian treatment involving abrading the skin over various parts of the body with a blunt object such as a coin or a piece of ginger which may create suspicious injuries. Here, the case of a 30-year-old woman who had undergone kerokan therapy is reported. She was complaining of retro-sternal pain and epigastric discomfort and subsequently became markedly short of breath and died. The observation of injuries predominantly located around the neck initiated a police investigation and forensic autopsy. Scattered abrasions, blisters and bruises were present on the forehead, the bridge of the nose extending to the ala, the upper and anterior aspect of the chin and the sternal notch, with discrete fresh and scabbed abrasions around the neck, over the sternum and on the backs of both hands. There were, however, no facial or conjunctival petechiae and no bruising of the underlying strap muscles, or fractures of the hyoid bone or thyroid cartilage. Histology revealed that myocarditis was the cause of death. Traditional practices may cause unusual bruises, abrasions, blisters and burns that may raise suspicion of inflicted injury from an assault. Knowledge of the manifestations of socio-ethnic practices such as kerokan is important in the evaluation of trauma in specific cultural groups.

Pitfalls in the Interpretation of Traumatic Socioethnic Practices.

The purpose of this case study was to raise awareness among forensic pathologists and medicolegal death investigators regarding two unique socioethnic practices and regional customs that have significant forensic implications. We present two cases involving coining (gua sha) and bloodletting (sapi) that represent two forms of traditional customs that involve the use of blunt force and sharp force trauma, respectively. In coining, the skin lesions are produced as a result of dermabrasion with oils and oval objects such as coin. In sapi, multiple superficial linear scrapes are made in the skin as part of a bloodletting ceremony. The identification of these lesions will prevent the interpretation of them as non-voluntary-inflicted trauma.

Bruising caused by traditional Chinese massage therapy (ba sha) complicating the assessment of a case of fatal child abuse.

Precise evaluation of bruises and patterned skin lesions in infants and children is an essential requirement in cases of potential abuse. Such injuries may be markers of more significant internal injuries and/or may be supportive of an assault rather than an accident. On occasion, however, unusual patterned skin lesions may be identified that have been inflicted as part of traditional therapeutic techniques. A five-year-old boy from a rural Chinese community is reported who died from ligature strangulation. In addition to bruises from abusive trauma he had a series of unusual patterned, often-paired, bruises over the anterior and posterior aspects of both shoulders, unrelated to the ligature mark. Upon further police inquiries it transpired that his grandmother and mother had been using traditional Chinese therapeutic massage or "ba sha" to treat an episode of vomiting. The term means "to pull out fever" and involves firm pinching of the skin between the thumb and index finger, often on the neck, chest or back. An awareness of the potential manifestations of traditional therapies is important in contemporary forensic practice so that injuries caused by these treatments are not confused with non-therapeutic inflicted injury.

Boxing and mixed martial arts: preliminary traumatic neuromechanical injury risk analyses from laboratory impact dosage data.

OBJECT: In spite of ample literature pointing to rotational and combined impact dosage being key contributors to head and neck injury, boxing and mixed martial arts (MMA) padding is still designed to primarily reduce cranium linear acceleration. The objects of this study were to quantify preliminary linear and rotational head impact dosage for selected boxing and MMA padding in response to hook punches; compute theoretical skull, brain, and neck injury risk metrics; and statistically compare the protective effect of various glove and head padding conditions. METHODS: An instrumented Hybrid III 50th percentile anthropomorphic test device (ATD) was struck in 54 pendulum impacts replicating hook punches at low (27-29 J) and high (54-58 J) energy. Five padding combinations were examined: unpadded (control), MMA glove-unpadded head, boxing glove-unpadded head, unpadded pendulum-boxing headgear, and boxing glove-boxing headgear. A total of 17 injury risk parameters were measured or calculated. RESULTS: All padding conditions reduced linear impact dosage. Other parameters significantly decreased, significantly increased, or were unaffected depending on padding condition. Of real-world conditions (MMA glove-bare head, boxing glove-bare head, and boxing glove-headgear), the boxing glove-headgear condition showed the most meaningful reduction in most of the parameters. In equivalent impacts, the MMA glove-bare head condition induced higher rotational dosage than the boxing glove-bare head condition. Finite element analysis indicated a risk of brain strain injury in spite of significant reduction of linear impact dosage. CONCLUSIONS: In the replicated hook punch impacts, all padding conditions reduced linear but not rotational impact dosage. Head and neck dosage theoretically accumulates fastest in MMA and boxing bouts without use of protective headgear. The boxing glove-headgear condition provided the best overall reduction in impact dosage. More work is needed to develop improved protective padding to minimize linear and rotational impact dosage and develop next-generation standards for head and neck injury risk.

Victim's scalp on the killer's head. An unusual case of criminal postmortem mutilation.

A case of unusual postmortem mutilation of a victim's body is presented. After killing his father, the son decapitated his body and dissected the scalp free, forming a mask of the father's head and neck. The young man wore the scalp-mask over his own head to imitate the father. The motive of the murder was revenge, and the postmortem mutilation was the realization of the perpetrator's fantasies, symbolically representing a penalty for the reprehensible past life of his father.

Accidental ligature strangulation due to a roller-type massage device.

A case is reported in which a woman was accidentally strangled when her blouse became entangled in a roller-type electric massage device that she was using to massage the back of her neck. Accidental strangulation in adults, outside of the workplace, is uncommon, and to our knowledge this is the first reported case of a strangulation due to this type of device. The findings of this interesting and unusual case are presented.