Pathological-forensic overview on self-burning at the Bureau of Legal Medicine of Milan: 1993-2014

Self-incineration features one of the most atrocious, dramatic and lethal methods of suicide, rarely reported in Western countries while more frequently seen in developing countries. The reasons for committing this type of suicide are, mainly, three: religious martyrdom, individual mistreatment and public protest against a regime. In Italy, the most striking case concerns the suicide of the writer Alfredo Ormando, who self-sacrificed in 1999 in St. Peter's Square, to protest against the homophobic repression of the Catholic Church.The authors, in this report, illustrate the retrospective analysis of cases of suicides by self-immolation occurred in the area of jurisdiction of the Bureau of Legal Medicine of Milan in over twenty years of activity, focusing on the peculiar aspects of this rare and complicated suicidal manner. The Authors conducted a retrospective study on judicial autopsy records of 22108 cases taken from the database of the Bureau of Legal Medicine of the University of Milan in the period 1993-2014, focusing on the total amount of 3667 cases of suicide and selecting only those that occurred for self-incineration. The parameters of the victims considered were: sex, age, medical history, previous suicide attempts or intentions, temporal analysis of events, place of discovery, circumstantial data of these fatalities and autopsy reports, paying particular attention to the damages produced by heat . A self-incineration was detected in 30 cases (0.8% of all suicides and 0.13% of all autopsies); it was performed in a simple pattern by 28 victims and in a combined complex pattern by 2 victims (together with plastic-bag suffocation, in one case, and with toxicological lesions in another case.) The progressive reduction of self-incineration cases (visible also in this casuistry) certifies the rarity of this typology of suicide. Thermal injuries are important topics in forensic pathology, and the attention on epidemiological data is fundamental for a complete and deepened study of such a typology of medico-legal event.