Left Thumb to Left Big Toe: An Uncommon Case of Electrocution Suicide

INTRODUCTION

These days, the number of suicides has virtually epidemic proportions, making it a serious public health concern. Suicides by electric current are very uncommon and inadequately researched (1). Numerous studies have described the cause of death and the pathological characteristics of electrical deaths; however, no studies have described the importance of investigating the death scene in electrical suicides. It could be possible to determine the cause and manner of death by an examination of the death scene and a technical examination of the electrical equipment (2,3). Cutaneous current markings could be the only indication of mortality linked to low voltage (4). The year-wise distribution of deaths due to suicidal electrocution in India, according to data from the National Crime Records Bureau. In 2020, there were 629 deaths (0.4%), while 2019 saw a higher number with 752 deaths (0.5%). In 2018, the number of deaths was 565 (0.4%), and in 2017, it was slightly lower at 560 (0.4%). The year 2016 recorded 647 deaths (0.5%) (5). We describe an uncommon incident of a planned electrocuted suicide and emphasize the necessity for investigators and emergency personnel to exercise caution when electrical suicides are found.

CASE PRESENTATION

Death scene: A young man electrical technician in his 30s was brought dead to the hospital emergency with an alleged history of electrocution. As per the police investigation report, the subject was found in a prone position dressed in jeans and a T-shirt at their home with doors and windows closed from the inside. The electric cables were fixed to the left thumb and left toe and cables were connected to the electric plug (220 V) with a switch on. In the room was found a written signed suicide note from which assumptions regarding the suicide's planning could be established and concluded that an electric current passed through the body.

Autopsy finding: Around the left thumb and left toe are electrothermal injuries with charring and/or blackening of the surrounding skin; electrical wire pattern marks; blister formation; skin slippage; loosening of the adjacent epidermis as shown in Figures 1 and 2 . Multiple parallel self-inflicting superficial incised wounds are present over the front of the lower one-third of the left forearm as shown in Figure 3 .

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Figure 1.

Blackish deep circumferential electric burn around left thumb.

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Figure 2.

Blackish deep circumferential electric burn around left toe.

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Figure 3.

Multiple parallel self-inflicting superficial incised wounds.

Internal examination: A thorough examination indicated edema in the lungs and no abnormality was detected in the brain, heart, or spleen. As there were no conjunctival petechiae, it was improbable that the intercostal muscles would contract technically as a result of exposure to electricity.

Toxicology examination: Alcohol and any drug traces were not detected by toxicologic screening in the blood or urine.

Cause of death: The cause of death was determined to be low-voltage electrocution, in accordance with the results of the death scene investigation and autopsy.

DISCUSSION

From an epidemiologic perspective of suicide, the victims are often individuals in their 20s or 30s, with a clear male predominance (1,2). In essence, bipolar illnesses, or depressive syndromes, frequently have a history of psychiatric illness. There is surprisingly little mortality despite the fact that electricity is widely used in households as well as manufacturing units and that countless people have access to this essential source of light and power. Due to current passing through the heart during suicidal electrocution, ventricular fibrillation is most likely the cause of death (3,6). Additionally, the literature has noted that ventricular fibrillation may only be brought on by currents >100 milli-Amperes (mA). At a voltage of 220 V, the body has a resistance of around 1000 to 2125 ohms, resulting in a current of between 100 to 220 mA (3,7,8). The macro morphologic manifestation of electrical current-related dermal modifications reveals a wide variety, including extensive burns involving the skin and tissues underneath or superficially crater-like lesions that are characteristic but nonspecific and can serve as a “negative” of the electrodes utilized (9,10).

We described the case of a young electrical technician in his 30s who had a history of electrocution and was taken dead to the emergency room of a hospital. A thorough inspection revealed that the electric lines were connected to the plug switch (220 V) and attached to the left thumb and left toe. In the room, a written, signed suicide note was discovered. From it, it was possible to learn more about how the suicide was planned and determine that an electric charge also passed through the body. A multidisciplinary approach combining forensic experts, emergency specialists, death scene investigations, and police investigations is required in this case because of the unusual tactics deployed.

CONCLUSION

When an electric current travels through the body, particularly across the heart or through the chest and abdomen, it can cause fatal disruptions to both cardiac and respiratory functions. The pathway from the left thumb to the left big toe is especially dangerous as it often passes directly through the heart, increasing the risk of fatal arrhythmias. A thorough forensic investigation, including on-site examination, is crucial to understanding the motivations and circumstances of these tragic events, potentially leading to improved prevention and support measures.