Abstract
Traumatic lethal injuries caused by crossbows are a rarity in forensic pathology. They occur as accidents, suicide and, more rarely, as murders. We report a case of murder received at the Institute of Legal Medicine in Milan carried out by two weapons – a crossbow and a hunting knife – that resulted in multiple thoraco-abdominal wounds. The case is also rare because of the unique circumstances involving the victim – a local service psychiatrist – and the perpetrator – a former medical specialist in psychiatry, suffering from a delusional psychotic disorder. The crossbow was the decisive instrument in the realization of the murder; it was chosen with premeditation for its high destructive capacity and the fact that it was easily obtainable, and it was used with darts that were specially modified to increase its harmful capacity. The presented case, as well as providing an opportunity to highlight the damaging effects of a rarely used weapon, stresses the problems inherent with access to tools such as the crossbow that are used in sport, and which are potentially dangerous but easily accessible, even to those with serious mental disorders, rendering them legally unfit for using firearms.
Introduction
In Italy, and in all countries where firearms are legally regulated and subject to the necessary mental suitability by the authority, the crossbow (a throw weapon) is easy to obtain because it is a sports item, freely for sale and not subject to authorization for ownership or to obligation of notifying the public security authorities. However, it is an extremely dangerous object because of its characteristics, and it has huge potential to harm, being capable of launching an arrow at a remarkable speed, with a high degree of penetration 1 that is able to pierce even the most resistant bony structures. 2
Traumatic lethal injuries from crossbow darts are very rare events in forensic pathology,3–6 attributable to suicide7–14 accidental events15–18 and, more rarely, to murder.3,19–21 The present case is unusual not only for the link between the two psychiatrists (one – the care provider – was the victim, and the other – the patient – was the murderer), but also for the particular combination of the murder weapons involved: a hunting knife and a crossbow, Hou Shiueh model which has not been previously reported in the literature.
The case
A 42-year-old physician, a specialist in clinical psychology and working as a psychiatrist in Milan in a local service of the Servizio Sanitario Nazionale, the Italian version of National Health System, was hit by a car while riding his bike. The driver got out of the car and assaulted him, trying to stab him with a hunting knife, but he failed. Immediately after, the assailant pointed a charged Hou Shiueh crossbow at the victim (which he held in his other hand) and shot at him with darts at the thorax. The darts, equipped with a multi-blade metallic tip, perforated the victim, and he fell on the ground. Subsequently, the weapon was sequestered by the police who noted how the tip had been modified from an ogival profile (the only one permitted by Italian law) to a three-blade profile by filing the tip.
Despite his injuries, the victim sought to escape, managing to walk a few metres, but his attacker caught up with him and struck him again in the chest with the hunting knife. He fell to the ground, and the assailant walked away. Despite rapid intervention by the emergency services, the victim died on the way to the nearest hospital.
The public prosecutor ordered an autopsy, which was performed at the Institute of Legal Medicine of the University of Milan, four days after death.
Results
The autopsy
The cadaver (length 184 cm, weight 78 kg) was in good condition due to cold storage, and it showed pale hypostasis.
External examination highlighted, at the left parasternal surface (Figure 1) and at the right dorsal surface, two injuries, both extending far into the underlying soft tissue, showing diastatic and blood-infiltrated edges, with a clover-leaf shape and sharp extremities. They were about 4 × 3.5 cm and 1.3 × 2.5 cm in size, caused by the crossbow darts.
At left parasternal region, a cutaneous injury deepening in the underlying soft tissues and on the rib cage, showing diastatic edges with a clover-leaf shape.
Corresponding with the mid-sternal line and at the right lower hemi-thorax, there were two injuries, with sharp extremities and blood-infiltrated margins, extending into the underlying soft tissue with two internal and blood-infiltrated channels, whose end was 1 cm and 14 cm respectively under the skin. These injuries were produced by the hunting knife. Finally, there were also multiple incised wounds, with sharp and blood-infiltrated ends, localized bilaterally at the proximal and distal phalanxes of hands, between 0.4 and 1.5 cm long, related to the victim’s attempts to defend himself from the knife.
Upon dissection, the thoracic cavities contained fluid blood (1500 mL on the right and 100 mL on the left). The lungs were collapsed. The right lung showed two Y-shaped pleuroparenchimal injuries to the lower lobe, reproducing the shape of the dart; each segment of the Y was 2 cm long. The pericardium and the heart (Figure 2) were both characterized by two injuries to the anterior and posterior surfaces, showing irregular and blood-infiltrated edges, with a clover-leaf shape produced by the dart. The aortic valve, the posterior wall of the ascending aorta and the superior vena cava were completely destroyed, probably due to the high kinetic energy of the dart that had exerted traction on the heart.
At the heart, an injury deepening in myocardium, showing diastatic and blood-infiltrated edges with a clover-leaf shape.
A laceration of the right hemi-diaphragm was caused by the hunting knife, a continuation of the two injuries to the liver, localized at the right lobe and characterized by sharp and blood-infiltrated edges. They were 3.5 cm and 2 cm long respectively, and they were linked by an intraparenchymal channel.
Considering the wounds and the pale hypostasis, the cause of death was determined as acute bleeding from the thoraco-abdominal injuries caused by stabbing and sharp-edged tools.
The perpetrator
The police identified the killer as a person known by the victim. He was a 47-year-old former psychiatrist, disbarred for health reasons. He confessed that the act was premeditated. He had modified the dart personally in order to increase its harmful potential, justifying the murder because of his forced hospitalization, which had been ordered by the victim, for the mental illness that he had suffered. The killer considered that this had not justified hospitalization.
About 10 years earlier, the perpetrator had suffered a severe psychological trauma. Threatened with a knife, he had been held prisoner for more than an hour in a key-locked office by one of his patients who was suffering from chronic paranoid schizophrenia. He was released only with the intervention of the police. Five years later, the murderer was assaulted again by another patient.
Afterwards, he began to show signs of mental disorder with severe psychological prostration, adjustment disorder, avoidance symptoms and hallucinatory episodes that made him unfit for work. He was subsequently discharged, suspended from professional practice and twice subjected to forced hospitalization. The second hospitalization was ordered by the victim, who in the meantime had become the psychiatrist to whom the killer was entrusted.
During the period that he was working, the perpetrator psychiatrist had reported to his superiors serious lapses in security that were detrimental to the nursing staff. Legal action was taken, claiming that his mental disorder was a result of his work. He put in a claim for compensation to the administration of the hospital where he worked, but the link between his work and his mental disorder was not accepted.
In the meantime, his psychopathological manifestations became more serious, and included delusions, persecutory ideation, an unwarranted fear of being attacked, violent reactions, constant resentment towards other people and a complete inability to relate to others. He also exhibited these symptoms towards his mother, some of his neighbours and finally his psychiatrist (the victim) who he deemed responsible for the lack of recognition of his rights.
The perpetrator always carried with him a list of other individuals he deemed as guilty of his demise, including doctors, judges and two members of law enforcement. In his car, he kept a variety of weapons: a wooden truncheon, an iron bar, a jackknife, two knives, a dagger, a hunting knife, a crossbow, two arrows with three-blade tips, a brass knuckles and a speargun.
He also denounced the hospital where he worked (for non-compliance with respect to the safety of employees at work); the public insurance that did not recognize his illness as being caused by an incident at work; and the judges who had not given reason to him and dismissed his constant complaints. He had also filed a lawsuit to the Italian Superior Council of the Magistrature and to the Senate of the Italian Republic.
After his arrest, by order of the court, he was subject to a psychiatric examination that revealed a ‘delusional disorder with a persecutory theme’ that had caused a defect of reason (‘an inability to understand or to determine’, according to the Italian Penal Code) at the time of committing the act. For this reason, he was declared not liable to imputation. A security measure was applied, consisting of his hospitalization in a judicial psychiatric hospital with mandatory re-evaluation after five years to verify the persistence of his clinical status and the degree of public danger that he posed.
Discussion
A particular murder case has been exposed here. The victim was a psychiatrist killed by a former psychiatrist who had become his patient. Injuries were caused to the chest and to the abdomen. The murder weapons comprised a small Hou Shiueh crossbow (80 lbs power), with an alloy frame and a fibreglass bow, equipped with a gun grip; and a hunting knife with a fixed blade, 16.5 cm long, with a maximum width of 1.5 cm and a thickness of 0.3 cm.
The peculiarity of the case lies in the rarity of one of the means used – the crossbow (a Hou Shiueh crossbow, never before cited in the literature, which reports cases of homicide only by a Barnett crossbow4,6,22 and by a Horton crossbow 22 ) – and in the contemporaneous use of a hunting knife. In the poor available literature, the area hit by the dart – the chest – is the preferred region in suicides,7,13 together with the head. 7 The lesions induced by a crossbow dart, whose cutting edge is extremely sharp and facilitates its penetration into bone and underlying structures, present with a characteristic clover-leaf shape due to the indentations of the three fins of the arrow. The dart caused a high-energy trauma due to its high penetration capacity and the combined action of cutting. It therefore resulted (in combination with the knife injuries) in complex and destructive thoraco-abdominal injuries that led to the victim’s rapid death.
The crossbow, which surprises its victim due to its ability to strike silently and very effectively, 22 is sold in Italy to adults without any restrictions, and its use does not require any formal training. From a regulatory perspective, the crossbow is not classified as a proper weapon, because it is an instrument used principally for sport, thus resulting in it being sold freely not only in armouries but also in sports shops and online shops. In Italy, it is forbidden to use a crossbow for hunting, unlike in other European Countries.
In the literature, there are proposals for revisions which would introduce legal restrictions on the sale of crossbows and enforce special training for users.15,22 In Italy, in the past, restrictions to the possibility of purchase and ownership were proposed by classifying the crossbow as a proper weapon. Regarding this issue, there is a judgment by the Italian Supreme Court, penal section, no. 11227 of 9 November 1994. However, in 1995, the Italian Government, in a special circular letter from the Ministry of the Interior, 23 stated that ‘modern crossbows of any size and the relative darts must be considered in the group of improper weapons’ and so they are subject to control by the police. Furthermore, darts must be exclusively shaped with an ‘ordinary ogival profile’ for the sport of shooting, with the characteristics officially provided by the sports federation, prohibiting ‘fixed, retractable, harpoon blades and any other type of blade’.
Despite effective control regulations, the presented case raises the problem of the availability of dangerous weapons (freely sold for sporting purposes) to psychiatric patients. It is a known risk factor in the presence of suicidal ideation or aggressive behaviour. Violent acts can be performed with improper instruments or weapons easily available at home. Their possession is never subject to restrictions under the law. 24
This case also offers insights about the management of severe mental disorders which can find satisfactory therapeutic response only in a coordinated set of psychopharmacological interventions in the acute phase, and in a network of psychosocial support that is appropriate to the needs of the patient in the long term. The risk of being a victim of aggression and serious injury or death in certain medical professions is a reality worthy of study and prevention.
This particular case demonstrates that the crossbow is a weapon that can be used from a distance, and is silent and very accurate. It is both easy to find and to use. It is capable of deep penetration into tissue and a harmful power. These characteristics make it an ideal weapon for murder.
Footnotes
Funding
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.