MASS MURDER FROM ANCIENT TIMES TO THE PRESENT "…And Pharaoh charged all his people, saying, Every son that is born ye shall cast into the river, and every daughter ye shall save alive" (Exodus 1:22).
Pharaoh decrees the drowning of every new male Offspring among the Israelites. Michiel van der.
Medical Research in Biblical Times Examination of Passages from the Bible, Exactly as Written
Liubov Ben-Nun
NOT FOR SALE
Murder of individuals is already well documented in Biblical times. Are any mass murders described in the Bible? Who were the victims? What were the motives for these killings? What weapons were used? Is the mass killing continuing? The Biblical texts were examined and verses dealing with mass killing were studied closely from a contemporary viewpoint.
Author: Liubov Ben-Nun, Professor Emeritus Ben Gurion University of the Negev Faculty of Health Sciences, Dept. of Family Medicine Beer-Sheva, Israel. B. N. Publication House. Israel. 2018. E-Mail:
[email protected] The Author gains no financial or other benefits. Technical Assistance: ILana Siskal
NOT FOR SALE
CONTENTS MY VIEW
4
FOREWORD
5
INTRODUCTION
6
BIBLICAL STORIES
9
DESCRIPTIONS OF MASS MURDER
13
ANCIENT WEAPONS
21
TYPES OF WEAPONS
24
SUICIDAL BEHAVIOR
34
FIREARMS
49
CHEMICAL, BIOLOGICAL, RADIOLOGICAL, NUCLEAR, AND EXPLOSIVE WEAPONS
61
CHEMICAL WEAPONS BIOLOGICAL WEAPONS EXPLOSIVES RADIOLOGICAL WEAPONS NUCLEAR WEAPONS
SUMMARY
64 78 88 95 100
105
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MY VIEW MEDICINE IN THE BIBLE AS A RESEARCH CHALLENGE This is a voyage along the well-trodden routes of contemporary medicine to the paths of the Bible. It covers the connection between body and soul, and the unbroken link between our earliest ancestors, accompanied by spiritual yearning and ourselves. Through the verses of the Bible flows a powerful stream of ideas for Medical Research combined with study of our roots and the Ancient texts. The Bible exists as evidence in the Book of Books, open to all humankind, the text that has been translated into hundreds of languages and dialects, and remains our eternal taboo. Many people ask me about the connection between the Bible and medical science. My reply is simple: the roots of science are buried deep in the biblical period and I am just the archeologist and medical researcher. This scientific medical journey to the earliest roots of the nation in the Bible has been and remains moving, exciting and enjoyable. It has created a kind of meeting in my mind between the present and those Ancient times, through examining events frozen in times. Sometimes it is important to stop, to look back a little. In real time, it is hard to study every detail, because time is passing as they appear. However, when we look back we can freeze the picture and examine every detail, see many events that we missed during that fraction of a second when they occurred. The Book of Books, the Bible, is an essential source for the whole world.
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FOREWORD Multicide and other mass killings are sufficiently dramatic to excite great interest from clinicians, criminologists and behavioral scientists. This paper revisits the history of the mass murderer, an entity that has progressively distinguished itself from the serial killer. The functional difference between mass and serial homicide is quite obvious, particularly in setting, time, victim status and modus operandi. Classification of these acts requires a number of parameters. The causes of mass murders are multiple and complex: although they rarely seem to be related to psychotic mental pathologies, they are always an expression of suffering that manifests itself in a psychological crisis that is both homicidal and suicidal. Several research teams have studied the sociodemographic and etiopathogenic characteristics of mass murderers and, in particular, the perpetrators of school killings. In addition to prevalent personality traits, these actions often jointly include suicides and homicides, which are brought together in the same psychic crisis. In keeping with the theory of little identity support, previous crimes influenced some mass murderers. Suicides and mass-murders are likely to be imitated. The media appears to play a crucial role in preventing the occurrence of imitation or copycat tragedies. The WHO recommendation regarding how to transcribe suicide and by extension, homicide, in the media is necessary (1). Mass killings, such as those in Newtown, Connecticut, and Aurora, Colorado, have brought new attention to mass killings in the U.S. This article examines 323 mass killings taking place between January 1, 2006, and October 4, 2016, to assess how they are distributed over time. In particular, they appear to be uniformly distributed over time, which suggests that their rate has remained stable over the past decade. Analysis of subsets of these mass killings sharing a common trait (e.g., family killings, public killings) suggests that they exhibit a memory less property, suggesting that mass killing events within each category are random in the sense that the occurrence of a mass killing event does not signal whether another mass killing event is imminent. However, the same memory less property is not found when combining all mass killings into a single analysis, consistent with earlier research that found evidence of a contagion
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effect among mass killing events. Because of the temporal randomness of public mass killings and the wide geographic area over which they can occur, these results imply that these events may be best addressed by systemic infrastructure-based interventions that deter such events, incorporate resiliency into the response system, or impede such events until law enforcement can respond when they do occur (2). References 1. Auxemery Y. The mass murderer history: modern classifications, sociodemographic and psychopathological characteristics, suicidal dimensions, and media contagion of mass murders. Compr Psychiatry. 2015;56:149-54. 2. King DM, Jacobson SH. Random acts of violence? Examining probabilistic independence of the temporal distribution of mass killing events in the United States. Violence Vict. 2017;32(6):1014-23.
INTRODUCTION Violent death represents a significant problem for people. All biblical texts were examined and verses relating to aspects of medico- social, domestic and interpersonal violent deaths were studied closely. The Bible provides numerous instances of violent death involving different people, as well as different causes and different patterns of deaths. The violent deaths in the Bible include Abel, Adonijah, Jael, Goliath, Eglon, Asahel, an Egyptian man, Athaliah, Jezebel, King Jehoam, Amnon, Absalom, and Zimri and Cosbi (1). The Bible tells us that Cain murdered his brother Abel. Here domestic violence led to homicide. This murder can be defined as a case of juvenile violence that led to homicide. We learn that domestic violence has accompanied humans since the dawn of history. In Cain, there are insufficient criteria to define some mental disorder relating to this assassination (2). Even today, the prevalence of physical domestic violence is high. Thus, vicious and brutal human behavior continues through the generations. King Solomon exploited his social position to order the assassination of his half-brother, Adoniah. In this case, the family conflict is identified as a trigger for interpersonal violence (1).
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In Sisera's case, Jael had struck violently his head with a tent nail. This simple weapon, causing skull fracture and intracranial hypertension, was most likely responsible for the Sisera's death.. The use of excessive force culminated in Sisera's death. Sisera died in military circumstances (3). David defeated a battle with a giant from Gath, Goliath. In this case, a simple weapon – a stone penetrated the Philistine's forehead and caused some deadly complication. Following this victory, David cut off his enemy's head and won the battle with Goliath. Since head injury is defined as physical damage to the brain or skull caused by external force, we are dealing with traumatic brain injury (4). In King Eglon case, Ehud attacked him, thrusting his weapon – the sword, into Eglon's abdomen. King Eglon suffered from penetrating abdominal trauma causing sigmoid colon injury. In this case, it is likely that evisceration of the sigmoid bowel and its contents took place. So intractable shock associated with sigmoid injury or severe hemorrhagic shock due to damage of one of the blood vessels are the most likely causes of his sudden death. Later complications, such as fatal peritonitis, abdominal abscess, or sepsis due to the fecal spill, which can develop following this specific abdominal injury, are irrelevant in this case (1). Additional case deals with Asahel. Abner, a captain in Saul's army, attacked his enemy Asahel, and stabbed his chest with the spear. The blow was so powerful that the spear emerged from Asahel's back. In this case, the simple weapon – the spear penetrated his chest and resulted in Asahel's death. Here we are dealing with penetrating chest injury (1). Athalia was a violent woman who killed her relatives, potential candidates to the throne. The behavior of Athalia points to an antisocial personality disorder, with psychopathic features. Eventually, this wicked woman was executed for her dreadful behavior. Athalia's death can be linked to her antisocial personality and criminal behavior (1). Jezebel was a princess, the daughter of Ethbaal, King of Sidon (Lebanon/Phoenicia) and the wife of Ahab. Jezebel refers to a shameless and immoral woman. Wife of a King, known for her wicked conduct, Jezebel was a married woman, whose wicked behavior was associated with persistent lying, and orchestrating various intrigues, which could indicate an undiagnosed mental
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disorder. For these transgressions against the God and people of Israel, Jezebel met a gruesome death - thrown out of a window by members of her own court retinue and the flesh of her corpse was eaten by stray dogs (1). King Jehoram died from the penetrating chest injury. In King Jehoram's case, the penetrating heart injury was caused by an arrow. In this type of injury, emergency surgery is needed in order to save the patients' life. If King Jeroham had undergo immediate surgery he would have had chance to survive (1). Amnon, King David's son, had forced sexual relations with his beautiful half-sister Tamar. Absalom did not forget that Amnon had defiled their sister, and he was eager for revenge. After two years, at the first opportunity, Absalom commanded his men to kill Amnon and the mission was performed. With the aid of external forces, Amnon paid with his life for his disgusting behavior. Amnon, King's David son was assassinated for his disgraceful behavior (2). Absalom prepared to fight with his father, King David's army. Absalom was assassinated for his rebellious and unacceptable behavior. Three sharp spears were thrown at his heart causing his death from penetrating heart injury (5). Religious violence is motivated by or in reaction to religious precepts, texts, or doctrines. This includes violence against religious institutions, people, objects, or by some religious aspect of the target or precept of the attacker. Religious violence is perpetrated for a wide variety of ideological reasons and is generally only one of the contributing social and political factors that lead to unrest. In Zimri and Cosbi cases, they were killed for their religious faith (1). Thus, murder of individuals is already well documented in Biblical times. Are any mass murders described in the Bible? Who were the victims? What were the motives for these killings? What weapons were used? Is mass killing continuing? The Biblical texts were examined and verses dealing with mass killing were studied closely from a contemporary viewpoint.
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References 1. Ben-Nun L. Aspects of violent death. B.N. Publication House. Israel. 2015. Available Liubov Ben-Noun (Nun) at Researchgate.net/. 2. Ben-Nun L. The Medical Record of Amnon the King David's Son. B.N. Publication House. Israel. 2014. Available Liubov Ben-Noun (Nun) at Researchgate.net/. 3. Ben-Nun L. Traumatic Brain Injuries in Biblical Times from the Viewpoint of Contemporary Medicine. B.N. Publication House. Israel 2015, pp. 33-36. Available Liubov Ben-Noun (Nun) at Researchgate.net/. 4. Ben-Nun L. The Family and Diseases of King David. B.N. Publication House Israel. 2015. Available Liubov Ben-Noun (Nun) at Researchgate.net/. 5. Ben-Nun L. How did Absalom the son of King David Die? Israel. 2014, pp. 99104. Available Liubov Ben-Noun (Nun) at Researchgate.net/.
BIBLICAL STORIES At the time when Hebrew was slaves in Egypt, they suffered from various cruel decrees of King Pharaoh. One such decree was that every newborn male should be killed by midwives: “..the king of Egypt spake to the Hebrew midwives, the name of the one was Shiphrah, and the name of the other Puah. …If it be a son, then you shall kill him: but if it be a daughter, then she shall live. But the midwives ….saved the men children alive” (Exodus 1:15-17). Midwives opposed Pharaoh's cruel decree with an official explanation of mass extermination "Because the Hebrew women are not as the Egyptian women; for they are lively, and are delivered before the midwives come to them" (1:19). Egypt's leader, after
it became obvious his initial plan failed, ordered all Egyptians to throw into the Nile any newborn child that was male "And Pharaoh charged all his people, saying, Every son that is born ye shall cast into the river, and every daughter ye shall save alive " (1:22). It is unknown how
many lives were lost under this second plan.
Throwing into Nile. Pinterest.
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At the time of King Pharaoh's cruel decree to kill each newborn male, as related in the Bible, two midwives demonstrated great courage by disobeying Pharaoh and saving the lives of new-born male babies. Midwifery is an old, fascinated profession although it has changed considerably over thousands of years. In their confrontation with Pharaoh over his wicked decree, the midwives took a brave decision and continued to deliver and save male newborns. Here is an example of great courage, probably even risking their lives to oppose Pharaoh's inhumane decision (1). Pharaoh's inhumane decree was associated with fear of a growing Hebrew population in Egypt. Simeon and Levi were the second and third oldest sons of the patriarch Jacob. One day Dinah, the daughter of Leah and Jacob, “..went out to see the daughters of the land. ...When Shechem the son of Hamor the Hivite, prince of the country, saw her, he took her, and lay with her, and defiled her” (Genesis 34:1,2). In spite of this act, Shechem fell in
love with Dinah. According to the custom at that time, he asked his father “Get me this damsel to wife” (34:4). So his father Hamor, went to Jacob “...I (the father) pray you give her him to wife” (34:8), proposing coexistence between the two peoples based on marriages and trading. However, Dinah’s brothers set a condition: “..every man of you be circumcised” (34:15). Only “then will we give our daughters to you and we will take your daughters to us, and we will dwell with you, and we will become one people” (34:16). The local people accepted this
proposal, but in spite of this agreement, “...Simeon and Levi, Dinah’s brethren took each man his sword, and came upon the city boldly, and slew all the males. And they slew Hamor and Shehem his son....” (34:25,26).
Jacob accused Simeon and Levi of slaughter that jeopardized his status among the Canaanites and Perizzites (2).
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Simeon and Levi slay the Shechemites. Illustrators of the 1728. Figures de la Bible, Gerard Hoet (1648-1733) and others, published by de Hondt P. The Hague, 1728.
The mass killings carried out by Simeon and Levi were motivated by the desire for is related to vengeance due to the alleged rape of their sister. Abimelech a son of Jerubbaal, went to Ophrah and killed his 70 half-brothers, the sons of Jerubbal from different wives (Judges 9:5). Later, Abimelech was anointed King, and he “…had reigned three years over Israel” (9:22). But, subsequently the men of Shechem betrayed Abimelech so a war developed between the people of Shechem and Abimelech. During this war Abimelech captured the city of Thevez (Judges 9:50,51), and from the tower of this city one woman “cast a piece of a millstone upon Abimelech’s head, and crushed his skull” (9:53).
Seeing approaching death, Abimelech asked his armor-bearer to kill him with a sword: "Draw thy sword, and slay me.." (9:54). Here Abimelech committed assisted suicide, rather than having it said that he died at the hands of a woman (3). In this description, mass killing is related to the desire to obtain a throne.
Abimelech slays his seventy brethren.
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The prophet Elijah proposes a direct test of the powers of Baal. Four hundred and fifty prophets of Baal and 400 prophets of Asherah are summoned to Mount Carmel (1 Kings 18:19).
Russian Icon of the Prophet Elijah. 12th century, Pskov school. Tretyakov Gallery. Moscow.
Two altars are, one for Baal and one for God. Wood is laid on the altars. Two oxen are slaughtered and cut into pieces; the pieces are laid on the wood. Elijah then invites the priests of Baal to pray for fire to light the sacrifice. They pray from morning to noon without success. Elijah ridicules their efforts. They respond by cutting themselves and adding their own blood to the sacrifice. Subsequently, Elijah orders the deaths of the priests of Baal "Take the prophets of Baal; let not one of them escape. And they took them: and brought them down to the brook Kishon, and slew them there" (1 Kings 18:40).
In this case, 450 prophets were assassinated for religious reasons.
The statue of Elijah at the Saint Elias Cathedral.
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References 1. Ben-Nun L. Midwifery in antiquity and modern times. B. N. Publication House. Israel. 2017. Available Liubov Ben-Noun (Nun) at Researchgate.net/. 2. Ben-Nun L. Family System Dynamics of Jacob. B. N. Publication House. Israel. 2011. Available Liubov Ben-Noun (Nun) at Researchgate.net/. 3. Ben-Nun L. Traumatic Brain Injuries. B.N. Publishing House. Israel. 2012. Available Liubov Ben-Noun (Nun) at Researchgate.net/.
DESCRIPTIONS OF MASS MURDER Genocide has been the leading cause of preventable violent death in the 20th-21st century, taking even more lives than war. The term 'ethnic cleansing' is used as a euphemism for genocide despite it having no legal status. Like 'Judenrein' and 'racial hygiene' in Nazi medicine, it expropriates pseudo-medical terminology to justify massacre. Use of the term reifies a dehumanized view of the victims as sources of filth and disease, and propagates the reversed social ethics of the perpetrators. Timelines for recent genocides (Bosnia, 1991-1996, 200,000; Kosovo 1998-2000, 10,000-20,000; Rwanda, 1994, 800,000; Darfur 2002-2006, >400,000) show that its use bears no relationship to death tolls or the scale of atrocity. Bystanders' use of the term 'ethnic cleansing' signals the lack of will to stop genocide, resulting in huge increases in deaths, and undermines international legal obligations to acknowledge genocide. The term 'ethnic cleansing' corrupts observation, interpretation, ethical judgment and decision-making, thereby undermining the aim of public health. Public health should lead the way in expunging the term 'ethnic cleansing' from official use. 'Ethnic cleansing' bleaches the atrocities of genocide, leading to inaction in preventing current and future genocides (1). The bacterial communities were analyzed in four samples of historical materials (plaster, brick, and wood) derived from buildings located in the former Auschwitz II-Birkenau concentration and extermination camp in Brzezinka, Poland. For this purpose a molecular strategy based on the construction of 16S rRNA clone libraries was used. In total, 138 partial 16S rRNA gene sequences
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(∼600bp) were obtained and compared. The clones belonged to phyla Proteobacteria (classes: Alphaproteobacteria, Betaproteobacteria, Gammaproteobacteria), Actinobacteria, Firmicutes, and Bacteroidetes. The plaster samples predominantly contained clones closely related to Actinobacteria and Alphaproteobacteria, brick samples contained Gammaproteobacteria, while wood samples had Actinobacteria clones. The historic plaster and brick samples contained the following bacteria with known and described biodeterioration potential: chemoorganotrophic Streptomyces sp. and Pseudonocardia sp., halotolerant or halophilic Rubrobacter sp., Salinisphaera sp. and Halomonas sp. Principal component analysis showed that amongst the bacterial species detected and identified none occurred on all the tested historical materials. The 16S rRNA clone library construction method was successfully used for the detection and diversity determination of bacterial communities inhabiting brick barracks located in the former Auschwitz II-Birkenau concentration and extermination camp in Brzezinka (2). Time is running out. Major contributors to declines in the health of Brazilian children, particularly street children, are the international debt crisis, the reverse flow of capital from the South to the North, and economic adjustment policies. There are medical consequences and an ecological debt. There is a question about the merits of having the poor pay for the folly of bad, past government decisions. All the major charities campaigned against repayment of debt. Banks are only exposed to 3% of their total assets in Third World debt, and are receiving tax relief for non-repayment. Austerity programs have meant cuts in health and education, and diversion of food, wages, and welfare to producing exports in order to repay the debt. The message is earn more and spend less. The poor are hit the hardest, particularly by rising food prices. Diseases which were thought to be eradicated are coming back. After decades of economic advances, countries are slipping back into mass poverty. Cuts in food subsidies or health care and family planning affect women and overpopulation. Land is being usurped from peasant farmers and tropical forests destroyed; urbanization has led to abandonment of 8 million children on the streets. The 1989 Brady plan suggests trading commercial debt for lower priced bonds which could be purchased by big business or even by the country itself. The deals tend to be complex.
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So far only 6 countries have benefited. Another proposal is English Prime Minister John Major's Trinidad Terms of September 1990, which is directed to low income country debtors. In December 1991, the UK cancelled 50% of the debt to the poorest countries over the next 3 years. The U.S. and Australia have set up rescheduling agreements. World Bank debt is still in question. Commercial banks should also make an offer of relief. It is suggested that doctors unite in an organization called Physicians Against International Debt-PAID to lobby banks, governments, and the international community to make human development a priority and reduce debt (3). A discussion of Nazi anti-Gypsy policy in Estonia needs to center on local interpretation and implementation of Reichssicherheitshauptamt (RSHA) and Reisekostenordnung (RKO) orders. Contradictions between various German instructions, which often discriminated among sedentary and itinerating Gypsies, created a state of confusion that increased chances for survival. Since in Estonia Sonderkommando 1a of the German Security Police exercised oversight rather than itself carrying out atrocities, the destruction of the Gypsy community in Estonia proceeded at a pace slower than elsewhere in Eastern Europe. Interested in exploiting slave labor, the German Security Police in Estonia did not consider liquidation of the Gypsies a priority. Acculturated to traditional antiGypsy prejudices and burdened by their own wartime travails, the majority of Estonians remained indifferent when Estonian police deported Gypsies (4). In Nazi Germany, physicians initiated a program of sterilization and euthanasia directed at the mentally-ill and physically disabled. Relatively little is known regarding the fate of the Jewish (J') mentally-ill. J' mentally-ill were definitely included and targeted and were among the first who fell victim. They were systematically murdered following transfer as a specialized group, as well as killed in the general euthanasia program along with non-J' mentally ill. Their murder constituted an important link between euthanasia and the Final Solution. The targeting of the J' mentally-ill was comprised of four processes including public assistance withdrawal, hospital treatment limitations, sterilization and murder. J' "patients" became indiscriminate victims not only on the basis of psychiatric diagnosis, but also on the basis of race. The killing was efficiently coordinated with assembly in collection centers prior to being transferred to their
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deaths. The process included deceiving J' patients' family members and caregivers in order to extract financial support long after patients had been killed. J' patients were targeted since they were helpless and considered the embodiment of evil. Since nobody stood up for the J', the Nazis could treat the J' patients as they saw fit. Several differences existed between euthanasia of J' and non-J', among which the J' mentally-ill were killed regardless of work ability, hospitalization length or illness severity. There was discrimination in the process leading up to killing (overcrowding, less food). For the Nazis, J' mentally-ill patients were unique among victims in that they embodied both "hazardous genes" and "racial toxins." For many years there has been silence relating to the fate of the J' mentally-ill. This deserves to be corrected (5). Fighting for the "pure" German nation during the World War II Nazis used euthanasia for killing mentally ill and disabled persons the action known under the cryptonym T-4. Throughout Poland under the German occupation during euthanasia action Nazis killed many patients of mental hospitals. The euthanasia in concentration camps - the action of murdering ill inmates - was called 14f13. In the Auschwitz concentration camp, thousands were murdered in gas chambers. The Nazis aimed at getting rid of disabled and mentally diseased people. Euthanasia was to serve the Nazi ideology (6). German army reprisals against the local Serbian population's resistance to the Occupation, between August and December 1941, were used by the army as an excuse to murder the J' men of Serbia. J' women and children (8,000-9,000) were then interned in Sajmiste, a concentration camp established at the site of an abandoned exhibition ground on the outskirts of Belgrade After seeking RSHA aid to deal with these Jews, the local German administration received a gas van with which it murdered the Jews, from March to May 1942. This is the only known instance of on-the-spot gassing outside of Eastern Europe (7). Ukrainian and Russian primary sources enable to integrate the civilian Soviet population into the story of the Wehrmacht's treatment of Soviet POWs during World War II. This article reveals a little-known phenomenon: the myriad attempts of bystanders-usually thwarted to save the lives of the prisoners. Most importantly, it seems likely that in Ukraine prisoners' mass mortality could have been avoided. However, German policy makers and prison guards'
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desire to eliminate most Soviet POWs, based on the view that these were "Russians" and thus irreversibly "Bolshevized" or simply superfluous, resulted in a "genocidal massacre" that lasted until at least the end of 1942 (8). From 1986-9, the Kurdish population of Iraqi Kurdistan was subjected to an intense campaign of military action, and genocide by the central Iraq government. This campaign, referred to as the Anfal, included systematic attacks consisting of aerial bombings, mass deportation, imprisonment, torture, and chemical warfare. It has been estimated that around 200,000 Kurdish people disappeared. Current priority mental health and psychosocial problems were evaluated among Kurdish survivors of the Anfal, and the subsequent design of culturally appropriate and relevant assessment instruments and services addressed these problems. This study (9) examined 1] the nature and cause of current problems of survivors of torture and/or civilian attacks and their families, 2] what survivors did to address these problems, and 3] what they felt should be done. A grounded theory approach was used. Free list interviews with a convenience sample (n=42) explored the current problems of Kurdish persons affected by torture. Subsequent key informant interviews (n=21) gathered more detailed information on the priority mental health problem areas identified in the free list interviews. Major mental health problem areas emerging from the free list interviews (and explored in the key informant interviews) included 1] problems directly related to the torture, 2] problems related to the current situation, and 3] problems related to the perception and treatment by others in the community. Problems were similar, but not identical, to Western concepts of depression, anxiety, PTSD and related trauma, and traumatic grief. In conclusion, Iraqi Kurdish torture survivors in Iraq have many mental health and psychosocial problems found among torture survivors elsewhere. The findings suggest that the problems are a result of the trauma experienced as well as current stressors. Development of mental health assessment tools and interventions should therefore address both previous trauma and current stressors (9). From 1992 to 1995 the Republic of Bosnia-Herzegovina experienced a war of genocidal proportions between the Bosnian Serbs, the Bosnian Croats, and the Bosnian Muslims. The international Criminal Tribunal for the Former Yugoslavia has indicted
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Dr. Radovan Karadzic - former President of the Bosnian Serb Republic, psychiatrist, and poet - as a suspected war criminal for his role in war crimes, crimes against humanity, and genocide. Karadzic remains enigmatic and poorly understood. Psychological profiling highlights in Karadzic's case the complex coalescence of the psychology of a genocide perpetrator with that of a charismatic narcissistic political leader. Such a profile may possess usefulness in forensic psychiatric investigations and legal proceedings (10). The extensive degree of mass murder that occurred throughout the twentieth century saw the rate of non-combatant (civilian) deaths rise by over seventy-five percent in the space of seventy years, amounting to a death toll exceeding 170 million. Where genocides are concerned, the central role of doctors is undeniable. Their participation arose from the preoccupation with eugenics for improving the health of the nation. From here, their belief in nationalism overrode the sacred duty to save lives. These doctors descended into moral anarchy, breaching an ethical code of two millennia. This paper examines the role of doctors in the Armenian genocide and that of psychiatrists (notably Radovan Karadzic), in the Bosnian genocide. That medicine contains the seeds of its own destruction is confirmed by the recurrent involvement of doctors in genocide (11). Qualitative methodology was used to investigate the intergenerational impact of the 1932-1933 Holodomor genocide on three generations in 15 Ukrainian families. Each family, residing in Ukraine, consisted of a first generation survivor, a second generation adult child and a third generation adult grandchild of the same line. The findings show that the Holodomor, a genocide that claimed millions of lives by forced starvation, still exerts substantial effects on generations born decades later. Specifically, thematic analysis of the 45 semi-structured, in-depth interviews, done between July and November 2010, revealed that a constellation of emotions, inner states and trauma-based coping strategies emerged in the survivors during the genocide period and were transmitted into the second and third generations. This constellation, summarized by participants as living in "survival mode," included horror, fear, mistrust, sadness, shame, anger, stress and anxiety, decreased self-worth, stockpiling of food, reverence for food, overemphasis on food and overeating, inability to discard unneeded items, an indifference toward others,
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social hostility and risky health behaviors. Since both the family and community-society were involved in trauma transmission, the findings highlight the importance of multi-framework approaches for studying and healing collective trauma (12). This article (13) analyses selected cases of mass killings and genocide during the civil wars in El Salvador and Guatemala in the 1980s and the way in which the truth commissions in both countries reframed locally grounded narratives to fit the state-centered language of human rights. Redefining wrongdoings as human rights violations produces stories that communicate poorly with local worldviews because the 'truths' that human rights language proposes disregard local realities and transform local conflicts into a type of 'modern', nationwide struggles. Thus, while the concept of genocide might capture well the horrendous nature of a mass killing, it will also ethnify the conflict. Comparisons between local readings and human rights-based reinterpretations reveal a 'modernizing' or 'Westernizing' bias of international law; more awareness is argued about such effects in analysis as well as in policy-making (13). In August 2014, the so-called Islamic State of Iraq and Syria (ISIS) attacked the Yazidi religious minority living in the area of Mount Sinjar in Nineveh governorate, Iraq. A retrospective household survey was conducted to estimate the number and demographic profile of Yazidis killed and kidnapped. The survey covered the displaced Yazidi population from Sinjar residing in camps in the Kurdistan Region of Iraq. Fieldwork took place between 4 November and 25 December, 2015. A systematic random sample of 1,300 incamp households was interviewed about the current household composition and any killings and kidnappings of household members by ISIS. Of the 1,300 interviewed households, 988 were Yazidi from Sinjar. Yazidi households contained 6,572 living residents at the time of the survey; 43 killings and 83 kidnappings of household members were reported. The probability of being killed and kidnapped was calculated by dividing the number of reported killings and kidnappings by the number of sampled Yazidis at risk, adjusting for sampling design. To obtain the overall toll of killings and kidnappings, those probabilities were multiplied by the total Yazidi population living in Sinjar at the time of the ISIS attack, estimated at roughly 400,000 by the United Nations and Kurdish officials. The demographic profile of those killed and kidnapped was examined,
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distinguishing between children and adults and females and males. Of the Yazidi population, 2.5% was either killed or kidnapped over the course of a few days in August 2014, amounting to 9,900 (95% CI 7,000-13,900) people in total. An estimated 3,100 (95% CI 2,1004,400) Yazidis were killed, with nearly half of them executed-either shot, beheaded, or burned alive-while the rest died on Mount Sinjar from starvation, dehydration, or injuries during the ISIS siege. The estimated number kidnapped was 6,800 (95% CI 4,200-10,800). Escapees recounted the abuses they had suffered, including forced religious conversion, torture, and sex slavery. Over one-third of those reported kidnapped were still missing at the time of the survey. All Yazidis were targeted regardless of age and sex, but children were disproportionately affected. They were as likely as adults to be executed but constituted 93.0% (95% CI 71.9-98.6) of those who died on Mount Sinjar. Children accounted for 18.8% (95% CI 8.4-36.9) of those who managed to escape captivity. The actual toll of killings and kidnappings may be underestimated because of survival bias. The uncertainty associated with inference from a small sample of incamp households and the reliance on a rough figure of 400,000 for extrapolation to the total Yazidi population of Sinjar at the time of the ISIS attack are the main limitations of this study. In conclusion, the data provide a clear indication of the severity of the ISIS attack against the Yazidis in terms of both the number and demographic profile of those targeted (14). References 1. Blum R, Stanton GH, Sagi S, Richter ED. 'Ethnic cleansing' bleaches the atrocities of genocide. Eur J Public Health. 2008;18(2):204-9. 2. Otlewska A, Adamiak J, Gutarowska B. Clone-based comparative sequence analysis of 16S rRNA genes retrieved from biodeteriorating brick buildings of the former Auschwitz II-Birkenau concentration and extermination camp. Syst Appl Microbiol. 2015;38(1):48-55. 3. Logie D. The great exterminator of children. BMJ. 1992;304(6839):1423-6. 4. Weiss-Wendt A. Extermination of the Gypsies in Estonia during World War II- popular images and official policies. Holocaust Genocide Stud. 2003;17(1):31-61. 5. Strous R. Extermination of the Jewish mentally - ill during the Nazi era - the "doubly cursed". Isr J Psychiatry Relat Sci. 2008;45(4):247-56. 6. Kucharski J. Euthanasia as a form of extermination applied by Germans in concentration camps during the World War II. Arch Hist Filoz Med. 1998; 61(4):335-44. 7. Shelach M. Sajmiste – an extermination camp in Serbia. Holocaust Genocide Stud. 1987;2(2):243-60.
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8. Berkhoff KC. The "Russian" prisoners of war in Nazi-ruled Ukraine as victims of genocidal massacre. Holocaust Genocide Stud. 2001;15(1):1-32. 9. Bolton P, Michalopoulos L, Ahmed AM, et al. The mental health and psychosocial problems of survivors of torture and genocide in Kurdistan, Northern Iraq: a brief qualitative study. Torture. 2013;23(1):1-14. 10. Dekleva KB, Post JM. Genocide in Bosnia: the case of Dr. Radovan Karadzic. J Am Acad Psychiatry Law. 1997;25(4):485-96. 11. Kaplan RM. Doctors and the Armenian and Bosnian Genocides. Health History. 2016;18(2):40-62. 12. Bezo B, Maggi S . Living in "survival mode:" intergenerational transmission of trauma from the Holodomor genocide of 1932-1933 in Ukraine. Soc Sci Med. 2015;134:87-94. 13. Ekern S. The modernizing bias of human rights: stories of mass killings and genocide in Central America. J Genocide Res. 2010;12(3-4):219-41. 14. Cetorelli V, Sasson I, Shabila N, Burnham G. Mortality and kidnapping estimates for the Yazidi population in the area of Mount Sinjar, Iraq, in August 2014: a retrospective household survey. PLoS Med. 2017;14(5):e1002297.
ASSESSMENT: humans' cruel behavior is associated with violent death, taking more lives than wars. Genocide, extermination, euthanasia, massacre, and killing can be referred as mass murder.
ANCIENT WEAPONS Categories of ancient weapons include: Angon; Bident, Blowgun, Bolas, Bow and arrow, Burning glass; Claw of Archimedes, Clipeus, Club (weapon); Dagger-axe, Dart (missile); Early thermal weapons, Eku, Epsilon axe; Falarica, Falx; Gun (staff); Harpe, Hunting dagger; Illyrian weaponry, Inuit weapons; Kestros, Keteriya, Korean spears; Lancea (weapon); Mammoth spear thrower, Mesangylon, Meteor hammer; Naboot; Oxborough Dirk; Parashu, Parazonium, Pilum; Rhomphaia, Rope dart; Sagaris, Sarissa, Sibyna, Sica, Soliferrum, Migration Period spear, Spear-thrower, Spiculum, Surujin, Sword; Tepoztopilli, Throwing stick, Toggling harpoon, Tomahawk, Trident; Verutum; Wind and fire wheels; Xyston (1).
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Ancient weapons
Since its discovery and initial description in the 1960s, the penetrating lesion to the left ninth rib of the Shanidar 3 Neandertal has been a focus for discussion about interpersonal violence and weapon technology in the Middle Paleolithic. Recent experimental studies using lithic points on animal targets suggest that aspects of weapon system dynamics can be inferred from the form of the bony lesions they produce. Thus, to better understand the circumstances surrounding the traumatic injury suffered by Shanidar 3, controlled stabbing experiments were conducted with replicas of Mousterian and Levallois points directed against the thoraces of pig carcasses. Stabs were conducted under both high and low kinetic energy conditions, in an effort to replicate the usual impact forces associated with thrusting spear vs. long-range projectile weapon systems, respectively. Analysis of the lesions produced in the pig ribs, along with examination of goat ribs subjected primarily to high kinetic energy stabs from an independent experiment, revealed consistent differences in damage patterns between the two conditions. In the case of Shanidar 3, the lack of major involvement of more than one rib, the lack of fracturing of the affected and adjacent ribs, and the lack of bony defects associated with the lesion (such as wastage, hinging, and radiating fracture lines) suggests that the weapon that wounded him was carrying relatively low kinetic energy. While accidental injury or attack with a thrusting spear or knife cannot absolutely be ruled out, the position, angulation, and morphology of the lesion is most consistent with injury by a low-mass, low-kinetic energy projectile weapon. Given the potential temporal overlap of Shanidar 3 with early modern humans in western Asia, and the possibility that the latter were armed with projectile weapon systems, this case carries more than simple paleoforensic interest (2). It is usually assumed that 'fire hardening' the tips of spears, as practiced by hunter-gatherers and early Homo spp., make them harder and better suited for hunting. This suggestion was tested by
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subjecting coppiced poles of hazel to a fire-hardening process and comparing their mechanical properties to those of naturally seasoned poles. A Shore D hardness test showed that fire treatment slightly increased the hardness of the wood, but flexural and impact tests showed that it reduced the strength and work of fracture by 30% and 36%, respectively. These results suggest that though potentially slightly sharper and more durable, fire-hardened tips would actually be more likely to break off when used, as may have been the case with the earliest known wooden tool, the Clacton spear. Fire might first have been used to help sharpen the tips of spears, and firehardening would have been a mostly negative side effect, not its primary purpose (3). It is generally difficult to establish a timeline for the appearance of different technologies and tools during human cultural evolution. Stochastic character mapping of discrete traits was evaluated using human mtDNA phylogenies rooted to the Reconstructed Sapiens Reference Sequence (RSRS) as a model to address this question. The analysis reveals that the ancestral state of Homo sapiens was hunting, using material innovations that included bows and arrows, stone axes and spears. However, around 80,000 years before present, a transition occurred, from this ancestral hunting tradition, toward the invention of protective weapons such as shields, the appearance of ritual fighting as a socially accepted behavior and the construction of war canoes for the fast transport of large numbers of warriors. This model suggests a major cultural change, during the Paleolithic, from hunters to warriors. In the light of the recent Out of Africa Theory, it suggests that the "Out of Africa Tribe" was a tribe of warriors that had developed protective weapons such as shields and used big war canoes to travel the sea coast and big rivers in raiding expeditions (4). Projectile weapons (i.e. those delivered from a distance) enhanced prehistoric hunting efficiency by enabling higher impact delivery and hunting of a broader range of animals while reducing confrontations with dangerous prey species. Projectiles therefore provided a significant advantage over thrusting spears. Composite projectile technologies are considered indicative of complex behavior and pivotal to the successful spread of Homo sapiens. Direct evidence for such projectiles is thus far unknown from >80,000 years ago. Data from velocity-dependent microfracture features,
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diagnostic damage patterns, and artifact shape reported here indicate that pointed stone artifacts from Ethiopia were used as projectile weapons (in the form of hafted javelin tips) as early as >279.000 years ago. In combination with the existing archaeological, fossil and genetic evidence, these data isolate eastern Africa as a source of modern cultures and biology (5). ASSESSMENT: there was a large arsenals of weapons used in ancient times. In this research, the sword was used in Simeon and Levi's cases: “...Simeon and Levi, Dinah’s brethren took each man his sword, and came upon the city boldly, and slew all the males. And they slew Hamor and Shehem his son....” (34:25,26). Similarly, Abimelech seeing
approaching death asked his armor-bearer to kill him with a sword: "Draw thy sword, and slay me.." (Judges 9:54). Reference 1. Categories of Ancient Weapons. Available 28 April 2018 at en.wikipedia.org/wiki/Category:Ancient_weapons. 2. Churchill SE, Franciscus RG, McKean-Peraza HA, et al. Shanidar 3 Neandertal rib puncture wound and paleolithic weaponry. J Hum Evol. 2009;57(2):163-78. 3. Ennos AR, Chan TL. 'Fire hardening' spear wood does slightly harden it, but makes it much weaker and more brittle. Biol Lett. 2016;12(5). pii: 20160174. 4. Moreno E. The "Out of Africa Tribe" (II): Paleolithic warriors with big canoes and protective weapons. Commun Integr Biol. 2013;6(3):e24145. 5. Sahle Y, Hutchings WK, Braun DR, et al. Earliest stone-tipped projectiles from the Ethiopian rift date to >279,000 years ago. PLoS One. 2013 Nov 13;8(11):e78092. Correction: Earliest stone-tipped projectiles from the Ethiopian Rift date to & gt; 279,000 years ago. [PLoS One. 2015].
TYPES OF WEAPONS MACHETES AND KNIVES Machetes (Spanish-American matchets) are sharp, long knives with a broad blade having a slightly curved edge and a thick back. They are used for clearing paths in rough, densely wooded areas. Just like axes and swords they are suitable for causing not only soft tissue wounds, but also deep slashes in the underlying bone. In military conflicts (especially in Central Africa) they are often used as short-range weapons, whereas it is in the nature of things that they
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are rarely used in Europe. On the basis of 5 cases from the Freiburg material fatal and survived injuries caused by machetes and similarly large knives are discussed. In 2 cases long chop injuries were inflicted on the head causing sharp-edged transections of the bony skullcap; in one case in which the victim survived a broken off part of the blade lodged in the right os parietale. In another 2 cases complete and subtotal decapitation respectively occurred in the victims. As the instrument can be used both for cutting and stabbing there were not only long cutting injuries, but also gaping stab wounds severing the skin over a length of several centimeters; due to the great length of the blade through-and-through wounds were also seen on the trunk. Massive blows with the thick back of the blade caused streak-like bruising (1).
Jungle Machete
During expert testimony in court, forensic pathologists are often asked to estimate the length of survival following fatal injuries. Though it is impossible to be precise, fatal vascular trauma survival times are generally considered short. Two unusual cases of delayed deaths are reported, one following homicidal stabbing of the heart and the other by suicidal cutting of the neck. In those two cases, investigation provided evidence of prolonged survival: slightly more than 2 hours for the first case and about 8 hours for the second (2).
Machete
Large Survival Knives
References 1. Nadjem H, Bohnert M, Pollak S. Appearance of injuries caused by machetes and unusually large knives. Arch Kriminol. 1999;204(5-6):163-74. 2. Sauvageau A, Trépanier JS, Racette S. Delayed deaths after vascular traumatism: two cases. J Clin Forensic Med. 2006;13(6-8):344-8.
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BOW AND ARROW There were at least four waves of bow and arrow use in northern North America. These occurred at 12000, 4500, 2400, and after about 1300 years ago. But to understand the role of the bow and arrow in the north, one must begin in the eighteenth century, when the Russians first arrived in the Aleutian Islands. At that time, the Aleut were using both the atlatl and dart and the bow and arrow. This is significant for two particular and important reasons. First, there are few historic cases in which both technologies were used concurrently; second, the bow and arrow in the Aleutian Islands were used almost exclusively in warfare. The atlatl was a critical technology because the bow and arrow are useless for hunting sea mammals. One cannot launch an arrow from a kayak because it is too unstable and requires that both hands remain on a paddle. To use an atlatl, it is necessary only to stabilize the kayak with a paddle on one side and launch the atlatl dart with the opposite hand. The Aleut on the Alaska Peninsula did indeed use the bow and arrow to hunt caribou there. However, in the 1,400 km of the Aleutian Islands, there are no terrestrial mammals except humans and the bow was reserved almost exclusively for conflicts among them. The most significant event in the history of the bow and arrow is not its early introduction, but rather the Asian War Complex 1300 years ago, when the recurve and backed bows first entered the region, altering regional and hemispheric political dynamics forever (1).
Bow and arrow
In the ancient American Southwest, use of the bow developed relatively rapidly among Pueblo people by the fifth century AD. This new technology replaced the millennia-old atlatl and dart weaponry system. Roughly 150 years later in the AD 600s, Pueblo socioeconomic organization began to evolve rapidly, as many groups
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adopted a much more sedentary life. Multiple factors converged to allow this sedentary pattern to emerge, but the role of the bow in this process has not been fully explored. In this paper, the development of the bow was traced and its role as sedentism emerged and social changes occurred in ancient Puebloan society were given from the fifth through seventh centuries AD (2). Bow and arrow technology spread across California between ∼AD 250 and 1200, first appearing in the intermountain deserts of the Great Basin and later spreading to the coast. The available data were evaluated for the initial spread in bow and arrow technology and examine its societal effects on the well-studied Northern Channel Islands off the coast of Southern California. The introduction of this technology to these islands between AD 650 and 900 appears to predate the appearance of hereditary inequality between AD 900 and 1300. This technology did not immediately trigger intergroup warfare. The introduction of the bow and arrow contributed to sociopolitical instabilities that were on the rise within the context of increasing population levels and unstable climatic conditions, which stimulated intergroup conflict and favored the development of hereditary inequality. Population aggregation and economic intensification did occur with the introduction of the bow and arrow. This observation is consistent with the hypothesis that social coercion via intra-group "law enforcement" contributed to changes in societal scale that ultimately resulted in larger groups that were favored in inter-group conflict. The interplay between intra-group "law enforcement" and inter-group warfare was essential for the ultimate emergence of social inequality between AD 900 and 1300 (3). The evolution of sociopolitical complexity, including heightened relations of cooperation and competition among large nonkin groups, has long been a central focus of anthropological research. Anthropologists suggest any number of variables that affect the waxing and waning of complexity and define the precise trajectories that groups take, including population density, subsistence strategies, warfare, the distribution of resources, and trade relationships. Changes in weaponry, here the introduction of the bow and arrow, can have profound implications for population aggregation and density, subsistence and settlement strategies, and access to resources, trade, and warfare. Bingham and Souza provide a general conceptual model for the relationship between complexity and the
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bow and arrow, arguing that this compound weapon system, whereby smaller projectiles travel at higher speed and are capable of hitting targets more accurately and at greater distances than handthrown darts, fundamentally favors the formation of larger groups because it allows for cost-effective means of dealing with conflicts of interest through social coercion, thereby dramatically transforming kin-based social relations. The impacts the introduction of the bow and arrow had on sociopolitical complexity in the North American Southwest (4). The timing and circumstances of the introduction of the bow and arrow into past North American economic and social life ways have been sources of interest and controversy among archeologists for a very long time. Initial interpretations of the adoption of the bow and arrow generally seem to have been based on the rather straightforward assumption of functional superiority as a hunting tool. That is, the bow and arrow was simply a better instrument than the atlatl-dart technology it replaced. More recently, however, researchers exploring the effectiveness of the atlatl as a hunting tool have responded with studies that challenge the assumed universal functional superiority of the bow and arrow as a hunting device. Social coercion and warfare theory presents an alternative perspective on the adoption of the bow and arrow (5). References 1. Maschner H, Mason OK. The bow and arrow in northern North America. Evol Anthropol. 2013;22(3):133-8. 2. Reed PF, Geib PR. Sedentism, social change, warfare, and the bow in the ancient Pueblo Southwest. Evol Anthropol. 2013;22(3):103-10. 3. Kennett DJ, Lambert PM, Johnson JR, Culleton BJ. Sociopolitical effects of bow and arrow technology in prehistoric coastal California. Evol Anthropol. 2013; 22(3):124-32. 4. VanPool TL, O'Brien MJ. Sociopolitical complexity and the bow and arrow in the American Southwest. Evol Anthropol. 2013;22(3):111-7. 5. Walde D. The bow and cultural complexity of the Canadian Plains. Evol Anthropol. 2013;22(3):139-44.
SWORD Five cases of penetrating chest wounds were caused by weapons made from swordfish swords, involving breakage of the sword that later appeared as a thoracic foreign body. The patients had been
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assaulted 2 days to 17 years earlier. Three of them had a chronic infected wound, one had a penetrating thoracic wound with hemopneumothorax, and one had a foreign body. Computed tomography showed a foreign body in the lung in 4 cases, with aortic penetration in one. The foreign body was removed via thoracotomy in all 4 patients, with aorta repair in one who presented later with a pseudoaneurysm (1). This report (2) provides an overview of the injuries caused by a unique blade-type weapon known as a cane sword. The cane sword usually consists of a blade that is stored in a cylindrical "cane" that can be released at the handle to reveal the hidden blade within. The victim of the case was found to have a stab wound in the left midback that caused perforation of both the lower and upper lobes of the left lung, resulting in a left hemothorax. Upon autopsy, it was concluded that the patient died from injuries caused by the stab wound to the back. Given the shape of the wound and the fact that the weapon itself was found at the site of the homicide, the weapon that caused the injury was believed to be a cane sword. This case will inform forensic pathologists, law-enforcement officers, emergency medical personnel, and physicians about rare weapon, the cane sword (2).
Cane sword
The use of Japanese swords for homicidal attempts is rare. A Japanese samurai sword is a sharp and cutting object. When faced with the use of this weapon, one must distinguish between stabs and incised wounds. Incised wounds can rarely lead to death, but because of the size of the weapon, stabs usually cause much more serious injuries. Stabs also imply a penetrating movement, whereas incised wounds can be the consequence of protective circular blows. Therefore, it is important to distinguish clinically between these two kinds of wounds. A case is reported where the perpetrator argued he
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had given a circular blow, unfortunately hitting the victim. The pieces of evidence are discussed (3). References 1. Ndiaye A, Gaye M, Ba PS, et al. Penetrating chest injuries caused by swordfish sword used as a weapon. Asian Cardiovasc Thorac Ann. 2017;25(3):22932. 2. Wysozan TR, Prahlow JA. The Cane Sword. J Forensic Sci. 2018;63(1):309-3. Raul JS, Berthelon L, Geraut A, et al. Homicide attempt with a Japanese samurai sword. J Forensic Sci. 2003;48(4):839-41.
SPEAR The Paleolithic site of Schöningen is famous for the earliest known, completely preserved wooden weapons. Results of an ongoing analysis are presented of the nine spears, one lance, a double pointed stick, and a burnt stick dating to the Holsteinian, c. 300 kyr. Macroscopic and microscopic analyses, as well as studies of thin sections, contribute to a better understanding of the manufacture of the wooden weapons are presented. They were deposited in organic sediments at a former lakeshore among numerous bones of butchered horses. In general, the spears are extremely well-preserved and show no or little sign of taphonomic alteration, although some of the weapons are broken and parts were slightly moved, probably by water action. The excellent preservation conditions provide considerable information on the operational sequence of production. The hunters selected thin trunks of spruce or pine and initially stripped off the bark. Traces of cutting, scraping, and smoothing can be observed on the spear surfaces in detail. In the case of spear X, repeated use of the weapon is implied by resharpening of the tip. Analyses of wood anatomy provide information on climatic conditions and contribute to the better understanding of the development of the site (1). Little is known about the organic component of Lower and Middle Paleolithic technologies, particular with respect to wooden tools. Some wooden throwing spears about 400,000 years old were discovered in 1995 at the Pleistocene site at Schöningen, Germany. They are thought to be the oldest complete hunting weapons so far discovered to have been used by humans. Found in association with stone tools and the butchered remains of more than ten horses, the
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spears strongly suggest that systematic hunting, involving foresight, planning and the use of appropriate technology was part of the behavioral repertoire of pre-modern hominids. The use of sophisticated spears as early as the Middle Pleistocene may mean that many current theories on early human behavior and culture must be revised (2).
European Spear by cold steel
ASSESSMENT: machetes and knives, bow and arrow, sword, and spear were used in ancient world. The Bible informs us that Simeon and Levi used a sword, while seeing approaching death, Abimelech asked his armor-bearer to kill him also with a sword.
References 1. Schoch WH, Bigga G, Böhner U, et al. New insights on the wooden weapons from the Paleolithic site of Schöningen. J Hum Evol. 2015;89:214-25. 2. Thieme H. Lower Palaeolithic hunting spears from Germany. Nature. 1997;385(6619):807-10.
PATTERN OF INJURIES Retained weapon (RW) injuries are uncommon, but there is no current consensus on the best management approach. One hundred and two consecutive patients with non-missile RWs in a high-volume metropolitan trauma service were managed over a 10-year period. Of the 102 patients, 95 were males (93%), 7 were females (7%), and median age was 24 (21-28) years. Weapons: 73% (74/102) knives, 17% (17/102) screwdrivers, 5% spears, 6% (6/102) others [axe (1), glass fragment (1), stick (1), sickle blade (1), wire (1) and stone (1)]. Location of injuries: 8% (8/102) in the head, 20% (20/102) face, 9% (9/102) neck, 14% (14/102) thorax, 25% (26/102) abdomen, 23%
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(23/102) upper limb, 2% (2/102) lower limb. Four per cent (4/102) were haemodynamically unstable and proceed immediately to the operating theatre for operative exploration and weapon extraction. Imagining: 88 (86%) plain radiographs, 65 (64%) non-contrast CT scans, 41 (40%) contrast CT angiography, 4 (4%) formal angiography. Seventy-two underwent simple extraction, and 29 underwent extract plus open operation. One patient absconded. Specialist surgeons involved in extraction: trauma surgeons (74), neurosurgeons (10), ophthalmic surgeons (11) and ear nose throat (ENT) surgeons (4). Overall, 92% (94/102) survived to discharge. In conclusion, the vast majority of patients with RWs will be admitted in a stable condition and haemodynamic instability was almost exclusively seen in the anterior thorax. The most common site was the posterior abdomen. Detailed imagining should be used liberally in stable patients and unplanned extraction in an uncontrolled environment should be strongly discouraged (1). In general, the forensic evaluation of sharp force injuries in living and dead individuals follows the same morphologic principles. Still, there are some special features of sharp force injuries in the clinical context, which have to be considered as examination findings on the living are interpreted to differentiate between accidental origin, selfinfliction or homicidal assault. These include the frequency and localization of defence injuries, injuries of the perpetrator, and artificial injuries, especially those inflicted for the purpose of insurance fraud (2). A ten-year series of 142 homicidal fatalities caused by sharp force injury was studied with the aim to systematize information inherent in the characteristics of the victim and the pattern of injuries. The population of victims consisted of 112 males (79%) and 30 females (21%); among perpetrators, 125 (88%) were males. Among victims as well as among perpetrators, persons of non-Swedish origin were overrepresented in relation to their share of the nonselected population. In 82 cases (58%), one or two wounds had been inflicted; in 23 cases (16%), ten or more wounds. In the latter group, eleven victims but no perpetrators were female. In the majority of cases, victim and perpetrator were known to each other, and in instances of multiple wounding, a close relationship between the two was clearly more common than in the group of one- to two-wound fatalities. Tests for blood alcohol were positive in 86 of 116 victims (74%), the
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majority being in elimination phase. Of 120 perpetrators, 96 (80%) had positive tests or were known to be drunk at the time of the killing. In multiple wound fatalities, alcohol inebriation was less common both among victims and perpetrators. In these cases, the two persons involved were usually closely related or intimately known to each other, and in the absence of psychiatric disorder in the assailant, the motive was of a passionate type (3). The injury findings in 58 perpetrators and 158 victims surviving bodily injuries due to sharp force are presented. Defense injuries were found in 45.9% of the victims without any significant differences between males and females. There was no clear predominance of defense injuries on the left forearm and hand, as is known from autopsy studies; the right and the left hands were affected with an almost identical frequency. Regarding other parts of the victims' bodies, the topographic distribution of injuries showed a marked concentration on the left side (63.7%). The thorax, head and neck were frequently affected (45.9%, 15.3% and 15.3%, respectively), and less often the abdomen (11.1%), the lumbar and gluteal region (6.3%) and the lower extremities (6.1%). In surviving victims with only one singular stab apart from the upper limbs, the incidence of additional defence injuries on the hands and/or forearms was significantly higher (28.3%) than in fatalities. When the perpetrators had unintentionally cut their own hands, the frequency of these injuries on the right and left hands was almost equal (4). Survival time and physical activity following fatal injury are especially important during investigation of homicide cases and the estimation of a victim's survival time and physical activity following a fatal injury from a sharp weapon is a commonly raised issue, particularly at trial. According to the literature, survival time and physical activity after cardiac damage are short-term estimates without high accuracy. The homicide case of a young man who died as a result of a left ventricle injury caused by a sharp pointed weapon is reported. This case is based on evidence from a video surveillance camera that recorded the whole scene after the fatal injury: the victim showed an adapted physical activity for 38 s, although the left ventricle incision measured 2 cm. Despite several cases in the literature, it is not possible to correlate precisely the size of the wounds and the acting capability (5).
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References 1. Kong V, Khan Z, Cacala S, et al. Retained weapon injuries: experience from a civilian metropolitan trauma service in South Africa. Eur J Trauma Emerg Surg. 2015;41(2):161-6. 2. Schmidt U. Sharp force injuries in "clinical" forensic medicine. Forensic Sci Int. 2010;195(1-3):1-5. 3. Ormstad K, Karlsson T, Enkler L, et al. Patterns in sharp force fatalities - a comprehensive forensic medical study. J Forensic Sci. 1986;31(2):529-42. 4. Schmidt U, Pollak S. Sharp force injuries in clinical forensic medicine findings in victims and perpetrators. Forensic Sci Int. 2006;159(2-3):113-8. 5. Franchi A, Kolopp M, Coudane H, Martrille L. Precise survival time and physical activity after fatal left ventricle injury from sharp pointed weapon: a case report and a review of the literature. Int J Legal Med. 2016;130(5):1299-301.
SUICIDAL BEHAVIOR Studying the suicide in the Byzantine Empire is difficult due to the limited number of references to it. Their number is greater in the early years of the Empire, mainly because of the persecution of Christians and gradually decreases. The attitude of the Church also gradually hardens, as well as the law. The law was strictly followed to the West, but as far as the Eastern Empire is concerned there are no references of punishment, confiscation of property or vandalism of dead bodies mentioned. Avoiding public humiliation after a public crime or a military defeat, religious redemption, emotional disturbance and debts, are the main cause of suicide. There are some references of mass suicides, while women suicides are relatively fewer, if the early Christian years are excluded. Suicide is more acceptable to the pagans because of their lifestyle. The therapeutic approach comes mainly through the treatment of depression. Aretaeus and Galen cite some ways to deal with the disturbance in the internal balance of black bile. Their view echoes through the centuries and the subsequent doctors embrace it. At least after the 9th century, more importance is given to the patient's bliss. Gemistus Pletho tried to revive the Platonic view of suicide shortly before the end of the Empire. The Church forbids Christian burial and troubled soul hovers in an intangible journey (1). There has been little attempt to integrate contemporary studies of suicide and mass murder to homicide-suicides. The current research attempts to do so in the context of 19th century parricides in
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America. This project uses archival records from The New York Times and the Chicago Tribune, 1851-1899, resulting in a total of 231 incidents. The results indicate that parricides, mass murders, and suicides tended to originate as spontaneous acts, usually during the course of an argument, gathering momentum as the interaction unfolded. Suicide is one way of alleviating threats to offender's loss of self-identity (2). Mass suicide can be defined as the simultaneous suicide of all the members of a social group and is closely linked to the human dimension of existence, although the social and cultural context may vary. In fact, the term mass suicide can also be used to describe situations in which a particular population has reacted to oppression by denying all normal activities of sustenance, with the intention of bringing about a traumatic metamorphosis in a cultural context (colonization, or exploitation by other populations), thus transforming a catastrophe in which a passive role is played into one constructed actively. Therefore, mass suicides can be subdivided into two categories: 1] hetero-induced, typical of defeated and colonized populations forced to escape from a reality that does not acknowledge their human dignity and 2] self-induced, in which the motivation is related to a distorted evaluation of reality, without there being either an intolerable situation or a real risk of death. The mass suicides that have taken place in the last 20 years are all related to the establishment of religious sects; the mystic delirium created within the sect leads to the self-destruction of the group as being interpreted as an act of self-assertiveness (3). On the basis of psychiatric interviews with 69 former prisoners of the Auschwitz-Birkenau concentration camp, the circumstances, motives, and ways of committing suicide in the camp are described. The interview made it clear that thousands of prisoners perished by suicide. The number of committed suicides was larger than that of attempted suicides. The most frequent types of suicide victims were prisoners of Jewish descent, foreigners, white-collar workers, and old people. The most common motives of suicides were depressive reactions; anxiety; somatic illnesses; the threat of death; emotional motives; loss of emotional support; beatings and tortures; and patriotic and altruistic motives. The most common methods of committing suicide were flinging oneself onto the electrified wires surrounding the camp, hanging, poisoning, cutting one's veins, and
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drowning. There were also cases of mass suicides, chiefly in the women's camp. Suicides committed from patriotic or altruistic motives testified to the fact that human beings were able to preserve their dignity even in the face of death (4). Living conditions in concentration camps were harsh and often inhumane, leading many prisoners to commit suicide. This topic was reviewed in Nazi concentration camps (KL), Soviet special camps, and gulags, providing some preliminary data for this research. Data show that the incidence of suicide in Nazi KL could be up to 30 times higher than the general population and was also much higher than in Soviet special camps (maybe due to more favorable conditions for prisoners and the abolishment of death penalty), while available data on Soviet gulags are contradictory. However, data interpretation is very controversial, because, for example, the Nazi KL authorities used to cover-up the murder victims as suicides. Most of the suicides were committed in the first years of imprisonment, and the method of suicide most commonly used was hanging, although other methods included cutting blood vessels, poisoning, contact with electrified wire, or starvation. It is possible to differentiate two behaviors when committing suicide; impulsive behavior (contact with electrified barbed wire fences) or premeditated suicide (hanging up or through poison). In Soviet special camps, possible motives for suicides could include feelings of guilt for crimes committed, fear of punishment, and a misguided understanding of honor on the eve of criminal trials. Self-destructive behaviors, such as self-mutilation in gulag camps or prisoners who let themselves die, have been widely reported. Committing suicide in concentration camps was a common practice, although precise data may be impossible to obtain (5). After World War II, Sachsenhausen Nazi concentration camp (Oranienburg) was administered until the spring of 1950 by Soviet occupation forces (Special Camp Number 7) and used mainly for political prisoners. Suicides in this camp during the Soviet period were analyzed. Data was collected from the archives of Sachsenhausen Memorial, Special Camp Collection. Original documents, containing certificates or autopsy reports of prisoners who committing suicide, were reviewed. In this period, authorities registered 17 suicides. The age of suicides was between 19 and 64 years. The most frequent cause of imprisonment was Blockleiter (Kapo in Nazi period, n=4), Mitarbeiter Gestapo (member of the
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Gestapo, n=3) and Wehrmacht (military, n=3). Hanging was the most frequent method of suicide. The average time spent in the camp until suicide was 715 days. The number of recorded suicides under Soviet control is considerably lower (calculated rate 2.8/10,000 per year) than under Nazi control (calculated rate 11/10,000 per year). This could be due to comparably more favorable conditions for prisoners and the abolishment of the death penalty during this period. Possible motives for suicides include feelings of guilt for crimes committed, fear of punishment and a misguided understanding of honor on the eve of criminal trials (6). About 18 million Soviet citizens passed through the Gulag system of labor and concentration camps between 1929 and 1953. Based upon literary evidence from camp survivors and published documents, reports of attempted suicide and completed suicide were presented, along with a discussion of whether suicide in Gulag camps was a frequent or rare behavior. Similar to reports from the Nazi concentration camps during WWII the existence of Muselmänner or dokhodyagi, the dying prisoners emaciated by hunger, sometimes considered as suicides, has been identified among the Gulag inmates. Self-mutilation also occurred among the camp inmates (7). People in custody are more likely to die prematurely, especially of violent causes, than similar people not in custody. Some of these deaths may be preventable. Causes of death (violent and natural) were examined among people in custody in Ontario. The causes of deaths were compared in 3 custodial systems (federal penitentiaries, provincial prisons and police cells). All available files of coroners' inquests into the deaths of people were examined in custody in federal penitentiaries, provincial prisons and police cells in Ontario from 1990 to 1999. Data collected included age, cause of death, place of death, history of psychiatric illness and history of substance abuse. Causes of death were categorized as violent (accidental poisoning, suicide or homicide) or natural (cancer, cardiovascular disease or "other"). Crude death rates were estimated for male inmate populations in federal and provincial institutions. There were inadequate numbers for women and inadequate denominator estimates for police cells. A total of 308 inmates died in custody during the study period; data were available for 291 (283 men, 8 women). Of the 283 deaths involving men, over half (168 [59%]) were from violent causes: suicide by strangulation (n=90), poisoning
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or toxic effect (n=48) and homicide (n=16). Natural causes accounted for 115 (41%) of the deaths among the men, cardiovascular disease being the most common (n=62 cases) and cancer the second most common (n=18). Most (137 [48%]) of the deaths among the men occurred in federal institutions; 88 (31%) and 58 (21%), respectively, occurred in provincial institutions and police cells. The crude rate of death among male inmates was 420.1 per 100,000 in federal institutions and 211.5 per 100,000 in provincial institutions. Compared with the Canadian male population, male inmates in both federal and provincial institutions had much higher rates of death by poisoning and suicide; the same was true for the rate of death by homicide among male inmates in federal institutions. The rates of death from cardiovascular disease among male inmates in federal and provincial institutions - 102.7 and 51.7 per 100,000, respectively, were also higher than the national average. Violent causes of death, especially suicide by strangulation and poisoning, predominate among people in custody. Compared with the Canadian male population, male inmates have a higher overall rate of death and a much higher rate of death from violent causes (8). Suicide rates in correctional institutions have been increasing during the last decades. The reasons for this increase remain unclear, yet a lot of contradictory explanations were stated: the increase might be due to mass incarceration and overcrowding of small cells resulting in high psychosocial stress, changes in psychiatric health policy which might have transferred the care for patients from mental hospitals to custodial institutions, or legislation changes that might have led to a selection of offenders at higher risk (e.g. offenders who committed high violent offences or suffered from mental disorders without being referred to psychiatric hospitals). In Greece, the situation is not described in details, at least during the last few years. By law, every death of prisoner is subject to medicolegal investigation. This study consists of the meticulous research of the data records of major Greek correctional facilities, for the time period 1999-2010. An official permission was obtained from the Hellenic Ministry of Justice, which gave us access to these restricted records. Data were also collected from the Piraeus Forensic Service, from the Department of Pathological Anatomy of the University of Athens and finally from the own records. Measures were taken to respect the anonymity of the cases. Data were
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collected for the social, penal, medical history as well as for the medicolegal investigation. A total of 339 cases were collected, only 259 of which had available full data records, due to weaknesses in the prison records. From the 259 cases, 70 incidents of suicide were collected. Victims of suicide in major Greek correctional facilities, appear to fulfill the expected profile, as in the general population (9). The causes of death were assessed for people in police or prison custody in Australia, with particular attention to the differences between Aboriginal and non-Aboriginal deaths. Retrospective collection and analysis of data was carried out about deaths occurring in police or prison custody in Australia in the 10-year period 1980-1989. In the period 1980-1989, 527 deaths occurred in police or prison custody. About half these deaths were due to self-harmful behavior, including hanging. The next most frequent causes of death were diseases of the circulatory system, injuries and diseases of the respiratory system. In conclusion, the high number of deaths in custody resulting from self-harmful behavior has important implications for the criminal justice and corrections systems. Minimization of the number of people held in police and prison custody is important in preventing such deaths. Close attention needs to be paid to ensuring the safety of lock-ups and prisons and to the screening of people likely to be at risk of death from self-harmful behavior. Custodial authorities have a clear responsibility to provide quality preventive and clinical health services to all people in custody. Special attention needs to be directed to the specific health needs of Aborigines, many of whom are at much greater health risk than are non-Aborigines (10). Data obtained from the records of the Greek Ministry of Justice revealed that there were 457 deaths in the Greek prison system (which includes prisons, mental hospitals and other general hospitals) over the past 20 years. Of these deaths, 93 were recorded as suicides - an average of 4.65 suicides per year or 112 per 100,000 inmates classified as convinced, on remand or hospitalized. The suicide rates fluctuated widely, from a low rate 32.3 in 1982 to the incredibly high rate of 390.8 in 1979 (11 total suicides, 10 of which occurred in prison hospitals). The present study, conducted in Greece, was based solely on unpublished prison data, which revealed defects in recording, e.g., 11% of the deaths recorded by the correctional administration remained without specification of cause
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in the years 1977 through 1996; social and penal demographic data of the inmates who committed suicide were kept unsystematically; detailed information on the circumstances of suicide was not always available, etc. Despite a noticeable decrease in the suicide rate in the years 1995 and 1996, the limited data suggest that the suicide rate in the Greek prison system has basically remained stable over the past 20 years (11). In Rwanda, an estimated one million people were killed during the 1994 genocide, leaving the country shattered and social fabric destroyed. Large-scale traumatic events such as wars and genocides have been linked to endemic post-traumatic stress disorder, depression and suicidality. The study (12) objective was to investigate whether the 1994 genocide exposure was associated with suicide in Rwanda. A population-based case-control study was conducted. Suicide victims were matched to three living controls for sex, age and residential location. Exposure was defined as being a genocide survivor, having suffered physical/sexual abuse in the genocide, losing a first-degree relative in the genocide, having been convicted for genocide crimes or having a first-degree relative convicted for genocide. From May 2011 to May 2013, 162 cases and 486 controls were enrolled countrywide. Information was collected from the police, local village administrators and family members. After adjusting for potential confounders, having been convicted for genocide crimes was a significant predictor for suicide (OR 17.3, 95% CI 3.4-88.1). Being a survivor, having been physically or sexually abused during the genocide, and having lost a first-degree family member to genocide were insignificantly associated with suicide. In conclusion, individuals convicted for genocide crimes are experiencing continued psychological disturbances that affect their social reintegration into the community even 20 years after the event. Given the large number of genocide perpetrators reintegrated after criminal courts and Gacaca traditional reconciling trials, suicide could become a serious public health burden if preventive remedial action is not identified (12). This article (13) evaluates what progress researchers and policy makers have made towards understanding and responding to the problem of suicidal behavior in custody over the last 15 years. It examines current program initiatives and strategies for minimizing this behavior. This has become an imperative issue for the Australian
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Capital Territory (ACT) as they are in the process of developing their first prison (due to open mid 2008). A report was prepared as part of the development of the prison. In developing a prison the ACT Government wanted to learn from the experiences of other jurisdictions including international 'best practice'. Australian prison system agenda has been dominated since the 1990s by the Royal Commission into Aboriginal Deaths in Custody which made 339 recommendations. These recommendations have been important for developing programs for intervention and prevention of suicidal behavior for all inmates. This article examined the experiences of Australian jurisdictions over the last 15 years since the Royal Commission report was published. For the ACT Government learning from both international and domestic experiences is essential in developing a new prison (13). The siege of Masada was one of the final events in the First Jewish–Roman War, occurring from 73 to 74 CE on a large hilltop. The siege was chronicled by Flavius Josephus, a Jewish rebel leader captured by the Romans, in whose service he became a historian. According to Josephus, the long siege by the troops of the Roman Empire led to the mass suicide of the Sicarii rebels and resident Jewish families of the Masada fortress. Masada has become a controversial event in Jewish history, with some regarding it as a place of reverence, commemorating fallen ancestors and their heroic struggle against oppression, and others regarding it as a warning against extremism and the refusal to compromise (14).
Masada National Park.
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ASSESSMENT: suicidal behavior is recorded in special camps, correctional facilities, prison, large-scale traumatic events such as wars and genocides linked to endemic post-traumatic stress disorder, depression, and refusal to surrender as in Masada case. References 1. Tsoukalas G, Laios K, Kontaxaki MI, et al. Suicide in the Byzantine Empire. Psychiatriki. 2013;24(1):55-60. 2. Shon PC, Roberts MA. An archival exploration of homicide - suicide and mass murder in the context of 19th-century American parricides. Int J Offender Ther Comp Criminol. 2010;54(1):43-60. 3. Mancinelli I, Comparelli A, Girardi P, Tatarelli R. Mass suicide: historical and psychodynamic considerations. Suicide Life Threat Behav. 2002;32(1):91-100. 4. Ryn Z. Suicides in the Nazi concentration camps. Suicide Life Threat Behav. 1986;16(4):419-33. 5. López-Muñoz F, Cuerda-Galindo E. Suicide in inmates in Nazis and soviet concentration camps: historical overview and critique. Front Psychiatry. 2016 May 26;7:88. , 6. López-Muñoz F , Cuerda-Galindo E, Krischel M. Study of deaths by suicide in the soviet special camp number 7 (Sachsenhausen), 1945-1950. Psychiatr Q. 2017;88(1):93-101. 7. Krysinska K, Lester D. Suicide in the Soviet Gulag camps. Arch Suicide Res. 2008;12(2):170-9. 8. Wobeser WL, Datema J, Bechard B, Ford P. Causes of death among people in custody in Ontario, 1990-1999. CMAJ. 2002;167(10):1109-13. 9. Sakelliadis EI, Goutas ND, Vlachodimitropoulos DG, et al. The social profile of victims of suicide in major Greek correctional facilities. J Forensic Leg Med. 2013;20(6):711-4. 10. McDonald D, Thomson NJ. Australian deaths in custody, 1980-1989. 2. Causes. Med J Aust. 1993;159(9):581-5. 11. Spinellis CD, Themeli O. Suicide in Greek prisons: 1977 to 1996. Crisis. 1997;18(4):152-6. 12. Rubanzana W, Hedt-Gauthier BL, Ntaganira J, Freeman MD. Exposure to genocide and risk of suicide in Rwanda: a population-based case-control study. J Epidemiol Community Health. 2015; 69(2):117-22. 13. Camilleri P, McArthur M. Suicidal behaviour in prisons: learning from Australian and international experiences. Int J Law Psychiatry. 2008;31(4):297307. 14. Siege of Masada. Available 20 April 2018 at en.wikipedia.org/wiki/Siege_of_Masada.
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TRENDS There are an estimated one million completed suicides per year worldwide. As a response to increasing concern about suicide within Europe, the EUROSAVE (European Review of Suicide and Violence Epidemiology) study was undertaken to examine recent trends in the epidemiology of suicide and self-inflicted injury mortality in the European Union (EU). Suicide and self-inflicted injury mortality data for the 15 EU countries for the years 1984-1998 were obtained from the World Health Organization (WHO), the European Statistical Office of the European Commission (EUROSTAT) and national statistical agencies. Data were also obtained for a second group of deaths classified as 'undetermined' or 'other violence'. Age-standardized mortality rates were calculated and examined for trends over time. Finland had the highest suicide rate, while Greece had the lowest for the latest available year (1997). Age-standardized suicide rates tended to be lowest in the Mediterranean countries. Significant downward linear time trends in suicide mortality were observed in most countries, although rates varied markedly between countries. Both Ireland and Spain displayed significant upward linear trends in suicide mortality. Portugal had the highest rate of undetermined deaths both in 1984 and 1998 while Greece had the lowest in both 1984 and 1997. Five countries (including Ireland and Spain) showed significant downward trends in deaths due to undetermined causes whereas Belgium and Germany showed borderline significant upward linear trends in deaths due to undetermined causes. In conclusion, although suicide rates in most countries seem to be decreasing, the validity of the data is uncertain. Misclassification may contribute to the geographical and temporal variation in suicide rates in some EU countries but it does not explain the phenomenon. More detailed research comparing suicide-recording procedures and practices across the EU is required. In the absence of adequate EU wide data on suicide epidemiology, effective prevention of this distressing phenomenon is likely to remain elusive (1). Trends of male and female suicides in the Baltic countries Estonia, Latvia and Lithuania - in the years 1968-90 were studied. As throughout the former the Union of Soviet Socialist Republics (USSR), suicide rates declined sharply from 1986, the year marking the onset of turbulent social change. During the "period of stagnation" from 1968 to 1984, the mean value of male suicide rates per 100,000
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males were 55.7 in Estonia, 52.5 in Latvia and 51.7 in Lithuania. The figures for female suicide rates were 14.3, 14.3 and 10.4, respectively. Suicide rates remained consistently high in Estonia and Latvia, while in Lithuania the male suicide rate rose gradually from 33.0 to 61.3 and the female rate from 8.0 to 13.1 during the stagnation period. In conjunction with perestroika in the former USSR (including a restrictive alcohol policy and the first tentative steps towards democracy), annual male suicide rates per 100,000 in the years 1986-90 fell considerably below those in the stagnation period. Mean values of male suicide rates decreased by 26.6% in Estonia, 26.6% in Latvia and 14.4% in Lithuania in the period 1986-90 compared with the mean values for the period 1968-84. Female suicide rates were relatively stable and the male-female ratio was accordingly lower in 1986-90 (Estonia and Latvia 3.1, Lithuania 4.2) than in 1968-84 (Estonia 3.9, Latvia 3.7 and Lithuania 5.0) (2). Observed changes in subcategories of injury death were used to test the hypothesis that a sizeable proportion of ''injury deaths of undetermined intent'' (Y10-Y34 in ICD 10) in the Baltic and Slavic countries after the USSR dissolved in 1991 were hidden suicides. Using male age-adjusted suicide rates for two distinctly different periods, 1981-90 and 1992-2005, changes, ratios and correlations were calculated. The data were compared with the EU average. After the USSR broke up, the obligation to make a definitive diagnosis became less strict. A massive increase in ''injury deaths of undetermined intent'' resulted. The mean rate for the second period reached 52.8 per 100,000 males in Russia (the highest rate) and 12.9 in Lithuania (the lowest), against 3.2 in EU-15. The rise from the first to the second period was highest in Belarus (56%) and Russia (44%). The number of injury deaths of undetermined intent was almost equal to that of suicides in Russia in 2005 (ratio 1.0) and Ukraine in 2002 (1.1). In all the countries, especially the Slavic ones, prevalence trends of injury-death subcategories were uniform, i.e. strongly correlated over time. No direct substitution of one diagnosis for another was evident. In conclusion, there is no evidence that the category of ''injury deaths of undetermined intent'' in the Baltic and Slavic countries hides suicides alone. Aggregate level analysis indicates that accidents and homicides could sometimes be diagnosed as undetermined (3).
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There are only a few recent studies on secular trends in child and adolescent suicides. Trends in rates and methods of suicide were examined among young people in Finland, where suicide rates at these ages are among the highest in the world. The data, obtained from Statistics Finland, consisted of all suicides (n=901) committed by persons under 18 years of age over the period 1969-2008. Genderspecific trends were analyzed separately for the years 1969-1989 and 1990-2008 using 3-year moving averages. Trends in methods of suicide were examined from 1975 to 2008 in five-year periods. The male-to-female ratio in youth suicides was 3.6:1. The male rates increased in 1969-1989, while the rates among females were inconsistent. After 1990, the rates decreased for males but turned to an increase among females. Shooting was the most common suicide method among males throughout the period, while hanging exceeded poisoning as the most common method among females after 1990. All violent suicides decreased for males and increased for females in 1990-2008. In conclusion, the increase in violent, i.e., more lethal, suicide methods among young females is alarming, as females are known to have higher rates of attempted suicide than males. Alcohol consumption, rates and treatment of depression and violent behavior among adolescents are discussed as approaches towards explaining this phenomenon (4). This study (5) compares government records of death by suicide, in Northern Ireland, during two quinquennia in the decade 19821991. Specifically these quinquennia are 1982-1986 and 1987-1991. During the latter quinquennium there was an increase in rate for males in most age groups, except the 45-54 years and the over 65 year age groups. However, females had an increase rate in the 15-24 and 35-54 years age groups, but have a decreased rate in the other age groups. There has been a decrease in the rate of suicides by poisoning with solids and liquids for both sexes. However, male suicide rates by more violent methods have increased substantially during the latter quinquennium. Three cohorts of males, those in the 15-24, 25-34, and 55-64 age groups, have shown substantial increases during the latter quinquennium. Suggestions for psychiatric intervention strategies are made (5). Annual figures collected by the Samaritans from the Registrar Generals' figures for suicides for the years 1984-2002 inclusive were analyzed. Trends by gender, age group, marital status and method
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were examined. Suicide rates were standardized where appropriate. The mean annual rate was calculated for the 10 year period 19841993 and compared with the nine year period 1994-2002. The mean annual rate of suicide increased by 4.7%. Female suicide rates decreased by 17%, while male suicides increased by 13.2%. The highest percentage increase was seen in males aged 25-34, (34%) followed by the 15-24 age group, (26.5%). There was a significant upward trend in suicide rates at p
