A 22-year-old male student did not show up for an appointment in the first afternoon, and as a consequence his parents were contacted. Thus, they called the janitor of the apartment building where the young man lived, as he did not answer the phone. The janitor, who had an extra set of keys of all the flats, entered the man’s house, whose door was closed. The janitor heard the water flowing in the bathroom and found him naked and unconscious, lying on the bathtub. She promptly alerted the emergency services.
The on-site judicial investigation
Upon arrival of the emergency team, the body was lying naked in the bathtub. The head was completely covered by a soaked canvas bag, held around the neck by a white nylon rope, and reached by the water jet coming from the showerhead. The emergency team turned off the water, cut the white rope around the neck, and partially lifted the canvas bag to expose his face (Fig. 1A, B). The man’s death was declared, and the emergency team did not modify the scene any further. The police and the forensic experts team then arrived at the scene. The door and the windows did not show any signs of forced entry, and the inside of the flat was clean and ordered. In the kitchen there were only a cup of coffee and a glass of water, laying on the table. On a closer examination, the victim presented a complex system of bindings. The two handles of the canvas bag were tied up to the upper limbs, with a grip at both the axillae. Each wrist was tied with a single nylon rope (Fig. 2A). In particular, the two nylon ropes were firmly rolled up in several loops all around his wrists and his hands. The left forearm was set on the back, the left hand close to the right hip. In this way, the hands could be placed near to each other, with a padlock that was binding the two ropes (Fig. 2B). A pair of scissors and the padlock key were found beneath the body, not far away from the hands (Fig. 3A). The rest of the nylon ropes was found on the floor of a bedroom (Fig. 3B). Protective plastic bags were placed on his hands and his wrists to prevent contamination. At the scene, the rectal temperature was 32.5 °C (environmental 24.0 °C), post-mortem lividity was intense, and it partially disappeared with pressure on the back. Rigor mortis was documented at the temporomandibular joints, the neck, and the main joints of the upper and lower limbs. The post-mortem interval was calculated based on the temperature relating to the nomogram by Henssge. The time of death was limited to between 5 and 12 h before the on-site investigation.
The family members were interviewed by the police. They reported that the victim did not suffer from psychiatric diseases or socio-economic difficulties. Furthermore, they reported that he had never showed suicidal proposals and/or attempts. A suicidal letter was not left by the victim. The prosecutor ordered a judicial autopsy at the Milan Institute of Legal Medicine 36 h after the on-site judicial investigation.
Prior to autopsy examination, face, neck, wrists, hands, and external genitalia were swabbed in order to avoid any contaminations. Also, the free margin of the nails, the nylon ropes, the padlock, and the canvas bag were collected for a subsequent forensic genetic analysis, which was requested by the prosecutor.
External examination indicated that the body was in good state of preservation (weight 70 kg, length 180 cm), with rigor mortis presented both at the neck, upper, and the lower limbs (the corpse was refrigerated). Intense post-mortem lividity was present on the back and fixed; furthermore, there were no conjunctival petechial hemorrhages. A current mark was not documented on the body. At autopsy, the body did neither show blunt force injuries nor defensive wounds. In particular, the upper limbs did not show any injuries. The hyoid bone and both the laryngeal superior cornua were undamaged. A pinkish frothy fluid was observed in the trachea and the main bronchi, but no foam was present in his mouth or his nostrils. The lungs were markedly overinflated (right = 1180 g; left = 1045 g), filling the thoracic cavity. The surface was pale and crepitant, with subpleural petechiae. The pulmonary parenchyma was waterlogged, with some areas of intrapulmonary bleedings. Furthermore, a lot of red-tinged frothy fluid exuded from the bronchi on the cut section. Upon autopsy, bilateral hemorrhages within the petrous temporal bones were observed. About 50 cc of brownish fluid material were found in the stomach, without any food traces. The heart, the abdominal viscera, and the pelvis did not show any gross lesions, and nothing else was observed upon autopsy. Viscera specimens (the brain, lungs, liver, kidneys), biological fluids (femoral and cardiac blood, bile, urine, and gastric content), hair, and nasal swabs were sampled for subsequent toxicological analyses. Samples of the brain, heart, lungs, stomach, liver, spleen, and kidneys were also collected for histopathologic examination. A specimen of psoas muscle was also sampled for forensic genetic analysis. All the analyses were authorized by the prosecutor.
Regarding the forensic genetic analysis, the PCR amplification only revealed the victim’s DNA, which was compared with the sample of psoas muscle collected during the autopsy examination.
Toxicological analyses were performed in accordance with the protocols adopted in the Milan Institute of Legal Medicine. Alcohol concentrations were analyzed by gas chromatography (GC) in specimens of femoral blood, gastric content, and the brain: all of them resulted to be negative. Specimens of urine and cardiac blood, tested by ELISA immunoassay, were analyzed for illicit psychotropic drugs, which were negative. In addition, no medicinal drugs and non-volatile toxic substances were found in urine, cardiac blood, or bile, which were analyzed by GC and liquid chromatography (LC). Finally, no drugs were detected in hair sample and nasal swabs.
Samples of the brain, heart, lungs, stomach, liver, spleen, and kidneys underwent standard post-fixative histopathologic examination. Slides were stained with hematoxylin and eosin (HE) and Masson’s trichrome staining (MT). Histologic slides of the brain, stomach, and kidneys showed post-mortem autolytic changes. Slides of the heart revealed wavy myocardial fibers, with a moderate fibrosis of the interstitium space. The spleen showed hyperemia, while the liver showed microvesicular steatosis. The pulmonary parenchyma showed a massive edema, with some areas of acute emphysema and hemorrhagic foci (Fig. 4). This latter morphological pattern can be defined as emphysema aquosum, since the edema fluid in the bronchi blocks the passive collapse that normally occurs at death, holding the lungs in the inspiratory position. The other organs did not show any abnormalities.
Finally, the cause of death was identified as an asphyxiation by drowning in combination with direct suffocation caused by the soaked canvas bag, in the context of waterboarding practice. Toxic substances and natural diseases were not documented.