Homicidal smothering on toilet paper: A case report.

Toilet paper is a ubiquitous personal hygiene product that is usually considered harmless. It was reported however to have been used as a mean of self-destruction in two unusual suicides, and is here reported to have been used to commit homicide. The body of a 91-year-old woman suffering from Alzheimer's disease was found in the bedroom of her nursing home, a roll of toilet paper near the body and toilet paper protruding from the mouth. At autopsy, pellets of toilet paper were impacted in the buccal cavity and the laryngopharynx above the epiglottis. The cause of death was established as smothering on toilet paper, whereas the manner of death was ruled as homicidal. Non-lethal blunt head injuries were considered to be a contributive factor, by lowering the victim's resistance. The perpetrator was another elderly woman, also suffering from Alzheimer's disease.