Self-mutilations in private-accident-insurance cases.

Self-inflicted injuries can be classified in groups. One group deals with the simulation of illness, another with the occurrence itself and the application of chemical, thermic or mechanical methods. One sector concerns self-mutilation, which, from a psychiatrist's point of view, is interesting. At this time we are more concerned with the problems of proving it. In wartime and even during military service in peace-time soldiers inflict mutilating injuries on themselves. They are motivated by the notion that they will gain benefit from their action. Economic gain plays a role in the case of people who have taken out private accident insurance: self mutilation to simulate the result of an accident. Our investigation into self-mutilation started with an analysis under the following aspects of 123 cases: age, sex, occupation, place of residence, place and time of deed, method employed (weapon used), localisation, single or multiple wound, direction of injury, position of fingers, nature of edges of wound. Whether or not an injury was suffered voluntarily or involuntarily can only be determined with the help of auxiliary facts. It must be clarified whether or not the information given by the injured person ties in with facts concerning the place where the injury was sustained, its position and its direction. The medico-legal expert should not interpret medical findings without relating them to the facts of the case. Indeed, he should start by examining the claimant's account of the accident. To some extent it almost requires the work of a general staff to compare the findings of a careful medical investigation with the injuries themselves. If the injury was inflicted by a certain tool information must be available regarding, for example, the "accident with the saw" together with an assessment of the wounds sustained (utilization of clinical material). Sometimes tests on corpses need to be carried out because these can provide information on mechanical and physical problems. When the direction of the wound is being clarified together with an appraisal of any traces found electron scanning and microscopic tests should also be incorporated into the examination in addition to medical and X-ray tests. At the slightest suspicion that a wound might have been self-inflicted appropriate tests should be carried out immediately. Conclusions should only be drawn by someone who has made an intensive study of this special field which is of such great forensic interest.