Self-Mutilation

SELF-MUTILATION, intentional self-injury having as its purpose to cause loss or weakening of the function of any organ or to simulate illness (see Simulation). Before the 1914-18 war, self-mutilation was encountered predominantly by military physicians when examining conscripts for military service. In those countries where insurance legislation existed in one form or another, self-mutilation was also found among the civilian population and was caused by the desire to receive benefits. The war that began undoubtedly increased both the number of self-mutilators and the methods of self-injury. The goal that the self-mutilator sets for himself often determines the nature, location of the self-injury, and the instrument chosen for this purpose. Thus, injuries among conscripts and soldiers were tailored to the articles of the schedule of diseases that exempted from military service. During wartime, intentional gunshot injuries to the hands, fingers of the hands, less frequently to the forearms and toes of the feet (so-called "self-shooters" or "self-gunshots") were known in armies. Kratter observed them as early as during the war in Bosnia in 1878. Meixner observed a large number of "self-shooters" during the world war. Since shots from close range leave characteristic traces, to avoid this, self-mutilators got used to wrapping the body part where the shot is fired with a wet rag, a hollow cloak, etc. Statistical data on self-mutilation in the tsarist army in the Kiev, Petrograd, Vilna, and Warsaw districts show 7% of all cases in military courts. Injuries to individual organs occurred with different frequency: injuries to hands-32%, organ of hearing-29%, shin-10% and eye-12%. Consequently, 83% fall on 4 types of self-mutilation, with injuries to fingers, especially the index finger of the right hand, being the most common. According to the report of the Warsaw City Board, deficiency and deformities of fingers were observed in 61% of conscripts. During the Russo-Japanese war, the amount of self-mutilation increased. The uniformity of injuries among conscripts from one region can be explained, on the one hand, by the existence in this region of a "specialist" engaged in self-mutilation, and on the other, by the belief in the "effectiveness" of certain methods. In contrast to the tsarist army, in the USSR when conscripting into the Red Army, not only are there no cases of self-mutilation, but on the contrary, attempts are made to conceal existing pathological conditions in persons seeking to join the ranks of defenders of the socialist homeland. Among the most frequently practiced self-mutilation injuries and the methods by which they are caused, the following can be mentioned: chopping off or shooting through fingers; atrophy of limbs and especially fingers, which is caused by bandaging and wearing leather or rubber dressings; contractures obtained by injecting caustic substances into the tendon sheaths; artificial ulcers in the area of joints with their subsequent scarring; artificial ulcers on the foot, shin, obtained by bandaging coins (then they have a round shape) or by applying caustic cauterizing substances (various acids, copper sulfate, alum, etc.), juices of some plants [Aconitum napellus (monkshood), Veratrum album, tobacco, pepper, garlic, etc.]. These means can also be used to maintain an existing ulcer. Artificial edemas are produced by tying off limbs, repeated bruises, beatings. Hernias are caused by special machines or by inserting a finger into the inguinal canal with subsequent rupture of deeper tissues; phlegmons - by injecting turpentine, kerosene and other caustic liquids. Prolapse of the rectum - by prolonged wearing of heavy objects in the rectum, by inserting a sponge on a thread for a day with its subsequent rapid removal, a bag with dry peas and pulling it out after it swells. Conjunctivitis and keratitis - by tobacco juice, ash, pepper, straws, glass fragments and other objects inserted under the eyelids. Cases of introduction of gonorrheal pus, secretions from trachoma patients are known, which, according to Kratter, caused an epidemic of trachoma in one of the regiments. Fistulas - by piercing the skin with pulling and leaving a thread, a piece of cotton, metal objects (needles) under the skin. Diseases of the ear - by damage to the eardrum by mechanical or chemical agents, by introducing irritating substances to cause purulent discharge from the auditory canal, etc. Among self-mutilators there can also be mentally ill persons, which must be remembered when examining and examining self-mutilators. In forensic medical practice, one also encounters self-injuries aimed at simulating, for example, an attack with the aim of robbery, etc. In this case, they inflict gunshot, punctured and cut wounds, bruises, abrasions on themselves; by placing a noose on the neck and subsequent compression, they simulate attempts at strangulation. At the same time, they may tie their hands and feet. Shibkov proposed to distribute the artificial diseases practiced by self-mutilators into 12 groups: 1. Artificial diseases without damage to the integrity of the skin and underlying tissues; these include: artificial coloring of the skin, skin deposits (artificial tangles, psoriasis, ringworm). Contractures obtained with the help of various bandages, reduction of chest volume, shortening of limbs, displacement of the pelvis, coxitis; foreign indifferent substances in body openings (ears, nose, eye slit, in the anus). 2. Artificial diseases without damage to the skin and mucous membrane, but with damage to deeper tissues and organs: bruises, edema from tying off; traumatic atrophy of limbs, especially fingers; strains; artificial hernias; displacement of the testicle under the skin of the inguinal area; prolapse of the rectum. 3. Artificial skin diseases: various dermatitis (mechanical, thermal, chemical and parasitic origin); abrasions, scars, artificial ulcers. 4. Artificial diseases with damage to the skin, subcutaneous tissue and other deeper tissues: emphysema, aseptic and septic phlegmons, artificial tumors, arthritis. Diseases of the sexual organs, except venereal: phlegmon of the scrotum, artificial epididymitis, orchitis. 5. Artificial wounds: cut, punctured, gunshot, contused. 6. Artificial diseases of internal organs: bronchitis, tuberculosis (mixing someone else's sputum), stomach ulcer (swallowing blood with subsequent vomiting), catarrh of the intestines, nephritis (taking irritating substances), diabetes, jaundice (taking picric acid), heart diseases. 7. Artificial nervous diseases: most often epilepsy. 8. Artificial venereal diseases: urethritis, ulcers, cystitis, syphilis. 9. Artificial eye diseases: conjunctivitis, leukomas, ulcers of the cornea, cataracts, aphakia. 10. Artificial ear diseases: perforation of the eardrum, catarrh of the auditory canal. 11. Artificial dental diseases: extraction of teeth, faking healthy roots as diseased, grinding teeth. 12. Artificial multiple (combined) diseases (see also Paraffinoma, Simulation).