Journal of Analytical Toxicology, Vol.
30, April 2006
[ Case Report
An Unusual Autoerotic Fatality AssociatedWith
Chloroform Inhalation
Peter P. Singer* and Graham R. Jones
Office of the Chief Medical Examiner, 7007 - 116 Street NW, Edmonton, Alberta, Canada T6H 5R8
Abstract I
We report the death of a young male attributed to chloroform
poisoning during autoerotic asphyxia. He was found lying
on the floor of his apartment, prone on a piece of foam and
a towel. His eyes were bound with a towel, his lower face
and nose were almost entirely covered with duct tape surrounding
a rubber hose in his mouth. The other end of the hose was
loosely sitting inside an open bottle which was in a box beside
him. He was bound-up by an intricate system of ropes, handles,
and rods, ending with a noose around his neck. Toxicology
testing indicated chloroform concentrations of 18.1 mg/L in
femoral blood and 1.5 mg/L in urine. Chloroform was measured
by headspace gas chromatography with flame-ionization
detection using 1,1,1-trichloroethane as the internal standard.
The cause of death was recorded as "chloroform toxicity"
with "autoerotic asphyxia" as a contributing factor, and the
manner of death was "accidental".
Introduction
Deaths due to autoerotic activity are relatively uncommon but
are very well-documented in the forensic literature. They usu-
ally involve males, although autoerotic deaths of females have
been reported (1). Because the circumstances can look so un-
usual, investigators unfamiliar with autoerotic deaths might
mistake them for suicides or even homicides. Autoerotic deaths
usually involve rigging a device with ropes and sometimes pul-
leys to partially asphyxiate the individual. Masturbation during
a hypoxic state is reputed to intensify the resulting orgasm. A
safety release mechanism is usually incorporated so that if the
individual loses consciousness, pressure on the rope causing the
asphyxia is released, allowing the individual to breath normally.
Although self-induction of asphyxia is usually attained using
ropes, the hypoxic state may occasionally be augmented by the
inhalation of solvents. We report an unusual case of autoerotic
asphyxia associated with the use of chloroform.
* Author to whom correspondence should be addressed.
216 Reproduction(photocopying)of editorial contentof this journal is prohibitedwithout publisher'spermission.
Case History
The decedent was an otherwise healthy young male who
worked in a local research laboratory with access to a variety of
solvents and chemicals. He was found lying prone on a piece of
foam and a towel on the floor of his apartment. His eyes were
bound with a towel, and his lower face and nose were almost en-
tirely covered with duct tape surrounding a rubber hose in his
mouth. The other end of the hose was sitting loosely inside an
open bottle that was in a box beside him. He was bound with an
intricate system of ropes, handles, and rods that ended with a
noose around his neck.
Strips of duct tape and plastic food-wrap and a roll of duct
tape were present in the bathroom closet. Also in the closet were
bondage-related paraphernalia, including leather strapping, a
ball with a rope tied through, and additional ropes and chains.
No drugs were found at the scene. The victim was last seen
about three days prior to being found. An external examination
was performed, but an autopsy was not performed because of
the obvious nature of the scene. Femoral blood, vitreous, and
urine were taken at examination for toxicology testing and
stored at 4-6~ prior to analysis.
Experimental
Specimens were screened by headspace gas chromatography
with flame-ionization detection (GC-FID) for the presence of
ethanol and other volatiles. Bloodwas screened for the presence
of drugs by immunoassay (ELISA and Abbott TDx) for ac-
etaminophen, salicylate, benzodiazepines, barbiturates, cocaine
metabolites, opiates, and amphetamines. Blood and urine were
also screened by GC-mass spectrometry (MS) in combination
with nitrogen-phosphorus detection (NPD). No drugs were
detected, although chloroform was detected by headspace
GC-FID.
Chloroform was quantitatively measured by headspace
GC-FID using an Agilent 5890II GC and 7694 headspace unit.
The following parameters were recorded: GC oven 60~ for
Journal of Analytical Toxicology, Vol. 30, April 2006
1 rain, ramped at 15~ to 150~ for I rain; injector 120~
detector 200~ valve temp 65~ line temp 70~ and platen
temp 60~ Separations were accomplished using a 30-m Restek
RTX BAC-1 capillary column. To 0.1 mL blood or other spec-
imen, 1,1,1-trichloroethane was added as the internal standard
(30 laL of a solution containing 0.2 I~L/mLmethanol). Chloro-
form eluted at 1.8 rain, and 1,1,1-trichloroethane eluted at 2.17
rain. Six blood-based calibrators ranging from 0.5 to 20 mg/L
were prepared by adding appropriate amounts of a methanolic
solution of chloroform (Caledon, distilled-in-glass). A similar
volume of methanol was added to case specimens and controls.
The calibration curve deviated only slightly from linearity, with
a correlation coefficient (quadratic fit) of better than 0.999 and
an intercept of less than 0.1 mg/L. An independently prepared
blood-based chloroform control was also run, and it read within
10% of the target (10.9 mg/L). The blood sample was opened
only once prior to chloroform analysis; the vitreous and urine
samples were unopened prior to analysis.
Results and Discussion
Chloroform was identified and quantified in femoral blood at
18.1 mg/L and in urine at 1.5 mg/L. No other volatiles, alcohol,
or drugs were detected by routine screening.
Autoerotic deaths using solvents to enhance the hypoxia are
relatively uncommon, but quite well-documented in the litera-
ture. There have been several reports of the use of chloroform
or other halogenated hydrocarbons to enhance sexual activity
(2-5), as well as other volatile agents such as propane (6), tetra-
chloroethylene (7), and nitrous oxide (8). The use of chloroform
has also been extensively reported in both homicides (9-15)
and suicides (16-18). In some cases it is not clear whether the
death is accidental or homicidal (19,20).
Interpretation of chloroform concentrations depends very
much on the circumstances. When properly administered as an
anesthetic under controlled medical conditions, blood chloro-
form concentrations range from roughly 20 to 230 rag/L, de-
pending on the depth of anesthesia (21-25). In contrast, blood
concentrations in chloroform-induced suicides and homicides
have ranged from 10 to 194 mg/L, with many in the lower end
of the range (17,26). Even though there may have been some
loss of chloroform between the time of death and ultimate anal-
ysis in some of these cases, the primary reason the postmortem
blood chloroform concentrations are low is the considerable
variation in the manner in which the chloroform is applied and
therefore the degree of mechanical asphyxia applied in the pe-
riod immediately prior to death. For example, many of the
homicides and suicides reported in the literature have involved,
respectively, use of a cloth in the mouth or throat, and a plastic
bag over the head. The toxicity of chloroform is increased
markedly as hypoxia increases or where the intake of chloroform
is too fast (and/or too high a concentration); therefore, death can
occur at concentrations that are relatively low compared to
concentrations that used to be seen in medically administered
chloroform.
A definition of autoerotic death has been suggested that
restricts the term to accidental deaths during individual sexual
activity in which the prop used to enhance the stimulation
causes the unintended death (27). In the case we report, the hy-
poxia probably resulted from both the noose and the chloroform.
However, the chloroform is in the range associated with fatali-
ties, and the recorded cause of death was "Chloroform Toxi-
city"with "AutoeroticAsphyxiation"as a contributing factor, and
the manner of death was "Accidental." It is acknowledged that
the concentrations of chloroform at the time of death probably
would have been higher than those measured because of the ex-
tended postmortem interval and possible in vitro losses. How-
ever, these changes would not be sufficient to affect the deter-
mination of the cause and manner of death.
Acknowledgments
We would like to thank Terrie Wispinski for her technical
expertise in performing the chloroform quantitation.
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Manuscript received April 29, 2005;
revision received September 28, 2005.