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Due to the high ambient temperature, sauna deaths show a few confounding particularities, such as an accelerated onset of the postmortem changes, that can make correct assessment of the manner of death difficult and severely constrain the accuracy of post- mortem interval estimates. This retrospective study, performed at the medicolegal institutes in Hesse, Germany, reviewed all autopsy reports from the years 1994-2014 for sauna-related deaths. 9 relevant cases were found involving one woman and eight men aged between 52 and 80 years (mean and median value: 67 years). Of the individuals who had died of a natural cause, four were found to have had coronary heart disease, which, in the setting of heart hypertrophy and exposure to high temperatures, ultimately led to cardiac failure. In three other cases, a non-natural cause of death had been diagnosed; however, all were attributable to accidents. In two of these, blood alcohol concentrations (BAC) of over two per mil were found. In our opinion, the manner of death should be classified as undetermined in sauna-related fatalities. Such cases require a court-ordered autopsy to reliably identify the actual cause of death.

A 26-year-old man, who was on probation, was found dead in his home by his mother. Insulin vials and 2 insulin pens, which the man's stepfather (an insulin-dependent diabetic) had been missing for over a week, were found next to the deceased. The circumstances suggested suicide by an injected insulin overdose. At the time of the autopsy, the corpse showed already marked signs of autolysis. Clinical chemical tests confirmed the injection of insulin, but indicated hyperglycemia at the time of death. Toxicological analyses revealed that the man had consumed amphetamine, cannabinoids, and tramadol in the recent past. Histological examination finally revealed extensive bronchopneumonia as the cause of death. The most plausible explanation for the results of the autopsy and the additional examinations was an injection of insulin as a failed attempt of self-treatment. It is conceivable that the man had discovered by a rapid test that he was a diabetic, but had decided not to go to a doctor to avoid disclosure of parole violation due to continued drug abuse. He may have misinterpreted the symptoms caused by his worsening bronchitis and the developing bronchopneumonia as symptoms of a diabetic metabolic status and may have felt compelled to treat himself with insulin.

In Germany, the term "domestic-setting corpse" is regularly used both in the medicolegal field (daily work, specialist literature) and by the general public (press, novels). The only formal definition of the term is in the German-language textbook "Basiswissen Rechtsmedizin" (Madea and Dettmeyer 2007). In this retrospective study, we compared the criteria for this definition with our findings. Autopsy reports from the Institute of Forensic Medicine at the Justus Liebig University in Giessen, Germany, for the period between 2005 and 2011 (including February), were reviewed retropectively to see if the criteria for this formal definition could be found. We chose a postmortem interval of more than 24 hours and discovery of the corpse in a private home as inclusion criteria for our study (n = 211). We could verify four of the criteria for the definition ("advanced signs of decomposition", "reclusiveness", "unclear cause of death", "difficult to identify") in our study. One criterion ("frequently a long postmortem interval") was too vague to be of use, and two further criteria ("discovery circumstances" and "high frequency of active alcohol dependence") could only be partially confirmed. In almost half of our cases there were, however, signs of general substance abuse. The proportion of male "domestic-setting corpses" was distinctly higher than that of females (approx. 3:1). The average age-at-death was 50.1 years for men, and 57.8 years for women, and thus clearly below the average life expectancies. In over half of the cases - even those with explicitly mentioned advanced facial decay--the identification method had not been noted. In the formal definition, the criteria "discovery circumstances" and "alcoholism" thus need to be more precisely defined. Also, due to the inexplicit time range, the criterion "frequently a long postmortem interval" was too vague to be applied to, or compared with, our cases as a classic criterion. We suggest specifying a minimum postmortem interval of 24 hours for "domestic-setting corpses". In addition, more attention should be paid to the identification of "domestic-setting corpses". To date, investigation authorities frequently seem to assume that a corpse discovered in a private residence is that of the home owner or occupant.

There are no verified statistics about deaths occurring in hotels, and only a few cases have been described in the literature. A recent case induced us to conduct a systematic search for deaths in hotels in the autopsy reports of the Institute of Legal Medicine in Giessen for the period from 1968 to 2009. This search yielded 22 evaluable cases in which persons had been found dead or had died in hotels. Data evaluated in the study were sex and age of the deceased, reason for the stay in the hotel and cause of death. Among the deaths, 18 were males and 4 females and the average age was 41 and 40 years respectively. 6 of the male guests had died from a natural and 10 from a non-natural cause. In the remaining two cases, the cause of death could not be determined, but as there was no evidence that another party had been involved, the cases were not further investigated. Of the 4 female guests, 3 had died of a natural cause; in one case, the cause of death remained unclear even after morphological and toxicological investigations. Surprisingly, a third of the men were found to be temporarily living in hotels due to social circumstances. This was not true for any of the women. Our retrospective analysis is based on a comparatively small number of deaths in what were mostly hotels in small to medium-sized towns. Interestingly, the gender ratio of 18:4 for deceased men and women was significantly higher than the usual gender ratio of 2:1 found for forensic autopsies. To be able to draw further conclusions, a greater number of cases would have to be analysed, for example by recruiting additional case files from other institutes of legal medicine. This would also open up the option of investigating possible regional variations.

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