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Affiliation
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Adelaide School of Medicine, The University of Adelaide, Level 2 Helen Mayo North Building, Frome Road, Adelaide, SA, 5005, Australia. roger.byard@sa.gov.au. |
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Abstract
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Acid attacks” refer to physical assaults where an acid or corrosive material is thrown over another individual with the intention to “maim, disfigure, torture or kill” [1]. As can be seen in the review by Kaur and Kumar in this issue [2] it can be a particularly devastating form of violence, as it is often associated with severe, permanent, disfiguring and incapacitating injuries with loss of tissue and organ function. Also known as vitriolism or vitriolage, the incidence varies greatly among different cultural and ethnic groups, as do the motivations behind such events.
The largest number of cases has occurred in Bangladesh with 3000 reported since 1999, although rates have been decreasing, with 116 cases in 2009 compared to 367 in 2002 [3]. As noted by Kaur and Kumar victims are most often young women who have refused marriage proposals or sexual advances [2]. It has also been reported following property or dowry disputes, or as part of more generalized domestic violence [4]. Similar motivations lie behind acid attacks in India although disturbingly the numbers in that country appear to be increasing. This may be particularly so given the suggestion that under-reporting may occur, especially with fatal cases in rural areas [5,6,7]. In Pakistan annual numbers have increased from 65 in 2010 to 150 in 2011 [8].
Acid attacks may also be used by criminal gangs as a form of punishment or intimidation. In the United Kingdom (UK) there has been a dramatic rise in cases of acid attacks with numbers increasing from 228 in 2012 to 601 in 2016 [9]. Most of the attacks occurred in London and often involved street gangs using “face melters”, with predominantly male perpetrators and victims [10]. Pouring acid into the eyes of 33 prisoners between 1979 to 1980 in Bhagalpur, India, was allegedly undertaken by police to intimidate suspects [11]. Reports of acid attacks have come from many countries including Jamaica, Iran, Taiwan, Colombia, Nepal, Uganda, Cambodia, United States, China, South Africa, Saudi Arabia, and Nigeria, where they accounted for 5.7% of burn patients in one study [9, 12,13,14,15,16].
Although sulfuric and nitric acid are usually employed, sometimes strong alkaline solutions such as sodium hydroxide may be substituted, particularly if access to acids has been restricted [17]. The effects of corrosive burning vary depending on the part of the body that has been targeted, but as many attacks involve the face and head the results are often limited to this area. Severe attacks may cause deaths due to the immediate effect of the burns, or at a later time from sepsis or multi-organ failure. However, as the head is often targeted, victims usually have less than 20% of the total body surface burned and so survival is usual, with 8.1% mortality in one Iranian study [12]. A British study reported that only 2% of cases had life threatening injuries [18]. Suicide due to the severely damaging psychological and emotional effects of the resultant physical deformities may occur ...
Language: en |