Fatal accidental burns in married women

Virendra Kumara,*, Chandra Bhal Tripathib

aDepartment of Forensic Medicine, KMC, Manipal, 576119 Karnataka, IndiabDepartment of Forensic Medicine, Institute of Medical Sciences, BHU, Varanasi (UP), India

Received 17 December 2002; received in revised form 10 March 2003; accepted 13 May 2003

Abstract

Burning incidents amongst women are a major concern in India as it has become pervasive throughout all social strata and

geographical areas. They may be homicidal, suicidal or accidental in nature. Here, in the study, the main objective is to present

the different epidemiological and medicolegal aspects of accidental burns in the married women. In a cohort of 152 burned

wives, 70 (46%) were accidental victims and these cases were analyzed accordingly for their different medicolegal and

epidemiological aspects. Data were collected from personal interview and from examining the different documents related to

death. In this series, most of the women were illiterate Hindu housewives hailing from joint families (i.e. multigenerational

groups of related individuals living under a single roof) of rural community. The majority (60%) of the affected wives were 16–

25 years of age at the time of the accident and sustained less than 90% total body surface area burn injury. Most had the survival

period more than 1 day, and more than half of them died of septicaemia.

q 2003 Elsevier Ireland Ltd. All rights reserved.

Keywords: Burn injury; Epidemiological aspects; Joint family; Kerosene stove; Medicolegal aspects; Septicaemia

1. Introduction

Married women are the most common victims of

burns in the Indian society. Every woman after

marriage starts her family life, where in the beginning

she has to face a lot of problems. The nature of their

work is mostly confined to the kitchen where the

accidents occur, especially during cooking. Confla-

grations caused accidental deaths in the house,

especially in the kitchen, are often started by clothing

such as saries catching alight by contact with

inadequately guarded fires. Apart from this, overwork,

neglect from in-laws, faulty safety measures in the

kitchen, etc., also predispose to such accidents. Other

factors contributing to such accidents are wrong use of

fuel by the victims, neglected conditions of her place

of work, and sometimes woman herself is not in sound

psychic condition because of her neglected status and

working under pressure.

In the Indian scenario, some women face these

challenges bravely and intelligently while most do

not. Once the women fail to acclimatize with the new

environment, accidents do occur. The main objective

of this study is to present the different epidemiological

and medicolegal aspects of accidental burns in the

married women. These burning accidents, especially

1344-6223/03/$ - see front matter q 2003 Elsevier Ireland Ltd. All rights reserved.

doi:10.1016/S1344-6223(03)00075-0

Legal Medicine 5 (2003) 139–145

www.elsevier.com/locate/legalmed

* Corresponding author. Tel.: þ91-820-2571-201 ext. 22450 (O)

and ext. 22745 (R), þ 91-820-2570-992 (R); fax: þ91-820-2570-

061/2570-062.

E-mail addresses: drvkr_2001@yahoo.com, drvirendrakr@

rediffmail.com (V. Kumar).

in the new brides are coincidental with illiteracy,

poverty, lack of urbanization, lack of modern

amenities in the houses especially in the kitchen,

etc. Apart from this some cases of homicidal and

suicidal burns are also seen in the newly wed brides.

But in this study, these homicidal and suicidal burns

have been excluded and only the accidentally burnt

victims have been analyzed.

2. Materials and methods

Of the 270 autopsies performed on married women

between June 13, 1987 and February 3, 1989, 152

(56%) were examined by the author. This work was

confined to the flame burns only. Of these, 70 deaths

(46%) were determined to be the result of accident

and form the cohort for this study. All autopsies were

performed in the Department of Forensic Medicine,

Institute of Medical Sciences, Banaras Hindu Univer-

sity, Varanasi, Uttar Pradesh, India. An in-depth

examination of the epidemiological features, medico-

legal aspects and familial interactions of these 70

women was performed in an effort to clearly under-

stand the dynamics surrounding these deaths. Data

were collected from personal interviews with the

husband, parents and in-laws, family friends and

neighbours as well as the police. Other documents

relating to the deaths were also examined, such as the

Inquest Report, First Information Report and the

complete Autopsy Report.

3. Results

Fifty-nine of the 70 women (82%) sustained less

than 90% total body surface area (TBSA) burns

(Table 1) and all of them died in the hospital after

receiving some form of treatment. Sixty seven percent

of these women survived for more than 1 day (Table 2)

and died mostly because of septicaemia. Almost all

the accidents were associated with kerosene and

purposeful ignition (Table 3) where the victims were

dressed either in synthetic or semi synthetic clothes

(Table 4). About 66% of the women were less than 25

years old at the time of their deaths (Fig. 1), the

majority 54 (77%) of them being from the joint

family, i.e. multigenerational family.

All but three of the women were Hindu and 77% of

them had less than 5th standard education (Fig. 2).

The overwhelming majority (84%) of the accidents

occurred inside the house, in the kitchen or living

areas (closed space) (Table 5).

Sixty five percent of the women sustained burn

injuries either during morning hours or in the evening

Table 1

Percentage of body area burnt

% age of burn No. (%)

25–30 5 (7.1)

31–40 7 (10)

41–50 8 (11.4)

51–60 7 (10)

61–70 13 (18.5)

71–80 7 (10)

81–90 12 (17.1)

91–99 8 (11.4)

100 3 (4.2)

Total 70 (100)

Table 2

Survival period of the victims

Duration of survival No. (%)

,6 h 8 (11.4)

7–12 h 8 (11.4)

13–24 h 7 (10)

1–2 days 3 (4.2)

3–5 days 11 (15.7)

6–10 days 16 (22.8)

.10 days 17 (24.2)

Total 70 (100)

Table 3

Source of fire

Source No. (%)

Wood cooking 28 (40)

Kerosene stove 24 (34.2)

Kerosene lamp 14 (20)

Gas cooking 2 (2.8)

Coke angithi 2 (2.8)

Total 70 (100)

V. Kumar, C.B. Tripathi / Legal Medicine 5 (2003) 139–145140

(Table 6) and most of them (82%) belonged to the

rural community (Fig. 3).

4. Discussion

Accidental burns in women are very common in

the Indian society. In this study, approximately 46%

of burn related deaths amongst women are due to

accidents. Deaths due to accidental burns are more

before the age of 25 years as the newly married

women are not accustomed with the new place of their

in-laws, their ways of living, cooking, etc. While most

of the household work, especially of kitchen are

allotted to them as soon as they reach the in-laws

house. As newly wed brides are yet to acclimatize

with the new environment at the in-laws house in the

beginning and hence they sustain the burn injuries

usually during cooking in earlier age group (16–25

years). These accidents are infrequent before the age

of 16. Agrawal and Agrawal [1] reported similar

findings in their study of 84 female burn patients of

which 70% were between 15 and 30 years of age.

Similarly, Agha and Benhamia [2] found twice as

many women as men burn victims between the age of

16 and 40 years. Soltani et al. [3] reported the highest

incidence of burn injuries in Tehran, Iran, in the

16–25 years age group, while Mzezewa et al. [4]

Table 4

Materials of Sari

Material No. (%)

Cotton 20 (28.5)

Semi synthetic 21 (30)

Synthetic 28 (40)

Not known 1 (1.4)

Total 70 (100)

Fig. 1. Age group of the victim.

V. Kumar, C.B. Tripathi / Legal Medicine 5 (2003) 139–145 141

found that 30% of female burn victims were between

21 and 40 years old in Harare, Zimbabwe.

Although in most countries deaths from burns

are at their lowest during the reproductive years

and highest in childhood and among the elderly,

but in Egypt burning incidence is highest among

young women (15–34 years), and Mauritius also

have the same pattern as reported by Saleh and

Gadalla [5], which are more or less consistent with

this study.

Religion has nothing to play much in the accidental

burns and in the study it was seen more in the Hindu

community, which was somewhat comparable to the

population distribution.

Fig. 2. Literacy of the victim.

Table 5

Place of burn

Place No. (%)

Kitchen 39 (55.7)

Living room 9 (12.8)

Kitchen-cum-living room 9 (12.8)

Store room 2 (2.8)

Open space 11 (15.7)

Total 70 (100)

Table 6

Time of incidents

Time No. (%)

Morning (04:00–10:00 h) 20 (28.5)

Mid-day (10:00–16:00 h) 18 (25.7)

Evening (16:00–22:00 h) 26 (37.1)

Night (22:00–04:00 h) 6 (8.5)

Total 70 (100)

V. Kumar, C.B. Tripathi / Legal Medicine 5 (2003) 139–145142

As the level of education increases, accidental

burns in women decrease. In this series, 77% of the

women had less than school level education. Simi-

larly, Sakhare [6] observed 35% of his cohort of 1200

Indian women to be illiterate, while 6% had college

level education. Urbanization makes women more

literate and confident to handle problems effectively

so the incidence of accidental burnt wives are less in

the urban areas and the literate class.

Almost all the cases were seen amongst the

housewives, who happened to work in the kitchen.

Accidents most commonly occurred when wives

lived in joint families – those of multiple generations

and relations living under a single roof. This living

arrangement is more common in rural India, as

compared with the nuclear family. As the newest

member of her in-laws joint family, the young bride is

expected to shoulder the largest burden of cooking

and other household duties.

As the young wife is expected to perform majority

of the cooking duties for the family, it is not

unexpected that the kitchen and living areas are the

most common sites of accident. In the Asian

community, Robinson [7] observed that many severe

burn injuries occurred in the kitchen, many as a result

of ignition of loose clothing. Similarly Sen and

Banerjee [8] reported accidental burns in females due

to domestic accidents in nearly 80% of cases.

Adamo et al. [9] reported that most burn accidents

occurred at home.

Most of the incidents occurred either in the evening

hours or in the morning hours because during these

Fig. 3. Community character of the victim.

V. Kumar, C.B. Tripathi / Legal Medicine 5 (2003) 139–145 143

periods the victims were busier in the kitchen

preparing meals.

Mzezewa et al. [4] have reported the time of burn

incidents as 38% in the evening, 24% in the morning

and 12% at midday hours, which are similar to the

present study. Singh et al. [10] have reported the peak

incidences of burns in females during morning hours,

i.e. 05:00–11:00 h.

Wood cooking and kerosene stoves are most

common means of cooking in the rural areas, which

were responsible as the source of fire in most of the

cases. Kerosene lamps that are still being used for

lights in the rural areas were responsible for as many

as 20% cases of accidental burns. Saleh and Gadalla

et al. [5] while studying the accidental burn deaths in

Egyptian women of reproductive age have reported

that nearly 2/3rd of burns were caused by kerosene

cooking stoves, which were more or less consistent

with the present study. Maya Natu et al. [11] in their

study of 409 married burn cases reported that the

pressure stoves were the source of fire in about 129

cases, wood fire, cooking gas and petrol in 78 cases,

kerosene lamp in 61 cases, match stick in three cases

and in rest of the victims, some other factors were

responsible. Dasgupta and Tripathi [12] in their study

found that the largest number of burn deaths were due

to the use of match stick (35.6%) followed by wood

cooking (28.7%), kerosene stoves (18.4%), angithi/

coke oven (11.5%) and kerosene lamps (5.7%).

Majority of the victims survived for more than 1

day of which more than half of the victims had the

survival period of more than 5 days which is because

of the fact that most of the victims had less extensive

and superficial burns and perhaps better intensive care

treatment. In all cases, there were no implications of

any inflammable substances. Rescue measures were

also provided in time resulting in less extensive burns.

Vilasco and Bondurand [13] reported 3–7 days of

survival in 40% of the burn deaths. Ragheb et al. [14]

also reported the survival period of about a week in

58% of burn victims. Reig et al. [15] have reported the

mean survival of 10.3 days in massive burn victims.

Synthetic clothes were most frequently used by

victims, as they are durable, cheaper and probably

prestigious in comparison with cotton. These syn-

thetic clothes are more likely to catch fire and produce

more severe burns by sticking onto the body in many

cases.

Septicaemia was the major cause of death rather

than shock as commonly thought, because nosocomial

infections were common, which led to death. Arora

and Antia [16] reported the cause of death as shock in

42, septicaemia in 21, urinary infection in 1,

pulmonary infection in 3 and gastroenteritis in one

out of 68-burn deaths. Agha and Benhamia [2]

reported that the main cause of death was shock

during the first 4 days after burn injuries (50%),

septicaemia from the 5th day to 3rd week (40%) and

cachexia after the 3rd week (10%). According to

Singh et al. [10] septicaemia was the major (55%)

cause of death in burns victims. Saleh et al. [5] and

Ragheb et al. [14] also reported that infection was the

major cause of death in burn cases.

5. Conclusion

The present study highlights the following features

pertaining to the accidental burnt wife deaths studied

at autopsy:

1. Accidental burn deaths in women occur usually

before the age of 25 years.

2. Education amongst women decreases such

accidents.

3. Incidents occur mostly in joint families.

4. Wood cooking and Kerosene stove or lamp is the

source of fire in most of the victims.

5. TBSA is usually less than 90%.

6. Most of the victims survive for more than 1 day.

7. Septicaemia is the major cause of death.

To check such accidents following measures is

recommended.

1. Spread of education especially about safety

measures amongst women making them aware of

the problems related to fire.

2. New brides should not be over burdened with

the kitchen work and every family member

should share the household work properly.

As long as this problem of married female deaths

by burning exists, Medicolegal experts would be

needed to look into their complex nature and

causation of burn. Henceforth, it is absolutely

V. Kumar, C.B. Tripathi / Legal Medicine 5 (2003) 139–145144

essential that every medico-legalist must be

thoroughly conversant with the circumstances and

nature of the burn injuries in married females, as he

will be frequently called upon by the courts to throw

light on the different aspects of the cases and thus to

help the administration of justice, both in civil and

criminal cases.

Acknowledgements

I am thankful to Dr Ritesh G. Menezes, postgradu-

ate trainee, Dept. of Forensic Medicine, KMC,

Manipal, for patiently editing this manuscript.

References

[1] Agrawal S, Agrawal SN. Analysis of causes of fatal burns.

J Indian Acad Forensic Sci 1967;6:40–3.

[2] Agha RB, Benhamia A. Epidemiology of burns in Algiers.

Burns 1979;5:204–5.

[3] Soltani K, Zand R, Mirghasemi A. Epidemiology and

mortality of burns in Tehran, Iran. Burns 1998;24:325–8.

[4] Mzezewa S, Jonsson K, Aberg M, Salemark L. A prospective

study on the epidemiology of burns in patients admitted to the

Harare burn units. Burns 1999;25:499–504.

[5] Saleh S, Gadalla S, Fortney JA, Rogers SM, Potts DM.

Accidental burn deaths to Egyptian women of reproductive

age. Burns 1986;12:241–5.

[6] Sakhare S. Analytical study of 1200 suspicious deaths of

newly married women in Vidharbha region of Maharashtra

state in India. In: a seminar on women and violence held on

11th July. Proceedings of the Womens’ Decade World

Conference 1985; July 10–19, Nairobi, Kenya.

[7] Robinson AC. Serious burns sustained from wearing Sari.

Burns 1984;11:138–9.

[8] Sen R, Banerjee C. Survey of 1000 admission to a burn unit

SSKM Hospital, Calcutta. Burns 1981;7:357–60.

[9] Adamo C, Esposito G, Lissia M, Vonella M, Zagaria N,

Scuderi N. Epidemiological data on burn injuries in Angola: a

retrospective study of 7230 patients. Burns 1995;21:536–8.

[10] Singh D, Singh A, Sharma AK, Sodhi L. Burn mortality in

Chandigarh zone: 25 years autopsy experience from a tertiary

care hospital of India. Burns 1998;24:150–6.

[11] Natu M, Jape V, Prasad K. A study of Burn cases. Indian J Soc

Work 1974;XXXV:241–6.

[12] Dasgupta SM, Tripathi CB. Burnt wife syndrome. Ann Acad

Med 1984;13:37–42.

[13] Vilasco B, Bondurand A. Burns in Abidjan. Cote D’Ivoire.

Burns 1995;21:291–6.

[14] Ragheb SA, Qaryoute S, El-Muhtaseb H. Mortality of burn

injuries in Jordan. Burns 1984;10:439–43.

[15] Reig A, Tejerina C, Baena P, Mirabet V. Massive burns: a

study of epidemiology and mortality. Burns 1994;20:51–3.

[16] Arora S, Antia NH. The treatment of burns: the treatment of

burns in a district hospital. Burns 1977;4:49–51.

V. Kumar, C.B. Tripathi / Legal Medicine 5 (2003) 139–145 145