How are human autopsies performed? Revelations of a female pathologist about her work, and what really happens in the morgue and crematorium
Today we will talk about a somewhat forbidden topic in modern society.
It is not customary to talk about death, but this is a normal side of life, it is pointless to impose a taboo on it.
Work in the morgue
So let's get started.
1. The surgeon performing the operation does not remove anything from operating table, because everything should be studied by the pathologist. Often the material comes from the foreskin, and sometimes the entire organ. Not the most great pleasure: to examine a member under a microscope. Sometimes you have to cut it yourself from a corpse when the diagnosis requires it.
2. Often someone's intestines are brought from the hospital, which must be examined and found a small problem. But to find it, you need to dig deep into them.
3. There is nothing worse than opening the intestines, because there is too much of everything. It also happens that pathologists decide not to make their diagnosis just because they don’t go into the intestines, because they will already die.
4. A person chooses the profession of a pathologist not because he likes death and corpses. Working with bodies takes about 10 percent of the time, in the remaining 90 percent of the time a person is studying a biopsy (a piece of an organ or tissue) of a living person, and also works with documents.
5. If a person likes to deal with corpses, he goes to work in a forensic medical examination, but not in the morgue at the hospital. These two professions are often confused (pathologist and medical examiner), however, the former are engaged only in those who died due to illness, and the latter work with crime.
6. The pathologist has the right not to open his relatives and friends, but sometimes he has to. For example, the author tells a case from her practice when she opened up a man she knew, who was not yet 30 years old. He used great amount alcoholic beverages for so many years. As a result, when an autopsy was performed, not a single living cell was found in his liver.
7. When a corpse is opened, the scalp is cut off on the crown of the head, and the skin is turned away on the face so that the face is not visible. It turns out that a person works like any other job.
8. Not all relatives grieve for deceased loved ones. Some do not cry at all, while others cry, but it is clear from them that a person does not have grief. After you have worked in this field for many years, you begin to distinguish.
9. Pathologists are not at all depressed people. When a person works hard with death, he begins to appreciate his life. And sometimes it's fun at work. One day, a drunken orderly was laid on a sectional table and covered, preparing him for the autopsy procedure. The reaction of the interns, when the orderly began to recover, was incomparable.
10. Fried human meat has a pleasant aroma.
11. It is often said that a pathologist is not a female profession at all, but in the modern world there are organizations in which there are no men at all.
Facts about the crematorium
Now let's talk a little more about cremation to cover the topic fully. Cremation today is more associated with concentration camps, it is cheaper than a classic burial, and many people like the idea of having their ashes scattered somewhere over the field. So a few interesting facts about the cremation process.
1. The bodies in the crematorium are delivered in most cases in cardboard coffins, sometimes in wooden ones, so that they burn better.
2. Before cremation, a person's identity is checked twice so as not to confuse anything, and an identification tag is attached to the body.
3. The cremation unit has two chambers. In the first chamber, the air is heated to 650 degrees, in which the burner is located on the ceiling. At this temperature, only bone fragments and gas remain from the body. In the second chamber, bone fragments and gas are heated to 900 degrees, as a result, the smell is destroyed and the bones are crushed.
4. In order to cremate a body weighing 45 kilograms, one and a half hours of time and 64 liters of kerosene are needed.
5. The actual ashes are mostly coffin ash and a small amount of bone fragments. From the ashes, what has not burned down (screws, prostheses) is removed and placed in a grinder similar to a kitchen mixer.
6. Despite the fact that many people want their ashes to be scattered, in most cases relatives keep them at home.
“Write any diagnosis - everything hurts in an old person!” - rightly notice the readers of "Peasant Woman" from the Dubovsky district. Is there a legal way to avoid surgery after death?
This letter to the editor came from the village of Peskovatka.
“New laws have appeared in our region,” the author writes on behalf of all the villagers, however, he does not name names “for obvious reasons”. - The fact is that all the dead are forced to be taken to the morgue for an autopsy. I am 80 years old and when I die I don't want to be cut. And they all don't want it. This is some kind of mockery of the dead - why cut 70-80-90-year-olds. The end of life has come - and that's it. And without it, the funeral is very expensive. Many have to go into debt. Who is to blame for this - the law or local authorities?
Well, good questions. Let's figure it out!
Who came up with this?
The authorities of the Dubovsky district immediately disowned: "The initiative is not ours."
We do not have the authority to resolve such issues, - says Alexander Shrainer, deputy head of the administration. - As far as I know, this problem is typical for the whole region. I believe that if the death is criminal in nature, then an autopsy is definitely necessary. And the police have to pay for it. And if a person died, as they say, from old age, why? If relatives insist, then another matter. And one size fits all ... This is wrong!
The local government really has nothing to do with it. And regional too. All manipulations with the bodies of the dead are carried out in strict accordance with federal law. And this was not invented today: it turns out that the current order has been in effect for many years!
When is an autopsy required?
As the leading legal adviser of the regional State Bureau of State Bureau Zhanna Yevtushenko told Krestyanka, there are several documents regulating the entire process. Namely:
Law of November 21, 2011 No. 323-FZ “On the basics of protecting the health of citizens in Russian Federation»;
Order of the Ministry of Health of Russia No. 354n “On the procedure for conducting post-mortem autopsies”;
Order of the Ministry of Health and Social Development
No. 346n "On Approval of the Procedure for Organization and Production of Forensic Medical Examinations in State Forensic Institutions of the Russian Federation".
An autopsy is a study of the body of a deceased person, which is carried out to determine the nature of painful changes and establish the cause of death, explains Zhanna Yevtushenko. - In other words, they open the body in order to understand the cause of death. There are a number of cases where an autopsy must be performed. Including:
- if there is a suspicion that the death is of a violent nature;
- if it is impossible to establish the final diagnosis of the disease that caused death;
- in the event that the patient was admitted to the hospital before death and spent less than a day here;
- if you suspect an overdose or intolerance medicines or diagnostic preparations;
- in the event that death occurred as a result of an infectious disease, oncology (in the absence of histological verification of the tumor). Also, if death is associated with preventive, diagnostic, instrumental, anesthetic,
- nimation, therapeutic measures, during or after the operation of blood transfusion and (or) its components;
- in case of birth dead child;
- if necessary, a forensic medical examination.
Is it possible to refuse?
The decision on the need for an autopsy is made by the hospital doctor or paramedic. If there is none of the above reasons, then the study is not necessary at all. But then why do people complain about the general direction in the anatomy? Most likely, there is no conspiracy here, it's just that most of the dead have recently been on the list of those required for autopsy.
Just in case, lawyers advise expressing one's will during one's lifetime: if the issue is controversial, then the doctor can meet halfway.
A wish can be expressed both orally, in the presence of witnesses, and in writing, - continues Zhanna Yevtushenko.
The application is written in free form, indicate the last name, first name, patronymic, address of residence. I, such and such, bequeath to bury myself without an autopsy (or refuse an autopsy). Date, signature, transcript of the signature. This letter remains with the family. Such a statement can also be written to the address of the organization that deals with the burial.
The law does not require mandatory certification of the paper by a notary, the expert clarifies. - In the absence of the will of the deceased, the spouse, close relatives (children, parents, adopted children, adoptive parents, siblings, grandchildren, grandfather, grandmother), other relatives or the legal representative of the deceased, and in the absence of such, other persons have the right to resolve the actions who took upon themselves the obligation to carry out the burial of the deceased (this is prescribed in Article 5 of the Law of 04/03/2007
No. 1436-OD "On burial and funeral business in Volgograd region»).
Practice shows that each situation is very individual, - they comment in the office of the Commissioner for Human Rights in the Volgograd Region. - For example, a citizen prepared a notice about the unwillingness to open his body after death, but after it was completed, during the inspection, representatives of law enforcement agencies had suggestions of possible violence. Then the doctors will reasonably conduct a post-mortem autopsy to establish exact reason of death. At the same time, at the autopsy of the body of the deceased patient, who was long time on an outpatient basis, for example after acute violation cerebral circulation (stroke), with confirmed entries in the medical book, doctors will not insist.
Marina Zlobina. Photo Publishing House "Volgogradskaya Pravda"
Autopsy(syn.: section, autopsy, obduction) - a study of the body of the deceased in order to determine the nature of the changes in it and to establish the cause of death. It is customary to distinguish V. pathoanatomical and forensic. Pathological anatomical - B. corpses of persons who died from various diseases in hospitals; production of pathoanatomical V. should be the rule for these institutions. Judgment-med. V. is produced by order of the judiciary in relation to the corpses of persons, the cause of death to-rykh can be assumed to be any violent or criminal acts.
V. corpse played an important role in the development of materialistic views on the structure of the human body, its functions and the essence of disease processes. V. is the main base for the development of problems of thanatology (see). A huge role belongs to V. in honey. education. Besides, it has big dignity. - epidemiological value, since quite often thanks to V. existence of these or those infectious diseases is established, to-rye could be the beginning of epidemic. In hospitals, V. controls the activities of hospital departments and compares clinical and pathoanatomical diagnoses (see Diagnosis, Diagnosis).
Story
The first autopsies of corpses date back to the last centuries BC.
In Egypt, by order of King Ptolemy II, the corpses of criminals began to be transferred to doctors for scientific research. The first anatomical studies of Herophilus and Hippocrates date back to this time. However, in subsequent times, under the influence of religious prejudices, the V. of corpses ceased; only a few, eg. K. Galen (2nd century AD), occasionally opened the corpses of animals. It is known that V. of human corpses produced Ibn-Sina; Leonardo da Vinci produced several dozen V. corpses. At the beginning of the Middle Ages, V. was viewed as a blasphemous act, and persons suspected of its production were prosecuted. During this period, few people managed to produce V. and publish its results [Mundinus (Mundinus), 13-14 centuries]. After a special encyclical (circular) of Pope Pius IV (16th century), which not only permitted, but also recommended V. to determine the causes of death, V. gradually began to enter as a scientific method into anatomy, pathology, and forensic medicine. V.'s significant role as scientific method attached A. Vesalius. However, even in the first half of the 19th century. V. were rarely made, and the departments of anatomy that existed at that time were in dire need of corpses. Usually V. were subjected almost exclusively to the corpses of people who did not have relatives. Subsequently, the number of V. in hospitals began to increase, and at the beginning of the second half of the 19th century. already opened 40-45% of all deaths in the hospital (Berlin Charité hospital).
Dissecting in Russia is more than two hundred years old; it arose from the appearance of the first hospitals, at which honey was founded from the very beginning. schools; in hospitals V. of corpses was made for the purpose of training listeners of normal anatomy. There were also court.-honey. V. for pedagogical purposes. The first anatomical theater was founded by decree of Peter I in 1706 at the Moscow hospital. The establishment of prosectoral work in Russia is associated with the name of P. 3. Kondoidi, who held a number of events that served as the beginning of the organization of prosectoral work.
Along with anatomical and court. - medical. V. in the first half of the 18th century. autopsies of a pathological anatomical nature were also produced.
In 1735, the General Regulations on Hospitals was published, in which it was prescribed to produce postmortem V. of corpses. By decree of 1745, all the corpses of the suddenly dead were delivered for V. to the anatomical theaters at hospital schools. In the "Instructions given to the junior doctors of general hospitals" (February 5, 1754), there were clauses regulating the dissecting business. In 1824, I. V. Buyalsky in the “Military Medical Journal” published “Guidelines for doctors to properly examine dead human bodies to indicate the causes of death, especially in forensic studies”, which introduced V.
Before the Great October Socialist Revolution in Russia, according to the existing rule, V. corpses were produced 24 hours after death; in hospitals, no more than 60-65% of corpses were opened; only in the clinics of the Moscow University has long been operating established rule on the mandatory autopsy of all those who died in them.
In 1919, if necessary, V. of the corpse was resolved earlier than the 24-hour period, but not earlier than half an hour from the moment of death.
In connection with the introduction of methods of electron microscopy and the development of V. transplantology, it is allowed to produce at any time after ascertaining by doctors to lay down. establishments biol, deaths (the order M3 of the USSR No. 667 of 15/X 1970, appendix No. 3; in the same place the instruction about V.'s order of corpses in to lay down. establishments).
Pathological anatomical autopsy
V.'s technique of a corpse developed and improved gradually. At the beginning of the second half of the 19th century. R. Virchow was the first to point out the definite and most rational order of V. of the corpse. The Virchow method is the most common and serves as the basis for all other methods (Geller - Zenker, Chiari, Letulle, Shor), which differ from it only in details.
Pathological anatomical V. is produced in specially adapted institutions that exist at hospitals and clinics (see the Pathological Anatomical Department), with special sectional tools. To prevent infection with infectious diseases, the dissector puts on a dressing gown and an oilcloth apron over the dress, and rubber gloves on his hands. The most real danger of infection with pyogenic flora from the focus purulent infection as a result of the remaining unnoticed pricks of the fingers with fragments of ribs, the tip of a scalpel, etc., for example, a cadaveric tubercle may appear on the skin of the dissector's hands in the area of the former injection.
V. must be made in daylight, because under artificial lighting it is difficult to make a correct conclusion about changes in the color of the integument and organs of the corpse.
Rice. 2. Cuts and cuts at the opening of some organs: 1 - separation of musculoskeletal flaps; bold lines - places of dissection of the costal cartilages and sternoclavicular joints; 2 - Medvedev's cuts for opening the neck; 3 - Medvedev's cuts for opening the hands; 4 - incisions for opening the heart; solid line - right ventricle, dotted line - left ventricle and aorta; 5 - incisions for opening the uterus; 6 - opening the cavities of the heart; bold lines and letters show the direction and sequence of incisions (a - b - c - the right half of the heart; d - e - e - the left half of the heart); 7 - incisions for opening the lungs; 8 - cuts for opening the kidneys, urinary tract, adrenal glands (bold lines) and large retroperitoneal vessels (dotted line); 9 - cutting line of the base of the skull for opening the paranasal sinuses (according to Kharka); 10 - places of dissections with a chisel of the base of the skull for opening (a - b - c - eye sockets; d - e - e - sinuses of the main bone and ethmoid bone; f - h - tympanic cavities); 11 - line of section of the brain according to Flexig; 12 - cuts for opening the base hemispheres brain; 13 - incisions for opening the cerebellum and pons (pons varolii).
For pathoanatomical V. of a corpse it is accepted general order. Before V., the opener and those present get acquainted with clinical course disease and lifetime diagnosis from the medical history or oral report of the doctor who observed the course of the disease. Then the autopsy performs an external examination of the corpse, noting data on the field, size, physique, constitutional appearance, nutrition, condition of the integument (color, cadaveric spots, rashes, hemorrhages, wounds, ulcers, scars, bedsores, tumors and swelling of the integument, etc. ), rigor mortis, cadaveric odor, determines the correspondence of the signs of the age of the deceased to the passport data. An external examination is followed by an incision and separation of the soft integument and V. of the cavities and organs of the body (Fig. 1 and 2). To do this, make the main incision of the integument, most often going from the chin to the pubis. Some use cuts of a different type. In all cases, care must be taken to ensure that the main sectional incision does not pass through postoperative wounds or defects. skin subject to special study. After the incision, the covers are separated and taken away from the midline; at the same time, the abdominal cavity opens and the chest cavity is exposed, which is opened by dissection cartilaginous parts ribs near the place of their transition to the bone parts. After V., the cavities are examined in detail with the elucidation of the peculiarities of the position and relationship of the organs, the presence of any accumulations, adhesions, etc., and then they begin to remove the organs from the corpse.
The procedure for extracting organs from a corpse and examining them may be different depending on the characteristics of the case. So, in the course of V., they deviate from the main method based on the data of the medical history and the results of the examination of organs in situ. The main method of extracting and examining organs in various pathoanatomical institutions, due to tradition, the characteristics of the school or the personal habit of the leader, may represent certain deviations from the Virchow scheme. In some in-tahs, organs are removed one by one, separating them from each other, in others, they prefer to extract organ complexes; nek-ry pathologists consider it rational to make cuts of bodies in situ, ie. before extracting them.
In the Moscow pathoanatomical school, proceeding from aspiration whenever possible, as A. I. Abrikosov described it, not to separate bodies and parts of anatomo-fiziol. systems, usually remove the organs of the neck and chest cavity in the form of a general complex, then separately the intestines, liver, stomach and duodenum- one complex; kidney, urinary tract and sexual organs also complex. In Leningrad, at autopsy, they mostly use the method of complete evisceration (G.V. Shor), which consists in the fact that the organs of the neck, chest, abdominal cavity and the small pelvis are removed in the form of one continuous complex, and in the future the organs are not separated from each other, but are examined in mutual connection. With V. corpses of patients who died after surgical interventions, produce thorough examination areas operating field(state surgical sutures, vessels, the presence and nature of the exudate, the correctness of the operation).
After the organs are removed from the corpse (by one method or another), their size, weight, shape, surface condition, color, consistency are studied; then if research hollow organs, make incisions and examine the surface of the incision and the condition of the cavities.
In case of V. of the skull, for the study of the brain, an incision of the integument of the head is made from one ear to the other through the crown of the head, the soft integuments of the skull are separated anteriorly and posteriorly from the incision, a circular cut of the skull is made and the vault of the skull is removed, after separation of the dura mater, the brain is removed and opened. To study the paranasal sinuses, a sagittal cut of the base of the skull is made (according to Harke). The spinal cord is removed after incision of the integument along the line of the spinous processes and opening spinal canal by sawing the posterior arches of the vertebrae. V. of the skull and spinal canal may precede or follow V. of the body cavities, depending on the characteristics of the case.
The last to open the limbs, if there are data for this; on the limbs examine the condition of the muscles, bones and bone marrow, joints, blood vessels, nerves.
At V. of corpses of newborns make a longitudinal cut of the lower epiphysis of a femur; with the help of this cut, the state of the line of endochondral ossification (the border between the epiphysis and diaphysis) is ascertained, which is important for the diagnosis of congenital syphilis, and the presence and size of the epiphyseal ossification nucleus are also established (see. Prematurity, radiological definition).
At the end of V., the detected changes are briefly summarized and the pathoanatomical diagnosis is reported, then the findings are compared with the lifetime manifestations of the disease and the development and manifestation of the underlying disease, its complications and the cause of death are explained from the point of view of the data found. From the organs and tissues of the corpse, material is taken for microscopic examination; in nek-ry cases the X-ray analysis of bones of a skeleton is made. In addition, often take material for bacterioscopic, bacteriological, serol., biochemical, and viral. research. Smears for staining for microbial flora upon detection of abscesses of organs, phlegmon, as well as purulent, purulent-hemorrhagic exudates of cavities are taken along B. For serol, research, blood is taken (in compliance with asepsis rules) from the femoral or cubital vein to V., from the right atrium and ventricle - along V.; cerebrospinal fluid receive with the help spinal tap, however, with appropriate precautions, it can be taken from the ventricles of the brain after the removal of the cranial vault. Taking of material for crops is made with observance of rules bacterial, equipments.
Taking material for bacterial, research in especially dangerous infections ( anthrax, plague, cholera, etc.) is regulated by the relevant instructions M3 of the USSR, compiled on their basis by service letters from local health authorities and guidelines All-Union scientific and methodological center of the pathoanatomical service at Ying-those human morphology of the USSR Academy of Medical Sciences. The same instructions determine the order of V. and organizational measures in case of suspicion of a particularly dangerous infection, for example, Urgent measures against the spread of infection, special protective clothing and disinfectant solutions (solutions of chloramine, bleach, carbolic acid, lysol) in the pathoanatomical department. It should be emphasized that the listed research methods in the conditions of therapeutically caused pathomorphism (see) are often crucial for pathoanatomical diagnosis. The order of V. can be significantly changed depending on the nature of the pathological process, the complexity of the surgical intervention, the need for special scientific research, for example, using a radiopaque method or preparation, etc. In some cases, to study the pathology of the brain, V. of the skull is produced after insertion through carotid arteries 5% formalin solution and other fixing mixtures.
In order to preserve the material for demonstration, it is not recommended to make unnecessary cuts in organs, especially in different directions. If necessary, photographs of the most important pathological processes, preservation of a picture of anatomic and topographic ratios to-rykh is important for the subsequent demonstration. The final moment of V. is the cleaning of the corpse: the organs are placed back into the cavities, the incisions are sewn up, the corpse is washed and dressed. Due to the fact that during V. no cuts are made on the open parts of the corpse, signs of the produced V. cannot be seen on the dressed corpse.
Recording of the autopsy is best done under the dictation of the autopsy. In the absence of appropriate personnel, and also, if necessary, during B., the detected changes should be explained in detail, the protocol should be written without delay, immediately after B.
In many pathoanatomical departments, typewriters are used to record protocols directly in the course of V.. There are attempts to use a voice recorder, according to Krom, the prosector transmits to the typist, who is in another room, the results of V. Recording the results of V. on tape widespread I didn’t get it, because with this method, the dissector spent much more time than when dictating the protocol directly in the sectional hall.
Each V. protocol consists of a descriptive part, representing a strictly objective and exact description found changes, and the final part, or pathoanatomical diagnosis, which determines the essence of these changes through brief pathoanatomical terms.
For greater clarity, it is advisable to illustrate the V. protocol with diagrams, for example, of surgical interventions, ready-made prints (stamps) of the contours of the body and internal organs. At the end of the protocol leave a place for recording the results of microscopic, bacterial. and other research.
The autopsy of the corpses of experimental animals should be carried out according to general rules accepted in practice; there are no special instructions.
Forensic autopsy
Forensic medical autopsy is made according to the decision of the investigating authorities and the ruling of the court in case of violent death or suspicion of it in case of sudden death (regardless of the place of its occurrence, when the cause of death is not established by the attending physician), death to lay down. institutions at the unspecified diagnosis, at admission to lay down. institution of the corpse of a patient who died on the way, when investigating complaints about incorrect or illegal treatment, upon discovering the corpse of an unknown person. The main purpose court. - medical. V. in accordance with Article 79 of the Code of Criminal Procedure of the RSFSR, the relevant articles of the Code of Criminal Procedure of the Union Republics and the "Rules for the forensic examination of a corpse" is to establish the cause of death, the nature of bodily injuries.
Judgment-med. V. of corpses is made by regular court. - medical. Bureau experts court.-med. examinations included in the system of health authorities. In the absence of such an expert, any doctor (expert doctor), regardless of his specialty, can be involved in the V. of a corpse. Therefore, every doctor should know the rights, obligations and degree of responsibility of experts set forth in the relevant articles of the Code of Criminal Procedure of the RSFSR and in articles 181 and 182 of the Criminal Code of the RSFSR, as well as in the relevant articles of the Code of Criminal Procedure and the Criminal Code of the Union republics.
Before V. of a corpse court. - honey. the expert must carefully study the documents delivered to him: the decision on the appointment of a court.-med. examination or order of the bodies of inquiry about V. of the corpse, a protocol for examining the corpse at the scene (or discovery), a medical history (if the corpse was delivered from a medical institution) and other materials of inquiry or investigation. If the materials necessary for the expert to give an opinion are insufficient, in accordance with Article 82 of the Code of Criminal Procedure of the RSFSR, he has the right to petition for the provision of the missing materials.
Judgment-med. V. of corpses should be carried out in daylight, in bright, specially adapted rooms (morgues), since the use of random rooms with insufficient lighting, as well as the presence of artificial lighting, distorts the color of the skin, organs under study and makes it difficult to use modern scientific and technical means. Judgment-med. V. it is advisable to produce in the presence of a representative of the investigation or inquiry, who issued a decision or order on V. Any stage of putrefactive change in the corpse cannot serve as a reason for refusing the court. - medical. C. When a frozen corpse is found, its opening is postponed until complete thawing in a room with an air temperature of 18-20 °; it is unacceptable to perform defrosting using various sources of high temperature, including and hot water, because it can distort the court.-honey. IN.
According to the “Rules for the forensic examination of corpses”, V. is allowed only after 12 hours. after death. In exceptional cases, it can be done earlier, but subject to the statement of death by a group of three doctors and the preparation of a protocol, in Krom, evidence of the onset of death is given, indicating the reasons, for which an earlier V.
An external examination of a corpse, as a rule, begins with an examination of clothing, which is of great expert and investigative significance. So, in pockets and folds it can be found, for example, suicide notes, medicinal substances; clothes may have damage, various marks and dirt associated with the incident, glass fragments and protector prints in case of car injuries, pellets, bullets, wads, soot and powder deposits in case of gunshot injuries, tears, cuts and other defects. All damage to clothing must be compared with the damage on the corpse. When V. of the corpse of an unknown person, clothing can contribute to its identification, therefore it must be characterized in detail (indication of the type and color of materials, style, size, etc.).
By removing clothes from the corpse, sex, age, physique, and degree of fatness are determined. At V. corpses of unknown persons for the purpose of their identification apply a method of a verbal portrait (see. Identification of the person ). In addition, attention should be paid to individual characteristics organism, malformations, the presence of scars, birthmarks, pigmentation and depigmentation, tattoos, traces of surgery. For investigative identification, forensic experts take photographs of the corpse (overview and detail), obtain fingerprints and draw up an identification card; during external examination determine the location and nature cadaveric spots, the state of rigor mortis, which makes it possible to judge the prescription of death. Coloring, intensity and arrangement of cadaveric spots make it possible to presumably judge the cause of death, as well as the initial position of the corpse, which could subsequently change. Inspection of the corpse to detect possible damage (abrasions, bruises, wounds, injection marks, entry and exit wound openings, etc.) begins with the head, then examine the chest, abdomen, back, limbs. Particular attention is paid to the examination of the eyes, ears, nose, mouth. Detected damages (their localization, size, color, depth, condition of the edges), possible overlays or contamination around and near the damage is carefully examined using objective methods; determine the signs of intravital or postmortem origin of injuries. By palpation, they are convinced of the presence or absence of damage to the bones of the face, head, chest, spine, pelvis, limbs. If necessary, cruciform incisions are made in soft tissues to differentiate subcutaneous hemorrhages and cadaveric spots. Then examine the external genitalia, the area anus; in women, attention is paid to the condition of the hymen: its integrity, fresh or healed breaks. If you suspect the presence of sperm and with discharge, smears are taken from the vagina for laboratory testing.
The internal examination of the corpse according to the technique has its own characteristics, due to the type of violent death (for example, with gunshot injuries, auto-injuries). Judgment-med. V. of a corpse necessarily provides V. of three cavities: cranial, chest and belly. If there are injuries in the spine or if they are suspected, the spinal canal is opened. In the presence of any injuries on the corpses, blood is taken to determine the group and type of affiliation. With V. of the cranial cavity, attention is paid to the integrity of the bones of the vault and base of the skull, to the tension of the dura mater, its blood supply, the color and nature of the blood in the sinuses (liquid, convolutions); when examining the pia mater - for transparency, swelling, purulent overlays. When examining the brain, the presence of foreign odors, the state of blood vessels, cortex, white matter, ventricles, determine the weight of the brain. After removal of the dura mater, the base of the skull is carefully examined. By chipping with a chisel, the cavities of the pyramids are examined temporal bones and sinuses of the main bone. After the main incision of the skin of the neck, chest and abdomen, if there is no suspicion of air embolism, begin to study the tissues of the neck. First of all, attention is paid to possible intravital hemorrhages from compression of the neck organs, to the integrity of the horns thyroid cartilage And hyoid bone. After removing the sternum with the cartilaginous part of the ribs, the chest and abdominal cavities are examined and their condition is noted. The organs are then removed. When examining the lungs, they describe their consistency, the presence of ecchymosis, the color of the surface and incision, blood filling, the presence of edema, etc. When examining the heart, the presence of ecchymosis under the epicardium or endocardium, fat deposits on it, blood filling and thickness of the muscle walls, the nature of the muscles in the incisions are noted , state coronary arteries and valves. Examining the state of the spleen, note the receipt or absence of scraping on the incision. Determine the condition of the mucous membrane of the esophagus. The stomach is opened (in a clean container) along the lesser curvature and the presence and degree of digestion of the contents are revealed, its quantity is measured, the color, smell, and texture are described; determine the presence of non-food substances (chemical substances, foreign bodies etc.); note the state of the mucous membrane, its blood supply. An autopsy of the small and large intestines is performed, the features of its contents and mucous membrane are established. Turning to the study of the liver, determine its density, color on the cut, pattern, blood supply, etc. At the same time, they examine gallbladder and patency biliary tract. The kidneys are examined simultaneously with the adrenal glands: the condition of the capsule and pelvis, the presence of stones, the color and severity of the pattern are noted. renal tissue, cortical and medulla of the adrenal glands. open up bladder and genitals, then the abdominal aorta and inferior vena cava. By palpation and incisions of soft tissues, they are convinced of the integrity of the bones of the spine and pelvis. The heart, spleen, liver and kidneys are measured in centimeters and weighed.
If at court. - medical. B. show signs of acute or especially dangerous infections, this is immediately reported to the sanitary epidemiological station, the station and the health department, and V. continues, performing the appropriate prof. Events.
If poisoning is suspected, the internal organs are opened in a clean container without the use of water. By directing organs to chem. analysis, are guided by the "Rules for the removal and direction of cadaveric material for forensic chemical research." When an adult is poisoned with an unknown poison, organs in the amount of 2 kg should be placed in carefully washed jars: in jar No. 1 they put the stomach with contents, 1 liter of small and large intestines with contents, in jar No. 2 - at least 2/3 of the most full-blooded sections of the liver and gallbladder with contents, in jar No. 3 - one kidney and all urine, in jar No. 4 - 1/3 of the brain, in jar No. 5 - the heart with the blood contained in it, the spleen and at least 1/4 of the most plethoric areas of the lungs. If you suspect the introduction of poison through the vagina, take the uterus with the vagina, and if you suspect the introduction of poison through the rectum - the rectum along with its contents. If subcutaneous or intramuscular injection poison take areas of skin and muscles from the site of the intended introduction of the substance. When poisoned, poisons in the body are distributed in individual bodies and tissues in different ways, therefore, depending on the alleged poison, the corresponding cadaveric material is also taken. For the purpose of quantification ethyl alcohol the blood taken from peripheral venous vessels (femoral, brachial) or bosoms of a firm meninx, and also urine in amount of 10 ml is directed to a research, to-ruyu type with sterile glass pipettes in separate sterile bottles.
At court.-med. V. corpses, in particular with sudden death, acute infectious diseases, poisoning, etc., there is a need for the production of other laboratory research. In this regard, the expert must know the relevant rules and instructions for the removal and direction of material for hist., biol., bacterial, botanical, spectral and other studies.
Forensic autopsy of the corpses of newborns makes it possible to establish live birth (see), full-term (see), viability (see), life expectancy of the baby after childbirth, cause of death (see Stillbirth).
A forensic re-opening of a corpse is carried out by order of the investigating authorities or by a court ruling in cases where it is assumed that the expert's conclusion is unfounded or there is doubt about its correctness. It is expedient to perform repeated V. on a commission basis and preferably in the presence of an expert who performed the primary V.
Documentation. At court.-med. autopsy, a document (conclusion, act) is drawn up, in which the actual data are necessarily and accurately recorded, on the basis of which conclusions are drawn that answer the questions of the bodies of inquiry, investigation and court. The document is drawn up in a specific form and consists of three sections - introduction, descriptive part and conclusions.
The introduction provides data on who produced the V. of the corpse (last name, first name, patronymic, position, specialty, qualification category, academic degree); time and place of V., on what basis it was produced; name, patronymic, surname and age of the deceased; who was present at V., what questions were put to the expert. This section includes the subsection "Preliminary information", which includes brief information from the materials presented by the investigation (protocol of inspection of the scene and the corpse, medical history, etc.).
The descriptive part has two subsections: external examination and internal inspection. When compiling a descriptive part, it is necessary to adhere to certain rules: it is impossible to use Latin words, diagnostic terms and designations instead of describing certain visible changes in the organs; to the descriptive part of the conclusion (act), especially when V. died from trauma and if there are injuries on the corpses, it is necessary to attach the contour diagrams of the human body with the application of the detected injuries and features to them, photographs and sketches are desirable. When describing damage, one cannot resort to various comparisons; dimensions are given in centimeters, shape in geometric shapes, coloring by color of spectrum bands and their combinations.
Conclusions - one of the critical parts of the conclusion (act). In them the scientifically grounded, objective conclusion of the expert about the cause of death and the motivated answers to the questions put by a consequence confirmed by morfol, changes is stated. The expert's legible signature is put under the conclusions.
The conclusion (act) is drawn up either in the process of V., when the expert dictates it to the laboratory assistant, or immediately after the end of V.
Documentation for repeated V. is made up, as in the case of primary V.; it notes what was opened initially, what defects were found and what was installed again. See also Corpse, Examination (forensic), Exhumation.
Bibliography: A. I. Abrikosov. Technique of post-mortem autopsies, M., 1948; Golovin D. I. Autopsy of corpses (method of complete evisceration), Chisinau, 1957; Zhitkov V. S. Fundamentals of the technique of forensic examination of corpses, Yuzhno-Sakhalinsk, 1969, bibliogr.; Medvedev I. I. Fundamentals of pathoanatomical technology, M., 1969; Guidelines on the forensic medical examination of the corpses of infants and early age who died from acute respiratory diseases, M., 1973; Naumenko V. G. and Grekhov V. V. Technique of a sectional research at a craniocereberal injury, M., 1967, bibliogr.; Khazanov A. T. and Ch and l and with about in I. A. Introduction to the sectional course, M., 1969, bibliogr.; Khrushche-levski E. and Shperl-Zey-fridova G. Section of corpses of fetuses and newborns, trans. from Polish., M., 1962; Shor G.V. On the death of a person, p. 224, L., 1925; Falk H. u. Pfeifer K. Praktische Sektionsdiagnostik mit Schnell-methoden, Lpz., 1964, Bibliogr.
I. V. Davydovsky, H. K. Permyakov; V. I. Prozorovsky (court).
Popular rumor associates many different fictions and legends with the profession of a forensic scientist. This happens largely due to the fact that his activities are already very specific, and, frankly, few people can remain indifferent if we are talking about the dead human bodies. Our photojournalist Kostya Voks tried to lift the veil of secrecy about the work of detectives in white coats.
1. Every day, 10-15 injured persons come here on their own for an examination of bodily injuries (including accidents). But in most cases, people who will never see the white light again are delivered to this almost century-old complex. Corpses with signs of violent death are the main "patients" of this institution
2. This is a branch of the Center for Forensic Medicine under the Ministry of Health of the Republic of Kazakhstan. Previously, the organization was called the Almaty Bureau of Forensic Medical Examination. The institution conducts forensic medical examinations based on the decision of the investigative authorities: inquiry, investigation, court, prosecutor's office
3. The furnishings, as you can see, are not the most modern. All examinations are carried out free of charge as part of the investigative measures. But in last years The center provides paid services individuals for conducting an examination, in which only the presence of any bodily injuries is ascertained, chemical and toxicological tests of blood and urine for the presence of alcohol and drugs with the issuance of an examination certificate. But such a document is not valid in court.
4. Takhir Khalimnazarov - Deputy Director for expert work of the Almaty branch of the Center for Forensic Medicine.
- Our service involves not only work in the morgue, as many people think. Mortuary is one of the divisions of forensic medicine. We also have a department for the examination of victims, defendants and other persons - in other words, a department for the examination of living persons. In addition, we also have auxiliary laboratory divisions in the structure, these are the “Forensic Biological Department”, “Forensic Histological Department”, “Chemical and Toxicological Department” and “Medical Forensic Department”. All departments of the institution work to conduct additional research and expertise. There is also a department of complex examinations, in which repeated examinations and examinations requiring the participation of the commission are carried out.
5. All the work of the Center takes place in close relationship with law enforcement agencies. The conclusion of a forensic medical examination is one of the most important evidentiary materials. In any incident involving the death of people, according to the law, it is necessary to carry out an examination
6. Due to the fact that the working conditions here are considered difficult, and the specifics of work in itself are harmful to health, a shortened working day is provided for experts - from 8 am to 3 pm. After 3 p.m., only the forensic expert on duty remains.
7. When a corpse is found with signs of violent death or with suspicions of it, the forensic expert on duty, together with the operational group, leaves for the scene. It also helps the investigator in describing external injuries on the corpse and early cadaveric phenomena so that later it would be easier for another expert who will perform the autopsy to determine the time of death
8. In the forensic-histological department, microscopic examination pieces of internal organs removed during the autopsy to establish or confirm the diagnosis
9. In the chemical-toxicological department, studies are carried out that reveal the release of poisonous, narcotic, psychotropic and potent substances in the human body
10. In the medical forensic department, the objects of research are traces of damage or imposition on the human body. They also carefully examine the marks on clothing that have arisen due to interaction with sharp and blunt objects. Also, blood stains are being examined.
11. Ballistic research is being done here. The experts of this department establish the fact of being hit by firearms, the amount of damage and the sequence of shots. In addition, they can determine the location of inlets and outlets, the distance of shots, indicate the type and characteristics of firearms and ammunition, and also tell what position and position the person was in at the time of the shot.
12. By the way, experts can tell everything from the remains: race, gender, age, lifetime growth, structural features of the body, diseases that were during life, bodily injuries
13. These expert studies are able to reconstruct all the events of the crime committed
14. In the forensic biology department, examinations are carried out with the study of blood, secretions, hair, muscles, bones and other biological objects originating from humans
16. Cytological studies carried out to establish the sex of a person by blood, saliva, hair and cells
17. According to the law, an expert is given a month to give an opinion. After the autopsy, he issues a medical certificate of death (it can be preliminary or final), where he indicates immediate cause death
18. Given the greater volume of work, it happens that laboratory departments do not always have time to issue the results of studies within the time frame provided for this. In this case, the expert comes with a petition to the investigator who appointed this expertise, with a request to extend the deadlines
19. People who died from diseases in hospitals are not brought here. For this there is a pathological anatomical service of the Department of Health.
20. The volume of work is very large, 5-10 corpses arrive here daily
Epigraph:
I don't grumble
That God took the baby
And it hurts why they
Cursed over him?
Why, like black crows,
Part of the body is white
Tormented? .. Really
Neither God nor the king will intercede?
Vikenty Veresaev, "Doctor's Notes"
When is a pathological anatomical autopsy scheduled?
In any case, death. Violent, from illness or from natural causes. That is, die man in the hospital from known diagnosis, at home, if he gets into a disaster or is killed - an autopsy will most likely be carried out.
Why close people do not want an autopsy?
You just don't want to, that's all. This man, this corpse belongs to them and to God, but not to the doctors, dissectors, pathologists who perform the autopsy. "Religious reasons" also exist. Some religions do not provide for an autopsy.
Why do you need to do an autopsy?
To try and find out true reason death, illness. Evaluate the correctness of treatment, identify and punish those responsible. "Here the dead teach the living" - definitely yes. When the attending physician goes to the pathology department and sees the organs of the person he was trying to treat, punctures, palpates, prescribes pills, a serious experience is formed in the doctor’s head for the future, an opinion appears about the correctness of his actions. He looks at the patient differently. In the case of similar symptoms, it can draw more correct conclusions.
And further. If the patient's relatives decide in a couple of months that the doctors are still murderers, it will be very difficult to prove something without an autopsy. This can be used by the warring clans of heirs when dividing property.
What happens when medical errors are discovered?
Usually nothing. The hand washes the hand. In the history of the disease, the pathoanatomical diagnosis differs from the clinical one, the case is analyzed at the clinical and anatomical conference (if death is in the hospital) and that's it. Divergence of the diagnosis. Healed for someone else. This information does not reach the relatives of the deceased. The death certificate contains a pathological diagnosis. And rightly so. The point is that it is usually more accurate diagnosis nothing changes in the fate of a person. Ah, if only… no. If a person has to die, he will die. Of course there are serious mistakes, but rarely. And, as far as I know, even in the case of obvious mistakes, doctors themselves do not write letters to the prosecutor's office.
What do they say to the relatives of the deceased at the request "not to open". And how to act?
The doctor hesitates, says that this is the way it should be, and an autopsy is mandatory. In this case, the Aesculapius do not own the topic of legislation more deeply and send people to the administration medical institution. There, if you really want to prohibit the autopsy, a statement is written:
"I ask you not to perform an autopsy on my **** who died then, in such and such a department, for religious reasons. I understand that in case of refusal to perform an autopsy, the possibility of accurately establishing the cause of death may be lost, I have no complaints against the hospital."
All. If such an application is written and a forensic autopsy is not scheduled, the pathologists will not touch the corpse. And what exactly "Religious reasons" - no one will ask, and if they do, you can answer "It's none of your business." In this case, the refusal of the hospital administration is a violation of the law.
Forensic autopsy.
Held in special morgues. It is prescribed if there is a suspicion of a violent death, whether it be trauma, poisoning, or any other reason. This opening cannot be avoided in any case.
Economics of pathology.
The hospital earns handsomely on their own dead. Each post-mortem examination costs money, this money is paid by the insurance company after the fact (CHI). Naturally, the administration of the hospital is directly interested in opening all the corpses. Business…
Whose corpses are usually not opened?
1. Natsmenov. A noisy flock will come running, screaming, talking loudly, in the end they manage to cancel the autopsy.
2. Relatives of doctors and important people. People quietly piglets and they go to meet or demand or pay :).
Legislation.
The main rule on the basis of which the pathoanatomical service now operates is Order of the USSR Ministry of Health of June 20, 1959 N 316. Since then, he has been rewritten several times, but in essence everything remains as it was formulated 50 years ago. The text of that order. And here is the order of the Ministry of Health of 1994, number 382.
The topic of refusing to open an autopsy is also considered in the Basic Law of present-day Russia. I quote article 48 in full:
BASIS OF THE LEGISLATION OF THE RUSSIAN FEDERATION ON PROTECTION OF THE HEALTH OF CITIZENS
(As amended by Decree of the President of the Russian Federation No. 2288 dated December 24, 1993; Federal Laws No. 30-FZ dated March 2, 1998; No. 214-FZ dated December 20, 1999)
Article 48
Carrying out pathological anatomical autopsies.
An autopsy is performed by doctors in order to obtain data on the cause of death and the diagnosis of the disease.
The procedure for conducting pathoanatomical autopsies is determined by the Ministry of Health of the Russian Federation.
For religious or other reasons, if there is a written statement from family members, close relatives or a legal representative of the deceased, or the will of the deceased himself expressed during his lifetime, a post-mortem autopsy is not performed in the absence of suspicion of violent death, unless otherwise provided by the legislation of the Russian Federation.
The conclusion on the cause of death and the diagnosis of the disease is issued to family members, and in their absence - to close relatives or the legal representative of the deceased, as well as to law enforcement agencies at their request.
Family members, close relatives or the legal representative of the deceased are given the right to invite a specialist of the appropriate profile, with his consent, to participate in the pathoanatomical autopsy. At the request of family members, close relatives or the legal representative of the deceased, an independent medical examination may be carried out.
