Pathological anatomical autopsy. Autopsy of a dead body in the morgue: stages and photo of the procedure
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).
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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 persecuted. 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. A. Vesalius attached a significant role to V. as a scientific method. 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 clinics of Moscow un-that the established rule about obligatory opening of all dead in them already for a long time acted.
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.
Pathoanatomical 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 of purulent infection as a result of remaining unnoticed pricks of 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; g - h - tympanic cavities); 11 - line of section of the brain according to Flexig; 12 - cuts for opening the base of the cerebral hemispheres; 13 - incisions for opening the cerebellum and pons (pons varolii).
For pathoanatomical V. of a corpse the general order is accepted. Before V., the autopsy and those present get acquainted with the clinical course of the disease and the lifetime diagnosis from the history of the disease or the 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, it is necessary to ensure that the main sectional incision does not pass through postoperative wounds or skin defects that are 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 dissecting the cartilaginous parts of the ribs near the place of their transition into 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 pathological 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 extract the organs of the neck and chest cavity in the form of a common complex, then separately the intestines, liver, stomach and duodenum - in one complex; kidneys, urinary tract and reproductive organs are 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 cavities and small pelvis are removed in the form of one continuous complex, and in the future the organs are not separated from each other, but explore them in mutual connection. When V. corpses of patients who died after surgical interventions, a thorough examination of the area of the surgical field is performed (the condition of surgical sutures, blood vessels, the presence and nature of 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 hollow organs are examined, incisions are made and the surface of the incision and the condition of the cavities are examined.
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 cutting the integument along the line of the spinous processes and opening the 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, the condition of muscles, bones and bone marrow, joints, blood vessels, and nerves is examined.
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 a 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 is obtained by lumbar puncture, but with appropriate precautions, it can be obtained from the ventricles of the brain after removal of the cranial vault. Taking of material for crops is made with observance of rules bacterial, equipments.
The taking of material for bacterial, research in especially dangerous infections (anthrax, plague, cholera, etc.) is regulated by the relevant instructions M3 of the USSR, official letters of local health authorities compiled on their basis and methodological recommendations of the All-Union Scientific and Methodological Center of the Pathological Anatomical Service at Institute -those human morphology of the Academy of Medical Sciences of the USSR. 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 the radiopaque method or preparation, etc. In some cases, to study the pathology of the brain V. of the skull produced after the introduction through the carotid arteries of a 5% solution of formalin 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, along the course of V., the most important pathological processes are photographed, preserving the picture of anatomical and topographic relationships to-rykh is important for 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 dissector transmits the results of V. to the typist, who is in another room. directly in the sectional hall.
Each V. protocol consists of a descriptive part, which is a strictly objective and accurate description of the changes found, and a 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 the general rules adopted in practice; there are no special instructions.
Forensic autopsy
A forensic autopsy is performed by order of the investigating authorities and a court ruling 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. corpses should be carried out in daylight, in bright specially adapted rooms (morgues), because 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 expedient to make in the presence of the representative of a consequence or inquiry which has taken out the decision or the instruction about V. Any stage of putrefactive change of a corpse cannot serve as the reason of refusal from 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 thaw using different sources of high temperature, including hot water, since this can distort the court data. AT.
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 can be damaged, various blots 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. the corpse of an unknown person, clothing can contribute to its identification, so it must be described in detail (indication of the type and color of materials, style, size, etc.).
By removing clothes from the corpse, sex, age, physique, 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 the individual characteristics of the body, malformations, the presence of scars, birthmarks, pigmentation and depigmentation, tattoos, and 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, the location and nature of cadaveric spots, the state of rigor mortis are determined, which makes it possible to judge the prescription of death. Coloring, intensity and an arrangement of cadaveric spots allow to presumably judge the cause of death, and also about an initial position of a corpse, a cut could change subsequently. 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 damage (their localization, size, color, depth, condition of the edges), possible overlays or contamination around and around the damage are 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 the soft tissues to differentiate subcutaneous hemorrhages and cadaveric spots. Then examine the external genitalia, the 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 discharge, swabs 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 the vessels, cortex, white matter, ventricles are noted, and the weight of the brain is determined. After removal of the dura mater, the base of the skull is carefully examined. By chipping with a chisel, the cavities of the pyramids of the temporal bones and the sinuses of the main bone are examined. After the main incision of the skin of the neck, chest and abdomen, if there is no suspicion of an air embolism, they begin to examine 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 of the 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 , the state of the 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, 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. e. At the same time, the gallbladder and the patency of the bile ducts are examined. 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 of the renal tissue, the cortical and medulla of the adrenal glands are noted. The bladder and genital organs are opened, 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. V. find signs of acute or especially dangerous infections, this is immediately reported to the sanitary epidemiologist, 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 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 of poison is suspected, skin and muscle patches are taken from the sites of the intended introduction of the substance. In case of poisoning, poisons in the body are distributed in individual organs and tissues in different ways, therefore, depending on the alleged poison, the corresponding cadaveric material is also taken. For the purpose of quantitative determination of ethyl alcohol, blood taken from peripheral venous vessels (femoral, brachial) or sinuses of the dura mater, as well as urine in the amount of 10 ml, is sent to the study, which is collected with sterile glass pipettes into separate sterile vials.
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 tests. In this regard, the expert must know the relevant rules and instructions for the removal and direction of material for hist., biol., bacteriological, botanical, spectral and other studies.
Forensic autopsy 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 advisable to carry out 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”, where brief information is entered from the materials submitted by the investigation (the protocol of the inspection of the scene and the corpse, the medical history, etc.).
The descriptive part has two subsections: external examination and internal examination. 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 figures, 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. Under conclusions the legible signature of the expert is put.
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 young children who died from acute respiratory diseases, M., 1973; Naumenko V. G. and Grekhov V. V. Method of section research at a craniocerebral 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 Sperl-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 is largely due to the fact that its activities are already very specific, and, frankly, few people can remain indifferent when it comes to 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 on the basis of a decision of the investigating authorities: inquiries, investigations, courts, prosecutors
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 recent years, the Center has also provided paid services to 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 units 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 conduct the autopsy to establish the time of death.
8. In the forensic histology department, a microscopic examination of pieces of internal organs removed during the autopsy is carried out 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 say 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 a person
16. Cytological studies are 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 the immediate cause of death
18. Given the larger 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
Yes, the first impression of the autopsy is very strong. To mentally prepare, first you need to imagine in advance what you will expect there. I am not a pathologist, so I will describe my impressions in a simpler language. Enter the morgue and you will be enveloped in a veil of heavy, vile smell. There are corpses preparing for autopsy - of any age and gender. Their scalps have been cut off and pulled over their faces. The picture looks like this:
Then the opening of the skull begins. The pathologist (or orderly) cuts the bones with a saw (it looks like sawing a log, the head dangles from side to side), opens the skull, removes the brain (crosses the brain stem with a long knife). The brain puts on the table and cuts into pieces. Looks for tumors, hemorrhages, evaluates the general condition. Puts a few pieces in jars with a solution. After extracting the brain, we observe this:
Then the chest is opened. An incision is made with a knife from the neck to the xiphoid process, then the ribs are cut off from the sternum. The pathologist takes out the sternum, pushes the ribs apart and takes out the lungs, heart and bronchi, trachea, and vessels.
These organs are placed on the table, studied, cut. The smell from the brain, lungs and heart is the least noticeable.
Next, the stomach is torn open and the stomach, intestines, liver, spleen are removed. When opening the abdomen, a layer of yellow subcutaneous fat is clearly visible even in thin corpses. If the corpse is thick, then swollen intestinal loops fall out after cutting.
This organ complex is placed on the table and each organ is cut. The stomach is opened, its contents are scooped up with a small scoop. The foul odor intensifies. It is better to take a medical mask with you - it slightly weakens the smell. You can see undigested food residues in the gastric juice, slightly crushed. The small intestine is then cut. Its contents are poured onto the table - a lot of yellow diarrhea. The smell is such that the eyes begin to water, the sight makes you sick. But the pathologist is imperturbable - he carefully cuts, studies, tells something, jokes, discusses current affairs. Along the way, the liver is cut, the gallbladder, spleen are opened. It comes to the large intestine - diarrhea darkens and thickens. When the lower part of the large intestine, the rectum, is cut, formed dark brown masses are visible. Fecal notes penetrate the smell.
Then the kidneys and bladder are removed.
And here we see a gutted human corpse
Then the remains of the organs are again placed in the corpse, the orderly sews up roughly and the deceased is ready for burial. After the end of the autopsy, the doctor takes off his dirty clothes, washes his hands, washes himself and goes to drink coffee - at the exit or outside the door there is just a dining table with a kettle.
Impressions are very strong. For several days, when you look at people, you imagine their internal organs. You look at your stomach and imagine the insides. Even sexual desire disappears for a few days.
Therefore, be prepared for loss of consciousness (particularly impressionable girls fainted), nausea or vomiting (it is better to drink antiemetics before opening), temporary loss of libido. With each time, openings are transferred easier and easier.
Thank you very much for the detailed answer. But tell me, how in general, in principle, to accept the fact that a person lies dead, gutted? The very essence of the fact that a person is dead and has not yet been opened brings me into shock and into real panic. How to accept this morally? I understand that it’s a matter of practice (but I’m not even a doctor, but a psychologist who is taken to morgues), but I can’t console myself with the fact that this is natural.
An autopsy, it is also an autopsy or a section, is performed to examine the body of the deceased in order to determine the cause of death or to study its structure, determine changes in tissues and organs. There are three main types of this procedure: anatomical, forensic and post-mortem. These types of autopsies differ somewhat in the features and sequence of manipulations.
Anatomical autopsyThese autopsies are produced, of course, in the departments of anatomy. They pursue one single goal - the study of the structure of the human body. Pathological anatomy as a subject is usually studied by medical students in the third year, because ideally, every doctor should have a thorough knowledge of the skills and abilities of a forensic expert in order to conduct an examination in the absence of a specialist if necessary. But in reality, such cases are extremely rare, nevertheless, a theory is needed.
Pathological anatomical autopsy
All those who died in hospitals are traditionally subjected to a post-mortem autopsy, which is strictly regulated by a special Instruction.
The process is carried out after two hours after fixing the moment of death. This is done by certified pathologists in specially equipped rooms. The purpose of the cadaver section is to establish the cause of death or the underlying disease, the complications caused by it. It is by the results of necropsy that one can adequately assess the correctness of the diagnosis made by the doctor and the prescribed treatment, which is very important for improving the treatment and diagnostic activity. Before starting work, the pathologist and his assistants put on overalls and perform an external examination of the body, paying special attention to the condition of the skin, the consequences of rigor mortis, tumors, ulcers, etc. After that, the autopsy begins directly. The chest cavity is opened by dissection of the costal cartilages, the abdominal cavity is examined, noting the characteristic features in the location of the internal organs. An incision of the soft tissues of the head from ear to ear begins the opening of the skull, which is then sawn in a horizontal direction, and the brain is removed. The internal organs are fished out of the corpse in a strictly designated sequence. In this case, they begin with the neck, chest, abdominal cavity and end with the small pelvis and genitourinary system. Each extracted organ is examined in turn, its weight, surface condition and color are determined and recorded. If necessary, pieces are taken for various studies: bacteriological, biochemical, histological, etc. After that, all organs are placed back into the body, all incisions are sewn up, the corpse is washed and clothes are put on it. Naturally, according to the results, a protocol is drawn up, which indicates an epicrisis and a pathoanatomical diagnosis, that is, a conclusion about the mechanism and the actual cause of death.
Forensic autopsy
This autopsy must be carried out in every case of violent death or if one is suspected of such, usually by court order. This autopsy involves determining the exact time of death, its cause, the presence of alcohol or drugs in the blood. They also begin a primary external examination, pay attention not only to injuries, cadaveric spots, putrefactive phenomena, but also to the victim's clothes. At this point, it is established what and how the damage was done. The officially unidentified dead have individual signs that can later help in establishing the identity of the deceased. While the corpse is in the morgue, an act is drawn up, or rather a conclusion, in which, depending on the appointed examination, the forensic expert answers all the questions posed.
If you open a heavy door with the inscription "Mortuary. No outsiders allowed" and walk a few steps, you can see a normal corridor with a pair of empty gurneys. After walking a couple of steps, you convince yourself that everything is not so scary - and then the smell overtakes you.
Remember the rhyme from childhood "What do crafts smell like?" - about the smell of dough in a bakery or the smell of shavings in a carpentry shop? Well, the morgue smells like death.
The wrong side of human life, its most unpleasant side - death, meets you in the morgue naked and unadorned. And people of various professions work at this penultimate stop of the express "life - eternity" - forensic experts, medical registrars and orderlies. These people have one task - not only to help relatives to see a loved one on their last journey, but also to determine whether a person went there due to someone's intention or fault.
The difference between a pathologist and a medical examiner is in fault
The average layman does not care about the specifics of the professions of a pathologist and forensic expert - until someone dies. Here you have to involuntarily delve into the subtleties of the profession.Death in the hospital, without suspicion of violent death - the deceased is sent to the pathologist. His task is to establish: did he die as a result of the disease and was his death inevitable - perhaps the diagnosis was erroneous, perhaps the treatment was incorrect?
All other cases fall within the area of responsibility of the forensic expert: whether a person died at home or on the street, there are signs of violent death or absent. The expert's task is to find the cause of death and answer the question: "Whose fault?" before himself and the law. Disease, coincidence or someone's malicious intent?
A man lived yesterday, loved - and he was loved, and today - he is on the sectional table. The reason for this is a disease that neither he, nor relatives, nor doctors suspected. It's non-violent sudden, death, but only a forensic expert can determine this.
A man fell in the bathroom and hit his head violent, premature death, let it be qualified as an accident.
A person gets on the table like a drowned man who fell through thin ice while fishing, but it turns out that first they crushed his head, and then threw his body into the hole - this is not just violent, it is criminal death.
Finding answers to all the riddles posed by a dead body is the job of a medical examiner.
Mortuary - penultimate stop
Forensic experts of the Office of the State Forensic Examination Committee of the Republic of Belarus for the Minsk region work in a morgue on the outskirts of the capital. The bodies of the dead and dead are brought here from several districts of the region.
- The complex consists of several buildings - in addition to the mortuary, administrative premises, forensic medical examination department, it houses a funeral services store and a farewell hall, - the state medical forensic expert starts the tour Mikhail Klimenko.
Before us are three doors, as in a gloomy fairy tale. If you go straight - you will get into a ritual store, if you go to the left - you will find yourself in a mortuary, to the right - you will visit the "department of a forensic medical examination for the reception of living persons."
- This is an outpatient appointment, at which an examination of persons is carried out to determine the nature of the severity of bodily injuries, and if it is simpler, an examination of the victims,- continues our guide.
It turns out that even among forensic experts there is a specialization. In addition to experts involved in the reception of living persons and autopsies, there are also histologists - they conduct research on tissue samples and determine the time, causes of death and prescription of injuries from them. Medical forensics can tell a lot from marks on clothing or a crime weapon. Chemists will answer the question of whether a person drank and how much, whether he took medicine or drugs, and if a person was poisoned, then with what kind of poison. Specialists of the biological department determine the objects of bioorigin and their belonging to a particular person - blood, secretions, hair, and so on. But there are still expert biochemists and many other narrow specializations.
We are led to the left - to the morgue. We pass into a small corridor, doors, another corridor with empty gurneys - and then we are overtaken by a smell.
The guide, noticing our reaction, gives us time to get used to him, showing us the sanitary room. In a small room with a glass roof fit several desks, a sofa and even a refrigerator with a microwave.
- How can you eat here?
- A person gets used to everything. I no longer smell, sniffed for 2 months, says one of the nurses.
In his opinion, the work in the morgue is calm, at the same time interesting, and, as we could see, it sets you in a philosophical mood.
- Aren't you afraid of the dead?
- Now I'm more afraid of the living.
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Painting on the wall in the sanitary room: specificity - appropriate |
Everyone needs to be respected - both the living and the dead.
The dead and dead enter the morgue from the back door. A minibus pulls up, the doors swing open, and a gurney with a body rolls out. Orderlies are in charge of receiving and processing documents, they also conduct an inventory of property and prepare the body for autopsy.
The brain protects its owner from shock - corpses on gurneys are not perceived as people, but rather like mannequins or wax sculptures. It is all the more strange to watch how the orderlies quickly but carefully shift the bodies and close the eyes of the dead - when someone close did not do this.
- Respect everyone - both the living and the dead, one of the orderlies remarks.
The autopsy itself is carried out in a sectional room, which is separated from the rest of the morgue by a room that serves as either a dressing room or a preoperative room. In this small room, experts and their assistants prepare for the autopsy: they put on special equipment - a blouse, pants, a dressing gown, an apron, a cap, a mask and special shoes.
Sectional - a small, unexpectedly bright room. In addition to a huge lamp, there is a large window with a frosted film, such glass transmits light well, but does not allow those passing by it to see what is happening in the room.
- Lighting is an indispensable assistant in our work. A simple example: when a bruise is just formed, it is burgundy, then turns blue, turns green, turns yellow. It is important for an expert to determine when he appeared, and natural light does not allow you to make a mistake.
On the sides of the entrance to the room - two metal sectional table. In some ways, they look like huge shower trays, the built-in sink, shower and drain for liquids add similarities.
There is also a small desk in the sectional room. During the autopsy, a medical registrar works behind him, whose task is to help the expert, leading the autopsy protocol under dictation. This position is usually occupied by women with a secondary medical education.
The tools that the expert uses during the autopsy look intimidating - a sectional knife, scissors, a saw, a hammer, a measuring spoon and something else, it is simply scary to ask about the purpose of some of them.
- This is not the whole set., - Mikhail Klimenko comments. - There is no need to place all the instruments on the preparation table - as needed, they are taken out of the cabinet and handed over by an assistant. 
The orderlies shift the prepared body from the gurney to the table - the autopsy begins. The human brain is dissected using the "open book method": a scalp is removed from the head, the skull is opened - this is done with an electric saw - the brain is taken out and cut into "leaves". The corpse itself is usually opened according to the Shor method. A median incision is made on the body, through which the entire organ complex is removed, starting from the tongue and ending with the rectum. The expert must weigh each organ and carefully examine, describing the condition and damage to the medical registrar. Samples are taken immediately for histological, chemical and other analyses.
- Stories that we take organs for experiments or feeding to pets are stories. From each organ we take a fragment half a centimeter thick and 1-2 centimeters long. After analysis, all biological samples are disposed of by cremation,- says the expert.
In the morning, the expert performed three autopsies - all three died of natural causes. And only in one case, the specialist could not immediately accurately determine the cause of death - despite the obvious signs of heart failure, the deceased drank a lot of alcohol, so the test results will be able to give an accurate answer to the question "alcohol poisoning or heart failure".
After opening, all organs are placed in the body, and the nurse sews up the incision. Then the body is washed, put in order and prepared for transfer to relatives.
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On one of the tables there is a cheerfully colored blanket, on it is a set of cosmetics. Relatives often ask: "Make it prettier" |
We are relieved to go outside. The light seems unusually bright, the air - unusually fresh, and life - beautiful and amazing.
You can and should be afraid of death, but it will not be possible to avoid it.
People die every day. Unfortunately, not a single duty of a forensic expert can do without autopsies.
On average, the morgue of the Office of Forensic Medical Examinations in the Minsk region, serving the Minsk, Logoisk districts and Zaslavl, receives 3-4 "patients" a day.
The medical examiner talks about what kills Belarusians.
- In my opinion, the most dangerous killer is alcohol. One way or another, it becomes the cause of death in half the cases.
A person who does not drink much has a protective mechanism - as soon as he "goes through" the norm, the gag reflex comes into play, which frees the body from excess alcohol. In an alcoholic or just a person who drinks a lot, the reaction is suppressed. He goes beyond the line where alcohol is absorbed in any quantities, but the body can no longer cope with such doses, which leads to death - alcohol poisoning.
There are also cases of poisoning by alcohol substitutes - various liquids not intended for internal use, but nevertheless used instead of alcoholic beverages, ranging from cologne to "singed" vodka based on technical alcohols.
Another reason for numerous deaths due to alcohol: after drinking, he fell from the balcony; got hit by a car in a state of intoxication; quarrels and conflicts in a drunken stupor, which often end in a stabbing, fight and death.
And if we add to all of the above all those diseases that arise on the basis of alcohol abuse and ultimately lead to death ...
The expert is also frightened by the number of suicides.
- I don't do statistics, but there are too many of them. Someone gets tired of fighting the disease, someone - with lack of money, someone - with loneliness. It is customary to feel sorry for suicides, but I cannot do this. Working with death every day, it is hard to imagine that someone of their own free will can refuse such a gift as life.
The worst thing is that suicides have become "younger". Mikhail Klimenko is not talking about those who are over 30 - we are talking about teenagers. Recently, he had to deal with the autopsy of a tenth grader.
- The child hanged himself because of unhappy love. And this is not an isolated case. What is going on in the minds of these children?
Listening to an expert, you involuntarily wonder: is there at least one positive side in this work?
- The medical examiner must determine the exact cause of death. He can establish that the driver who hit a person lying on the road has already run over a corpse. Or she can prove that a woman who was severely beaten by her husband for decades and who only once rebuffed him, pushing him away, did not cause his death. He didn't die from a fall, it was alcohol poisoning that killed him.Do you think the triumph of justice is a sufficient reason to love your profession?
From visiting the morgue and talking with the forensic expert, there is an ambiguous impression that cannot be formulated: "we will all be there" is intertwined with the thought "how you want to live."
Death is to be feared, but it cannot be avoided. You can only make every effort to ensure that, having lived your life happily ever after, die in a dream quietly and calmly, surrounded by relatives and friends.
The editors would like to thank the Office of the State Forensic Examination Committee of the Republic of Belarus for the Minsk Region for their assistance in preparing the material.
