1) dark liquid blood in the heart and large venous vessels;
2) overflow of blood in the right half of the heart as a result of venous congestion in the pulmonary circulation (in the lungs);
3) venous plethora of internal organs due to significant venous stasis of blood;
4) bright red pinpoint hemorrhages under the pulmonary pleura and epicardium (Tardier spots);
5) alveolar emphysema. It occurs in the process of asphyxia, when sudden respiratory movements contribute to an increase in intrapulmonary pressure, which causes not only the expansion of the alveoli, but often the rupture of the interalveolar septa;
6) plethora of organs, increased permeability of the vascular walls, stagnation of blood in the pulmonary circulation favor the development of pulmonary edema;
7) anemia of the spleen - a sign that is rare.
Despite the numerous general asphyxia signs, none of them are specific for mechanical asphyxia. All of them are signs of a quick death. Therefore, the diagnosis of death from mechanical asphyxia should be based on their combination. In addition, in each specific case, the possibility of death from other causes should be excluded, as well as investigative data on the circumstances of death should be taken into account.
There are the following types of mechanical asphyxia.
1. From compression:
1) strangulation (from compression of the neck organs). Occurs as a result of hanging, strangulation with a loop, strangulation with hands;
2) compression (from compression of the chest and abdomen with solid objects and loose substances).
2. From obturation:
1) from closing the respiratory holes;
2) from obstruction of the respiratory tract by soft and solid bodies, loose substances and liquids;
3) strangulation asphyxia.
Hanging is called compression neck loop under the influence of the gravity of the body or part of it.
Enough strength to hang heaviness of the head only. Hence the various postures of the corpse in this type of mechanical asphyxia. Hanging can occur in a standing position, kneeling, sitting, lying down.
The loop can be made of a variety of materials (rope, belt, lace, wire, towel, scarf, scarf, piece of linen). An imprint remains on the neck from the loop - a strangulation furrow. It will not be the same depending on the material (with soft material, the furrow is soft and vice versa). On a corpse, the furrow appears as a slightly deepened, more or less wide, purple-cyanotic strip from translucence of the muscles. If the surface of the loop is uneven, such as folded (from a folded towel) or patterned (from a braided rope or scarf), then the folds and pattern are imprinted on the skin. The stiffer and thinner the material, the sharper the trace of the loop. From compression and sedimentation of the epidermis with a loop, the skin dries out, and more or less firm strangulation furrows are formed. They protrude relatively deeply into soft tissues, are dense to the touch, brownish in color, reminiscent of parchment, often with obvious sedimentation of the stratum corneum. The severity of the furrow depends on the duration of the hanging of the corpse. When the corpse is hanging, the loop has an oblique position, so the strangulation furrow is well expressed in the part opposite the knot, and closer to it may be absent. The knot is more often behind.
A specific sign of death by hanging is strangulation groove - a trace from compression of the neck by a loop (negative imprint of a loop on the neck). When examining the strangulation furrow, the following properties are determined: location, direction, number of individual elements of the furrow, which depends on the number of turns of the loop (between the individual elements of the furrow, ridges of pinched skin are formed).
Question No. 31 Damage to internal organs and bones in case of gunshot wounds. Bullet hydrodynamic action.
The bullet strikes the body with a powerful blow, whose power is concentrated in a very small area. Here tissue compression occurs, their rupture, partial knocking out and ejection, as well as the transmission of the compression wave to the sides. Therefore, after the passage of the bullet, part of the compressed tissues continues its movement to the sides, as a result of which a cavity is formed that is several times larger than the diameter of the bullet. This cavity pulsates, and then subsides, turning into a regular wound channel.
If a bullet with a very large speed, enters a cavity with liquid content or into a tissue rich in liquid, then a hydrodynamic effect may occur here. As a result, this organ or even part of the body can receive extensive damage.
Bullet with high energy, knocks out an area of skin, forming a typical gunshot bullet inlet with a tissue defect. This action of the bullet is called penetrating. In deeper tissues, the bullet loses energy and can act like a blunt wedge, only squeezing and pushing (tearing) the tissues, including the skin in the area of the exit hole (wedge-shaped action).
If the bullet has significantly lost speed, then it can only show a contusion effect. At the site of impact, an abrasion with a bruise or a superficial bruised wound occurs.
A bullet can do more than one thing, but several injuries if it successively passes through several parts of the body, for example, an arm and a torso, two legs, etc. Such injuries are called combined. Several injuries may also occur from a bullet that exploded near the body. In this case, the damage is no longer a solid bullet, but its fragments. Such damage is called shrapnel-bullet.
In a gunshot wound, it is customary to distinguish three zones: 1) the zone of the immediate wound channel; 2) a zone of bruising of the tissues that are the walls of the canal, with a width of several millimeters to 1-2 cm; 3) a zone of molecular concussion of tissues, sometimes extending for 4–5 cm or more. The last zone is revealed after several hours and even days, as small hemorrhages and tissue degeneration increase. A through bullet wound has an inlet, a wound channel and an outlet. A typical entry hole occurs when the bullet enters the body with its head more or less perpendicular to the skin surface. Such a hole has a defect, or “minus-tissue”, a belt of settling and a belt of contamination (rubbing).
Penetrating (lethal) action of a bullet (Hydrodynamic action of a bullet.)
Hydrodynamic action consists in the destruction of not only those tissues that are directly affected by the bullet, but also neighboring tissues. The hydrodynamic effect is manifested when a bullet hits at high speed (over 700 m / s) in areas rich in liquid. This phenomenon is explained by the fact that the resistance of the liquid medium increases with increasing speed. Wound, accompanied by hydrodynamic action, resembles the action of explosive bullets.
Since shooting from small arms is carried out not only at open manpower, but also at those behind light cover, the penetrating effect of the bullet becomes important. Those. the ability of a bullet to penetrate various obstacles. The penetrating effect depends on the properties of the barrier, the kinetic energy of the bullet at the moment it hits the barrier, the caliber of the bullet, its weight, shape, and design. Increasing the speed of the bullet, and consequently the kinetic energy, leads to an increase in penetration. Therefore, as the firing range increases, the penetration action decreases. However, at very close distances, the opposite phenomenon is observed: at high speed, the penetrating effect is not only not increased by the fact that bullets with high speed deform when they meet an obstacle and penetrate it more difficult.
Question #32 Damage from point-blank and close range shots. close shot factors.
If the muzzle of the weapon is tightly attached to the body , it is customary to talk about a shot at close range. In such conditions, the pre-bullet air causes damage before the bullet, and the bullet enters the already formed wound. Following the bullet, the gases of the shot burst into the wound channel. They not only cause a rupture of the skin wound, which acquires a star-shaped shape, but also have a destructive effect along the wound channel. In it you can find the soot of a shot, half-burnt powders, particles of clothing (if the weapon was tightly attached to a part of the body covered with clothing). The skin around the entrance gunshot wound is covered with a small amount of soot, but it is found in abundance from the inside and along the wound channel, especially if the cartridge was equipped with black powder.
When tightly attached to the skin ( clothing) muzzle of a weapon, its imprint may appear - "stamp mark" (stamp-imprint of the muzzle of a weapon), which has forensic significance. According to the configuration of the imprint of the muzzle of a weapon, one can judge its appearance. The bullet acts wedge-shaped, causing, as a rule, blind wounds. A bullet with a minimum kinetic energy (“at the end”, a weak charge, after a ricochet, etc.) can only cause a concussion effect. When a bullet hits an obstacle, a shock head wave arises and the substance through which the bullet moves, in the zone of the wound channel, experiences a concussion. After the passage of the bullet, the walls of the wound channel also experience oscillatory movements.
The most important sign of a shot at close range is the deposition of soot around the inlet on the fabrics of clothing and on the skin. Soot around the inlet is usually observed when struck from pistols from a distance of up to 15 - 20 cm, and from a rifle - from a distance of up to 35 - 40 cm.
Intensity of pumping, the shape and area of soot deposition depend on many factors and, above all, on the distance from which the shot was fired, the position of the weapon in relation to the surface of the target and the nature of its surface. Usually soot is deposited in the form of a black or dark gray coating of a rounded, oval, and sometimes annular shape.
If the shot is fired perpendicular to the surface of the affected object, then the soot is deposited in the form of a circle, in the center of which there is a gunshot hole. When fired at an acute angle, the injection area has the shape of an oval or ellipse, and the gunshot hole is located closer to the edge from which the shot was fired.
With increasing shot distance, the area deposits of soot, as a rule, increases, and its intensity, on the contrary, decreases. So, a distinct soot deposit in the form of a circle or oval of black or gray-black color with a diameter of 10 - 15 cm is observed when fired from 5 - 10 cm. When fired from a distance of 25 - 35 cm, the soot deposit looks like separate gray or pale gray spots , poorly distinguishable against the background of the skin and almost invisible on dark clothes.
Together with powder gases and soot Particles of incompletely burned and charred powder grains also fly out of the bore of the weapon, which are not only deposited on the surface of the object, but also pierce the relatively thin fabrics of clothing and are embedded in the skin. Powders can penetrate the skin when fired from a distance of up to 50 cm, and the deposition of individual powders on the surface of the affected object can be observed when fired from a distance of up to 1 - 1.5 m. In this case, particles of powder grains are weakly fixed on clothing and skin, and therefore can easily be separated when removing clothes from the victim or during transportation.
Close shot factors have mechanical, thermal and chemical effects. The damage they cause is usually associated with specific deposits. Such deposits are formed by soot, metal particles, powder grains and grease.
The damage and deposits caused by these factors are called close shot marks. These include: 1) the mechanical action of powder gases and air from the barrel bore - penetrating action, tears in clothing and skin, tears
and stratification of tissues in the wound channel, the imprint of the muzzle end of the weapon, sedimentation and subsequent parchmentation of the skin, radial smoothing of the pile of clothing fabrics; 2) thermal effect of gases, soot and powder grains - scorching of the pile of clothing fabrics and body hair, burning of clothing fabrics, burns; 3) the chemical action of gases - the formation of carboxyhemoglobin and carboxymyoglobin; 4) deposition and penetration of soot into clothing fabrics, skin, walls of the wound channel; 5) deposition and penetration of particles of powder grains and large metal particles into clothing fabrics, skin, walls of the wound channel; traces of the impact of these particles in the form of small abrasions on the skin and holes in the fabrics of clothing; 6) deposition of splashes of gun grease on clothing or skin.
Question No. 33 Damage from the action of stabbing, cutting and chopping tools.
The main signs of cut wounds
Incised wounds are more often located on open parts of the body: neck, face, forearms, hands.
The form of cut wounds is linear, although other forms of wounds are possible. Due to the contraction of the elastic fibers of the skin, the muscles can be spindle-shaped or oval. In case of damage to body parts with skin folds form a zigzag wound, which may not look like a cut wound. Under the action of the tool at an acute angle, a patchwork wound is formed. If the incision passed at the place of rounding, on a convex surface, then the wound becomes arched.
The edges incised wounds are even throughout and throughout the depth.
ends cut wounds are sharp. Sometimes there may be superficial incisions in the skin (notches) at the ends of the wound. The walls of the wound are smooth.
Sometimes, if the tool was blunt, with notches, then the edges of the incised wound may be uneven, resembling a bruised wound caused by a dihedral object.
Incised wounds, as a rule, have a small depth, i.e. length prevails over depth and width, and is limited to soft tissues. The size and depth of the wound depends on the sharpness of the blade of the tool, the force of pressure. The depth of the incised wound is often the greatest, in the middle and closer to the initial part than at the end. Sometimes wounds penetrate to cartilage and bones. Cartilage and bones, covered with a thin layer of muscles, are easily damaged by a knife, the ribs can be cut, the periosteum is damaged on the bones, on which notches remain. Under the action of a cutting tool in the area of the scalp, the hair intersects in the initial and middle parts of the wound; as a rule, the hair above the end part of the wound is not damaged.
The degree of gaping (divergence of edges) wound depends on whether the incision went along or across and elastic fibers. The contraction of the crossed and elastic fibers causes a significant gaping of the incised wound.
A characteristic sign of a cut wound is profuse external bleeding from cut vessels.
The main signs of stab wounds
Stab wounds are more often located on the chest, back, abdomen, less often on the neck and head.
The form stab wounds can be slit-like, spindle-shaped, oval and round, depending on the divergence of the edges, after bringing the edges together - always slit-like, without a tissue defect.
The shape of the wound depends from the cross section of the piercing object. If the cross section is round or polygonal, then a linear wound is formed, and when gaping, an oval or almost round wound is formed. With an appropriate diameter, wounds can occur that resemble entrance gunshot wounds, three- and four-sided objects form wounds with three or four rays. Wounds caused by a thin piercing tool (knitting needle, awl, etc.) have a small slit-like shape and are hardly noticeable during examination.
stab wound usually does not correspond to the cross section of the damaging tool due to contraction of the elastic fibers of the skin.
Wound size depends on the size of the cross section of the tool and on the depth of immersion. With an increase in the depth of immersion, the size of the damage to the skin and clothes increases, more and more approaching the size of the cross section of the gun. Along the edge of damage to clothing and wounds, a belt of sedimentation and a belt of contamination (rubbing) may form, the severity of which depends on the irregularities and contamination of the surface of the tool. Depending on the angle of subsidence, the rubbing is expressed from the side of the acute angle of subsidence. The edges of the stab wound are often uneven.
A stab wound has a wound channel. In a stab wound, the depth of the wound channel always prevails over the length and width of the wound, the walls of the channel are smooth.
In the muscles, a stab wound is determined with great difficulty, since the stabbing tool pushes the fibers apart, and when it is withdrawn, the fibers fall off.
A stab wound is much better in such organs as the liver, kidney, where the shape of the wound approaches the shape of a tool.
Even better about features of a piercing weapon can be judged by injuries on flat bones (skull, sternum, scapula, pelvis), on which the shape and size of the wound often correspond to the shape and size of the weapon.
Piercing weapons can inflict wounds of various depths. depending on the degree of immersion of the blade, including more than its length, in areas that are pliable under external pressure (anterior wall of the abdominal cavity, gluteal region) and can reach a significant value from 5 to 10 cm.
Direction of travel guns is determined by the direction of the wound channel. The localization of the wound and the conformity or displacement of the damage to the clothing help to judge the position of the victim's body or parts of it at the time of injury.
The piercing tool can tamponate (close) the wound, preventing massive bleeding. Therefore, at the scene of the incident, when the victim is still alive, one should not rush to remove the instrument from the wound.
Signs of chopped wounds
Situated chopped wounds more often on the head, arms, legs, back.
The form chopped wounds linear, triangular, arcuate, patchwork.
The edges of the wound even if the ax is well sharpened, if damaged by a blunt ax, the edges of the wound may be uneven, slightly raw and bruised.
ends chopped wounds depend on the conditions of immersion of the chopping part of the ax.
With perpendicular immersion of the ax blade, the ends of the wounds are sharp.
At deep immersion of the wedge of the ax, due to overstretching of the tissues at the ends of the wound and along the edges, tears occur, the ends of the wound are rounded. When inflicting damage with a blunt blade, the ends of the wound are somewhat rounded and raw.
With predominant immersion the toe or heels of the ax wedge, the ends of the chopped wound will be different: one end of the wound will be sharp (from the side of the blade), the other is blunt or U-shaped (from the side of the toe or heel) and may have an additional tear and rawness; the shape of the wound takes the form of a triangle.
In case of immersion of the chopping tool under the angle of the wound is of a patchwork shape and its edge from the side of the acute angle of immersion is upset.
The walls of the chopped wound are uneven , hemorrhages are formed in the thickness of the skin and subcutaneous fatty tissue due to the striking action of the gun.
The gaping of a chopped wound depends not only on the contraction of the skin, but also on the spreading of the edges of the wound with an ax wedge.
Flat bone injuries skulls with a chopping tool can be slit-like, comminuted, longitudinally perforated, or have the form of superficial notches.
Depending on the impact force, linear-slit-like cuts are formed on the bones, often penetrating into the cranial cavity.
When hit with the toe or heel of an ax wedge-perforated fractures occur (one is acute-angled, corresponding to the blade, the other is rounded, corresponding to the toe or heel of the ax) penetrating into the cranial cavity.
Brain damage in the form of dissection and crushing.
External bleeding from chopped wounds is significant, healing of chopped wounds is different, often with complications.
Death often occurs from damage to the substance of the brain, hemorrhages under the lining of the brain, or from bleeding.
Fatal injuries with a chopping tool are more often inflicted by an outside hand, injuries, as a rule, separate the bone, forming a kind of thin section on the surface of the cut, which can be used for identification purposes.
Question No. 34 Damage caused by AK-74U assault rifle, self-made, shotguns and sawn-off shotguns. Their features.
Question number 35 Damage caused by sharp tools. Classification. Characteristic features of damage by various types of sharp tools.
1.1 Damage from sharp tools. Classification of sharp tools. Signs characterizing damage from various types of sharp tools
In forensic medicine, sharp tools are those whose traumatic part has a sharp end or a sharp edge.
Some tools, such as knives, have both a sharp end and a sharpened edge - a blade.
Among sharp tools, several groups are distinguished, based on the mechanism of action of these tools. :
1) stabbing;
2) cutting;
3) piercing-cutting;
4) chopping;
5) sawing;
6) combined action.
In forensic medical monographs, one can also find other options for classifying sharp instruments of trauma.
IN device dependent The traumatic part of sharp tools and the mechanism of their action cause a variety of damage to the tissues of the human body. Accordingly, they distinguish cut, stab-cut, stab and chopped wounds.
Stab wounds remain from piercing weapons. The mechanism of their formation is characterized by the fact that the sharp end, when interacting with the tissues of the human body, pushes these tissues apart, thereby damaging them, tissue destruction is insignificant, and stab wounds on the skin usually look like a small slit-like defect.
When a piercing tool enters the tissues of the body from its lateral surface, traces of sedimentation remain in the circumference of the skin wound. In this zone, particles can be deposited that pollute the surface of the blade and particles of the substance from which the blade is made.
With a powerful impact of a strong piercing blade in the area of \u200b\u200bflat bones (skull bones, scapula, pelvic bones) bone defects in the form of perforated fractures can form. With a significant kinetic energy of the action of the gun, such injuries to flat bones can resemble gunshot injuries.
The cutting action is characterized by the simultaneous pressure of an acute edges on the fabric and its translational movement. As a result of this action, wounds are formed that have a length greater than depth, smooth edges and sharp ends. If the forward movement was not in a straight line, but in an arc or zigzag, then the shape of the wound will not be straight, but arcuate or zigzag.
With deep penetration cutting tools, deep incised wounds will occur, while large vessels and nerves can be damaged, sometimes incised wounds penetrate to the bones and cartilage. From the cutting action of the blade on the bone, only notches remain. Cartilage dissections can have on their walls parallel ridges and grooves from the microrelief of the blade, called tracks.
Stab wounds. When the knife blade is immersed in the tissues of the body, the tissues are simultaneously pulled apart by the tip and cut from the action of the blade. A stab-cut wound is formed, which in most cases is characterized by a relatively small length, smooth edges, and considerable depth (wound channel). The ends of the wound, with one-sided sharpening of the blade, are different: one is sharp: the other can be rectangular, rounded or diamond-shaped, depending on the shape of the back of the knife and the nature of the stretching of the wound.
Wound distension - the divergence of its edges does not depend on the thickness of the damaging blade, but on the location of the dissected elastic fibers of the skin relative to the length of the wound. At the transverse intersection of the fibers, the edges of the wound move apart as much as possible, but if the length of the wound and the direction of the fibers coincide, then its edges will be moved apart slightly.
Immersion and extraction of the blade when inflicted knife damage does not occur strictly in the same direction. In this case, the so-called main incision is formed in the wound (when the blade is immersed) and an additional one (when it is removed). Along the length of the main cut, it is possible to set the width of the blade at the level of its immersion in the body of the victim.
Characteristic features of chopped wounds are their significant dimensions - both length and depth. When exposed to body tissues with a chopping tool, due to high kinetic energy, not only soft tissues are damaged, but also the underlying bones. The nature of chopped wounds on the skin depends in part on the structure of the chopping blade and its length. Well-sharpened chopping objects inflict wounds with smooth, almost not aggravated edges, the depth of the wounds all the fibers are completely crossed. If the chopping object is sharpened poorly, then wounds remain from its impact, resembling wounds from the action of the edge of a blunt object. The edges of such wounds are raw, bruised, and in the depths, uncut connective tissue fibers are observed.
Under the action of sharp chopping objects on the bone and cartilaginous tissue on the walls of the cuts there are traces suitable for the individual identification of the instrument of injury. Under the action of a blunt chopping tool, the tracks are usually rough or completely absent, and the cuts themselves are more reminiscent of fractures.
Damage from sawing tools. By the nature of the action, two large groups of sawing tools are distinguished: mechanical, the movement of the working parts of which relative to the object is carried out by converting the energy received from the electric motor, internal combustion engine or other forces; manual, driven by the muscular energy of a person.
Mechanical tools are more often causing fatal and non-fatal injury. Hand saws are sometimes used by criminals to dismember the corpses of victims in order to cover up the crime. Damage received by a person from the impact of the teeth of a mechanical saw is quite typical. With a small tangential contact, linear wounds with uneven edges and ends are noted. With a significant impact on the human body, deep and gross damage to both soft tissues and underlying bones are found.
Question number 36 The concept of "infanticide". Definition of neonatal and live births. Life trials, their significance. Causes of death of a newborn child.
Infanticide
(infanticidium) in forensic medicine - the murder of a mother of her child during childbirth or immediately after birth.
Infanticide active - D., carried out by inflicting violence.
Infanticide passive - D., carried out by deliberately leaving the newborn without the necessary help.
Neonatal period lasts from the day of birth until the 28th day of life.
During this period, the improvement of all organs and systems continues, there is an adaptation to new conditions, to a new living environment for him. In the quick and painless adaptation of the newborn to extrauterine conditions, its maturity is of great importance.
Her criteria : gestational age 38-40 weeks, length - more than 45 cm, weight - more than 2500 g. Clinical criteria for maturity are pink skin color, sufficient development of subcutaneous fat, the presence of vellus hair only on the shoulder girdle, on the upper back, hair length on head - 2-3 cm, dense cartilages of the auricles and nose, hard nails that go beyond the tips of the latter on the fingers (the nail bed is completed), the place of origin of the umbilical cord is located in the middle between the womb and the xiphoid process. In boys, the testicles are in the scrotum (as a rule), in girls, the large labia close the small ones. A morphologically mature full-term baby, as a rule, is mature and functional: it keeps body temperature well (at an adequate ambient temperature), it has pronounced sucking, swallowing and other unconditioned reflexes (see below), a stable and correct rhythm of heartbeats and breathing, it does not burp, shows sufficient motor activity (makes periodic "worm-like" movements of the limbs), emits a loud emotional cry, emotionally reacts to strong light, sound, examination, hunger.
With the definition of live birth, those. the child must have at least one of the 4 symptoms of life: spontaneous breathing, palpitations (heart rate), umbilical cord pulsation, voluntary muscle movement.
OR: live birth- complete removal or removal from the mother of the product of conception (regardless of the course of pregnancy, the placenta separated or not, the umbilical cord is tied or not), which, after separation, breathes or has functional signs of life - heartbeat, pulsation of the umbilical cord or spontaneous muscle movement.
In the absence of all 4 signs of a live birth, the child is considered stillborn. If a born child (regardless of the gestational age) has at least one of the listed signs, he is given resuscitation assistance.
LIFE TESTS , are essential for resolving the issue of live birth of the fetus in forensic medical examinations of the corpses of infants. Usually, as a rule, pulmonary and gastrointestinal hydrostatic tests are performed. The basis of the pulmonary test (dokimasia pulmonalis) is the fact of a decrease in the specific gravity of the lungs due to the entry of air into the alveoli with the first respiratory movements after the birth of the fetus.
Causes of death of a newborn baby
Fetal death may occur : before childbirth (in the antenatal period), during childbirth and after them (in the postnatal period), It can be both non-violent and violent.
Nonviolent death fetus and newborn may be due to either underdevelopment (non-viability), or the presence of malformations incompatible with life (anencephaly, eventration of internal organs, etc.). In addition, non-violent death of the fetus and newborn can be caused by various pathological processes or birth trauma.
In more than half of all cases, the cause of death is intrauterine asphyxia (which may be based on changes both on the part of the fetus and on the part of the mother) from circulatory disorders, placenta previa and its infarction, true nodes of the umbilical cord, etc. In other cases, non-violent death can be caused by acute infectious diseases, some chronic diseases (for example, syphilis, etc.).
common cause of death in children during childbirth is a birth injury that occurs more easily in premature and immature fetuses, with a narrow pelvis of the mother, with a large fetus and with prolonged childbirth. Birth trauma can be expressed in fractures of the bones of the skull, intracranial hemorrhage in the membranes and substance of the brain, in damage to the bones of the skeleton: clavicles, cervical vertebrae; in injuries of internal organs (subcapsular hematomas of the liver, apoplexy of the kidneys and adrenal glands, hemorrhages in the lung tissue, etc.).
Violent death newborns during childbirth is rare.
Here we should note the injuries that occur during self-help during childbirth, which occur outside the obstetric institution and without assistance. Trying to help herself, having no experience, a woman in labor with her hands damages the presenting part of the fetus, more often the head. In this case, abrasions, bruises, wounds, dislocations of the lower jaw, bone fractures can occur.
Violent death after childbirth newborns may be the result of infanticide, murder and accident.
There are cases when a newborn thrown into reservoirs, cesspools. In these cases, death occurs from drowning, hypothermia, etc. There are cases of death from closing the respiratory openings with hands, soft objects. It should be borne in mind that during childbirth outside a hospital, when the woman in labor is alone and cannot provide the necessary assistance to the newborn, he can bury his face in a soft object and suffocate.
How a method of infanticide can be used strangulation with a loop, which can be used as rags, twine, sometimes parts of the mother's linen or clothes.
It should be borne in mind that sometimes a loop of the umbilical cord is found around the baby's neck. May have the place where the umbilical cord wraps around the neck during childbirth. At the same time, the possibility of killing a newborn by strangulation with the umbilical cord cannot be ruled out.
Mechanical damage as a way of infanticide is less common. There may be damage to vital organs with blunt or sharp objects. Blunt injury must be differentiated from birth trauma and damage that occurs during the so-called rapid birth.
Question No. 37 The concept of "object", "tool", "weapon". Mechanical damage (bruises, abrasions, wounds, etc.) their characteristics and healing time.
Question number 38 The concept of death. Socio-legal classification of death. Early changes occurring in a corpse.
The concept of death
Forensic medical aspects of death are explored by forensic thanatology. Death is an inevitable, irreversible and necessary outcome of life. Death is a biological phenomenon. The concept of death refers to the organism as a whole. An irreversible outcome of life is possible only with the cessation of the function of blood circulation. Unfortunate is the term "brain death", which is used in the case of irreversible brain death. Here we should not talk about the death of the whole organism, but about the death (death) of the brain.
Dying. The process of transition from life to death is called dying and usually consists of five successive stages.
1. Predagonal state: consciousness is depressed, the pulse is not palpable, heart sounds are sharply weakened, blood pressure progressively decreases, breathing is frequent and shallow, the reaction to stimuli is sharply reduced.
2. Terminal pause: consciousness, pulse, reflexes, and breathing are absent, blood pressure is close to zero.
3. Agony: consciousness is lost, but occasionally returns for a short time. The function of the cerebral cortex is depressed, there is some increase in heart rate and a slight rise in blood pressure, breathing is rare and deep with the involvement of almost all skeletal muscles. The end of the stage is characterized by an even greater decrease in breathing and a drop in blood pressure.
4. Clinical death: complete depression of consciousness, reflexes, cardiac activity of breathing. At this stage, the possibility of restoring all basic vital functions remains. Its duration is on average 5-6 minutes, but at low ambient temperatures it can be 5-20 minutes.
5. Biological death, in which irreversible changes in the functions of the central nervous system, blood circulation and respiration occur.
According to the pace of attack, they distinguish quick and slow death. With rapid death, the agonal period is either not fixed at all, or is very shortened. With slow death, the agonal period can last days and weeks, hence the name of slow death - agonal.
Rapid death is characterized by a sharp venous plethora of internal organs, overflow of dark liquid blood in the right half of the heart, hemorrhages under the mucous membranes and intense confluent dark purple cadaveric spots. With agonal death, the blood supply to the internal organs is uneven, in the vessels there are red, white and mixed blood clots, moderate pale purple cadaveric spots.
Socio-legal classification provides for the division of death by category, genus and type.
Depending on the category, death is divided into violent and non-violent.
Depending on the type of death- murder, suicide and accident.
Type of death determined by what cause, what impact it was caused, as a result of which, what impact it occurred (occurred). Death can be caused by physical factors (mechanical, thermal, electrical, acoustic, changes in atmospheric pressure, the action of radiant energy), as well as chemical, biological and mental types of external influence.
Depending on what(immediate cause) death occurred, it is divided: from cardiac arrest, or breathing, from injuries incompatible with life, from blood loss, from shock, bruising, concussion of the brain, from intracranial hemorrhage, from concussion or contusion of the heart, from compression of organs blood or air, from an embolism.
Depending on the speed of advance death (the rate of dying), it is classified into quick death (acute death), which occurs instantly, suddenly, without an agonal period, and slow death (agonal death), which occurs slowly and is accompanied by agony, the duration of which is from several hours to days, and sometimes more.
Cooling. With the onset of biological death, metabolic processes stop and heat is released from the body to the external environment, which leads to a gradual cooling of the corpse. The drop in temperature occurs until the temperature of the corpse becomes 0.5-1 ° C below the environment. The lower temperature of the corpse compared to the ambient temperature depends on evaporation from the surface of the skin of the corpse. At low temperatures (below 0 °C), the cooling of the body turns into freezing of the corpse. The speed of cooling is affected by body weight and the severity of the subcutaneous fat layer. With exhaustion, cooling occurs faster, on the contrary, in obese people this process proceeds more slowly. Of no small importance is the posture of the corpse and the nature of the clothes on it, the warmer it is, the slower the cooling develops. The corpses of newborns cool especially quickly, it depends on the larger surface of the skin in relation to body weight, moreover, the very delicate and thin epidermis in newborns contributes to the intensive cooling of the corpse.
The cause of death also influences the rate of drop in body temperature of a corpse. So, if death occurred from tetanus during convulsions, from sepsis, typhus, mechanical asphyxia and some poisonings, the body temperature after death may rise for a short time. According to some reports, body temperature within the next two hours after death can reach +40°C and even higher.
Although many conditions affect the rate of decrease in the temperature of a corpse, however, approximately at normal room temperature (+16- +18 ° C), the drop in body temperature of a corpse has some regularity. Upon the onset of death, cooling is primarily noted on the open parts of the body: after 1 hour, a cooling of the hands is noticeably felt, after 2-3 hours - the skin of the face. Many researchers point out that the body temperature drops by an average of 1 ° C in 1 hour. According to other sources, the drop in body temperature slows down somewhat after six hours: it falls by 1 ° C every 1.5-2 hours. For a more accurate determination regularities of the temperature drop of the corpse, which would take into account the ambient temperature, it is necessary to measure the temperature of the corpse after a strictly defined time at the beginning and at the end of the examination of the corpse at the place of discovery, and then when the corpse enters the morgue, while simultaneously taking into account the ambient temperature. It is better to measure the temperature every 2 hours in order to establish guidelines indicating the rate of its fall under these specific conditions.
Question number 39 The concept of poisoning. Classification of poisons. The mechanism of action of the poison.
General concept of poison and poisoning
Forensic toxicology is the science of poisonous substances and the poisoning they cause. She studies the chemical and physical properties of poisons, their effect on the body and develops methods for the quantitative and qualitative determination of poisons in the external environment and the body.
In toxicology, the following definition of poison is accepted:
A poison is a substance that, when introduced into the body from the outside and in small quantities, is capable, under certain conditions, of causing chemical or physico-chemical changes that lead to its illness or death.
Poisoning (intoxication) - a pathological condition of the body that develops when a poisonous substance enters it, and is characterized by various functional or organic disorders.
Forensic classification of poisoning:
There are various classifications of poisons and toxic substances: according to the hygienic principle (according to the quantitative scale of the danger of poisons), pathochemical (according to the mechanism of interaction with enzymes), etc.
In forensic medicine, a classification of poisonings based on the pathophysiological effect of poisons has been adopted. According to this classification, each poisoning is considered as a disease affecting the whole organism, but with a predominant selective effect on individual tissues, organs or organ systems.
According to this, the following groups of poisons are distinguished:
- caustic poisons.
The group of caustic poisons includes substances (caustic alkalis and acids, ammonia and iodine vapors, phenol, etc.) with a pronounced effect in the area of \u200b\u200bprimary contact with tissues. Local action is the main one in the symptom complex of poisoning. Death occurs as a result of damage to internal organs, the development of shock phenomena, bleeding from eroded vessels.
The action of these poisons, of course, is not limited only to local damage, being absorbed, they also cause a general toxic effect on the entire body.
- resorptive poisons
The toxic effect of this group of toxic substances appears only after absorption. All resorptive poisons are divided into:
a) destructive poisons
Cause significant morphological changes in internal organs (liver, kidneys, heart, intestines, etc.)
b) blood poisons
Substances that are diverse in toxicodynamic terms and cause changes in the composition and properties of the blood.
c) functional poisons
They cause mainly functional lesions, without significant violations of the morphology of the organ.
Question #40 Loss of vision and hearing. Assess the severity of these injuries.
Severe bodily injury (serious bodily injury).
Serious harm to health is considered to be harm to health that is life-threatening or that results in loss of sight, speech, hearing or any organ, or the loss of its functions by an organ; or indelible disfigurement of a person, as well as the infliction of other harm to health, life-threatening or causing a health disorder, associated with a significant permanent loss of general ability to work (at least one third) or with a complete loss of professional ability to work, which is known to the perpetrator; or resulting in an abortion, mental disorder, drug addiction or substance abuse.
1. Loss of vision. Loss of vision is understood as a complete loss of the ability to see or a state of vision in which a person cannot distinguish the outlines of objects at a very close distance. This does not mean temporary loss of vision, but incurable blindness.
If, as a result of an injury, a person blind in one eye has lost the ability to see with the other eye (less than 0.04%), then this is not assessed as a loss of vision, but only as a loss of vision in one eye. On the basis of a permanent disability of more than one third, such damage will also be classified as serious. This feature will be discussed below.
2. Hearing loss. Hearing loss refers to the inability to hear loud speech further than 2–5 cm from the auricle. If hearing is lost in only one ear, then such damage will be classified as less serious.
Question No. 41 Loss of an organ or loss of its functions by an organ as a serious bodily injury, their expert assessment.
Loss of any organ or loss of function by the organ. This is understood as an anatomical loss of an organ (traumatic amputation, surgical amputation for health reasons) and a functional loss of an organ, i.e. termination of his functions (for example, the hand is preserved, but it hangs without movement).
Organ loss can also be assessed on other grounds, in particular on the basis of persistent disability.
Question No. 42 Rights and obligations of a forensic medical expert. Withdrawal of an expert.
Rights, duties and responsibilities of an expert
Forensic medical experts are obliged to appear on the call of the person conducting the inquiry, the investigator, the prosecutor or the court and give an objective opinion on the issues put before them; moreover, if the proposed question goes beyond the expert's special knowledge or the available materials are insufficient for drawing up an opinion, then the expert reports the impossibility of giving an opinion.
The expert has the right:
To get acquainted with the materials of the case relating to the subject of the examination;
Submit petitions for providing him with additional materials necessary for giving an opinion;
Be present during interrogations and other investigative and judicial actions, ask interrogated questions related to the subject of the examination (Article 82 of the Code of Criminal Procedure "Duties and rights of an expert").
Upon explanation to the expert of his rights and obligations, he is warned about the responsibility for giving a deliberately false conclusion (Article 275 of the Code of Criminal Procedure "Explaining to the expert his rights and obligations").
The production of knowingly false examinations is a criminal offense (Article 307 of the Criminal Code of the Russian Federation "Knowingly false testimony, expert opinion or incorrect translation"). In cases where experts, without good reason, evade giving opinions at the suggestion of bodies of inquiry, investigation or court, they are also held criminally liable (Article 309 of the Criminal Code of the Russian Federation "Bribery or coercion to testify, or evasion from testifying, or to incorrect translation").
Disclosure of preliminary investigation or inquiry data without the permission of the prosecutor, investigator or the person who conducted the inquiry is criminalized (Article 310 of the Criminal Code of the Russian Federation "Disclosure of preliminary investigation data").
Expert challenge
The procedural rules provide for a number of conditions under which an expert must be disqualified from participating in a case, in particular when the expert:
Personally, directly or indirectly interested in the case;
Was or is in official or other dependence on the accused, civil plaintiff or civil defendant;
Produced on this case an audit, the materials of which served as the basis for initiating a criminal case;
Revealed his incompetence;
He participated in the case as a specialist, with the exception of the case of participation of a doctor-specialist in the field of forensic medicine, in the external examination of a corpse (Article 67 of the Code of Criminal Procedure "Recusal of an expert").
Question No. 43 Subject and content of forensic medicine.
Forensic Medicine - a branch of medicine that studies issues of a medical and biological nature that arise in the course of the activities of the investigative and judicial bodies. In addition, forensic medicine assists health authorities in improving the quality of treatment, preventing morbidity, and improving working and living conditions.
subject of judicial medicine are the theory and practice of forensic medical examination, i.e. specific application of medical knowledge for the purposes of investigative and judicial practice.
1. Forensic thanatology - the doctrine of death and post-mortal processes.
2 Forensic traumatology - the doctrine of injuries, mechanisms and conditions of their occurrence.
3. The study of damage from the action of physical factors - extreme temperatures, electricity, barometric pressure, radiant energy.
4. Forensic toxicology - the study of poisons and the diagnosis of poisoning.
5. Forensic obstetrics and gynecology - the study of controversial sexual conditions, crimes and other sexual activities.
6. Development of methods for the study of physical evidence of biological origin, methods for identifying a person and a crime weapon.
7. Expertise on the materials of criminal and civil cases.
Question No. 44 Termination of pregnancy as a grievous bodily injury. Expert review.
Termination of pregnancy, regardless of its duration, is a serious bodily injury if it is not associated with the individual characteristics of the organism, but is in a direct causal relationship with the injury. Forensic medical examination in these cases is carried out jointly with an obstetrician-gynecologist.
Question No. 45 Procedural basis of forensic medical examination.
A forensic medical examination is a scientific and practical research carried out by a doctor by order of the investigating authorities or a court order to give an opinion on medical and some biological issues arising in the course of an investigation or trial (Article 78 of the Code of Criminal Procedure "Expertise").
There is a mandatory appointment of an examination to establish:
4. To establish the age of the accused, the suspect and the victim in cases where this is important for the case, and there are no documents on age (Article 79 of the Code of Criminal Procedure "Obligatory examination").
There are the following types of forensic medical examination:
Primary;
Additional;
Repeated (Art. 81 Code of Criminal Procedure "Additional and repeated examination");
commission;
Complex.
Primary examination is the initial study with a conclusion based on its results. Additional expertise is appointed in case of insufficient clarity or completeness of the conclusion. Assigned to the same or another expert. If the expert's opinion is unfounded or there are doubts about its correctness, a second expert examination may be assigned to another expert or other experts. A commission forensic medical examination is carried out if it is necessary to resolve issues that require knowledge in related medical sciences, consultants, specialists are involved (Article 194 of the Code of Criminal Procedure "Procedure for the appointment and production of additional and repeated examination"). Each member of the commission has the right to his opinion; the commission solves only medical issues; examination is carried out only on original medical and other documents; the commission is guided by special orders, instructions, and if there are none, then generally accepted opinion. Comprehensive examination involves the participation of specialists from various, including non-medical fields of knowledge (for example, forensic medical examiner, forensic chemist, forensic expert, technician, etc.).
There is a mandatory appointment of an examination to establish:
1. Causes of death and nature of bodily injuries;
2. To determine the mental state of the accused or suspect in cases where there is doubt about their sanity or ability to be aware of their actions and manage them by the time of the proceedings;
3. To determine the mental or physical state of a witness or victim in cases where there is doubt about their ability to correctly perceive the circumstances relevant to the case and give correct testimony;
4. To establish the age of the accused, the suspect and the victim in cases where this is important for the case, and there are no documents on age (Article 79 of the Code of Criminal Procedure "Compulsory examination").
Question No. 46 Disorder of health and death from the action of high temperatures. Classification of thermal burns. Signs revealed during external examination and internal examination of the corpse.
During heat stroke, the temperature body rises to 44C. At the same time, weakness, intensification, and then cessation of sweating, pain in the epigastric region, frequent urge to urinate, increased heart rate, drop in blood pressure, redness of the face, loss of consciousness, convulsions, and in severe cases, death develop. Thus, heat stroke is a consequence of the general overheating of the body. In a forensic medical examination of a corpse in such cases, there is a rapid onset of rigor mortis, a sharp plethora of internal organs, especially the lungs, which appear almost black. There is swelling of the brain, foci of small hemorrhages.
Sunstroke - refers to the defeat of the central nervous system by the action of direct sunlight (ultraviolet) on an uncovered head. This causes a rush of blood to the head, overheating of the brain, followed by a violation of the central nervous system. Clinical symptoms are similar to heat stroke (headache, vomiting, loss of consciousness, convulsions). Scalding - changes from the action of hot liquids, steam. In addition, as a result of burns, a person may develop a burn disease. The danger of burns to life depends on the size of the burnt surface: the larger the surface, the sooner death occurs. If the area of a burn of 2-4 degrees exceeds 10-15% of the body surface (and 1 degree - 50%) and the victim does not die in the near future, then changes in the internal organs occur, which are combined under the name of burn disease. The first period of burn disease, or the period of burn shock, is characterized by excitation, followed by general severe depression.
There are four degrees of burns. First degree burns - redness and swelling of the skin, soreness. Almost impossible to find on a corpse. Second degree burns - the formation of blisters with serous contents, which after 3-4 days thickens and becomes jelly-like. Bubbles should never be opened. Healing occurs without scar formation. Bursting blisters dry up on a corpse, turn brown and resemble abrasions. With third-degree burns, necrosis of the skin is formed, sometimes thick-walled blisters appear, the epidermis is detached from the inner layer of the skin and hangs down in the form of tatters. With fourth-degree burns, not only the skin, but also deeper tissues (muscles, bones) die. Extensive charring and burning of tissue suggests a post-mortem effect of the flame. Healing occurs with the formation of tightening scars, limiting mobility in the joints and disfiguring the face, which further determines the degree of disability. The death of victims can occur at different times.
When a burnt corpse is found, it is first of all necessary to resolve the question: did the flame act on the corpse or were the burns caused to a living person? The following signs can be used to establish the vitality of the impact of the flame:
1) Smoke irritates the eyes and a person closes them, as a result, skin wrinkles form in the corners of the eyes, not covered with soot.
2) The presence of 1-2 degree burns as an intravital reaction, since only 3-4 degree burns occur on the corpse.
3) The presence of soot in the small bronchi and lungs; on a corpse, soot can only enter the initial respiratory tract (trachea).
4) Burns of the upper respiratory tract, as a person breathes hot air.
5) High content of carboxyhemoglobin (combination of blood with carbon dioxide).
6) The presence of soot in the sinuses of the frontal and main bones.
7) Soot from the lungs can enter the lumen of the blood vessels and is carried by the blood flow to the internal organs.
Question No. 47 Disorder of health and death from the action of low temperatures. General effect of cold. Factors contributing to the cooling of the body.
The local effect of cold manifests itself in the form of frostbite and is well studied in medicine, especially in military surgery. There are 4 degrees of frostbite:
Grade 1 - characterized by circulatory disorders, skin vessels narrow (protective reaction to vital organs), blood rushes to the internal organs, the skin turns pale. However, soon the skin vessels dilate, the skin becomes bluish, sharply painful.
Grade 2 - redness, swelling, blisters filled with bloody inflammatory contents appear. This stage is inflammatory, blisters can burst spontaneously, leaving ulcers that are difficult to heal.
Grade 3 - when there is necrosis of the skin area and subcutaneous tissue - necrotic.
Grade 4 - when necrosis spreads to the bones, wet gangrene appears, complicated by infection.
There are the following types of frostbite:
1) Frostbite from the action of dry frost,
2) Frostbite that occurs at temperatures above 0 degrees,
3) Contact frostbite,
4) Refreshments.
Trench foot - wet shoes in the spring, there may be 4 degrees of frostbite.
Chilling - chronic frostbite that occurs under the influence of systematic, unsharp, short-term cooling. Clinic: edema, cyanosis, itching, loss of sensation, cracks, dermatitis, ulcers, forensic definition of death from cold.
Main Factors
1. Water temperature. Especially dangerous is water with a temperature below 10 ° C, since the survival time of a person in it is within half an hour. This requires high responsiveness. rescuing the victim.
2. Time spent in water. When searching for a casualty at sea,
take into account that only certain individuals are able to survive in cold water for a significant time.
3. Violation or insufficiency of the mechanism of thermoregulation. These phenomena can be caused by depletion of the body's energy resources (age, malnutrition or starvation), previous or existing diseases, poorly developed subcutaneous fat layer of the victim.
4. Lack or ineffective protection from the cold. Ceteris paribus, persons who are naked, lightly dressed, or their collective life-saving equipment does not provide effective protection from the cold die faster.
live birth- complete expulsion or extraction of the product of conception from the mother's body at any stage of pregnancy; at the same time, after separation, regardless of whether the umbilical cord is cut and the placenta is separated, the fetus breathes and (or) shows other signs of life: heartbeat, pulsation of the umbilical cord, muscle movements.
Stillbirth- the death of the product of conception before its complete expulsion or extraction from the mother's body.
Practically during the autopsy, live birth is determined using vital tests, the positive result of which is based on the ingress of air with the first breaths into the lungs (Galen test) and the gastrointestinal tract (Breslau test).
Galen's test- are carried out by immersing both lungs in water, after bandaging the trachea; then each lung is lowered into the water, preliminarily bandaging the bronchi, and then successively fragments of the lungs from each lobe. Air-expanded lungs float. Bubbles are released from separate fragments of the lungs squeezed under water in the presence of air in them.
Breslau test- the stomach and intestinal fragments isolated with ligatures are cut out, lowered into the water; When there is air in them, they float. It should be noted that the samples of Galen and Breslau are about indicative. They lose their value with the development of putrefactive changes in the corpse, when gases accumulate in the tissues. Both samples are non-informative when artificial respiration is performed on a stillborn. In addition, their negative result does not allow the expert to exclude a live birth, since the lungs of a breathing child drown in water with secondary atelectasis, pneumonia, etc.
To resolve the issue of the birth of a child alive or dead, it is necessary histological examination: in lung tissue in stillborns, the alveolar epithelium has a cubic shape; alveoli collapsed or partly straightened in the form of cracks, contain amniotic fluid; interalveolar septa are thickened; elastic fibers are tortuous, arranged randomly in the form of thick bundles; reticular fibers are dense, tortuous, braiding the alveoli from all sides; the lumen of the bronchioles are star-shaped. In live births, the alveolar epithelium is flattened, the alveoli themselves are round in shape with clearly visible gaps; interalveolar septa thin; elastic fibers are located around the circumference of the alveoli in the composition of thin bundles, not crimped; reticular fibers form the "argyrophilic membrane"; bronchioles have an oval or round lumen. An indicator of live birth is hyaline membranes in the alveoli, which does not happen in the lungs of stillborns.
The samples of Galen and Breslau are positive after resuscitation of a child who did not breathe on his own, as well as with putrefactive changes in the corpse of such a child. However, a histological examination of the lungs in such cases makes it possible to clearly determine the fact of stillbirth: during artificial respiration to a stillborn, the alveoli are mostly collapsed, and some are expanded and torn, as in acute emphysema; with putrefactive changes, the structure of the lung tissue does not differentiate, putrefactive gases form bubbles in the interalveolar septa.
Additional information can be provided histological examination of other tissues, as well as radiological, biochemical and other methods: on microscopic examination, the umbilical arteries in stillborns are not reduced, unlike in living children; radiographs of the chest of corpses indicate the former breathing, when air evenly fills the airways to small bronchi, at least in separate fragments of the lungs, on the survey radiographs of the corpse, the filling of the stomach and intestines with air is well observed; determination of the percentage of albumins and globulins in the blood serum is a differentiating sign of still and live births.
21. The concepts of newborn, full-term, viability, maturity in forensic terms, morphological features. The concept of "infanticide".
newborn - the period from the first breath of a child to 28 days of his life (previously, in the SM definitions, the neonatal period was calculated as the first day after birth). In the SME, if there is reliable data on the life span of the child (first of all, medical documents indicating the time of birth and life span), he is considered a newborn under the age of 28 days of life; in the absence of documentary data on the age of the child, the child is considered a newborn only if there are signs of a recent birth (in fact, the first few days of life).
Newborn signs: 1) the presence of blood and cheese-like lubricant on the skin 2) a birth tumor 3) the remains of the umbilical cord and placenta 4) traces of meconium (original feces) on the skin and in the intestines 5) the absence of food in the stomach and intestines 6) local atelectasis of the lungs.
full-term pregnancy- a pregnancy that ended in childbirth at a period of 37 to 42 completed weeks (259-293 days). A baby born between 28 and 37 weeks is considered premature, and a baby born before 28 weeks is considered a miscarriage. Postterm pregnancy is considered to be more than 42 weeks.
Maturity- optimal functional and morphological development of organs and tissues of a newborn, corresponding to the gestational age of a full-term baby. The latter may have signs of immaturity, when certain morphological and functional indicators correspond to earlier periods of intrauterine development.
Maturity indicators:
1) body length not less than 45 cm and weight not less than 2500 g.
2) the length of the parietal bone diagonally in a mature newborn child is 7.6 cm, the diameter of the Beclery nuclei (the ossification zone in the lower epiphysis of the thigh) is at least 0.5 cm.
3) internal organs have a mass corresponding to the gestational age
4) elastic skin with a well-developed subcutaneous fat layer, vellus hair only in the area of the shoulder blades and a small amount on the shoulders
5) quite thick hair on the head more than 1 cm long
6) the navel is located in the middle of the distance between the xiphoid process and the pubic joint
7) the cartilages of the nose and auricles are elastic and resilient, the nails reach the edge of the nail beds on the fingers and toes.
8) in boys, the testicles are lowered into the scrotum, in girls, the genital slit is closed and the large labia cover the small ones.
The discrepancy between any of the indicated indicators in a full-term baby allows us to state intrauterine growth retardation, i.e. immaturity.
Viability - sufficient morphological and functional development of tissues and organs of a newborn child, allowing him to live outside the mother's body. Modern medical science recognizes viable fetuses with a gestational age of 22 weeks or more, weighing 500 g or more, and 25 cm long or more. However, from the point of view of most authors, for the practice of SME viable should be considered a newborn with a minimum period of intrauterine development of 32 weeks (8 lunar months), weighing at least 1500 g and a length of at least 40 cm, able to exist without creating special conditions for incubation. In addition to the gestational age, the viability of the newborn is determined by the absence of life-threatening malformations and other pathological conditions, including pronounced signs of immaturity.
Infanticide- mother killing her newborn baby:
a) active - when any damage is caused to the newborn
b) passive - leaving the newborn without the necessary care, which leads to his death.
A newborn child and a child of the infancy period constantly need to create optimal living conditions for them. Leaving such children without proper care can be fatal for them. Lack of care can be judged by the following signs:
Finding the corpse of a child in a forest, barn, abandoned building, cesspool, etc.;
The presence in the newborn of an untreated umbilical cord, not separated from the umbilical cord of the placenta;
The presence of fetal membranes, blood, mucus, meconium, and other contaminants on the body of a newborn;
Lack of clothes on the child’s body (diapers, undershirts, etc.) or inconsistency with the temperature conditions of the environment;
Lack of food in the stomach;
The presence of insects on the body of a child, intravital injuries by animals, insects, birds, etc.
The life expectancy of a child left without care and nutrition depends on the conditions in which he is located, and can be calculated up to several days. Data indicating the lack of care for the child must necessarily be compared with the peculiarities of the situation and conditions in which the corpse of the baby was found.
22. Forensic histological studies during the forensic medical examination of a corpse: taking sectional material, issues to be resolved.
This study is optional in some cases. in solving a number of issues:
Establishing the lifetime of damage and the limitation of its receipt
Confirmation of the presence of the disease, establishing its form
Establishing the cause of death, etc.
Principles of taking sectional material:
1) pieces of tissue are cut with a sharp knife or razor blade. The thickness of the pieces due to the slow penetration of formalin into the tissues should be no more than 1 cm (recommended 0.5-0.7 cm). Under a standard coverslip, the length and width of the pieces are usually up to 2x2 cm; if it is necessary to obtain topographic sections, fragments of a larger area are cut out.
2) the removal of tissue fragments is carried out taking into account the anatomical structure of the organ, so that various structures fall into the preparation. In case of injuries and focal painful tissue changes, fragments are removed separately from the affected area, at the border of the affected and unaffected areas and from healthy tissue. In cases of removal of several pieces from one organ or tissue of the same type from different places (skin, muscle tissue), the material is marked with signed labels, wrapping them together with tissue fragments in gauze. The removed material is immediately placed in a fixative liquid - a 5-10% formalin solution. The volume of the fixing fluid must exceed the volume of the tissue placed in it by at least ten times.
3) dried tissue pieces (mummified), tissue fragments after exposure to extremely high temperature (charring) or in the state of peat tanning or fat wax are sent to the forensic histological laboratory without fixation.
When taking material for additional histological examination, the expert himself determines which tissues and in what volume should be removed. When examining corpses, at a minimum, fragments of the heart, lungs, kidneys, liver, brain, and, if necessary, any other tissues should be removed. If it is possible to determine the cause of death and solve the tasks set only according to the data of a macroscopic sectional examination, then the tissues correctly removed and fixed in formalin can be stored for a long time and, if necessary (repeated examinations, scientific research), be subjected to further processing and histological examination.
23. Withdrawal of sectional material for bacteriological and virological examination during the forensic medical examination of the corpse.
To conduct microbiological and virological studies, the following are carried out:
a) inoculation of the material on nutrient media and subsequent verification of the grown culture
b) obtaining smears-imprints on glass and identifying microorganisms using staining or fluorescent reactions
c) carrying out verification reactions for specific antibodies to microorganisms and their toxins or for microorganisms (for example, RIF, RW, etc.);
d) isolation of DNA and typing of specific sections of the genome of microbes, protozoa or viruses (for example, using polymerase chain reaction).
Microbiological and virological studies must be carried out in case of suspected death from infectious diseases. Objects should preferably be confiscated within the first day after death; at a later date, the likelihood of obtaining reliable research results is reduced, especially when sowing.
Principles for the removal of sectional material for microbiological examination:
1) the removal of the material is carried out by a bacteriological laboratory specialist, and in his absence - by a doctor (SME-t).
2) to take the material, sterile tools burned in the flame of a burner are used. Blood in a volume of 5-10 ml from the cavities of the heart or blood vessels is taken with a sterile syringe or a sterile pipette into a sterile vial or test tube; the surface of the heart or vessel before dissection is cauterized with a hot spatula. The sizes of the taken pieces of the brain and parenchymal organs are usually about 1x1x1 cm. The pieces of the brain are cut out before it is removed from the opened skull; before dissection, the dura mater and the surface of the brain are cauterized.
The surfaces of parenchymal organs are also cauterized with a hot spatula before dissection to take pieces. Pieces of the lungs are cut from the basal areas and from the middle of each lobe. Pieces of the liver are cut from each lobe. The gallbladder is removed entirely along with the contents after the application of ligatures. To study the contents, fragments of the intestine 10-20 cm long are previously isolated with ligatures, then a dissection is made along their outer edge.
3) the objects are placed in a sterile dish. A 30% glycerin solution can be used as a fixative. Immediately upon removal, it is possible to inoculate the material (usually with a bacterial loop) on nutrient media for growing microorganisms and their subsequent verification.
4) In addition to the removal of tissues, it is necessary to make smears-imprints from the surface of the examined organs
Objects are withdrawn depending on the alleged diagnosis, based on preliminary information about the clinical picture of the disease and morphological changes revealed during the autopsy. So, with disseminated mycoses (actinomycosis, blastomycosis, etc.), lungs and other morphologically altered tissues are removed; with rabies - the medulla oblongata and pieces of the cerebral hemispheres; with whooping cough - lungs; with meningococcal infection - meninges, brain, blood, pharyngeal mucus, pus; with AIDS - blood from the cavity of the heart. In each case, it is necessary to remove material from altered tissues (foci of inflammation), as well as from organs where the accumulation of infectious agents is possible without any morphological manifestations.
LIFE TESTS- Methods for determining live birth, establishing the presence of air in the lungs or gastrointestinal tract.
According to § 79 of the "Rules for the forensic examination of corpses", it is mandatory to conduct two hydrostatic tests: pulmonary and gastrointestinal. To establish the fact of live birth (see), Dillon's radiographic test, a test for the patency of the vessels of the umbilical cord, optical and ear tests are also proposed.
Pulmonary test based on the physical law of specific gravity. After the first breath, the lungs of a newborn are filled with air and their specific gravity becomes lowered into a vessel with water, floats and floats on the surface.
The lungs of a non-breathing baby are an airless dense tissue, the specific gravity of which is more than one; they sink to the bottom of a vessel filled with water. In the production of a lung test, before opening the chest cavity, the soft tissues of the neck are separated and the trachea is tied in its upper third. After examining the organs of the chest cavity, they are removed in a single complex (before transection of the esophagus, it should be bandaged at the entrance to the stomach). The extracted complex is carefully lowered into a wide vessel with clear cool water. If the complex sinks, then, after changing the water in the vessel, the lungs are separated from the bronchi and each lung is lowered into the vessel separately. The test is repeated with each lobe of the lung, and then with separate sections of the lung tissue, which stand out in a lighter color. The ability of the lungs or their parts to float indicates the content of air in the alveoli, which came during the first respiratory movements of the infant, and is evaluated as a positive result of the lung test. However, it should be borne in mind that with a putrefactive change in the corpse, freezing of the lungs with the formation of ice in them, carrying out various measures to revive the newborn, the lungs of a non-breathing infant can float.
Gastrointestinal test is based on the fact of penetration of air into went. - kish. a path simultaneously with the beginning of independent pulmonary respiration as a result of swallowing of air by the baby. To carry it out, the stomach is bandaged at the entrance and exit with two ligatures until the cervicothoracic complex is removed, the large and small intestines in several places, especially where there is an accumulation of gases. Next, the entire intestine is carefully separated from the mesentery and, together with the stomach, is lowered into a vessel with cool water and tested for swimming similarly to the lungs. It is important to note the partial immersion of the complex, i.e. which departments went. - kish. a path have appeared surfaced and on what extent since at an extrauterine life of the baby this or that part went. - kish. a path happens it is filled with air and the longer life proceeded, the more deeply on went. - kish. air enters the path. Then the stomach and intestines are sequentially opened with a scalpel under water, noting the absence or presence of air bubbles. Positive result went. - kish. samples are evaluated in the same way as pulmonary. Reliability of results went. - kish. samples are sharply reduced or completely lost if there are signs of putrefactive decomposition of the corpse. It should also be remembered that air can fill the stomach and intestines during resuscitation of a newborn. Content of air in went. - kish. the path does not always correspond to the strength and duration of breathing: in the case when the lungs remain in a state of atelectasis, went. - kish. the tract fills with air faster than with free breathing. A positive result of this test, coinciding with the same result of a pulmonary test, confirms the life of the child after birth. If wished. - kish. the test is positive, and the lungs are airless, then it in itself can serve as a sign of extrauterine life. Quite often lungs contain air, and in went. - kish. it is not in the path. This phenomenon becomes understandable and does not contradict the fact of the extrauterine life of a newborn, if we take into account that it takes more time for air to penetrate into the stomach than into the lungs.
Dillon's test proposed in 1937. According to the observations of Ya. G. Dillon, even in the absence of air in the lungs, the child lives for a certain time, if air penetrates into his stomach immediately after birth; this air is sucked in and sustains life. By X-ray examination, it is possible to detect even a small amount of air (up to 0.2 cm 3) in the lungs and stomach of newborns.
optical test is based on the presence of the characteristic marble appearance of the lung surface of a breathing infant. When examining the surface of the lungs with the naked eye or with a magnifying glass, you can find light areas consisting of many shiny bubbles, which are alveoli straightened by air. They are located under the pleura, surrounded by capillaries stretched with blood and are considered a sign of breathing that has taken place. However, air-flattened alveoli are also present during artificial respiration and with putrefactive decomposition of the lung tissue; in such cases, the establishment of live birth by optical test becomes impossible.
Test for the patency of the vessels of the umbilical cord comes from the ability of the umbilical cord in stillborn babies to pass water, and in live births to delay its passage. The test has no scientific justification, its results are inconsistent, therefore it is proof of a live birth only in combination with positive results from other tests.
ear test, associated with the fact of air penetration into the auditory (Eustachian) tube and tympanic cavity, has not received practical application due to the complexity of implementation.
Bibliography: Rosenblum E. E., Serdyukov M.G. and Smolyaninov V.M. Forensic obstetric and gynecological examination, M., 1935; Serdyukov M. G. Forensic gynecology and forensic obstetrics, M., 1964, bibliogr.; Smolyaninov V. M., Shirinsky P. P. and Pashinyan G. A. Forensic diagnostics of live birth, M., 1974, bibliogr.
P. P. Shirinsky, G. A. Pashinyan.
Along with questions about the newborn, full-term and maturity of the baby, the decision on the issue of live birth or stillbirth is of paramount importance. To solve the question of live birth means to find evidence of the extrauterine life of an infant. The most important of the signs of extrauterine life is external respiration. Therefore, it is necessary to establish whether the baby was breathing. For this, the so-called vital (hydrostatic) tests are performed: the Galen lung test and the Breslau gastro-intestinal test.
The lung test is based on the difference in the specific gravity of breathing and non-breathing lungs. Non-breathing lungs are dense and airless, of a uniform dark red color, their surface is smooth and uniform, in the pleural cavities they occupy the posterior sections. The specific density of non-breathing lungs is more than one - 1.05-1.06, so they sink in water.
With the very first breath of the child, when the transition from apneustic (intrauterine) to pneumotoxic (external) breathing is made, the alveoli begin to fill with air, the lungs expand, their volume increases and they almost completely fill the pleural cavities. The surface of the lungs takes on a kind of "marble" appearance, they become lighter. The specific density of breathing lungs is less than unity, so they float on the surface of the water.
Technique for performing a lung test. Before opening the chest cavity, the larynx is separated and, below the larynx, a ligature is applied to the trachea and esophagus. The chest cavity is opened, a ligature is applied to the esophagus at the diaphragm. The tongue, neck organs, thymus gland, heart, lungs are removed in a single organ complex and lowered into a vessel with clear cold water. After that, the heart, pulmonary artery, and ductus arteriosus are examined. Then the thymus gland, the pericardial shirt, the heart with large vessels are separated, and the lungs and larynx with the trachea are lowered into the water. Then the larynx, trachea and bronchi are opened, if necessary, smears are taken, the lungs are cut off at the root and lowered into the water. Sequentially, each lung individually, the lobes of the lungs, and individual parts of the lobes are lowered into the water. Observation data on whether the lungs, their lobes and individual parts of the lobes are floating or sinking, are recorded in the act of examining the corpse.
Evaluation of the results of the lung test. A positive result (lungs or their lobes, areas floating) indicates that the baby breathed after birth, therefore, lived. However, this provision is true only under the conditions that it is not rotten (rotten lungs will float due to the presence of putrefactive gases in them), that the corpse is not frozen (frozen and not completely thawed lungs will also float in water) and that the baby after birth was not artificial respiration.
In some rare cases, the so-called secondary atelectasis can be observed - the collapse of already breathing lungs, while they will sink in water. A histological examination of the lungs will help to correctly resolve the issue: with secondary atelectasis, the middle bronchi have well-defined gaps, small bronchi in the form of narrow slits, and wide alveolar passages. In the lumen of the alveolar passages, the so-called hyaline membranes are found - formations stained with eosin in a bright pink color. In a non-breathing infant, the lungs are in a state of primary atelectasis, small bronchi, bronchioles and alveoli are collapsed, irregular in shape and of various sizes, do not contain air, alveolar cubic, elements of amniotic fluid can be found in the bronchi and alveoli.
Technique for performing a gastrointestinal test. Immediately after the onset of independent external respiration, air enters the stomach, and then into the intestines. The stomach and intestines filled with air acquire the ability to swim in water. This is the basis of the gastrointestinal test. For its implementation, even before the removal of the stomach and intestines, ligatures are applied to the stomach at the entrances to the exit, to the intestines in those places where the presence of air can be visually determined, and to the rectum (Fig. 3). After that, the entire intestine is freed from the mesentery and, together with the stomach, is lowered into a vessel with clean cold water. Note which parts float and which sink. In order to make sure that the stomach or intestines contain air (gas), they are immersed in water and carefully punctured, air bubbles will be released.
Rice. 3. Arrangement of ligatures for hydrostatic tests.
Evaluation of the results of the gastrointestinal test. If the corpse does not show signs of decay and if it is established that the newborn was not artificially respired, and also if the lung test is positive, it can be considered that the child was born alive.
If the corpse has signs of putrefactive decomposition, then a positive result of the gastrointestinal test is unreliable, since putrefactive gases can accumulate in the lumen of the stomach and intestines. In this case, the accumulation of gases will be uneven: some areas may be swollen with gases, others - collapsed. Air can get into the stomach and intestines even when artificial ventilation of the lungs was performed. In these cases, a positive test result cannot be considered proof of a live birth.
The results of pulmonary and gastrointestinal tests should be evaluated in combination. As a rule, the results of these tests are the same. However, if he lived for a very short time, then the lung test may be positive, and there may be no air in the stomach and intestines.
Unlike the lungs, which at the first breath can straighten out and fill with air, air penetrates into the stomach and intestines gradually, first filling the stomach and the initial sections of the intestine. Therefore, according to the degree of air filling of the gastrointestinal tract, one can roughly judge the life expectancy of an infant.
So, if air is found only in the stomach, then life expectancy was several minutes; if the stomach and small intestines are filled with air, life expectancy was within 4-6 hours; if the entire gastrointestinal tract is filled with air, life expectancy was at least 12 hours.
In addition to lung and gastrointestinal swimming tests, the so-called radiographic test is used to establish the live birth - the entire corpse of a newborn (before autopsy). On radiographs, the presence of air (gas) in the lungs, stomach, intestines, as well as gases formed as a result of putrefaction in the vessels and internal organs is determined.
With the help, it is possible to identify the ossification nuclei in various bones, and using them to establish the intrauterine age of the fetus, bone damage.
The question of the life expectancy of an infant is decided on the basis of the presence and changes in the signs of a newborn, the results of vital tests.
The cleansing of the child's oral cavity from mucus and blood testifies to the carrying out of the necessary; separation of the umbilical cord and its ligation; release of the fetus from the membranes; measures ; protection of the child's body from cooling.
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