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Table of contents

1. The subject of forensic medicine (Forensic medicine and its main tasks. The subject and objects of forensic medicine. Features of forensic medicine. The importance of forensic medicine for lawyers and doctors. The emergence and development of forensic medicine in Russia)
2. Procedural and organizational issues of a forensic medical examination (Classification of forensic medical examinations. Procedure for the appointment and production of a forensic medical examination. Duties and rights of a forensic medical expert. Forensic medical institutions)
3. Forensic traumatology (Damaging factors Classification of damage. The concept of traumatism. Mechanical damage)
4. Forensic medical examination of injuries caused by blunt solid objects (Mechanisms for the formation of blunt injuries. Types of blunt injuries)
5. Forensic medical examination of injuries caused by sharp objects
6. Gunshot injuries (Damaging factors of a shot. Characteristics of a gunshot wound. Types of shots. Explosive injury)
7. Forensic medical examination of mechanical asphyxia
8. Forensic medical examination of living persons. Examination of harm to health, state of health, determination of age, feigned and artificial diseases (Expertise of harm to health. Examination of working capacity)
9. Forensic medical examination of living persons. Examination of sexual conditions and sexual crimes (General provisions. Examination of the victim. Sex determination. Establishment of virginity. Examination of pregnancy, childbirth, abortion)
10. Forensic medical examination of poisoning (Conditions for the action of poison on the body. Forensic medical diagnosis of poisoning)
11. Forensic examination of injuries from exposure to high and low temperatures (Action of high temperature. Action of high temperature. Action of low temperature. Action of low temperature)
12. Forensic medical examination of electrical injury (Death by technical electricity. Defeat by atmospheric electricity)
13. Forensic thanatology (The concept of death. Classification of death. Cause and genesis of death. Classification of signs of death)
14. Examination of the corpse of a newborn baby
15. Forensic medical examination of physical evidence of biological origin (Preliminary samples for the presence of blood. Studies of other human tissues and secretions)

LECTURE No. 1. The subject of forensic medicine

Often in the literature there are unsuccessful definitions of the concept of "forensic medicine" given by many respected authors. These definitions are pseudoscientific, cumbersome and, therefore, difficult to understand. Here is an unsuccessful version of such a definition: "Forensic medicine is a science that is a collection of knowledge and research in the field of natural science, medicine, physics, chemistry and medical forensics, purposefully directed in its development, improvement and practical application to the implementation of the tasks of justice and healthcare ".

We adhere to another version of this definition, arising from the understanding of the first and main task of forensic science, which is to assist law enforcement agencies in cases (criminal and civil) related to crimes against life, health, dignity of the individual and the health of the population as a whole.

Forensic medicine is an independent medical discipline that studies and resolves issues of a medical and general biological nature that arise for forensic investigators in the process of investigation and trial.

The second task of forensic medicine is to assist health authorities in improving the quality of treatment and prevention work.

Forensic medicine is of great social importance in the fight against crimes against the life, health and dignity of the individual, as well as in the prevention of injuries, intoxications, sudden and sudden death.

Federal Law No. 31-FZ of May 2001, 73 "On State Forensic Activities in the Russian Federation" defines: "Forensic examination (including forensic examination) is a procedural action consisting of conducting research and giving an opinion by an expert issues, the resolution of which requires special knowledge in the field of science, technology, art or craft and which are put before an expert by a court, judge, body of inquiry, a person conducting an inquiry, an investigator or a prosecutor, in order to establish the circumstances to be proved in a particular case.

Forensic science is the practical application of forensic medicine.

The subject of forensic medicine is the theory and practice of forensic medical examination. Forensic medicine studies and finds ways to solve medical and general biological problems that arise in the work of forensic investigative bodies. The totality of the scientific problems that arise in this case constitutes the content of forensic medicine.

The objects of a forensic medical examination are the corpses or remains of people, living persons (victims, accused and other persons), material evidence, samples for comparative research. The objects are also materials of criminal and civil cases containing information about living persons, corpses, material evidence, as well as other information.

As a medical discipline associated with practical activities, forensic medicine differs significantly from other medical disciplines. Let's note its features.

I. Forensic medicine uses many sciences to best solve its problems.

We list the main ones.

1. Physics - the science of the properties and structure of matter, the forms of its movement and change, the general laws of natural phenomena.

2. Chemistry - the science of the composition, structure, properties of substances and their transformations.

3. Biology - the science of development, structure, functions, relationships of living beings and their relationship with the environment.

4. Normal human anatomy - studies the macroscopic structure of the body of a healthy person, taking into account the conditions of existence (i.e., the action of environmental factors), as well as the features of age-related changes in organs, variants and anomalies of their development.

5. Histology is a science that studies the microscopic structure of human organs and tissues in normal conditions.

6. Normal physiology - studies the functions of organs and tissues of a healthy person.

7. Biochemistry - a branch of chemistry that studies chemical processes in the human body.

8. Pathological anatomy - studies the macroscopic and microscopic structure of organs and tissues in various diseases.

9. Pathological physiology - studies the functions of human organs and tissues in various diseases and exposure to environmental factors.

10. Microbiology - the science of bacteria, viruses, their toxins.

11. Medical sciences: surgery, therapy, pediatrics, obstetrics, gynecology, ophthalmology, otorhinolaryngology, etc.

12. Legal sciences: criminology, criminal law, criminal procedure, forensic science.

Initially, there was no division into criminology and forensic medicine. In the future, this division took place, and as it developed, forensic medicine developed questions of a medical and general biological nature. In forensic medicine, sections began to appear, which later separated and became independent sciences. These include toxicology, forensic psychiatry, forensic chemistry, etc. At the same time, the following sections have appeared in forensic medicine: forensic traumatology, forensic gynecology, forensic serology (the study of biological media), medical forensics, forensic radiology, etc. .

II. The universal nature of forensic medicine lies in the fact that, unlike other medical disciplines, it simultaneously deals with the study of a corpse, a living person, the study of material evidence that is not medical objects (clothes with traces of secretions, traumatization tools, etc.). Also, the object of forensic medicine is not only medical documents (medical record of an inpatient patient, medical record of an outpatient patient, laboratory test results, etc.), but also legal documents (materials of criminal and civil cases, protocols of examination, investigative experiment, etc.).

The methods used in the practice of forensic medicine are very diverse. Let's list these methods.

1. General dialectical-materialistic method.

2. General scientific methods - a system of techniques for studying objects, phenomena, facts. These are observation, measurement, description, comparison, experiment, modeling, mathematical methods, etc.

3. Methods taken from other sciences. For example, the following methods are taken from various branches of medicine and biology: histological, biochemical, immunological, genotyposcopy, etc. Others are taken from physics, chemistry, technology: X-ray, photographic, spectral, chromatographic, and many others. Currently, in the practice of forensic medicine, mathematical methods of statistical analysis are increasingly used.

4. Methods developed by forensic medicine itself. This is the determination of the cause and prescription of death, the establishment of lifetime or post-mortality, as well as the prescription of injuries, the establishment of the type of instrument of crime by injuries on the human body, the establishment of sex, age, height, etc. from bone remains, the method of photocombination of images of the skull and intravital photography for the purpose of identification personalities, etc.

III. The formal nature of forensic science also distinguishes it from other medical disciplines. The order of appointment, production and registration of the results is strictly regulated by the relevant procedural legislation. Conducting most studies is associated with the obligatory use of various official regulatory documents: rules, instructions, guidelines, etc. Thus, all studies are carried out in accordance with the "Instructions for the organization and production of expert studies in the bureau of forensic medical examination". Based on the results of the forensic medical examination, an "Expert opinion" is drawn up. It has its own structure and order of filling. In the introductory part, there is a receipt from the expert explaining his duties and warning him of criminal liability for giving a knowingly false opinion.

IV. The political nature of forensic medicine also distinguishes it from other medical disciplines. In the world, separate investigations have been going on for decades. These investigations lead to different, sometimes opposite results, depending on the changing political situation in the countries.

Numerous forensic medical examinations were also carried out in these cases.

The results of many forensic medical examinations have a great social and political resonance. Such are the examinations on the identification of the remains of the royal family of the Romanovs, on the identification of the remains of Bormann, etc.

The importance of forensic medicine was well expressed back in 1901 by the largest medical scientist in Europe, whose textbooks taught several generations of forensic doctors, including in Russia, E. Hoffmann. He wrote: "If we imagine how great is the number of trials in which the participation of a forensic doctor is necessary, if we take into account that in most such cases the entire further course of the trial, and mainly this or that sentence, depends on the study and conclusion of the forensic doctor that in this way not only the public interest is entrusted to him of paramount importance, but also the personal fate, honor and freedom, and sometimes the life of the persons concerned, it is hardly necessary to adduce evidence in favor of the great importance of forensic science.

Knowledge of the basics of forensic medicine is necessary for a lawyer as a representative of the investigation and the court. Already when appointing an examination, using this knowledge, he must skillfully and rationally put questions to the specialist and accurately formulate, draw up a plan for an investigation or trial. Studying the conclusion of the expert, he must correctly, critically evaluate his conclusions. In case of doubts about the correctness or completeness of the data obtained, he is obliged to take measures to clarify or change the questions, appointing an additional or repeated examination, sending new material evidence, or with the participation of an expert to carry out one or another investigative action. For this, it is necessary to know the possibilities of forensic medical examination, modern research methods.

As for the study of forensic medicine by future doctors, it is determined by the provision that, in accordance with the Code of Criminal Procedure, any doctor can be involved as a specialist in investigative actions and in the production of a forensic medical examination. Knowledge of forensic medicine in general enriches the training of a doctor of any specialty, developing expert thinking that is useful for him. Finally, forensic medicine allows future doctors and lawyers to be convinced of the significant legal responsibility of their specialty and the seriousness of the consequences of professional errors.

In pre-Petrine times, there are only a few indications of medical examinations, which were of a forensic nature. In the XNUMXth century inspections of wounds, mutilations and corpses of the dead were carried out by officials with witnesses. The first official instructions on mandatory forensic medical research date back to the beginning of the XNUMXth century.

In 1716, the Military Charter of Peter I appeared. Article 154 of the Military Charter ordered in cases of death after injuries received in a fight to involve a doctor to open the corpse and determine the cause of death. In 1737, there was an instruction to keep physicians in "noble cities", whose duties included forensic medical examinations.

Forensic medicine in the XNUMXth and XNUMXth centuries. developed in accordance with the development of general medicine and changes in the judicial system. Practical forensic activity in the XVIII and XIX centuries. run medical institutions. The latter have repeatedly undergone reforms and transitions from one ministry to another. Medical institutions were not in charge of doctors, but officials who did not have a medical education.

In 1797, medical boards were established, whose functions included forensic medical activities. In the regulation on the rights and obligations of medical boards there were already instructions on the autopsy of corpses.

The teaching of forensic medicine in Russia began over one hundred and fifty years ago. In 1798 medical and surgical schools were opened in Moscow and St. Petersburg. In St. Petersburg, the medical-surgical school later turned into the Military Medical Academy, which celebrated its 1949th anniversary in 150. Departments of forensic medicine were established in these schools.

In 1812, the laws on civil and criminal proceedings were supplemented by rules according to which the courts had to turn to experts if information about science, art or craft was needed in a case.

In 1815, an order was given to examine the mentally ill also in civil cases.

In 1823, a military medical journal began to appear, in which individual works of a forensic nature began to appear.

In 1828, the Medical Council issued an "Instruction for Physicians on Judicial Examination and Autopsy of Dead Bodies."

From the first Russian textbooks of forensic medicine, Gromov's textbook is known, which was published in the first edition in 1832.

This textbook indicates the high level and wide range of issues of forensic activity in Russia. Major medical figures in Russia also paid attention to forensic medical issues. The famous Russian surgeon I. V. Buyalsky (1799-1866) drew up the first rules for the forensic autopsy, which were later included in the Medical Charter.

N. I. Pirogov published a special atlas of anatomy for forensic doctors. In his works, there are separate observations of a forensic nature, for example, regarding gunshot injuries.

The judicial reform of 1864, the introduction of open court proceedings influenced the development of forensic medicine in Russia. The Charter of Criminal Procedure determined the rights and obligations of forensic doctors and the need to involve them in necessary cases. Some reforms were also carried out in medical institutions that were in charge of forensic medical activities.

In the last century, many Russian forensic doctors are known for their activities: S. A. Gromov, V. O. Merzheevsky, Ya. A. Chistovich, N. A. Obolonsky, Neiding and many others who have done a lot for domestic forensic medicine, the level of was higher than the state of this science in other European countries, despite the difficult conditions for scientific activity due to the unbearable oppression of the tsarist regime and the reactionary nature of the tsarist court. Many issues of forensic medicine were by that time developed by Russian forensic doctors. V. O. Merzheevsky and Ya. A. Bellin gave classic works on forensic gynecology. The discovery by Chistovich of the special properties of blood (precipitins) was the basis of the Chistovich reaction, which makes it possible to establish its origin from a person or a certain type of animal by traces of blood. Widely known are the studies of hair carried out by P. A. Minakov, and a number of other works by Russian scientists - forensic doctors, who significantly expanded and deepened domestic forensic medicine.

At the end of the XNUMXth century, the activities of the largest Russian forensic physician, Professor P. A. Minakov, began. A well-known forensic figure and criminologist, Professor N. S. Bokarius, worked in Ukraine. These scientists did a lot for the development of Soviet forensic medicine. N. S. Bokarius was the founder and head of the Kharkov Research Institute of Forensic Science, which now bears his name.

In 1918, a sub-department of medical examination was established in the People's Commissariat of Health in Russia, in 1920 the positions of provincial, city and district experts were introduced, special institutions began to be organized - forensic laboratories, which were later transformed into a bureau of forensic medical examination. Since 1925, scientific societies of forensic doctors have been organized, and the first in the country was the North Caucasian in Rostov-on-Don, then in Leningrad and Moscow. In 1947, the All-Union NOSM was created. In 1932, a research institute for forensic medicine was organized in Moscow. A number of governmental and departmental official documents were issued on the organization, strengthening and development of forensic medical examination, congresses and conferences were held. Textbooks, manuals, monographs began to be published, the journal "Forensic Medical Examination", and collections of scientific papers were periodically published.

In 1951, previously disparate institutions of forensic medical examination were merged into an independent group - the bureau of forensic medical examination. This reorganization completed the construction of a unified system of the country's forensic medical service, which has largely remained in the same form to this day.

LECTURE #2

Procedural and organizational issues of forensic medical examination

The fundamentals of the Law of the Russian Federation on the protection of the health of citizens dated July 22, 1993 No. 5487-1 in section IX "Medical examination" provides for the production of forensic medical examinations: "Article 52. Forensic medical and forensic psychiatric examinations.

A forensic medical examination is carried out in medical institutions of the state or municipal health care system by an expert of the forensic medical examination bureau, and in his absence, by a doctor involved in the examination, on the basis of a decision of the person conducting the inquiry, the investigator, the prosecutor or a court ruling.

A forensic psychiatric examination is carried out in institutions of the state or municipal health care system designated for this purpose.

A citizen or his legal representative has the right to petition the body that appointed the forensic or forensic psychiatric examination to include an additional specialist of the relevant profile in the expert commission with his consent.

The procedure for organizing and conducting forensic medical and forensic psychiatric examinations is established by the legislation of the Russian Federation.

The conclusions of institutions that carried out forensic and forensic psychiatric examinations may be appealed in court in accordance with the procedure established by the legislation of the Russian Federation.

Forensic medical examination in accordance with the current legislation refers to both forensic and medical activities. Forensic activities in accordance with the Federal Law of August 8, 2001 No. 128-FZ "On Licensing Certain Types of Activities" do not require licensing. Forensic medical examination as a medical activity in accordance with this Federal Law is subject to mandatory licensing.

In accordance with the "Nomenclature of works and services for the provision of appropriate medical care", approved by order of the Ministry of Health of the Russian Federation dated July 26, 2002 No. 238 "On the organization of licensing medical activities", forensic medical examination is divided into the following types:

1) forensic medical examination and examination of a corpse;

2) forensic medical examination and examination of victims, accused and other persons;

3) forensic medical examination based on materials of criminal and civil cases;

4) forensic medical examination of physical evidence and research of biological objects:

a) forensic biological;

b) forensic cytology;

c) genetic;

d) medico-criminalistic;

e) spectrographic;

f) forensic chemical;

g) biochemical;

h) chemical-toxicological;

i) forensic-histological.

By the decision of the Supreme Court of the Russian Federation of June 23, 2004, the need to license forensic medical examinations based on materials of criminal and civil cases was abolished.

Recently, on January 22, 2007, the Decree of the Government of the Russian Federation No. 30 approved the "Regulations on Licensing Medical Activities". This provision defines the procedure for licensing medical activities, licensing requirements, the procedure for obtaining a license, etc. as well as the "List of works (services) in the implementation of medical activities".

Primary examination is the initial study of the object with the preparation of an expert opinion. In the vast majority of cases, the primary examination gives answers that fully satisfy the investigation. As a rule, the primary examination is carried out by one expert. However, in particularly complex and responsible cases, the primary examination can be carried out by a group of specialists.

A re-examination is appointed in case of groundlessness of the expert's opinion or doubts about its correctness, as well as in cases of violations of a procedural nature. It is entrusted to another expert or a commission of experts.

An additional examination is carried out if new information is revealed in the course of a preliminary or judicial investigation that requires a special expert study. An additional examination may be carried out by the expert who performed the primary examination, by another expert or by a group of other experts.

Commission examination - an examination conducted by at least two experts of the same specialty.

Comprehensive examination is an examination carried out by experts of various specialties.

The terms "expertise" and "expert" appeared for the first time in the criminal procedure legislation of our country in the Code of Criminal Procedure of the RSFSR of 1922. The Criminal Procedure Code of the Russian Federation of 2002, considering the participants in criminal proceedings, includes an expert and a specialist in their number (the concepts of these participants are contained and in other normative acts of procedural legislation: Civil Procedure and Arbitration Procedure Codes). Both of these procedural figures are characterized by one quality peculiar only to them - the possession of special knowledge. Special knowledge can be used in procedural and non-procedural forms. In the procedural form, special knowledge is used through the participation of a specialist in investigative actions; through the production of expertise. In a non-procedural form, special knowledge is applied through the advisory and reference activities of knowledgeable persons; through the participation of specialists in operational-search activities.

In turn, the concept of "forensic examination" is enshrined in the Federal Law "On State Forensic Expert Activities in the Russian Federation", where it is understood as a procedural action consisting of conducting research and giving an opinion by an expert on issues whose resolution requires special knowledge in the field of science. , techniques, arts or crafts and which are placed before an expert by a court, a judge, a body of inquiry, a person conducting an inquiry, an investigator or a prosecutor, in order to establish the circumstances to be proven in a particular case.

Forensic examination is the most important procedural form of application of special knowledge in legal proceedings. As a result of its production, new information of probative value, which cannot be obtained by other procedural means, is at the disposal of the investigation and the court.

The term "expertise" comes from the Latin expertus, which means "experienced, knowledgeable." Examination can be carried out in various state institutions, public organizations (interdepartmental, scientific, administrative, forensic examinations). When people talk about expertise in the broad sense of the word, they mean any research conducted by a knowledgeable person to answer questions that require special (scientific, professional, experienced) knowledge. Judicial examinations are carried out in connection with the investigation and consideration of criminal cases, administrative offenses, civil cases, including arbitration disputes (Articles 57 and 195 of the Code of Criminal Procedure of the Russian Federation; Article 26.4 of the Code of Administrative Offenses of the Russian Federation; Article 79 of the Code of Civil Procedure of the Russian Federation; Article 82 of the APC RF).

Federal Law No. 31-FZ of May 2001, 73 "On State Forensic Activities in the Russian Federation" defines: "Forensic examination (including forensic examination) is a procedural action consisting of conducting research and giving an opinion by an expert issues, the resolution of which requires special knowledge in the field of science, technology, art or craft and which are put before an expert by a court, judge, body of inquiry, a person conducting an inquiry, an investigator or a prosecutor, in order to establish the circumstances to be proved in a particular case.

The legal basis for forensic activities is the Constitution of the Russian Federation, Federal Law of May 31, 2001 No. 73-FZ, the Civil Procedure Code of the Russian Federation, the Arbitration Procedure Code of the Russian Federation, the Code of Criminal Procedure of the Russian Federation, the Code of Administrative Offenses of the Russian Federation, the Customs Code of the Russian Federation, the Tax the Code of the Russian Federation, the legislation of the Russian Federation on health care, other federal laws, as well as regulatory legal acts of federal executive bodies regulating the organization and production of forensic examination.

The procedure for the appointment and production of a forensic medical examination, as well as any examination, is determined by the procedural legislation of the Russian Federation and Federal Law No. 31-FZ of May 2001, 73.

The court, prosecutor, investigator, inquirer in the resolution (determination) on the appointment of an expert examination indicate the grounds for the appointment of an expert examination, the name of the expert or the name of the institution in which the expert examination is to be carried out, the issues subject to an expert decision, as well as the materials to be placed at the disposal of the expert. The person who appointed the examination has the right to be present during all stages of the examination.

The Code of Criminal Procedure provides for a special article that defines the cases when an expert examination is mandatory and its appointment does not depend on the opinion or desire of the inquirer, investigator, prosecutor and court. This is Art. 196 "Obligatory appointment of a forensic examination", according to which the appointment and production of a forensic examination is mandatory if it is necessary to establish:

1) cause of death;

2) the nature and degree of harm caused to health;

3) the mental or physical state of the suspect, the accused, when there is doubt about his sanity or ability to independently defend his rights and legitimate interests in criminal proceedings;

4) the mental or physical state of the victim, when there is doubt about his ability to correctly perceive the circumstances that are important for the criminal case and give evidence;

5) the age of the suspect, the accused, the victim, when it matters for the criminal case, but the documents confirming his age are absent or in doubt.

An examination is mandatory if it is necessary to establish the cause of death and (or) the nature and degree of harm caused to health. These issues are fully within the competence of the forensic medical examination. The concept of "the nature of the harm caused to health" is quite broad. It includes morphological features, and the mechanism of formation, and prescription (period) of their formation, and the harm that damage causes to human health, and many other issues.

The next reason for the mandatory examination is the solution of questions about the mental state of the accused or suspect, when it is necessary to determine the sanity of a person, his ability to critically and sensibly assess the situation, navigate in place and time. This reason is entirely within the competence of an independent forensic psychiatric examination. Another reason for the mandatory examination is the assessment of the mental state to be conducted by a forensic psychiatric examination, and in relation to the physical state - to the competence of a forensic medical examination. The need to determine the physical condition of the victim may be associated with the infliction of injuries, the presence of somatic or infectious diseases that prevent the investigator from appearing on the call of the investigator or in court and giving evidence, or the simulation of such diseases.

The fifth reason for the mandatory examination also belongs to the competence of forensic medicine. The need to establish age arises in the absence of documents certifying it in criminal or civil cases. This is a rather rare, but very complex type of forensic medical examination. The difficulties of this examination are related to the fact that a person is distinguished by passport or calendar age, bone or skeletal age, and functional or biological age. The question of age is solved relatively simply and accurately at the initial stage of a person’s life, and as we age, the discrepancy between calendar, skeletal and biological age increases, and at the final stage of life (50 years or more), the error in determining age can be 5 or even 10 years.

Thus, in all cases when any harm is caused to the health or life of a person or there are doubts about mental or physical health, the judicial investigative authorities are obliged to appoint a forensic medical or forensic psychiatric examination.

The general scheme for conducting a forensic medical examination:

1) study of the resolution (determination) on the appointment of an expert examination;

2) clarification of the circumstances of the incident, the reason for the examination and issues subject to expert decision;

3) assessment of the sufficiency and quality of the materials submitted by the investigator for expert research and answering the questions posed;

4) drawing up a plan for conducting an examination in the form of an optimal sequence for solving expert problems and rationally applying the necessary set of research methods;

5) the actual study of the object or objects of expertise;

6) analysis and synthesis of the results of all studies;

7) drawing up an expert opinion.

The results of the examination are formalized as "Expert opinion". The content of the "Expert's opinion" is defined by Art. 25 of the Federal Law of May 31, 2001 No. 73-FZ. The conclusion of an expert or a commission of experts should reflect:

1) the time and place of the forensic examination;

2) grounds for conducting a forensic examination;

3) information about the body or person who ordered the forensic examination;

4) information about the state forensic institution, about the expert (last name, first name, patronymic, education, specialty, work experience, academic degree and academic title, position held), who are entrusted with the production of a forensic examination;

5) warning the expert in accordance with the legislation of the Russian Federation on liability for giving a knowingly false opinion;

6) questions put before an expert or a commission of experts;

7) objects of research and case materials submitted to the expert for the production of a forensic examination;

8) information about the participants in the proceedings who were present during the production of a forensic examination;

9) the content and results of the research, indicating the methods used;

10) evaluation of research results, substantiation and formulation of conclusions on the issues raised.

Materials illustrating the conclusion of an expert or a commission of experts are attached to the conclusion and serve as its integral part.

Federal Law No. 31-FZ of May 2001, 73 "On State Forensic Activities in the Russian Federation" establishes the following duties and rights of an expert:

"Article 16. Duties of an expert.

The expert must:

1) accept for production the forensic examination entrusted to him by the head of the relevant state forensic expert institution;

2) conduct a full study of the objects and materials of the case provided to him, give a reasonable and objective conclusion on the questions put to him;

3) draw up a reasoned written report on the impossibility of giving an opinion and send this message to the body or person that appointed the forensic examination, if the questions raised go beyond the expert’s special knowledge, the objects of research and case materials are unsuitable or insufficient for conducting research and giving an opinion to the expert their addition was refused, the current level of development of science does not allow answering the questions posed;

4) not to disclose information that became known to him in connection with the production of a forensic examination, including information that may restrict the constitutional rights of citizens, as well as information constituting a state, commercial or other secret protected by law;

5) ensure the safety of the provided research objects and case materials.

The expert also performs the duties stipulated by the relevant procedural legislation.

An expert may not:

1) accept orders to conduct a forensic examination directly from any bodies or persons, with the exception of the head of the state forensic institution;

2) carry out forensic activities as a non-state expert;

3) enter into personal contacts with the participants in the proceedings, if this casts doubt on his disinterest in the outcome of the case; independently collect materials for the production of forensic examination;

4) notify anyone about the results of a forensic examination, with the exception of the body or person who appointed it;

5) destroy objects of research or significantly change their properties without the permission of the body or person who ordered the forensic examination.

"Article 17. Rights of an expert.

The expert has the right:

1) to petition the head of the relevant state forensic institution to involve other experts in the forensic examination, if this is necessary for conducting research and giving an opinion;

2) to make statements to be recorded in the minutes of the investigative action or court session regarding the misinterpretation by the participants in the proceedings of his conclusion or testimony;

3) appeal in accordance with the procedure established by law against the actions of the body or person who appointed the forensic examination, if they violate the rights of the expert.

The expert also has the rights provided for by the relevant procedural legislation.

The forensic medical expert may appeal to the prosecutor against the actions of the inquirer or investigator in the appointment and conduct of the examination, as well as receive reimbursement of the expenses incurred.

During the examination, the expert is warned about the inadmissibility of disclosing the data of the preliminary investigation. Otherwise, he is criminally liable for disclosure of information and for giving a false conclusion."

The main instructive and methodological document of forensic medical examination is the order of the Ministry of Health of the Russian Federation dated April 24, 2003 No. 161 "On approval of the Instructions for the organization and production of expert studies in the bureau of forensic medical examination", which includes the following sections.

I. Participation of a doctor - a forensic expert in the examination of a corpse at the place of its discovery.

II. Expert examination of the corpse.

III. Expert studies of females in crimes against sexual integrity and sexual freedom of the individual and in civil cases.

IV. Expert studies of males in crimes against sexual integrity and sexual freedom of the individual and in civil cases.

V. Forensic-histological expert studies.

VI. Forensic biological expert research.

VII. Molecular genetic expert research.

VIII. Medico-criminalistic expert research.

IX. Spectral expert research.

X. Forensic-chemical expert research.

XI. Biochemical expert research.

XII. Complicated commission expert studies based on materials of criminal and civil cases.

The activities of forensic medicine institutions can be divided into practical expert and research.

Forensic medical examination in Russia is under the jurisdiction of the Ministry of Health and Social Development (except for the forensic medical examination of the Ministry of Defense). The work of the relevant institutions is regulated by the current norms of the law, departmental instructions and regulations. All important normative documents are coordinated with the Supreme Court, the prosecutor's office, the Ministry of Internal Affairs and other interested ministries and departments.

The management of forensic medicine is carried out by the chief forensic expert. He also heads the Russian Center for Forensic Medical Examination, which consists of the Bureau of Forensic Medical Examination and the Research Institute of Forensic Medicine.

At the level of the subjects of the Russian Federation there are bureaus of forensic medical examination. Organizationally and methodically, they are subordinate to the Russian Center for Forensic Medicine, administratively and economically - to the health authorities of the constituent entities of the Federation.

All bureaus of forensic medical examination of the subjects of the federation have a standard structure.

1. Department of forensic medical examination of corpses, including forensic histological departments.

2. Department of forensic medical examination of victims, accused and other persons.

3. Department of complex forensic medical examinations.

4. Organizational and methodological department, including departments (offices):

1) Introduction of new technologies;

2) Software and software;

3) Cabinet for work with complaints and statements.

5. Departments of forensic medical examination, including:

1) Urban;

2) District;

3) Interdistrict.

6. Department of forensic medical examination of physical evidence, including departments (laboratories):

1) Forensic biological;

2) Forensic cytology;

3) Forensic chemical;

4) Forensic biochemical;

5) Forensic bacteriological (virological);

6) Department of medical criminology;

7) Spectral laboratory.

8) Forensic molecular genetic laboratory.

7. Other structural divisions.

Some bureaus have organized centers for scientific, practical and methodological work in certain areas of forensic medicine.

LECTURE #3

Forensic Traumatology

Traumatology (from the Greek trauma - "wound, injury" and logos - "teaching") is the doctrine of injuries, their diagnosis, treatment and prevention.

The great importance of injuries for human health and life, the extreme diversity of their nature, localization, course, conditions of occurrence determine that the issues of traumatology are studied not only by traumatologists who have devoted themselves to studying this problem, but also by representatives of other medical specialties, in particular health care organizers. , neurosurgeons, ophthalmologists, dentists, otolaryngologists, etc. Traumatology issues are also actively studied by forensic experts.

Forensic traumatology is one of the most important and complex sections of forensic medicine. Its essence is the doctrine of damage and death from any kind of external influence on the human body.

Trauma in general and mechanical in particular is the leading cause of violent death.

In forensic medical terms, damage is usually defined as a violation of the anatomical integrity and physiological function of organs and tissues that has arisen as a result of the interaction of the human body and environmental factors. Violation of the anatomical integrity of organs, ascertained macroscopically and microscopically, is always accompanied by a violation of the function of an organ or tissue. Since the unity of structure and function is inherent only in a living organism, we are talking about intravital damage.

The nature of damage is different depending on the properties of the damaging factor, the conditions of its interaction and the human body.

Under the influence of external factors, the structure of organs and tissues of a dead organism, where the function is absent, can be changed. Such injuries are called post-mortem.

There are, in addition to forensic, general biological and legal concepts of damage.

The general biological concept of damage covers any violation of the structure and function caused by both external and internal causes.

Lawyers understand damage as an action (illegal, intentional or careless) that leads to a health disorder. They denote such an action as causing harm to health. The outcome of a health disorder can be:

1) complete recovery;

2) preservation of persistent disability;

3) death.

Aspects of studying the issues of traumatology by clinicians and forensic doctors are different and are primarily determined by the peculiarities of the goals and objectives they face.

The tasks of the clinician include:

1) establishment of the volume and localization of damage;

2) choice of the most rational method of treatment;

3) the fastest rehabilitation of the victim;

4) the study of injuries and the development of measures for its prevention.

The tasks of a forensic medical expert are somewhat different. First, he must, like a traumatologist, establish the presence, volume and nature of damage, then determine the degree of damage to health and ascertain the external influence factor that caused the damage; solve the problem of the mechanism of damage.

The expert needs to establish the prescription of damage, and if there are several damages, then determine the sequence of their occurrence.

When examining a corpse, in many cases it is also necessary to resolve the issue of the intravital or posthumous origin of injuries; find out whether there is a causal relationship (direct or indirect) between the impact of an external factor and the health disorder or death of the victim.

Based on these tasks, the forensic medical approach to the study of any injuries is characterized by the following fundamental provisions:

1) forensic focus, i.e., the solution of those special issues that arise from the essence of a particular case under investigation;

2) a comprehensive, complete and objective approach to the study of objects of forensic medical examination;

3) the use of such a complex of basic, laboratory and special research methods, the results of which are necessary to fully substantiate the conclusions of the examination;

4) a certain sequence of application of research methods, which guarantees the receipt of maximum factual information about the object of research (initial use of methods that do not change the primary morphology of the damage, then - methods that partially, and then completely destroy the damage);

5) the need to formulate each provision of expert conclusions in a reasonable and reasoned form;

6) documenting each provision of expert conclusions;

7) a certain order of description of damage, ensuring the completeness of the reflection of their morphological properties (localization, shape, size, nature of the edges, ends, walls and bottom of the damage, the presence and nature of foreign bodies in the wound, extraneous layers around the damage, etc.).

A damaging factor is a material body (object) or a material phenomenon that has the ability to cause damage. This ability is called the traumatic property.

According to the volume of impact, all damaging factors can be divided into groups:

1) local impact;

2) general impact;

3) mixed impact - general and local.

Damaging objects and damaging phenomena exist in time. Therefore, they can have permanent or temporary damaging properties. Some damaging factors may have predominantly one (single, simple) traumatic property, others are capable of causing damage, exerting a multi-valued (complex) traumatic effect on the body.

One or more damaging factors may be involved in the formation of damage. Damage resulting from the action of several damaging factors is called combined.

The mechanism of injury formation (mechanism of injury, mechanogenesis of injury) is a rather complex process of interaction between the traumatic factor and the injured part of the body (or the organism as a whole) that leads to the appearance of injury, which occurs under the influence of environmental conditions and the properties of the organism itself.

Damage classification

By their nature, all factors affecting a person can be divided into physical, chemical, biological and mental, which are also subdivided. Accordingly, all damage is divided as follows:

1) damage from physical factors:

a) mechanical damage (blunt damage, transport injury, sharp damage, gunshot damage, damage from ammunition and explosives);

b) thermal damage (effect of high or low temperature);

c) electrical damage (the action of technical or atmospheric electricity);

d) damage from the action of radiant energy;

e) damage from high or low atmospheric pressure (barotrauma);

2) chemical:

a) damage from the action of alkalis;

b) damage from the action of acids;

c) poisoning;

3) damage from biological factors:

a) damage from the action of poisonous animals, plants;

b) damage from the action of microorganisms;

4) mental:

a) macrosocial (for example, wars, armed conflicts, riots, etc.);

b) microsocial, representing the negative impact of human relations, most often in everyday life.

A synonym for bodily injury is trauma. However, the concept of traumatism has a different meaning.

Under traumatism understand the totality of injuries that have arisen over a certain period of time in certain groups of the population who were in similar conditions.

Types of injury:

1) production (industrial, agricultural);

2) non-production (sports, household);

3) military.

Industrial injuries include injuries received on the territory of an industrial or agricultural organization by workers and employees during work, as well as when performing production tasks outside the territory of the organization or being delivered to or from work by the organization’s transport.

Circumstances of occurrence of industrial injuries:

1) landslides, collapses, falls and throwing of various objects;

2) getting into working machines and mechanisms;

3) the operation of internal production vehicles;

4) falling from a height and on a plane;

5) shots from construction and assembly firearms;

6) explosions of boilers, cylinders with compressed gas, explosive and explosive substances.

In agricultural production, it is often possible to meet a mechanical injury resulting from road accidents (damage to wheeled and caterpillar tractors, their trailers and other transport equipment), contact with moving parts of working agricultural machines (plow, cultivator, etc.).

Non-occupational injuries should include injuries received at home, during sports and accidents related to the operation of personal vehicles.

Domestic injuries cover a wide range of injuries that occur during a wide variety of types of household work (from culinary to construction), conflict situations in everyday life between individual citizens.

Sports injuries are classified by sport. Although fatal sports injuries are relatively rare, they occur in almost all sports. The variety of existing damaging factors determines the large polymorphism of sports injuries.

Under military injuries it is customary to understand the totality of injuries that occur in military personnel in peacetime and wartime. In peacetime, injuries are distinguished during combat training, maintenance of military equipment, transportation, physical education and sports, household work, and in everyday situations. In wartime, combat and non-combat injuries are distinguished. Combat injuries - injuries that occur during the period of hostilities from the damaging effect of various types of military weapons. Combat trauma is the subject of study of pathological anatomy. Non-combat injuries cover injuries that occur during tactical and tactical-special training, other types of combat training, during the maintenance of military equipment, the performance of engineering, sapper-technical, construction, and household work. Injuries received in non-combat conditions are studied and evaluated in the process of forensic medical examination.

In forensic practice, most often we have to deal with cases of injuries in transport. In connection with the operation of transport equipment, representatives of some groups of the population under similar conditions receive injuries similar in nature. The combination of these injuries is called traffic injuries.

Mechanical damage is damage that occurs when a person is exposed to a moving object, that is, an object that has kinetic energy. In terms of frequency of cases, mechanical damage is more common than other damage.

Mechanical damage can be single and multiple, isolated and combined. These concepts are to a certain extent conditional, since in forensic medicine there are private classifications of mechanical damage.

Single damage - one isolated injury, often occurring with a single traumatic impact.

Multiple damage - a set of several single injuries that occur with repeated traumatic exposure.

Isolated injuries - injuries within one part of the body (head, neck, chest, abdomen, limbs). Isolated injury can be single or multiple.

Combined injuries - injuries of several parts of the body or organs. Most often, the associated injury is multiple.

In forensic medicine, an object that causes damage is considered as an instrument of injury. All tools by origin and purpose are divided into the following groups:

1) weapons - devices and objects, structurally designed to hit a live or other target, give a signal;

2) household and industrial items - tools;

3) items that do not have a specific purpose (stone, stick, etc.).

The nature of mechanical damage at the time of its formation depends on:

1) the kinetic energy possessed by the damaging object at the moment of impact on the body;

2) the size and shape of the traumatic surface;

3) the relative position and mutual movement of the damaging object and the human body.

LECTURE #4

Forensic examination of injuries caused by blunt solid objects

Blunt injuries are caused by objects that mechanically act only on their surface.

The morphological variety of blunt injuries is determined by the shape, size, strength, elasticity, nature of the surface of blunt objects, their kinetic energy, and the place and direction of their impact.

The sizes distinguish limited and unlimited (wide) traumatic surfaces. A bounded surface is a surface whose boundaries do not extend beyond the surface of the body part. This concept is relative and depends on the size of the body part. If the dimensions of the traumatic surface of a blunt object go beyond the impact area, then such a surface is considered as unlimited. In the case of the impact of an object with a limited traumatic surface, one can accurately speak about its specific shape and specific dimensions.

The top layer of the traumatic surface can be smooth and rough.

The shape of the traumatic surface can be:

1) flat - triangular, square, rectangular, oval, etc.;

2) angular - there are faces, edges and a vertex;

3) curve - spherical, cylindrical, etc.;

4) combined - a combination of the above forms.

There are four main types of blunt impact: impact, compression, tension, friction.

Impact is a complex short-term process of interaction between the body or part of the body of a person and a blunt object, in which the latter has an impulsive unilateral centripetal effect on the body or part of the body. The shorter the impact time, the more energy is transferred to the affected body part, the greater the amount of damage. The shock effect is exerted by both a moving object and a stationary one. Massive objects acting with great force are capable of shaking the body or part of the human body.

Compression is the process of interaction of the body or part of the human body, as a rule, with two massive, hard, blunt objects, in which both of these objects, acting towards each other, have a bilateral centripetal effect on the body or part of the body. Of the two squeezing objects, one is always mobile, the other is most often motionless.

Stretching is the process of interaction of the body or body part of a person with two solid objects, which, acting in divergent directions, have a bilateral centrifugal effect on the body or body part. Of two objects, one is always mobile, the other is usually motionless. An immovable object fixes the body or body part, and another object has an eccentric action.

Friction is the process of surface interaction of the damaged surface of the body and the damaging surface of a blunt solid object, in which both contact surfaces are displaced in a tangential or tangential direction relative to each other. Both the damaged part of the body and the damaging object can be mobile.

The type of damage is determined by the variant of traumatic blunt impact. Bruised wounds, fractures will be typical for impact action; for compression - flattening of a part of the body, kneading organs and tissues; for stretching - lacerations, skin detachment; for friction - extensive precipitation. At the same time, some types of damage can be the result of different mechanisms. So, bruising occurs both from a blow and from compression; abrasions - both from impact and friction; ruptures of internal organs - from impact, compression and stretching.

Abrasion

An abrasion is a superficial damage to the skin that does not extend deeper than its papillary layer and is formed during the tangential action of blunt objects. With the tangential action of the sharp end of the object, a scratch is formed on the skin - a linear abrasion. Abrasions can also occur from the scraping action of the blade of a sharp object.

However, most often abrasions occur from the impact of a blunt hard object.

The number of abrasions, as a rule, is equal to the number of traumatic actions. But abrasions localized on protruding parts within one area of ​​​​the body can also be formed from a single action of the wide surface of a blunt object.

The sizes of abrasions fluctuate more often from point to several tens of square centimeters. If the abrasion is extended, then its width reflects one of the dimensions of the contact surface. The area of ​​abrasions depends: 1) on the area of ​​the surface of the blunt object in contact with the body and 2) on the length of the movement of the object along the body.

As a result of dynamic contact with the skin, the blunt object forms a deeper initial site of abrasion than the final site. In the latter, whitish shreds of exfoliated epidermis can be found. Based on these signs, it is possible to establish the direction of movement of a blunt object in relation to the body. Initially, the bottom of the abrasion is moist and located below the areas of the surrounding skin. After a few hours, the bottom dries up, thickens and becomes covered with a scab (crust). After 20-24 hours or more, the surface of the abrasion is at the level of the surrounding intact skin areas, on the 3-5th day the dark-colored scab is above them. At the same time, redness of the skin is noted around the abrasion. In a corpse, such a local reaction of tissues to damage is not observed, which is a criterion for determining the lifetime of an abrasion. After 7-10 days, the scab falls off, exposing the pinkish surface of the new epidermis. After 2 weeks, the abrasion site does not differ from the surrounding skin.

The forensic medical significance of abrasions is as follows. It indicates the place of application of force, is an external sign of violence, reflects the properties of the damaging object and the direction of its action, it establishes the age of damage.

Bruise. Hemorrhage. Hematoma

Bruising is the soaking of subcutaneous fatty tissue with blood that has leaked under pressure from a damaged vessel. The integrity of the skin is not violated.

Bruising is typical of the action of a blunt hard object. Like abrasions, they can have a wide variety of localization. The shape and size of bruises depend on the shape and size of the traumatic surface of a blunt object. In some cases, the shape of the bruise reflects the shape of the impacting object, which is a specific forensic criterion for establishing the mechanism of injury.

Usually one bruise is formed from one blow. However, with strong impacts with elongated objects, two oblong bruises can occur, located along the edges of the striking surface of the object. The reason for this phenomenon is that blood vessels are more resistant to compression than to rupture. Therefore, at the point of impact, the vessels are compressed and retain their integrity, but stretch and tear at the border of this band.

The blood released from the vessel into the subcutaneous adipose tissue begins to change. Its most important component, hemoglobin, undergoes chemical transformation outside the vessels. Each connection of this chain of transformations has its own color, which serves as a criterion for determining the prescription of a bruise. Initially, the bruise has a blue-purple color (reduced hemoglobin is formed), on the 3-4th day it is green (biliverdin is formed), on the 7-9th day it is yellow (bilirubin is formed). After this period, the bruising, as a rule, becomes invisible. However, when dissecting the skin, a brownish hemorrhage can be found for a long time in the subcutaneous fatty tissue due to the deposition of hemosiderin.

When hitting a dead body, bruises are not formed.

The forensic significance of bruising is to indicate the place of application of force, reflect the shape of the instrument of influence, and establish the prescription of damage.

Hemorrhage usually means the release of blood from a damaged vessel into any membranes (lip mucosa, eyelid conjunctiva, brain membranes, liver capsule, etc.), organ parenchyma (lungs, liver, spleen, brain, etc.). In some cases, small point hemorrhages are formed in the skin with blunt trauma (the action of the loop on the skin of the neck) or certain diseases.

A hematoma is an accumulation of blood that has escaped from a damaged vessel into a cavity or anatomically existing (intersheath spaces of the brain, pericardial cavity, pleural cavity, etc.), or formed by stratification of tissues with blood (subperiosteal hematoma). Hematomas located on or near vital organs compress them, thereby disrupting the function of these organs.

Wounds

A wound is an injury that extends deeper than the papillary layer of the skin. Any wound has an inlet and a wound channel. The wound may be:

1) blind or through (absent or has an outlet);

2) tangent (the wound channel does not have one wall);

3) penetrating or non-penetrating (with a penetrating wound, a damaging object enters any body cavity);

4) single, combined, multiple.

The following properties are identified and described in the wound:

1) location in relation to the part of the body being studied;

2) the shape, length and width of the inlet;

3) the condition of the edges and ends of the inlet;

4) the condition of the skin around the inlet;

5) depth and condition of the walls of the wound channel;

6) the bottom of a blind wound (if a blind wound ends in a hollow organ, then it is difficult to describe the bottom, since the depth of penetration of the damaging object into the hollow organ is unknown);

7) length, width, edges of the outlet at the through wound.

Wounds formed from the action of blunt solid objects are divided into bruised, torn, bruised-torn, crushed. Bruised wounds arise from a blow, lacerations - from stretching, bruised-torn - from a combination of both mechanisms, crushed - from strong compression.

A bruised wound is characterized by uneven, raw, often crushed edges; whitish connective tissue bridges are visible in the depths of the wound. There are bruises around the wound. A lacerated wound has only uneven edges, walls of the wound channel and connective tissue bridges, other signs are absent.

Bruised wounds can form anywhere on the body. However, more often they occur where the bone is close to the skin.

Under the action of objects with a large surface, wounds are formed with a wide deposit around, most pronounced in the central sections and decreasing towards the periphery. In the center of the wound, there is a site of the greatest crushing of soft tissues with outgoing pointed ruptures. The bottom is formed by crushed soft tissues. If the scalp is damaged, hair hangs over the bottom of the wound. Connective tissue bridges are stretched between the walls of the wound.

When exposed to a blunt object with a limited surface, the nature of bruised wounds is determined by its shape and size. The dimensions of such wounds are limited by the boundaries of the traumatic surface of the object. The edge of a blunt object causes rectilinear wounds, square and rectangular traumatic surfaces form L- and U-shaped wounds, triangular - angular, round and oval - C-shaped. The edges of such wounds usually have a narrow deposit. The bottom of the wounds is deepened, the connective tissue bridges are represented by individual fibers. The walls of wounds arising from a perpendicular impact are sheer. When struck at an angle, one of the walls of the wound is beveled, the other is undermined.

Blunt objects acting with a spherical or cylindrical surface cause rectilinear wounds with additional edge breaks. They are surrounded by a relatively wide sedimentation. The edges of such wounds are often crushed.

The forensic medical significance of wounds consists in reflecting the properties of the instrument of influence, determining the direction of its movement, establishing the position of the victim at the time of the incident, determining the possibility (impossibility) of inflicting a wound with one's own hand.

Fractures

Fractures are called damage to the bone or cartilage with a violation of their integrity. Parts of the bone that come apart during a fracture are called fragments, and smaller fragments are called fragments. If there are only two fragments, the fracture is called simple, and if there are two or more segmental fragments along the length of the bone, it is called multiple. Fractures with one or more fragments are called comminuted.

Fractures can be closed or open, direct or indirect. With closed fractures, the integrity of the skin is preserved, and with open fractures, there is a wound.

Direct fractures occur from direct contact with a traumatic effect. Indirect fractures - from mediated, indirect impact - "fractures over".

Direct fractures make it possible to judge the properties of the traumatic object and the mechanism of fracture formation. With these fractures, destruction, crushing and mutual layering of bone structures occur at the site of application of the traumatic object. As a result, defects are formed due to the chipping of the bone substance, along the edges of which the bone plates are layered on top of each other, creating a picture of a "tiled roof". The edges of direct fractures are coarsely serrated broken lines.

Indirect fractures allow us to judge only the mechanism of their occurrence. They lack many of the features of direct fractures. The edges of indirect fractures are finely serrated.

Fractures of tubular bones can be formed from shear, bend, compression, twisting and tearing.

Bone shift occurs from a sharp blow with a rib, edge or narrow limited surface of a blunt object. Shear fractures are always straight and transverse or oblique in nature. A small cleavage of a compact substance is formed at the place where the force is applied. Thin cracks extend from the edges of the fracture, the free ends of which indicate the place of impact.

The bend of the bone leads to a change in mechanical stresses in the bones: on the convex surface of the bend there is a zone of tension, on the curved - compression. Since the bone is less resistant to tension, a transverse crack forms on the convex side, which extends to the lateral surfaces, where it bifurcates. The ends of the crack are connected on the compression side, forming a large fragment. Flexion of the tubular bone can be with transverse pressure on the diaphysis, with longitudinal pressure on the bone, as well as with flexion of the bone, one of the epiphyses of which is fixed.

Compression of the bone in the longitudinal direction underlies the formation of impacted fractures. They are localized in the metadiaphyseal region and represent a local compression destruction of the beam structure, often combined with fractures that split the diaphysis in the longitudinal direction. Such fractures occur when falling from a great height onto straightened legs.

Twisting of the bone is its rotation around the longitudinal axis while fixing one of its ends. In this case, helical fractures occur, often observed in skiers.

The separation of the bone substance is possible only in the area of ​​attachment of the tendons. The detached part of the bone mass is usually small. As a rule, such fractures are observed with sharp tension on the tendons in subjects with incomplete ossification processes.

Fractures of flat bones depend on the size and shape of the traumatic surface of a blunt solid object and the variant of its action (impact or compression). From a blow to the place of application of force, unilateral direct fractures occur.

In forensic medicine, a large place is occupied by studies of skull fractures. Direct fractures of the cranial vault include depressed, perforated and comminuted. Depressed and perforated, often repeating the shape of the surface of a traumatic object, are formed under strong influences. Fragments in the form of terraces can be located along the edges of such fractures.

A small force impact with an unlimited surface of a blunt object leads to the formation of one or two or three radially divergent cracks. When hitting a large force in the place of its application, a focus of comminuted fractures is formed, limited by an arcuate crack. Linear cracks radiate from this source. If the blow is applied perpendicularly, then the cracks diverge evenly from the place of depression, if at an angle in any direction, then most of the cracks move away in the same direction. With several blows to the head, the line of fracture formed from the subsequent blow will be interrupted by the lines of fractures that have arisen from previous blows. On the base of the skull, the location of transverse and longitudinal cracks corresponds to a transverse impact or impact from the front or back.

When struck in the pelvic area at the site of application of force, unilateral direct single or double transverse or comminuted fractures occur. When the pelvis is compressed, bilateral double vertical fractures are formed.

The forensic medical significance of bone fractures consists in indicating the violence, the strength of the damage caused, the direction of the action of the weapon, determining the type and shape of the weapon of influence.

Damage to internal organs

The morphological features of damage to internal organs make it possible to very limitedly judge the mechanism of action of a blunt solid object and, to an even lesser extent, its properties.

When acting on the head, objects of small mass can cause injury only at the place of application of force, where a single injury is observed, including a bruised wound (less often an abrasion or bruise), depressed, terrace-like, comminuted or comminuted-depressed fractures, ruptures of the dura mater and damage to the edges of broken bones, brain tissue and meninges.

Almost any type of intracranial injury and hemorrhage can occur with a head injury. Of these, the most specific are focal bruises of the cerebral cortex and, as one of the options, the destruction of the cerebral cortex and pia mater.

The location of the bruises of the cortex relative to the place of application of force is noteworthy. When struck from behind, they are found on the base and poles of the frontal and temporal lobes. When struck from the front, they are usually localized in the same place, and only with blows of extremely high force can they form on the convex surface and poles of the occipital lobes. Lateral blows to the head in 2/3 of cases lead to the formation of foci of bruising of the cortex on the convex surface of the opposite temporal lobe, in 1/3 of cases - in the temporal lobe at the place of application of force. If the place of application of force is the parietal region, foci of bruising of the cortex are found on the basal surface of the frontal and temporal lobes. In these places, bruises of the cortex are found under the action of force from below, for example, when falling from a great height onto straightened legs and buttocks.

Spinal cord injury occurs only in places of violation of the integrity of the spinal column in the form of compression fractures and dislocations of the vertebral bodies, ruptures of the ligamentous apparatus. Lesions can range from local intrathecal hemorrhages to complete interruption.

Damage to the internal parenchymal organs is diverse: hemorrhages under the capsule, into the tissue of the organ, ruptures of the capsule, ligamentous apparatus and tissue of the organ, partial crushing, complete destruction and separation of the organ.

Small superficially located hemorrhages, isolated superficial tissue ruptures are most often formed with strong impacts with objects with a limited traumatic surface. Multiple ruptures of the membranes and tissue of the organ, combined with extensive hemorrhages in its tissue, can be the result of both a strong blow with a massive object and compression. Partial crushing or complete destruction most often occurs when a part of the body is squeezed by a massive object.

Damage to hollow internal organs is no less diverse: complete or partial ruptures of the organ wall, intrathecal hemorrhages, damage to the ligamentous apparatus and complete separation of the organ. Ruptures of a hollow organ and local hemorrhages in its wall arise from a strong impact or squeezing action.

Detachments of internal parenchymal and hollow organs from the places of attachment, as well as ruptures of their ligamentous apparatus, are observed with strong impacts with massive blunt objects, leading to a general concussion of the body. At the moment of injury, a sharp displacement of the organ occurs, leading to a partial or complete rupture of its fixing apparatus, and in case of blows of extremely high force, to the complete separation of the organ.

Transport injury

The traumatic consequences of human exposure to various types of moving vehicles are in most cases considered as blunt trauma.

Depending on the type of transport, there are such types of transport injury as:

1) automotive;

2) motorcycle;

3) rail;

4) aviation, etc.

Automobile injury. This type of traffic injury is the most common. Car injury is understood as a set of injuries that occur to the driver, passenger and pedestrians when they interact with parts of a moving vehicle.

Classification of automobile injury.

1. Injury from a collision (impact) of a car on a person.

2. Moving a person with the wheels of a car.

3. Falling out of a person from a moving car.

4. Injury inside the car.

5. Compression of the human body between a moving car and other objects.

6. A combination of the listed types of injuries.

All damages arising from the action of the car can be divided into three groups:

1) specific;

2) characteristic;

3) uncharacteristic.

Specific damage occurs only with a specific type of car injury. These include fractures of the bones of the lower extremities due to hitting a bumper, arcuate bruising from hitting a headlight, intradermal hemorrhages and abrasions in the form of a tread pattern and strip-like peeling of the skin when rolling a wheel, hemorrhages and abrasions in the form of a steering wheel imprint.

Characteristic injuries occur in various types of car injury, and they are used to judge the sequence of stages of the accident. These include whiplash fractures of the cervical spine from its sharp flexion or extension, multiple fractures of the ribs along the anatomical lines and damage to the pelvic bones as a result of compression, bruises of the chest and abdomen on the instrument panel, fractures of the pelvic bones when hitting the steering wheel, dislocations and fractures of the bones of the lower limb in the driver, bruises and wounds when hitting the windshield, impacted fractures of the base and deformity of the cranial vault, etc.

Uncharacteristic damage occurs not only in a car accident. These include traces of dragging in the form of multiple extended abrasions, hemorrhages in internal organs, as well as their ruptures, etc. In each type of car accident, successive phases are distinguished, differing in different mechanisms of traumatic impact. Knowledge of these phases serves to establish the sequence of damage and the picture of the incident. The sequence of damage depends on the initial position of the person in relation to the car - the primary impact acts on the back surface, front surface or side surface of the torso.

For example, when a person collides with a moving car, the car first hits, more often with its bumper; then the body is thrown onto the car - the second blow; then the body falls to the ground - the third blow. The last phase is the sliding of the body on the ground.

When moving, five phases are distinguished - the primary impact by the wheel, the translational displacement of the body along the ground in the direction of the car, the entry of the wheel onto the body, the wheel rolling over the body, and the dragging of the body.

Motorcycle injury. This type includes injuries resulting from a road accident for the driver and passengers of motorcycles and scooters, as well as for pedestrians. When a motorcycle collides with other vehicles, damage is formed that is conditionally related to automobile, rail and railway injuries.

The following types of motorcycle injuries can be distinguished:

1) from a collision between a pedestrian and a moving motorcycle;

2) from moving the wheel of a moving motorcycle;

3) from falling from a moving motorcycle;

4) from a collision of a motorcycle with stationary objects.

In all types of motorcycle injuries, injuries from primary impacts and friction predominate: bruises, bruises and lacerations, fractures of the ribs, bones of the limbs, spine, severe damage to the skull and brain, especially in the driver and passenger, if protective helmets were not used, various injuries to internal organs.

Damage to the driver and passengers from hitting a part of oncoming traffic or roadside objects is very diverse.

Rail injury. The interaction between a person and rail transport can be different:

1) moving the wheels of a moving rail transport;

2) collision of a person with a rail vehicle;

3) falling from a moving rail transport;

4) crushing a person between cars;

5) compression between rail transport and track facilities;

6) injuries inside the wagons.

All mechanisms of interaction and damage can be divided into non-specific and specific.

Non-specific injuries in most cases correspond to similar types of car and motorcycle injuries. The main mechanism of their formation is the impact of parts of a moving vehicle. The consequences of such an impact are more significant, since the mass of rail transport is of great importance. Often the blow is accompanied by the dragging of the injured person. Sometimes the dragging of a corpse or its parts occurs over a long distance, up to hundreds of meters in case of a railway accident.

A specific rail injury is a complex of injuries that occur when the wheels of a moving rail vehicle run over the body of a person lying on the rails. The design features of the wheel, the large mass of rail transport determine the nature of the damage. A specific complex of injuries includes a strip of compression, a strip of rubbing and settling, dismemberment of the limbs and head, and dismemberment of the body. The width of the compression (crush) band corresponds to the width of the rail surface and the height of the ledge (flange) of the wheel. The flange of the wheel has a scissor action, separating body parts. The total width of the pressing surface of the railway wheel is 15-16 cm. Along the edges of the pressure strip there are strips of sedimentation up to 12-15 cm wide. The edge of the strip formed by the flange is more even and clear, often dirty (wiping strip). The edge of the opposite strip, formed by the outer part of the wheel, is less clear and almost unpolluted. The rail head forms a deposition strip with clear edges. According to the relationship of the pressure bands from the wheel and the rail head, the expert can judge the side of the collision. On the side of action of the rail head, the skin may remain in the form of bridges.

Aviation injury. Aviation trauma is understood as a complex of damages that occur under the action of the internal and external parts of the aircraft during its movement, as well as during explosions and fires.

Aviation injury is diverse and is classified as follows:

1) injury during flight - in the event of a collision of an aircraft with flying and stationary objects, explosions, fires, depressurization, ejection;

2) injury during the fall of the aircraft to the ground - a blow to the ground followed by an explosion and fire;

3) injury while the aircraft is on the ground - explosion, fire, poisoning, running over by the wheels of the landing gear, wing impact, impact by propeller blades, the action of a jet of jet gases from the engine.

The main damaging factors in aviation trauma are:

1) a wave of explosive gases;

2) thermal factors;

3) chemical factors;

4) barometric factors;

5) counter air flow;

6) moving and fixed parts of the aircraft;

7) hard ground.

In each variant of an aviation accident, there are damaging factors that are characteristic of this particular situation.

So, during the explosion of an aircraft, three factors act: a blast wave, thermal and chemical effects. Depending on the center of the explosion, a person can be affected completely by all factors or partially. Accordingly, it is possible to fix the almost complete destruction of the body of the victim or only abrasions, bruises, bruised wounds, fractures.

Of particular danger are chemical factors when paints, synthetic materials of aircraft construction, and electrical wiring insulation ignite. In this case, toxic substances are released - formaldehyde, vinyl chloride, methyl chloroacryl, etc. Another group of chemical factors includes exhaust gases, fuel vapors, a suspension of oils and antifreeze, which cause severe poisoning.

The complexity of the work of forensic physicians at the scene of an aviation accident is due to the large number of combinations of injuries and the task of determining the cause of death of each victim, if possible.

Fall damage

Damage is the object on the surface of which the body falls. There are 2 types of falling: from a great height and from a height of one's height (falling on a plane).

With a direct (unhindered) fall, the main damage to the human body occurs from a single impact. The nature of these damages is determined by the size and topography of the impact surface.

With an indirect (stepped) fall, the body encounters, during its movement, any protruding objects with a limited traumatic surface (balconies, canopies, cornices). Falls in a limited space (mines, flights of stairs), as well as falls on uneven inclined surfaces: steps of stairs, steep mountain slopes, usually differ in a stepped character.

Often, during the collapse of any structures or their individual structures, various objects fall along with the human body (the so-called non-free fall), which can cause damage to it both during movement and after the body falls to the ground.

Depending on the position of the body at the moment of impact with the surface, the following types of fall from a height are distinguished:

1) falling on straightened legs;

2) falling on the buttocks;

3) fall on the head;

4) falling flat on the back, side or front surface of the body.

When falling from a height, the occurrence of multiple injuries that form on various parts of the body is characteristic.

In a direct free fall, damage is formed that has the following typical set of features:

1) insignificance or absence of external damage;

2) unilateral localization of damage;

3) the presence of fractures far from the place of application of force (the so-called fractures along the length, or distant fractures, impacted fractures of the metaphyses of long tubular bones of the lower extremities, compression fractures of the vertebral bodies, annular fractures of the base of the skull);

4) the predominance of the volume of damage to internal organs over damage to external ones;

5) the presence of signs of a general concussion of the body (hemorrhages in the para-aortic tissue, the hilar zone of the lungs, the ligamentous apparatus of the liver, the hilum of the kidneys and spleen, the mesentery of the small intestine).

With strong impacts on the ground, ruptures of parenchymal organs can form. The following injuries are formed during a direct free fall: on the head - multi-comminuted fractures of the cranial vault, on the buttocks - comminuted fractures of the ischial bones, on the legs - destruction of the heel bones, on the lateral surface of the body - direct fractures of the ribs on the side of the fall and indirect fractures on the opposite side, on the back - comminuted fractures of the scapula, spinous processes of the vertebrae and multiple direct fractures of the ribs, on the anterior surface of the body - oblique or comminuted fractures of the sternum, multiple bilateral fractures of the ribs, injuries of the facial skull, fractures of the patella, impacted fractures of the distal metaphyses of the radius bones.

Distant fractures are also characteristic of a direct free fall from a height: compression fractures of the vertebral bodies and the body of the sternum - when falling on the buttocks, the plantar surface of the feet of straightened legs and the head; impacted fractures in the area of ​​the metaphyses of the femur and tibia - when falling on the heels; ring-shaped fractures of the base of the skull - when falling on the buttocks and the plantar surface of the feet of straightened legs.

The place of application of force when hitting the ground is related to the trajectory of the fall and depends on the height of the fall, the initial posture of the victim, and whether the body was given preliminary acceleration. To soften the blow, a falling person sometimes strains certain muscle groups, exposes the limbs in the direction of the fall. Such a fall is called coordinated. If the person is inactive, unconscious, or under the influence of alcohol, the fall may be uncoordinated.

Damage resulting from stepped and non-free falls have some distinctive features. Retaining all the signs of damage from a fall from a height, they are characterized by versatile localization and can be located not only on adjacent, but also on opposite surfaces of the body. If in a direct free fall damage is formed from a blunt, predominantly impact impact, then in a step-like and non-free fall, lacerated, stab, cut and stab wounds can also occur.

In this type of fall, the head is predominantly affected. In places where force is applied, abrasions, bruises, bruised wounds, fractures of the bones of the facial or brain skull, brain contusions, intraventricular and subdural hematomas usually occur.

Human Injury

Finger pressure causes several small round or oval bruises, sometimes combined with arcuate or short strip-like abrasions from the nails located on their background.

Punching or kicking can lead to injuries of various sizes and nature: from superficial abrasions and bruises to bone fractures and ruptures of internal organs. Similar injuries can be caused to the head, elbow, knee.

A blow with the edge of the hand can cause significant damage in a limited area. Such blows inflicted on the neck sometimes cause dislocations, fracture-dislocations or fractures of the cervical vertebrae, even with damage to the spinal cord.

Tooth damage has a characteristic appearance. When bitten, several abrasions, bruises or superficial wounds are formed. These damages are located in the form of two arcuate strips, turned by bulges in opposite directions. A steeper arc of damage usually arises from the action of the teeth of the lower jaw, a more flat one - the upper. Bite damage can also show features of the dental apparatus: malocclusion, gaps in the place of missing teeth, atypical structure of one or more teeth, unusual position of the tooth.

LECTURE #5

Forensic medical examination of injuries caused by sharp objects

Lethal and non-lethal injuries from sharp objects are quite common. According to the Russian Center for Forensic Medical Examination, at present, deaths from injuries caused by sharp objects account for about 15% of all violent deaths.

Sharp tools is a collective concept, it includes all objects (tools, weapons) that have a sharp edge, called a blade, and a sharp end.

Depending on the properties of the object, all sharp tools are divided into:

1) stabbing - have a sharp end (nail, knitting needle, needle, bayonet, stylet, pitchfork, fork, folded scissors, pike, narrow screwdriver);

2) cutting - have a sharp edge (a dangerous and safety razor blade, various types of knives during a cutting action, glass, a metal edge, a scythe);

3) piercing-cutting - have a sharp end and edge (various types of knives, blades);

4) chopping - have a sharp edge and a large mass (axe, chopper, hoe, saber, checker, machete);

5) sawing - the cutting edge is represented by sharp teeth (hand saw, metal saw, circular saw, grinder saw);

6) piercing-chopping (chisel, chisel, wide screwdriver);

7) chopping and cutting (checker, saber);

8) other items of combined action.

The main mechanism of the impact of sharp objects on trace-perceiving objects is cutting or cutting, piercing, piercing with cutting. As a result, damages with different properties are formed.

The difference between injuries caused by sharp objects and injuries caused by blunt solid objects lies in the fact that here in the vast majority of cases we observe shear deformation, and under the action of blunt objects - stretching, compression, bending, torsion and, less often, shear.

The next feature is that the resulting damage from the action of sharp objects carries information about the shape of the blade and the degree of its sharpness. Since the device and mechanism of action of each of the types of sharp instruments have their own individual characteristics, the morphology of damage to various tissues should also reflect the characteristic features of the structure, which makes it possible to establish the type of injury instrument.

From the action of sharp objects, such injuries as scratches, wounds, damage to soft tissues, internal organs, less often bones and cartilage are formed.

As the point of a piercing object or a cutting or chopping blade becomes blunt, they acquire the properties of a blunt object.

Most sharp objects have a handle. If the object enters the full length of its blade, then a blow with the handle is possible and the formation of sediment and bruising in the skin around the entrance hole. The shape of the bruise may reflect the cross-sectional shape of the handle.

In contrast to lacerations, in acute injuries, the walls of the wound channel are smooth. When reduced, the edges of the acute wound coincide well. If the wound channel ends blindly in any parenchymal organ (liver, spleen), then it is possible to determine the depth of penetration and the shape of the end of the blade using radiopaque substances that are clearly visible on x-rays. By determining the depth of the wound channel, the specialist can assume the length of the blade that was damaged.

Penetrating to great depths, sharp objects can damage bones and cartilage and leave traces of the microrelief of the blade surface on them.

stab wounds

The stabbing includes various objects (tools, weapons) with a small cross-sectional size, a sharp predominance of length and a pointed end. The more pointed the working part and the smaller its cross-sectional area, the less force is needed to form damage to the tissues of the human body.

The shape of piercing objects is very diverse, which makes it difficult to classify them and makes it very general and conditional.

According to the shape of the cross section, they can be:

1) round;

2) oval;

3) triangular;

4) quadrangular;

5) polygonal, etc.

Usually, a piercing object means a cylindrical rod, turning into a cone at the very point (awl, nail, needles, etc.). Many of them have handles. Some piercing items may contain not one, but several piercing rods. So, the fork usually has four stabbing rods located in one line, the damage from which has a very characteristic appearance, which makes it possible to establish their origin, and sometimes the model of the fork by the distance between the stab wounds.

The main trace-forming part in stabbing objects is the working part, in which the following are considered as features:

1) length;

2) cross-sectional shape;

3) the size of the cross section.

The mechanism of action of piercing tools: the sharp end of the tool cuts or tears the skin under pressure, and the blade of the tool, as it sinks into the body, pushes or tears the tissues.

When the working part is immersed for its entire length, the front surface of the handle of the piercing object also leaves a trace-damage. Due to the high elasticity of the skin, the size of a stab wound on the skin is usually less than the cross section of the working part of the stabbing object.

The main characteristic of stab wounds is the small size (length and width) of the inlet and the large depth of the wound channel.

The size and shape of the wound inlet depends on the cross section of the blade. Breaks and sedimentation are found along the edges of the inlet. If the blade had a rounded cross-section, then the breaks go along the elastic fibers of the skin. If there are ribs on the side walls of the blade, then the breaks go regardless of the course of the elastic fibers and exactly repeat the shape of the blade section. When the flat bones of the skull are damaged, perforated fractures are formed.

If the object has a small cross section (knitting needle), then the inlet on the skin looks like a small hemorrhage. Such a wound can be overlooked during a cursory examination. The danger of piercing objects also lies in the fact that with their end they can damage deeply located large blood vessels and organs, thereby causing massive internal bleeding.

Cut wounds

A distinctive characteristic of cutting objects is a sharp blade. Mechanism of action - the blade, with pressure on the skin and underlying tissues, while pulling the tool, separates (cuts) soft tissues, causing the formation of a cut wound.

Incised wounds have very characteristic features:

1) smooth and undamaged edges of wounds;

2) the ends of incised wounds are sharp. In those cases when, when the instrument of injury changes direction during extraction from the wound, one of the ends may, as a result of an additional incision, take on the form of a "dovetail";

3) the length of incised wounds almost always prevails over the depth. The depth of cut wounds is determined by the sharpness of the blade, the force of pressure and the nature of the damaged tissues. As a rule, the depth of the wounds, other things being equal, is determined by how deep the bone is located under the skin, which is an insurmountable barrier to the blade of the tool (with the exception of thin bones in children and ribs, which can be crossed, for example, with a straight razor). The cartilages are fairly easily traversed with cutting implements;

4) for incised wounds, their gaping is characteristic as a result of the elasticity of the skin and the contractile action of the muscles. The closer to the right angle between the direction of the skin fibers and the length of the wound and the deeper the wound, the greater this gaping;

5) the shape of the incised wounds is fusiform or semi-lunar. When the edges are brought together, the wound acquires a linear shape. If, in the direction of the cutting tool, the skin gathered into folds and these folds were cut, then when the edges were brought together, the wound would look like a zigzag line;

6) cut wounds are accompanied by significant external bleeding, the magnitude of which is determined by the caliber of the damaged vessels. When crossing the main arteries, such as carotid and accompanying veins, bleeding can be so massive that it quickly leads to death;

7) the depth of incised wounds is not the same throughout, it is greater in the middle part.

The location and depth of the wound can be used to determine the possibility of inflicting injury with the victim's own hand. Wounds inflicted by one's own hand are usually located in accessible places, often shallow, and look like multiple superficial, often parallel skin incisions.

As noted above, incised wounds bleed profusely. The resulting blood streaks on clothing and body can serve as an indicator of the position of the victim's body during and immediately after the injury.

stab wounds

Tools with a sharp end and a cutting edge have a complex effect, i.e., such tools not only pierce, but also cut tissues when immersed in them.

Piercing-cutting tools combine the properties of piercing and cutting. Consequently, the damage from them will combine the signs of both stab and cut wounds.

A stab wound has the following elements:

1) an inlet in the skin;

2) wound channel in tissues or organs;

3) sometimes an outlet (with through damage).

Stab-cut wounds have their own characteristic features that distinguish them from both stab and cut wounds:

1) spindle-shaped and slit-like stab wounds are more common. The shape of the wounds can also be arcuate, angular, etc. In cases where the tool, when it is removed from the wound, rotates around its axis, an additional incision occurs, in addition to the main one;

2) the edges of stab-cut wounds are usually even, without or with slight sedimentation, respectively, according to the area of ​​action of the butt;

3) the shape of the ends of the wound in the case of the action of a double-edged blade - in the form of an acute angle. With one-sided sharpening of the tool, one end of the wound is sharp, and the other from the butt is rounded or P-, M-, L-shaped;

4) the wound channel in more or less dense tissues has a slit-like character, its walls are even, smooth, fatty lobules of subcutaneous tissue can protrude into the lumen of the wound channel. The depth of the wound channel will not always correspond to the length of the weapon blade: the blade may not be completely immersed in the body, then the depth of the wound channel will be less than the length of the tool blade. When such a pliable part of the body as the abdomen is injured, the blade of the weapon can be completely immersed in the wound and, when pressed, the anterior abdominal wall can be moved backwards. In such cases, after removing the instrument from the wound, it may turn out that the depth of the wound channel will be greater than the length of the wedge of the injury instrument. The depth of the wound channel can also change with a change in the position of the body with a change in the relative position of the injured organs.

Most fatal stab wounds are located on the left side of the chest. One of the explanations for this fact is that most people are right-handed and, standing face to face with the victim, will strike more likely to the left side of the chest. Also, if there is an intent to kill, the blow is to the left side because that is where the heart is located.

In most cases, fatal stab wounds to the chest involve the heart or aorta. Death due to lung injury alone is less common.

Most deaths from stab wounds are homicide. In such cases, there are usually many widely scattered wounds on the body. Most of them are often shallow and therefore not life-threatening. Death usually occurs rather quickly, due to the large loss of blood.

Infliction of a stab wound with the intent of suicide is a rarity. When a person decides to stab, he usually unbuttons or turns away his clothes to expose the part of the body where he is going to stab. In most of these cases, stab wounds are found in the middle and left side of the chest and there are many of them, most of them minimally damaging the skin. These are the so-called "indecisive" wounds. Stab wounds during suicide vary in size and depth, usually one or two of the latter are deep enough to penetrate through the wall of the chest cavity into the internal organs. Sometimes the knife plunges into the body without a trace of "indecision".

A specific method of suicide associated with the traditions of Japanese samurai is noted, which consists in inflicting a stab wound on the abdomen (hara-kiri), that is, when one large wound is inflicted. Sudden evisceration of the internal organs leads to an immediate drop in intra-abdominal pressure and cardiac outflow, and as a result, to a sudden collapse. A properly performed hara-kiri consists of a sharp blow with a short sword to the left side of the abdomen, passing the blade through the right side of the abdomen and turning down, thus making an L-shaped cut.

Chopped wounds

The main mechanism of action of a chopping object is tissue dissection. Due to the large mass of the chopping object, and, consequently, the kinetic energy, a strong blow is provided, the dissecting effect of which extends to the bone tissue. The resulting wounds gape and bleed heavily. An additional damaging effect is associated with the design features of the chopping object. In particular, the heel or toe of the ax has a tearing effect on the skin.

Among intravital injuries, the most common are wounds inflicted by an ax on the head. When dismembering a corpse, wounds can be located in any part of the body, but they are mainly found in the lumbar region and the area of ​​\uXNUMXb\uXNUMXbthe joints of the extremities. Self-harm usually affects the fingers of the limbs.

Wounds are usually spindle-shaped, with the reduction of the edges it becomes straight. The edges of the wound may be smooth or serrated, depending on the sharpness of the blade. In some cases, a chopped wound looks like a cut wound.

The shape of the ends of the wound depends on the depth of immersion of the blade of the chopping object. If the blade is immersed only in its middle part, then the ends of the wound will be sharp. When the heel or toe of the wedge of the ax is immersed, one of the ends of the wound has an M-shape, and the skin in this place is often upset. When struck with a short-bladed ax, the wedge of the ax can almost completely sink into the damaged part of the body, and then both ends of the wound will be M-shaped. The walls of the chopped wound are smooth. The length and depth of the wound prevail over its width.

The action of the ax on tubular bones (bones of the limbs) leaves characteristic traces on them in the form of cuts, cuts and cuts. Notches and cuts are wedge-shaped, one end is sharp, the other is either sharp or U-shaped. The walls of cuts and cuts are flat or with multiple superficial and parallel traces of irregularities and notches of the blade.

Cuts are the complete separation of the bone with a chopping object. Most of the surface of the cut is flat, but at the point corresponding to the end of the movement, the bone usually breaks off and small bone "spikes" form.

On flat bones (bones of the cranial vault), chopping objects form various fractures: notches, comminuted, longitudinally perforated, wedge-perforated, patchwork. The nature of these fractures depends on the properties of the damaging part of the chopping object (blade, toe, heel) and the direction of impact. On the walls of damage, traces of irregularities and notches of the blade may form.

sawn wounds

Intravital sawn injuries are usually caused by a circular saw, posthumous - by a hacksaw for wood or metal, a two-handed saw. The cutting edge of the saw can be simple or with a wavy divorce.

Incomplete cuts have an oblong shape, the edges are uneven, finely serrated, the ends are often sharp and bifurcated. With complete separation of the body part, the nature of the damaged skin edges is preserved.

To identify the sawing object, its traces on the cuts and cuts of bones are of great importance. The notches are in the form of a gutter. Their ends are either arcuate if a saw with a wavy set worked, or bifurcated if a saw with a simple set worked. The cuts have parallel walls. The bottom of the notch or cut is either rounded or M-shaped. The cross-sectional width of the notch usually corresponds to the width of the saw set. During bone sawing, the teeth of the saw butt into the bottom of the notch, and then the distance between the dotted recesses will correspond to the pitch of the saw (the distance between the tops of the teeth).

Sawing off bones is the complete separation of the bone with a sawing object. The sawn surface is uneven due to the many surface straight rollers and grooves, which are either parallel to each other with a saw tooth height of less than 2 mm, or intersect with each other if the saw tooth height is more than 2 mm.

LECTURE #6

Gunshot damage

A firearm is a specially designed and manufactured device designed to mechanically hit a target at a distance with a projectile that receives directed movement due to the energy of a powder or other charge.

Gunshot damage is the damage that occurs as a result of a shot from a firearm.

Firearms are divided into types (civilian, service, military), according to the length of the barrel (long-barreled, medium-barreled and short-barreled), according to the cutting of the barrel (rifled, smooth-bore). Small-caliber weapons are called weapons with an internal bore diameter of 5-6 mm, medium-caliber - 7-9 mm, large-caliber - 10 mm or more.

A cartridge for a military weapon consists of a firearm (bullet), a cartridge case, a charge of gunpowder and a primer. A cartridge for hunting weapons consists of a brass, plastic or cardboard sleeve, a projectile covered with a wad, gunpowder covered with a cardboard gasket and a wad, and a primer. The projectile in a hunting cartridge can be shot, buckshot, special bullets. Hunting cartridges are loaded with black powder. Wads are made from felt, cardboard, plastic, etc. Capsules in hunting cartridges are similar to combat ones.

The damaging factors of a shot are divided into the main ones (bullet, shot, buckshot, wad, fragments of an exploding projectile) and additional ones (pre-bullet air, powder gases, soot, powder particles, microparticles from the barrel, primer, gun grease).

When a bullet impacts an object, secondary projectiles can be formed: fragments of an obstacle, fragments of clothing, fragments of bones. In some cases, the muzzle end and moving parts of the weapon, buttstock, fragments of an exploding weapon can be affected.

Due to the high speed and hence the high kinetic energy of a firearm, it is capable of causing damage in any part of the outer ballistic trajectory. Additional factors can cause damage only at a certain distance when flying out of the weapon's barrel. If the damage is inflicted within the reach of additional factors of the shot, they speak of a close distance of the shot, and outside of their action, when the damage is inflicted only by a bullet, it is said to be not close.

With a gunshot wound, through, blind and tangential bullet wounds can form.

A through bullet wound is called a wound that has an input and output gunshot wounds connected by a wound channel. Penetrating wounds arise from the action of a bullet with high kinetic energy, or when wounding thin parts of the body or only soft tissues.

A typical entrance gunshot wound is small in size, round in shape, in the center of it there is a skin defect (minus-tissue), which has the form of a cone, the apex facing inward, the edges are uneven, with short radial ruptures of the surface layers of the skin that do not extend beyond the belt of deposition, surrounding defect. If the bullet penetrates the body at an angle close to a straight line, then the width of the belt of deposition along its entire perimeter is the same and amounts to 1-3 mm. If the bullet penetrates the body at an acute angle, then the girdle will be wider on the side of the bullet flight, since in this place the contact area between the skin and the bullet is the largest. The belt of sedimentation looks like a dark narrow strip along the edge of the skin wound. The outer diameter of the belt of sedimentation is approximately equal to the caliber of the firearm. The surface of the belt of deposition is contaminated with the metal of the bullet surface. Hence the other names: pollution belt, metallization belt, rubdown belt.

Exit gunshot wounds are more variable in shape, size and nature of the edges. They usually do not have a sedimentation belt and a metallization belt. The defect in the area of ​​the exit wound is either absent or has the shape of a cone with its apex facing outward.

The main distinguishing feature of the entrance gunshot injury on the flat bones of the skull is a chip of the inner bone plate, forming a funnel-shaped defect, opened in the direction of the bullet's flight. Output gunshot injury is characterized by a chipping of the outer bone plate.

When a through wound is formed, it is necessary to differentiate the inlet from the outlet. Differential diagnosis should be based on a comparative assessment of the entire set of morphological features.

Inlet features:

1) the shape of the hole is round or oval due to the presence of a defect, occasionally crescentic or irregular;

2) the shape of the defect is cone-shaped with an inward-facing apex, sometimes irregularly cylindrical or hourglass-like;

3) dimensions - a defect in the dermis is always smaller than the diameter of the bullet; a defect in the epidermis approximately equal to the diameter of the bullet;

4) the edges of the wound - the edges of the defect in the dermis are often finely scalloped, sometimes even and sloping;

5) the belt of deposition is usually well defined, 1-3 mm wide, its outer diameter is approximately equal to the diameter of the bullet;

6) there is a wiping belt either on the skin or on clothing; when injured through clothing, the edges may be contaminated with threads of clothing;

7) metallization of the edges is usually available according to the rubdown belt; may sometimes be absent in wounds through thick clothing;

8) the imprint of the fabric of clothing in the form of small abrasions is not found.

Exit signs:

1) the shape of the hole is irregularly stellate, slit-like, arcuate, often without tissue defects, sometimes round or oval with a slight tissue defect;

2) the shape of the defect (if any) is cone-shaped with the apex facing outward;

3) size - often larger than the size of the inlet, sometimes equal to it or less than it;

4) edges - usually uneven, often turned outward;

5) the belt of deposition is often absent, sometimes well expressed due to the impact of the edges on the clothes;

6) wiping belt, as a rule, is absent, the edges may be contaminated with threads of clothing;

7) metallization of the edges - often absent;

8) an imprint of the fabric of clothing in the form of small abrasions is sometimes found around the hole or near one edge of it.

The wound channel can be:

1) rectilinear;

2) broken - with an internal ricochet from the bone or fascia, the bullet abruptly changes direction, resulting in the formation of bone fragments, secondary projectiles;

3) encircling - meeting dense tissues along a tangent trajectory, the bullet describes an arcuate trajectory;

4) intermittent - during the flight, the bullet consistently damages different parts of the body (thigh - thigh, arm - torso, etc.) and forms two wound channels;

5) stepwise - due to the displacement of organs (for example, intestinal loops) after a bullet lesion.

Blind is called such a bullet wound, in which the firearm remained in the body. Blind wounds are usually caused by bullets with low kinetic energy due to its low initial speed, unstable flight, design features that lead to its rapid destruction in the tissues, a large distance to the target, preliminary interaction of the bullet with an obstacle, damage to a large array of dense and soft tissues in the body , internal rebound, for example in the cranial cavity.

Tangential bullet wounds occur if the bullet does not penetrate the body and forms an open wound channel in the form of an elongated wound or abrasion. The entrance end of the wound is rounded, with a defect in the skin and small radial skin ruptures that do not go beyond the semicircular sedimentation. The greatest depth of the wound at its input end. The general shape of the wound is in the form of a gutter, thinning towards the exit end.

Tissue damage is accompanied by the transfer of a part of its energy by the bullet. The resulting sharp fluctuation of tissues increases damage along the wound channel and causes new ones in places remote from it. This effect is more pronounced when a bullet passes through a full stomach, brain (hydrodynamic effect).

Passing through clothing, skin and other formations, the bullet moves the embossed tissue along the wound channel. There is a "skidding" of the tissue in places that are unusual for the location.

Damage caused by bullets fired from modern models of hand-held small-caliber combat firearms has certain morphological features: more often than when fired from medium-caliber weapons, blind wounds are formed, in a gunshot wound there can be many metal fragments of a destroyed fragmented bullet, exit gunshot wounds are very extensive, and often represented by one or more small lesions. These features of damage depend on the ability of the bullets fired from these weapons to give all or almost all of their kinetic energy to the affected tissues. This is due to the high muzzle velocity of the bullet, combined with its low stability in flight, as the center of gravity of the bullet is shifted towards its tail. As a result, the head of the bullet in flight performs rotational movements of large amplitude.

Shot at close range

When fired at close range, tissue damage is caused by the main and additional damaging factors.

Additional factors of a shot within close range have a different effect depending on the distance between the muzzle of the weapon and the object being struck. In this regard, a point-blank shot is distinguished, when the muzzle of the weapon at the time of the shot is in contact with the surface of clothing or a damaged part of the body, and three conditional zones, when the muzzle at the time of the shot is at some distance from the object being struck.

I - zone of preferential mechanical action of powder gases.

II - a zone of pronounced action of shot soot, powder grains and metal particles.

III - zone of deposition of powder grains and metal particles.

In the I zone of a close shot, the entrance gunshot wound is formed due to the bursting and concussive action of powder gases and the penetrating action of a bullet. The edges of the wound may be torn. If there are no ruptures, then the wound is surrounded by a wide annular sedimentation (a bruising effect of gases). The effect of powder gases in zone I is limited to skin damage and does not extend into the depth of the wound channel. Around the wound there is an intense deposition of dark gray, almost black soot and powder grains. The area of ​​deposition of soot and powder grains increases as the distance from the muzzle of the weapon to the target at the time of the shot increases. According to the area of ​​soot deposition, the thermal effect of powder gases may appear in the form of shedding of vellus hair or clothing fibers. Around the entrance wound, when using ultraviolet rays, splashes of gun grease in the form of multiple luminescent small spots can be detected. The length of zone I depends on the power of the weapon used: for a Makarov pistol, this zone is about 1 cm, for a Kalashnikov assault rifle with a caliber of 7,62 mm - up to 3 cm, for a rifle - about 5 cm, AK-74U - up to 12-15 cm.

In the II zone of a close shot, the wound is formed only by a bullet. Soot, powder grains, metal particles, splashes of gun grease are deposited around the entrance wound. As the distance from the muzzle of the weapon barrel to the target object increases, the area of ​​deposition of additional factors of the shot increases, and the intensity of the soot color decreases. For many samples of modern handguns II, the close shot zone extends up to 25-35 cm. Soot and powder grains fly in the direction opposite to the direction of the shot, settling within a radius of 30-50 cm, and sometimes 100 cm.

In the III zone of a close shot, the wound is formed only by a bullet. Powder grains and metal particles are deposited around it. When fired from a Makarov pistol, these particles can be detected at a great distance - up to 150 cm from the muzzle, from a Kalashnikov assault rifle - up to 200 cm, from a rifle - up to 250 cm. On a horizontal surface, particles are found at a distance of up to 6-8 m. increasing the distance, the number of powder grains and metal particles reaching the target becomes less and less. At extreme distances, as a rule, single particles are detected.

Point-blank shot

When fired point-blank at a right angle to the body surface, the pre-bullet air and part of the powder gases, acting compactly, pierce the skin, expand in all directions in the initial part of the wound channel, exfoliate the skin and forcefully press it against the muzzle end of the weapon, forming a bruise in the form of its imprint, stamp. Sometimes there are breaks in the skin. Together with powder gases, soot, powders and metal particles rush into the wound channel. Penetrating into the wound channel, powder gases interact with blood and form oxyhemoglobin and carboxyhemoglobin (bright red color of tissues). If the powder gases reach the hollow organs, then, sharply expanding, they cause extensive ruptures of the internal organs.

Signs of a point-blank shot:

1) the inlet on clothing and skin - star-shaped, less often - angular or rounded;

2) a large defect in the skin, exceeding the caliber of the firearm, as a result of the penetrating action of powder gases;

3) detachment of the skin along the edges of the entrance gunshot wound, ruptures of the edges of the skin as a result of the penetration of powder gases under the skin and their explosive action;

4) abrasion or bruising in the form of a stamp - an imprint of the muzzle end of the weapon (punching mark) due to the sticking of skin on the barrel, exfoliated by powder gases that have penetrated under the skin and expanded (an absolute sign);

5) extensive ruptures of internal organs as a consequence of the explosive action of powder gases that have penetrated into cavities or hollow organs;

6) skin ruptures in the area of ​​the exit wound in case of damage to thin parts of the body (fingers, hand, forearm, lower leg, foot) as a result of the explosive action of powder gases;

7) the presence of soot only along the edges of the entrance wound and in the depth of the wound channel due to a tight stop, making it impossible for them to penetrate into the environment;

8) light red coloration of the muscles in the area of ​​the entrance wound due to the chemical action of powder gases, which causes the formation of oxyhemoglobin and carboxyhemoglobin.

When fired point-blank at a certain angle to the body surface, part of the powder gases, soot, powder has a damaging effect on the skin surface near the wound, which leads to the formation of unilateral skin ruptures and eccentric deposition of soot and powders near the edges of the entrance gunshot wound.

Shot at close range

A sign of a shot from a short distance is the absence of deposits of soot and powders around the inlet. The bullet forms a wound with the features described above.

However, there are cases of soot deposition on the inner layers of clothing and the skin of the body, covered with multilayer clothing (Vinogradov phenomenon). A similar phenomenon of a shot from a short distance must be preceded by the conditions:

1) the speed of the bullet at the moment of impact must be high, not less than 450 m/s;

2) the distance between the layers of clothing is 0,5-1,0 cm.

During the flight, small zones of air turbulence form around the side surface of the bullet, in which soot can spread along with the projectile. This soot, at the time of the formation of a hole in the surface layer of clothing by a bullet, reaches the deeper layers of clothing or skin and is fan-shaped fixed around the inlet in them.

shot wound

After the shot, the shot charge usually flies as a single compact mass over a distance of one meter, then individual pellets begin to separate from it, after 2-5 m the shot charge completely crumbles. The range of the shot is 200-400 m.

A point-blank shot causes a significant amount of internal damage, such as the complete destruction of the head. When fired at point-blank range, extensive skin defects, an imprint of the muzzle of the 2nd barrel, soot in the depths of the wound channel, and light red staining of the muscles are observed. With a loose stop and a very close distance, skin burns are observed from the pronounced thermal effect of black powder.

When shots are fired within one meter, one entrance gunshot wound is formed with a diameter of 2-4 cm with uneven scalloped sooty edges. At a distance of 2 to 5-2 m, the main inlet gunshot hole of a similar size and nature is formed, around which there are separate round wounds with a small skin defect, raw and metallized edges. As the distance of the shot approaches 5-2 m, the number of such wounds increases. At distances exceeding 5-XNUMX m, only separate small round wounds are formed from the action of single pellets. Shot wounds are usually blind.

When shot with a hunting shotgun cartridge, damage can be caused by wads, some of which (for example, felt ones) fly up to 40 m. Wads have a mechanical, and in some cases, local thermal effect.

Automatic burst wounds

Due to the high rate of fire, the mutual position of the weapon and the victim during the automatic burst practically does not change. When shot at close range, this can lead to the formation of connected (double or triple) wounds. Gunshot injuries caused by automatic burst bullets have a complex of the following distinguishing features: multiplicity, one-sided, and sometimes close to each other location of input gunshot wounds, their similar shape and size, parallel or somewhat divergent direction of wound channels, as well as properties of input wounds, allowing their occurrence when fired from one distance. When firing in a short burst at a distance close to the stop, the wounds are located next to one another, when firing in a long burst from an insufficiently firmly fixed weapon, they are scattered. When fired in bursts from a short distance, the body is hit by one, less often by two bullets.

An explosion is a pulsed release of a large amount of energy as a result of physical or chemical transformations of matter.

In forensic practice, the most common injuries are from explosions of explosives. During the explosion, a detonation wave occurs, which is a chemical process of converting a solid explosive into gaseous products.

Instantly expanding, gases create powerful pressure on the environment and lead to significant destruction. At a short distance from the center of the explosion, they have a thermal and chemical effect. They are conditionally called explosive gases. Continuing to expand, they form a shock wave, at the front of which a pressure of up to 200-300 thousand atm is created. As the distance from the explosion center increases, the surface of the shock wave front gradually increases, while its velocity and pressure decrease.

As a result of detonation, individual particles can detach from the mass of the explosive, which, together with the shell and other elements of the explosive device, scatter at a separation speed of about 1000 m/s.

Explosive gases and a shock wave can destroy various obstacles, forming fragments of secondary projectiles.

The damaging factors of the explosion include:

1) explosive gases, explosive particles, explosion soot;

2) shock wave;

3) fragments and particles of an explosive device - fragments and parts of a fuse, fragments of an explosive device shell;

4) special damaging agents: elements of mechanical action (balls, rods, arrows, etc.), chemical substances, thermal substances (phosphorus, napalm, etc.);

5) secondary projectiles - fragments of destroyed barriers, surrounding objects, parts of clothing and footwear, destroyed and torn off parts of the body.

Damage resulting from the action of these factors is called blast injury.

Explosive gases act mechanically, thermally and chemically. The nature of the mechanical action depends on the magnitude of the charge and the distance from the center of the explosion. Explosive gases destroy skin at a distance of 2 times the explosive charge radius, and textile fabrics at a distance of 10 explosive charge radii. The destructive effect is expressed in extensive defects and crushing of soft tissues.

Skin ruptures from the action of explosive gases are observed at a distance of 10, and textile fabrics - 20 explosive radii. Explosive action is expressed in ruptures of the skin and stratification of soft tissues.

The damaging effect of explosive gases on the skin is observed at a distance of up to 20 charge radii. It manifests itself in the form of precipitation and intradermal hemorrhages, sometimes repeating the shape of the folds of the victim's clothing.

The thermal effect of gases is expressed in the form of hair loss and rarely superficial burns of the skin, and the chemical effect is in the formation of oxy-, sulfo-, meth- and carboxyhemoglobin in destroyed soft tissues.

Explosive particles are capable of local mechanical (small abrasions, bruises, superficial wounds), thermal and chemical effects (burns). Explosion carbon black usually impregnates the superficial layers of the epidermis.

The consequences of the action of the shock wave are similar to injuries from blows with a blunt solid object with a wide flat traumatic surface. A pressure drop in the front of the shock wave of 0,2-0,3 kg/cm2 can lead to rupture of the eardrums, 0,7-1,0 kg/cm2 can cause fatal damage to internal organs.

The lungs on the side facing the center of the explosion are more likely to suffer. In the parenchyma of the lungs, hemorrhages are observed mainly in the region of the apexes, the hepatic surface and in the root zone. Under the pleura of the lungs, multiple punctate hemorrhages are visible, located in accordance with the intercostal spaces.

Passing from the air into the liquid media of the body, the shock wave, due to the high density and incompressibility of these media, can increase the speed of its propagation and lead to significant damage. This phenomenon is called an inward explosion.

Fragments and parts of an explosive device have different energies depending on their mass and density, the power of the explosion and the distance from its center. Therefore, shrapnel damage is highly variable.

Depending on what factors had a damaging effect, three distances are distinguished:

1) very close (contact explosion or contact) - detonation products, shock wave and fragments act;

2) relatively close - damage is formed from the combined action of a shock wave and fragments;

3) not close - only fragments work.

Damage from secondary projectiles can occur at any of the three ranges.

LECTURE #7

Forensic medical examination of mechanical asphyxia

Mechanical asphyxia is a violation of external respiration caused by mechanical causes, leading to difficulty or complete cessation of oxygen supply to the body and the accumulation of carbon dioxide in it.

Depending on the mechanism of formation of obstacles, the following types are distinguished.

1. Strangulation asphyxia that occurs when the respiratory organs are compressed on the neck.

2. Compression asphyxia arising from compression of the chest and abdomen.

3. Obstructive (aspiration) asphyxia, which occurs when solid or liquid substances enter the respiratory tract and block them.

4. Asphyxia in a closed and semi-closed space.

Regardless of the mechanism of formation of a mechanical obstacle, all types of mechanical asphyxia have common manifestations noted during the examination of a corpse.

Periods of development of mechanical asphyxia

I. Pre-asphyctic - lasts up to 1 minute; there is an accumulation of carbon dioxide in the blood, respiratory movements increase; if the obstacle is not removed, then the next period develops.

II. Asphyctic - conditionally divided into several stages, which can last from 1 to 3-5 minutes:

1) the stage of inspiratory dyspnea - is characterized by increased inhalation movements following one after another, caused by the accumulation of carbon dioxide in the blood and excitation of the central nervous system. As a result, the lungs expand greatly, and ruptures of the lung tissue are possible. At the same time, blood flow to them increases (the lungs are filled with blood, hemorrhages form). Further, the right ventricle and the right atrium of the heart overflow with blood, and venous congestion develops throughout the body. External manifestations - cyanosis of the skin of the face, muscle weakness. Consciousness is retained only at the beginning of the stage;

2) the stage of expiratory dyspnea - increased exhalation, a decrease in the volume of the chest, excitation of the muscles, which leads to involuntary defecation, urination, ejaculation, increased blood pressure, and hemorrhages. With physical activity, damage to surrounding objects is possible;

3) short-term cessation of breathing - a drop in arterial and venous pressure, muscle relaxation;

4) terminal stage - erratic respiratory movements.

5) persistent cessation of breathing.

Under certain conditions encountered in practice, respiratory arrest may develop before the development of any or all of the previous stages of asphyxia.

These manifestations are also called signs of rapid death and hemodynamic disorders. They occur with any kind of mechanical asphyxia.

Manifestations during external examination of the corpse:

1) cyanosis, cyanosis and puffiness of the face;

2) petechial hemorrhages in the sclera, the albuginea of ​​the eyeball and the fold of the conjunctiva, passing from the inner surface of the eyelid to the eyeball;

3) petechial hemorrhages in the mucous membrane of the lips (the surface of the lips facing the teeth), the skin of the face and, less often, the skin of the upper half of the body;

4) intense diffuse dark purple cadaveric spots with multiple intradermal hemorrhages (cadaveric ecchymosis);

5) traces of defecation, urination and ejaculation.

Autopsy manifestations:

1) liquid state of blood;

2) dark shade of blood;

3) venous plethora of internal organs, especially the lungs;

4) overflow of blood in the right atrium and right ventricle of the heart;

5) Tardieu spots, small focal hemorrhages under the visceral pleura and epicardium;

6) imprints of the ribs on the surface of the lungs due to swelling of the latter.

strangulation asphyxia

Depending on the mechanism of compression of the neck organs, strangulation asphyxia is divided into several types:

1) hanging arising from uneven compression of the neck by a noose tightened under the weight of the victim's body.

2) strangulation with a loop, which occurs when the neck is uniformly squeezed by a loop, more often tightened by an outside hand.

3) hand pressure, which occurs when the organs of the neck are squeezed with fingers or between the shoulder and forearm.

Loop characteristic

The loop leaves a trace in the form of a strangulation groove, which is detected during an external examination of the corpse. The location, nature and severity of the elements of the furrow depend on the position of the loop on the neck, the properties of the material and the method of applying the loop.

Depending on the material used, the loops are divided into soft, semi-rigid and rigid. Under the action of a rigid loop, the strangulation furrow is pronounced, deep; ruptures of the skin and underlying tissues are possible under the action of a wire loop. Under the action of a soft loop, the strangulation furrow is weakly expressed and, after removing the loop, may not be noted when examining a corpse at the site of discovery. After some time, it becomes noticeable, as the skin sieged by the loop dries out before the intact adjacent skin areas. If clothes, objects, limbs get between the neck and the loop, the strangulation furrow will be open.

By the number of revolutions - single, double, triple and multiple. Strangulation furrows are similarly subdivided.

The loop can be closed if it is in contact with the surface of the neck from all sides, and open if it is in contact with one, two, three sides of the neck. Accordingly, the strangulation furrow can be closed or open.

In the loop, a free end, a knot and a ring are distinguished. If the knot does not allow changing the dimensions of the ring, then such a loop is called fixed. Otherwise, it is called sliding (moving). The position of the node, respectively, and the free end can be typical (behind, on the back of the head), lateral (in the auricle) and atypical (in front, under the chin).

When hanging in a vertical position, the legs usually do not touch the support. In cases where the body touches the support, hanging can occur in a vertical position with bent legs, sitting, reclining and lying down, since even the mass of one head is enough to compress the organs of the neck with a loop.

When hanging, there are some features of changes in the body. Against the background of respiratory failure, increased intracranial pressure develops due to the cessation of blood outflow through the compressed jugular veins. Although the carotid arteries are also compressed, blood flow to the brain is carried out through the vertebral arteries, which pass through the transverse processes of the vertebrae. Therefore, cyanosis, cyanosis of the face are very pronounced.

It should be borne in mind that asphyxia in this case may not fully develop due to reflex cardiac arrest that occurs when the loop of the vagus, superior laryngeal and glossopharyngeal nerves, as well as the sympathetic trunk, is irritated by the loop.

When hanging, the strangulation groove has an obliquely ascending direction, located above the thyroid cartilage. The furrow is not closed, it is most pronounced at the site of impact of the middle part of the loop ring and is absent at the position of the free end. Cadaverous spots are formed in the lower abdomen, on the lower extremities, especially on the thighs.

At autopsy, signs may be noted that indicate stretching of the neck during hanging:

1) transverse ruptures of the inner shell of the common carotid arteries (Amass sign);

2) hemorrhages in the outer shell of the vessels (Martin's sign) and the inner legs of the sternocleidomastoid muscles. The presence of these features is directly dependent on the rigidity of the loop and on the sharpness of its tightening under the influence of the gravity of the body.

Hanging may be intravital or posthumous. Signs that indicate the lifetime of hanging include:

1) sedimentation and intradermal hemorrhages along the strangulation furrow;

2) hemorrhages in the subcutaneous tissue and neck muscles in the projection of the strangulation furrow;

3) hemorrhages in the legs of the sternocleidomastoid muscles and in the area of ​​intima tears of the common carotid arteries;

4) reactive changes in the area of ​​hemorrhages, changes in the tinctorial properties of the skin, a violation of the activity of a number of enzymes and necrobiotic changes in muscle fibers in the pressure band, detected by histological and histochemical methods.

When strangulated with a loop, its typical position is the region of the neck corresponding to the thyroid cartilage of the larynx or slightly below it. The strangulation furrow will be located horizontally (transversely to the axis of the neck), it is closed, evenly expressed along the entire perimeter. Its area corresponding to the node often has intradermal multiple hemorrhages in the form of intersecting bands. As with hanging, signs are noted in the furrow that characterize the properties of the loop itself: material, width, number of revolutions, relief.

At autopsy, fractures of the hyoid bone and cartilage of the larynx, especially the thyroid cartilage, are often found, numerous hemorrhages in the soft tissues of the neck, respectively, the projection of the action of the loop.

As with hanging, the noose when squeezing the neck can cause severe irritation of the nerves of the neck, often resulting in rapid reflex cardiac arrest.

When strangulated with hands, small rounded bruises from the action of fingers are visible on the neck, no more than 6-8 in number. Bruises are located at a small distance from each other, their location and symmetry depend on the position of the fingers when the neck is squeezed. Often, against the background of bruising, arcuate strip-like abrasions from the action of the nails are visible. External lesions may be mild or absent if there was a tissue pad between the arms and neck.

An autopsy reveals massive, deep hemorrhages around the vessels and nerves of the neck and trachea. Fractures of the hyoid bone, cartilage of the larynx and trachea are often detected.

When the neck is compressed between the forearm and shoulder, external injuries usually do not occur on the neck, while extensive diffuse hemorrhages form in the subcutaneous tissue and muscles of the neck, fractures of the hyoid bone and cartilage of the larynx are possible.

In some cases, the victim resists, which causes the attacker to put pressure on the chest and abdomen. This can lead to the formation of numerous bruises on the chest and abdomen, hemorrhages in the liver and fractures of the ribs.

Compression asphyxia

This asphyxia occurs with a sharp compression of the chest in the anteroposterior direction. Strong compression of the lungs is accompanied by a sharp restriction of breathing. At the same time, the superior vena cava is compressed, which drains blood from the head, neck, and upper limbs. There is a sharp increase in pressure and stagnation of blood in the veins of the head and neck. In this case, ruptures of capillaries and small veins of the skin are possible, which causes the appearance of numerous petechial hemorrhages. The face of the victim is puffy, the skin of the face and upper chest is purple, dark purple, in severe cases almost black (ecchymotic mask). This coloration has a relatively clear border in the upper part of the body. In places where clothes fit snugly on the neck and supraclavicular areas, stripes of normally colored skin remain. On the skin of the chest and abdomen, stripe-like hemorrhages are noted in the form of a relief of clothing, as well as particles of material that squeezed the torso.

When opening a corpse in the muscles of the head, neck and torso, focal hemorrhages can be detected, the vessels of the brain are sharply plethoric. With a slow onset of death, stagnation of oxygenated blood in the lungs occurs, which can cause them to be bright red in color, unlike other types of asphyxia. An increase in air pressure in the lungs leads to numerous ruptures of the lung tissue and the formation of air bubbles under the pleura of the lungs. Numerous fractures of the ribs, ruptures of the diaphragm, ruptures of the internal organs of the abdominal cavity, especially the liver, can be observed.

Obstructive (aspiration) asphyxia

There are several types of obstructive asphyxia.

Closing the nose and mouth with a hand, as a rule, is accompanied by the formation of scratches on the skin around their holes, arcuate and strip-like abrasions, round or oval bruises. At the same time, hemorrhages form on the mucous membrane of the lips and gums. When closing the openings of the nose and mouth with any soft objects, the above damage may not form. But since this asphyxia develops according to the classical scenario, then in the stage of inspiratory dyspnea, individual fibers of tissue, hairs of wool and other particles of used soft objects can enter the oral cavity, larynx, trachea, and bronchi. Therefore, in such cases, the thoroughness of the study of the respiratory tract of the deceased is of great importance.

Death from closing the mouth and nose may occur in an epileptic patient when, during a fit, he finds himself with his face buried in a pillow; in infants as a result of the closing of the respiratory openings by the mammary gland of the mother, who fell asleep during feeding.

The closure of the lumen of the respiratory tract has its own characteristics, depending on the properties, size and position of the foreign body. Most often, solid objects close the lumen of the larynx, the glottis. With complete closure of the lumen, signs of a typical development of asphyxia are revealed. If the size of the object is small, then there is no complete overlap of the airway lumen. In this case, a rapid edema of the mucous membrane of the larynx develops, which is a secondary cause of the closure of the airways. In some cases, small objects, irritating the mucous membrane of the larynx and trachea, can cause swelling of the mucous membrane, reflex spasm of the glottis or reflex cardiac arrest. In the latter case, asphyxia does not have time to fully develop, which will be ascertained by the absence of a number of typical signs of asphyxia. Thus, the detection of a foreign object in the respiratory tract is the leading evidence of the cause of death.

Semi-liquid and liquid food masses usually quickly penetrate into the smallest bronchi and alveoli. In this case, at autopsy, a bumpy surface and swelling of the lungs are noted. On the section, the color of the lungs is variegated; when pressed, food mass is released from the small bronchi. Microscopic examination reveals the composition of food masses.

Aspiration of blood is possible with injuries of the larynx, trachea, esophagus, severe nosebleeds, fracture of the base of the skull.

Drowning is a change that occurs in the body as a result of the entry of some liquid into the respiratory tract and the closure of their lumen. There are true and asphyxic types of drowning.

All signs of drowning can be divided into two groups:

1) intravital signs of drowning;

2) signs of the presence of the corpse in the water.

With the true type of drowning in the stage of inspiratory dyspnea due to increased breaths, water in large quantities enters the respiratory tract (nasal cavity, mouth, larynx, trachea, bronchi) and fills the lungs. In this case, a light pink finely bubbled foam is formed. Its resistance is due to the fact that with increased inhalations and subsequent exhalations, water, air and mucus are mixed, produced by the respiratory organs in the presence of liquid as a foreign object. Foam fills the above respiratory organs and exits from the openings of the mouth and nose.

Filling the pulmonary alveoli, water contributes to a greater rupture of their walls along with the vessels. The penetration of water into the blood is accompanied by the formation of light red blurry hemorrhages 4-5 mm in diameter under the pleura covering the lungs (Rasskazov-Lukomsky spots). The lungs are sharply enlarged and completely cover the heart with the pericardium. In some places they are swollen and the imprints of the ribs are visible on them.

Mixing water with blood leads to a sharp increase in the volume of the latter (blood hypervolemia), accelerated breakdown (hemolysis) of red blood cells and the release of a large amount of potassium from them (hyperkalemia), which causes arrhythmia and cardiac arrest. Breathing movements may persist for some time.

Blood thinning leads to a decrease in the concentration of blood components in the left atrium and left ventricle, in comparison with the concentration of blood components in the right atrium and right ventricle.

Microscopic examination in the fluid taken from the lungs reveals particles of silt, various algae, if drowning occurred in a natural reservoir. At the same time, elements of diatom plankton can be detected in the blood, kidneys and bone marrow. With this type of drowning, a small amount of water is found in the stomach.

In the asphyxic type of drowning, the mechanism for the development of changes is determined by a sharp spasm of the glottis on the mechanical effect of water on the mucous membrane of the larynx and trachea. Persistent spasm of the glottis lasts for almost the entire time of dying. A small amount of water can only enter at the end of the asphyxial period. After respiratory arrest, the heart may contract for 5-15 minutes. An external examination of the corpse clearly reveals general signs of asphyxia, fine bubble foam around the openings of the nose and mouth - in a small amount or absent. At autopsy, swollen, dry lungs are found. There is a lot of water in the stomach and the initial sections of the intestine. Plankton is found only in the lungs.

Signs of a body being in the water include:

1) pallor of the skin;

2) pink shade of cadaveric spots;

3) particles of silt, sand, etc. suspended in water on the surface of the body and clothing of the corpse;

4) "goosebumps" and raised vellus hair;

5) the phenomenon of maceration - swelling, wrinkling, rejection of the epidermis ("gloves of death", "washerwoman's skin", "sleek hand").

The severity of maceration depends on the temperature of the water and the time spent by the corpse in it. At 4 °C, the initial effects of maceration appear on the 2nd day, and the rejection of the epidermis begins after 30-60 days, at a temperature of 8-10 °C - on the 1st day and after 15-20 days, respectively, at 14-16 ° C - in the first 8 hours and after 5-10 days, at 20-23 ° C - within 1 hour and after 3-5 days. After 10-20 days, hair begins to fall out. The bodies float to the surface of the water due to the gases formed during decay. In warm water, this usually occurs on the 2-3rd day. In cold water, the processes of decay slow down. The corpse can be under water for weeks and months. Soft tissues and internal organs in these cases are saponified. The first signs of adiposity usually appear after 2-3 months.

By the presence of the above signs, we can only talk about the presence of the corpse in the water, and not about intravital drowning.

Death in water can occur from various mechanical damage. However, signs of the survival of such injuries are well preserved for one week of the corpse's stay in the water. Further stay of the body leads to their rapid weakening, which makes it difficult for an expert to give a categorical conclusion. A common cause of death is a violation of cardiovascular activity from exposure to cold water on a heated body.

After removing the corpse from the water, various injuries can be found on it, which are formed when the body hits the bottom or any objects in the reservoir.

Asphyxia in enclosed and semi-enclosed spaces

This type of mechanical asphyxia develops in spaces with a complete or partial lack of ventilation, where there is a gradual accumulation of carbon dioxide and a decrease in oxygen. The pathogenesis of this condition is characterized by a combination of hypercapnia, hypoxia, and hypoxemia. The biological activity of carbon dioxide is higher than that of oxygen. Increasing the concentration of carbon dioxide to 3-5% causes irritation of the mucous membranes of the respiratory tract and a sharp increase in breathing. A further increase in the concentration of carbon dioxide to 8-10% leads to the development of typical asphyxia, without the development of specific morphological changes.

LECTURE #8

Forensic medical examination of living persons. Examination of harm to health, state of health, determination of age, feigned and artificial diseases

Harm to health is understood as either bodily injury, i.e., a violation of the anatomical integrity of organs and tissues or their physiological functions, or diseases or pathological conditions that have arisen as a result of exposure to various environmental factors: physical, chemical, biological, mental.

The tasks of the forensic medical expert include:

1) establishing the presence of harm to health (damage) and its medical characteristics;

2) elucidation of the mechanism of damage formation, the tool that caused it;

3) establishing the limitation period for causing damage;

4) determination of the severity of harm to health;

5) other questions.

Forensic medical examination of bodily injuries consists of the following stages:

1) study of the circumstances of the occurrence of damage according to the data contained in the decision on the conduct of the examination, according to the case materials, according to medical documents and circumstances reported by the victims;

2) forensic medical examination of the victim, suspect, accused;

3) laboratory and other special studies;

4) drawing up a conclusion.

When examining bodily injuries for a forensic medical examiner, the basic document is the Criminal Code of the Russian Federation.

Order of the Ministry of Health of the USSR dated 11.12.78 No. 1208 "On the introduction into practice of the Rules for the forensic determination of the severity of bodily injuries" was valid until 1996. The new Criminal Code of the Russian Federation, which has entered into force, provides for liability for causing not bodily injuries, but harm to health , which includes a broader meaning. By order of the Ministry of Health of the Russian Federation of December 10.12.1996, 407, No. 2001, the above order was declared invalid and new "Rules for forensic medical examination of the severity of harm to health" that meet the requirements of the new Criminal Code of the Russian Federation were put into practice. However, these Rules, as not registered with the Ministry of Justice, were canceled in 11.10.01. And by an information letter from the Prosecutor General's Office and the chief forensic expert of the Ministry of Health of Russia dated 102 No. 2199/1978, the experts were recommended to "temporarily" base their activities on provisions of the rules of 1996 as amended by the Criminal Code of the Russian Federation of XNUMX

Modern legal conditions, characterized by significant changes in the legal field around the expert, challenge him not only to make a meaningful decision, but also to have a much deeper understanding of the significance of the work performed for criminal proceedings based on ideas about the expectations of lawyers from an expert opinion.

Hopes that sooner or later new Rules will be adopted that will allow the expert to return to the old practice of determining harm to health cannot be considered justified, since the very possibility of registering such a document with the Ministry of Justice is doubtful on the grounds that:

1) the articles of the Criminal Code, which provide for criminal liability for causing harm to health, are not blanket, i.e., for making a decision on them, the use of any document other than an expert opinion is not provided;

2) substantiation of the conclusion about the degree of harm to health should be based on the special knowledge of the expert, and not on the provisions of the normative document;

3) experts, in principle, have (and have always had!) an objective opportunity to make a decision on the degree of harm to health without using any regulatory document, which is confirmed by the modern working conditions of experts, characterized by the virtual absence of the Rules.

The Criminal Code of the Russian Federation establishes a three-level division of the severity of harm to health: serious harm to health, medium severity of harm to health and light harm to health.

In addition, the Criminal Code of the Russian Federation provides for special methods of causing damage: beatings, torment, torture, the establishment of which is not within the competence of a forensic medical expert. The solution of this issue belongs to the competence of the bodies of inquiry, investigation, prosecutor's office and court.

Serious harm to health

The qualifying signs of serious harm to health are (Article 111 of the Criminal Code of the Russian Federation):

1) danger of harm to health for human life;

2) the duration of the health disorder;

3) persistent loss of general ability to work;

4) loss of any body or loss of its functions by the body;

5) loss of vision, speech, hearing;

6) complete loss of professional ability to work;

7) termination of pregnancy;

8) indelible disfigurement of the face;

9) mental disorder, drug addiction or substance abuse disease.

To establish the severity of harm to health, one of the qualifying features is sufficient. If there are several qualifying signs, the severity of the health damage is determined by the sign that corresponds to the greater severity of the health damage.

The duration of a health disorder is determined by the duration of temporary disability (temporary disability). When assessing the severity of harm to health, both temporary and permanent disability are taken into account.

When assessing the severity of harm to health caused to a person suffering from any disease, only the consequences of the injury should be taken into account. It is advisable to resolve this issue by a commission of experts with the participation of relevant clinical specialists.

In the presence of multiple injuries, the severity of harm to health is assessed separately for each injury.

In case of damage to a part of the body with a completely or partially previously lost function, only the consequences of the injury are taken into account.

Small few injuries (abrasions, bruises, small superficial wounds), which do not entail a short-term health disorder or a slight permanent loss of general ability to work, are not regarded as harm to health.

Life-threatening damage. A life-threatening injury is an injury that causes a life-threatening condition that can result in death. Prevention of death as a result of medical care does not change the assessment of harm to health as life-threatening. Life-threatening harm to health can be both bodily injuries and diseases and pathological conditions.

Life-threatening injuries include:

1) penetrating wounds of the skull, including those without brain damage;

2) open and closed fractures of the bones of the vault and base of the skull, with the exception of fractures of the bones of the facial skeleton, and isolated cracks only in the outer plate of the cranial vault;

3) severe brain contusion, both with and without compression of the brain;

4) brain contusion of moderate degree in the presence of symptoms of damage to the stem section;

5) epidural, subdural or subarachnoid intracranial hemorrhage in the presence of life-threatening events;

6) penetrating wounds of the spine, including those without damage to the spinal cord;

7) fracture-dislocations and fractures of the bodies or arches of the cervical vertebrae, as well as unilateral fractures of the arches of the 1st and 2nd cervical vertebrae, including those without impaired spinal cord function;

8) dislocations of the cervical vertebrae;

9) closed injuries of the spinal cord in the cervical region;

10) fracture or fracture-dislocation of one or more thoracic or lumbar vertebrae with dysfunction of the spinal cord or with the presence of clinically established severe shock;

11) closed injuries of the thoracic, lumbar and sacral segments of the spinal cord, accompanied by severe spinal shock or dysfunction of the pelvic organs;

12) penetrating wounds of the pharynx, larynx, trachea, esophagus, as well as damage to the thyroid and thymus glands;

13) closed fractures of the cartilage of the larynx and trachea with ruptures of the mucous membrane, accompanied by severe shock or respiratory disorders or other life-threatening phenomena;

14) chest wounds penetrating into the pleural cavity, pericardial cavity or mediastinal tissue, including without damage to internal organs;

15) wounds of the abdomen, penetrating into the cavity of the peritoneum, including without damage to the internal organs;

16) closed injuries of the organs of the chest or abdominal cavity, pelvic cavity, as well as organs of the retroperitoneal space in the presence of life-threatening phenomena;

17) wounds penetrating into the cavity of the bladder, upper and middle sections of the rectum;

18) other open wounds of the retroperitoneal organs (kidneys, adrenal glands, pancreas);

19) rupture of the internal organ of the chest or abdominal cavities, or pelvic cavity, or retroperitoneal space, or rupture of the diaphragm, or rupture of the prostate gland, or rupture of the ureter, or rupture of the membranous part of the urethra;

20) open fractures of long tubular bones - humerus, femur and tibia;

21) bilateral fractures of the posterior half-ring of the pelvis with a rupture of the iliac-sacral joint and a violation of the continuity of the pelvic ring or double fractures of the pelvic ring in the anterior and posterior parts with a violation of its continuity;

22) fractures of the pelvic bones, accompanied by severe shock or massive blood loss or rupture of the membranous part of the urethra;

23) open injuries of the hip and knee joints;

24) damage to a large blood vessel: aorta, carotid (common, internal, external), subclavian, brachial, femoral, popliteal arteries or accompanying veins;

25) damage resulting in severe shock or massive blood loss that caused collapse, clinically pronounced fat or gas embolism, traumatic toxicosis with symptoms of acute renal failure;

26) thermal burns of the body III-IV degrees, occupying at least 15% of the body surface; III degree burns over 20% of the body surface; second degree burns over 30% of the body surface, as well as burns of a smaller area, accompanied by severe shock;

27) burns of the respiratory tract with symptoms of edema and narrowing of the glottis;

28) burns with chemical compounds (concentrated acids, caustic alkalis, various cauterizing substances), which, in addition to local, have caused a general toxic effect that threatens life;

29) compression of the neck organs and other types of mechanical asphyxia, accompanied by a pronounced complex of life-threatening phenomena (cerebrovascular accident, loss of consciousness, amnesia, etc.), if this is established by objective data.

Life-threatening injuries are injuries that have resulted in a life-threatening condition. Life-threatening are also diseases or pathological conditions that have arisen as a result of exposure to various external factors and are naturally complicated by a life-threatening condition or that themselves pose a threat to human life. These include:

1) severe shock of various etiologies;

2) coma of various etiologies;

3) massive blood loss;

4) acute heart or vascular insufficiency, collapse;

5) severe degree of cerebrovascular accident;

6) acute renal or acute liver failure;

7) severe acute respiratory failure;

8) purulent-septic condition;

9) disorders of regional and organ circulation, leading to infarction of internal organs, gangrene of extremities, gas or fat embolism of cerebral vessels, thromboembolism;

10) a combination of life-threatening conditions.

Damage related to serious outcome and consequences

1. Loss of vision - complete permanent blindness in both eyes or a condition where there is a decrease in vision to acuity of 0,04 or less (up to counting fingers at a distance of 2 meters and up to light perception). Loss of vision in one eye entails a permanent disability of more than one third and, on this basis, is classified as serious bodily injury.

2. Hearing loss - persistent complete deafness in both ears or such an irreversible condition when the victim does not hear spoken language at a distance of 3-5 cm from the auricle.

3. Loss of an organ or loss of its function by an organ:

1) loss of an arm, leg, i.e. their separation from the body or their loss of function (paralysis or other condition that excludes their activity); anatomical loss of an arm or leg should be understood as a separation from the body of the entire arm or leg, as well as amputation at a level not lower than the elbow or knee joints;

2) loss of speech - loss of the ability to express one's thoughts in articulate sounds understandable to others, or loss of voice;

3) loss of productive ability, which consists in the loss of the ability to fertilize, conceive and procreate;

4) termination of pregnancy - establishing as a fact is not difficult. It is more difficult to establish a direct causal relationship between trauma and termination of pregnancy. The examination should be carried out in a hospital, where the question is decided whether the termination of pregnancy is a direct consequence of an injury or whether it coincided in time and was caused by other reasons: the pathology of pregnancy, the peculiarities of its course, etc .;

5) mental disorder - if it has arisen as a result of an injury; determined by a forensic psychiatric examination;

6) a health disorder associated with a permanent disability by at least 1/3 (with a definite outcome). Persistent - permanent, almost for life. The establishment of this sign is made after the determined outcome of the damage and / or the end of treatment;

7) indelible disfigurement of the face - residual pathological changes (scars, deformities, changes in facial expressions, etc.), the elimination of which requires surgical intervention (cosmetic surgery). Establishing the fact of facial disfigurement is not within the competence of a forensic medical expert, since this concept is not medical, but aesthetic. An expert can only determine the indelibility of certain damages and their consequences. The possibility of eliminating facial disfigurement with the help of cosmetic surgery is not taken into account.

Moderate damage to health

The criteria for causing harm to health of moderate severity are (Article 112 of the Criminal Code of the Russian Federation):

1) no danger to life;

2) the absence of the consequences specified in Art. 111 of the Criminal Code of the Russian Federation;

3) long-term health disorder - temporary disability lasting more than 21 to 120 days;

4) significant permanent loss of general ability to work by less than one third - permanent loss of general ability to work from 10 to 33%.

Minor health hazard

Signs of slight harm to health are (Article 115 of the Criminal Code of the Russian Federation):

1) short-term health disorder - temporary disability lasting more than 6, but not more than 21 days;

2) minor permanent loss of ability to work - permanent loss of general ability to work, equal to 10%.

The state of health is established in connection with civil or criminal proceedings. An expert examination is appointed, for example, to determine the ability of the testified to physical labor or to work in a certain specialty, to clarify the possibility of interrogation by the investigator or summons, bringing a witness, victim, accused to court, to establish the possibility for the defendant to serve the sentence imposed, and in other cases.

Before conducting an examination, a representative of the bodies of inquiry, an investigator or a court must collect and submit to the forensic medical expert for examination all the medical documentation of those medical institutions where the witness was previously treated. The examination is carried out on a commission basis with the inclusion in the commission, in addition to the forensic medical expert, of the necessary doctors of other specialties.

Disability can be temporary or permanent (permanent). Temporary loss is established by doctors of medical institutions with the issuance of a certificate of incapacity for work, permanent loss is established by medical and social expert commissions (MSEC) of social security authorities, which determine three groups of disability and degrees of disability. Above stood out as headings.

In addition to disability groups, in some cases it is required to establish whether a permanent disability has occurred and which one.

An examination of determining the degree of permanent disability is carried out in civil cases in connection with claims for compensation for damage caused by injury or other damage to health.

Commissions must establish the degree of loss of both general and professional disability. Under the general working capacity is understood the ability to unskilled work, and under professional - the ability to work in one's profession. Persistent disability is determined as a percentage, which is associated with the need for the courts to establish the amount of compensation for damage, depending on the disability, expressed in some precisely indicated value.

An examination of determining the degree of permanent disability can also be appointed in divorce proceedings in the event of disability due to sexual activity.

Age determination by medical institutions is carried out both on the restoration of lost birth records by the registry office, and at the suggestion of the judicial and investigative authorities in the absence of documents on the age of the accused, suspect, victim.

The need to determine the age at the suggestion of the bodies of inquiry, investigation and court arises both in civil and criminal cases. Determining the age in criminal proceedings is often necessary to resolve the issue of bringing the witness to criminal responsibility.

Age is determined by the totality of age characteristics using as many of them as possible. These signs depend on numerous and not always detected factors, individual characteristics and external influences, they do not have a clear distinction. Therefore, age is determined only with a greater or lesser approximation: in children - with an accuracy of 1-2 years, in adolescence - up to 2-3 years, in adults - up to 5 years, and in people over 50 years old with an approximation of up to 10 years.

Age signs include: height (body length), chest circumference; length of the upper and lower limbs (shoulder, forearm, thigh, lower leg); head dimensions (circumference, longitudinal, transverse and vertical diameters); the number and condition of the teeth (milk, permanent, wisdom teeth, degree of wear); the condition of the vegetation on the face, in the armpits, on the pubis (fluff, sparse, thick hair, their graying, loss); the condition of the skin (color, texture, wrinkles, pigmentation of the nipples, genitals); in girls - the development of the mammary glands, the appearance of menstruation and the size of the pelvis; in boys - voice change; the degree of formation and age-related changes in the bone skeleton, detected by X-ray examination.

The last method of studying the age-related features of the skeletal system has now acquired leading importance. This is due to its objectivity and greater reliability of the data obtained, which serve as the basis for the expert's conclusions about the specific age of the testified.

It has been established that it is possible to more accurately determine age-related signs by the skeleton before the end of puberty, and in relation to the processes of differentiation of bone tissue - until the completion of synostosis (fusion) of individual bone elements into a single whole, which occurs, as a rule, by 23-25 ​​years.

The X-ray method of research allows, to a certain extent, to determine the age even at a later date, when it is possible, although with a lesser degree of probability, to speak about a particular age period based on the processes of bone tissue aging.

The teeth that appear in a child from the second half of a year of life also differ in more permanent signs. By the age of 2 years, 20 teeth grow. The replacement of milk teeth with permanent ones begins at the age of 6-8 years, and by the age of 14-15 there are usually 28 permanent teeth. Wisdom teeth erupt between 18 and 25 years of age. Gradually, the surface layer (enamel) begins to be erased from the tubercles and the chewing surface of the molars, and from the age of 40 - the inner layer (dentin).

The remaining signs are less constant, but still have some patterns. So, from the age of 20, nasolabial and frontal wrinkles appear, at the age of 25-30 years - wrinkles on the lower eyelids and at the outer corners of the eyes, about 30-35 years - pre-tragus (in front of the auricle). Wrinkles on the lobes and neck appear around 50 years of age. At the age of over 50-60 years, the elasticity of the skin on the hands decreases, pigmentation and wrinkling appear.

Anthropometric data of the witnesses are compared with the average indicators established for individual age groups. Other age characteristics are also taken into account, because at present the age examination should be considered as a complex one, when the degree of reliability of the conclusions depends on the totality of the applied modern methods.

Fake and artificial diseases

Sometimes people tend to exaggerate certain symptoms of an existing disease or reproduce the symptoms of a non-existent disease. There are also cases when a disease or a manifestation of a health disorder is caused artificially, inflicting certain injuries on oneself or using other methods.

Such diseases are called feigned, artificial. They are resorted to in order to free themselves from military service, from forced labor, to hide this or that incident, etc.

Feigned diseases can be expressed in the form of aggravation and simulation.

Aggravation is an exaggeration of complaints and symptoms of the disease. There is a disease in reality, but it does not proceed in the way that the witness presents it.

Simulation is a deception, a pretense, when there is no illness and the person being witnessed complains about non-existent phenomena and symptoms.

Various diseases can be simulated. Of the internal most often reproduce heart and gastrointestinal diseases.

The recognition of a sham presents significant difficulties and must be based on a comprehensive clinical observation in a hospital with laboratory tests. It is necessary to establish a thorough observation of the subject, which is not noticeable to him, to analyze all his complaints and manifestations of the disease. For the most part, individual symptoms of the disease are simulated, since it is difficult to reproduce the disease completely without special medical knowledge. The "disease" proceeds unusually, without improvement, the patient constantly and persistently complains of pain, which helps to identify the simulation.

Examination of the simulation is carried out on a commission basis with the participation of medical specialists. To identify simulators, it is unacceptable to use anesthesia, hypnosis.

Experts can be put, for example, such questions: is there a disease and what kind; whether the complaints of the witness and the manifestations of the disease revealed in him are reproduced artificially or correspond to the existing disease; does not aggravate the existing disease; if the disease is simulated, then in what way.

Dissimulation. In practice, there are cases when a person is ill or in a state of recovery, but downplays, hides the existing disease or condition and its signs. To avoid liability, for example, a sexually transmitted disease, a former birth can be hidden. Sometimes the disease is hidden when applying for a job, in an educational institution, when drafted into military service, and in other cases.

Artificial diseases, self-mutilation. Some authors combine artificial diseases and self-mutilation under a common name, others consider them separately, understanding self-mutilation as the infliction of mechanical damage, and under artificial diseases - diseases caused by chemical, thermal, bacteriological and other means. In both cases, self-harm occurs, although it is often caused with the help of other persons.

Self-mutilation can be done with firearms, sharp and blunt tools and objects. In this case, the infliction of injuries that are not life-threatening is characteristic.

Firearms inflict damage by shooting most often in the upper limb, mainly in the area of ​​the hand. Injuries to the forearm, lower extremities, and other parts of the body are rare. Diagnosis is based on the localization of damage, the direction of the wound channel, the shape of the inlet and outlet, their features, and the presence of powder deposits. It should be borne in mind that the self-harm can use various gaskets when firing. Sometimes self-mutilation is carried out with the help of an explosive projectile.

Sharp tools are axes, sapper shovels, with which one or more often several fingers are cut off, mainly on the left hand. The blow is usually applied on a hard lining from the side of the back surface in a transverse or somewhat oblique direction with respect to the length of the arm. Cuts, notches are often found on the separated parts of the fingers or stumps. The witness refers to an accident during work, and in a combat situation - to a wound from a shell fragment. Comparison of the story with the available objective data makes it possible to recognize this type of self-mutilation.

Injuries with blunt objects are caused by placing fingers or the entire hand or foot under the wheels of rail vehicles and heavy objects. This method is resorted to extremely rarely, passing it off as an accident. The nature of the damage itself makes it difficult to distinguish between an accident and self-mutilation, therefore, a targeted questioning of the testified and clarification of the situation of the incident is of particular importance.

In all cases, the participation of a doctor - a specialist in the field of forensic medicine in examining the scene of the incident and conducting an investigative experiment in order to reproduce the situation and conditions of the incident is important.

Physical evidence is subject to examination: separated parts of limbs, clothing (depending on the location of the damage), weapons and objects that served as a means of self-mutilation, linings, pads, etc.

In conclusion, the expert must indicate what damage is present; what subject, method and when caused; whether it could have arisen under the circumstances referred to by the testified.

Chemical, thermal, bacterial and other means cause the formation of various ulcers, burns, suppuration, frostbite and other lesions of the skin and subcutaneous tissue, as well as other diseases. For this purpose, gasoline, kerosene, turpentine, caustic alkali, acid, soap, table salt, caustic plant juices (buttercup, milkweed, etc.), saliva, urine, feces, pus, hot objects, etc. are used. subcutaneously, intramuscularly and applied externally, often with preliminary skin irritation. Sometimes they freeze the toes and hands.

Artificial surgical diseases include hernia and prolapse of the rectum. Their recognition is possible in recent cases by traces of hemorrhages and abrasions in the area of ​​soft tissues.

LECTURE #9

Forensic medical examination of living persons. Examination of sexual conditions and sexual crimes

The production of expertise in these cases is regulated by the order of the Ministry of Health of the Russian Federation dated April 24, 2003 No. 161 "On approval of the Instructions for the organization and production of expert studies in the bureau of forensic medical examination."

The effectiveness of the results of the examination is greater, the earlier after the incident it is carried out. Therefore, in special cases that require a hasty investigation (if, due to the prevailing circumstances, the remoteness of the scene of the incident from the bodies of inquiry, investigation or judicial institutions, etc., it is impossible to obtain a decision on the production of an examination in a timely manner), a forensic obstetric and gynecological examination can be carried out as an exception at the request of the victims themselves, as well as parents, legal representatives of minors and appropriate officials.

Persons performing the examination

An examination in the event of a violation of virginity, signs of forced sexual intercourse or indecent acts is carried out by a forensic medical expert who has undergone advanced training in forensic medicine, in particular in obstetric and gynecological examination. Examinations of sexual ability, pregnancy, childbirth, abortion, etc. are carried out either by the expert himself, if he has special training in the field of forensic gynecology and obstetrics, or by commission - together with an obstetrician-gynecologist. If other special medical knowledge is required during an examination regarding sexual conditions, then the relevant specialists are invited and the examination is carried out on a commission basis.

Conditions for the production of expertise

Before the examination, the expert is obliged to establish the identity of the testified by checking the passport or other document with a photograph. In the absence of such, the identity of the testified is certified by the representative of the investigation (an appropriate entry is made about this in the conclusion, the act of examination) or the testified is photographed, the pictures are pasted on the forensic medical document being drawn up and its duplicate. Examination of persons under 16 years of age is carried out upon presentation of a birth certificate, in the presence of parents or adults replacing them, or a teacher.

To clarify information of a medical nature and complaints, a survey of the testified is carried out. The story of the children must be approached carefully, writing it down as verbatim as possible.

Items of clothing that were on the victim at the time of the incident, which may contain traces of sperm, blood, must be examined in the forensic laboratory of the forensic medical examination bureau. A representative of the investigative (inquiry) bodies sends for research, according to whose decision the examination is carried out. If the clothes were not previously seized, and the examination is carried out in the absence of a representative of these bodies, the expert must immediately notify him of the need to seize the relevant items and send him for examination. The witness in these cases is warned not to wash her clothes.

Testimony of the suspect. In the case of a sexual crime (rape, indecent acts), a forensic medical examination of the suspect matters. Therefore, if such an examination has not been appointed, then the expert is obliged to notify the investigating (inquiry) authorities of the need to conduct it urgently.

The examination should be carried out, if possible, by the same expert who testified to the victim. During the examination, information of a medical nature is clarified, the physical development of the suspect is established (in particular, the condition of the external genitalia), a thorough examination of clothing and body is carried out in order to identify damage, pollution and other signs that characterize a forced sexual intercourse or an attempt to do so.

Items of clothing that were on the suspect at the time of the incident, which may contain traces of blood, feces, vaginal discharge, hair, etc., are subject to mandatory examination in a forensic laboratory. The study of pollution of a different nature (for example, soil, grass) is carried out in the appropriate laboratories.

On the body of the suspect, especially in the genital area, sometimes they find the victim's hair, traces of blood, etc., which must be removed by an expert and sent by a representative of the investigation (inquiry) to the forensic laboratory. The hair is sent along with samples of the corresponding hair (from the head or from the genitals) of the victim and the accused.

Making an examination. During the examination, an expert opinion is drawn up, which should, if possible, be illustrated with photographs fixing injuries to the body, etc.

The expert opinion is either issued to representatives of the investigating (inquiry) bodies or the court, by whose order the examination was carried out, or sent by mail. The issuance of this document or certificates of the examination carried out directly to the witness or to other persons, except for representatives of these bodies, is not allowed.

There are cases of deviations from the norm in the development of the genital organs, which leads to the appearance of signs of two sexes in one person. Such persons are called hermaphrodites, and a similar phenomenon is called hermaphroditism.

There are true and false hermaphroditism. True hermaphroditism is very rare. In these cases, the same person has both male (testicles) and female (ovaries) gonads, but they are underdeveloped.

With false hermaphroditism, which is observed more often, the gonads of only one sex, male or female, are developed, but along with this, signs of the other sex are expressed. For example, a false male hermaphrodite in the presence of female gonads has male sexual characteristics: an underdeveloped penis, scrotum, etc.

Therefore, an incorrect entry is sometimes found in the metric certificate at the birth of a child.

Subsequently, when revealing the inclinations of the other sex, it becomes necessary to conduct an examination to determine the true sex of the hermaphrodite. An examination of hermaphroditism can also be carried out upon receipt of a passport, consideration of a claim for alimony, upon divorce, when the question arises of the ability to have a normal sexual life, conception or fertilization, in case of insult, sexual crime, sexual perversion and in other cases.

Since it is difficult to determine the sex in some cases, the examination should be carried out by a commission with the participation of a forensic expert, an obstetrician-gynecologist, an endocrinologist and a psychiatrist.

The conclusion about the field of a hermaphrodite is given on the basis of a combination of signs: general development, characteristics of the external and internal genital organs, the severity of secondary sexual characteristics, the presence and nature of sexual desire, secretions from the genital organs (semen, menstrual flow), as well as mental development.

To clarify the diagnosis, sometimes a microscopic examination of the material obtained by puncture or excision of a piece of the gonad is sometimes performed. Such a study is possible only with the consent of the testified in an inpatient medical institution.

The establishment of a woman's sexual ability is based on the determination of her ability to have sexual intercourse and conception and is carried out in cases of divorce in cases where a woman who is unable to conceive kidnaps a child and pretends to be his mother, as well as in determining the severity of the harm health, if there is a question of loss of productive capacity.

Normal sexual intercourse can be prevented by various defects in the genital organs of a woman, for example, a short vagina, its congenital absence, infection, narrowing, and tumors.

When establishing the ability to conceive, it is necessary to take into account the age of the testified, anatomical and physiological features, the presence of female diseases, internal secretion disorders, chronic infections and intoxications, radiation exposure, etc. It is required to study medical documents if the testified has been treated, and in difficult cases - send her for an inpatient examination.

If the examination is carried out in a divorce case, the husband of the subject must also be examined.

Establishing the sexual ability of a man is to determine the ability to have sexual intercourse and fertilization. This examination is carried out and appointed when initiating a case for divorce, alimony, sexual crimes and perversions (sodomy), when determining the severity of harm to health, when the question of loss of productive ability arises.

The inability to have sexual intercourse may depend both on certain anatomical features and changes, and on diseases that prevent tension and the introduction of the penis into the vagina. Such features and changes are: various defects of the penis, scars that change its shape, tumors of the genital organs, large hernias, etc. Diseases that lead to the inability to have sexual intercourse include endocrine diseases, tuberculosis, diseases of the central nervous system, chronic alcoholism, etc. The inability to have sexual intercourse is sometimes also caused by certain neuropsychiatric conditions. In such cases, the production of an examination presents certain difficulties, and therefore an inpatient examination is usually required.

When conducting an examination, care should be taken in assessing the existing changes, since fertilization is possible even in the absence of the ability to have sexual intercourse, because the eruption of the seed sometimes occurs on the eve of the vagina.

The inability to fertilize is caused by both the complete absence of sperm in the seminal fluid (azoospermia) and their immobility (necrospermia). This may be due to malformations of the testicles, trauma to the genital organs, sexually transmitted and other inflammatory diseases, in which persistent cicatricial changes often occur, causing infection of the vas deferens. Inability to fertilize is caused by some infectious diseases (typhoid, tuberculosis, mumps, etc.), diseases of the central nervous system. Alcoholism, drug use, occupational hazards (the effect of X-rays, radioactive exposure, lead, etc.) are also important.

One of the main methods for determining the fertilizing ability of men is the study of seminal fluid, which is advisable to produce after some abstinence (5-7 days) from sexual intercourse. Seminal fluid is extracted immediately before the study. The conclusion about the inability to fertilize is given if the spermatozoa are completely absent or not viable (immobile). If in doubt, the study should be repeated. With a small number of spermatozoa (oligozoospermia), the probability of fertilization is reduced, but it cannot be completely excluded. If at least one normal motile spermatozoon is found, it cannot be argued that it is completely incapable of fertilization. In this case, it should be said that the ability to fertilize is present, but it is reduced.

The main sign is an intact hymen located at the entrance to the vagina. At the first sexual intercourse, it is torn in most cases.

Virginity is also characterized by the elasticity of the labia majora, covering the minor and closing the genital gap, the pink color of the mucous membrane of the labia minora and the vestibule of the vagina, its narrowness and well-defined folding, the elasticity of the mammary glands, etc. But the listed signs are unstable. They depend on congenital characteristics, age, general condition of the body and some other circumstances and may persist in women who are sexually active and absent in virgins.

An examination to establish virginity is prescribed both in civil proceedings (for insults, slander) and in criminal proceedings (for forced sexual intercourse, indecent acts, during sexual intercourse with a person who has not reached puberty).

The forensic medical expert must establish the shape, features and integrity of the hymen, and if it is violated, determine, if possible, the mechanism and prescription of the violation. The latter is done on the basis of the condition of the edges in the area of ​​ruptures: for 1-3, and sometimes more days, they are reddened, bruising, they can bleed when touched, in the area of ​​​​ruptures, hemorrhages into the thickness of the hymen are often visible. In the future, healing begins, the period of which depends on the properties of the hymen: for a low thick one, it is 6-8 days; for high fleshy - 10-14. Sometimes, due to various circumstances, healing is delayed up to 18-20 days. At a later date, it is usually impossible to determine the prescription of a violation of the hymen. At the base of the hymen, in the area of ​​the rupture, a scar is formed in the form of a section of whitish compacted and thickened tissue, the edges of the rupture do not grow together, acquire a whitish tint and are somewhat thickened.

Damage to the hymen, up to breaks, can be caused by a finger during indecent acts. Insignificant damage in the form of hemorrhages, precipitation, tears are observed in some cases with onanism, as well as with scratching produced by the girl herself with itching caused by untidy content of the genital organs, as well as with helminthic disease. It is impossible to exclude a violation of the integrity of the hymen in case of accidental injury, but this is extremely rare.

With a small height and extensibility of the hymen, the presence of a large hole, deep recesses, as well as with a roller-shaped hymen, sexual intercourse is possible without violating its integrity. In these cases, it is important to examine the person suspected of having sexual intercourse in order to have an idea of ​​the size of his penis.

Sometimes natural notches can be taken as places of former ruptures, but they usually do not reach the base of the hymen, their edges are soft, not thickened and not compacted, they have the same color with the rest of the hymen surface.

When deciding on the violation of the integrity of the hymen, an important sign is the so-called "ring of contraction", which occurs when the tip of the finger is carefully inserted into the opening of the hymen. With the integrity of the hymen, it is felt that it is squeezed by the free edge of the hymen.

The indisputable proof of sexual intercourse is the detection of spermatozoa in the vagina, in the area of ​​​​the external genital organs, on the pubis, underwear, clothing.

When examining the establishment of virginity, the forensic medical examiner is asked the following questions: is the integrity of the hymen broken, when and with what; whether the prescription of the violation corresponds to the period indicated by the testified; if the integrity of the hymen is not broken, was it possible to have sexual intercourse without damaging it; whether pregnancy or infection with a sexually transmitted disease occurred as a result of sexual intercourse.

The need to resolve these issues arises both in criminal and civil cases, when it is required to determine the presence and duration of the current pregnancy, interrupted pregnancy, and former births.

If the forensic expert does not have special training in obstetrics and gynecology, then the examination should be carried out with an obstetrician-gynecologist.

Pregnancy leads to significant changes in the body, which are especially pronounced in the second half. Establishing pregnancy in its first half can be difficult.

Examination of pregnancy is carried out in cases where forced sexual intercourse, sexual intercourse with a girl who has not reached puberty; inflicted bodily injury that led to the termination of pregnancy; as well as in cases of divorce, alimony; simulation or concealment of pregnancy, etc.

Early signs of pregnancy include: the cessation of menstruation, changes in the mammary glands and uterus, positive results of biological tests. But the absence of menstruation can be observed without pregnancy, with some diseases. Enlargement and swelling of the mammary glands is observed from the second month of pregnancy. Somewhat later, pigmentation of the areola is revealed. An increase in the uterus and a change in its shape occurs after the third month. According to the listed signs, it is not always possible to determine pregnancy. Together with clinical data, some laboratory tests contribute to the establishment of pregnancy during this period: Ashgeim-Tsondek, Galli-Mainini, etc. tests. If they cannot be carried out, then a re-examination is prescribed after 2-3 weeks.

At a later date, it is usually not difficult to establish pregnancy and determine its term. The mammary glands increase even more, enlarged lobules are felt in them; the areola become dark brown in color, the second areola appear and colostrum is separated. On the face and in the midline of the abdomen, pigment deposition is detected. Noticeable enlargement of the abdomen. From the fourth month, the fetal skeleton can be detected on an x-ray, and from the fifth or sixth month, the fetal heartbeat is heard and its movement is felt. The gestational age is determined by the height of the fundus of the uterus above the pubis.

Relationship between abortion and trauma. The need for an examination is related to the investigation of cases of injury to a pregnant woman that led to the termination of pregnancy. In such cases, a thorough questioning of the victim, her examination and the study of the medical documents of the antenatal clinic and obstetric institutions, where the testified applied earlier, are of great importance.

It should be borne in mind that termination of pregnancy in its first half (especially up to 10 weeks) in a healthy woman is almost completely excluded from injury, because the uterus is in this period in the pelvic cavity and is well protected from mechanical influences.

Termination of pregnancy as a result of significant mechanical impact in the second half of pregnancy is possible. So, a strong blow to the abdomen or to the genital area, compression of the abdomen, a sharp fall on the buttocks can lead to rupture of the fetal bladder or detachment of the placenta with termination of pregnancy. If this happened in a healthy woman immediately or shortly after the injury, then the expert has reason to draw a conclusion about a direct connection between the injury and the termination of pregnancy.

Violation of pregnancy can occur spontaneously or can be caused artificially.

An injury resulting in an abortion is classified as a serious bodily harm. In the event that there were objective signs of a threatened miscarriage (bloody discharge, uterine excitability) that appeared shortly after the injury, but the pregnancy was saved due to the placement of the woman in a medical institution, the assessment of the severity of the injury depends on the duration of treatment. In the absence of objective signs of a threatened miscarriage, the severity of only the bodily injury itself is established.

The determination of the former childbirth is carried out in case of suspected infanticide, in the case of misappropriation of someone else's child, simulation of pregnancy and childbirth, and in some other cases.

After childbirth, the postpartum period begins, when within 6-8 weeks in the body of a woman there is a reverse development of the changes that occurred during pregnancy and childbirth.

A day or two after childbirth, it is no longer colostrum that begins to separate, but milk, the microscopic examination of which allows us to roughly judge the date of the former birth. The reddish-bluish color of the labia majora and minora disappears; the genital gap closes; the transverse folds of the vagina are smoothed; the uterus quickly decreases and the discharge stops. After three weeks, the uterus is already in the small pelvis, and by the end of the sixth it reaches normal size. The external os of the cervix closes by the end of the postpartum period and turns from round to slit-like. Discharge from the uterus - at first bloody - gradually becomes grayish-whitish and usually stops by the end of the third week.

The postpartum period ends with the formation of some persistent anatomical signs: scars in the corners of the external os of the cervix, in the perineum, on the mammary glands, skin of the abdomen and thighs, myrtle papillae in place of the hymen. However, these signs only testify to former births, but do not allow us to establish their term.

In case of childbirth that took place in medical institutions, the forensic medical expert establishes their prescription according to medical documents (history of childbirth, the history of the development of the newborn). In case of out-of-hospital childbirth and the absence of medical documents, a conclusion can be given on the basis of the state of the birth canal only about childbirth that occurred no more than two to three weeks ago. After this period, it is difficult to establish the prescription of childbirth, especially in multiparous women. But at present, it is proposed to use for diagnostic purposes a laboratory study of the secretion of the mammary gland, which continues to separate after the reverse development of the changes in the uterus that have arisen for quite a long time (6-10 months).

Abortion can occur spontaneously or be artificially induced. Abortion refers to the termination of pregnancy before the expiration of 28 weeks, i.e. within the first seven obstetric months. An examination is appointed in cases where illegal abortion is suspected.

Spontaneous abortion - termination of pregnancy caused by some disease of the mother or fetus, which occurred without outside intervention. Abortion can be caused by: acute and chronic infectious diseases, such as typhoid, malaria, tuberculosis, influenza, syphilis, decompensated heart defects, kidney disease, diabetes, severe poisoning, inflammation of the uterus and appendages, underdevelopment of the uterus, etc.

Sometimes the testified in the presence of an induced abortion tries to pass it off as spontaneous, claiming that it occurred as a result of an injury. But from the foregoing, it follows that abortion can only cause significant trauma.

Artificial abortion can only be performed by doctors in medical institutions for medical reasons or at the request of a pregnant woman who is referred for abortion by a doctor of a women's clinic, if there are no contraindications to this.

An abortion performed in a medical institution, but without proper justification, either by a doctor outside the medical institution or by a person without a higher medical education, is considered illegal, and its implementation entails criminal punishment. The latter is aggravated if the abortion was performed by the same person repeatedly or caused the death of the pregnant woman or other serious consequences.

During an abortion, various complications are possible: the uterus and even the vagina are damaged. Perforation of the uterus sometimes entails damage to the intestines, bladder. There may be severe bleeding, air embolism, burns of the vagina and uterus, poisoning with abortive drugs, infection, shock. Air embolism is often the cause of sudden death in illicit abortion.

Illegal abortions can be carried out by pregnant women themselves, but more often they resort to the services of persons without medical education or to medical workers, up to obstetrician-gynecologists and doctors of other specialties, who perform abortions in various settings and under different conditions, even in unsanitary conditions.

The means causing abortion are diverse. These primarily include special medical instruments, then various mechanical and thermal means, as well as medicinal substances that have a toxic effect.

Examination of an abortion that did not cause complications is difficult, sometimes even impossible, especially if the pregnancy did not exceed two months and more than two weeks have passed since the abortion. The presence of bleeding and discharge from the genital organs, the condition of the cervix and body of the uterus contribute to the establishment of a former pregnancy in the early stages. Laboratory research of a secret of a mammary gland matters. On examination, you need to pay attention to whether there are injuries in the area of ​​​​the vagina and cervix, traces of foreign fluid. Establishing an abortion in the second half of pregnancy with the timely production of an examination usually does not cause difficulties.

Diagnosis of abortion on a corpse, as a rule, also does not cause difficulties. The presence in the uterine cavity of traces of attachment of a child's place, remnants or a whole fetus and its membranes; a true corpus luteum in one of the ovaries; damage to the vagina, uterus and their condition; traces from the introduction of various means, etc. is evidence of a former abortion. Microscopic examination of the uterus, discharge from it, discharge of the mammary glands, forensic chemical examination of foreign fluid found in the genitals facilitates the examination.

When examining the corpse of a young woman who died suddenly, it is necessary to test for air embolism. It should be clarified whether the testified has recently applied for medical assistance to medical institutions, request and study medical documents.

A thorough examination with the participation of a doctor - a specialist in the field of forensic medicine of the place of abortion often reveals various objects or means used for the abortion, as well as traces of blood.

When appointing an examination regarding an abortion, questions may be raised: was the witness pregnant and did she have an abortion, at what stage of pregnancy, spontaneously or artificially, when and in what way, by the witness herself or by an outsider, could it have occurred under the circumstances indicated evidence of the health damage caused by the abortion.

Examination of rape

Sexual intercourse with a person who has not reached puberty, committed by voluntary consent, is established by the state of the hymen. In this case, puberty is necessarily determined.

Examination of rape, which can be committed with the use of physical violence, using a helpless state and using threats. In these cases, it is important for a forensic medical expert to find objective data that testify to a previous sexual intercourse, injuries on the body that characterize a forced sexual intercourse or an attempt to do so, and also to establish whether the victim was in a helpless state.

If a woman has not previously lived a sexual life, check the integrity of the hymen. If it is not violated, then it turns out the possibility of sexual intercourse without damaging it. In women who have been sexually active, the study of the hymen does not clarify, since its repeated ruptures are extremely rare.

In all cases, the victim is examined in order to identify signs of struggle and self-defense, which can be in the form of various injuries on the whole body, in particular on the face, neck, mammary glands, in the vulva, on the inner surface of the thighs, on the hands, shins.

It is necessary to send the contents of the vagina and the external os of the cervix to investigate and determine the presence of spermatozoa and the group belonging to the sperm. It is not advisable to perform this study five to six days after sexual intercourse.

Traces of semen can be found in the form of dried spots in the pubic area, external genitalia, thighs, underwear and clothes of the victim.

Forced sexual intercourse is sometimes accompanied by damage to the genitals, perineum; they can be especially significant in juveniles, leading even to death. Sexual intercourse can lead to neuropsychiatric disorders of the victims.

When examining forced sexual intercourse, the question arises whether a woman who is physically developed enough can be raped by one man. Its resolution depends on many conditions. If the forces are approximately equal, then this possibility is excluded. But if there was a threat to life, an unexpected and swift attack, a woman was tired of heavy physical exertion or a long struggle, physically weakened, then she may not offer sufficient resistance.

Gang rape is quite possible. But there are cases when a woman resisted several men. To rape a girl who has not reached puberty, especially a minor, is easier than a woman.

A helpless state due to severe alcohol intoxication, a deep syncope, shock, any disease, including mental illness, the presence of deformity deprive a woman of the opportunity to resist. In such cases, there are no traces of physical violence, and therefore it is important to establish whether there was a sexual intercourse, as well as the state in which the victim was. A criminal can lead a woman to a helpless state by tying her hands, causing severe pain, etc.

The question of the possibility of rape of a woman during natural sleep is resolved by the majority of authors in the negative. Sometimes women report sexual intercourse with them in a state of artificial sleep caused by the addition of narcotic substances to food or drinks. This possibility cannot be ruled out.

Threats, intimidation, deception can force a woman to have sexual intercourse and are considered as a mental influence.

It should be borne in mind that there are sometimes slanders and false statements about the commission of violent sexual intercourse with infliction of bodily injuries allegedly received during resistance, while they were caused by the woman herself or her accomplice.

The following questions may be put before the forensic expert: whether there was forced sexual intercourse or an attempt to do so; what was the violence? whether bodily injuries were inflicted, what kind and by what means, the degree of their severity; what consequences did sexual intercourse lead to (infection with a venereal disease, pregnancy, etc.). If a person who did not live a sexual life was subjected to rape, then the question is raised whether and how long the integrity of the hymen or sexual intercourse was possible without damaging it.

Perverse actions. They are understood as the satisfaction of sexual passion without performing a normal sexual intercourse (touching the genitals with the hand, touching the penis in the genital area or between the thighs, irritating the penis with the hands, etc.).

Examination of indecent acts is very difficult, since objective signs of their commission are rarely observed. In girls, they are expressed in redness of the mucous membrane, tears and ruptures of the hymen, in hemorrhages in the thickness, along the edge or at the base of the hymen, in cracks, tears, scratches and hemorrhages on the mucous membrane of the external genital organs, in particular in the region of the labia minora, external opening of the urethra, in various lesions in the pubis, perineum, anus, etc. If there is only redness of the mucous membrane of the external genital organs, a re-examination is required after 3-5 days to check whether it has disappeared, since the redness and even single scratches are sometimes observed with untidy maintenance, combing the genitals by the girl herself, with helminthic disease, onanism, etc.

The detection of traces of sperm in the genitals, in their circumference, as well as on the body of a minor, her underwear and clothes, acquires evidentiary significance. The presence of a sexually transmitted disease or trichomoniasis (a parasitic disease of the genital organs) is important, although non-sexual infection is also possible.

When examining for indecent acts, it is necessary to examine the anus, while paying attention to the possibility of the presence of gonorrhea of ​​the rectum. It must be borne in mind that children are easily suggestible, prone to exaggeration, and under the influence of adults can draw a picture of uncommitted depraved acts.

Sodomy, that is, sexual intercourse between a man and a man through the anus, is one of the forms of perversion of sexual intercourse and is subject to criminal punishment. Other forms of perversion are not provided for by criminal codes.

Objective data during this examination are not always expressed, especially in active homosexuals (inserting their penis into the anus of another), who do not experience any anatomical changes even with systematic acts of sodomy. Indirect evidence of the commission of an act of sodomy is the detection of fecal particles on the penis (under the foreskin, in the region of the frenulum, coronal groove, etc.), which are subject to microscopic examination after making prints of the penis on a glass slide.

Single acts of sodomy by passive pederasts, as a rule, do not lead to permanent changes in the anus and rectum, except in cases accompanied by significant damage, after healing of which scars may remain. Superficial lesions of the mucosa and skin that occur in the anus and rectal mucosa usually heal without traces.

If passive pederasts systematically commit acts of sodomy, then they may have changes in the anus and rectum: funnel-shaped retraction, gaping of the anus, smoothing of the folds in the circumference of the anus and rectal mucosa, relaxation of the muscles that block the anus, purple red with a bluish tint coloring of the mucous membrane of the rectum. The severity of these signs may be different, some of them are sometimes absent.

More evidence is the presence of a venereal disease in the rectum.

Indisputable evidence is the detection of spermatozoa in smears, which should be taken from the rectum if there was no act of defecation after intercourse. During this examination, the following questions are usually resolved: whether an act of sodomy took place and when; whether the witness is an active or passive bugger; whether there are signs of systematic, over a long period of time, committing acts of sodomy as a passive pederast.

Examination of infection with venereal disease. "Infection of another person with a venereal disease by a person who knew that he had this disease" is a criminal offense.

Examination is appointed in cases of infection during voluntary sexual intercourse, rape, indecent acts and in divorce proceedings. It is usually produced to establish syphilis and gonorrhea. The same person can have syphilis and gonorrhea at the same time. Sometimes the patient may not know that he has a venereal disease.

With fresh diseases with well-defined manifestations, moreover, in different stages in both partners, it is not difficult to decide which of them infected the other. The examination is complicated if the disease is in a latent state or the stage of the disease is the same for both witnesses. Syphilis and gonorrhea are characterized by a certain constancy in the development of the clinical picture and the timing of the onset of individual manifestations of the disease, which allows, to a certain extent, to establish the onset of the disease.

In these cases, it is important to conduct a thorough, as detailed as possible, targeted research, including familiarization with the case materials, questioning and examination of the testified, obtaining and studying medical documents of those medical institutions where they were treated. It is recommended to examine the area of ​​the anus, where manifestations of syphilis can be detected, to take swabs from the rectum for gonococci. Witnesses are sent to a venereal dispensary or dermatological and venereal clinics to examine discharge from the urethra for gonococci, and in cases of syphilis - to examine blood, cerebrospinal fluid, as well as examine scrapings from a syphilitic ulcer (hard chancre), from the surface of syphilitic rashes, juice lymph glands for the presence of the causative agent of syphilis - pale spirochete. All these data allow to establish the presence and picture of the disease in dynamics.

An examination should be carried out jointly with a venereologist to resolve questions about whether the testified venereal disease is sick, when the infection occurred, who is the source of the infection.

In addition to the above types of forensic medical examination of victims, accused and other persons, other types are also carried out, for example:

1) examination of alcohol intoxication;

2) forensic medical examination of traces of old wounds.

LECTURE #10

Forensic medical examination of poisonings

According to the World Federation of Poison Control Centers (2000), a toxicological situation has developed in the modern world, which is caused by an increase in the number of acute accidental and intentional poisonings by drugs and industrial products.

WHO (International Chemical Safety Program) indicates that the frequency of poisoning with drugs alone is increasing from year to year in almost all countries, with centrally acting drugs accounting for 60 to 75%. The topical issue is the toxicological aspects of drug addiction, substance abuse and acute overdoses.

Poison - a substance that enters the body from the outside, has the ability to have a chemical and physico-chemical effect and is capable, under certain conditions, even in small doses of causing poisoning. Poison is a relative concept. The same substance, depending on the dose, can lead to fatal poisoning, cause a therapeutic effect or be indifferent, and under certain conditions can be used as a medicine.

Poisons can be systematized by their origin (mineral, organic, etc.), their ability to cause acute or chronic poisoning, their selectivity (poisons with a predominant effect on the cardiovascular, urinary, central or peripheral nervous systems, etc.), their ability to exert predominantly local or general resorptive effect on the body, depending on the state of aggregation of the poison, etc. In forensic medicine, it is customary to consider poisons depending on their ability to have one or another local damaging effect.

Caustic poisons include poisons that cause sharp morphological changes at the point of contact with the body (chemical burns): concentrated acids, alkalis, hydrogen peroxide, etc.

The action of destructive poisons is associated with the formation of dystrophic and necrotic changes in organs and tissues, including the place of contact of the poison with the body. This group includes salts of heavy metals (mercury, copper, zinc), phosphorus, arsenic, organic compounds of mercury, etc.

The third group consists of carbon monoxide and methemoglobin-forming poisons (bertolet salt, aniline, sodium nitrite, etc.).

The fourth group is the most diverse, which includes poisons that have a predominant effect on the central and peripheral nervous systems: excitatory of the central nervous system include the actual excitatory (atropine, phenamine, phenatin) and convulsive (strychnine, ergotamine, etc.), depressing the central nervous system system - narcotic (morphine, codeine, chloroform, ethylene glycol, ethyl, methyl alcohols, etc.) and sleeping pills (barbiturates), to paralyze the central nervous system - cyanide and organophosphorus compounds, to poisons that act mainly on the peripheral nervous system - natural and synthetic muscle relaxants.

The nature of morphological and functional changes in poisoning depends on the combined influence of a number of conditions. These include: the properties of the poison, the state of the body, the routes of administration, distribution, deposition and ways of removing the poison from the body, environmental conditions, the combined effect of poisons.

The properties of the poison that can affect the nature of the poisoning include its dose, concentration, state of aggregation, solubility and persistence in the external environment. Dose - the amount of poison that enters the body.

Poisons can be introduced into the body in solid, liquid and gaseous states. The most aggressive are those that enter the blood faster, i.e. liquid and gaseous. More dangerous are poisons that can quickly dissolve in body fluids and tissues. Some poisons do not have the ability to persist in the external environment for a long time, such as potassium cyanide.

The development and outcome of poisoning are influenced by the properties of the organism itself, body weight, the amount and nature of the contents of the stomach, age and gender, concomitant pathology, individual sensitivity and general resistance of the organism. In a person with a lower body weight, poisoning is more severe than in a person with a larger body weight. Here the distribution of the dose of the poison taken per kilogram of mass matters. A significant role is played by the use of poison inside its quantity, consistency and chemical composition of the contents of the stomach, which can reduce the concentration of the poison, oxidize, restore, completely or partially adsorb it. The course of poisoning is aggravated by various diseases that disrupt the detoxification function of the liver, the filtration and excretory function of the kidneys, and thereby contribute to the accumulation of poison in the body.

Children are more susceptible to poisons than adults, which is usually explained by the insufficiently formed general resistance of the child's body to various exogenous influences, as well as the low activity of the biotransformation of the child's liver enzymes.

It is known that during periods of pregnancy and menstruation, the resistance of the female body to poison decreases. The action of a poison on an organism sensitized by this poison can lead to serious consequences and even death at a relatively small, non-lethal dose. Tachyphylaxis (quick defense) is also observed - a decrease in the body's sensitivity to certain substances when they are repeatedly injected at short intervals.

Features of the course of poisoning may be due to genetic causes. It is known that approximately 1 out of 1000 inhabitants has a sharply reduced activity of serum cholinesterase, which hydrolyzes dithylin, used for induction of anesthesia. Some residents of Africa, Southeast Asia and the Mediterranean region have a genetically determined deficiency in the activity of the enzyme glucose-6-phosphate dehydrogenase of erythrocytes, which makes them insensitive to sulfonamides, phenacetin and some antibiotics, the introduction of which leads to hemolysis of erythrocytes.

Repeated administration of small doses of certain poisons into the body is addictive and increases tolerance to this poison. Thus, drug addicts remain alive when doses of drugs are injected into the body that are many times higher than lethal levels. The course and consequences of intoxication are also influenced by the general resistance of the organism. Poisoning is more severe in people weakened by injuries, chronic diseases, detrained and mentally exhausted.

The importance of routes of introduction of poison into the body is determined by how quickly they provide the flow of poison into the blood. Skin applications of the poison are the least dangerous, although some of them (phenol, tetraethyl lead, some fat-soluble substances) are quite aggressive when interacting with the skin surface, depending on the area and time of contact. The most dangerous is the aerogenic and parenteral intake of the poison, although there are substances that are dangerous mainly when taken orally and are almost harmless when administered subcutaneously (barium carbonate). The aerogenic route of administration usually leads to poisoning under industrial conditions when the maximum permissible concentrations (MPC) in the air of the working area are exceeded.

Other things being equal, the most dangerous is the direct introduction of poison into the blood. The mucous membrane of the gastrointestinal tract has a good absorption capacity, so the introduction of poison through the mouth or rectum leads to its rapid entry into the bloodstream and the development of acute poisoning. The poison can be quickly absorbed into the blood through the mucous membrane of the vagina. The peculiarities of the course of poisoning when poisons are administered through the rectum and vagina are due to the fact that poisons enter the bloodstream bypassing the hepatic barrier, and thus have a more pronounced toxic effect than when the same poisons and in the same doses through the mouth.

The distribution and deposition of poison in the body largely depend on the chemical structure and state of aggregation of the poison, its ability to dissolve in various tissues and environments of the body. Fat-soluble poisons (dichloroethane, carbon tetrachloride, benzene, etc.) accumulate in adipose tissue, liver, and brain. Water-soluble poisons, spreading throughout the body, are mainly concentrated in muscle tissue, brain, liver, kidneys. Some poisons can be deposited in bones and hair (arsenic, lead, phosphorus, etc.).

The excretion of poisons from the body occurs in most cases through the kidneys and lungs. Mostly water-soluble and non-volatile poisons are excreted through the kidneys, and volatile and gaseous substances are excreted through the lungs. Poisons are less actively excreted through the gastrointestinal tract (alkaloids, salts of heavy metals, methyl alcohol, etc.). Alcohols, drugs, essential oils are excreted with bile; through the salivary and mammary glands - salts of heavy metals, morphine, ethyl alcohol, pilocarpine and berthollet salt; through the sweat glands - phenol, halides.

Routes of administration, the nature of distribution, deposition and excretion of poisons often determine the localization, nature and extent of morphological changes in a particular type of poisoning. Knowledge of these features of intoxication is necessary for a targeted search for poison in the body.

Environmental conditions (high and low temperatures, humidity, atmospheric pressure, etc.) are of the greatest importance for occupational poisoning in special production conditions. In general, adverse external conditions weaken the overall resistance of the body and thus increase the clinical course of intoxication. A classic example is the aggravating effect of low ambient temperature on the course of alcohol poisoning. The lack of ventilation is a factor contributing to the occurrence of gas poisoning in the atmosphere of mines, underground wells (methane, hydrogen sulfide, carbon dioxide, etc.).

With the simultaneous intake of several poisons into the body, they can have a combined effect: synergists (alcohol and barbiturates, novocaine and physostigmine, ephedrine and adrenaline, etc.) aggravate the course of poisoning, antagonists (pachycarpine and scopolamine, alcohol and caffeine, potassium cyanide and glucose, cyanides and sodium nitrite, strychnine and chloral hydrate, etc.) mutually weaken the toxic effect of each other. Chemical and physico-chemical antagonism of poisons is widely used in antidote therapy.

The properties of the poison and the set of conditions that accompany its action determine the clinical and morphological consequences of poisoning, which can be expressed in mild, moderate, severe degrees of poisoning, fulminant, acute, subacute and chronic clinical course, local, general manifestations, primary and metatoxic effects, selectivity of action. on subtle biochemical processes in the body, the predominant lesion of certain body systems with a corresponding syndromic course, various ways and intensity of excretion of the poison, a variety of immediate causes of death (pain and toxic shock, infectious complications, acute renal and hepatic failure, exhaustion, etc.). The complex process of interaction between poison and the organism is covered by the concept of toxicodynamics.

The fate of various poisons in the body is not the same. Some do not undergo significant changes, others are oxidized, reduced, neutralized, adsorbed. In this case, new compounds are formed with both reduced and increased toxicity. Benzene, for example, is first oxidized in the body and then destroyed with the formation of toxic metabolites: hydroxyhydroquinone, phenylmercapturic and muconic acids. Hydrolysis of organophosphates leads to the loss of their toxicity, oxidation - to a sharp increase. The processes of biotransformation of poisons mainly take place in the liver, gastrointestinal tract, lungs, kidneys, adipose tissue, etc. The degree of activity of the transformation of poisons in the liver is of the greatest importance. Lingering in the body, the poison can be fixed by the proteins of tissues and blood plasma. In these cases, the resulting "poison-protein" complex becomes partially or completely non-toxic, in others, the protein acts as a carrier of poison to the affected structures. The formation of non-toxic complexes is often accompanied by the consumption of substances that are important for the life of the organism. Deficiency of these substances in the body can lead to severe and sometimes irreversible changes in carbohydrate and other types of metabolism. The transformation of poison in the body is determined by the concept of toxicokinetics.

The source of information used in the forensic medical diagnosis of poisoning is: materials of the investigation, medical documents of the victim, data from the forensic medical examination of the corpse, the results of forensic chemical analysis and other additional studies.

The external and internal examination of the corpse in the mortuary faces mutually complementary tasks. In an external study, they seek to establish signs indicating:

1) on the way the poison enters the body (chemical burns on the lips, skin, around the mouth, on the mucous membrane of the oral cavity, the skin of the perineum and on the mucous membrane of the vestibule of the vagina, puncture wounds from injections with a syringe, etc.);

2) on the chemical nature of the poison (the color of cadaveric spots, the nature of chemical burns, the size of the pupils, the color of the sclera, etc.);

3) the rate of death (the intensity of cadaveric spots, the presence of cadaveric ecchymosis, subconjunctival hemorrhages, etc.).

The purpose of the internal examination of the corpse is to establish:

1) ways of introducing poison (burns of the mucous membrane of the esophagus, stomach, vagina and other organs, the presence of poison residues in the stomach, etc.);

2) organs and tissues affected to the greatest extent;

3) the nature of contact (chemical burns) and dystrophic changes in internal organs;

4) the presence and nature of the developed complications;

5) signs characteristic of the action of individual poisons (the color of blood and internal organs, the nature of chemical burns of the mucous membranes, the localization and nature of inflammatory changes in the gastrointestinal tract, the specific smell from the opened cavities and from the opened internal organs, etc.);

6) immediate cause and rate of death;

7) collection of materials for additional laboratory research.

The most important among additional methods is a forensic chemical examination of internal organs, tissues and body fluids. Its purpose is to identify the poison, determine its quantitative content and distribution in the body. Of great importance, the results of forensic chemical research are not absolute.

A negative result of a forensic chemical study does not always rule out poisoning. In case of deliberate poisoning, it can be due to the following reasons: intravital transformations of the poison in the body (destruction, oxidation, reduction, neutralization, formation of complexes with proteins, etc.), excretion of the poison from the body (naturally, with vomiting, gastric lavage, etc.) , the use of antidote therapy, improper sampling of biological material for forensic chemical analysis, improper storage of seized biological material, incorrect choice of chemical analysis technique, low sensitivity of the applied chemical research technique, technical errors.

A positive result of a forensic chemical study does not always indicate poisoning. The reasons for a positive result of such an analysis (in the absence of poisoning) may be: endogenous formation of poison in various diseases (for example, the formation of acetone in diabetes), prolonged use of medications, prolonged professional contact with poison, post-mortem formation of some poisons during rotting of a corpse, post-mortem penetration of poison into tissue of a corpse from soil or clothes, intentional post-mortem administration of poison, accidental ingress of poison during improper sanitation of the corpse, errors in the organization and technique of forensic chemical research.

Therefore, forensic evidence of poisoning should be the result of an evaluation of all collected data: investigation materials, medical history data, results of sectional, histological and forensic chemical studies.

Simple alcohol intoxication

Single (simple) alcohol intoxication - acute alcohol intoxication. Ethyl alcohol has a general inhibitory effect on the central nervous system. This manifests itself in three main stages:

1) stages of excitation;

2) stages of anesthesia;

3) agonal stage.

The rate of appearance and severity of symptoms of intoxication are determined by the quantity and quality of alcoholic beverages taken, psychophysical conditions, and individual sensitivity to alcohol.

There are light, medium, and severe degrees of intoxication.

Biochemical parameters (blood alcohol content) of the degree of intoxication:

1) light - 0,5-1,5%;

2) average - 1,5-2,5%;

3) severe - 2,5-5%;

4) fatal - 5-6%.

In the initial period, with a mild degree of intoxication, there is a pleasant feeling of warmth, muscle relaxation and physical comfort. The mood rises: a person is satisfied with himself and others, self-confident, optimistically overestimates his capabilities, boastful. An intoxicated person speaks a lot and loudly, easily moving from one topic to another. Movements lose their precision. Criticism towards oneself and others is reduced.

When intoxication approaches the middle degree, the complacent euphoric mood begins to increasingly give way to irritability, resentment, compliance, and this is reflected in the content of statements and behavior.

The distinctness of the perception of the environment decreases, thought processes, associative activity slow down.

Speech becomes jerky, slurred, blurred, perseverations appear.

Due to a decrease in a conscious, critical attitude towards the behavior of others and their own personality, intoxicated people often perform inappropriate actions. The arisen desires, thoughts can easily be realized in impulsive aggressive acts against others. As a result of the action of alcohol on the body, individual characterological features are sharpened or exposed.

In this stage of intoxication, old psycho-traumatic experiences and resentments easily surface. This leads to scandals, fights, etc.

Reduced pain and temperature sensitivity. Memories relating to the period of intoxication, as in a mild degree, are preserved quite fully.

In severe cases, there is a change in consciousness of varying depth - from stunning to coma.

Coordination of movements is sharply disturbed, orientation in space and time worsens. Vestibular disorders appear (dizziness, nausea, vomiting, etc.). Cardiac activity weakens, blood pressure and temperature decrease, physical weakness increases, interest in the environment is lost.

The intoxicated one looks drowsy and soon falls into drug-induced sleep, sometimes in the most inappropriate places. In some cases, involuntary urination, defecation, convulsions are noted.

After deep sleep, real events during intoxication can be stored in memory, memories are fragmentary, and complete forgetting is possible.

In the practice of examination, there are atypical states of simple intoxication with hysterical phenomena, elements of exaggeration, mischief, conscious licentiousness, swagger, etc.

Minor quarrels, an offensive word, an unsuccessful remark, an unfulfilled desire turn out to be a sufficient reason for the aggressive actions of the intoxicated, which are immediately realized. The ability to realize the actual nature and social danger of one's actions or to manage them remains, sometimes only weakening.

LECTURE #11

Forensic medical examination of damage from exposure to high and low temperatures

Tissue damage from local action of high temperature is called a thermal or thermal burn. Thermal agents can be flames, hot solids, liquids, steam and gases (including air). Burns with hot liquids and steam are also called scalding. There are four degrees of burns.

I degree - erythema of the skin, characterized by redness and slight swelling of the skin. It occurs with a short-term effect of a temperature of about 70 ° C.

II degree - serous inflammation and the formation of blisters containing a clear or slightly cloudy liquid. Bubbles may not appear immediately, but after a few hours, as fluid sweats out of the vessels, lifting the surface layer of the skin. In place of a burst or torn bladder, moist pink-red skin is visible.

III degree - coagulative necrosis of the superficial layers of the dermis with partial damage to the germ layer (Sha) or necrosis of the dermis to the entire depth with the death of the sebaceous and sweat glands (Sb). The dead area of ​​the skin is dense, ash-gray or dark brown, depending on the nature of the thermal agent.

IV degree - charring of tissues, including bones. The skin looks dry, hard, its superficial layers are black.

The higher the temperature and the longer the exposure time, the deeper the damage and the more severe the burn. The severity of a burn depends not only on the degree, but also on the surface area of ​​the body that it occupies. So, for example, in adults are fatal:

1) II degree burns with damage to 1/2 of the body surface;

2) III degree burns with damage to 1/3 of the body surface.

The larger the area of ​​damage and the deeper the degree of burn, the stronger the local changes on the part of the burnt surface affect the state of the whole organism. The overall reaction can range from mild malaise to severe impairment of bodily functions (burn disease) and death. The course of a burn disease can be divided into four periods.

I period - burn shock (in the first 2 days). In some cases, shock occurs with burns of II-III degrees, occupying even less than 10% of the body surface, for example, in the genital area.

II period - burn toxemia (from 3 to 10 days). There are phenomena of intoxication of the body associated with the development of infection on the burn surface and the entry into the blood of the decay products of burned tissues.

III period - burn infection. Approximately ten days after the burn, due to the increased development of infection and poisoning of the body, infectious complications occur - pneumonia, purulent inflammation of the kidneys, purulent foci of inflammation in other organs and tissues.

IV period - burn exhaustion. A month after the burn or later, general wound depletion may occur as a result of prolonged absorption of decay products from festering wound surfaces.

The immediate cause of death in the first hours and days is burn shock, on days 4-10 - intoxication with concomitant inflammation of the lungs, after 10 days and later - purulent complications from the kidneys, lungs and other organs, as well as general blood poisoning (sepsis ).

Signs of lifetime burns:

1) intact skin on the folds of the face when closing the eyes;

2) absence of soot on the inner surface of the eyelids;

3) deposition of soot on the mucous membrane of the respiratory tract when smoke is inhaled;

4) burns of the mucous membrane of the mouth, pharynx, larynx, trachea;

5) arterial thrombi in damaged areas;

6) fatty embolism of vessels;

7) the presence of minimal amounts of coal in the blood vessels of the internal organs;

8) the presence of carboxyhemoglobin in the blood, mainly in the cavity of the heart, in the liver, i.e., in deep-lying organs;

9) the fluids of the blisters contain a large amount of protein and leukocytes.

Signs of postmortem burns:

1) the presence of carboxyhemoglobin in the blood of only superficial vessels;

2) cracks in the skin, simulating wounds and tears;

3) charring of a large surface of the body;

4) organs and tissues are compacted;

5) "boxer posture" - arms and legs are bent and brought to the body, the chest protrudes forward, and the head is tilted back - due to muscle contraction and shortening;

6) when the head is burned, post-mortem accumulations of blood are formed between the dura mater and the bones of the skull.

Overheating and heat stroke

A long stay of a person in conditions of high ambient temperature leads to a general overheating of the body, a sharp manifestation of which is heat stroke. It often occurs when working in conditions of high air temperature in rooms, as well as during long marches and transitions, especially in dense columns.

The air temperature that can lead to overheating is not absolute and fluctuates depending on the duration of exposure, humidity and air velocity. The human body is able to carry out thermoregulation if the ambient temperature does not exceed 45 ° C. Under the influence of adverse environmental factors, this ability is lost already at a lower temperature and overheating of the body occurs. Overheating also contributes to muscular work and tight clothing.

Victims complain of general weakness, headache, dry mouth, thirst. Prolonged overheating sharply disrupts the activity of the most important organs and systems of the body, causing heat stroke. In this case, the body temperature rises to 40-41 ° and above. The activity of the central nervous system is upset, either its oppression or excitation occurs. Speech disorder, delirium, darkened consciousness, sometimes convulsions are noted. Violation of the activity of the cardiovascular system leads to increased heart rate and a drop in blood pressure, the skin turns red, in some cases there is blue lips, nosebleeds. Vomiting and diarrhea often occur. In the future, with prolonged overheating, pallor and dryness of the skin appear, which becomes cold to the touch, the body temperature drops below normal, cardiac and respiratory activity drops sharply and death occurs.

On the basis of one morphological picture, it is impossible to establish the diagnosis of death from heat stroke. The examiner also needs information about the development of symptoms of the disease prior to death, the circumstances of the incident and physical environmental factors.

Sunstroke

Sunstroke differs from heat stroke in that it does not appear due to high ambient temperature and overheating of the entire surface of the body, but from exposure to direct sunlight on an uncovered head and neck, resulting in local overheating that affects the central nervous system. Consequently, sunstroke is able to appear without a previous general overheating of the body and a violation of thermoregulation revealed. The clinical manifestations of sunstroke and heatstroke are identical. In cloudless hot weather, there can be a mixed negative effect of sunlight and high ambient temperature on the body. Sunstroke in very rare severe cases can be fatal, while post-mortem examination notes the same changes as with heat stroke.

The local effect of low temperature on any part of the body causes tissue damage - frostbite. Usually those areas that are worse supplied with blood - fingers, auricles, the tip of the nose - suffer. Frostbite is promoted by circulatory disorders associated with prolonged immobility of the body, tight shoes, clothing, and humidity. The skin under the action of cold first turns red, there is a feeling of tingling, slight soreness. Then the skin turns white, its sensitivity is gradually lost. The continued effect of cold leads to a decrease in the temperature of the tissues, capturing ever deeper layers. The nutrition of tissues is disturbed, and when their temperature drops to + 10-12 ° C, they die. The severity of the lesion increases, without giving subjective sensations.

Frostbite symptoms develop only a few hours after the cessation of the cold. Therefore, it is possible to determine the depth of the lesion, i.e., the degree of frostbite, only after thawing.

There are 4 degrees of frostbite.

I degree - characterized by vascular disorders. A slight cyanosis and swelling of the skin appear, which disappear within a few days, sometimes peeling occurs in their place.

II degree - inflammatory. The skin becomes purple-blue, the edema also captures the subcutaneous tissues and spreads to neighboring non-frozen areas. On the first, less often on the second day, flabby blisters filled with a clear liquid are formed on the skin, which are easily torn. The affected areas are painful. In a normal course, after 10-12 days, the skin at the site of the blisters heals. There remains a local hypersensitivity to cold.

III degree - necrosis of the skin, subcutaneous tissue and muscles to various depths. Skin necrosis is detected on the first day, deeper tissues - later. The skin becomes blue-purple, sometimes dark purple, with blisters containing a dark brown bloody fluid. Significant swelling develops. In place of dead tissue, a scab forms, around which inflammation develops. The scab, depending on the size, is rejected on the 7-10th day. Healing lasts 1-2 months. In place of dead areas, scars form.

IV degree - necrosis of soft tissues and underlying bones, dry gangrene develops, black tissues; long course with rejection of the affected areas. With frostbite III and IV degrees of large parts of the body, infectious complications of a local (extensive deep suppuration) and general (general blood poisoning) character often occur, which can lead to death.

In the cold season, contact with sharply chilled metal objects may cause contact frostbite. Such frostbites are outwardly similar to burns, reflect the shape and size of the contact surface of a cooled object.

Frostbite occurs not only in the cold, but also with prolonged exposure to a temperature of about 5-8 ° C above zero in wet weather. In order to cause injury to oneself, frostbite is sometimes caused artificially.

Cooling of the body occurs due to the long-term influence of a reduced ambient temperature on the entire surface of the body. It can lead to death.

The adverse effect of low temperature increases with increased air humidity and wind. The exhaustion of the body, the state of hunger, intoxication, sleep, shock, blood loss, diseases and injuries, as well as the immovable position of the body contribute to a general cooling. It is more likely to develop in young children and the elderly. Individual characteristics also matter.

The body initially responds to the action of low temperature with protective reactions, trying to maintain body temperature. Heat transfer is maximally reduced: superficial vessels are reduced, the skin becomes pale. Heat generation increases: due to reflex muscle contraction, a person begins to tremble, metabolism in tissues increases. With the continued action of cold, the compensatory capabilities of the body dry out and the body temperature decreases, which leads to disruption of the normal activity of the most important organs and systems, primarily the central nervous system. The blood vessels of the skin dilate, it becomes cyanotic. Muscle tremor stops. Respiration and pulse slow down sharply, blood pressure drops. Oxygen starvation of tissues occurs due to a decrease in their ability to absorb oxygen from the blood. The nervous system is in a state of oppression, which leads to an almost complete loss of sensitivity. At a body temperature of about 31 ° C, a person loses consciousness. Sometimes there are convulsions, involuntary urination. With a drop in body temperature to + 25-23 ° C, death usually occurs.

General cooling of the body with a fatal outcome can occur under adverse conditions with prolonged exposure to an ambient temperature of + 5-10 ° C. Death usually comes slowly, within a few hours of the onset of cooling.

When dying from cold, some signs of frostbite sometimes develop in open areas of the body. Depending on its severity, the skin of these areas may appear unchanged or somewhat swollen, cyanotic, with small blisters. As a result of histological analysis, signs of frostbite II degree can be observed, which confirms the lifetime exposure to low temperature. The posture of those who died of cold in some cases resembles a person cowering from the cold, but it may be different.

glaciation of corpses

A person dies from the general cooling of the body more often in conditions when the air temperature is below 0 ° C. Therefore, when the action of cold continues after death, the corpse completely or partially (from the surface) freezes - it freezes, becomes hard, and small parts of the body (fingers, nose, ears) become fragile.

When the brain, which contains a large amount of water, freezes, its volume increases, which often leads to a violation of the integrity of the bones of the skull, divergence of the sutures or the appearance of cracks (usually in the area of ​​the bottom of the posterior cranial fossa). In corpses that have been in the cold for a long time (at frost or at a temperature slightly above 0 ° C), a pinkish tint of cadaveric spots, skin, and sometimes individual sections of internal organs, especially the lungs, is always noted. The pink-red color of cadaveric spots and blood is not a sign of death from freezing. The so-called "goosebumps" also has no diagnostic value, since it occurs for various reasons both in vivo and during the period of agony and in the near future after death.

Circumstances of death from general cooling

Death from general cooling of the body is relatively rare. It occurs, as a rule, in people who are in a state of intoxication or exhausted. With a concentration of ethyl alcohol in the blood up to 3 ppm, they talk about the contributing effect of alcohol on the onset of death. The detection of ethyl alcohol in the blood at a concentration of more than 3 ppm is the basis for the conclusion about the possible competition of causes of death (general hypothermia and acute alcohol poisoning).

As a method of killing, cooling is sometimes applied to newborns and young children, leaving them helpless in a deserted place.

Signs of death from cooling are not specific, since each of them individually can occur in other disease states. Therefore, it is possible to establish the cause of death from cooling the body only if there are a combination of signs, and in some cases, the conclusion about the cause of death has to be based on an analysis of the circumstances of death and the exclusion of other possible causes of it (trauma, disease, poisoning). In the cold, the corpse can be preserved indefinitely, which makes it difficult to establish the prescription of the onset of death.

LECTURE #12

Forensic medical examination of electrical injury

Electrical injury is the result of the action of technical (from the power and lighting network) and atmospheric (lightning) electricity on a living organism.

Mostly these accidents in everyday life and at work occur due to violation of safety regulations, technical malfunction of electrical equipment, instruments and electrical equipment, damage to electrical insulation. Cases of murder and suicide by electrocution are rare.

A forensic medical examination is also carried out in cases where it is necessary to determine the degree of disability in persons affected by electric current.

Factors and conditions of action of technical electricity on the body

The damaging effect of electric current on the body is due to its physical properties, conditions of action and the state of the body.

More often, electric shock occurs due to direct contact with a current-carrying object, less often - at a short distance from the current source (for example, step voltage acting in the area of ​​a fallen wire of a high-voltage network at a distance of several steps).

The physical properties of electric current are determined by its voltage, strength, type and frequency. Low voltage - 110-220 V, high - over 250 V. On electric railways, the voltage reaches 1500-3000 V. Mostly there are cases of low voltage shock, with which a person is more likely to come into contact at home and at work.

A current of 50 mA is life-threatening, and at a power of more than 80-100 mA, death occurs.

By type, alternating and direct current are distinguished. AC shock is more common. Alternating current up to 500 V is more dangerous than direct current. The latter is more harmful at voltages above 5000 V.

Alternating low-frequency current (40-60 oscillations per second) is dangerous. High frequency currents (from 10 thousand to 1 million Hz and more) are not dangerous for the body and are used in medical practice during physiotherapeutic procedures.

The figures given are not absolute. The conditions for the action of the current are essential.

current conditions. These include: the resistance value of the body tissues, the area and density of contact with the electrical conductor, the time of current exposure, the path of the current in the body.

The resistance of the body is due to the moisture content of the skin, its thickness, blood supply, and the state of the internal organs.

Skin resistance ranges from 50 to 000 million ohms. Dramatically reduces the resistance of wet skin. Wet clothing does not protect well from electric current. The resistance of the internal organs (especially the brain and heart) is much lower than that of the skin. Therefore, the passage of current through organs with low resistance is very dangerous, especially when both hands are included in the electrical circuit, the "head - legs", "left arm - legs" systems.

There is a concept of current-hazardous premises - with high humidity (baths, washrooms, dugouts, etc.).

The denser the contact with the current-carrying conductor and the longer the time of current exposure, the greater its damaging effect.

The state of the body matters. Current resistance is reduced in children and the elderly, sick, tired, intoxicated.

The mechanism of action of electric current on the body

Electric current has a thermal effect - from local burns to charring, mechanical - damage to tissues from convulsive muscle contractions, when the body is thrown away from the conductor, and electrical - electrolysis of tissue fluids.

With non-fatal injuries, disorders of the nervous system (paralysis), organs of vision and hearing can be observed. Sometimes electric shock is accompanied by a deep loss of consciousness.

Signs of electrical injury.

Typical signs of electric shock:

1) the presence of electrotags;

2) anisocoria (different pupil size);

3) "boiled muscles" in the direction of current flow;

4) increased pressure of the cerebrospinal fluid.

A specific sign of electric shock are electrotags. They arise from contact with a current-carrying conductor, usually at a voltage of 100-250 V and a temperature not higher than 120 ° C released at the same time. In 10-15% of cases, electrotags are not formed (especially in areas of moist and thin skin).

A typical electromark is a damage in the form of formations of a round or oval shape, grayish-white, pale yellowish in color with roller-shaped edges and a sinking center, usually without signs of inflammation, sometimes with swelling of the tissues around and plaque of metal particles, peeling of the epidermis. The sizes of electrotags are usually within 1 cm.

High voltage burns can be large. The metallization of the electrotag, depending on the metals that make up the conductor, gives it the appropriate color. The shape of the conductor can be reflected in the electrotag. Electrotags can have different localization, but more often they are located on the palms and plantar surfaces of the feet.

The microscopic picture of the electrotag is characteristic. The diagnosis of an electrical mark is greatly facilitated by the detection of electrical conductor metals in it by the methods of color prints, microcrystalline reactions, spectrographic and other laboratory studies. The configuration of the trace-forming part of the conductor, in addition to the methods of color prints, can be detected using an electron-optical converter (study in infrared rays).

Electrotags come in various shapes and degrees of severity.

Atypical electrotags look like abrasions, hemorrhages, tattoos, burns, calluses, etc. All suspicious areas that may be an electrotag are excised for further laboratory research.

Melted metal objects may be found in the victim's pockets. From the action of electric current, metal accessories of clothes and shoes are melted, there is a rupture and fall of clothes.

When a corpse is opened, signs of a rapidly occurring death are distinguished, indirectly indicating death from an electrical injury, - a violation of blood circulation and permeability of the walls of blood vessels, swelling of internal organs, small-point hemorrhages in the membranes and in the substance of the brain, etc. The thermal effect of high voltage currents is manifested by extensive burns of the body up to charring. The greatest difficulty for diagnosis is presented by cases of electrical injury without any of its manifestations or in the presence of concomitant injuries of another origin (for example, when falling from a power pole, car roof, etc.).

Assuming an electrical injury, the investigator must competently inspect the place where the corpse was found with the participation of a forensic medical expert and an electrical engineer.

To this end, it is important to establish the source of electrical energy, identify the environment and conditions conducive to electrical injury, the nature of contact with the conductor, and make sure that the corpse is disconnected from the current source. When examining a corpse, it is necessary to pay attention to the condition of clothing, its metal attributes, and the presence of electrical marks on the body. The forensic medical expert must be presented for use and the results of the electrical examination.

Atmospheric electricity damage is observed during periods of increased thunderstorm activity. Lightning is a powerful charge of atmospheric electricity (with a voltage of millions of volts and a force of up to 1 A), striking both outdoors and indoors, in a tent, in transport. More often it affects people who are near high objects, electrical equipment and other conductive objects.

Both fatal and non-fatal injuries are possible. Lightning damage occurs due to its mechanical and thermal effects. At the same time, tears in the fabric of clothing and holes in it, its burning, and melting of metal objects are revealed. Sometimes clothes are torn to shreds and scattered.

Lightning damage is characterized by hair fall, burns of the body of various sizes and depths, as well as "lightning figures" on the skin in the form of tree-like branches of a reddish color. "Lightning figures" usually disappear by the end of the first day. At the same time, there may be no traces of the damaging effect of lightning on clothing and body.

Of great importance for the forensic medical diagnosis of cases of lightning strikes is a detailed examination of the scene and the corpse. Split and burnt trees, damaged buildings, caked clods of earth and sand, traces of destruction and fire in the room, deformed and melted metal objects can be found at the scene of the incident.

When examining the corpse, attention is drawn to the presence of ruptures in clothing, its burning, melting of metal objects, as well as damage to the body characteristic of lightning.

LECTURE #13

Forensic thanatology

Death is an inevitable and irreversible cessation of the interaction of protein structures, which is expressed in the complete cessation of all vital functions of the body. In multicellular organisms, the interaction of protein structures is expressed as a function of cells and tissues.

The concept of the death of a person and warm-blooded animals refers to the body as a whole and is associated primarily with the cessation of breathing and blood circulation, followed by a violation of the activity of the central nervous system, primarily the cerebral cortex. The consequence of this is the death of the individual as a separate living system.

In forensic medicine, taking into account the interests of law enforcement agencies, the following social and legal classification is common.

Categories of death:

1) non-violent death;

2) violent death.

Non-violent death is caused by diseases, deep senile changes. The category of death is determined by the forensic physician.

In case of violent death, the forensic physician decides on its type, determined by the nature of the factor that led to the death of a person.

Types of violent death:

1) from mechanical damage;

2) from mechanical asphyxia;

3) from the action of a changed barometric pressure;

4) from the action of high or low temperature;

5) from the action of electricity;

6) from the action of radiant energy;

7) from poisoning.

In case of a violent death, the question of its kind is decided - about murder, suicide or an accident. The type of death is determined by law enforcement agencies. The forensic physician, with his research at the scene and in the mortuary, with his conclusions, gives the bodies of inquiry grounds for ascertaining the type of death. For example, he may note that the damage in question could not have been caused by his own hand.

Dying stages

In the process of dying, the following stages are most often distinguished.

1. Predagonal state - consciousness is depressed, the pulse is not palpable, when listening to heart sounds are sharply weakened, the heart rate is first increased and then reduced, blood pressure decreases, breathing is frequent and shallow, the reaction to various stimuli is sharply reduced.

2. Terminal pause - temporary breath holding, consciousness, pulse, reflexes are absent, heart rate is sharply reduced, blood pressure is close to zero.

3. Agony - there is no consciousness and pain sensitivity, the pupils are dilated, respiratory movements are either weak rare or short maximum fast. The efficiency of heart contractions after the terminal pause increases slightly, which leads to a slight increase in blood pressure. In this case, the restoration of consciousness is possible. These signs do not indicate an improvement in the condition of the victim. By the end of the agony, the heart rate slows down, blood pressure decreases. During agony, tonic convulsions (the muscles of the body are sharply tense), involuntary urination and defecation are often observed. The manifestations and duration of agony depend on the causes that caused it.

4. Clinical death - no breathing, cardiac activity, all reflexes. It lasts no more than 8 minutes at normal ambient temperature. At low temperatures, clinical death is longer. The changes taking place in the body at this time, especially in the brain, in the cerebral cortex, are reversible due to the available reserves of molecular energy sources in the cells. At this stage, resuscitation may be effective.

5. Biological death - an irreversible cessation of physiological processes in the cells and tissues of the body, in which resuscitation measures remain unsuccessful. Reliable signs of the onset of biological death are post-mortem changes.

The cause of death is the underlying injury (disease), which itself or through complications led to death. Therefore, the concepts of the cause of death and the main damage (disease) coincide.

The genesis of death is a chain of successively arising morpho-functional disorders, which are manifestations and consequences of the main damage (disease), developing under the influence of the properties of a particular organism and environmental conditions. A full judgment about the genesis of death involves the mandatory identification of the underlying damage (disease), its complications, concomitant diseases, and the immediate cause of death.

A complication is understood as such pathological processes that are secondary to the main damage (or disease), but are etiologically and pathogenetically associated with it. Being always secondary to the main injury (or disease), complications can become leading in the development of injury (or disease) and play a decisive role in the onset of death.

Concomitant injuries (or diseases) are such nosological forms that are not etiologically associated with the underlying injury (or disease) and its complications. Concomitant pathology can form and manifest both before and after the onset of the main damage (or disease).

The direct cause of death is understood as such morphological changes in organs that led to the development of irreversible functional disorders and made it impossible to continue human life as a single living organism. Such a cause may be the main damage or complications of the injury.

Immediate causes of death if injured:

1) damage itself - in case of gross destruction of the body or gross damage to vital organs;

2) acute blood loss - in an adult, the loss of 2-2,5 liters of blood is fatal;

3) shock - occurs as a reaction of the body to injury;

4) reflex cardiac arrest - occurs after an injury to the reflexogenic zones: blows to the heart area, epigastric region, blows or pressure on the carotid sinus zone, with strong shaking of the body;

5) aspiration of blood - occurs when crossing large vessels of the neck and larynx, fractures of the base of the skull;

6) compression of organs by blood - occurs when bleeding into the pericardial cavity (cardiac tamponade), with hemorrhages above and below the hard shell of the brain; with pneumothorax;

7) compression of organs by air - occurs with pneumothorax;

8) embolism - blockage of blood vessels with air or gas, fat, pieces of damaged tissue, foreign bodies, detached blood clots and, as a result, damage to the vital centers of the brain;

9) traumatic toxicosis (syndrome of prolonged crushing, crash syndrome) - occurs with prolonged compression of a large amount of muscle tissue;

10) acute renal failure - occurs when poisoning with certain poisons, with extensive thermal burns, with crush syndrome;

11) acute liver failure;

12) secondary disorders of intraorganic circulation - primarily intracerebral circulation;

13) infectious complications.

All signs of death can be divided into two groups - probable and reliable.

Likely signs of death

Probable signs suggest the onset of death. In everyday life, there are cases of a person developing a deep coma, fainting and other similar conditions that can be mistakenly taken as death.

Possible signs of death:

1) immobility of the body;

2) pallor of the skin;

3) lack of response to sound, pain, thermal and other stimuli;

4) maximum expansion of the pupils and the absence of their reaction to light;

5) lack of reaction of the cornea of ​​the eyeball to mechanical impact;

6) lack of pulse on large arteries, especially on the carotid artery;

7) lack of heartbeat - according to auscultation or electrocardiography;

8) cessation of breathing - there is no visible excursion of the chest, the mirror brought to the nose of the victim does not fog up.

Reliable signs of death

The presence of reliable signs of death indicates the development of irreversible physical and biochemical changes that are not characteristic of a living organism, the onset of biological death. By the severity of these changes, the time of death is determined. Reliable signs of death according to the time of manifestation are divided into early and late.

Early cadaveric changes develop within the first 24 hours after death. These include cadaveric cooling, rigor mortis, cadaveric spots, partial cadaveric drying, cadaveric autolysis.

Corpse cooling. A reliable sign of death is a decrease in the temperature in the rectum to 25 ° C and below.

Normally, a person's body temperature is in the range of 36,4-36,9 ° C when measured in the armpit. In the internal organs, it is 0,5 °C higher, the temperature in the rectum is 37,0 °C. After death, the processes of thermoregulation cease and the body temperature tends to catch up with the ambient temperature. At an ambient temperature of 20 °C, the cooling time lasts up to 24-30 hours, at 10 °C - up to 40 hours.

At the time of death, the body temperature may be 2-3 °C higher than normal due to the development of infectious diseases, in case of poisoning, overheating, after physical work. The rate of cooling of a corpse is influenced by the humidity of the environment, wind speed, ventilation of the premises, the presence of contact of the body with massive cold (warm) objects, the presence and quality of clothing on the body, the severity of subcutaneous fatty tissue, etc.

To the touch, a noticeable cooling of the hands and face is noted after 1,5-2 hours, the body remains warm under clothing for 6-8 hours.

With instrumental thermometry, the time of death is determined quite accurately. Approximately body temperature decreases by 1 °C for 1 hour in the first 7-9 hours, then it decreases by 1 °C for 1,5 hours. Body temperature should be measured twice with an interval of 1 hour, at the beginning and at the end of the examination of the corpse.

Rigor mortis. This is a kind of state of muscle tissue, which causes a restriction of movement in the joints. The expert with his own hands tries to make this or that movement in any part of the body, limbs of the corpse. Encountering resistance, an expert on its strength and limited range of motion in the joints determines the severity of muscle stiffness. To the touch, stiff muscles become dense.

Immediately after death, all muscles, as a rule, are relaxed and passive movements in all joints are possible in full. Rigor mortis is noticeable 2-4 hours after death and develops from top to bottom. The muscles of the face stiffen faster (opening and closing the mouth is difficult, lateral displacements of the lower jaw are limited) and hands, then the muscles of the neck (movements of the head and cervical spine are difficult), then the muscles of the limbs, etc. The corpse completely stiffens in 14-24 hours When determining the degree of stiffness, it is necessary to compare its severity in the right and left parts of the body.

Rigor mortis persists for 2-3 days, after which it resolves due to the activation of the process of putrefaction of the actomyosin protein in the muscles. This protein causes muscle contraction. The resolution of rigor mortis also occurs from top to bottom.

Rigor mortis develops not only in the skeletal muscles, but also in many internal organs (heart, gastrointestinal tract, bladder, etc.) that have smooth muscles. Their condition is judged during an autopsy.

The degree of rigor mortis at the time of examination of the corpse depends on a number of reasons, which must be taken into account when determining the time of death. At low ambient temperatures, stiffness develops slowly and can last up to 7 days. On the contrary, at room and higher temperatures, this process accelerates and complete rigor develops faster. Rigor is strongly pronounced if death was preceded by convulsions (tetanus, strychnine poisoning, etc.). Rigor mortis also develops more strongly in individuals:

1) having well-developed muscles;

2) younger;

3) who do not have diseases of the muscular apparatus.

Muscle contraction is due to the breakdown of ATP (adenosine triphosphate) in it. After death, some of the ATP is free from binding to carrier proteins, which is enough to completely relax the muscles in the first 2-4 hours. Gradually, all ATP is utilized and rigor mortis develops. The period of complete utilization of ATP is approximately 10-12 hours. It is during this period that the state of the muscles can change under external influence, for example, you can unbend the brush and put some object into it. After a change in the position of a body part, stiffness is restored, but to a lesser extent. The difference in the degree of stiffness is established by comparing different parts of the body. The difference will be the smaller, the sooner after death the position of the corpse or its part of the body is changed. After 12 hours from the moment of death, ATP completely disappears. If the position of the limb is disturbed after this period, then stiffness in this place is not restored.

The state of stiffness is judged by the results of mechanical and electrical effects on the muscles. When hit with a hard object (stick) on the muscle, an idiomuscular tumor is formed at the site of impact, which is determined visually in the first 6 hours after death. At a later date, such a reaction can only be determined by palpation. When a current of a certain strength is applied to the ends of the muscle, its contraction is observed, assessed on a three-point scale: a strong contraction is observed in the period up to 2-2,5 hours, an average - up to 2-4 hours, a weak one - up to 4-6 hours.

Dead spots. The formation of cadaveric spots is based on the process of redistribution of blood in the vessels after death. During life, the tone of the muscles of the walls of the vessels and the contraction of the myocardium of the heart contribute to the movement of blood in a certain direction. After death, these regulatory factors disappear and the blood is redistributed to the lower parts of the body and organs. For example, if a person lies on his back, then the blood flows into the back area. If the corpse is in a vertical position (hanging, etc.), then the blood flows into the lower parts of the abdomen, lower limbs.

The color of the spots is most often bluish-purple. In case of carbon monoxide poisoning, carboxyhemoglobin is formed, and therefore the color of the spot is reddish-pink; when poisoned by some poisons, the color is grayish-brown (formation of methemoglobin).

The blood is redistributed to areas that are not pressed. With severe blood loss, spots form slowly and are poorly expressed. With asphyxia, blood thinning occurs and the spots are abundant, spilled and strongly pronounced.

In a living organism, the components of blood pass through the wall of blood vessels only in capillaries, the smallest vessels. In all other vessels (arteries and veins), blood does not pass through the wall. Only in certain diseases or after death, the vascular wall, its structure changes and it becomes permeable to blood and interstitial fluid.

Cadaverous spots in their development go through three stages.

Stage I - hypostasis, develops after 2-4 hours. If you press on the spot at this stage, it completely disappears. In this case, the blood is squeezed out of the vessels, the wall of which is still impermeable, i.e., the components of the blood do not pass through it into the tissue. If the pressure is stopped, the stain is restored. Rapid restoration of the spot in 3-10 s corresponds to 2-4 hours ago of death, the time equal to 20-40 s corresponds to 6-12 hours. When the position of the corpse changes at this stage, the spots in the old place disappear, but other spots appear in the new place ("spot migration").

Stage II - diffusion (stasis), develops after 14-20 hours. In this stage, the vessel wall becomes permeable to a certain extent; intercellular fluid diffuses through the wall into the vessels and dilutes the plasma; hemolysis (destruction) of red blood cells occurs. At the same time, blood and its decay products diffuse into the tissue. When pressed, the stain fades, but does not disappear completely. The recovery of the spot occurs slowly, in 5-30 minutes, which corresponds to 18-24 hours ago of death. When the position of the corpse changes, the old spots turn pale, but new ones appear in those places that are located below the locations of the previous spots.

Stage III - hypostatic imbibition, develops after 20-24 hours or more. The vessel wall is completely saturated with blood plasma and interstitial fluid. Blood as a liquid system is completely destroyed. Instead, in the vessels and in the surrounding tissues there is a liquid formed from the mixing of destroyed blood and interstitial fluid that has soaked the tissues. Therefore, when pressed, the spots do not turn pale, retaining their color and shade. When the position of the corpse changes, they do not "migrate".

All the changes described above are also observed in the internal organs, more precisely, in those departments that are located below other areas. There is an accumulation of fluid in the cavities of the pleura, pericardium, peritoneum. The walls of all vessels, especially large ones, are saturated with liquid.

Partial cadaveric desiccation. Drying is based on the process of evaporation of moisture from the surface of the skin, mucous membranes and other open areas of the body. In living people, the evaporated liquid is compensated by the newly incoming one. There is no compensation process after death. Drying begins immediately after death. But the first visually noticeable manifestations of it are observed after a few hours.

If the eyes are open or half-open, drying quickly manifests itself in the form of clouding of the cornea, which acquires a grayish tint. When pushing the eyelids, triangular opacities are visible. The time of appearance of these spots is 4-6 hours.

Next, the border of the lips dries out (6-8 hours); the surface of the lip becomes dense, wrinkled, red-brown in color (very similar to lifetime sedimentation). If the mouth is ajar or the tongue protrudes from the oral cavity (mechanical asphyxia), then its surface is dense, brown.

The same changes are observed on the genitals, especially if they are naked. Thinner areas of the skin dry out faster: the glans penis, the foreskin, the scrotum. The skin in these places becomes dense, brown-red, wrinkled (similar to lifetime trauma).

Drying is faster if the body is naked; with dry air. Skin areas with post-mortem abrasions dry out faster. Their color is brown-red (on the underlying parts of the corpse) or "waxy" (on the overlying parts of the corpse). These are "parchment stains", the central section of which is located below the edges. Abrasions are lifetime. Their surface also dries quickly, the color is red-brown, but it slightly protrudes due to tissue edema. Microscopic picture - plethoric vessels, swelling, hemorrhage, leukocyte infiltration.

Cadaveric autolysis. In the human body, a number of glands produce chemically active secretions. After death, these secrets begin to destroy the tissue of the glands themselves, since the organ's own defense mechanisms are absent. Self-destruction of the gland occurs. This is especially true for the pancreas and liver. At the same time, secretions leave the glands to other organs (into the gastrointestinal tract) and change it. Organs become flabby, dull. The action of enzymes on the structure of organs is stronger, the faster death occurs. The shorter the agony lasts, the less time the body has time to utilize the enzymes and the faster the cadaveric changes develop. All changes caused by autolysis can be seen only at autopsy.

Pupil reaction. During the first day, the pupils retain the ability to respond to the effects of certain pharmacological substances introduced into the anterior chamber of the eye. The reaction rate of the pupils decreases with increasing time of death. After the introduction of pilocarpine, pupillary constriction after 3-5 seconds corresponds to 3-5 hours after death, after 6-15 seconds - 6-14 hours, 20-30 seconds - 14-24 hours.

The phenomenon of Beloglazov. In 15-20 minutes after the onset of death, intraocular pressure in the eyeballs decreases. Therefore, when the eyeball is compressed, the pupil takes an oval shape. Living people don't.

Late cadaveric changes dramatically change the appearance of the corpse. Their beginning is noted in the period of manifestation of early cadaveric changes. But outwardly they appear later, some - by the end of 3 days, others - after months and years.

Depending on the preservation of individual signs of a person and damage to the corpse, late cadaveric changes are divided into types:

1) destructive - rotting;

2) preservatives: fat wax, mummification, peat tanning, freezing.

During conservation, the appearance changes, but individual features and damage are preserved to a certain extent.

Rotting. Decay is a complex process of decomposition of organic compounds under the influence of microorganisms and their enzymes. According to the conditions of vital activity, microorganisms are divided into aerobes and anaerobes (living with or without oxygen). Aerobes produce destruction more intensively. Anaerobes slowly destroy tissues, while unpleasant odors are released.

Microorganisms decompose protein to peptones, amino acids. Further, valeric, acetic, oxalic acids, creosol, phenol, methane, ammonia, nitrogen, hydrogen, carbon dioxide, hydrogen sulfide, methyl mercaptan, ethyl mercaptan are formed. The latter have an unpleasant odor. During decay, unstable substances are formed - putrescine, cadaverine.

The optimal conditions for decay are 30-40 ° C. The rate of decay is highest in air. The process is slower in water, even slower in soil, and very slowly in coffins. At temperatures of 1 ° C and less, 50 ° C and above, the process of decay slows down sharply and even stops. Decay is accelerated if death was preceded by prolonged agony (rapid destruction of the tissue barrier of the colon), purulent infection, sepsis.

After death, putrefaction occurs immediately in the large intestine, where a living person has certain types of bacteria that are anaerobes, the vital activity of which continues after the death of a person. Microorganisms contribute to the formation of gases, especially hydrogen sulfide. It penetrates through the intestinal wall and its vessels into the blood. In the blood, hydrogen sulfide combines with hemoglobin and forms sulfohemoglobin, which has a greenish color. Spreading through the vessels, sulfohemoglobin penetrates into the venous network of the skin and subcutaneous tissue of the anterior wall of the abdomen, its hypogastric region. All this explains the greenish coloration of the skin of the inguinal regions 36-48 hours after death. Further, the color is enhanced by an increase in the concentration of sulfohemoglobin and the formation of iron sulfide (greenish-gray color).

The accumulation of gases in the intestines leads to bloating of the intestines, the entire abdomen. This pressure is so strong that pregnant women experience miscarriage of the fetus (the so-called "postmortem birth") and uterine inversion. Gas penetrates into the subcutaneous tissue of the entire body and causes swelling of the face, lips, mammary glands, neck, scrotum. The tongue protrudes from the mouth. Gas puts pressure on the stomach, which leads to post-mortem vomiting.

Sulfohemoglobin and iron sulfide, spreading through the vessels, stain them, which is noted in the form of a "putrid venous network" of a dirty green color after 3-5 days. After 8-12 days, the skin of the entire corpse has a dirty green color. The epidermis exfoliates, blisters with bloody contents form. Hair changes its color after 3 years. Damage to the bones, traces of a shot on the skin and its pattern, traces of cardiosclerosis persist for a relatively long time.

Zhirovovsk. Synonyms - saponification, saponification of fats. Formation conditions - a humid environment without air access. This phenomenon is well expressed in people with significant subcutaneous adipose tissue.

Water penetrates through the skin (the phenomenon of maceration), then penetrates into the intestines and washes out microorganisms from it. Decay sharply weakens and even stops. Under the action of water, fat decomposes into glycerol and fatty acids: oleic, palmitic, stearic, etc. These acids combine with alkali and alkaline earth metals, which are abundant in body tissues and in the water of reservoirs. A fat wax is formed, which has a gelatinous consistency of a dirty gray color (potassium and sodium compounds), or a dense gray-white substance (calcium and magnesium compounds). This process is subjected to subcutaneous tissue, fat accumulations in the chest and abdominal cavities, the brain, and the liver. However, individual traits, the shape of organs, traces of damage to tissues and organs are preserved.

The first signs of saponification of the tissues of the corpse are observed from 25 days to 3 months. Complete saponification occurs no earlier than 6-12 months on the corpses of adults, on the corpses of children faster.

Mummification. Natural mummification occurs at different ambient temperatures (often at high temperatures), lack of moisture in it, access and movement of dry air, and rapid release of liquid from the corpse. In the first days after the onset of death, the processes of decay intensively occur in the corpse. Parenchymal organs (lungs, liver, kidneys and other organs) turn into a liquid mass, which flows out through decayed tissues. A decrease in the amount of liquid creates unfavorable conditions for the vital activity of putrefactive microorganisms, as a result of which putrefaction gradually stops and the corpse begins to dry out quickly. Drying begins, as a rule, in areas devoid of the epidermis, in macerated areas of the skin, with open eyes - in the cornea and conjunctiva, on the lips, fingertips, etc. Complete drying of the corpse is most often observed in dry, loose, well-ventilated and suction moisture to the soil, in rooms with adequate ventilation.

The corpses of lean and emaciated individuals are easily mummified. On average, the mummification of a corpse occurs in 6-12 months, in some cases the corpse of an adult can be mummified in 2-3 months. The mass of the mummy is 1/10 of the original body weight. Skin color - parchment, yellowish-brown or dark brown. The internal organs dry out and become flat. The tissues become dense. During mummification, the external appearance of a person is preserved to varying degrees. You can determine gender, age, anatomical features. There are traces of a shot, acute wounds, a strangulation furrow.

Peat tanning. Impregnation and tanning of tissues and organs with humic acids, which are decay products of dead plants, occurs in peat bogs. The skin becomes dark brown, dense. Internal organs are reduced. Mineral salts are washed out of the bones, so the shape of the latter changes. Bones look like cartilage. All damage is preserved. In this state, corpses can be preserved for a very long time, sometimes for centuries.

LECTURE #14

Examination of the corpse of a newborn baby

The study of the corpse of a newborn baby is generally carried out according to the general scheme adopted in forensic medicine. However, this study has some peculiarities. In particular, the range of issues to be resolved in this case includes the clarification of the following number of circumstances:

1) whether the baby is a newborn, full-term (if not, what is his uterine age), viable;

2) whether born alive or dead;

3) whether he breathed and how long he lived after birth;

4) whether he was given proper care;

5) what caused death.

When resolving these issues, the expert is guided by a number of signs. Of course, when examining a corpse of a newborn, as in other types of forensic medical examination, one cannot proceed from the presence, absence or severity of one sign, a complex of signs is taken into account with the obligatory consideration of the individual characteristics of the organism.

The issue of a newborn baby is of great medical and legal importance. The fact is that the term "infanticide" implies the killing by the mother of her child directly or within a relatively short period of time after birth. Obviously, under these circumstances, the answer to the question about the newborn baby is of great importance in qualifying the committed act, since the deliberate deprivation of the child's life, committed by the mother at a later date after birth, will already contain signs not of infanticide, but of ordinary murder. In addition, one should keep in mind another circumstance of a purely medical nature. Sometimes (albeit very rarely) in a woman who was previously completely normal, during the period of time corresponding to childbirth, or immediately after them, a temporary acute mental disorder occurs - the so-called "Aschaffenburg confusion effect." Being in such a state and without extraneous supervision, a woman can commit senseless acts, including the murder of her own newborn child. This psychosis passes quickly, so if the murdered child is not a newborn, then there is no need to talk about the "affect of confusion". Of course, if there is reason to assume the presence of psychosis, the suspect should be subjected to a forensic psychiatric examination.

There are three indisputable signs of a newborn:

1) umbilical cord;

2) the presence of a birth tumor;

3) the presence of a cheese-like, original lubricant. Immediately after birth, the baby has a juicy,

moist and shiny umbilical cord. Sometimes with it there is an unseparated placenta (placenta or baby's place), but usually the end of the umbilical cord is cut off (or torn off). In order to save the life of the child, to avoid umbilical bleeding, the umbilical cord is tied up. The absence of such a ligation, as well as the condition of the end of the umbilical cord (break instead of cutting) may, to a certain extent, indicate the circumstances under which the birth took place. In the future, the umbilical cord dries up and falls off on the 4-10th day after birth. The navel heals approximately two weeks after birth.

Given the forensic significance of the umbilical cord for determining the fact of a newborn, as well as for establishing the duration of the extrauterine life of an infant, it must be carefully examined and described in detail in the autopsy report.

During childbirth, on that part of the baby's body that moves ahead along the birth canal (more often it is the head), a birth tumor is formed as a result of mainly suction action. It has the character of an extensive soft swelling, clearly visible on the corresponding part of the body, without violating the integrity of the skin; on the cut, it is a bloody gelatinous impregnation of the subcutaneous soft tissues.

The birth tumor usually resolves within a day after birth. It should not be confused with possible traumatic injuries that occur after birth due to blows, bruises, etc. The latter are usually accompanied by traumatization of the skin (abrasions, wounds), and sometimes the underlying soft tissues and even internal organs.

Cheese grease is a white brand mass. Before birth, this lubricant covers the entire body of the baby in a thin layer. When passing through the birth canal, it is partially erased, but its remnants can always be found in the armpits, in the inguinal folds, behind the auricles, and also in deep folds of the skin, for example, on the neck.

Whether a baby is full-term or premature is determined by whether the baby was born on or before term.

The normal duration of pregnancy is 280 days, or 10 lunar months (a lunar month is 28 days). Deviations from this period are possible; in such cases, the infant will be considered premature or postterm.

The full-term baby is characterized by a combination of a number of signs. His body length is 50 cm, the head circumference is 32 cm, the distance between the shoulders is 12 cm, between the hips is 9,5 cm, and the weight is 3 kg. The skin of a full-term baby is pink, elastic, covered with a delicate fluff in the shoulder area. The nails on the hands protrude beyond the ends of the fingers, and on the legs they reach the ends. The cartilages of the nose and auricles are dense and elastic. The mammary glands in boys and girls are slightly swollen. In boys, the testicles are located in the scrotum, in girls, the large labia cover the small ones. In a transverse section of the distal epiphysis of the femur, in the central part of the section, the so-called ossification nucleus is clearly visible in the form of a dark red focus with a largest diameter of 0,5 cm, located against the background of white cartilaginous tissue.

In a premature baby, the body length, other dimensions and weight will be the smaller, the more premature he is. The skin is pale, flabby, wrinkled, everywhere covered with fluff. The face has an old-looking appearance, the cartilages of the nose and auricles are devoid of elasticity. The nails of the hands and feet do not reach the ends of the fingers. In boys, the scrotum is empty due to the location of the testicles in the abdominal cavity. In girls, the large labia do not cover the small ones.

When examining the corpse of a premature infant, it is important to establish the intrauterine age. It is believed that the most reliable criterion for determining the term baby is body length. The technique used in forensic practice is as follows. Up to the fifth lunar month, the length of the baby's body, expressed in centimeters, is equal to the square of the number of lunar months of intrauterine life. This means that by the end of the first month, the body length will be 1 cm, by the end of the second month - 4 cm, the third - 9 cm, the fourth - 16 cm, the fifth - 25 cm. After a five-month period, the body length, expressed in centimeters, is equal to the number of lunar months, multiplied by 5. That is, by the end of the sixth month, the body length will be 30 cm, by the end of the seventh month - 35 cm, etc. In accordance with this technique, on the tenth lunar month, the body length of a full-term baby will be 50 cm. This technique gives the opportunity to answer the question of what lunar month of uterine life a premature baby was born.

The answer to questions about the full-term or prematurity of the baby, as well as the duration of his uterine life, to a large extent depends on expert opinion regarding all subsequent questions - about viability, live birth and cause of death.

The viability or non-viability of an infant means its ability or inability to live after birth. Non-viability can be caused, firstly, by prematurity, secondly, by developmental defects (malformations) and, thirdly, by intrauterine diseases.

In obstetric institutions where it is possible to provide qualified medical care, unviable (miscarriages) are considered premature babies born at a period of intrauterine life up to 7 lunar months, having a body length of not more than 35 cm and weighing not more than 1 kg. If childbirth occurs in the absence of medical care (secret birth), then, as a rule, children born before the eighth month do not survive either. Babies born after this period can live, but their body is weakened in the initial period of extrauterine life and, therefore, more susceptible to adverse external influences. In the future, their condition levels off and becomes indistinguishable from the condition of full-term babies.

In the study of out-of-hospital miscarriages, a forensic medical examination is aimed at identifying various bodily injuries that may indicate the use of various, including pointed objects (knitting needles, etc.) for the purpose of fetal expulsion.

One of the reasons for non-viability in some cases are malformations of vital organs - blood circulation, respiration, etc. (for example, the location of the heart outside the chest, the absence of a windpipe, the absence of a brain). Diseases of the fetus in the womb (syphilis, blood diseases) are also the cause of non-viability.

Non-viability should not be confused with stillbirth. Non-viable children can sometimes be born alive, but they inevitably die shortly after birth.

The determination of the live birth or stillbirth of an infant is carried out mainly using two methods - pulmonary and gastrointestinal tests. With their help, the question is resolved whether the baby was breathing or not breathing. There are other methods, but these methods are recommended for mandatory use in all such cases.

While in the womb, the baby's lungs are in a collapsed state, they do not contain air. After birth, at the very first breaths, they straighten out, become airy. The lung test is based on this. The lungs are immersed in water, in the presence of air they float. However, it may also be that in a breathing baby, not all of the lungs, but only some of their parts, will straighten out. Such lungs may not float. In this case, the lungs are cut into pieces with scissors under water: the straightened (breathing) pieces float up, the rest sink. However, this test alone cannot be given decisive importance. So, for example, putrefactive gas formation can cause unbreathing lungs to float. In addition, the lungs of frozen corpses can also float, whether they were breathing or not. Sometimes there is a secondary collapse of already breathing lung tissue, which will lose its buoyancy.

The gastrointestinal test is based on the fact that a living baby not only inhales, but also swallows air. Accordingly, the stomach containing air, when immersed in water, floats. After 6 hours of extrauterine life, air penetration into the small intestine is usually determined, and after 12 hours - into the large intestine (this can be used to determine life expectancy after birth). When conducting a gastrointestinal test, the stomach is first ligated at both ends and then cut off. This procedure for performing this test was established in order to prevent air from being sucked in from the outside or, conversely, squeezing it out of the stomach. Of course, everything that was said about the interfering effect of putrefaction in the production of a lung sample is fully applicable to the gastrointestinal sample.

It can be seen from the above that both samples are not absolutely specific. Therefore, you should pay attention to other signs of live and stillbirth. Non-breathing lungs have a uniform dark red, cyanotic color from the surface and on the cut, they are in a collapsed, unexpanded state, as a result of which the lungs do not fill the entire volume of the pleural cavities. Their texture is thick and fleshy. Breathing lungs have a marble appearance - pale pink areas alternate with red; the lungs fill the pleural cavities, they are as if fluffy to the touch. Histological examination of the lungs may be decisive. Obviously, the presence of curdled milk in the stomach indicates that the child not only lived, but also ate.

The life expectancy of an infant after birth is determined quite accurately, especially on the first day, using the above methods for studying the characteristics of the umbilical cord and the degree of air penetration into the intestine.

The presence in the large intestine of the original feces is also important - a dark green mushy mass. The emptying of the large intestine from the original feces usually occurs on the 2-4th day after birth. However, deviations are also possible here. So, with asphyxia, the original feces can be excreted from the intestine both before birth (in the womb) and immediately after the baby is born.

The ligation of the umbilical cord, the condition of the skin (contamination), the presence of a diaper, etc., indicate the provision or failure to provide care.

The causes of death in a newborn may be in general the same as in an adult - natural and violent, but they have some specifics inherent in this age.

The most common causes of natural death of an infant in the womb and a newborn are those associated with the abnormal course of the birth act. This category of causes includes asphyxia resulting from intrauterine circulatory disorders - detachment of the child's place, breakage of the umbilical cord, compression of it between the fetal head and the walls of the birth canal, entanglement of the umbilical cord around the fetal neck with compression of the latter. The cause of death can be a birth injury that occurs when the fetus passes through the birth canal, leading to rupture of the dura mater, ruptures of internal organs, and violation of the integrity of the bones of the skull.

Special mention should be made of unintentional injuries caused to the fetus by the mother in the process of self-help during childbirth. This happens more often when a primiparous mother gives birth without assistance. In an effort to speed up the birth, she sometimes tries with her hands to pull the child out of the part that has appeared from the genital slit. In this case, abrasions, scratches (traces of nails), injuries of the spine, ruptures of the soft tissues of the neck and compression of it with subsequent asphyxia occur.

The causes of the violent death of a newborn are different, but their specific nature is due to the helpless state of the infant and his inability to resist.

More often than others, it is left in a helpless state. In this case, the infant usually dies from the action of low temperature (even ordinary room temperature is fatal for him if the body is not covered). This is facilitated by blood loss, the cause of which is an untied umbilical cord.

This is a passive form of infanticide. Among the active forms, mechanical obstructive asphyxia, which occurs as a result of the introduction of various foreign bodies into the lumen of the respiratory tract, as well as due to the closing of the mouth and nose with various, most often soft objects or hands, should be indicated as the most common cause.

Strangulation can be done by squeezing the neck with a hand, a loop, and in rare cases, the umbilical cord.

Often there is a drowning of a child in reservoirs, latrines, and sometimes in a bucket of water, in a bath, etc.

The cause of traumatic injuries can be both a blow by some blunt hard object, and the result of throwing a child with a fall and hitting a blunt hard object. Sometimes the mother explains that she accidentally dropped the baby, or talks about the spontaneous fall of the baby as a result of a rapid birth. This is generally acceptable, but often a large number of injuries, as well as their localization on various parts and surfaces of the body, make it possible to reject the version put forward by the killer.

The killing of newborns with the help of stabbing, piercing-cutting, cutting and other sharp objects is infrequent.

Poisoning in newborns is rare. In this case, both caustic and other poisons can appear. The method of administering the poison, for example, with an enema, may also be unusual.

Sometimes there are cases of dismemberment or burning of the corpse of a child in order to hide the traces of the crime.

Examinations in all cases of death of newborn babies are carried out according to the general rules for the study of a corpse with the obligatory thorough description and documentation of the data found, as well as a detailed description of the tests performed and the results obtained.

LECTURE #15

Forensic medical examination of physical evidence of biological origin

When finding blood traces is particularly difficult, preliminary blood tests may be used. Three reactions are most common: with a 3% solution of hydrogen peroxide, a benzidine test modified by V. I. Voskoboinikov, and a reaction with luminol.

The reactions are very sensitive, but not specific and not constant: a positive result can be obtained not only with blood and blood can sometimes give a negative result. A positive result allows you to select items (their parts) to be sent for examination. A negative result should be neglected if the circumstances of the incident make it possible to consider the study of specific subjects as promising.

Preliminary samples are used in cases where visible traces of blood cannot be detected and the question arises: what should be removed for research?

The tests are easy to perform. A drop of 3% hydrogen peroxide solution is applied to the edge of the stain. In the presence of blood, white fine foam forms.

When testing with benzidine, a reagent is prepared, consisting of a mechanical powder mixture: barium peroxide (5 parts), basic benzidine (2 parts), citric acid (10 parts). Before use, a small amount of powder (at the tip of a knife) is dissolved in water (1/4 cup). A small cotton swab is moistened with the solution and touched to the edge of the trace. In the presence of blood, the swab acquires a bright blue color.

In a darkened room, if it is necessary to examine a relatively large area or detect traces of blood after its removal, a reaction with luminol is used. A drop of the reagent is applied to the edge of the track or sprayed on the room. In the presence of blood, a bright bluish flash occurs - luminescence, lasting almost a minute.

Establishing the presence of blood

Determination of the presence of blood is based on the detection of the coloring matter of blood - hemoglobin and its derivatives. The most common research methods are thin layer chromatography, microluminescence, spectral and microspectral analyses. They are based on the ability of hemoglobin and its derivatives to absorb light waves of a certain length.

For each hemoglobin derivative, the nature of these spectra is specific in terms of the number, location, width, and intensity of absorption bands. To establish the presence of blood, they practically use the spectra of hemoglobin derivatives - hemochromogen and hematoporphyrin, obtained after processing a part of the trace with the appropriate reagents. For such a study, a negligible amount of the object is sufficient, the reaction is very sensitive, and its results are determined using spectral nozzles SPO-1, AU-16, a direct vision spectroscope and a microscope. A microspectral study makes it possible to establish the presence of blood even after attempts to remove it (wash) in traces of a long time ago. Detection of a hemochromogen or hematoporphyrin spectrum certifies the presence of blood.

The thin layer chromatography method is the main one and allows you to get a positive result even in difficult cases. This method is based on the fact that the solvent, when passing through the extracts applied to the Silufol plates, leads to the decomposition of blood into components, after which the latter are treated with an alcohol solution of benzidine and a 3% hydrogen peroxide solution.

The microluminescence method is based on the fact that hemoglobin derivatives, in particular hematoporphyrin, have bright fluorescence in UV light. The method is informative in the study of old and washed out traces of blood.

Determining the type of blood

The conduct of such a study, on the one hand, is dictated by the circumstances of the incident, when in the course of the investigation there are versions about the origin of blood on objects not only from humans, but also from birds, mammals, fish, and on the other hand, it is determined by further research into the blood group in the traces, which cannot be carried out without establishing the type of blood.

To determine the type of blood, the protein precipitation reaction (Chistovich-Ulengut) is most often used. The precipitation reaction involves two components: an extract from a blood spot and an immune serum that precipitates a certain type of protein. This reaction is based on the interaction of a protein from a blood spot with the corresponding serum, with a positive result of the reaction, a precipitate is formed - a precipitate. Serums are produced that precipitate the protein of a person, cattle (large, small), horses, pigs, cats, dogs, birds. It should be borne in mind that sera can be prepared to precipitate proteins and other animals.

In addition to the main experiment with an extract from a blood stain, control experiments are performed, including with extracts from an object outside the blood stains, since human protein can be present on objects (most often on clothes) and not only with blood (for example, discharge from the nose, sweat , urine, etc.). In such cases, it is impossible to determine the type of blood. If a positive result with serum for human protein has not been obtained, the expert must perform a precipitation test with sera prepared for proteins of various animal species until a positive result is obtained.

Currently, to determine the type of blood, precipitation reactions in agar gel, counter immunoelectrophoresis, and immunofluorescence are used.

The gel precipitation reaction was proposed by O. Ouchterlony (1949). Its principle is as follows: an antigen and an antibody are placed in two wells in agar, they diffuse into each other and a precipitation band is formed at the contact point.

Counter immunoelectrophoresis (electroprecipitation) was first proposed by Bussardom (1959). The essence of the reaction is as follows: globulin fractions of serum containing antibodies are sent from "+" to "-", and antigens - from "-" to "+". Thus, moving towards each other, they form a precipitation band. This reaction can be carried out both in agar gel and on cellulose acetate films.

RIF immunofluorescence reaction was proposed in 1942 by Coons et al. It is based on the luminescence of antibodies labeled with various fluorochromes, while the antibodies come into contact with antigens on the surface of the objects of study. An indirect immunofluorescence reaction is used, consisting of two stages:

1) contact of the antigen with non-fluorescent serum;

2) treatment of the object of study with luminescent serum.

After establishing the belonging of blood to a person, its group is determined.

Determination of the blood group

When investigating such serious crimes as murder, rape, committed in the absence of witnesses, finding out the possible belonging of the blood to the victim or suspect is of particular importance.

Group affiliation can be determined in traces of blood on objects, in tissues of dissected parts of corpses, in liquid blood taken from victims or suspected as samples. When examining a corpse with injuries accompanied by external bleeding, determination of the blood group taken from the corpse is mandatory. In the future, traces of blood may be found on objects, on persons suspected of committing a crime, on vehicles, and at the scene of the incident. The group affiliation of these traces should be compared with the group affiliation of the blood samples of the deceased.

The determination of blood grouping is based on the detection of specific substances present on the surface of erythrocytes (antigens) and in the blood serum (agglutinins). In the blood serum of a healthy person, as a rule, there are no agglutinins that react with antigens that are in the erythrocytes of this person. This is the basis for the division of all people into groups. Group signs develop in the uterine period of life. Subsequently, these characteristics do not change qualitatively. In dry blood and its traces, agglutinins can persist for several years. Antigens persist much longer.

In addition to erythrocytes, the same antigens are found in human organs and tissues, its secretions, which makes it possible to determine their group affiliation. Each person has an individual set of antigens and serum proteins characteristic of him.

The group affiliation of traces of blood is practically determined within the ABO erythrocyte isoserological system, if necessary, according to the systems P, Lewis, MNSs, Rhesus, serum globulin system. In liquid blood, a broader definition is possible. It is possible to detect or exclude in liquid blood stains a significantly larger amount of both erythrocyte and serum systems, enzyme systems, etc.

According to the ABO system, human blood is divided into four groups: O (I), A (II), B (Sh) and AB (IV). When determining the group affiliation of liquid blood samples, erythrocytes and serum are examined separately. When examining spots, a control reaction is set by the material of the object - control of the carrier object.

Difficulties in determining the grouping of blood in stains are mainly due to the influence of the material itself, the object on which traces of blood were found, as well as a small amount of blood in stains, the initial strength of antigens and agglutinins.

Determining the grouping of blood makes it possible to exclude its belonging to a certain person (victim or suspect) or to indicate that such an exception cannot be made.

The group affiliation of liquid blood is determined in connection with the resolution of questions about disputed paternity, replacement of children, theft of a child, and, as an exception, about disputed motherhood. The study is based on the patterns of transmission of group traits to descendants by inheritance.

Differentiation of the blood of an adult and a fetus

The blood of a fetus, a newborn child, and a child under the age of about 1 year is different from the blood of a person older than this age. The differences lie in the structure of some specific proteins, in particular R-fetoprotein. The differentiation of proteins present in the blood of an adult from the corresponding proteins of an infant is carried out using electrophoresis methods. It is also possible to detect differences in the activity of certain enzymes using biochemical methods. The above methods are not widely used in everyday practice due to the complexity of their implementation, as well as the need to use expensive reagents and equipment.

In addition, adult hemoglobin is less resistant to alkaline denaturation than fetal hemoglobin.

In 1958, German researchers proposed a cytological method for the detection of fetal hemoglobin for clinical purposes.

In 1984, N. V. Belikhina proposed a method for detecting FeHb for forensic examination of material evidence. The fundamental basis of the method is that FeHb is more resistant to HCl (hydrochloric acid) and pepsin than Hb in an adult.

Possibilities of regional origin of blood

In forensic practice, methods are used to identify impurities in traces of blood. The nature of these impurities is determined by the place of bleeding. The cells and tissues of any organ have their own individual structure. Even tissues of the same type in different organs can have certain differences. So, for example, with nosebleeds, it is possible to determine an impurity consisting of mucus and tissue cells of the epithelium of the nasal cavity, with bleeding from the uterus, cells of the corresponding epithelium and characteristic mucus are found, with bleeding from the rectum, feces can be detected as an impurity.

Currently, new methods are being developed based on the detection of impurities in the form of enzymes in blood traces and on the measurement of enzymatic activity.

Determining the Age of Blood Spots

The hemoglobin contained in erythrocytes gradually changes under the influence of environmental factors. These changes are called "aging". Over time, hemoglobin is converted from oxyhemoglobin to hematoporphyrin in several steps. Each form of hemoglobin has its own spectral characteristics. The spectrophotometric method establishes the stage of hemoglobin conversion. Based on the results of applying this method, one can judge the age of blood formation in a stain on material evidence. However, the process of "aging" of hemoglobin is influenced in each case by some individual set of factors. Among them, one can indicate humidity, sunlight, temperature, the properties of the material of the object on which the trace of blood is located, as well as the initial state of the blood, etc. These circumstances make the result of determining the age of blood stain formation very approximate.

At the same time, at present, using biochemical methods, it is possible to answer the question of the prescription of blood traces by determining the enzymatic activity of blood. Some blood enzymes retain their activity for 80-100 days.

Establishing the amount of liquid blood poured out by its traces

In some cases, in connection with the investigation of cases involving the infliction of injuries accompanied by external bleeding, it becomes necessary to determine the volume of bleeding in traces of blood. It is known that when drying 1000 ml of liquid blood, approximately 211 g of dry residue is obtained. Based on these data, it is possible to determine, by the amount of dry blood in the detected traces, the initial volume of the outflowing liquid blood. In this case, one should take into account the approximate nature of these calculations, due to several circumstances. The fact is that the degree of drying of the blood and obtaining a dry residue in each case are individual. And at the same time, it is not possible to accurately measure the mass of dry blood in its traces.

Determination of the state of pregnancy by blood stains

There is evidence that shortly after the onset of pregnancy, starting from about the 8th-10th day of her pregnancy, the corresponding hormone appears in the woman's blood. It has good stability in the external environment. As a result, its detection in traces of blood is not difficult and serves as proof of the origin of blood from a pregnant woman.

Also in the blood of pregnant women there is an enzyme - oxytocinase. After childbirth, it gradually disappears during the first month. This enzyme is also well preserved in traces of blood. It can be detected even 2-3 months after the formation of a blood spot. The detection of the presence of this enzyme in traces of blood also indicates the origin of blood from a pregnant woman or a woman who has recently given birth.

Determination of the origin of blood from a living person or from a corpse

This question rarely arises in forensic practice. The principle of the technique used for this is as follows. Some time after death, after about 1-2 hours, enzymes begin to penetrate into the blood of the corpse, which during life were exclusively in the tissues. Consequently, gradually the blood in the corpse acquires other properties. The solution to this issue is based on the detection of the above enzymes in the traces of blood. However, it should be noted that since the blood of a recently deceased person is practically no different from the blood of a living person, this technique does not work in such a situation. Therefore, it is not possible to say that the stain formed while the person was still alive, or immediately after the onset of death.

Establishment or exclusion of the origin of blood from a particular individual

The question of the origin of blood from a particular person is of great importance in cases of solving crimes against a person. An expert opinion on the origin of blood on the instrument of injury, as well as on the body or clothing of the victim from the suspect, or on the origin of blood on any physical evidence from the victim, is one of the important evidence.

This issue is resolved in two ways. The first is to compare the grouping of blood with material evidence and blood from a specific person. In human blood, in its various components, there are antigen proteins, they are due to the individual properties of DNA, which is inherited by each person from both parents. These antigens are very similar in different people and represent variants of the structure of the same protein, however, there are some differences in the structure of these proteins. Different antigens of the same type are called isoantigens. Antigens of the same type with the above differences constitute a system. For example, according to the ABO system, people can be divided into four blood groups, the differences of which are predetermined by the presence or absence of two isoantigens. There are also other systems with different numbers of groups in them. For example, there are nine groups in the MNSs system. In any particular person, you can determine the blood type in many systems. For example, according to the ABO system, the blood of an individual can belong to the first group, according to the MNSs system - to the eighth, etc. There are more than 300 thousand variants of blood groups, for example, according to ten systems. Consequently, a specific variant of blood groups according to ten systems is found in one out of 300 thousand people. The number of variants of blood groups for other systems or for a different number of systems will differ to some extent. Nevertheless, the foregoing quite clearly illustrates the possibility of using this method, for example, in order to identify a specific culprit from a finite and relatively small number of suspects.

The second approach to establishing the origin of blood from a particular individual is carried out by using a relatively young molecular genetic method. This method reveals the individual features of the structure of deoxyribonucleic acid (DNA). Any parts of the body, blood and even secretions can be subjected to research. The main condition for this method is the presence of DNA in the test material. The method has a very high reliability of the results, which makes it possible not in a probabilistic way, as is the case with most forensic methods, but in an almost categorical form, to judge the biological identity or difference of the objects under study. Limitations in the application of this method are associated with its high labor intensity, science intensity, and also with a relatively high cost.

Much less often there is a need to investigate traces of other secretions (in addition to blood and sperm) of a person or part of his soft and bone tissues. Traces of saliva can be found on "gags", cigarette butts, postage stamps, envelopes, in the area of ​​damage on the clothes of the victims. Traces of sweat, nasal discharge, urine, feces are examined on various parts of a person's clothing or other items found at the scene. The discharge of female genital organs may be on the clothing or body of a person suspected of committing a crime. Parts of soft or bone tissues are found in cases of dismemberment of corpses or injuries, accompanied by separation of body parts (fingers, hands, feet). A study of the traces of these secretions establishes their presence, determines the species affiliation, and reveals a group characteristic. When examining parts of the body (cartilage, skin, bones, etc.), their gender can be determined. The presence of traces of secretions is established by two main methods - morphological examination and biochemical color reactions (for amylase - for saliva, for creatinine - for urine, for amino acids - for sweat). The determination of the type of secretions is based on the precipitation reaction; for urine, a reaction is put on the product of oxidation of uric acid. Species and group affiliation of feces is not determined. The group affiliation of other secretions is established within the ABO erythrocyte isoserological system for the detection of antigens. Determining the group affiliation of secretions excludes their origin from a certain person or suggests that traces of secretions on a particular object could come from the victim or suspect, or another person with the same blood type.

Forensic Hair Examination

Hair is one of the derivatives of the skin in the form of horn formations. Hair is found in mammals and, in particular, in humans. Hair covers almost the entire surface of the human body. They are well expressed on the head, in the armpits, on the pubis, sometimes on the chest and other parts of the body. On different parts of the body, hair can differ significantly from each other. In the structure of the hair, the shaft and the root are distinguished. The hair shaft in the region of one of its ends ends with a bulb, which is a thickening located in the thickness of the skin. The hair follicle is the site of hair growth. Three layers are distinguished in the structure of the hair: the outermost one is the cuticle, under it is the cortical layer, in the center is the shaft. Natural hair growth is constantly taking place. Individual hairs fall out. Hair can also be removed as a result of breaking off, cutting off, and also pulling out. At the same time, the growth of existing as well as new hair is carried out.

From this it is clear that human hair of various regional origins, as well as animal hair, can be found at the scene. Hair detection should be done by carefully examining various objects with the naked eye, as well as using a magnifying glass. The detected hair is appropriately seized and packaged for inclusion in the case file as material evidence. In the report of the inspection of the scene and on the packaging, records are made of the place where the hair was found. It is possible to use photography and video filming to document the location of hair detection. The hair is then sent for forensic examination. In the course of this study, it is initially established that the objects seized are indeed hair. For this, elements characteristic of the structure of the hair in the form of a rod and a bulb, as well as elements of the internal structure of the rod and cuticle, are established. By the structure of the hair, one can also judge whether the hair belongs to a person or an animal. In the study of human hair, by their morphological features, one can judge the origin of hair from a specific part of the body: from the scalp; from the area of ​​the mustache and beard on the face; from eyebrows and eyelashes; from the armpits; from the pubis and from some other regions of the body. Experts judge the mechanism of separation of hair from the place of their growth by the state of the root ends of the hair.

The detection of a hair follicle may indicate the fact that the hair has been pulled out from the root, the presence of a clear boundary of separation of one part of the hair from another indicates the cutting of the hair, etc. physical, chemical and other factors. For example, the discovery of the fact that the upper parts of the hair were dyed with some kind of paint indicates that the person dyed the hair on his head. Sometimes it is possible to establish the nature of the dye used for this. By the location of the border between the painted and unpainted parts, one can judge how long ago they were stained. The nature of extraneous overlays on the hair can inform us about hair care, about their sanitary and hygienic condition. When identifying specific features of the detected hair, it is possible to judge other features of their condition. For example, when using emission spectral analysis, it is possible to establish the elemental composition of detected hairs. The results of applying this research method can characterize some of the circumstances in a particular case. When hair is found at the scene, the investigation, of course, is interested in the question: what color is the hair of the subject from whom they originated.

At first glance, this question is easy to answer, but in practice there are problems with its solution. They are due to the fact that individual hairs on the head of a person, and on other parts of the body, can differ significantly in color from the totality of hairs as a whole. Moreover, these differences may lie not only in the presence of gray hair among blacks, but also blond hair among dark or dark among light ones. Color combinations can be very different. Therefore, with a small amount of hair, as well as when traces of their changes are found, it is sometimes difficult to judge the hair color of the person from whom they originated. The question of the origin of the hair from a particular person is decided by a comparative study of the hair found during the inspection of the scene and the hair samples taken from the suspect and the victim, and, if necessary, from other persons who could have left the hair at the scene. Hair samples are taken from a person's head from five areas: frontal, occipital, parietal and two temporal. Hair from each area is taken in an amount of at least 15-20 pieces by cutting at the root.

If it is necessary to compare hair follicles found at the scene with samples of hair follicles from a particular person, the hair should be removed by pulling out from the root. If it becomes necessary to compare hairs from other regions of the body, appropriate samples should be taken. The removal of hair samples is carried out in accordance with procedural requirements, hair from each area of ​​the body is packed in separate envelopes with the appropriate inscriptions. If any changes in the hair are known from the moment of the incident until the moment the samples were taken for examination, this fact should be reflected in the protocol of the removal. A direct hair comparison is made by an expert in all possible characteristics. General features are compared: length, thickness, cuticle pattern, etc. Individualizing characteristics are analyzed: their presence or absence on the compared hair, the possibility of influence on them by the time factor, as well as external factors, and much more. In addition to morphological characteristics, some physical parameters can be compared, for example, tensile strength, optical density of native hair and their mineralizates.

In a serological study of hair, antigens of the ABO system are established quite well, which makes it possible to judge their origin from a particular person. In the presence of cells in the area of ​​hair follicles, it is possible to determine the gender of their owner. With the exclusion of the origin of the hair found at the scene from the victim of the crime or strangers, one can assume the origin of the hair from the criminal and try to get as much information about him as possible from the detected hair.

The results of hair research may contain various information about such important characteristics of the wanted person as gender, hair color, hair care features; the fact of contact with rare chemicals; blood group according to the ABO system; the presence of various diseases and some others. Establishing such characteristics can be of great importance for the search for a criminal. Hair as an object of forensic research in criminal cases is quite informative, well studied in scientific and practical terms. With the introduction of molecular genetic research methods into everyday expert practice, the role of hair as an object - a source of evidence in criminal cases - will increase even more.

Author: Levin D.G.

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