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Lecture notes, cheat sheets
Forensic Medicine. Cheat sheet: briefly, the most important
Directory / Lecture notes, cheat sheets Table of contents
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. 2. Features of forensic medicine 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. 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, and the study of physical evidence that are not medical objects. Also, the object of forensic medicine is not only medical documents (inpatient medical record, outpatient medical record, laboratory test results, etc.), but also legal ones. 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. 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. 3. The emergence and development of forensic medicine in Russia 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. In 1797, medical boards were established, whose functions included forensic medical activities. In 1812, the laws on civil and criminal proceedings were supplemented by rules according to which the courts had to apply to experts. In 1815, an order was given to examine the mentally ill also in civil cases. In 1823, a military medical journal began to appear. The judicial reform of 1864, the introduction of open court proceedings influenced the development of forensic medicine in Russia. 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 Chistovich's 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 conducted by P. A. Minakov. 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. He 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. In 1951, previously disparate institutions of forensic medical examination were merged into an independent group - the bureau of forensic medical examination. 4. Procedural and organizational issues of forensic medical examination The fundamentals of the Law of the Russian Federation on protecting 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. 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: 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". 5. The procedure for the appointment of a forensic medical examination The Code of Criminal Procedure of the Russian Federation of 2002, considering the participants in criminal proceedings, includes an expert and a specialist among them. 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. 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). 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 APK 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. 6. Production of a forensic medical examination 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 investigating 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. 7. Duties and rights of a forensic medical expert 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 complete study of the objects and materials of the case provided to him, give a reasonable and objective conclusion on the front issues raised; 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) to ensure the safety of the provided research objects and sang 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. 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, or at the same time receive reimbursement of the expenses incurred. During the examination, the expert is warned about the inadmissibility of disclosing the data of the preliminary investigation. 8. Forensic institutions 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. 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) an office for handling complaints and applications. 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. 9. Forensic traumatology Traumatology (from the Greek trauma - "wound, injury" and logos - "teaching") is the doctrine of injuries, their diagnosis, treatment and prevention. 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. 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. 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 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 medical orientation; 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; 4) a certain sequence of application of research methods, guaranteeing the receipt of maximum factual information about the object of research; 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. 10. Damaging factors 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. Classification of damage. 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, etc.); b) thermal damage; c) electrical damage; 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); b) microsocial, representing the negative impact of human relations, most often in everyday life. 11. The concept of injury 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; 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, which is a consequence of traffic accidents, contact with moving parts of working agricultural machines. n 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. Under military traumatism it is accepted 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. Non-combat injuries cover injuries that occur during tactical and tactical-special exercises and other types of combat training. 12. Mechanical damage 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. 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. 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. 13. Mechanisms of blunt injury formation 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 bounding surface is such a surface, the boundaries of which 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 shape of the traumatic surface can be: 1) flat - triangular, square, rectangular; 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. 14. Types of blunt injuries Abrasion 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. 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 on: 1) from the area of the surface of a blunt object in contact with the body; 2) on the length of the movement of the object through 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. Lastly, whitish shreds of exfoliated epidermis can be detected. 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 3rd-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. 15. Bruising. Hemorrhage. Hematoma Bruising is the soaking of subcutaneous fatty tissue with blood that has leaked out 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 hemo-siderin. 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. 16. 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; 2) tangent (the wound channel does not have one wall); 3) penetrating or non-penetrating; 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; 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-leno-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. 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. 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. 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. 17. 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. 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. The edges of indirect fractures are finely serrated. 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 have the character of transverse or oblique transverse. A small cleavage of a compact substance is formed at the place where the force is applied. 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. 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 compressive destruction of the beam structure. Twisting of the bone is its rotation around the longitudinal axis while fixing one of its ends. 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. In forensic medicine, studies of skull fractures occupy a large place. 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. 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. 18. 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 a 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 injuries the edges of broken bones of brain tissue and meninges. Almost any type of intracranial injury and hemorrhage can occur with a head injury. 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. 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. 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 impacts of extremely high force, to the complete separation of the organ. 19. Car and motorcycle injuries Automobile injury. 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. 6. A combination of the listed types of injuries. Specific damage occurs only when specific type of car injury. These include fractures of the bones of the lower extremities due to impact with the bumper, arcuate bruising from a headlight impact, intradermal hemorrhages and abrasions in the form of a tread pattern, and band-like peeling of the skin when rolling a wheel. Characteristic injuries occur with various types of car injury, and they are used to judge the sequence of stages of the incident. 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. Uncharacteristic damage occurs not only in a car accident. These include traces of dragging in the form of multiple extended abrasions, hemorrhages in the 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. 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. 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 damage resulting from a traffic accident to the driver and passengers of motorcycles and scooters. 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. 20. Rail and aircraft injuries 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. Non-specific injuries in most cases correspond to similar types of automobile and motorcycle injuries. The main mechanism of their formation is the impact of parts of a moving vehicle. 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. 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 edge of the strip formed by the flange is more even and often dirty (rubbing 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. 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 the flight; 2) injury when the aircraft crashed to the ground; 3) injury while the aircraft is on the ground. 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. 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. Chemical factors pose a particular danger when paints, synthetic materials for aircraft construction, and electrical wiring insulation ignite. 21. Fall injury 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, or distant fractures); 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. 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. 22. Forensic medical examination of injuries caused by sharp objects 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) piercing - have a sharp end (nail, knitting needle, needle, bayonet, stylet, pitchfork, fork, folded scissors, peak); 2) cutting - have a sharp edge (a dangerous and safety razor blade, various types of knives during a cutting action); 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); 6) piercing-chopping (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. From the action of sharp objects, such injuries are formed as scratches, wounds, damage to soft tissues, internal organs, less often - bones of the ichthroid. 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. 23. Stab and cut wounds 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 shape of piercing objects is very diverse, which makes it difficult to classify them and makes it very general and conditional. Usually, a piercing object means a cylindrical rod, turning into a cone at the very point. Many of them have handles. Some piercing items may contain not one, but several piercing rods. 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. 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. 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. n 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; 4) incised wounds are characterized by their gaping as a result of skin elasticity and contractile action of muscles; 5) the shape of the incised wounds is fusiform or semi-lunar. When the edges are brought together, the wound acquires a linear shape; 6) incised wounds are accompanied by significant external bleeding; 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 ones. 24. 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. 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-shaped stab wounds are more common. The shape of the wounds can also be arched, angular, etc. In those cases when 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 sedimentation or with slight sedimentation, respectively, in 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. 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. 25. Chopped and sawn wounds 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. 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. 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. 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. 26. Gunshot injuries 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. Injuries caused by bullets fired from modern models of small-caliber hand-held combat firearms have certain morphological features: more often than when fired from medium-caliber weapons, blind wounds are formed, in a gunshot wound there may be many metal fragments of a destroyed fragmented bullet, exit gunshot wounds are very extensive, and are 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. 27. Characteristics of a gunshot wound 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. 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. Blind is called such a bullet wound, in which the firearm remained in the body. Blind wounds are usually inflicted by bullets with low kinetic energy due to its low initial speed, unstable flight, design features that lead to its rapid destruction in 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. 28. 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 explosive 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. 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 object being struck 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. 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. 29. Shot at point-blank range and shot from a distance When fired at point-blank range 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 press it with force to the muzzle end of the weapon, forming a bruise in the form his 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 oxy- 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 depths of the wound channel due to a tight stop, making it impossible for them to penetrate 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 oxy- and carboxy-hemoglobin. 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). 30. Shot wound and automatic burst 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. Shot range is 200-400 m. The degree of dispersion of a shot shell determines the characteristics of shot damage at different shot distances. 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, aggravated 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 fired 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. Wound by automatic burst Due to the high rate of fire, the relative 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. 31. Explosive injury 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. 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; 4) special submunitions: elements of mechanical action (balls, rods, arrows, etc.), substances of chemical action, substances of thermal action; 5) secondary projectiles. 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. 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. 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-, methyl carboxyhemoglobin in destroyed soft tissues. Explosive particles are capable of exerting local mechanical, thermal and chemical effects (burns). Explosion carbon black usually impregnates the superficial layers of the epidermis. The consequences of the action of a shock wave are similar to damage 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. 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. 32. 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. 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, following one after another, inhalation movements caused by the accumulation of carbon dioxide in the blood; 2) the stage of expiratory dyspnea - increased exhalation, a decrease in the volume of the chest, excitation of the muscles; 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. 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; 3) petechial hemorrhages in the mucous membrane of the lips; 4) intense diffuse dark purple cadaveric spots; 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; 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. 33. 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 loop tightened under the weight of the victim's body; 2) strangulation with a loop, which occurs when the neck is evenly 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 the fingers or between the shoulder and the fore-shoulder. 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. 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. 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. 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. 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. When strangulated with hands, small rounded bruises from the action of fingers are visible on the neck, no more than 6-8 in number. The 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. 34. Obstructive (aspiration) 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. 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. 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. 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. 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. 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. 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. Asphyxia in enclosed and semi-enclosed spaces This type of mechanical asphyxia develops in spaces with complete or partial lack of ventilation, where there is a gradual accumulation of carbon dioxide and a decrease in 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. 35. Examination of harm to health 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. 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. Serious bodily harm 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. 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) slight permanent loss of general ability to work - persistent loss of general ability to work, equal to 10%. 36. Examination of working capacity 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. 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. 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. 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 sizes; the number and condition of the teeth (milk, permanent, wisdom teeth, degree of wear); the state of vegetation on the face, in the armpits, on the pubis; 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; mal-chikov - change of voice; the degree of formation and age-related changes in the bone skeleton, detected by X-ray examination. 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). 37. Feigned 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. Feigned diseases can be expressed in the form of aggravation and simulation. Aggravation - 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. 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. 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. 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. 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. 38. Examination of the victim 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, on which there may be traces of blood, feces, vaginal discharge, hair, etc., are subject to mandatory examination by the 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. 39. Sex determination 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. 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. 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, discharge from the genital organs, 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. 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. n 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. 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, endocrine disorders, chronic infections and intoxications, radiation exposure, etc. It is required to study medical documents if the testified was treated, and in difficult cases - send her to a hospital examination. 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 inability to have sexual intercourse include endocrine diseases, etc. 40. Establishing virginity 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 covering 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. An examination to establish virginity is prescribed both in a civil process (in case of insults, slander) and in a criminal one (in case of forced sexual intercourse). 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 due to hemorrhages, precipitation, tears are observed in some cases with onanism, as well as with scratching, produced by the girl herself during itching. 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. 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. 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. 41. Examination of pregnancy, childbirth, abortion 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. 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. Early signs of pregnancy include: the cessation of menstruation, changes in the mammary glands and uterus, positive results of biological tests. 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. 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. 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. 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. 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. 42. 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. 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. 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 sufficiently physically developed can be raped by one man. Its resolution depends on many conditions. If the forces are approximately equal, then this possibility is excluded. 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. Threats, intimidation, deception can force a woman to have sexual intercourse and are considered as a mental influence. Perverse actions. They are understood as the satisfaction of sexual passion without performing a normal sexual act. Examination of indecent acts is very difficult, since objective signs of their commission are rarely observed. 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. 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. 43. Forensic medical examination of poisoning 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%. 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 a 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 classify yals depending on their ability to exert 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), paralyzing the central nervous system - cyanide and organophosphorus compounds, poisons that act mainly on the peripheral nervous system, - natural and synthetic muscle relaxants. 44. Forensic medical diagnosis of poisoning 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; 2) on the chemical essence of the poison; 3) the rate of death. The purpose of the internal examination of the corpse is to establish: 1) ways of introducing poison; 2) organs and tissues affected to the greatest extent; 3) the nature of contact (chemical burns) dystrophic changes in internal organs; 4) the presence and nature of the developed complications; 5) signs characteristic of the action of individual poisons; 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. 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, excretion of poison from the body, use of antidote therapy, improper sampling of biological material for forensic chemical analysis, improper storage of the seized biological material, incorrect choice of chemical analysis technique, low the sensitivity of the applied technique of chemical research, technical errors. A positive result of a forensic chemical study does not always indicate poisoning. The reasons for the positive result of such an analysis (in the absence of poisoning) may be: endogenous formation of poison in various diseases, 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 the tissues of a corpse from soil or clothing, deliberate post-mortem administration of poison, accidental ingestion of poison due to improper sanitization of the corpse, errors in the organization and technique of forensic chemical research. Therefore, forensic evidence of poisoning must be the result of an evaluation of all collected data. 45. 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 pleased with himself and those around him, self-confident, optimistically overestimates his capabilities, boastful. The intoxicated one speaks a lot of games, 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. 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. 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. 46. The action of high temperature. Local damage 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. II degree - serous inflammation and the formation of blisters containing a clear or slightly cloudy liquid. 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). IV degree - charring of tissues, including bones. The higher the temperature and the longer the exposure time, the deeper the damage and the more severe the burn. The severity of the burn depends not only on the degree, but also on the surface area of the body. 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). II period - burn toxemia (from 3 to 10 days). 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. IV period - burn exhaustion. A month after the burn or later, general wound exhaustion may occur. 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; 9) the fluids of the blisters contain a large amount of protein and leukocytes. 47. The action of high temperature. General action 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 the premises, as well as during long marches. 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 ° C 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 blue rv6 is observed, 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. 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 lead to death, while pathoanatomical examination shows the same changes as with heat stroke. 48. The effect of low temperature. local action 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. There are 4 degrees of frostbite. I degree - characterized by vascular disorders. There is a slight cyanosis and swelling of the skin, which disappear within a few days. 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. 49. Effect of low temperature. General action 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 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. 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. 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. 50. Defeat by technical electricity 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 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 as a result of direct contact with a current-carrying object, less often - at a short distance from the current source. 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 with a force 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. 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. Human 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). The denser the contact with the current-carrying conductor and the longer the time of current exposure, the greater its damaging effect. 51. 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) 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 exceeding 120 ° C released at the same time. 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). Atypical electrotags look like abrasions, hemorrhages, tattoos, burns, calluses, etc. All suspicious areas that may be an electrotag are excised for further laboratory research. 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. 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. 52. Classification of death 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. With 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. 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 the heart sounds are sharply weakened, the heart rate is first increased and then reduced, blood pressure decreases, breathing is frequent. 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. 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. 53. Classification of signs of death 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; 6) lack of pulse on large arteries; 7) lack of heartbeat; 8) cessation of breathing. Reliable signs of death Corpse cooling. A reliable sign of death is a decrease in the temperature in the rectum to 25 ° C and below. 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. 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. 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. 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 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. Dead spots. 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). 54. Examination of the corpse of a newborn baby Such a 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. There are three indisputable signs of newbornness: 1) umbilical cord; 2) the presence of a birth tumor; 3) the presence of a cheese-like, original lubricant. 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. In the study of out-of-hospital miscarriages, the forensic examination is aimed at identifying various bodily injuries that may indicate the use of various objects for the purpose of fetal expulsion. One of the reasons for non-viability in some cases are malformations of vital organs 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. 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. 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. 55. Preliminary tests for the presence of blood 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 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. 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 track. In the presence of blood, the swab acquires a bright blue color. 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. Determining 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 ingests 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 human and cattle proteins. Determination of the blood group 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 located 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. 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 I-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. 56. Studies of other human tissues and secretions Much less often, it becomes necessary to investigate traces of other secretions of a person or parts 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 clothes 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. 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, 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 At the scene, human hair of various regional origins, as well as animal hair, can be found. In the course of the investigation, 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. According to 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 particular part of the body. Author: Levin D.G.
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