Establishing the limitation of death (1). Prescription of death Prescription of death forensic medicine

Time of death (hours)

Pace. in the rectum

Time of death (hours)

Pace. in the rectum

Place of irritation

Degree of reaction

1. At the corners of one eye

Contraction of the muscles of half the face, compression of the eyelids

Eyelid compression

Fibrillation of the eyelid muscles

2. At the outer corners of both eyes

Contraction of the muscles of the entire face, compression of the eyelids

Eyelid compression

Fibrillation of the eyelid muscles

3. At the outer corners of the mouth

Contraction of the muscles of the mouth and neck. Eyelid compression

Contraction of the orbicularis oris muscle

Oral muscle fibrillation

Prescription of death

1- to 5-7 hours.

2- to 3-5 hours.

3- to 2-3 hours.

1-7-10 o'clock

2-to 5-7 hours.

3- to 3-5 hours.

1-10-12 hours.

2-to 8-10 hours.

3-to 5-7 hours.

HYPOSTASIS

The cadaveric spot disappears when pressed and appears after 30 seconds - 2 minutes. This is observed within 6-8 hours after death.

The cadaveric spot disappears when pressed and appears after 2-5 minutes. This is observed 8-16 hours after death.

The cadaveric spot turns pale when pressed and recovers after 5-10 minutes. This occurs 16 to 24 hours after death.

IMBIBITION

Cadaveric spots do not fade when pressed if more than 2 days have passed since death.

Type and cause of death

Time elapsed since death (in hours)

Death is acute and comes quickly

9,5+ 0,45

15,5+ 0,9

21,7+ 1,4

43,9+ 4,7

58,5+ 3,6

87,6+ 9,8

135,9+ 15

143,5+ 31,5

Mechanical asphyxia

11,3+ 0,8

19,1+ 2,1

27,8+ 2,9

40,7+ 8,2

56,5+ 8,9

59,4+ 14,2

137+ 36,5

Alcohol poisoning

15,8+ 1 ,9

24,0+ 5,8

36,9+ 4,4

61,9+ 6,1

90,9+ 6,1

111,7+ 35

Sudden

14,5+ 1,3

19,5+ 1,9

33,2+ 5,1

49,1+ 4,1

169,4+ 24,4

Trauma without blood loss

17,7+ 1,6

24,4+ 2,6

65,2+ 9,2

108+ 14,2

213,5+ 86,5

Trauma with moderate blood loss

12,2+ 0,8

19,6+ 1,3

39,3+ 3,6

53,3+ 4,4

130,2+ 13,3

171+ 27,4

Trauma with sudden blood loss

15,7+ 4,6

26,7+ 2,8

44,0+ 4,2

69,9+ 7,6

109+ 14,4

Alcoholic death

14,8+ 1,8

26,8+ 5,8

44,1+ 8,0

51,8+ 6,0

151+ 11,7

240+ 30,3

• a) in summer – 2 months;
• b) in winter about 1 year

• 20-30 days at T° 15°-20°
• 15-20 days at T° 20°-25°
• 9-15 days at T° 25-30°

Determining the duration of death. Determining the duration of death is an expert determination of the timing of its occurrence in hours for the early postmortem period (up to 2-3 days) or in days (and even months) in the presence of late changes in the corpse.

When investigating crimes against human life, very often there is a need for a forensic medical establishment of the statute of limitations for the occurrence of death, which provides great assistance to the bodies of inquiry, investigation and court and is often decisive for identifying the specific person who committed the crime.

The study of the problem of the limitation of death, undertaken to solve special forensic issues, is also of no small importance for health authorities. The duration of death, determined in the early stages of the postmortem period, is established primarily on the basis of changes associated with the survival of tissues and organs. The results of studies of early post-mortem changes obtained by forensic doctors using modern laboratory methods can be useful for transplantologists, resuscitators, pathophysiologists, biochemists and representatives of other medical specialties. It was noted that in most tissues the phenomena of autolysis are noticeable by 12-18 hours of the post-mortem period and sharply expressed by 36-48 hours. Glycogen in the liver is practically not determined by 24 hours, by the same time the content sharply decreases. A certain dynamics of changes in activity was noted depending on the time period from the moment of death with a pronounced tendency to decrease by 48 hours. ATP activity in muscle tissue disappears by 12 hours of the postmortem period.

Consistent indicators for early death have been obtained using a number of physicochemical and biophysical methods. These primarily include the method of recording changes in ultra-weak luminescence (chemiluminescence) of homogenates of various tissues and determining the concentration of potassium ions in the blood.

Data have been obtained indicating certain patterns in the increase in the content of individual elements ( , ) in body fluids and, conversely, some decrease (sodium) depending on the duration of death.

When examining corpses at the place of discovery and when examining them in a morgue, methods for determining the duration of death are widely used, based on the dynamics of the formation and development of early and late changes in the corpse.

Cadaveric spots in the stage of hypostasis they appear 2-4 hours after death; in the period from 2-4 to 12-14 hours, cadaveric spots completely disappear when pressed on them and after some time restore their original color. In the diffusion stage, which approximately lasts from 14 to 24 hours, cadaveric spots turn pale when pressed and restore their color much more slowly, and finally, after 24 hours, cadaveric spots do not change their color. This pattern of changes in the nature of cadaveric spots makes it possible to roughly determine the duration of death. However, this technique is of a pronounced subjective nature.

Indicative data for determining the duration of death depending on the time of restoration of the color of cadaveric spots are presented in Table 1.

The table shows average indicators. The color of cadaveric spots and the time required to restore their color depend on the causes of death. For example, in case of death from mechanical asphyxia, which is characterized by abundant bluish-purple cadaveric spots, the time required to restore their original color is less than in death caused by large loss of blood, when the color of cadaveric spots is restored more slowly. Thus, in some cases, a certain correction is necessary in assessing changes in cadaveric spots, taking into account their severity and cause of death.

Determination of the duration of death based on cadaveric phenomena

Study of corpse cooling. There is a certain pattern in the cooling sequence of a corpse. In most cases, the process of cooling a corpse ends completely within the first day after death (according to some sources, within the first 16 hours after death, according to others, no earlier than 1.5 days after death). Cooling of a corpse begins with the exposed parts of the body; the hands and feet cool first. A noticeable cooling of exposed parts of the body can be detected 1-2 hours after death. Warmth is retained longest in the armpits, stomach and neck under the chin. Therefore, it is recommended to measure body temperature in the armpits, rectum, mouth and other parts of the body. This is done using a medical (maximum) thermometer or some electric thermometers produced by our industry, the latter being preferable. Some thermometers are equipped with special sensors for measuring temperature in the rectum, armpit, etc.

Study of cadaveric spots. The time of death is determined based on the presence of cadaveric spots, their ability to turn pale and disappear when pressed, taking into account the conditions affecting the rate of appearance and intensity of cadaveric spots, the amount and condition of the blood (thick or thin), the reasons causing this or that state (disease , poisoning, injury). Thus, with asphyxia, sepsis and a number of other conditions in which the blood remains liquid, cadaveric spots appear quickly and are usually sharply expressed. With thick blood, cadaveric spots are revealed slowly. Cadaveric spots appear very quickly upon death from carbon monoxide poisoning (the transition to the imbibition stage is observed by the end of the day). The reason is severe blood thinning (edema). The rate of appearance of cadaveric spots is also affected by the ambient temperature.

It is impossible to accurately determine the time of death from cadaveric spots - the timing of their appearance and the transition from one stage to another are extremely different, and the duration of each stage is very long. In addition, the assessment of changes in the cadaveric spot when pressing on it is subjective, since the force of pressure cannot be taken into account. To cause the spot to fade at the end of the stasis stage, significant force is required - at least 2 kg/cm2. If the pressure on the area of ​​the spot is not strong enough, it may not fade, which can lead to an incorrect determination of the time of death.

In the first 12-24 hours after death, dynamometry of cadaveric spots can be used to determine the time of death with an accuracy of 2-4 hours. The results obtained must be assessed taking into account the type and cause of death. Dynamometry can also be used in the study of cadaveric spots that have moved to other areas of the body in the first 14-16 hours from the moment of their formation with an accuracy of determining the timing of death up to 4-6 hours.

Dynamometry of cadaveric spots is undoubtedly of practical importance, but the assessment of the results obtained should be carried out in conjunction with other methods of establishing the duration of death.

Rigor mortis research also allows you to determine the duration of death. At present, the time of appearance and reproduction on the corpse of various types of insects devouring dead tissue has been well studied. The timing of egg laying, their transformation into larvae, pupae and adults is known. These data are used in expert practice to diagnose the time elapsed after death.

Detection of testicles, larvae and pupae of flies. Various types of flies lay their eggs in the nasal openings, the corners of the eyes, as well as under the eyelids, in the mouth and in all natural orifices of the body, especially in damp places. The process of development from eggs to adults is determined by the type of fly and conditions (warmth and humidity). Knowing the type of insect and the conditions of its development, one can judge the time that has passed since death.

When determining the time of death, the following approximate calculations are used: fly larvae appear on the corpse approximately 48 hours after death (therefore, the presence of only fly testicles on the corpse indicates that death occurred 24-48 hours ago); after 10-14 days, pupae form from the larvae, after another 12-14 days, the pupae turn into new flies (the flight of flies from the pupae lasts about 2 hours); the presence of empty pupal shells means that the corpse has lain in place for at least 4 weeks. The above calculation is approximate and requires taking into account the specific conditions for the reproduction of insects, mainly the temperature and humidity of the surrounding air. For example, a housefly can complete its entire development cycle at a temperature of +30 C in 10-11 days, but at a temperature of +18 C this period extends to 25-30 days.

Study of the sequence of appearance of various insect species on corpses. There is a certain sequence (alternation) of the appearance of various types of insects on a corpse (buried or unburied). One type is replaced by others. These data can be used to determine the duration of death. In all such cases, it is necessary to conduct a special entomological study.

Study of enzymes and stomach contents. It has now been established that data obtained from the study of enzymes and stomach contents can be used to determine the time of death. But since the length of time food stays in the stomach varies from person to person, it is impossible to make an accurate assessment of this symptom.

It is generally accepted that a well-filled stomach in the presence of undigested food particles indicates that the person ate less than 2 hours before death. If the stomach is empty, then food was not taken for approximately 2 hours before death. The following indicative data are recommended for judging the length of time food remains in the stomach: after a light meal - 1.5 hours; with an average lunch density - 3; after a heavy meal - 4 hours.

The degree of bladder filling can also help in deciding how long ago the patient died.

Modern forensic medical practice does not yet have research methods that would allow us to answer the question of time of death with sufficient accuracy. In practice, in each specific case, one should make maximum use of the information obtained using a set of methods, and make a subsequent assessment based on the totality of the results. The choice of methods and their number is determined by the expert based on the specific situation and the technical equipment at his disposal.

Some data to determine the time of death, obtained during inspection of the place where the corpse was found. Indications of the time that has passed since death, in addition to those obtained during the examination of the corpse or its parts, can be given by some features of the place where it was found (for example, dry or wet traces of blood on and around the corpse).

In case of poisoning with hydrocyanic acid or potassium cyanide, if it occurs during daylight hours, a large number of dead flies are found on the windowsills in the apartment.

In the spring and summer months, when a corpse is found on grass or cereals, the condition of the plants under and around the corpse should be compared. If the corpse lay in a given place for more than 6-8 days, then the grass located directly under it and deprived of sunlight will turn pale due to the loss of chlorophyll. The development of plants under a corpse is somewhat delayed compared to plants near it. The length of time the corpse remained at the site of its discovery is also indicated by the growth of plant roots through it.

The growth of algae on the surface of the corpse removed from the water indicates that it had been there for about 18-20 days.

Consequently, taking into account some features of the place where the corpse was found, we can also judge the time it spent there. If it is established that the place where the corpse was found is at the same time the place of death of the deceased, then the characteristics of this place can be used to judge the time that has passed since the moment of death. Naturally, in such cases, the time of death must be established based on the totality of all the data obtained during the examination of the corpse. Examination of the scene of the incident will help determine the time that has passed since the death of the subject.

Determining the age of burial. A forensic medical report on the age of burial is extremely important evidence in the investigation of cases involving the discovery of a skeletal corpse.

The data available in the literature indicate that the nature of changes in the bone tissue of buried corpses is determined by the properties of the soil. The severity and timing of the appearance of various signs of bone decomposition, which can be noted during the study, depend on them. The issue of the timing of burial of a corpse based on bone remains can be resolved only by using the entire complex of objective research methods. In this case, an analysis of the morphological and physicochemical properties of the soil in which the corpse was buried is mandatory.

Rational methods for studying bones to determine how long ago a corpse was buried are: direct microscopy, emission spectral analysis, exposure to ultrasound, etc.

Upon visual inspection of exhumed bones a gradual change in their color and the appearance of traces of surface destruction in the form of weathering and defects in the compact layer are noticeable. However, judging the age of a material based on color alone is only possible in a purely approximate manner. The destruction of bone surfaces is a more reliable sign; it is closely related to the qualitative characteristics of the soil. If surface weathering and defects of the compact layer on the bones of corpses buried in leached low-humus thick black soil appear no less than 20 years after burial, then on bones exhumed from soddy-carbonate and dark red forest soil, defects of the compact layer, especially in the area epiphyses of long tubular bones, are diagnosed 15-17 years after burial (the listed soils have high physicochemical activity). Carbonate low-humus chernozems are even less active in this sense than leached chernozems.

It should be especially noted that soft tissues, ligaments and cartilage of corpses buried in leached low-humus thick black soil are completely destroyed 2-3 years after burial.

It has been established that in places where corpses are buried there is an increased content of free forms of phosphoric acid compared to control soil samples. Thus, the presence of a large amount of phosphorus in the soil can serve as an indicator of the burial of a corpse in a given place in the event of its disappearance or the movement of bones.

Direct microscopy method complements visual research and makes it possible to differentiate the time of burial based on the bones of corpses exhumed in the next 15-20 years after burial. The signs of bone decomposition in the soil revealed by this method include a gradual change in color, the appearance of traces of destruction in the form of scarifications, cracks and initial signs of mineralization of the surface of the compact layer of the diaphyses of the femurs. Thus, on bones that were exposed to conditions of leached low-humus thick black soil, the first signs of mineralization are revealed 9-19 years after burial. As the length of time the bones remain in the ground increases, the severity of these signs increases.

Changes in the color of bones, determined by microscopy in reflected light, can also be used in a purely indicative form for the purposes of forensic determination of how long ago a corpse was buried.

Emission spectral analysis method most effective when examining exhumed bones to determine how long ago a corpse was buried. Qualitative and semi-quantitative visual assessment of spectrograms allows, based on the content of a number of elements (manganese, aluminum, silicon, iron, strontium), to differentiate fresh bone tissue from exhumed bones of various dates from the burial of a corpse within 10 years. A relative quantitative characteristic expressing the ratio of elements based on the results of photometry of spectrograms with subsequent statistical processing makes it possible to establish the age of burial of a corpse in the range from 2 to 4 years. Using emission spectral analysis, it is possible to simultaneously record the degree of accumulation of various microelements from the soil by bones.

Duration of bone decalcification decreases as the period of its stay in the ground increases. This fact can be used to determine the age of burial of a corpse based on bone remains by taking into account the time required for this process. Depending on the nature of the soil at comparable burial times, bone decalcification varies. Dark gray forest and soddy-carbonate soils have a more active influence on the process of destruction of the mineral component of bones. Based on the duration of decalcification, it is possible to establish the age of burial of a corpse in leached thick chernozem, in soddy-carbonate soil on marls and in carbonate low-humus chernozem with reliability within 2 years.

In order to avoid mistakes, it is imperative to comply with the following condition - to conduct a comprehensive study with an analysis of the morphological and physicochemical properties of the environment in which the bones were located.

These are the main early and late cadaveric phenomena and methods for determining the duration of death.

Signs of biological death:

1) drying of the cornea; 2) the “cat’s pupil” phenomenon; 3) decrease in temperature;. 4) body cadaveric spots; 5) rigor mortis

Definition signs of biological death:

1. Signs of drying out of the cornea are the loss of the iris of its original color, the eye appears to be covered with a whitish film - a “herring shine”, and the pupil becomes cloudy.

2. The thumb and forefinger squeeze the eyeball; if the person is dead, then his pupil will change shape and turn into a narrow slit - a “cat’s pupil.” This cannot be done in a living person. If these 2 signs appear, this means that the person died at least an hour ago.

3. Body temperature drops gradually, by about 1 degree Celsius every hour after death. Therefore, based on these signs, death can only be confirmed after 2-4 hours or later.

4. Purple cadaveric spots appear on the underlying parts of the corpse. If he lies on his back, then they are identified on the head behind the ears, on the back of the shoulders and hips, on the back and buttocks.

5. Rigor mortis is a post-mortem contraction of skeletal muscles “from top to bottom”, i.e. face - neck - upper limbs - torso - lower limbs.

Full development of signs occurs within 24 hours after death.

Signs clinical death:

1) absence of pulse in the carotid or femoral artery; 2) lack of breathing; 3) loss of consciousness; 4) wide pupils and their lack of reaction to light.

Therefore, first of all, it is necessary to determine the presence of blood circulation and breathing in the patient or victim.

Definition signs of clinical death:

1. Absence of pulse in the carotid artery - main sign circulatory arrest;

2. Lack of breathing can be checked by visible movements of the chest during inhalation and exhalation, or by placing your ear to the chest, hearing the sound of breathing, feeling (the movement of air during exhalation is felt by the cheek), and also by bringing a mirror, a piece of glass or a watch glass, or a cotton swab to your lips or thread, holding them with tweezers. But precisely to determine this sign you should not waste time, since the methods are not perfect and unreliable, and most importantly, they require a lot of precious time to determine;

3. Signs of loss of consciousness are a lack of reaction to what is happening, to sound and pain stimuli;

4. The victim’s upper eyelid is raised and the size of the pupil is determined visually, the eyelid lowers and immediately rises again. If the pupil remains wide and does not narrow after lifting the eyelid again, then we can assume that there is no reaction to light.

If out of 4 signs of clinical death one of the first two is determined, then you need to immediately begin resuscitation. Since only timely resuscitation (within 3-4 minutes after cardiac arrest) can bring the victim back to life. They do not perform resuscitation only in case of biological(irreversible) of death, when irreversible changes occur in the tissues of the brain and many organs.

Stages of Dying

The pregonal state is characterized by severe circulatory and respiratory disorders leading to the development of tissue hypoxia and acidosis (lasting from several hours to several days).
. Terminal pause - cessation of breathing, sharp depression of heart activity, cessation of bioelectrical activity of the brain, extinction of corneal and other reflexes (from a few seconds to 3-4 minutes).
. Agony (from several minutes to several days; can be prolonged by resuscitation to weeks and months) is an outbreak of the body’s struggle for life. It usually begins with a short breath hold. Then a weakening of cardiac activity occurs and functional disorders of various body systems develop. Externally: the bluish skin turns pale, the eyeballs sink, the nose becomes pointed, the lower jaw droops.
. Clinical death (5-6 min) Deep depression of the central nervous system, spreading to the medulla oblongata, cessation of circulatory and respiratory activity, reversible condition. Agony and wedge death can be reversible.
. Biological death is an irreversible condition. First of all, irreversible changes occur in the brain cortex - “brain death”.

Resistance to oxygen starvation varies among different organs and tissues; their death occurs at different times after cardiac arrest:
1) GM bark
2) subcortical centers and spinal cord
3) bone marrow - up to 4 hours
4) skin, tendons, muscles, bones - up to 20 - 24 hours.
- it is possible to establish the duration of death.
Supravital reactions are the ability of individual tissues after death to respond to external stimuli (chemical, mechanical, electrical). From the moment of biological death to the final death of individual organs and tissues, about 20 hours pass. They determine the time from the moment of death. To establish the duration of death, I use chemical, mechanical and electrical stimulation of the smooth muscles of the iris, facial muscles and skeletal muscles. Electromechanical muscle responses are the ability of skeletal muscles to respond by changing tone or contracting in response to mechanical or electrical stress. These reactions disappear by 8-12 hours post-mortem. When mechanical impact (impact with a metal rod) is applied to the biceps brachii muscle in the early postmortem period, a so-called idiomuscular tumor (ridge) is formed. In the first 2 hours after death it is high, appears and disappears quickly; in the period from 2 to 6 hours it is low, appears and disappears slowly; when the onset of death is 6-8 hours ago, it is determined only by palpation in the form of a local compaction at the site of impact.
Contractile activity of muscle fibers in response to stimulation by electric current. The threshold of electrical excitability of muscles gradually increases, therefore, in the first 2-3 hours after death, a contraction of the entire facial muscles is observed, in the period from 3 to 5 hours - compression of only the orbicularis oris muscle into which the electrodes are inserted, and after 5-8 hours only fibrillar twitching is noticeable orbicularis oris muscle.

The pupillary reaction to the introduction of vegetotropic drugs into the anterior chamber of the eye (constriction of the pupil upon administration of pilocarpine and dilation due to the action of atropine) persists up to 1.5 days after death, but the reaction time becomes increasingly slower.
The reaction of the sweat glands is manifested by postmortem secretion in response to subcutaneous injection of adrenaline after treating the skin with iodine, as well as by blue staining of the mouths of the sweat glands after applying a developing mixture of starch and castor oil. The reaction can be detected within 20 hours after death.

Diagnosis of death

WMD - it is necessary to establish that in front of us is a human body without signs of life or it is a corpse.
Diagnostic methods are based on:
1. life safety test
Concentrated around the so-called. “vital tripod” (heart, lungs and brain)
Based on evidence of the presence of the most important vital functions:
- integrity of the nervous system
- presence of breathing
- presence of blood circulation
2. identifying signs of death

Signs indicating death:

Lack of breathing (pulse, heartbeat, various folk methods - for example, a glass of water is placed on the chest)
. Lack of sensitivity to painful, thermal and olfactory (ammonia) stimuli
. Lack of reflexes from the cornea and pupils, etc.

Life safety tests:

a. Feeling the heartbeat and the presence of a pulse in the area of ​​the radial brachial carotid temporal femoral arteries (panadoscope - device). Aloscutation is a method of listening to the heart.
b. listening to the heart (1 beat for 2 minutes)
c. when examining the hand of a living person -
Beloglazov's sign (cat's eye phenomenon)
. Already 10 and 15 minutes after death
. When the eyeball is compressed, the pupil of the deceased takes on the appearance of a vertically running slit or oval.
Absolute, reliable signs of death are early and late changes in the corpse.
Early changes in the corpse:
1. Cooling (reducing the temperature to 23 degrees in the rectum, the first hour - by 1-2 degrees, the next 2-3 hours by 1, then by 0.8 degrees, etc.) It is necessary to measure at least 2 times (in at the beginning of the medical examination and at the end.
2. Muscle rigor (onset 1-3 hours, all muscles by 8 hours)
3. Drying of the corpse (parchment spots) - post-mortem abrasions, spots in the corners of the eyes.
4. Cadaveric spots. Location in the lower part of the body depending on the position of the human body.
Stages of their appearance
1) hypostasis 1-2 hours after death (drip - stagnation of blood in the veins and capillaries of the underlying parts of the body as a result of blood flowing after death under the influence of gravity, but the possibility of its flow due to movement of the body remains, during its movement it cannot be noted in what way the state of the body
2) stasis 10 - 24 hours of stagnation of blood, which when moving the body has the property of swelling, then the previous spots remain noticeable.
3) imbibition: after 24-36 hours, blood stagnates to such an extent that blood cannot flow when the person’s body moves.
5. Autolysis - tissue decomposition
Late changes in the corpse
. Rotting (starts from the front wall of the abdomen - 1-2 days in the abdominal area), formation of blisters, emphysema.
(They are also forms of conservation)
. mummification (the process of dehydration of tissues and organs of a corpse and their drying out.
. Fat wax (saponification)
. Peat tanning is the late preservation of a corpse under the influence of humic acids in peat bogs.

Establishing the cause of death

1. identifying signs of the action of a damaging factor on the body
2. establishing the lifetime effect of this factor, the duration of the injury
3. establishment of thanatogenesis - a sequence of structural and functional disorders caused by the interaction of the body with a damaging factor leading to death
4. exclusion of other injuries that could lead to death.

Primary causes of death:

1. damage incompatible with life (damage to vital organs - heart, g.m. - due to transport trauma).
2. blood loss - rapid loss of one-third to one-half of the amount of available blood usually leads to death. (profuse and acute blood loss). A sign of acute blood loss is Mnakov spots - striped pale red hemorrhages under the inner lining of the left ventricle of the heart.
3. compression of organs important for life by escaping blood or absorbed air
4. concussion of vital organs
5. asphyxia with aspirated blood - blood entering the respiratory organs
6. Embolism - blockage of a blood vessel that disrupts the blood supply to an organ (air embolism - when large veins are damaged,
adipose - with fractures of long tubular bones, extensive crushing of subcutaneous adipose tissue, when drops of fat enter the bloodstream and then into the internal organs - g.m. and lungs; thromboembolism - in case of vascular disease - thrombophlebitis, tissue - when particles of tissues and organs enter the bloodstream when they are crushed; solid bodies - foreign objects - bullet fragments)
7. Shock is an acutely developing pathological process caused by exposure to an extremely strong psychological phenomenon on the body.

Secondary causes of death

1. infections (brain abscess, purulent peritonitis, pleurisy, meningitis, sepsis)
2. intoxication (for example, with crush syndrome or compression syndrome) traumatic toxicosis, characterized by local and general pathological changes in response to prolonged and extensive damage to soft tissues.
3. other non-infectious diseases (hypostatic pneumonia (congestion and pneumonia), etc.)

Directory Forensic Medical Examination

Establishing the duration of death

Determining the duration of death. Determining the duration of death is an expert determination of the timing of its occurrence in hours for the early postmortem period (up to 2-3 days) or in days (and even months) in the presence of late changes in the corpse.

When investigating crimes against human life, very often there is a need for a forensic medical establishment of the statute of limitations for the occurrence of death, which provides great assistance to the bodies of inquiry, investigation and court and is often decisive for identifying the specific person who committed the crime.

The study of the problem of the limitation of death, undertaken to solve special forensic issues, is also of no small importance for health authorities. The duration of death, determined in the early stages of the postmortem period, is established primarily on the basis of changes associated with the survival of tissues and organs. The results of studies of early post-mortem changes obtained by forensic doctors using modern laboratory methods can be useful for transplantologists, resuscitators, pathophysiologists, biochemists and representatives of other medical specialties. It was noted that in most tissues the phenomena of autolysis are noticeable by 12-18 hours of the post-mortem period and sharply expressed by 36-48 hours. Glycogen in the liver is practically not determined by 24 hours, by the same time the content of DNA and RNA sharply decreases. A certain dynamics of changes in enzyme activity was noted depending on the time period from the moment of death with a pronounced tendency to decrease by 48 hours. ATP activity in muscle tissue disappears by 12 hours of the postmortem period.

Consistent indicators for early death have been obtained using a number of physicochemical and biophysical methods. These primarily include the method of recording changes in ultra-weak luminescence (chemiluminescence) of homogenates of various tissues and determining the concentration of potassium ions in the blood.

Data have been obtained indicating certain patterns in the increase in the content of individual elements (potassium, phosphorus) in body fluids and, conversely, some decrease (sodium) depending on the duration of death.

When examining corpses at the place of discovery and when examining them in a morgue, methods for determining the duration of death are widely used, based on the dynamics of the formation and development of early and late changes in the corpse.

Cadaveric spots in the stage of hypostasis they appear 2-4 hours after death; in the period from 2-4 to 12-14 hours, cadaveric spots completely disappear when pressed on them and after some time restore their original color. In the diffusion stage, which approximately lasts from 14 to 24 hours, cadaveric spots turn pale when pressed and restore their color much more slowly, and finally, after 24 hours, cadaveric spots do not change their color. This pattern of changes in the nature of cadaveric spots makes it possible to roughly determine the duration of death. However, this technique is of a pronounced subjective nature.

Indicative data for determining the duration of death depending on the time of restoration of the color of cadaveric spots are presented in Table. 1.

The table shows average indicators. The color of cadaveric spots and the time required to restore their color depend on the causes of death. For example, in case of death from mechanical asphyxia, which is characterized by abundant bluish-purple cadaveric spots, the time required to restore their original color is less than in death caused by large loss of blood, when the color of cadaveric spots is restored more slowly. Thus, in some cases, a certain correction is necessary in assessing changes in cadaveric spots, taking into account their severity and cause of death.

Muscle rigor in skeletal muscles is usually detected 2-4 hours after death and is finally formed by 24 hours. Starting from the 3rd day, its resolution occurs. Consequently, the absence of muscle rigor indicates that death occurred within the first 2-4 hours or after 3 days. This type of early cadaveric changes is of very relative importance for determining the duration of death, since at present there are no methods for quantitatively recording the development of muscle rigor that could determine the intensity of rigor in a temporal aspect, especially since for some causes of death (mechanical head injury brain, poisoning with certain poisons) rigor develops very quickly and, conversely, with other types of death (prolonged agony, septic process) it may be very mild or not manifest at all.

Intensity cooling the corpse depends on many reasons, which include the weight of the corpse, the severity of the subcutaneous fat layer, the presence or absence of clothing, its seasonality, as well as the ambient temperature, etc. To determine the age of death when a corpse is discovered in normal room conditions and a relative humidity of 40-60 %, while simultaneously measuring the temperature of a corpse (in the armpits and in the rectum), you can use the data given in Table. 2.

The most intense changes in temperature begin 6 hours after cardiac arrest. Before this period, it turns out to be very close to the normal body temperature of a living person. After 24 hours, the body temperature of the corpse approaches the ambient temperature, and therefore it is also advisable to measure the temperature in the rectum most carefully. To measure the temperature in a corpse, it is recommended to use electric thermometers with high resolution (tenths and hundredths of a degree C); measurements should be taken repeatedly over 1 - 1.5 hours. Currently, a program for the calculator has been developed and proposed, allowing for the process of changing body temperature establish with a fairly high degree of certainty the duration of death within two days of the postmortem period.

The earliest sign of the beginning drying of a corpse, by which one can judge the time of death, are Larchet spots, which are clearly visible on average 4-5 hours after death, therefore, the absence of Larchet spots indicates that death occurred no more than 4-5 hours after death. hours ago.

A number of signs that help establish the timing of death can be identified using pharmacological agents or using electrical, mechanical and other influences.

In expert practice, a method is used based on the definition pupil reactions when exposed to a number of pharmacological substances. With the introduction of a 1% atropine solution, the effect of pupil dilation is observed on average up to 24 hours after death; the effect of pupil constriction in the same period is determined with the administration of a 1% pilocarpine solution. A more accurate diagnosis of the timing of death is possible by injecting these solutions directly into the anterior chamber of the eyes (using a needle and syringe).

In order to establish the duration of death, a technique based on registration of phenomena is also used. electrical excitability muscle tissue. To do this, use devices with a current source (flashlight batteries). Needle electrodes are inserted into the eye muscles, facial muscles, or limb flexors. The greatest effect on the contractility of muscle tissue is observed when irritating the muscles of the eye, then the facial muscles and, finally, the limbs.

To judge how long ago death occurred, the response of muscle tissue to mechanical irritation. With sufficiently strong and sharp blows to the flexors and extensors with a hard object (hammer and other hard objects with a limited surface), the so-called phenomenon of the appearance of an idiomuscular tumor in the form of a muscle roll, well defined under the skin, is observed. A similar response of muscle tissue to mechanical irritation occurs in the first 4-8 hours after death.

Signs such as cooling, changes in the nature of cadaveric spots and muscle rigor, electrical excitability and some others, it is advisable to study in dynamics, starting from the moment of examining the corpse at the scene of the incident and in the morgue (after 1-2 hours) at the beginning and end of the examination of the corpse.

The examination of the contents of the gastrointestinal tract is of forensic medical importance. From the stomach to the duodenum, food contents of plant origin move in 2-4 hours, fatty foods - in 6-10 hours. Through the small intestine, food masses move 180-200 cm per hour. Through the small intestine, food contents pass in 3-4 hours The presence of contents in the ascending colon is detected 6 hours after a meal, in the transverse colon - after 12 hours, in the descending colon - after 18 hours. These data are conditional, but in the general complex of signs they have a certain meaning.

Determining the duration of death in cases where late changes in the form of decay or preservation develop in a corpse is an even more difficult task in forensic medical practice.

Determining the duration of death by the degree of putrefactive changes in the corpse is of very relative importance, since the process of putrefaction is associated with tissue destruction, the intensity of which depends on the variety of influences of endogenous and exogenous factors. However, based on some average data, tentative conclusions can be drawn. Thus, cadaveric greenery in the ileal areas appears after approximately 24-36 hours, the initial signs of putrefactive emphysema can be seen after 3 days, pronounced emphysema and a greenish coloration of the entire skin of the abdomen are determined by 5 days, the appearance of putrefactive blisters and a dirty green color of everything corpse with rejection of the epidermis are observed after 1.5-2 weeks, pronounced putrefactive softening of the tissues of the corpse is determined by 3-4 months. Natural skeletonization of a corpse (without the participation of animals) with preserved bone connections by the ligamentous apparatus can be seen no earlier than after one year; for complete skeletonization with the disintegration of the bone skeleton into its constituent fragments, it takes at least 5 years, which depends on the conditions in which the corpse was located .

When establishing the timing of death, the entomological research, based on knowledge of the patterns of appearance of various insects on the corpse, individual species of which are consistently involved in the destruction of corpse tissue. The greatest significance in determining the duration of death is the detection of various stages of housefly development on a corpse. The usual biological development cycle of flies at a temperature of 18-20 ° C is 3-4 weeks. With the above development cycle, the duration of death can be approximately determined by the following signs: the presence of only eggs on the corpse indicates that death occurred about two days ago, if eggs and larvae are detected - more than two days, with a large number of larvae it can be assumed that death occurred about a week; the appearance of pupae indicates that more than a week has passed since death. All these signs are very conditional, since the development cycles of flies can be shortened and lengthened depending on the ambient temperature, as well as layered on top of each other, and in this case it is impossible to draw any specific conclusions at all.

Some data for making a conclusion about how long ago death occurred can also be obtained by examining a corpse in a state of mummification or fat wax. Partial mummification of the corpse of an adult, depending on the conditions in which it was located, occurs after 2-3 months; complete mummification can usually form no earlier than after 6-12 months. Complete mummification of a newborn's corpse can be completed in 3 months.

Fat wax also, depending on environmental conditions, partially begins to form after 2-3 months. Under favorable conditions (water temperature about 30 °C), the initial signs of fat wax development are microscopically recorded after 2 weeks. The complete transformation of an adult corpse into adipose wax usually ends after a year. The tissues of the corpse of a newborn can completely turn into the adipose wax state 4-5 months after death, and visible initial signs of the transition to this state can be detected after 3-4 weeks.

Most of the above signs only tentatively indicate how long ago death occurred, in relatively large time ranges; it must be taken into account that an expert assessment of certain early, and even more so later, changes in the corpse can become subjective.

Control questions
1. What is the significance for forensic medical examination of establishing the occurrence of death?
2. Describe the methods and methods of establishing the duration of death.

3. Describe the limits of accuracy in establishing the age of death based on the analysis:
a) neuromuscular reactions;
b) dynamics of body temperature of a corpse;
c) the nature of muscle rigor;
d) cadaveric spots;
e) entomological and botanical data.

• Audience 2
• Audience 1
• Drugs
• Audience 4
• Folk remedies

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