From Big Medical Encyclopedia

DAMAGES — the disturbances of an anatomic integrity of fabrics or bodies which caused disorder of their function.

More often the term is used for designation patol, by impacts on an organism of various environmental factors. In this sense mean an injury by P., napr, mechanical, thermal, chemical, acoustic, mental p other P. consider also as one of manifestations diseases (see) when tell about morfol, changes in fabrics or bodies at any disease, e.g. P. muscles of heart at a giperkatekholaminemiya. The term «damage» designate, at last, changes in structure of a cell at various patol, states, e.g. P. of a lamellar complex of a cell at an infection.


Distinguish exogenous and endogenous Items. Exogenous P. (the most frequent and diverse) arise at influence of various environmental factors. From them the biggest group — the mechanical P. resulting from influence, as a rule, of significant mechanical force (blow, compression, stretching etc.). Mechanical P.'s option is the vibrotrauma of fabrics and bodies caused by long action of vibration (see. Vibration disease , Vibrotrauma ). Among P. the physical factors caused by influence, allocate the thermal P. arising at action of low high temperatures of a pla (see. Burns , Freezing injury ). At influence of high or low atmospheric pressure it is possible barotrauma (see), at influence excessive on force or duration of sound waves — acoustic injury (see), impacts of ionizing radiation result beam damages (see), radial illness (see). At defeat by light radiation the specific injury of organs of sight develops (see. Ophthalmia ). Electric current causes characteristic local and general changes in an organism — electric trauma (see). Considerable acceleration (see), napr, at ejection (see), can be followed by the peculiar P. connected with redistribution of blood in an organism. Chemical P. are connected with action on an organism of acids, alkalis (see. Acids and bases ). poisons (see), toxic agents (see).

A specific place among exogenous P. is held by so-called mental injuries (see. Reactive psychoses ), arising, e.g., at heavy nervous shocks.

P. of wartime (fighting P.) differ in special specifics. Are characteristic of them, depending on influence of various striking factors of the used weapon, weight of defeat, the multiple or combined nature of wounds (damages), contemporaneity of their emergence, especially at use of means of mass defeat, involvement in patol, process of many bodies and systems. Such P., a proximate cause carry to endogenous to-rykh is in the organism — internal injuries toxic products, naira, at traumatic toxicosis (see), inf. diseases, intoxications (see), alterativny processes at an inflammation, as a result of the immune or autoimmune conflict.

Patol, the state which arose at combined action of two and more etiologically various disturbing factors name the combined P., napr, a change together with beam damages (see).

Distinguish production, home, sports, road and transport and other accidents (see. Traumatism ). Road and transport injuries divide into autoinjuries, railway injuries, etc. In connection with specifics of genesis and frequent uniformity of localization of P. allocate injuries during the falling from height — a katatravma. Allocate P. which are one of types professional vrednost (see). A specific place is held so-called. Iatrogenic P., napr, operative measures, punctures and others to lay down. the actions connected with damage of fabrics.

Depending on duration and force of influence of a disturbing factor arise acute and chronic P. Posledniye develop at long repeated action of irritants, weak on force, and are, as a rule, one of types microtraumas (see). Considering a kliniko-morphological condition of fabrics at the time of an injury, allocate P. patholologically of the changed fabrics, naira, the pathological changes arising under the influence of an insignificant injury in the changed bone.

Distinguish also reversible and irreversible effects of P. E.g., P. of skin and mucous membranes are more often reversible, and P. of tissue of a head or siinny brain usually are irreversible that is connected with unequal ability of various fabrics to regeneration. At heavy and massive P. of vitals — a brain, especially brain trunk, heart, and also at extensive P. of other internals sometimes speak about an injury, incompatible with life.

Bruises depending on that, it is damaged or not skin, divide on closed and opened. Carry to the closed P. bruises (see), hypodermic gaps (see) or stretchings of fabrics (see. Distortion ), concussion (see), the prelum of fabrics and bodies closed changes (see) and dislocations (see). To open P., for to-rykh outside bleeding and, as a rule, infection is characteristic, carry grazes And scratches (i.e. injuries of epidermis of skin), wounds (see. Wounds, wounds ), open changes and dislocations, as well as the most severe injuries of a musculoskeletal system — separations (so-called traumatic amputations) and crushes of extremities.

Depending on a point of application of the injuring force distinguish direct and indirect Items. At direct injuries patol. changes in fabrics appear in a place of application of force, e.g. a wound on site of blow by a sharp object. At indirect P. patol, changes of fabrics arise not in a place of application of force, and in the neighboring or more remote areas, napr, dislocation of a hip at blow in the field of a knee joint.

In a wedge, the practician P. divide on their localization, naira. The item of bodies of a stomach, P. of a brain, and also depending on defeat of separate systems, e.g. P. of bodies of urinogenital system, a musculoskeletal system.

All mechanical P. divide on isolated, multiple and combined. Isolated call P. of one internal body or a segment of a musculoskeletal system. The isolated P. can be mo-nofokalny (e.g., a single wound of a liver or a small bowel, a fracture of a femur at one level) and polyfocal (e.g., several wounds of a nechena, several wounds of a small bowel, a fracture of a femur at several levels). Call multiple P. of two and more internals in one anatomic cavity either fascial space or P. of two and more segments of a musculoskeletal system (P. of a large and small bowel, a rupture of a liver and spleen, a fracture of femoral and humeral bones). The combined P. name joint injuries of internals in various anatomic cavities or fascial spaces; damage of internal body (or bodies) in combination with an injury of elements of a musculoskeletal system (e.g., P. of a lung and a liver, an injury of a kidney and spleen, a bruise of a brain and a fracture of a femur). For of both multiple, and combined P.' designation use the term polyinjury (see). From the tactical point of view at a polyinjury it is important to allocate dominating P. Eto most often life-threatening injuries of internals, and at multiple injuries of a musculoskeletal system — open changes.

From all variety of mechanical P. allocate some types differing in the specific mechanism and uniformity of damages of fabrics and bodies. P. at childbirth are that — birth trauma (see). Allocate so-called endogenous mechanical P.: e.g., the forced in-coordinate reduction of muscles during an attack of tetanus or in labor can cause avulsion fractures, compression spinal fractures. Injuries of internals or other fabrics can be ranked by acute fragments of bones as this group P. conditionally.

After action of a disturbing factor in an organism local and general changes in fabrics and bodies develop. Specifics of these changes, their intensity, duration and an outcome depend on many factors. The basic among them is character of the damaging agent — his look, speed at blow, the weight, height of falling and character of a surface of collision (at a katatravma); P.'s localization and extensiveness (volume) of anatomic damages of fabrics; a condition of the victim at the time of getting injured (age, a somatic background, a mental state, etc.).

According to intensity of manifestation of the general disturbances after P. it is accepted to estimate the general condition of the victim as satisfactory, moderately severe, heavy and extremely (extremely) heavy. Extremely serious, agonal condition and clinical death are carried to to terminal states (see).

Expression «heavy damage» can testify both to extensiveness of the center of P., and to specifics of reaction to an injury; e.g., the fracture of a neck of a femur for the person at senile age is much more severe injury, than at mature age.

Each P. is estimated (predict) from the point of view of its danger to life or dysfunction of this or that body. The preliminary forecast — P.'s assessment in the course of treatment (so-called dynamic forecasting). It is especially urgent for the multiple, combined and combined P., at to-rykh during various periods of a disease P., various on localization, and therefore the forecast in the course of treatment can change can dominate.

The final forecast is formulated at the end of treatment. At the same time judge anatomic, functional and labor outcomes P. Posledny (i.e. extent of recovery of the general and the prof. of working capacity) depends both on functional result, and on specifics of a profession. The forecast includes also duration of stay of the patient in a hospital, duration temporary and probability of resistant disability, threat of a lethal outcome.

Terms of healing at P. and terms of disability are extremely variable that is connected with localization and P.'s character, age and a sex of the victim, his somatic condition, existence or lack of complications, time of the beginning and adequacy of the carried-out treatment P.

Iskhod P. can be various: an absolute recovery, recovery with the residual phenomena or irreversible changes, vedush; them to disability, a lethal outcome.

The reasons of a lethality at mechanical P. are diverse: The item of vitals, early and a pozd-npa heavy complications of P. (shock which at mechanical P. is quite often combined with blood loss, a fatty embolism, a thromboembolism of a pulmonary trunk, pneumonia, sepsis, an acute renal failure, wound istoshch; eniye, peritonitis, abscess of a lung and empyema of a pleura, other purulent processes of internals, etc.).

Measures of prevention Items consist in actions organizational, technical and a dignity. - a gleam, character. Methods of protection against P. happen collective (use of the accident prevention on production, observance of safety rules on transport, in sport, etc.) and individual (use of various defensors).

DAMAGES to the medicolegal relation

Damages are an object court. - the medical examination which is carried out according to offers of law enforcement bodies. According to the purposes and problems of this examinations (see) it is accepted to define P. as the disturbance of an anatomic integrity or physiological function of bodies and fabrics which resulted from influence of environmental factors: motive energy

of any body (P. blunt and sharp objects, firearms), thermal and volumetric factors, radiant energy, atmospheric and tekhnich. electricity, change barometrich. pressure.

The nature of disturbances of an anatomic integrity or physiological function of bodies and fabrics happens various that depends on properties povrezhdayush; its factor. In court. - medical practice examination of a mechanical injury is most often carried out, to a cut carry: grazes and bruises (hemorrhages), wounds, dislocations and changes, contusions, concussions, gaps and separations of internals, razmya-ty, crush and division (partition, department) of parts of a body.

Each type of these P. is connected with the specific tool of traumatization possessing a certain mechanism of action. E.g., grazes are always caused by blunt firm objects, their localization corresponds to a place of application of force. They can be the only outside sign of violence in this connection it is necessary to investigate in details subject fabrics where hematomas, fractures of bones and ruptures of internals are possible. In a form of grazes sometimes it is possible to judge properties of the damaging subject and the direction of the operating force. E.g., longitudinal striate grazes on skin arise during the drawing of a body of the person, extensive grazes in the form of wide strips are formed during the moving by wheels of the train etc. However it must be kept in mind that at action of the same damaging subject there can be grazes of a different form and size. Therefore, the conclusion about an origin of a graze as a result of influence of a certain subject can be made only when the sizes and a form of a graze reflect features of the damaging subject. In this respect detection on a surface of grazes of particles of a subject is of great importance, the Crimea the graze was caused (e.g., particles of asphalt during the drawing of a body of the victim, etc.).

Unlike grazes localization of bruises not always corresponds to a place of application of force, sometimes they appear out of P.'s place in the form of so-called leak-ins of blood. E.g., at fractures of base of the skull blood accumulates in cellulose of eye-sockets, appearing through through skin a century. Velichrsha and a form of bruises usually do not correspond to features of a blunt firm object, the Crimea bruise is caused.

The form and localization of grazes and bruises can indicate a way of their drawing and the nature of incident; e.g., semi-lunar grazes on skin of a neck testify to a prelum her hands, multiple grazes and bruises in the field of generative organs and on an inner surface of hips at women can indicate attempt of rape (violent commission with it sexual intercourse), grazes on hands — quite often result of fight and self-defense. At influences, more considerable on force, disturbance of an integrity of fabrics in the form of wounds, fractures, ruptures of internals, razmyatiya and department of parts of a body happens blunt objects. Ruptures of internals result from direct stroke or a prelum of a body or at its concussion that most often happens during the falling from height when P. of internals considerably prevail over P. нарул^ных covers. Parenchymatous bodies are broken off more often than band. Ruptures of internals owing to a direct injury can not be followed by outside P. in the place of blow. Such gaps should be differentiated with the spontaneous gaps developing owing to patol, changes of internals. During the falling backwards from a standing position characteristic shock-proof bruises of frontal and temporal lobes of cerebral hemispheres which along with P. in occipital area allow to install this mechanism of an injury are noted.

Razmyatiye (crush) of fabrics and bodies meets at a prelum of a body between two massive firm blunt objects, napr, at automobile and railway injuries, blockages the fallen buildings etc. Quite often in such cases department of parts and even a partition of a body is observed.

P.'s prescription is defined taking into account dynamics of their healing. For grazes this process is subdivided into 4 stages: from the moment of its education (the bottom of a graze is lower than the level of the unimpaired skin) before emergence of a crust, usually observable later 12 hours after traumatization; during 12 — 24 hours (sometimes to 48 hours) after an injury the bottom of the dried-up graze begins to grow as if, is compared to level an okra-zhayush; to it skin, and then becomes higher; with 4 — the 5th day the stage of epithelization of a graze which is coming to an end to 7 — begins to the 12th day falling away of a crust; on 7 — the 15th day after an injury all signs on site of the former graze completely disappear.

The prescription of bruises is determined by change of their coloring eventually. Initial blue-crimson color of fresh bruise in several hours is more often or 1 — 2 day passes in blue, on 3 — the 6th day is replaced greenish and at the beginning of the 2nd week becomes ocherous then coloring disappears. Bruises under conjunctivas of eyes, mucous membranes of lips do not change initial color and gradually turn pale.

Intensity of healing of grazes, bruises and other P. depends as on reactivity of an organism, and many other reasons (the size, depth, P.'s localization, etc.). Therefore P.'s prescription can be established only within certain terms. Accuracy of determination of prescription of P. first of all depends on time of survey. What earlier it is made by, especially

P. V prescription process court can be precisely defined. - medical researches of a corpse need to be specified what P. are available, their character and localization; by what tool they are caused, to define the mechanism of an injury and its prescription, to establish whether there is a causal relationship between put to P. and approach of death, to concretize a cause of death. Make a macroscopic research taking into account P.'s localization, a form, the sizes, character of edges for the solution of these questions, a surface, a condition of surrounding fabrics. Apply such methods of a research as direct stereomicroscopy (to finding of foreign particulates and features of P. which are not revealed visually), a X-ray analysis (to definition of features of fractures of bones and detection of foreign bodys in the wound channel), a method of chromotypes and staining chemical changes (to identification of marks of the metals left by the damaging subject), the issue spectrographic analysis (to definition of chemical composition of foreign particulates in the area P.), trasological researches (to identification of the tool of an injury according to P. of a body and clothes), researches of imposings (blood and tissues of the person, hair, fibers of fabrics of clothes, etc.) on the tool of an injury (to its identification), experimental and mathematical modeling, histologic and histochemical researches (to identification of a prizhiz-nennost and P.'s prescription) etc.

One of the most difficult questions court. - medical examinations of P. at a research of a corpse establishment of their intravital or posthumous origin is.

Posthumous P. happen accidental and intentional. Accidental P. can arise at unqualified performing resuscitation, the wrong transportation of corpses, defects of opening, to be caused by animals (e.g., rodents) etc. Intentional posthumous P. are sometimes put for an instsenirovaniye of accident, simulation of suicide, etc. Under nek-ry circumstances (the fire with a collapse of a ceiling, movement of a corpse by a rapid current of the river, etc.) posthumous P. are connected with features of incident.

It is difficult to establish P.'s prizhiznennost in cases of approach of death immediately after an injury when signs of an inflammation do not manage to develop. The main difference of intravital P. from posthumous is existence of hemorrhages in P.'s circle, plentiful bleeding with formation of splashes at wounds of large arteries. Traumatic hypostasis which is especially expressed in a circle of considerable hemorrhages, and also reduction of muscles in cases of traumatic amputation of an extremity is intravital P.'s sign.

Considerable sites of hemorrhages, big polymorphism of erythrocytes and their more intensive coloring by eosine, the increased content in the damaged fabrics of leukocytes, fibrinferments of vessels can be microscopic signs of intravital P. Refer aspiration and swallowing blood, a fatty and air vascular embolism of lungs and heart, detection of erythrocytes in regional limf, nodes to accessory signs of intravital P.

Causes of death at mechanical P. can be subdivided into primary and secondary (complications). Primary causes of death are directly connected with an injury and lead to the termination of vital; functions of an organism. These reasons conditionally divide into the following groups. 1. Gross anatomic violations of vitals, napr, razmyaty heads, partition of a trunk, cardiorrhesis, etc. 2. Blood losses: acute — due to sharp falling of intracardiac pressure and an anemia of a brain at damage of large vessels (striate hemorrhages under an endocardium of a left ventricle — Minakov's spots) and plentiful — are characteristic at loss of 50 — 70%, i.e. 2,5 — 3,5 l, blood (it is characterized by pallor and a xeroderma, weak expressiveness of livors mortis, a sharp muscular okocheneniye, an anemia of internals). 3. A prelum of vitals (a brain, heart, lungs) the streamed blood, as a result of pheumothorax, etc. Death comes at intracraneal hemorrhage of 100 — 150 L1L, at a cardiac tamponade of 500 — 700 ml of the blood which streamed in a pericardiac cavity. At a prelum of heart the blood which streamed in a pericardiac cavity matters not only its mechanical prelum, but also irritation of receptors of a pericardium at stretching its blood. These can explain cases of death when in a pericardiac cavity find rather small amount of blood (200 — 300 ml). 4. Bruises of a brain of heavy degree often are followed by fractures of bones of a skull, hematencephalons and under its covers. Especially big hazard to life is posed by the isolated bruises of a myelencephalon involving bystry death from paralysis of breath. They can arise at blows by a nape owing to falling backwards. For court. - medical diagnoses in such cases the detailed research of soft tissues of occipital area and cervical department of a rachis where hemorrhages are observed matters. Bruises of heart meet at blows of a thorax and falling that can be followed by a rupture of a cardiac muscle of a pla a reflex cardiac standstill. 5. At mechanical P. primary or secondary traumatic shock is possible. At primary shock death is caused by a reflex cardiac standstill owing to irritation of peripheral nerve terminations of the certain zones (a throat, testicles, distal phalanxes of fingers, etc.) which are richly supplied with sensitive nerve terminations. Secondary traumatic shock develops gradually, within several hours after an injury. At court. - medical diagnosis of secondary traumatic shock should consider rough P.' presence, pictures of the general blood loss, deposition of blood in abdominal organs, a vein thrombosis of extremities and gistol, signs of increase in permeability of walls of arterioles and capillaries. 6. Embolism (see) quite often is one of primary causes of death at Item 7. Asphyxia arises when bleeding is followed by aspiration of blood in respiratory tracts (cut wounds of a neck, fractures of bones of a base of skull, etc.).

At court. - medical survey of the victims, suspects and other persons concerning corporal P. it is necessary to diagnose P. (a graze, bruise, a wound) and to specify their localization and properties; to establish a type of the tool or means, to-rymi they could be caused, origins and prescription (term) of causing, severity of corporal Items.

Definition of severity of corporal P. is carried out according to the criminal and criminal procedure legislation of federal republics and according to «Rules of medicolegal definition of severity of injuries» (see. Survey ).

Corporal P. are subdivided on heavy, less heavy and easy corporal severity of corporal P. makes P. Otsenka proceeding from P.'s character, i.e. danger to life, and effects or an outcome of the Item. P. which threaten life of the victim at the time of their drawing are life-threatening or at their usual current come to an end with death. At the same time do not consider influence on P.'s outcome of medical aid. To P., life-threatening, carry: 1) the getting wounds of a skull, a backbone, a stomach, a thorax, including and without damage of internals; 2) the opened and closed fractures of bones of the arch and base of skull, except for fractures of face bones and the isolated crack only of an outside plate of bones of a calvaria; 3) a bruise of a brain of heavy degree both with a prelum, and without prelum of a brain, and also a bruise of a moderately severe brain in the presence of symptoms of defeat of a brain trunk; 4) epidural, subdural or subarachnoidal intracraneal hemorrhage in the presence of the life-threatening phenomena; 5) The item of cervical department of a backbone, in particular dislocation-fractures and dislocations of cervical vertebrae, fractures of bodies or both legs of arches of cervical vertebrae or even unilateral changes of arches of I and II cervical vertebrae, including and without dysfunction of a spinal cord; 6) the closed damage of cervical department of a spinal cord; 7) a change or a dislocation-fracture of one or several chest or lumbar vertebrae with disturbance of functions of a spinal cord or with existence of clinically established shock of heavy degree; 8) the closed P. of chest, lumbar and sacral departments of a spinal cord which were followed by heavy spinal shock or dysfunction of pelvic bodies; 9) the getting wounds of a throat, a throat, a trachea, a gullet, and also the closed fractures of cartilages of a throat and trachea with ruptures of a mucous membrane which were followed by heavy shock, disorders of breath or other life-threatening phenomena; 10) open wounds of bodies of retroperitoneal space (kidneys, adrenal glands, a pancreas, etc.), the getting wounds of a bladder, upper and average departments of a rectum; I) the closed P. of bodies of a chest or abdominal cavity, a pelvic cavity, and also bodies of retroperitoneal space in the presence of the life-threatening phenomena; 12) open fractures of long tubular bones — humeral, femoral and tibial, and also the changes of pelvic bones which were followed by shock of heavy degree or massive blood loss or a rupture of a webby part of an urethra; 13) The items which caused shock of heavy degree or massive blood loss with the subsequent collapse, clinically expressed fatty or gas embolism, traumatic toxicosis with the phenomena of an acute renal failure; 14) Items of a large blood vessel (an aorta, a carotid artery, subclavial, axillary, humeral, ileal, femoral, subnodal arteries or veins accompanying them), of other vessels are qualified by P. individually depending on their specific danger to life, napr, massive blood loss, objectively established shock of heavy degree; 15) thermal burns of the III—IV degree of St. 15% of a body surface, burns of the III degree more than 20% of a body surface, burns of the II degree of St. 30% of a body surface, and also the burns of the smaller area which were followed by shock of heavy degree, burns of respiratory tracts with the phenomena of hypostasis and narrowing of a glottis; 16) burns the chemical connections (concentrated to-tami, alkalis, various cauterizing substances) if they are followed by life-threatening all-toxic action; 17) the prelum of bodies of a neck and other types of mechanical asphyxia which were followed by a complex of the expressed life-threatening phenomena (frustration of cerebral circulation, a loss of consciousness, amnesia, etc.) if it is established by objective data.

Carry all life-threatening P., and also P. which led to heavy outcomes and effects to heavy corporal P.: to loss of sight, hearing or any body or loss of its functions by body, a mental disease, the disorder of health connected to permanent disability not less than on one third to abortion or led to indelible to an obezobrazheniye (see). Understand a total persistent blindness on both eyes or such decrease in sight when the person cannot count the number of fingers at distance of 2 m and less as loss of sight. Loss of sight on one eye also belongs to heavy corporal P. since the unilateral blindness leads to permanent disability more than on one third. The hearing loss means full persistent deafness or heavy degree of relative deafness when the victim does not hear informal conversation at distance of 3 — 5 cm from an auricle. The hearing loss on one ear should be considered as less heavy corporal P. as unilateral deafness is followed by permanent disability less than on one third. Understand loss of ability to express the thoughts the articulate sounds clear to people around as an alalia; mean department by loss of a hand, leg them from a trunk or loss of functions by them (persistent paralysis, etc.). If the extremity is lost not completely, then loss of a hand consider its amputation at the level not below an elbow joint, loss of a leg — its amputation at the level not below a knee joint. All other cases consider as loss of a part of an extremity and estimate on the basis of permanent disability. Loss of productive ability consists in loss of ability to copulation or in loss of ability to fertilization, conception and a child-bearing. To heavy corporal P, development of a mental disease owing to an injury belongs. Diagnosis of a mental disease and establishment of its causal relationship with traumatized is competence of the judicial psychiatrist (see. Examination, forensic-psychiatric ). Assessment of severity of P. in such cases is made with participation court. - the medical expert.

At children define possible disability, the edge is resulted by P. in the future. At in-valpd of the II patients disability in connection with damage is defined as at almost healthy people not manager[[ simo from group of disability and the available disease.

Abortion irrespective of its term is heavy injury if it is caused by P. and is not connected with individual to features and an organism of the pregnant woman. Court. - medical examination in these cases is made together with and a jackpot rum gynecologist.

P., harmless for life, which caused long disorder of health lasting St. 3 weeks (more than 21 day) or considerable permanent disability less than on one third under a cut belong to less heavy corporal P. understand loss of the general working capacity from 10 to 33%.

Easy corporal P. subdivide on caused short-term disorder of health (duration more than 6 days, but not over 3 weeks) or insignificant permanent disability (to 10%) and not caused short-term disorder of health or insignificant permanent disability, to the Crimea the items which caused insignificant effects, lasting no more than six days belong.

Establishment of the fact of a beating, i.e. drawings multiple blows, is within the competence of investigation authorities and vessels. If a beating was resulted by P., the expert establishes a raznovremennost of their causing and severity according to the signs described above. At the beating which did not leave visually distinguishable P., the expert notes complaints of testified and specifies that objective signs of P. are not revealed. Establishment of the fact tortures (see), i.e. intentional causing the sufferings to the person which are followed by disturbance fiziol, functions of an organism and involving disorder of health or even danger to life of the victim, it is also made by law enforcement bodies.

Bibliography: Brukman M. S. The pre-medical help at acute surgical diseases and accidents, JI., 1980; Vishnevsky A. A. and Schreiber M. I. Field surgery, M., 1975; M. V. Wolves and L yu about sh and N. A c. Damages and diseases of a musculoskeletal system, M., 1979; The Result of treatment of injuries, under the editorship of N. N. Priorov, M., 1960; Kaplan A. V. Fundamentals of traumatology of advanced age, M., 1965; it. Injuries of bones and joints, M., 1979; Kaplan A. V. and Markova O. N. Open fractures of long tubular bones, Tashkent, 1975; Kobylyansky L. N. Metabolism of amino acids at an injury, Chisinau, 1978; To r at the isthmus about I. L. Guide to traumatology and orthopedics, book 1, L., 1974; Kulagin V. K. Pathological physiology of an injury and shock, L., 1978; Nikitin G. D., Mitya Nin N. C. and Gryaznukhin E. G. Multiple and combined fractures of bones. L., 1976; Novachenko I. P. Fundamentals of orthopedics and traumatology. M, 1961; Sketches of field surgery, under the editorship of Yu. G. Shaposhnikov, M., 1977; P about are and sky V. F. Resuscitation at severe skeletal injuries. M, 1972; Revenko T. A., Chirakh of Page X. and Babosha V. A. Combined damages of pelvic bones, bladder and urethra, Kiev, 1978; The Guide to traumatology, under the editorship of V. G. Weinstein, L., 1979; Sverdlov Yu. M. Traumatic dislocations and their treatment. M, 1978; Smirnov E. I. War and military medicine of 1939 — 1945. M, 1979; The Combined injury and multiple fractures, under the editorship of M. V. Volkov and A. V. Kaplan, M., 1974; Watson-Jones R. Fractures of bones and injury of joints, Cher. with English. M, 1972; The surgical help in policlinics and out-patient clinics, under the editorship of B. M. Khromov, L., 1973; Complication and late results in traumatology, ed. by G. Chapchal, Basel a. o., 1978; Cowley R. A. a. o. A prognostic index for severe trauma, J. Trauma, v. 14, p. 1029, 1974; F ran to e K. Traumatologic des Sports, B., 1980; Matts-s o n E. I. Psychological aspects of severe physical injury and its treatment, J. Trauma, V. 15, p. 217, 1975; Sarwar H. o. Objective assessment of the trauma patient in a surgical intensive care unit, ibid., V. 17, p. 367, 1977; Symposium on trauma, ed. by A. J. Walt, Philadelphia a. o., 1977; Traumatic surgery, ed. by N. E. MacSwain, N. Y., 1976.

DAMAGES to the medicolegal relation

Avdeev M. I. Forensic medical examination of living persons, M., 1968; it, Forensic medical examination of a corpse, M., 1976; Akopov V. I. Forensic medical examination of damages by blunt objects, M., 1978; A. P. Biomekhanik's Thunders of an injury, M., 1979; 3 and r I d-Skye A. P., Edelev N. S. and Fuhrman M. A. Forensic medical examination at damages by saws and scissors, Gorky, 1976; V. V Goats. Medicolegal definition of weight of injuries, Saratov, 1976; V. N Hooks. Mechanisms of fractures of bones, M., 1971; Smusin Ya. F. Forensic medical examination of damages by shots from the fowling piece, L., 1971; Medicolegal traumatology, under the editorship of A. P. Gromov and V. G. Naumenko, M., 1977, bibliogr.; Topography of si.lovy tension in bones at an injury. The atlas, under the editorship of V. N. Kryukov, Barnaul, 1977.

B. F. Pozharisky; A. P. Gromov (court. - medical).