From Big Medical Encyclopedia

From the point of view of forensic medicine of S. is considered as the death of the whole organism connected first of all with the termination of action of the heart and which is characterized by irreversible changes of the central nervous system, and then and other body tissues.

Biological S.'s ascertaining is carried out by doctors, most often emergency medical service, receptions department of BC and policlinics, and also court. - medical experts at survey of a corpse on site its detection. The fact of approach of biological S. is determined on existence of set of signs: disappearance of pulse on large arteries; lack of reductions of heart (according to auscultation and the bioelectric activity of heart confirmed with an electrocardiography), the termination of breath, lack of spontaneous movements, reactions to sound, pain proprioceptive stimulations, maximum expansion of pupils and lack of their photoharmose, lack of a lid reflex, and also on so-called reliable signs of the come S.: to decrease in temperature of skin is lower 20 °, to existence of livors mortis and a cadaveric spasm, Larcher's spots (see. Postmortem changes ). Valuable diagnostic test is Beloglazov's sign (a phenomenon of «a cat's eye»), to-ry is observed in 10 — 15 min. after S.'s approach and is that at side squeezings of an eyeglobe the pupil gets an oval form from a corpse, at the living person the form of a pupil does not change. Anyway, if at court. - the medical expert there is a doubt in the fact of approach of S. of the person found on site incidents, it is necessary to begin resuscitation actions urgently (see. Resuscitation ), to cause emergency medical service or to bring a body to the nearest medical institution.

The main question, to-ry first of all it is necessary to resolve after the research of a corpse in a morgue, consists in establishment of the reason of Page. At the same time understand the main damage or a disease as S.'s reason, a cut in itself or through pathogenetic related complication brings to Page. When death comes not from the damage or a disease, and from its complication, court. - the medical expert is obliged to establish a causal relationship between damage (disease), a complication and S.'s approach, i.e. to track thanatogenesis (see). Establishment of the reason of S. has basic value for judicial investigating authorities at investigation of the crimes directed against the personality, especially when multiple damages are found, several suspects are under examination and it is necessary to establish which of them put deadly damage. It can be difficult if each damage separately can in itself lead to death i.e. when there is a competition of the reasons of S. V these cases it is necessary to analyze carefully the facts of the case, to establish origins and that is especially important, to define the sequence of drawing damages, and then to allocate from them the most life-threatening, the Page taken in this specific case for the reason. At multiple damages, each of to-rykh separately is not deadly, and lack at the same time of any other possible reason of S. which does not have a direct bearing on an injury (poisoning, a myocardial infarction, etc.), S.'s reason consider set of the caused damages. In doubtful cases appoint commission court. - medical examination with involvement of qualified specialists of other specialties.

At bruises weight of the damage (rough destructions of a body incompatible with life or its parts), blood loss, shock, a cardiac standstill [is the most often proximate cause of S. at traumatization of reflexogenic zones — solar (celiac, T.) textures, a sinocarotid zone, etc.], fatty, air and gas embolisms, aspiration of blood, a prelum of bodies the blood which streamed in a cavity — a cardiac tamponade, intracranial hematomas, fibrinferments and thromboembolisms, traumatic toxicosis, complications of infectious and noninfectious character, e.g. sepsis, bleedings, and also secondary diseases — traumatic heart diseases, aneurisms, etc. (see Damages in court. - the medical relation).

(See) generally acute hypoxia is a proximate cause of S. at asphyxia, at the general overcooling of an organism (see Cooling of an organism) — an apnoea owing to oppression of activity of c. N of page, at burns (see) — shock, a burn toxaemia, a septicotoxemia (depending on depth and the area of a burn surface) or inf. complications. At to an electric trauma (see) a proximate cause of S. shock, a cardiac standstill or breath can be, and at fatal poisonings (see), besides, hypoxia, a renal and liver failure, etc. In the presence of characteristic signs of influence of electric current S.'s reason in court. - medical practice consider effect of technical or atmospheric electricity, and poisons — poisoning with this poison.

For the solution of special expert and investigative questions in forensic medicine S.'s classification with its division by categories, childbirth and types is accepted. Two categories C. — violent and nonviolent are marked out. Violent death (see) is caused by impact on an organism of various environmental factors — mechanical, physical, chemical, thermal, etc., nonviolent — owing to various diseases. Judicial physicians most often deal with is reserved or hardly noticeably proceeding diseases not causing any fears for life, however under certain conditions leading to death, bystry, unexpected for people around (see. Sudden death), suspicious on violent.

As violent S.'s family allocate murder (see), suicide (see) and accident. Establishment of a family of violent S. is included into competence and carried out only by sudebnosledstvenny bodies.

Depending on the factors leading to death the following types of violent death are conditionally allocated: Page from bruises, mechanical asphyxia, poisonings, action of extreme temperatures, electric current, a radiant energy, change of atmospheric pressure, etc. Types of nonviolent death is S. from diseases of cardiovascular system, a respiratory organs, went. - kish. path, nervous system, malignant new growths, etc. Establishment of category and S.'s type is included into competence court. - the medical expert, in this connection judicial investigating authorities have the right to demand the exact answer to these questions.

At investigation of crimes against the personality quite often there is a question of ability of the victim who got a fatal injury to make independent purposeful actions. It is unambiguous to answer this question extremely difficult, however numerous literary data and expert experience specify that at deadly injuries of heart, large vessels, bodies of a neck, chest and belly cavities, bones of a skeleton in some cases victims can make independent actions — to go, talk, shout, show resistance, etc. Such states to a loss of consciousness and death depending on the nature of damage can proceed of several minutes till several o'clock and even days. Similar cases are explained by features of development of traumatic process, napr, increase of a subdural hematoma, a cardiac tamponade, individual functional and physiological opportunities of an organism, its adaptation to extreme conditions. Even in the agonal period of people it is sometimes capable to change position of a body, to move and put itself various damages. For judgment of a possibility of commission of any actions at deadly damages, including and purposeful, in each case it is necessary to study carefully the version of incident, the testimony of witnesses and the defendant, to compare them with morfol. indicators of an injury and functionality of the damaged body.

Bibliography: Avdeev M. Forensic medical examination of a corpse, M., 1976; Medicolegal traumatology, under the editorship of A. P. Gromov and V. G. Naumenko, M., 1977.

Yu. L. Melnikov.