How a human autopsy is performed. Autopsy of a dead body in the morgue: stages and photos of the procedure

Autopsy(syn.: section, autopsy, obduction) - examination of the body of the deceased in order to determine the nature of the changes present in it and establish the cause of death. It is customary to distinguish between pathological and forensic V. Pathoanatomical - V. of corpses of persons who died from various diseases in hospitals; production of pathological V. should be the rule for these institutions. Forensic medical V. is carried out by order of judicial authorities in relation to the corpses of persons whose cause of death can be assumed to be any violent or criminal act.

V. of the corpse played a big role in the development of materialistic views on the structure of the human body, its functions and the essence of disease processes. V. is the main basis for developing the problems of thanatology (see). A huge role belongs to V. in honey. education. In addition, it has great san.-epidemiological significance, because often thanks to V. the presence of certain infectious diseases is established, which could be the beginning of an epidemic. In hospital institutions, V. exercises control over the activities of hospital departments and compares clinical and pathological diagnoses (see Diagnosis, Diagnostics).

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The first autopsies of corpses date back to the last centuries BC.

In Egypt, by order of King Ptolemy II, the corpses of criminals began to be transferred to doctors for scientific research. The first anatomical studies of Herophilus and Hippocrates date back to this time. However, in subsequent times, under the influence of religious prejudices, the killing of corpses ceased; only a few, e.g. K. Galen (2nd century AD), occasionally dissected animal corpses. It is known that Ibn Sina produced human corpses; Leonardo da Vinci produced several dozen V. corpses. At the beginning of the Middle Ages, V. was viewed as a blasphemous act and persons suspected of its production were persecuted. During this period, rarely did anyone manage to produce V. and publish its results [Mundinus, 13-14 centuries]. After the special encyclical "(circular) of Pope Pius IV (16th century), which not only permitted, but also recommended V. to determine the causes of death, V. gradually began to enter as a scientific method into anatomy, pathology and forensic medicine. A. Vesalius attached a significant role to mathematics as a scientific method. However, even in the first half of the 19th century. V. were rarely performed, and the departments of anatomy that existed at that time were in dire need of corpses. Usually, V. was subjected almost exclusively to the corpses of people who had no relatives. Subsequently, the number of V. in hospital institutions began to increase, and at the beginning of the second half of the 19th century. 40-45% of all hospital deaths have already been autopsied (Berlin Charité Hospital).

The autopsy business in Russia dates back more than two hundred years; it arose with the advent of the first hospitals, where honey was founded from the very beginning. schools; In hospitals, they performed examinations of corpses for the purpose of teaching students normal anatomy. Forensic medical examinations were also carried out there. V. for pedagogical purposes. The first anatomical theater was founded by decree of Peter I in 1706 at the Moscow hospital. The establishment of autopsy work in Russia is associated with the name of P. 3. Kondoidi, who carried out a number of events that served as the beginning of the organization of autopsy work.

Along with anatomical and forensic medical. Century in the first half of the 18th century. They began to perform autopsies of a pathological nature.

In 1735, the “General Regulations on Hospitals” was published, in which it was prescribed to carry out pathological examination of corpses. According to the decree of 1745, all corpses of those who died suddenly were delivered for V. to anatomical theaters at hospital schools. In the “Instructions given to junior doctors of general hospitals” (February 5, 1754), there were points regulating dissection work. In 1824, I. V. Buyalsky published “A Guide for Doctors to the Correct Examination of the Dead” in the Military Medical Journal human bodies to indicate the causes of death, especially during forensic investigations,” which introduced V.’s rules.

Before the Great October Revolution socialist revolution in Russia, according to the existing rule, the examination of corpses was carried out 24 hours after death; in hospitals, no more than 60-65% of corpses were autopsied; Only in the clinics of Moscow University has long been in force the established rule on the mandatory autopsy of all those who died in them.

In 1919, it was allowed, if necessary, to dispose of a corpse earlier than 24 hours, but not earlier than half an hour after death.

In connection with the introduction of electron microscopy methods and the development of transplantology, V. is allowed to be performed at any time after diagnosis by doctors to treat. institutions of biol, death (order M3 of the USSR No. 667 dated 15/X 1970, Appendix No. 3; there are also instructions on the procedure for V. corpses in medical institutions).

Pathoanatomical autopsy

The technique of V. of a corpse developed and improved gradually. At the beginning of the second half of the 19th century. R. Virchow was the first to indicate the definite and most rational order of the death of a corpse. The Virchow method is the most common and serves as the basis for all other methods (Geller - Zenker, Chiari, Letulle, Shor), which differ from it only in details.

Pathoanatomical V. is performed in specially adapted institutions that exist at hospitals and clinics (see Pathoanatomical Department), with special sectional instruments. To prevent infection with infectious diseases, the prosector puts on a robe and an oilcloth apron over the dress, and rubber gloves on his hands. The most real danger of infection with pyogenic flora from the outbreak purulent infection as a result of unnoticed finger pricks with fragments of ribs, the tip of a scalpel, etc., for example, a cadaveric tubercle may appear that appears on the skin of the prosector’s hands in the area of ​​the former injection.

V. must be performed in daylight, because with artificial lighting it is difficult to make a correct conclusion about changes in the color of the integument and organs of the corpse.

Rice. 2. Incisions and cuts when opening some organs: 1 - separation of musculocutaneous flaps; thick lines - places of dissection of the costal cartilages and sternoclavicular joints; 2 - Medvedev incisions for opening the neck; 3 - Medvedev incisions for opening the hands; 4 - incisions for opening the heart; solid line - right ventricle, dotted line - left ventricle and aorta; 5 - incisions for opening the uterus; 6 - opening of the cavities of the heart; bold lines and letters show the direction and sequence of cuts (a - b - c - right half of the heart; d - e - e - left half of the heart); 7 - incisions for opening the lungs; 8 - incisions for opening the kidneys, urinary tract, adrenal glands (thick lines) and large retroperitoneal vessels (dotted line); 9 - cutting line at the base of the skull to open the paranasal sinuses (according to Harka); 10 - places of dissection of the base of the skull with a chisel for opening (a - b - c - eye sockets; d - d - e - sinuses of the main bone and ethmoid bone; g - h - tympanic cavities); 11 - line of brain section according to Flexig; 12 - cuts for opening the base cerebral hemispheres brain; 13 - incisions for opening the cerebellum and pons (pons).

For pathological examination of a corpse it is accepted general order. Before V., the opener and those present get acquainted with clinical course illness and lifetime diagnosis from the medical history or oral communication from the doctor who observed the course of the disease. Then the autopsy performs an external examination of the corpse, noting data on sex, size, build, constitutional appearance, nutrition, condition of the integument (color, cadaveric spots, rashes, hemorrhages, wounds, ulcers, scars, bedsores, tumors and swelling of the integument, etc.), rigor mortis, cadaveric odor, determines the correspondence of signs of the age of the deceased with passport data. The external examination is followed by an incision and separation of the soft tissues and V. cavities and organs of the body (Fig. 1 and 2). To do this, a main incision is made, most often running from the chin to the pubis. Some people use other types of incisions. In all cases, care must be taken to ensure that the main sectional incision does not pass through post-operative wounds or defects. skin, subject to special study. After the incision, the integument is separated and moved to the sides from the midline; at the same time, the abdominal cavity opens and the chest cavity is exposed, which is opened by dissecting the cartilaginous parts of the ribs near the place of their transition into the bone parts. After V., the cavities are examined in detail, identifying the peculiarities of the position and relationship of the organs, the presence of any accumulations, adhesions, etc., and then they begin to remove the organs from the corpse.

The procedure for removing organs from a corpse and examining them may vary depending on the characteristics of the case. Thus, during V., they deviate from the main method based on medical history data and the results of an examination of organs in situ. The main method of extracting and examining organs in various pathological institutions, due to tradition, the characteristics of the school or the personal habit of the leader, may represent certain deviations from the Virchow scheme. In some institutes, organs are removed one by one, separating them from each other, in others, they prefer to extract organ complexes; Some pathologists consider it rational to make incisions of organs in situ, i.e. before removing them.

In the Moscow pathoanatomical school, based on the desire, if possible, as described by A. I. Abrikosov, not to separate organs and parts of anatomical and physical physiology. systems, the organs of the neck and chest cavity are usually removed as a common complex, then the intestines, liver, stomach and duodenum- one complex; kidneys, urinary tract and genitals are also complex. In Leningrad, during autopsy, they mostly use the method of complete evisceration (G.V. Shor), which consists in the fact that the organs of the neck, chest, abdominal cavities and the small pelvis are removed in the form of one continuous complex, and in the future the organs are not separated from each other, but are examined in their mutual connection. When V. corpses of patients who died after surgical interventions, perform a thorough examination of the area of ​​the surgical field (condition surgical sutures, vessels, the presence and nature of exudate, the correctness of the operation).

After removing the organs from the corpse (by one method or another), their size, weight, shape, surface condition, color, consistency are studied; then, if hollow organs are examined, incisions are made and the cut surface and the condition of the cavities are examined.

In case of V. of the skull, to study the brain, an incision is made in the integument of the head from one ear to the other through the crown, the soft integument of the skull is separated anteriorly and posteriorly from the incision, a circular cut of the skull is made and the calvarium is removed, after separating the hard meninges The brain is removed and opened. To examine the paranasal sinuses, a sagittal cut of the base of the skull is made (according to Harke). The spinal cord is removed after cutting the integument along the line of the spinous processes and opening the spinal canal by sawing through the posterior vertebral arches. V. of the skull and spinal canal may precede V. of the body cavities or follow it, depending on the characteristics of the case.

The last to be opened are the limbs, if there is evidence for this; on the limbs, the condition of the muscles, bones and bone marrow, joints, blood vessels, and nerves is examined.

In case of V. of newborn corpses, a longitudinal cut of the lower epiphysis is made femur; using this cut, the state of the enchondral ossification line (the border between the epiphysis and diaphysis) is determined, which is important for diagnosis congenital syphilis, and also establish the presence and size of the epiphyseal ossification nucleus (see Full term, x-ray determination).

At the end of the V., the detected changes are briefly summarized and the pathological diagnosis is reported, then the findings are compared with the intravital manifestations of the disease and the development and manifestation of the underlying disease, its complications and the cause of death are explained from the point of view of the detected data. Material is taken from the organs and tissues of the corpse for microscopic examination; in some cases, radiography of the skeletal bones is performed. In addition, material is often taken for bacterioscopic, bacterial, serol, biochemical, and viral. research. Smears for staining for microbial flora when organ abscesses, phlegmons, as well as purulent, purulent-hemorrhagic exudates of cavities are detected are taken along the V. For serola, research, blood is taken (in compliance with the rules of asepsis) from the femoral or ulnar vein to the V., from the right atrium and ventricle - along the V.; Cerebrospinal fluid is obtained by spinal tap, but with appropriate precautions it can be obtained from the ventricles of the brain after removing the calvarium. The collection of material for crops is carried out in compliance with the rules of bacteria and technology.

Taking material for bacteria, research in especially dangerous infections ( anthrax, plague, cholera, etc.) is regulated by the relevant instructions of the USSR M3, compiled on their basis by official letters local authorities health and methodological recommendations All-Union Scientific and Methodological Center for Pathoanatomical Service at the Institute of Human Morphology of the USSR Academy of Medical Sciences. The same instructions determine the procedure for V. and organizational measures if a particularly dangerous infection is suspected, for example, Urgent measures against the spread of infection, special protective clothing and disinfectant solutions (solutions of chloramine, bleach, carbolic acid, Lysol) in the pathology department. It should be especially emphasized that the listed research methods in conditions of therapeutically determined pathomorphosis (see) are often of decisive importance for pathological diagnosis. V.'s order can be significantly changed depending on the nature of the pathological process, complexity surgical intervention, the need for special scientific research, for example, using a radiopaque method or preparation, etc. In some cases, to study the pathology of the brain, V. of the skull is produced after the administration of a 5% solution of formalin and other fixative mixtures through the carotid arteries.

In order to preserve material for demonstration, it is not recommended to make unnecessary sections of organs, especially in different directions. If necessary, along the way, photographs of the most important pathological processes, preservation of the picture of anatomical and topographic relationships of which is important for subsequent demonstration. The final point of V. is the cleaning of the corpse: the organs are placed back into the cavities, the incisions are sutured, the corpse is washed and dressed. Due to the fact that during V. no incisions are made on the open parts of the corpse, the signs of the V. produced are invisible on a dressed corpse. Partial V. cannot be performed, for example, only the abdominal cavity or the cranial cavity, since this can lead to incorrect results.

It is better to record the autopsy under the dictation of the autopsy person. In the absence of appropriate personnel, and also if it is necessary during the V. to explain in detail the detected changes, the protocol must be written without delay, immediately after the V.

In many pathology departments, typewriters are used to record protocols directly along the pathology course. There are attempts to use a dictaphone, by which the prosector transmits the results of V. to a typist located in another room. Recording the results of V. on tape has not become widespread, since with this method the dissector spent much more time than when dictating the protocol directly in the section hall.

Each V. protocol consists of a descriptive part that represents a strictly objective and exact description the changes found, and the final part, or pathological diagnosis, which defines the essence of these changes using brief pathological terms.

For greater clarity, it is advisable to illustrate V.’s protocol with diagrams, for example, of surgical interventions, ready-made imprints (stamps) of the contours of the body and internal organs. At the end of the protocol, space is left for recording the microscopic and bacterial results. and other studies.

Necropsies of experimental animals should be carried out according to general rules, accepted in practice; special instructions does not exist.

Forensic autopsy

A forensic medical autopsy is performed by order of the investigative authorities and a court ruling in case of violent death or suspicion of it in the case of sudden death (regardless of the place of its occurrence, when the cause of death has not been established by the attending physician), death in treatment. institutions with an unknown diagnosis, upon admission to treatment. establishment of the corpse of a patient who died on the way, when investigating complaints about improper or illegal treatment, when discovering the corpse of an unknown person. The main goal of forensic medicine. V. in accordance with Article 79 of the Code of Criminal Procedure of the RSFSR, the corresponding articles of the Code of Criminal Procedure of the Union Republics and the “Rules for Forensic Medical Examination of a Corpse” is to establish the cause of death and the nature of bodily injuries.

Forensic medical V. of corpses is carried out by staff medical examiners. experts from the Bureau of Forensic Medicine examinations included in the health care system. In the absence of such an expert, any doctor (expert doctor) may be involved in the examination of a corpse, regardless of his specialty. Therefore, every doctor must know the rights, duties and degree of responsibility of experts set out in the relevant articles of the Code of Criminal Procedure of the RSFSR and in Articles 181 and 182 of the Criminal Procedure Code of the RSFSR, as well as in the relevant articles of the Code of Criminal Procedure and the Criminal Code of the Union Republics.

Before the V. corpse, the medical examiner the expert must carefully study the documents delivered to him: the resolution on the appointment of a court medical examiner. examination or order of the bodies of inquiry about the V. of the corpse, a protocol for examining the corpse at the scene of the incident (or discovery), medical history (if the corpse was delivered from a medical institution) and other materials of the inquiry or investigation. If there are insufficient materials necessary for the expert to give an opinion, in accordance with Article 82 of the Code of Criminal Procedure of the RSFSR, he has the right to petition for the provision of the missing materials.

Forensic medical The examination of corpses should be carried out in daylight, in bright, specially adapted rooms (morgues), since the use of random rooms with insufficient lighting, as well as the presence of artificial lighting, distorts the color of the skin and organs being examined and complicates the use of modern scientific and technical means. Forensic medical It is advisable to carry out V. in the presence of a representative of the investigation or inquiry who issued a decision or order about V. Any stage putrid change a corpse cannot serve as a reason for refusal of forensic medicine. B. If a frozen corpse is discovered, its autopsy is postponed until complete thawing in a room with an air temperature of 18-20°; It is unacceptable to defrost using different sources high temperature, including and hot water, because this may distort the forensic medical data. IN.

According to the “Rules for Forensic Medical Examination of Corpses,” V. is allowed only after 12 hours. after death. IN exceptional cases it can be carried out earlier, but subject to the ascertainment of death by a group of three doctors and the drawing up of a protocol, which provides evidence of the death with an indication of the reasons for which an earlier V. was required.

An external examination of a corpse, as a rule, begins with an examination of clothing, which is of great expert and investigative significance. So, in pockets and folds it can be found, for example, suicide notes, medicinal substances; clothing may have damage, various marks and stains associated with the incident, glass fragments and tread marks from car injuries, pellets, bullets, wads, soot and powder deposits from gunshot injuries, ruptures, cuts and other defects. All damage to clothing must be compared with damage to the corpse. When V. of the corpse of an unknown person, clothing can facilitate his identification, so it must be characterized in detail (indicating the type and color of materials, style, size, etc.).

By removing clothes from the corpse, the sex, age, physique, and degree of fatness are determined. When V. corpses of unknown persons, in order to identify them, the method of verbal portrait is used (see Personal identification). In addition, you should pay attention to the individual characteristics of the body, developmental defects, the presence of scars, birthmarks, pigmentation and depigmentation, tattoos, and traces of surgical intervention. For investigative identification, forensic experts take photographs of the corpse (overview and detailed), obtain fingerprints and draw up an identification card; during an external examination, the location and nature of cadaveric spots and the state of rigor mortis are determined, which makes it possible to judge the duration of death. The coloring, intensity and location of cadaveric spots make it possible to presumably judge the cause of death, as well as the initial position of the corpse, which could subsequently change. Examination of the corpse for detection possible damage(abrasions, bruises, wounds, injection marks, entry and exit wound holes, etc.) start with the head, then examine the chest, abdomen, back, and limbs. Special attention Pay attention to examining the eyes, ears, nose, mouth. Detected damage (their location, size, color, depth, condition of the edges), possible overlaps or contamination around and around the damage are carefully examined using objective methods; determine signs of intravital or postmortem origin of damage. By palpation, they are convinced of the presence or absence of damage to the bones of the face, head, chest, spine, pelvis, and limbs. If necessary, cross-shaped incisions of soft tissues are made to differentiate subcutaneous hemorrhages and cadaveric spots. Then the external genitalia are examined, the area anus; in women they pay attention to the condition hymen: its integrity, fresh or healed ruptures. If the presence of sperm is suspected or there is a discharge, vaginal smears are taken for laboratory testing.

The internal examination of a corpse using the technique has its own characteristics, determined by the type of violent death (for example, with gunshot injuries, auto injuries). Forensic medical V. of a corpse necessarily includes V. of three cavities: cranial, thoracic and abdominal. If there are injuries in the spine or if they are suspected, the spinal canal is opened. If there are any injuries on the corpses, blood is taken to determine the group and type. When V. of the cranial cavity pay attention to the integrity of the bones of the vault and base of the skull, the tension of the dura mater, its blood supply, the color and nature of the blood in the sinuses (liquid, convolutions); when examining the pia mater - for transparency, swelling, purulent deposits. When examining the brain, the presence of foreign odors, the condition of blood vessels, cortex, white matter, ventricles, determine the weight of the brain. After removing the dura mater, the base of the skull is carefully examined. By chipping with a chisel, the cavities of the pyramids of the temporal bones and the sinuses of the main bone are examined. After the main incision of the skin of the neck, chest and abdomen, if there is no suspicion of air embolism, begin to examine the tissues of the neck. First of all, pay attention to possible intravital hemorrhages from compression of the neck organs, to the integrity of the horns thyroid cartilage and hyoid bone. After removing the sternum with the cartilaginous part of the ribs, the thoracic and abdominal cavities are examined and their condition is noted. After this, the organs are removed. When examining the lungs, they describe their consistency, the presence of ecchymoses, the color of the surface and the incision, blood filling, the presence of edema, etc. When examining the heart, the presence of ecchymoses under the epicardium or endocardium, fat deposits on it, blood filling and the thickness of the muscle walls, the nature of the muscles on the incisions are noted , condition of the coronary arteries and valves. When examining the condition of the spleen, note the receipt or absence of scraping on the incision. Determine the condition of the mucous membrane of the esophagus. The stomach is opened (in a clean container) along the lesser curvature and the presence and degree of digestion of the contents is revealed, its quantity is measured, the color, smell, and consistency are described; determine the presence of non-food substances (chemical substances, foreign bodies etc.); note the condition of the mucous membrane, its blood supply. The small and large intestines are opened and the characteristics of its contents and mucous membrane are determined. Moving on to examining the liver, determine its density, color on the section, pattern, blood supply, etc. At the same time, they examine gallbladder and patency of the bile ducts. The kidneys are examined simultaneously with the adrenal glands: the condition of the capsule and pelvis, the presence of stones, the color and severity of the pattern of the renal tissue, the cortical and medulla of the adrenal glands are noted. Opening up bladder and genitals, then abdominal aorta and the inferior vena cava. By palpating and cutting soft tissues, they are convinced of the integrity of the bones of the spine and pelvis. The heart, spleen, liver and kidneys are measured in centimeters and weighed.

If at court medical V. show signs of acute or particularly dangerous infections, this is immediately reported to the sanitary-epidemiological station, the station and the health department, and V. continues, carrying out the relevant prof. Events.

If poisoning is suspected internal organs open in a clean container without using water. Directing organs to chemical analysis, are guided by the “Rules for the seizure and direction of cadaveric material for forensic chemical research.” In case of poisoning of an adult with an unknown poison, organs in the amount of 2 kg should be placed in thoroughly washed jars: in jar No. 1 put the stomach with contents, 1 liter of small and large intestines with contents, in jar No. 2 - at least 2/3 of the most full-blooded sections of the liver and gall bladder with contents, in jar No. 3 - one kidney and all urine, in jar No. 4 - 1/3 of the brain, in jar No. 5 - the heart with the blood contained in it, the spleen and at least 1/4 of the most full-blooded areas of the lungs. If there is a suspicion of the introduction of poison through the vagina, the uterus with the vagina is taken, and if there is a suspicion of the introduction of poison through the rectum, the rectum along with its contents is taken. If you suspect subcutaneous or intramuscular injection The poison is taken from skin and muscle areas from the sites where the substance is supposed to be administered. In case of poisoning, poisons in the body are distributed differently in individual organs and tissues, therefore, depending on the suspected poison, the corresponding cadaveric material is taken. For the purpose of quantification ethyl alcohol blood taken from peripheral venous vessels(femoral, brachial) or sinuses of the dura mater, as well as urine in the amount of 10 ml, which is collected with sterile glass pipettes into separate sterile bottles.

At court medical V. corpses, in particular in cases of sudden death, acute infectious diseases, poisoning, etc., there is a need for other laboratory tests. In this regard, the expert must know the relevant rules and instructions for removing and sending material for histological, biological, bacterial, botanical, spectral and other studies.

Forensic medical autopsy of newborn corpses makes it possible to establish live birth (see), full-term (see), viability (see), life expectancy of the baby after birth, cause of death (see Stillbirth).

A forensic medical re-autopsy of a corpse is carried out by order of the investigative authorities or a court ruling in cases where it is assumed that the expert’s conclusion is unfounded or there is doubt about its correctness. It is advisable to carry out repeated V. on commission and preferably in the presence of the expert who performed the primary V.

Documentation. At court medical During the autopsy, a document (conclusion, act) is drawn up, in which factual data is necessarily and accurately recorded, on the basis of which conclusions are drawn that answer questions from the bodies of inquiry, investigation and court. The document is drawn up in a certain form and consists of three sections - introduction, descriptive part and conclusions.

The introduction provides information about who produced the corpse (last name, first name, patronymic, position held, specialty, qualification category, academic degree); time and place of V., on what basis it was produced; first name, patronymic, last name and age of the deceased; who was present at V., what questions were posed to the expert. This section includes the subsection “Preliminary information”, where you enter brief information from materials presented by the investigation (record of inspection of the scene of the incident and the corpse, medical history, etc.).

The descriptive part has two subsections: external inspection and internal inspection. When compiling a descriptive part, it is necessary to adhere to certain rules: you cannot use Latin words, diagnostic terms and designations instead of describing certain visible changes in organs; To the descriptive part of the conclusion (act), especially in cases of V. who died from trauma and if there are injuries on the corpses, it is necessary to attach contour diagrams of the human body with the detected damage and features applied to them; photographs and sketches are desirable. When describing damage, you cannot resort to various comparisons; dimensions are given in centimeters, shape in geometric shapes, coloring by color of spectrum bands and their combinations.

Conclusions are one of the important parts of the conclusion (act). They set out a scientifically substantiated, objective expert opinion on the cause of death and motivated answers to the questions posed by the investigation, confirmed by morphological changes. The expert's legible signature is placed under the conclusions.

The conclusion (act) is drawn up either during the test, when the expert dictates it to the laboratory assistant, or immediately after the test is completed.

Documentation for repeated V. is drawn up, as for primary V.; it notes what was initially opened, what defects were discovered and what was installed again. See also Corpse, Examination (forensic), Exhumation.

Bibliography: Abrikosov A. I. Technique of pathoanatomical autopsies of corpses, M., 1948; Golovin D.I. Autopsy of corpses (method of complete evisceration), Chisinau, 1957; Zhitkov V. S. Fundamentals of techniques for forensic medical examination of corpses, Yuzhno-Sakhalinsk, 1969, bibliogr.; Medvedev I. I. Fundamentals of pathological techniques, M., 1969; Guidelines for forensic research corpses of infants and early age, died from acute respiratory diseases, M., 1973; Naumenko V. G. and Grekhov V. V. Methods of sectional research for traumatic brain injury, M., 1967, bibliogr.; Khazanov A. T. and Ch a l i s o v I. A. Introduction to sectional course, M., 1969, bibliogr.; Khrushche-levski E. and Shperl-Zeyfridova G. Section of corpses of fetuses and newborns, trans. from Polish, M., 1962; Shor G.V. About the death of a person, p. 224, L., 1925; Falk H.u. Pfeifer K. Praktische Sektionsdiagnostik mit Schnell-methoden, Lpz., 1964, Bibliogr.

I. V. Davydovsky, N. K. Permyakov; V. I. Prozorovsky (court).

After the autopsy, all the organs are placed in the body, and the orderly sews up the incision. We must respect everyone, both the living and the dead,” notes one of the orderlies. After the autopsy is completed, the organs of the corpse are placed back into the cavities, the incisions are sutured, and the corpse is washed and dressed.

This is precisely what the performance “Autopsy of a Woman” is dedicated to and the sociological survey that precedes it, during which men and women were asked the question: What qualities do you value in a woman? I know that there are all sorts of anecdotes, jokes and stereotypes about how morgue workers, without fear of anything, can eat a sandwich with one hand right over a corpse and stitch it up with the other.

During a shift, there is usually either no one there or two or three corpses. True, according to the law of meanness, on my very first shift at the morgue there were 11 dead people at once. They differ only in the amount of payment, and are usually completely embalmed for long-distance transportation of the dead to other cities. Secondly, I'm performing an autopsy. Thirdly, I sew up corpses. There is a peculiarity: when a needle and thread pass through skin with a small layer of fat, it creaks and whistles - and at first it was creepy.

If there is a complete autopsy, the tongue and larynx are pulled out and studied. Lastly, if no cause of death is found in the organs of the body, the head is opened. The brain does not return to the skull; it is placed in the chest cavity with other organs. Then we put the organocomplex back into the body cavity. We make a mask of formaldehyde to fix the face, then put it in a bag and put it in the refrigerator.

One woman asked her husband to put a pack of Belomor cigarettes under his pillow, because he loved smoking them. Everyone has their own quirks and desires in this matter. After work, thoroughly wash and disinfect everything. Then he went, washed himself, wiped himself with alcohol, and was ready. I know that in the “dashing 90s” people were not afraid of anything; their hygiene was much easier. After sewing up the corpse, they bit the threads with their teeth.

In general, there were real gang fights there; for the orderly responsible for these grandmothers, it all ended somehow horribly. There was a case when a “float” (a drowned man - Dialog news agency) was brought to the university. In general, the students began to cut it, reached the stomach - and “bang” happened. Guts are on the ceiling, on the teacher, on the students - everywhere. So there are many nuances in this work. An autopsy is usually performed no earlier than two hours after death is established.

To autopsy corpses, a sectional set of instruments is used. To extract and open the spinal cord, it is necessary to saw through the posterior arches of the vertebrae. During or after the autopsy, a protocol is drawn up, in the descriptive part of which the changes discovered during the autopsy are objectively recorded.

Wrong side human life, its most unpleasant side - death, meets you in the morgue naked and unvarnished. And people of various professions work at this penultimate stop of the “life - eternity” express - forensic experts, medical registrars and orderlies. His task is to establish: did he die as a result of the disease and was his death inevitable - perhaps the diagnosis was erroneous, perhaps the treatment was incorrect?

Just yesterday a man lived, loved, and was loved, but today he is on the dissecting table. The reason for this is a disease that neither he himself, nor his relatives, nor doctors suspected. A man fell in the bathroom and hit his head - this is a violent, premature death, even if it is classified as an accident. In addition to experts involved in the examination of living persons and autopsies, there are also histologists - they conduct examinations of tissue samples and determine from them the time, causes of death and how long ago the injuries were.

But there are also biochemist experts and many other narrow specializations. The small room with a glass roof accommodated several desks, a sofa and even a refrigerator with a microwave. The autopsy itself is carried out in a sectional room, which is separated from the rest of the morgue by a room that serves as either a locker room or a preoperative room. The sectional also contains a small desk. During the autopsy, a medical registrar works behind him, whose task is to assist the expert by taking the autopsy protocol under dictation.

Morgue worker: No one eats sandwiches over corpses

The orderlies transfer the prepared body from the gurney to the table - the autopsy begins. The corpse itself is usually opened using the Shor method. A median incision is made on the body, through which the entire organ complex is removed, starting from the tongue and ending with the rectum.

You can and should be afraid of death, but you cannot avoid it

In the morning, the expert performed three autopsies - all three died from natural causes. Then the body is washed, put in order and begins to be prepared for handing over to relatives. One way or another, it causes death in half the cases. It goes beyond the point where alcohol is absorbed in any quantity, but the body can no longer cope with such doses, which leads to fatal outcome- alcohol poisoning.

The survey was shown on two monitors, with male and female voices overlapping each other, causing the viewer to experience slight discomfort. IN large quantities Such impressions turned out to be too much, I lost a lot of nerves there. Got a job at the morgue. Here I’m not nervous at all - the silence is deathly quiet. I'm not scared or disgusted, as many people think. At first it was unusual to work with the dead and not the living.

The pathological epicrisis presents the results of a comparison of medical history data and autopsy materials, taking into account all additional research. At the end of the epicrisis, a conclusion is given about the mechanism and causes of death. This is a combination of formaldehyde and rot that remains in the memory forever as the “smell of death.”

An autopsy is a medical procedure performed in a morgue to determine the exact cause of a person's death. If there is no suspicion of criminal or medical causes of death, refusal of an autopsy is POSSIBLE by law. Therefore, if the deceased was taken to the pathological anatomical morgue (PAM), refusal of an autopsy is possible, since the bodies of those who died from natural causes are placed in the PAO.

Refusal to autopsy the deceased

Often the relatives of the deceased are faced with the question: “Is it possible to refuse an autopsy of the deceased?”, since for many, refusing an autopsy is relevant. The reasons for refusing an autopsy can be different: the religious beliefs of the deceased, his will and testament, the wishes of his family members. Federal Law No. 323-FZ (Article 67.3) states that refusing an autopsy is fundamentally possible. At the same time, the same law clearly defines situations in which an autopsy must be performed.

Presumption of consent to organ removal in Russia

In Russia, at the legislative level, there is a presumption of consent of relatives to the removal of organs of the deceased (transplantation). This means that permission from relatives is not required to remove organs. If the family of the deceased has provided a notarized application of the deceased to refuse the autopsy or has themselves issued a written application to refuse the transplant, the procedure will not be carried out (except for situations where it is impossible to refuse the autopsy - see the paragraph below “In what cases is it impossible to refuse the autopsy? ").

How to refuse an autopsy?

Many people are interested in how to refuse an autopsy. You can refuse an autopsy by submitting an application addressed to the head of the morgue. The application to refuse opening is written in free form, but you must indicate:

• Full name and passport details of the applicant
• Full name, date of birth, date and place of death of the deceased
• reason for refusing to open
• a notarized copy of the will (if the deceased has stated a refusal to open it in his will)

The final decision to perform or not to perform an autopsy is made by the pathologist based on the available medical indications.

Reasons for refusing to open

The fundamental possibility of refusing an autopsy is established by federal and local legislation. The opportunity to refuse an autopsy is spelled out in Article 67 No. 323-FZ “On the fundamentals of protecting the health of citizens” and paragraph 1 of Article 5 of Federal Law No. 8 “On burial and funeral business”.

The main reasons for refusing an autopsy are the will of the deceased and religious prohibitions. For example, in Judaism it is forbidden to dissect the remains of the dead.

The mortuary is more likely to accept an autopsy waiver if:

• The deceased was ill and died under the care of doctors;
• Eat outpatient card with data on the illness/illnesses of the deceased, including those leading to death;
• Death was due to a long illness
• There are results of histological analysis in cases of death from oncology (cancer).

How much time do you have to refuse an autopsy?

You have 3 days to refuse opening. There are two main reasons:

• An autopsy in a morgue must be performed within three days after the body is delivered to the morgue
• Burial in accordance with the norms of confessional funeral rites is allocated from 1 to 3 days

Therefore, if the relatives of the deceased want to refuse an autopsy of the deceased, they should not hesitate to submit an application to the morgue.

Who applies for an autopsy waiver?

• relatives (burial organizer on the part of relatives)
• funeral agent

In addition to relatives, an application for refusal of an autopsy can be submitted by the funeral agent of the funeral service organizing the funeral.

Sample application for refusal to open

A sample application for refusal to open an autopsy can be downloaded

In what cases is it impossible to refuse an autopsy?

The law establishes situations when a mortuary may refuse an application to waive an autopsy - even if the deceased has recorded a refusal to perform an autopsy in his will. Federal Law No. 323 provides a list of situations when it is impossible to refuse an autopsy.

• Suspicion of violent death (incl. traffic accident, accident)
• Suspected death from drug overdose
• Suspected death due to drug intolerance
• Death from infection (or suspicion of it)
• Death from oncology (if there is no histological analysis)
• Death associated with blood transfusion
• Death of a pregnant woman during childbirth, shortly after birth
• Death of a child under one month of age or stillborn
• Death from an environmental disaster
• It is impossible to determine the cause of death without an autopsy.
• Before death, the deceased was in hospital for less than 24 hours

In order No. 1064 (dated December 29, 2016), the Moscow Department of Health clarified and supplemented this list with the following cases:

• The will of the deceased or the request of his relatives to conduct an autopsy
• Death of an unidentified person
• Death within a month after discharge from hospital
• Death as a result of preventive measures medical procedures
• Death from acute surgical pathology

If the body has been sent to the medical examiner's office, you cannot refuse an autopsy.

If the body arrived at the forensic morgue (FME), and not the pathological morgue (PAO), it is impossible to refuse an autopsy. In addition to the suspicion of death due to external circumstances, refusal of an autopsy is impossible if the deceased died on the street.

If, after the death of a person, his relatives first called the police, and not the funeral service or ambulance, then the body with high probability will be taken to the forensic morgue. In this case, refusal of a pathological autopsy is impossible.

An application for refusal to open an autopsy may not be considered on time. What to do?

Due to the heavy workload of hospitals, an application to waive an autopsy may not be reviewed in time for an autopsy to be performed. There is always such a risk.

Entrust refusal of opening to the website service

It is better to entrust the funeral agent of the official city funeral service to deal with the refusal of an autopsy, since she has established contacts with the city morgues of Moscow and will help not only in organizing the funeral, but also in negotiations with the morgue.

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Autopsy (synonym: section, autopsy) is an examination of the body of the deceased in order to study the structure of the body, determine changes in organs and tissues, and also to determine the cause of death. It is customary to distinguish between anatomical, pathological and forensic autopsies (see below). Autopsy have great importance in the study of thanatology (the study of death), epidemiology, as well as in the teaching of medical disciplines.

Anatomical dissections are performed in departments of anatomy to study the structure of the human body.

Those who die in medical institutions are usually subjected to a pathological autopsy, which is regulated by instructions on the procedure for autopsies of corpses in medical institutions. An autopsy is usually performed no earlier than two hours after death is established. Pathoanatomical autopsies are performed by pathologists in specially equipped rooms (sectional rooms) of the departments pathological anatomy and pathological departments of medical institutions. The purpose of such an autopsy is to establish the underlying disease, complications and concomitant diseases, as well as causes of death. Based on the results of the autopsy, one can judge the correctness of the lifetime diagnosis and the therapeutic measures, which is important for improving diagnostic and treatment work.

The autopsy is preceded by familiarization with all medical documents relating to the deceased. To autopsy corpses, a sectional set of instruments is used. The pathologist and the staff assisting him put on rubber gowns, sleeves and an apron. In cases of death from particularly dangerous infections or in the presence of substances (radioactive, chemical agents, etc.) that are dangerous to the health of the doctor and those present at the autopsy, special suits are used. After autopsy of the corpses of people who died from especially dangerous infections, all persons who were in the section are subjected to; the room where the autopsy was performed, and the coffin with the body of the deceased - wet. The body is not released to relatives.

The autopsy is preceded by an external examination; note the physique, nutrition, body weight and condition of the skin, pay attention to rigor mortis, cadaveric spots, ulcers, tumors, etc.

Then they begin to autopsy the corpse. For this purpose, various soft tissue incisions are used (straight, Leschke, Fischer and combined). The chest cavity is opened by dissecting the costal cartilages near their transition into the bone (Fig.). Examining the abdominal pleural cavity and the pericardial cavity, note the presence of adhesions of the layers of serous membranes, effusion, the nature of the arrangement of organs, etc. The skull is opened by cutting the soft tissues from ear to ear and detaching them anteriorly, then sawing horizontally and removing the roof of the skull. To extract and open it is necessary to saw through the posterior arches of the vertebrae.

When opening internal organs, they are examined on the spot, then removed from the corpse in a certain sequence: organs of the neck, chest and abdominal cavities, and pelvis. Organs genitourinary system sometimes they are isolated as a separate complex; in some cases, all internal organs are removed as a single complex.

The extracted organs and organ complexes are carefully examined, their size, weight, color and surface condition are determined, then they are examined after appropriate incisions. Pieces are taken from organs and tissues for histological examination, as well as material for serological and biochemical studies.

After the autopsy is completed, the corpse's organs are placed back into the cavities, the incisions are sutured, washed and dressed. During or after the autopsy, a protocol is drawn up, in the descriptive part of which the changes discovered during the autopsy are objectively recorded. A pathological diagnosis and epicrisis are also prepared. The diagnosis is the essence of the detected changes, described briefly in pathoanatomical terms, in accordance with the course of the main disease process, complications and concomitant diseases. The pathological epicrisis presents the results of a comparison of data and autopsy materials, taking into account all additional studies. At the end of the epicrisis, a conclusion is given about the mechanism and causes of death.

A forensic autopsy is performed in all cases of violent death (murder, suicide, accident), if it is suspected; when it did not occur in a medical institution; in cases where the cause of death is not clear, if there are doubts about the correct treatment of the deceased. A forensic autopsy is carried out only subject to a decision by the investigative or inquiry authorities, as well as a court decision. In case of death in medical institutions on the first day after admission with an unknown diagnosis of the disease, a forensic autopsy is also performed.

During a forensic autopsy of a corpse, the cause of death, the time of its occurrence, the presence of alcohol in the corpse are determined, and other issues are resolved depending on the specific circumstances of the case.

During an external examination of the corpse, attention is paid to clothing, cadaveric spots, rigor, temperature, putrefactive phenomena are noted; if there are damages, their exact location, nature is indicated and it is established what they could have been caused by (blunt, piercing or cutting objects, firearms, vehicles and etc.).

All individual characteristics of unidentified corpses are recorded in detail. Parts of organs and body fluids can be taken for histological, forensic chemical and some other laboratory tests.

After the autopsy of the corpse, an act or conclusion is drawn up, in which the forensic expert gives answers to the questions contained in the decision to order the examination (see Medical, forensic documentation).

Yes, the first impression from the autopsy is very strong. To mentally prepare, you first need to imagine in advance what will be waiting for you there. I am not a pathologist, so I will describe my impressions in simpler language. Enter the morgue and you are enveloped in a veil of heavy, vile smell. There are corpses lying around, preparing for autopsy - of any age and gender. Their scalp is cut off and pulled over their face. The picture looks like this:

Then the opening of the skull begins. The pathologist (or orderly) cuts the bones with a saw (it looks like he is sawing a log, the head swings from side to side), opens the skull, removes the brain (crosses the brain stem with a long knife). The brain is placed on the table and cut into pieces. Looks for tumors, hemorrhages, evaluates general state. Place several pieces in jars with solution. After removing the brain we see this:

Then it opens rib cage. An incision is made with a knife from the neck to the xiphoid process, then the ribs are cut off from the sternum. The pathologist takes out the sternum, spreads the ribs and takes out the lungs, heart and bronchi, trachea, and vessels.

These organs are placed on the table, studied, and cut. The smell from the brain, lungs and heart is the least noticeable.

Next, the stomach is cut open and the stomach, intestines, liver, and spleen are removed. When the abdomen is opened, a layer of yellow tissue is clearly visible. subcutaneous fat even in thin corpses. If the corpse is thick, then after cutting, swollen loops of intestine fall out.

This organ complex is placed on the table and each organ is cut. The stomach is opened and its contents are scooped up with a small scoop. The disgusting smell intensifies. It's better to take it with you medical mask- it weakens the smell a little. Undigested food remains visible in gastric juice, slightly crushed. The small intestine is then cut. Its contents are poured onto the table - a lot of yellow diarrhea. The smell is such that your eyes begin to water and the sight makes you sick. But the pathologist is unperturbed - he carefully cuts, studies, tells something, jokes, discusses current affairs. Along the way, the liver is cut, the gallbladder and spleen are opened. It comes to the large intestine - the diarrhea darkens and thickens. When to cut lower section large intestine, rectum - formed dark brown masses are visible. Fecal notes pervade the smell.

Then the kidneys and bladder are removed.

And now we see a gutted human corpse

Then the remains of the organs are put back into the corpse, the orderly roughly stitches it up, and the deceased is ready for burial. After completing the autopsy, the doctor takes off his dirty clothes, washes his hands, washes himself and goes to drink coffee - at the exit or behind the door there is a dining table with a kettle.

The impressions are very strong. Some days, when you look at people, you imagine their internal organs. You look at your stomach and imagine your insides. Even sexual desire disappears for several days.

Therefore, be prepared for loss of consciousness (especially impressionable girls fainted), nausea or vomiting (it is better to take antiemetic drugs before the autopsy), temporary loss of libido. Each time the autopsies are tolerated easier and easier.

Thank you very much for your detailed answer. But tell me, how can we, in principle, accept the fact that a person is lying dead, gutted? The very essence that a person is dead and has not yet been opened puts me in shock and in real panic. How to accept this morally? I understand that this is a matter of practice (but I’m not even a doctor, but a psychologist who is taken to morgues), but I cannot reassure myself that this is natural.