The study of death, its causes has become a whole scientific direction in the study of diseases and their consequences in medicine. Religious ideas of a person about death and its causes made this phenomenon not final, but continuing the existence of a person in the other world. This became the starting point for the study of man and his organization in the development of scientific views and methods in medicine and science.
History of the development of autopsy
The study of the dead began in antiquity with the help of autopsy. Autopsy as a way of understanding human nature was of interest to such scientists as Hippocrates, Galen.
Post-mortem research was first described in the 13th century by Guglielmo of Saliceto, who conducted a forensic examination of his nephew, Marquis Palavicini.
The autopsy to determine the causes of death of the suddenly deceased Alexander V, who lived in the XIV century, was carried out as the first post-mortem post-mortem examination in the modern concept. In the 16th century, the anatomist Vesalius conducted many studies and made a great contribution to the development of ideas about the structure of man. Since 1700 autopsieshave already been carried out more often, and there are many descriptions of them. Autopsy is a term that came up later. It has become very common in Europe.
In the 19th century, with the invention of the microscope and the discovery of the cellular theory of pathologies by R. Virchow, pathoanatomical studies acquired a new meaning. They began to enter into the practice of studying deaths in hospitals and for compiling post-mortem reports of those who died outside of it.
Signs of death
Dying of a person has several stages, and in order to ascertain death, you need to know its signs.
Distinguish between clinical death and biological death.
- Clinical death has signs of reversibility and lasts from 3 to 6 minutes. It is characterized by coma, asystole and apnea. Resuscitation measures increase the chance of its reversibility.
- Biological death has signs that are determined by the time of absence of heart rate (up to 30 minutes) and breathing, pupil dilation. Proper handling of the corpse in the first two hours will ensure its full examination in the pathoanatomical laboratory.
An autopsy can only be performed after 12 hours of death.
Organization of the morgue
Patological and anatomical rooms and laboratories should be in a separate building, isolated from residential and utility rooms. The mortuary has work rooms such as:
- sectional room where the autopsy is carried out;
- laboratory;
- biopsy room;
- room with sections for storing corpses;
- wash;
- museum etc.
The mortuary building is located in the green zone at a distance of 15 m from the hospital buildings. The sanitary gap with the rest of the buildings is at least 30 m. The interior design consists of walls lined with tiles, 3 meters high. Floors and walls must be impervious, level and rounded at the joints between floor and wall.
The room must be dry, equipped with refrigeration units for storing corpses, a shower cabin, a sanitary room for staff.
The dissecting table should be made of a corrosion-resistant material that will withstand frequent disinfection. The mortuary should be well lit and provide access to the corpse from all sides, which allows the study to obtain complete information.
Types of studies
According to the purpose of the autopsy, a pathoanatomical autopsy and a forensic examination are distinguished.
Pathological anatomical autopsy is the identification and confirmation of diseases, the study of organs, systems of the deceased to determine the exact clinical diagnosis that caused death.
Forensic medical examination differs from autopsy in documents on the results, objectives, methods and objects of research.
Legislative regulation of autopsy
Autopsy is a study that is regulated by the order of the Ministry of He alth No. 82 of April 29, 1994, which determines the procedure for its conduct.
Post-mortem being performed:
- to determine the cause of death if impossibleconfirmation of the clinical diagnosis resulting in death;
- in case of drug poisoning or overdose;
- in case of death due to therapeutic measures and procedures in inpatient treatment;
- if death occurred as a result of diseases of an infectious or oncological nature with confirmation of the diagnosis and taking a biopsy;
- in case of death following an environmental disaster, pregnant women, giving birth and giving birth, which requires additional clarification of the reasons;
- infant and child death, with stillbirth of children weighing 500 gr. an autopsy is required in the mortuary.
A forensic autopsy is an examination conducted to determine the cause of death from:
- violence;
- mechanical damage;
- impact of physical (a range of very high / low temperatures and electricity on the human body) factors.
Expertise consists of two stages. These include:
- study of materials for resolving judicial issues using certain methods and techniques;
- drawing up a conclusion on the results of the study at the request of the investigation.
Opening tools
The dissection kit used for autopsy is a set of these tools:
- knives - large and small sectional, amputation, cartilaginous costal, Pick's myelotome, Virchow's brain knife;
- abdominal scalpel;
- scissors - anatomical intestinal, blunt straight, straight with onepointed end, ophthalmic pointed straight, bony with strong jaws for biting off bones;
- saws - arc, sheet, double and others;
- tweezers;
- measuring instruments.
The main rules of the autopsy in the morgue is the preparation of the pathologist for the operation. The doctor puts on personal protective equipment, which are gloves, gown, apron, mask.
Opening Rules
Preparing a corpse for an autopsy consists of an external examination and a report on the constitution, skin, cadaveric spots and more.
Autopsy in medicine is an important diagnostic method that takes 2-4 hours to complete. Full reporting after biopsy results is completed after 30-60 days.
The autopsy takes place in several stages:
- a U or Y-shaped incision is made that starts from the front of the shoulder and reaches the navel, going down to the pubic bone;
- the skin and muscles are separated from the chest, freeing the chest;
- ribs are cut with a saw to gain access to the lungs and heart;
- abdominal muscles are removed to gain access to internal organs, which are also removed and rinsed under running water, weighed, and if necessary dissected, with tissue samples taken to investigate causes of death; all organs, vessels are examined individually;
- the brain is removed through a deep incision from ear to ear through the top of the head, soft tissues and muscles are separated; saw cutthe skull and the brain, which is placed in a special solution for two weeks for preservation.
The removed organs are placed back into the corpse, if it is not possible to put them back, then the body is stuffed with foam rubber.
Differences between a forensic report and a study
An autopsy is performed by a qualified pathologist, who may work as a forensic pathologist at the Bureau of Forensic Medicine.
In the order of the forensic medical examination of the corpse, it is supposed to identify the grounds for resolving the issues of the investigation. Whereas research is necessary to initiate a criminal case.
Procedure for conducting a forensic medical examination
Conducting a study of a corpse in a forensic medical examination of the causes and circumstances of a person's death requires compliance with a certain procedure for a forensic medical examination of a corpse.
The autopsy is carried out according to the protocol on the autopsy technique, which is a single rule for all stages of research in medical practice. A forensic medical examination is carried out in the presence of representatives of the investigating authorities. The expert has the right to demand the information they have about the corpse. These could be:
- initials;
- age;
- lifestyle;
- medical record;
- place and time of discovery of the corpse and much more.
The results of the autopsy are recorded in the protocol, which indicates the day, month, year of its conduct. The expert opinion mustbe written in clear and legible handwriting and language, without using jargon.
Biopsy diagnostics
Histological study of tissues is carried out to determine the clinical diagnosis, toxicological, forensic expert opinion. It consists of stages that allow you to get complete and reliable information.
The biopsy is fixed with formalin to preserve the integrity of the cellular and intracellular material and its genetic information. Then it is treated with chemicals and after dehydration is subjected to paraffin infiltration.
The next step in the work is microtomy. The results of this stage depend on the work done earlier and the quality of the paraffin infiltration.
The biopsy is cut with a special knife on a microtome. Through the notches on the biopsy, it is cut into thin, up to 2-3 microns thick, plates. They are dried and stained for diagnostic results. When preparing a report on the results of the study, the expert relies on scientific knowledge and experience.
The next step is microscopy of the biopsy, which determines the causes, pathological processes and an accurate clinical diagnosis of the disease.
Research by a pathoanatomical laboratory is carried out with a biopsy after diagnostic instrumental procedures, post-mortem autopsies to determine a clinical diagnosis that cannot be determined by sampling biomaterials in a clinical diagnostic laboratory.
