The study of death, its causes has become a whole scientific direction in the study of diseases and their consequences in medicine. The religious beliefs of man about death and its causes made this phenomenon not final, but continuing the existence of man in the other world. This was the starting point for the study of man and his organization in the development of scientific views and methods in medicine and science.
Autopsy History
Investigation of the dead began in antiquity with the help of an autopsy. Autopsy as a way of knowing the nature of man was of interest to such scientists as Hippocrates, Galen.
Post-mortem studies were first described in the 13th century by Guilhelmo of Saliceto, who conducted a forensic examination of his nephew Marquis Palavicini.
An 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 pathological study in the modern concept. In the XVI century, the anatomist Vesalius conducted many studies and made a great contribution to the development of ideas about the structure of man. Since 1700, autopsy was carried out more often, and there are many of their descriptions. Autopsy is a term that appeared 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, pathological studies acquired a new meaning. They began to enter into the practice of studying deaths in hospitals and for drawing up posthumous conclusions of the dead outside it.
Signs of death
The dying of a person has several stages, and to state death, it is necessary to know its signs.
There are clinical and biological deaths.
- 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 the absence of a heart rhythm (up to 30 minutes) and breathing, pupil dilation. Proper handling of the corpse in the first two hours will provide a full study of it in the pathological laboratory.
An autopsy can be performed only after 12 hours after death.
Morgue Organization
Pathological facilities and laboratories should be in a separate building, isolated from residential and utility rooms. The morgue has work rooms, such as:
- sectional, in which an autopsy is performed;
- laboratory;
- biopsy room;
- room with sections for storing corpses;
- washing;
- museum, etc.
The morgue building is located in the green zone at a distance of 15 m from the hospital buildings. Sanitary gap with the rest of the buildings is not less than 30 m. The interior design consists of walls, tiled, 3 meters high. Floors and walls should be impermeable, even and rounded at the joints between the floor and the wall.
The room should be dry, equipped with refrigeration units for storing corpses, shower, sanitary room for staff.
The section table must be made of corrosion-resistant material that can withstand frequent disinfection. The morgue should be well lit and provide access to the corpse from all sides, which allows the study to get complete information.
Types of Research
For the purpose of autopsy, a pathological autopsy is distinguished from a forensic examination.
Postmortem autopsy is the identification and confirmation of diseases, the study of organs, systems of the deceased to determine the exact clinical diagnosis that caused the death.
Forensic examination from an autopsy differs in documents on the results, objectives, methods and objects of the study.
Legal regulation of autopsy
Autopsy is a study that is regulated by order of the Ministry of Health No. 82 of April 29, 1994, which determines the procedure for its conduct.
Postmortem autopsy performed:
- to find out the causes of death if it is impossible to confirm the clinical diagnosis that led to death;
- with drug poisoning or overdose;
- with death due to medical measures and procedures in a hospital setting;
- if death has occurred as a result of diseases of an infectious or oncological nature with confirmation of the diagnosis and taking a biopsy;
- in the event of death following an environmental disaster, pregnant, giving birth and giving birth, which requires additional clarification of the reasons;
- infant and child death, with stillbirth of children weighing from 500 g. requires an autopsy in the morgue.
Forensic autopsy is a study conducted to identify the causes of death from:
- violence;
- mechanical damage;
- exposure to physical (a range of very high / low temperatures and electricity on the human body) factors.
The examination consists of two stages. These include:
- the study of materials to resolve judicial issues using certain methods and techniques;
- drawing up a conclusion on the results of the study at the request of the investigation.
Tampering tools
The autopsy section kit is a set of tools like this:
- knives - large and small sectional, amputation, cartilaginous costal, Peak myelot, Virkhov's brain knife;
- abdominal scalpel;
- scissors - anatomical intestinal, blunt straight, straight with one sharp end, ophthalmic pointed straight, bone with strong branches for biting off bones;
- saws - arc, sheet, double and others;
- tweezers;
- measuring instruments.
The basic autopsy rules in a morgue are to prepare a pathologist for surgery. The doctor puts on personal protective equipment, which are gloves, a dressing gown, an apron, a mask.
Showdown Rules
Preparation of the corpse for an autopsy consists of an external examination and drawing up a report on the constitution, skin integument, cadaveric stains, and more.
Autopsy in medicine is an important diagnostic method, which takes 2-4 hours in terms of time. A full report after the biopsy results is completed after 30-60 days.
An autopsy takes place in several stages:
- a U or Y-shaped incision is made, which begins from the front of the shoulder and reaches the navel, going down to the pubic bone;
- 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;
- the abdominal muscles are removed to gain access to the internal organs, which are also removed and washed under running water, weighed, and, if necessary, dismembered with the taking of tissue samples to study the causes of death; all organs, vessels are examined individually;
- the brain is removed through a deep incision from ear to ear through the crown, soft tissues and muscles are separated; the skull is cut with a saw and the brain is taken out, which for preservation is placed in a special solution for two weeks.
The removed organs are placed back into the corpse, but if it is not possible to place them back, then the body is stuffed with foam rubber.
Differences between forensic report and research
The autopsy procedure is carried out by a qualified pathologist who can work as a forensic medical expert in a forensic medicine bureau.
In the forensic medical examination of a corpse, it is supposed to identify the grounds for resolving investigation issues. While the investigation is necessary to initiate criminal proceedings.
Forensic medical examination procedure
Carrying out a corpse study during a forensic medical study of the causes and circumstances of a person's death requires compliance with a certain procedure for forensic medical examination of a corpse.
An autopsy is performed according to the protocol on the autopsy technique, which is a single rule for all stages of ongoing research in medical practice. Forensic medical research is carried out in the presence of representatives of the investigating authorities. An expert has the right to demand information about a corpse that they have. It can be:
- initials;
- age;
- Lifestyle;
- medical record;
- location and time of the discovery of the corpse and much more.
The results of the autopsy are recorded in the protocol, which indicates the date, month, year of its conduct. The conclusion of the examination should be written in an understandable and legible handwriting and language, without the use of terms.
Biopsy Diagnostics
Histological examination of tissues is carried out to determine the clinical diagnosis, toxicological, forensic opinion. It consists of stages that allow you to get complete and reliable information.
The biopsy specimen 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 stage in the work is microtomation. The results of this stage depend on the work done earlier and high-quality paraffin infiltration.
The biopsy sample is cut with a special knife on the microtome. Through incisions on a biopsy specimen, it is cut into thin, up to 2-3 microns thick, plates. They are dried and stained for diagnostic results. When compiling a report on the results of the study, the expert relies on scientific knowledge and experience.
The next stage is the microscopy of the biopsy specimen, which determines the causes, pathological processes and an accurate clinical diagnosis of the disease.
Research by the pathology laboratory is carried out with a biopsy after diagnostic instrumental procedures, post-mortem autopsies to determine the clinical diagnosis, which cannot be determined by taking biomaterials in the conditions of clinical diagnostic laboratories.