Signs of drowning in water. Drowning. Causes and mechanism of development of the pathological condition. Types of drownings. Rules for emergency and medical care. Complications, consequences and prevention of drowning. Drowning a person in other liquids

Drowning is a type of mechanical suffocation that occurs as a result of the lungs filling with fluid. The time and nature of death in water depends on external factors and the state of the body. Around 70,000 people worldwide die from drowning every year. The victims are mainly young men and children.

Causes of drowning

Risk factors include alcohol intoxication, the presence of heart disease, and damage to the spine when diving upside down. Drowning can also be caused by sudden temperature fluctuations, fatigue, or various injuries during diving.

The risk of drowning increases in the event of a whirlpool, high water flow speed, or the presence of key springs. Calm behavior in a critical situation and lack of panic can significantly reduce the risk of drowning.

Types of drowning

There are three types of drowning.

The true form of drowning is characterized by the filling of the respiratory tract with liquid to the smallest branches - the alveoli. In the alveolar septa, under fluid pressure, capillaries burst, and water or other liquid enters the blood. As a result, water and salt balance is disrupted and red blood cells disintegrate.

Asphyxial drowning is characterized by spasm of the respiratory tract, which ultimately leads to suffocation from lack of oxygen. When water or liquid enters the respiratory tract, laryngospasm occurs, which leads to hypoxia. In the final stages of drowning, the airways relax and fluid enters the lungs.

Syncopal drowning is characterized by death from reflex cardiac and respiratory arrest. This type of drowning occurs from hypothermia or severe emotional shock. Accounts for 10-14% of all drowning cases.

Signs of drowning

The main symptoms and signs of drowning depend on the type of drowning.

In case of true drowning, a sharp cyanosis of the skin and mucous membranes is observed, pink foam is emitted from the respiratory tract, and the veins in the neck and limbs are very swollen.

In asphyxial drowning, the skin is not as blue in color as in true drowning. Pink fine bubble foam is released from the victim's lungs.

In syncopal drowning, the skin is pale in color due to capillary spasm; such victims are also called “pale.” This type of drowning has the most favorable prognosis. It is known that in case of syncope drowning, even after 10 or more minutes of being under water, revival is possible.

It should be noted that the prognosis for drowning in sea waters is more favorable than in fresh water.

Drowning assistance

Assistance in case of drowning consists of performing resuscitation measures. It must be remembered that the sooner resuscitation measures are taken, the better the prognosis will be, and the higher the victim’s chances of recovery.

The main help for drowning is artificial ventilation and chest compressions.

It is advisable to perform artificial respiration as early as possible, even during transportation to shore. First, it is necessary to free the oral cavity from foreign bodies. To do this, a finger wrapped in a bandage (or any clean rag) is inserted into the mouth and all excess is removed. If there is a spasm of the masticatory muscles, which makes it impossible to open the mouth, then it is necessary to insert a mouth opener or any metal object.

Special suction can be used to free the lungs from water and foam. If they are not there, then it is necessary to lay the victim stomach down on the rescuer’s knee and vigorously compress the chest. If the water does not drain within a few seconds, you need to start artificial ventilation. To do this, the victim is placed on the ground, his head is thrown back, the rescuer places one hand under the neck and the other on the patient’s forehead. It is necessary to advance the lower jaw so that the lower teeth protrude forward. After this, the rescuer takes a deep breath and, pressing his mouth to the victim’s mouth or nose, exhales the air. When respiratory activity appears in the victim, artificial ventilation cannot be stopped unless consciousness is restored and the breathing rhythm is disrupted.

If there is no cardiac activity, then indirect cardiac massage must be performed simultaneously with artificial respiration. The rescuer's hands should be placed perpendicular to the patient's sternum in its lower third. The massage is performed in the form of sharp jolts with intervals of relaxation. The frequency of tremors is from 60 to 70 per minute. When indirect cardiac massage is performed correctly, blood from the ventricles enters the circulatory system.

If the rescuer performs resuscitation alone, then it is necessary to alternate cardiac muscle massage and artificial ventilation. For 4-5 pushes, one blow of air into the lungs should fall on the sternum.

The optimal time for resuscitation is 4-6 minutes after saving a person. When drowning in ice water, revival is possible even half an hour after being removed from the water.

In any case, at the first opportunity, even if all vital functions are restored, it is imperative to take the victim to a hospital.

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Diagnosis of death from drowning is often difficult; only a set of signs and the use of laboratory research methods allows one to correctly determine the cause of death.

Rice. 12. Foam around the mouth and nose openings during drowning.

During an external examination of a corpse, the following signs are important, allowing one to suspect: the skin, as a result of a spasm of the skin capillaries, is paler than usual; cadaveric spots are purple with a gray tint and pinkish coloring along their periphery. So-called goose bumps are often observed, which is a consequence of contraction of the muscles that lift the hair. Around the openings of the mouth and nose, as a rule, pinkish-white, persistent, fine-bubble foam is detected (Fig. 12). The foam around the breathing holes persists for up to two days after the corpse is removed from the water, then it dries and a mesh film of a dirty gray color is visible on the skin.

During internal examination, a number of characteristic signs attract attention. When opening the chest, a sharply pronounced appearance is observed; the latter completely fill the chest cavity, covering the heart. Imprints of the ribs are almost always visible on the posterolateral surfaces of the lungs. The lungs have a doughy consistency to the touch due to significant swelling of the lung tissue. The increase in lung volume while the corpse is in water gradually disappears by the end of the week. Lukomsky-Rasskazov spots are observed under the visceral pleura. These spots are hemorrhages of a reddish-pink color, much larger in size compared to Tardieu spots, located only under the visceral pleura: Their color and size depend on the amount of water entering the systemic circulation through the torn and gaping capillaries of the interalveolar septa. Diluted and hemolyzed blood becomes lighter, its viscosity decreases, and therefore hemorrhages become blurry. Lukomsky-Rasskazov spots disappear after the corpse remains in water for more than two weeks. Thus, the absence of Lukomsky-Rasskazov spots when the corpse remained in water for a long time does not indicate that they did not exist at all.

The visceral pleura is cloudy. When examining the respiratory tract, a grayish-pink, finely bubbled foam is found in them, in the composition of which, upon microscopic examination, foreign inclusions (sand, small algae, etc.) can often be detected. The mucous membrane and bronchi are edematous and cloudy. Bloody, foamy fluid flows copiously from the surface of the lung incisions. The stomach usually contains a large amount of fluid. The liver capsule is also somewhat cloudy. The gall bladder bed and its wall are markedly swollen. In the serous cavities one can see a significant amount of , which, according to a number of authors, is formed 6-9 hours after the corpse has been in the water and essentially refers to the signs indicating that the corpse has been in the water. The detection of fluid in the tympanic cavities of the middle ear is of the same importance. As a result of laryngospasm, the pressure in the nasopharynx decreases, and therefore water enters the sinuses of the main bone through the pyriform slits. The volume of water in the sinuses can reach 5 ml (Sveshnikov's sign). In case of drowning, hemorrhages are found in the tympanic cavity, mastoid cells and mastoid caves, which look like free accumulations of blood or abundant soaking of the mucous membranes. The occurrence of this phenomenon is associated with an increase in pressure in the nasopharynx, circulatory vascular disorders, which, in combination with severe hypoxia, lead to an increase in the permeability of the vascular walls with the formation of these hemorrhages.

Laboratory tests, especially the plankton detection method, are important for the diagnosis of drowning. Plankton are the smallest organisms of plant and animal origin that live in lakes, rivers, seas, etc. Each body of water is characterized by certain types of plankton, which have specific differences. For the diagnosis of drowning, plankton of plant origin is of greatest importance - phytoplankton, especially diatoms. Diatoms have a shell consisting of inorganic compounds - silicon. This shell can withstand high temperatures, strong acids, etc. Diatom phytoplankton has different shapes and is found in the form of sticks, stars, boats, etc. Diatoms up to 200 microns in size, together with water, through broken capillaries of the alveoli, penetrate into the systemic circulation and are carried through the bloodstream throughout the body, lingering in the parenchymal organs and bone brain. Detection of this type of plankton in internal organs and bone marrow is an objective method of proving death from drowning.

Isaev Yu.S., Sveshnikov V.A. : Information mail. - Irkutsk, 1988. - 8 p.

Prepared by the Head of the Department of Forensic Medicine of the Irkutsk State Medical Institute, Head of the Bureau of Forensic Medicine of the Irkutsk Regional Health Department, Candidate of Medical Sciences, Associate Professor Yu.S. Isaev. and Ph.D. Sveshnikov V.A.

Forensic medical substantiation of death from drowning in water

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Irkutsk State Medical Institute

Yu.S. Isaev, V.A. Sveshnikov

Forensic medical substantiation of death from drowning in water

Information mail

Irkutsk - 1988

Assessing the results of forensic medical examination of corpses of persons recovered from water presents certain difficulties due to the need to resolve 3 main issues:

• 1 - prove a person’s lifetime entry into a body of water;
• 2 - establish the thanatogenetic mechanism of death;
• 3 - try to find out the reasons that led to drowning in water.

In most cases, forensic experts try to substantiate the diagnosis of drowning in water as a variant of mechanical asphyxia from the closure of the respiratory tract with water, using, as a rule, signs indicating penetration of the body of water into the body. In this regard, drowning is considered by a forensic expert as one of the types of obstructive or aspiration asphyxia. It should be noted that this provision has been established and reinforced by a similar formulation of the definition of drowning in all textbooks and manuals on forensic medicine.

However, the possibility of the existence of several thanatogenetic variants of drowning in water has now been convincingly proven, each of which is characterized by certain diagnostic signs. Analysis of literature data and our own observations, covering more than 500 studies of corpses of persons recovered from water, allowed us to formulate new concepts regarding the thanatogenetic mechanisms of drowning and the diagnostic capabilities of differentiating types of drowning. The correctness of our provisions was confirmed by the editors of the journal “Forensic Medical Examination” (SME, 1986, No. 1, pp. 26-29, SME, 1989, No. 1, pp. 23-25) and the Great Medical Encyclopedia (third edition, 1985, v. 26, pp. 142-146), materials of the II All-Russian (Irkutsk, 1987) 1, III All-Union (Odessa, 1988) congresses of forensic doctors, plenum of the All-Russian Scientific Society of Forensic Physicians (Krasnoyarsk, 1988). In this regard, we considered it possible to summarize the results of our work in the form of this letter.

The process of drowning in water is complex and is associated with a complex of exo- and endogenous factors that precede drowning and cause deep disturbances in the functioning of the body. Initial acute functional disorders do not leave noticeable morphological signs on the corpse during drowning.

They are also, as a rule, obscured by pathological processes that arise as a result of the closure of the airways with water and the penetration of the drowning environment into the body. These changes form the signs that form the basis of existing methods of forensic medical diagnosis of drowning. But the severity of these changes is variable and depends on the thanatogenetic variant of drowning, which often complicates the recognition of this type of death.

At the same time, the phenomena of obstruction or aspiration during drowning in water are possible only in cases where a person is immersed in water as a result of acute violations of the basic functions of the body (central nervous

systems, breathing, blood circulation). In the absence of such violations, drowning becomes impossible. If conditions arise under which only the head or part of it is immersed in a liquid (puddle, basin of water, etc.) with the closing of the respiratory openings, for example, in persons under the influence of alcohol, during an epileptic seizure or other acute developed painful conditions with impaired consciousness and not related to the influence of the aquatic environment on the body, they should be considered as obstructive or aspiration asphyxia, and not as a variant of drowning.

Consequently, drowning is a type of violent death that occurs when a person is immersed in water (rarely another liquid) and is caused by an acute disruption of the functions of the vital systems of the body (central nervous system, respiration, blood circulation) under the influence of the aquatic environment.

Drowning in water is a fairly common form of death in almost all regions of the globe, including our country. According to WHO, death from drowning has a global average of 1.0-1.2 per 10 thousand population. In this regard, the forensic medical solution to the entire complex of the above issues acquires a significant role in increasing the objectivity of the expert opinion and is important in the development of preventive measures for drowning and methods of treating drowning victims.

THANATOGENESIS OF DROWNING IN WATER

The process of drowning in water is complex and is associated with a complex of exo- and endogenous factors preceding drowning, which determine the development of specific pathogenetic mechanisms, each of which in turn is characterized by certain changes in the body.

There are 4 main types of drowning in water:

1. Aspiration type of drowning(until now very inaccurately called “true”) is characterized by penetration into the respiratory tract, lungs and blood of the reservoir environment. This type of drowning, according to our materials, occurs on average in about 20% of cases. Our data on the frequency of occurrence of various types of drowning do not contradict the statistical observations of other researchers. So, R.A. Klimov (1970), S.S. Bystrov (1975), G.P. Timchenko (1975) and others in more than 50% of observations did not encounter phenomena of water penetration into the body of humans and animals during death from drowning. Depending on the nature of the water (fresh or salt), the changes that occur in the body will be different:

• A) drowning in fresh water is accompanied by a significant intake of water from the lungs due to osmotic processes into the bloodstream, causing hypervolemia, hydremic hemolysis of red blood cells, a significant increase in the concentration of potassium in the blood plasma, which leads to cardiac fibrillation and the development of acute heart failure. The duration of the drowning period (according to experimental data) is 3-5 minutes, accompanied by a short-term increase in blood pressure, followed by its decrease and a stable decrease in venous pressure. The cessation of cardiac activity occurs 10-20 seconds earlier than breathing completely stops;
• b) drowning in salt water(marine), which in relation to blood is a hypertonic environment, entails the release of the liquid phase of blood into the lumen of the alveoli with the development of severe pulmonary edema and the occurrence of acute pulmonary failure. In the initial period of drowning (according to experimental data), high systolic pressure is observed against the background of a decrease in diastolic pressure, which leads to a significant increase in pulse pressure, and peripheral venous pressure increases. Cardiac arrest, as a rule, as a result of asystole develops gradually, over 7-8 minutes with increasing myocardial hypoxia. Cardiac activity stops after breathing for 10-20 seconds.

2. Spastic (asphyxial) type of drowning is associated with the occurrence of persistent laryngospasm as a response to irritation of the receptor apparatus of the laryngeal mucosa by the drowning environment, which prevents the latter from penetrating the respiratory tract and lungs. The duration of the drowning period (according to experimental data) is 5.5-12.5 minutes, accompanied by a progressive decrease in blood pressure and an increase in central venous pressure. The cessation of cardiac activity occurs against the background of arterial hypotension 20-40 seconds after the cessation of breathing. This type of drowning is observed in 35% of cases. It is accompanied by significant changes in the lung tissue due to the occurrence of false respiratory respiratory movements with a closed glottis. Phenomena of acute hyperaeria of the pulmonary tissue develop with damage to its structural elements, the possibility of air penetration into the pulmonary vessels and the left side of the heart appears, significant disturbances occur in the microvasculature of the lungs, which leads to acute pulmonary failure, cerebral hypoxia and air embolism of the heart.

3. Reflex (syncope) type of drowning is caused by the simultaneous cessation of respiratory and cardiac function when a person suddenly finds himself in extreme conditions. This type of drowning can develop in a state of psychogenic tension in the body (fear), as well as when exposed to water, especially low temperatures, on the receptor apparatus of the skin, larynx, pharynx, middle ear cavity in the presence of a defect in the eardrum, etc. In the occurrence of this type of drowning Pathological changes in the heart, lungs, and a specific allergic reaction to the aquatic environment may be important. The reflex type of drowning is observed on average in 10% of cases and is more common at a young age and in women whose nervous system is characterized by increased emotionality.

4. Mixed type of drowning occurs on average in 35% of observations and is characterized by polymorphism of detected signs, which is associated with a combination of different types of dying. More often, this type of drowning can begin with laryngospasm, which subsequently resolves in later phases of drowning, which entails the penetration of water into the respiratory tract and lungs with the development of phenomena characteristic of the aspiration type of drowning. However, other combinations are possible (spastic type plus reflex, aspiration plus reflex).

Thus, the existence of several types of drowning with certain changes in the body requires their mandatory consideration when expertly substantiating the cause of death in persons removed from the water.

DIAGNOSTIC SIGNS OF DROWNING

Depending on the type of drowning, the tactics of the forensic expert in substantiating the conclusion should be strictly unified and include the phased use of morphohistological, planktoscopic and laboratory physical and chemical research methods.

However, fulfilling the above task is to a certain extent difficult without attempts to clarify the reasons that led to the development of extreme conditions associated with a number of exogenous and endogenous factors.

Exogenous factors, or risk factors, include:

• a) sudden entry into the aquatic environment with the development of a psychotraumatic situation (feeling of fear) - a reflex type of drowning often develops;
• b) the occurrence of psychogenic tension (stressful situation) associated with swimming and diving in an unfamiliar body of water and having conditions unusual for a particular person (uneven bottom, increased vegetation of the reservoir, uneven temperature due to spring waters, fast currents with the formation of water funnels, etc.) . In this case, reflex, spastic, mixed and, less commonly, aspiration types of drowning may develop;
• c) a person entering an aquatic environment that differs sharply from the temperature of the human body, with the development of cold shock phenomena (the temperature difference between the aquatic environment and the human body, exceeding 20-25 ° C, is especially dangerous). This situation is often accompanied by the development of a reflex, less often spastic type of drowning, caused by a sharp inhibition of the central nervous system;
• d) hydrostatic pressure at a depth of 1.5-2 meters or more causes compression of peripheral vessels and can lead to collapse. Pressure on the pliable abdominal wall leads to compression of the abdominal organs, displacement of the liver, stomach, intestines, and a change in the position of the diaphragm, disrupting cardiac activity.

Endogenous factors form a risk group. It includes various negative reasons leading to the occurrence of extreme conditions, namely:

A) seasonal disadaptation of the body to the aquatic environment. A prolonged absence of contact of the body with the aquatic environment of reservoirs disrupts the stabilization of physiological processes when the human body is immersed in water. A similar situation occurs in almost all regions of the country, where the mass swimming season lasts only 2-3 months. Moreover, even in a practically healthy young person, during the first bath after a long break, acute functional changes occur in the central nervous system, cardiovascular and pulmonary systems. There is rapid fatigue, decreased blood pressure, a significant increase in heart rate with a weak pulse wave, rapid shallow breathing, etc. Physiological parameters are normalized only 15-30 minutes after leaving the reservoir. With subsequent bathing, such changes become less pronounced and return to normal faster. Full adaptation of the body to the aquatic environment with stabilization of physiological parameters occurs on average after no less than 5 regular daily baths, carried out in a strict regime. In cases of death of persons in this group, the pathogenetic type of drowning can be different, including all 4 options;

b) decompensation of the physiological capabilities of the body when the cardiovascular and respiratory systems are overstrained during prolonged or intense swimming and diving (sport swimming, swimming when attempting self-rescue, etc.). In this case, the aspiration type of drowning often develops;

V) accompanying illnesses, being a trigger for the development of drowning:

• - organic and functional diseases of the cardiovascular system, lungs, central nervous system (coronary artery disease, heart defects, cardiopathy of various origins, pneumosclerosis, chronic pneumonia, epilepsy, etc.);
• - diseases of the hearing organs with perforation of the eardrum;
• - unfavorable allergic status (including specific allergy to the aquatic environment).

In this group, a spastic or reflex type of drowning occurs more often; a mixed type is possible;

G) presence of alcohol intoxication organism, leading to inadequate actions of the deceased. In cases of intoxication, aspiration or mixed type of drowning often develops. When assessing the degree of alcohol intoxication, it is necessary to take into account the possibility of reducing the true concentration of ethanol due to the hydremic effect - hemodelution;

d) traumatic injuries(mainly the skull, cervical spine, chest and abdominal organs), occurring before entering the water, at the time of immersion in a body of water or in the body of water itself. In case of trauma, various types of drowning are observed, determined by the nature of the injury and the body’s reaction to the aquatic environment;

e) swimming and diving after a heavy meal. Fullness of the stomach leads to the redistribution of blood, its deposition in the gastrointestinal tract, which causes relative hypoxia of the brain, other organs and systems, thereby reducing the body's resistance and its reserve capabilities in the fight against oxygen starvation. In addition, the pressure of the aqueous environment on the anterior abdominal wall causes vomiting. In this group, the aspiration type of drowning is more common.

Thus, exo- and endogenous factors play a certain role in the development of drowning, which creates the need to systematize diagnostic signs depending on the type of drowning. The complexity of carrying out this task lies in the fact that for the purposes of diagnosing drowning, many different signs and methods have been proposed, most of which were developed without taking into account the type of drowning, which significantly reduced their practical significance. In addition, when tested in expert practice, a number of diagnostic signs turned out to be untenable, and some, although evidentiary, were not widely used in forensic medical examination due to the excessive technical complexity of their identification.

In this regard, further presentation of the material is carried out taking into account this situation, focusing the attention of forensic experts on a rational set of the most reliable, easily identified and implemented diagnostic signs and methods.

1. Diagnostic signs for aspiration type of drowning

a) Drowning in fresh water.

The skin is pale, cold, often “goosey-looking.” Cadaveric spots are grayish-cyanotic (gray-gray) due to blood thinning with water, and appear quickly, after 30-40 minutes. After removing the corpse from the water and exposure to air, the spots turn pink due to oxygenation through the loosened epidermis, but their bluish tint remains. At the mouth, nose and respiratory tract there is a white, fine-bubbly persistent foam, sometimes with a pinkish tint, which is associated with hemolysis of red blood cells. The lungs are increased in volume, heavy due to hyperhydria (“balloon” appearance). To objectively assess the degree of airiness of the lung tissue, as a diagnostic sign of aspiration of the drowning environment, a technically simple and fairly objective method for examining the lungs has been proposed. After isolating the thoracic organ complex, the lungs are separated with ligatures applied to the bronchi, they are weighed, and then each of the lungs is placed in a vessel with water, preferably glass, on the wall of which the liquid (water) level is marked until the lungs are immersed. After this, the lung is completely immersed under water, and the level of rise of the liquid (water) is noted. The lung is removed and its volume is determined by the amount of displaced liquid in the vessel by adding water from a measuring container (measuring cups, flask, cylinder, etc.) to the level of the upper mark (water level in the vessel after immersion of the lung). The coefficient of airiness of the lung tissue, determined by the ratio of the volume of the lungs to their mass, was, according to our data, an average value of 1.43 ± 0.13. Due to significant damage to the surfactant (the substance lining the alveoli and preventing the collapse of the alveoli and the penetration of the water-air environment through their wall) by the hypotonic environment of the reservoir, foci of atelectasis arise in the lungs with the accumulation of fluid in the pulmonary alveoli and early edema of the interstitial tissue. Under the pleura, more on the posterolateral surfaces of the lungs, striped, large-focus, reddish hemorrhages without clear boundaries are formed (Paltauf-Rasskazov-Lukomsky spots). Heart failure is realized according to the left ventricular type, as it is associated with fibrillation of the heart and is accompanied by an overflow of liquid blood in the left part of it. Confirmation of ventricular fibrillation is increased transverse striation of the myocardium (contractural degeneration), bands of contraction and rupture of individual myofibrils or the entire muscle fiber (myofragmentation).

Noteworthy is the increased transudation of fluid into the serous cavities, swelling of the wall and bed of the gallbladder, membranes and substance of the brain. There is a significant amount of urine in the bladder. Hydremia caused by drowning leads to the rapid development of osmotic hemolysis of red blood cells, the severity of which is determined both by conventional biochemical studies of free hemoglobin and by pink staining of blood plasma and imbibition of the intima of blood vessels with blood pigment. Due to heterogeneous hemodelution, hemolysis processes are significantly expressed in the arterial system.

At the moment of drowning, the constituent particles of the reservoir environment enter the body along with the water through the wall of the alveoli. Of particular expert importance is plankton (diatoms), which are present in almost any body of water and are extremely resistant to various types of external influences. The silica shell of diatoms is not destroyed in the body under the influence of postmortem autolytic processes, and plankton can be established in the medullary canal of long tubular bones even in skeletonized corpses. Each body of water has a certain species specificity of plankton, and the number of diatoms mainly depends on the time of year. The maximum of vegetative activity falls during the warm period, and therefore, in case of drowning during the swimming season, diatoms will be clearly visible in the internal organs, bone marrow, and choroid plexuses of the brain. The number of identified diatoms can reach several dozen in each seized object. When carrying out planktoscopic research, in addition to identifying plankton, it is necessary to carry out qualitative identification of diatoms in the reservoir environment, in the lungs and other organs and tissues (liver, kidneys, bone marrow, choroid plexuses of the brain). The latter allows, in addition to a reliable statement of the fact of intravital penetration into the body along with the environment of the reservoir, to resolve the issue of the place of drowning.

The entry of water from the lungs into the arterial bed during drowning entails significant changes in the water-electrolyte balance of the body, characterized mainly by heterogeneous hemodelution and a violation of the potassium-sodium ratio, which acquires diagnostic significance for substantiating the causes of death.

The phenomena of hydremia are established on the basis of a comparative study of blood taken from the arterial and venous beds. For these purposes, blood obtained from the right and left parts of the heart, from the common iliac artery and inferior vena cava is examined using methods well known in clinical medicine (determining the specific gravity of plasma and whole blood, solids, viscosity, plasma protein, etc. .). However, osmotic and especially post-mortem hemolysis to a certain extent neutralize the processes of heterogeneous hemodelution, which somewhat reduces the practical significance of these methods. In this regard, it is more expedient to study the refractometric index of the hemolysate or protein-free filtrate of the compared blood samples using the method of S.S. Bystrova (1975). Blood hemolysis is carried out using solid carbon dioxide (dry ice) and acetone. Protein-free blood filtrate is obtained by adding an equal volume of 10% trichloroacetic acid solution to it, followed by centrifugation. Comparative ratios of the refractive indices of hemolysates and protein-free filtrate in blood from the arterial and venous systems show with a high degree of reliability a more significant dilution of arterial blood. For the same purposes, it is recommended to carry out a diagnostic test directly at the dissecting table with separate application of drops of arterial and venous blood on filter paper, assessing the results by the area of ​​the spot and the severity of the yellowish halo around it; The wider the halo and the larger the area of ​​the spot, the greater the degree of blood dilution with water. With heterogeneous hemodelution (aspiration and mixed types of drowning), the area of ​​the spot and halo resulting from a drop of arterial blood, compared with that from a drop of venous blood, often increases by 50% or more (this sign should be considered reliable if the indicator increases by 30%).

The content of sodium and potassium in the blood with this type of drowning also undergoes significant changes that are regional in nature. When studying the level of electrolytes using the generally accepted method using flame photometry or using ion-selective electrodes, a significant increase in the concentration of potassium in the plasma (3-4 times) and a decrease in sodium content (by 50%) are clearly revealed. Moreover, more significant changes occur in the arterial system, especially in the blood from the left side of the heart, where the potassium-sodium ratio increases more than 5 times.

Thus, the listed signs indicate the fact of penetration of the drowning medium (fresh water) into the human body, which allows them to be used to prove the aspiration type of drowning.

b) Drowning in salt (sea) water

This type of aspiration type of drowning does not have signs indicating penetration of the reservoir environment into the blood. The phenomena of hemolysis and heterogeneous hemodelution are absent; on the contrary, processes of hemoconcentration of arterial blood occur with an increase in its viscosity coefficient and hypovolemia.

In the lungs there is a picture of focal atelectasis, severe edema and large-focal hemorrhages with a significant decrease in the airiness of the lung tissue. The foam found in the respiratory tract and lungs has a fine-mesh appearance and is bright white in color. Planktonoscopic examination of the organs of the deceased was inconclusive. Studying the state of the electrolyte balance of the blood also does not reveal noticeable changes, and therefore conditions for the occurrence of fibrillation of the ventricles of the heart are not created.

Thus, the diagnostic substantiation of expert conclusions about the cause of death is carried out mainly based on the changes that occur in the lungs.

2. Diagnostic signs for spastic (asphyxial) type of drowning.

The leading link in the pathogenesis of this type of drowning is the development of acute disturbances in the functions of external respiration with the occurrence of hypoxia, which leads to the formation of morphological signs characteristic of the so-called asphyxial picture of death. However, a thorough analysis of the totality of all identified signs allows us to prove with a high degree of certainty the spastic type of drowning. In the sectional picture, attention is drawn to the severity of the cadaveric spots and their blue-violet color, the cyanosis of the skin, especially the face; the presence of pinpoint hemorrhages in the mucous membrane of the eyelids, the tunica albuginea of ​​the eyeballs, pinpoint hypostatic hemorrhages in the skin in the area of ​​cadaveric spots. Often there are signs of involuntary release of feces, urine, sperm, and the release of the Christeller plug from the cervical canal of the uterus. The bladder contains a small amount of urine. The internal organs are sharply congested, with pinpoint hemorrhages. There is a sharp filling of the right side of the heart with blood. At the same time, due to increased lymphatic drainage from the lungs and the entry of lymph in significant quantities into the thoracic lymphatic duct, venous blood is diluted compared to arterial blood. Loose blood clots are often found in the left side of the heart.

Persistent spasm of the larynx causes the formation of a number of signs that are pathogenetic for this type of drowning. Due to laryngospasm and excursion of the chest during pseudo-respiratory respiratory movements, intrapleural pressure sharply decreases, which leads to an increase in the volume of the lungs and their significant airiness (the airiness coefficient reaches 2.0 units and higher). In the lungs, there is a thinning of the interalveolar septa, their ruptures with hemorrhages into the lung tissue, and acute pulmonary emphysema (“marble” lungs occurs). The lungs are dry, foam, as a rule, is not found, but if it is found, it is in small quantities and has a bright white color. In the pulmonary veins, especially in the left side of the heart, air bubbles are often found that penetrate into the vascular bed through damaged lung tissue. This sign is reliable only when taking into account the severity of air embolism and excluding the possibility of putrefactive gases being in the heart cavity. For these purposes, it is recommended to use a simple device (similar to a blood transfusion system), consisting of a container with an outlet tube in the bottom area (tube), a rubber catheter with an injection needle at the end, a glass measuring burette, both end outlet tubes of which are connected to the catheter, two adjustable clamps placed on the catheter in the burette area. Using clamps, the entire system is filled with water, after which the needle is inserted into the left side of the heart, and both clamps are opened. The level of the container with water should be such that air from the heart cavity, displacing water, enters the measuring burette. The amount of air is determined by the volume of water it displaces from the burette. To eliminate expert errors associated with the possibility of putrefactive gases occurring in the heart cavity, the system used must be filled with weakly concentrated, colorless aqueous solutions of lead salts (from 0.1 to 1.0%). It is more expedient to use a 0.5% aqueous solution of lead acetate for these purposes. This lead salt dissolves easily in water and does not change the color of the solution. If there are putrefactive gases in the cavities of the heart, one of the products of which is hydrogen sulfide, they will cause a clearly visible reaction with the formation of lead sulfides, which will precipitate in a black color.

In addition, it is also necessary to puncture the right side of the heart, where putrefactive gases usually form much earlier and in greater volume than in the left side.

The occurrence of laryngospasm with loss of connection with the atmosphere is known to lead to a significant decrease in pressure in the nasopharynx. In this regard, due to the pressure difference, the drowning medium begins to flow through the pyriform slits into the sinus of the main bone. Its volume can reach 5 ml or more. After removing the upper wall of the sinus with a chisel, the liquid is taken with a syringe, its volume is determined, then native preparations are prepared for microscopic examination in order to identify plankton, plant spores, protozoa and other elements of the reservoir environment. In cases of late section of corpses of persons removed from water (skeletal corpse or with pronounced putrefactive changes) or during repeated examinations (exhumations), examination of the sinus of the main bone is also advisable. If there is no liquid in it, it is recommended to inject 2 ml of distilled water into the sinus using a syringe, followed by its removal and study of native preparations under a microscope for the presence of elements of the drowning environment. Even with a long postmortem period, it is often possible to obtain positive results.

A decrease in pressure in the nasopharynx and involuntary swallowing movements lead to the penetration of large quantities of water into the stomach and duodenum. Up to 1 liter or more of liquid can be found in the stomach.

To exclude its food origin, it is necessary to identify the liquid with the environment of the reservoir, in particular by the presence of contaminants. A method is recommended (S.S. Bystrov, 1975) for studying fluid from the stomach using ultraviolet rays, which cause luminescence of petroleum product oils, which often contaminate water bodies.

Acute circulatory disturbance in the area of ​​the small circle with the spastic type of drowning causes significant venous stagnation of blood, mainly in the vena cava system, which leads to venous hypertension. As a result of this phenomenon, a retrograde reflux of red blood cells occurs into the lumen of the thoracic lymphatic duct. The degree of lymphohemia and its extent along the duct depends on the severity of laryngospasm. In this regard, microscopic examination of the thoracic lymphatic duct is recommended to confirm the type of drowning. Before the thoracic lymphatic duct is separated, two main ligatures are applied in the area of ​​its mouth and in the initial section, then, by applying additional ligatures, the duct is divided into 3 fragments: initial, middle, final. The isolated and ligated duct is fixed in formalin, and each fragment is subjected to histological examination (hematoxylin-eosin staining), and a counting chamber is used to quantify lymphohemia.

Thus, the spastic type of drowning, having no signs of penetration of the reservoir environment into the lungs and vascular bed, can be objectively justified by a diagnostic tetrad (water in the sinus of the main bone, acute swelling of the lungs, air embolism of the left heart, lymphohemia of the thoracic duct), indicating the intravital occurrence of laryngospasm when a person falls into the water.

3. Signs of a reflex type of drowning.

Since this type of drowning is not characterized by laryngospasm and penetration of the body of water into the body, no changes in the lungs occur. There is a sharp pallor of the skin and skeletal muscles due to vasospasm, a sharp congestion in the inferior vena cava system and signs of acute death. A thorough histological examination is necessary, especially of the endocrine system, which allows us to establish the presence of acute functional disorders in the human body. Thus, the reflex type of drowning does not have pronounced diagnostic signs and can be determined based on the totality of these circumstances of the incident, anamnestic status and the results of examination of corpses, excluding the possibility of other variants of thanatogenesis.

4. Signs of mixed type of drowning.

Depending on the predominance of one or another type of drowning, the sectional picture and the results of additional laboratory methods will be extremely different. Common to this type are signs indicating impairment of external respiration to varying degrees, which is determined by the pathomorphological picture of the lungs. The level of morphological manifestation of acute hypoxia will also be different. The severity of signs indicating penetration of the drowning environment into the body or accompanying laryngeal spasm will vary widely. For an expert substantiation of thanatogenesis in this type of drowning, a quantitative assessment of the entire complex of diagnostic signs characterizing aspiration, spastic or reflex types of drowning is important.

Considering that the cause of drowning can be mechanical trauma, in any case, when examining corpses removed from water, it is necessary to conduct a targeted study to identify it. In order to establish or exclude barotrauma when diving, it is necessary to examine the eardrums. The presence of hemorrhages in the soft tissues of the cranial vault, sternocleidomastoid muscles, the area of ​​the nuchal ligament and in the interspinous ligaments of the lumbar spine requires an examination of the spine and spinal cord. For the cervical spine, the V.A. method is used. Sveshnikov (1957), and for the thoracic and lumbar regions - the methods of A.A. Solokhin (1986) and Yu.S. Isaeva (1982). When examining corpses of persons removed from water, it is necessary to take into account the possibility of a person’s corpse getting into a body of water, which a forensic expert must establish by determining the cause of death before the body enters the water.

METHOD FOR ESTABLISHING THE TYPE OF DROWNING

The recommended method, which allows us to objectify the conclusion about the type of drowning, is based on a quantitative assessment of the severity of a number of diagnostic signs, taking into account their interdependence. The severity of each of the used signs is assessed conditionally using a 5-point system.

All signs are divided into 2 groups. The first group of signs is a consequence of the penetration of the drowning environment into the body. The second group is associated with the severity of laryngeal spasm and its duration.

The first group includes the following signs:

A. Presence of plankton (P) in internal organs and tissues:

• 1) no plankton - 1 point;
• 2) single diatoms in only one of the studied objects - 2 points;
• 3) single diatoms in each of the seized objects - 3 points;
• 4) up to 10-20 diatoms in each object - 4 points;
• 5) a lot of diatoms in each of the objects - 5 points.

b. Phenomena of heterogeneous hemodelution (D): dilution of arterial blood compared to venous:

• 1) identification of the opposite pattern: statistically significant dilution of venous blood by lymph (t>3.0) - 1 point;
• 2) absence of signs of liquefaction in arterial and venous blood parameters - 2 points;
• 3) tendency to dilute arterial blood (statistically weak degree of reliability, 2.5
• 4) statistically significant difference in the indicator due to dilution of arterial blood (3.0
• 5) a sharp difference with a high degree of statistical significance (t > 3.5) of the compared indicators due to arterial hemodelution - 5 points.

V. Osmotic hemolysis (O) due to delution of arterial blood:

• 1) absence of hemolysis - 1 point;
• 2) the initial phenomenon of hemolysis of arterial blood in the absence of it in venous blood (established only by laboratory methods) - 2 points;
• 3) moderately expressed phenomena of hemolysis of arterial blood (plasma coloration pinkish) - 3 points;
• 4) clearly visible phenomena of hemolysis of arterial blood (plasma is stained red, the intima of the aorta acquires a pinkish tint) - 4 points;
• 5) pronounced phenomena of hemolysis of arterial blood (impossibility of obtaining plasma, the supernatant becomes dark red, the endocardium and intima of the aorta are dark red) - 5 points.

d. Morphological signs (M), indicating the possibility of penetration of the reservoir environment into the body (see pp. 10-13):

• 1) absence of morphological signs - 1 point;
• 2) tendency to the appearance of individual vaguely expressed signs - 2 points;
• 3) the presence of only a few clearly defined signs - 3 points;
• 4) identification of several well-defined morphological characteristics - 4 points;
• 5) clear expression of the absolute majority of morphological characteristics - 5 points.

The second group consists of the following diagnostic signs:

A. Establishment of air (B) in the left side of the heart:

• 1) lack of air - 1 point;
• 2) traces of air (individual air bubbles) - 2 points;
• 3) presence of up to 3 cm3 of air - 3 points;
• 4) presence of up to 5 cm3 of air - 4 points;
• 5) the presence of a large amount of air (more than 5 cm3) - 5 points.

b. Degree of airiness of lung tissue (L):

• 1) airiness coefficient in the range of 1.00-1.20 - 1 point;
• 2) airiness coefficient in the range of 1.20-1.50 - 2 points;
• 3) airiness coefficient in the range of 1.50-1.70 - 3 points;
• 4) airiness coefficient in the range of 1.70-2.00 - 4 points;
• 5) airiness coefficient over 2.00 - 5 points.

V. The degree of lymphohemia (E) in the thoracic lymphatic duct:

• 1) absence of red blood cells in the thoracic lymphatic duct - 1 point;
• 2) single red blood cells in the final section of the thoracic lymphatic duct (ostium zone) - 2 points;
• 3) single red blood cells in the middle section of the thoracic duct with a moderate number of them (tens) in the final section - 3 points;
• 4) single red blood cells in the initial section of the thoracic duct if they are present in its final and middle sections - 4 points;
• 5) a lot of red blood cells throughout the thoracic lymphatic duct - 5 points.

d. Detection of fluid in the sinus of the main bone (G):

• 1) lack of fluid - 1 point;
• 2) traces of liquid (no more than 0.5 ml) - 2 points;
• 3) presence of liquid up to 1.5 ml - 3 points;
• 4) presence of liquid up to 3 ml - 4 points;
• 5) presence of liquid over 3 ml - 5 points.

The type of drowning (t) in persons removed from the water is determined by the ratio of the severity of the above symptoms, assessed on a 5-point system, using the following formula:

t = (v+l+f+e) / (p+d+g+m)

• T - ratio coefficient of the studied characteristics;
• B - score of the degree of air embolism of the left heart;
• L - score indicator of the degree of airiness of the lung tissue;
• E - score indicator of the degree of lymphohemia in the thoracic lymphatic duct;
• F - score indicator of the presence of fluid in the sinus of the main bone;
• P - score indicator of the presence of plankton in the studied organs;
• D - score indicator of the degree of heterogeneity of hemodelution (degree of dilution of arterial blood);
• G - score indicator of the degree of osmotic hemolysis;
• M - score of the degree of severity of morphological diagnostic signs.

For different types of drowning, in quantitative terms, the T coefficient ranges from 0.2 to 5.0. Thus, with a spastic (asphyxial) type of drowning, accompanied by severe spasm of the larynx, the T coefficient is significantly higher than 1.0 (approaching 5.0). With the aspiration type of drowning, the numerical indicator of the coefficient is significantly lower than one (within 0.2-0.4). In cases of reflex type of drowning, which occurs without significant disturbances in the function of external respiration and without penetration of the drowning environment into the body, the digital indicators of the T coefficient are within 1.0.

The mixed type of pathogenesis of drowning is characterized by various fluctuations in the numerical indicators of the T coefficient, both upward and downward, which will depend on the specific mechanism of death.

Thus, the use of the proposed method makes it possible to objectively prove the type of drowning and the immediate cause of death.

BASIC PRINCIPLES OF CONSTRUCTION OF PATHOLOGANATOMICAL DIAGNOSIS AND CONCLUSIONS WHEN STUDYING CORDS OF PERSONS WHO DIED FROM DROWNING

The preparation of a pathological diagnosis is carried out on the basis of generally accepted provisions on the substantiation of the nosological form of the pathological process. The structure of the diagnosis clearly distinguishes three main sections. In the first section, based on a forensic medical examination of the corpse and data from additional research methods, the main pathology is indicated, its thanatogenetic mechanism is revealed, with mandatory confirmation by specific diagnostic criteria. The second section of the diagnosis, which includes complications of the underlying pathological process, reflects signs that prove a specific immediate cause of death. And finally, the third part of the diagnosis combines concomitant pathological processes or premortem factors (trauma, alcohol intoxication, etc.) that contribute to the onset of death.

In the forensic medical report, the expert must reflect, in addition to reasonable answers to specific questions posed by the lawyer, the pathogenetic mechanism and conditions under which the drowning occurred. Regardless of the issues required to be resolved, the forensic medical report must necessarily include the rationale for the following sections:

1. Establishing the cause of death and the pathogenetic mechanism of its occurrence.
2. Determining the statute of limitations for death.
3. The presence of injuries and the nature of their connection with the occurrence of death.
4. Identification of diseases and their influence on the development of death.
5. Presence and degree of alcohol intoxication.
6. Exo- and endogenous factors contributing to the development of drowning.

Literature

1 Methodology for proving the pathogenetic type of drowning / Isaev Yu.S. // Mater. II All-Russian. Congress of Forensic Physicians: abstracts of reports. - Irkutsk-M., 1987. - P. 282-284.

For the materials provided

The most common occurrence is drowning in water. The following types of drowning occur:

1. aspiration (true, wet);
2. asphyxial (spastic, dry);
3. reflex (syncope).

Aspiration drowning is the most common and is characterized by the obligatory penetration of water into the lungs with its subsequent entry into the blood, and the nature of the resulting changes to a certain extent depends on the salt composition of the water.

Asphyxial drowning - due to water irritation of the respiratory tract receptors, reflex laryngospasm occurs and water does not enter the lungs. This type of drowning most often occurs when entering contaminated water containing impurities of various chemicals, sand, and other suspended particles.

Syncopal drowning is characterized by cardiac and respiratory arrest almost immediately after a person enters the water.

There are also combined forms of drowning in water.

Drowning is one of the types of mechanical asphyxia, when an obstacle to the flow of air into the lungs is the closure of the airways with liquid, which in most cases occurs in water. Drowning occurs not only when a person’s body is completely immersed in water, but can also occur when one head is immersed in water and even only the breathing holes in small streams, puddles, vessels with water, etc.

Drowning can be caused by a painful state of the body, overwork, a state of intoxication or stunned by receiving blows, etc. Drowning can occur in physically healthy people, even in swimmers, when suddenly immersed in cold water. In this case, a short-term reflex spasm of the glottis occurs, intrapulmonary pressure rises sharply, and acute asphyxia develops, accompanied by loss of consciousness.

The mechanism of death from drowning, unlike other types of mechanical asphyxia, has some specifics. When the body is immersed in water, a reflexive holding of breath occurs. At the stage of inspiratory dyspnea, water begins to actively enter the respiratory tract, irritating the mucous membrane of the trachea and large bronchi, causing coughing movements. The mucus released during this process mixes with water and air, forming a foamy mass of grayish-white color that gradually fills the lumen of the respiratory tract.

During the stage of inspiratory and expiratory dyspnea, a person usually tries to float to the surface of a reservoir. In the stage of relative rest, when respiratory movements are temporarily suspended, the human body plunges into depth. At the stage of terminal respiratory movements, water under pressure enters the depths of the respiratory tract, fills the smallest bronchi and, together with the remaining air, enters the alveoli. Due to high intrapulmonary pressure, alveolar emphysema develops. Water enters the tissue between the alveolar septa, tearing the walls of the alveoli. Through capillaries, water enters the blood vessels. Blood diluted with water penetrates the left half of the heart, and then into the systemic circulation. Following the terminal stage comes the final cessation of breathing.

The entire drowning period lasts 5-6 minutes. When drowning, water is usually swallowed and enters the stomach and the initial part of the small intestine.

The mechanism of death from drowning in other liquids is essentially no different from drowning in water.

Aspiration drowning is characterized by:

• the presence of fine-bubbly persistent foam at the openings of the mouth and nose (50-70%);
• acute bloating (in 90% of cases);
• "marble" surface of the lungs;
• mottled appearance of the lungs on sections;
• hypoaeria (less commonly hyperhydria);
• Rasskazov-Lukomsky-Paltauf spots are hemorrhages under the visceral pleura, sometimes small 1-2 mm. in diameter, but more often spotted, light red. When drowning in salt water, Paltauf's spots become more saturated in color;
• presence of water in the stomach;
• the presence of water in the sinus of the main bone (Sveshnikov’s sign);
• overflow of blood in the right side of the heart.
• histologically: focal atelectasis, diatoms with characteristic striations of shells in fluid from the sinus of the main bone, in the kidney or in other organs; pallor of red blood cells due to their hemolysis; frequent absence of hemorrhages in the area of ​​ruptures of the interalveolar septa.

Asphyxial drowning characterized by pronounced general asphyxial symptoms, very rarely there is the presence of a small amount of white persistent fine bubble foam at the openings of the nose and mouth, there are cases of the presence of air in the left ventricle of the heart (up to 5 cm 3), sometimes a fairly large amount of fluid in the sinus of the main bone.

Particular consideration should be given to cases of death in water from other causes, in which the aquatic environment serves only as the site of death (the so-called death in the water).

It must be borne in mind that there are unusual cases when, for example, a corpse taken from the water may have its limbs tied, heavy objects, stones, etc. may be found in the pockets of clothing. This is not always a sign of violence. Such actions are also carried out by suicides with the goal of drowning as quickly as possible.

Changes associated with the presence of a corpse in water accompany signs of drowning. A person's body may end up in water when the cause of death is not related to drowning, for example, if the corpse is placed in water to cover up a crime.

Signs of a corpse being in water:

1. Maceration of fingertips - 2-3 hours;
2. Maceration of palms and soles - 1-2 days;
3. Maceration of the dorsal surface - a week;
4. Skin shedding (gloves and socks of death) - a week;
5. Algae on the body - a week;
6. Baldness - month;
7. The beginning of the formation of adipose wax is 3-4 months;
8. Transition of a corpse into adipose wax - 1 year;
9. Pink coloration of cadaveric spots (due to loosening of the epidermis and
10. improving oxygen access to cadaveric spots)
11. Presence of goose bumps.

The timing of the development of maceration is affected by the temperature of the water: in colder water it occurs more slowly, in warm water it occurs faster. The maceration process is accelerated in running water. Clothes on the corpse, gloves on the hands and shoes delay the development of maceration. Due to loosening of the skin, hair loss begins after about 2 weeks and by the end of the month, especially in warm water, complete “baldness” may occur. Moreover, in contrast to ordinary, intravital baldness, the holes from lost hair are clearly visible on the scalp of a corpse. The possibility of hair loss when a corpse remains in water for a long time must be taken into account when the need arises to identify the corpse. The detection of phytoplankton only in the lungs indicates that the corpse is in water, since it penetrates the respiratory tract even when the corpse enters the water, when death occurred from other causes not related to drowning.

A corpse in water gradually begins to undergo putrefactive decomposition with the formation of a large amount of gases. The lifting force of putrefactive gases is so great that a load weighing 30 kg tied to a corpse with a total body weight of 60-70 kg is not an obstacle to its ascent. In summer, in relatively warm water, decay processes develop quickly. Cold water prevents rotting, and the corpse can remain at the bottom of the reservoir for weeks or even months.

It should be borne in mind that a human corpse can be placed in water after causing fatal mechanical damage. On a corpse, damage from blunt and sharp objects, gunshot wounds, signs of poisoning with certain poisons, etc. are usually clearly visible. The main issue when mechanical damage is detected on a corpse is to establish whether it was intravital or postmortem in origin. Damage in water of intravital origin in the form of abrasions, bruised wounds, damage to the bones of the vault and base of the skull can occur when jumping into water from impacts with stones, piles and other objects. Injuries in the form of compression fractures of the cervical vertebrae usually occur when diving upside down into shallow water. Therefore, in all cases of drowning, it is necessary to make control incisions in the back of the neck to examine the soft tissues and vertebrae.

The human body in water, even during life, can be exposed to the action of propellers and hydrofoils of river and sea vessels, and the mechanisms of dredgers. Post-mortem injuries can also be caused by hooks, poles and other objects used to remove a corpse from the water. As a result of too vigorous artificial respiration, can they be discovered during the examination of a corpse? injuries in the chest, abdomen and limbs.

Corpses in water can be damaged in various ways by animals inhabiting water bodies: crayfish, water rats, crayfish. Typical damage is caused by leeches, forming multiple T-shaped superficial wounds on the skin of a corpse.

While swimming, death sometimes occurs from other causes. When examining a corpse, cerebral hemorrhage, ruptured aneurysm, cardiac tamponade, thrombosis and embolism of the coronary vessels may be detected; There are no signs of death from asphyxia due to drowning.

One of the important evidence of this type of death is the detection of plankton (diatoms), which have specific characteristics: species, class, etc., allowing one to draw a conclusion about the place of death.

PLANKTON(from the Greek “wandering”) is a collection of organisms that live in the water column and are unable to resist being carried by the current. It consists of numerous bacteria, diatoms and some other algae (phytoplankton), protozoa, some coelenterates, mollusks, crustaceans, tunicates, eggs and larvae of fish, and the larvae of many invertebrate animals (zooplankton). Plankton, directly or through intermediate links in food chains, serves as food for all other animals living in water bodies. The section of hydrobiology that studies plankton, its species composition, spatial distribution, seasonal changes, food relationships, etc., has received such great development that it has become a special branch - planktonology (algology).

PSEUDOPLANTON- These are grains of sand, grains of starch, etc. suspended in water, which can enter the blood along with water from the lungs.

DIATOM ALGAE(diatoms, siliceous algae), division (or type) of algae. Unicellular and colonial organisms. Their cells have a hard flint shell, consisting of two halves - the lower (hypotheca) and the upper (epithecium). Reproduction is by division, and after several generations - sexual. About 20 thousand species in fresh and sea waters, on damp soil, etc. Fossil diatoms have been known since the Jurassic period, sometimes forming thick deposits - diatomites. Special studies show that diatom plankton is specific to a particular body of water, and its structure may not change for decades due to the high preservation of its main characteristics. It should be noted that the flint shell of diatoms can withstand high temperatures, strong acids and alkalis. The stability of diatom plankton species makes it possible to resolve issues related to determining the location of a drowning incident, since in certain bodies of water plankton, while maintaining its structural properties, changes little or does not change at all.

Forensic medical research on this issue has shown that in a true type of drowning, diatoms up to 200 microns in size, together with water, through broken capillaries of the alveoli, penetrate into the systemic circulation and are carried through the bloodstream throughout the body, lingering in the parenchymal organs and bone marrow of long tubular organs. bones. Diatoms of the “pinnate” class, types “B” and type “D”, as well as the class “centric”, type “F”, are identified.

According to instructional letters and methodological manuals, the main objects for research can be the following fluids, organs and tissues from a corpse in various combinations:

• bud;
• blood (at least 100 ml) from the left half of the heart;
• brain substance (not less than 100 g);
• spinal cord;
• heart muscle (at least 100 g);
• skeletal muscle in intact fascia (at least 100 g);
• spleen with intact capsule;
• fragment of the femur or humerus with bone marrow (10-15 cm);
• lung tissue (subpleural plate about 1 cm thick and weighing at least 100 g);
• water samples (2-3 l) from a reservoir (at the place where the corpse was found and from the suspected place of drowning) in different containers.

Asphyxia in incompletely closed spaces

takes place in wineries, various wells, silos, etc. In this case, there is rotting, fermentation, that is, a deficiency of oxygen and the concentration of various gases (carbon dioxide, inert, poisonous, ...) increases.

Asphyxia in confined spaces (refrigerators, chests, etc.) arise due to a gradual decrease in the amount of oxygen and the accumulation of carbon dioxide in the inhaled air. In such cases, the lack of oxygen in the inhaled air plays a major role in the mechanism of death. In both cases, in the mechanism of death, asphyxia seems to compete with the pathological conditions that existed in the victim before the accident.

During forensic medical examination of the corpses of persons who died from lack of oxygen, as a rule, pronounced signs of rapid death are found. In the diagnosis of death, a special place is occupied by the mandatory examination of air samples from the room where the body was found.

Drowning- this is the closing of the respiratory openings of the mouth and nose by immersing the face in a liquid or semi-liquid medium, causing closure of the airways or reflex closure (spasm) of the glottis, accompanied by disruption or cessation of external respiration and causing death from suffocation.

Drowning can occur while swimming in fresh and salt water, in various reservoirs, rivers, lakes, the sea, a bathtub, falling into a puddle, liquid mud, falling into various containers filled with technical or food liquids, semi-liquid masses, and sewage.

Drowning is facilitated by intoxication, overwork, hypothermia, increased sweating, overheating of the body, fullness of the stomach with food, a sharp change in blood circulation conditions in water, increased stress on the cardiovascular system, mental factors, diseases of the cardiovascular and nervous systems, and injuries.

Swimming in cold water or prolonged exposure to relatively warm water can lead to convulsive contractions of certain muscle groups. This reaction occurs when swimming in one style for a long time, a feeling of fear, and panic. Occasionally, the so-called “immersion syndrome” (water, ice or cryogenic shock) occurs, which occurs due to a sharp temperature change that causes overirritation of skin thermoreceptors, vascular spasm, cerebral ischemia and reflex cardiac arrest.

Most often, drowning is caused by injuries caused by incompetent diving, diving in a shallow place, hitting objects on the water, in the water and at the bottom. Sometimes there is damage from parts of water transport. Damage caused by sharp tools and firearms is extremely rare.

The sudden and rapid immersion of a person in water, depending on the low temperature of the water compared to the body and the surrounding air, hydrostatic pressure changing with the depth of immersion, psycho-emotional stress, causes certain changes that determine the type of drowning and the genesis of death.

Drowning can occur in several types. Among them are: aspiration (true, wet drowning), spastic (asphyxial, dry drowning), reflex (syncope) and mixed types.

Death in water sometimes occurs due to diseases (myocardial infarction, non-traumatic cerebral hemorrhage), as well as injuries not related to drowning.

The pattern and duration of drowning is influenced by a number of conditions, such as the temperature of the water, fresh or salty, the speed of the current, waves, training in cold water, the will to live.

The aspiration type is characterized by filling of the respiratory tract and alveoli with fluid and a significant dilution of the blood by the absorbed fluid. This type of drowning occurs in several phases, just like mechanical asphyxia.

At the onset of true (wet) drowning, the person is conscious and fighting for his life. Trying to escape, thanks to the movements of his arms and legs, he either floats to the surface, then plunges into the water again, screams, calls for help, and grabs onto surrounding objects.

When immersed in water, a person instinctively holds his breath (pre-asphyxial period) for a varying amount of time, depending on his state of health and fitness (about 1 minute), and tries to emerge.

On the surface it takes convulsive breaths and makes chaotic swimming movements. Due to the increasing lack of oxygen in the body, involuntary respiratory movements appear. The accelerated breathing rate during surfacing increases tissue oxygen consumption. Respiratory failure is aggravated by aspiration of even small amounts of water, coughing in response to irritation of the trachea, and bronchospasm. Then comes a deep breath (inspiration), and water under pressure enters the oral cavity, nose, larynx, trachea and bronchi, causing irritation of the receptors of their mucous membranes, which is transmitted to the cerebral cortex, where the process of excitation occurs. Overirritation of the mucous membranes leads to the release of a large amount of mucus containing protein, which during breathing mixes with water and air, forming a persistent grayish-white or pinkish foam, colored in this color by an admixture of blood from the ruptured blood vessels of the alveoli (stage of inspiratory dyspnea).

Taking convulsive breaths while surfacing, a person can swallow water. A full stomach makes it difficult for the diaphragm to move. Physical stress and fear further increase oxygen deficiency, irritating the respiratory center. Involuntary respiratory movements occur under water (stage of expiratory dyspnea). Following this reflexively a deep exhalation occurs, expelling the air contained there along with the water from the respiratory tract. At 3-4 minutes, diffuse protective inhibition of the cortex occurs. By this time, consciousness is usually lost, air bubbles appear on the surface of the water and the person sinks to the bottom. In the middle or end of the second minute after immersion in water, general convulsions occur due to the spread of overexcitation processes throughout the cortex and their capture of the motor zones of the cortex, and reflexes are lost. The person becomes motionless. Next, waves of initial motor excitation begin to descend into the underlying parts of the central nervous system and, reaching the cervical part of the spinal cord, cause a series of deep but rare breaths with the mouth wide open (the so-called terminal respiratory movements). Water, when swallowed, enters the stomach and the initial part of the small intestine. In the stage of terminal respiration, it enters the airways in a wide stream under pressure that increases with the depth of the body's immersion, filling the bronchi and alveoli. Due to high pulmonary pressure, dilation of the alveoli develops - alveolar emphysema. Water enters the tissue of the interalveolar septa, breaks the walls of the alveoli, penetrates the lung tissue, displaces the air in the bronchi, and mixes with the air contained in the lungs (normally up to 2.5 liters). Through capillaries, water enters the vessels of the pulmonary circulation, significantly diluting the blood and hemolyzing it. Blood diluted with water penetrates the left half of the heart, and then into the systemic circulation. A final cessation of breathing occurs, soon the heart stops working, and after 5-6 minutes death occurs from lack of oxygen (Fig. 281).

When examining a corpse in cases of wet drowning, paleness of the skin is observed, resulting from spasm of the skin capillaries, goose bumps caused by contraction of the muscles that lift the hair, grayish-white or pink persistent fine bubble foam around the respiratory openings of the nose and mouth, described by the Russian scientist Krushevsky in 1870 It occurs as a result of mixing air with a large amount of mucus containing protein, released due to irritation of the mucous membrane of the respiratory tract with water. This foam lasts up to 2 days. after removing the corpse from the water, and then dries to form a film. Its formation is facilitated by the leaching of a surfactant (sulfactant) from the surface of the alveolar epithelium, which ensures the straightening of the alveoli during breathing, which was noted by the Ukrainian scientist Yu.P. Zinenko in 1970

The presence of foam indicates active respiratory movements during drowning. Due to the rupture of blood vessels in the alveoli, the released blood turns the foam pinkish.

The spastic type is caused by persistent reflex laryngospasm, which closes the entrance to the respiratory tract due to irritation of the respiratory tract receptors by water.

This type of drowning occurs when water with a temperature of about 20 ° C suddenly enters the upper respiratory tract. Water irritates the mucous membranes and endings of the upper laryngeal nerve, leading to spasm of the vocal cords and reflex cardiac arrest. Spasm of the vocal cords closes the glottis, which prevents water from entering the lungs during a dive and air from leaving the lungs when surfacing. A sharply increased intrapulmonary pressure causes acute asphyxia, accompanied by loss of consciousness. The phases of deep and atonal breathing are manifested by intense movements of the chest. Sometimes there may be no terminal pause. Due to the decline in cardiac activity, conditions are created for the development of pulmonary edema, a violation of the permeability of the alveolar-capillary membranes, which causes the entry of blood plasma into the air spaces of the final units of the lungs (alveoli), which, mixing with air, forms a persistent fine-bubble foam. Edema can also be caused by mechanical damage to the membrane due to a drop in intrapulmonary pressure due to intense false inspiration with a closed glottis.

Sometimes a small amount of fluid enters the airways, which is quickly absorbed, especially in cases of drowning in fresh water, and does not cause blood thinning. On the cut, the lungs are dry, and therefore such drowning is called asphyxial, or dry, or drowning without aspiration of water.

The likelihood of laryngospasm depends on age, body reactivity, gender, water temperature, contamination with chemical impurities, chlorine, sand, shells and other suspended particles. Laryngospasm is most often observed in women and children.

During examination of the corpse, attention is paid to the blue-purple coloration of the skin, especially in the upper parts of the body, abundant confluent cadaveric spots, hemorrhages in the skin of the face and mucous membrane of the eyelids, dilation of the vessels of the white membrane of the eyes. Occasionally, white fine-bubble foam is found around the openings of the nose and mouth.

An internal examination reveals severe emphysema of the lungs, their fluffiness, multiple pinpoint hemorrhages under the organ pleura, epicardium, in the mucous membrane of the respiratory and urinary tract, gastrointestinal tract against the background of dilated vessels. Rasskazov-Lukomsky-Paltauf spots are absent. The right ventricle of the heart is filled with blood. Blood in the heart can be in the form of clots, especially in the case of alcohol intoxication. The stomach usually contains a significant amount of watery contents, and the internal organs are filled with blood.

Sometimes drowning begins as an asphyxial type, and ends as a true drowning, when laryngospasm is resolved by water penetrating the respiratory tract and lungs. You can distinguish true insulation from false insulation by the signs given in table. 26.

Occasionally, signs of asphyxial and true drowning are absent. This kind of drowning is called reflex (syncope). This type is associated with rapid reflex cessation of breathing and primary cardiac arrest as a response of the body to the aquatic environment under extreme conditions (water shock, allergic reaction to water, etc.).

It occurs from the action of cold water on the body, which increases spasm of blood vessels in the skin and lungs. Contraction of the respiratory muscles occurs, resulting in severe disturbances in breathing and cardiac activity, brain hypoxia, leading to the rapid onset of death even before the development of drowning itself. Syncopal type drowned contribute to: emotional shock immediately before immersion in water (shipwreck), hydroshock caused by exposure to very cold water on the skin, laryngopharyngeal shock from the action of water on the receptor fields of the upper respiratory tract, irritation of the vestibular apparatus by water in people with a perforated eardrum.

Death in the waterrarely occurs in expert practice. As a rule, it is observed in persons suffering from diseases of the cardiovascular system (angina pectoris, post-infarction cardiosclerosis, acute coronary and respiratory failure), pulmonary tuberculosispneumosclerosis,diseases of the central nervous system (ethilepsy and mental disorders). The cause of death in water for divers can be barotrauma of the lungs, nitrogen narcosis, oxygen starvation, oxygen poisoning, subarachnoid hemorrhage due to diseases of the cerebral vessels, allergic shock to water associated with the effect of an allergen in the water on a sensitized organism, fainting followed by a reflex caused by irritation by water nasopharynx and larynx, leading to drowning, prolonged exposure to water at a temperature of +20 ° C, causing progressive heat loss, leading to hypothermia, damage to the tympanic membranes with subsequent irritation of the middle ear by water and reflex cardiac arrest or water entering the middle ear through a perforated eardrum due to a previous disease, irritation of the vestibular apparatus, leading to vomiting and drowning, loss of orientation in survivors, irritation of water entering the mouth, upper respiratory tract ways, aspiration of vomit upon the onset of unconsciousness.

An internal examination reveals fluid in the tympanic cavities of the middle ear. It penetrates through the Eustachian tubes or a damaged eardrum. The same fluid is revealed when opening the sinuses of the frontal and basal bones of the skull. It enters these sinuses due to laryngospasm, which causes a decrease in pressure in the nasopharynx and the flow of water into the pear-shaped slits. The volume of water in them can reach 5 ml, which was first noticed and described by V.A. Sveshnikov (1965).

Drowning may be accompanied by an outpouring of blood into the tympanic cavities, mastoid cells and caves. It can be in the form of loose accumulations or abundant soaking of the mucous membranes. Their occurrence is associated with increased pressure in the nasopharynx, circulatory vascular disorders, which, in combination with severe hypoxia, lead to increased permeability of the vascular walls and bleeding.

The tympanic cavity contains sand and other foreign particles from the reservoir. Blood effusions are detected in the middle ear and eardrum.

When examining the corpses of drowned people, bilateral, parallel to the longitudinal fibers, blood dissections of the sternocleidomastial and pectoralis major muscles (Paltauf), broad and scalene muscles, as well as neck muscles (Reuters) are found. They occur as a result of severe muscle tension during an attempt to escape from drowning. Occasionally, vomit is found around the nose and mouth and in their openings, indicating vomiting in the agonal period.

The mucous membrane of the entrance to the upper respiratory tract is reddened, swollen, sometimes with pinpoint hemorrhages, which is explained by the irritating effect of water.

The same foam as in the circumference of the mouth and nose is also detected in the respiratory tract. Sometimes foreign inclusions are found in it (sand, algae, silt, small and large stones), indicating drowning in a shallow place.

Foreign particles can penetrate into the corpse when they are located and remain for a long time in turbid water containing them, in reservoirs with fast currents, and therefore their evidentiary value is small. Large stones and pebbles that have penetrated deeply into the trachea indicate active aspiration during the convulsive period of drowning. Sometimes gastric contents are found in the respiratory tract, penetrating to the small bronchi. In such cases, it is necessary to note whether it is squeezed out of the bronchi on the incision. Its presence indicates vomiting in the agonal period. Occasionally, mucus is found in the respiratory tract. Foam in the respiratory tract can form as a result of pulmonary edema, during vigorous artificial respiration, mechanical asphyxia from compression of the neck with a noose or hands and, as a result, prolonged agony. The mucous membrane of the trachea and bronchi is edematous, cloudy, the foam is usually unstable and large-bubbly.

Lungs - large, completely fill the pleural cavities and sometimes “bulge” out of them, cover the heart, emphysematously swollen, increased in volume and sometimes in weight, which is explained by the penetration of fluid during wet drowning. The edges of the lungs are rounded, overlap each other, and sometimes cover the heart sac. On the surface of the lungs you can see imprints of the ribs, appearing traps, between which the lung tissue protrudes in the form of ridges - “the lung of a drowned man.” Similar imprints are found on the posterolateral surfaces of the lungs. Such changes are explained by the pressure of water penetrating through the respiratory tract into the lungs on the air present there, which breaks the walls of the alveoli and passes under the pulmonary pleura, causing emphysema. Water penetrates to replace the displaced air. As a result, the lungs significantly increase in volume, exerting pressure from the inside on the chest, as a result of which transverse grooves appear on them - traces of pressure from the ribs.

An increase in lung volume occurs during vigorous and prolonged artificial respiration, which must be remembered when examining a corpse. The upper lobes and the edges adjacent to the root of the lung are usually dry and distended with air. The organ pleura is cloudy, under it there are rather large diffuse reddish-pink spots with indistinct blurry boundaries, described independently of each other by Rasskazov (1860), Lukomsky (1869), Paltauf (1880) and received in the literature the name Rasskazov-Lukomsky-Paltauf spots. Their color and size are determined by the amount of water that has entered the systemic circulation through the torn and gaping capillaries of the interalveolar septa, and by hemolysis of the blood, as a result of which the diluted and hemolyzed blood becomes lighter, its viscosity decreases, it thins out, and the hemorrhages blur, acquiring fuzzy contours. The lungs become “marbled” due to the alternation of protruding pink and receding red areas. Drowning in sea water does not cause hemolysis, and they retain their normal color.

It feels light and doughy to the touch, reminiscent of a sponge soaked in water. With wet drowning, the lungs are distinguished by their enormous volume, with alternating dry areas with watery ones, and take on a gelatinous appearance. A foamy liquid similar to that contained in the respiratory tract flows from the cut surface of such lungs. The lungs are heavy, full of blood, with hemorrhages under the pulmonary pleura.

In cases of dry drowning, the lungs are emphysematously swollen, dry, under the pulmonary pleura, mucous membrane of the gastrointestinal tract, renal pelvis, bladder - Tardieu spots, which form during the period of inspiratory dyspnea. In the initial parts of the respiratory tract there may be particles of sludge, etc. The venous system is congested with blood with a small amount of dark red clots.

Drowning in sea water, which is a hypertonic environment in relation to blood, results in the release of blood plasma into the alveoli, which leads to the rapid occurrence of pulmonary edema and pulmonary failure. The blood does not thin, its viscosity increases, there is no hemolysis of red blood cells, and Rasskazov-Lukomsky-Paltauf spots are not observed. Areas of atelectasis are combined with foci of emphysema and uneven blood supply.

Thinning of the blood contained in the cavity of the left ventricle is a consequence of intravascular hemolysis and is a valuable sign that occurs only during true drowning in fresh water, which quickly permeates the endocardium of the left ventricle and the intima of the aorta.

Examining the corpses of drowned people, F.I. Shkaravsky drew attention to the swelling of the liver, bed and walls of the gallbladder of drowned people.

As a result of stagnation and an increase in the volume of fluid in the bloodstream, the volume and weight of the liver increase.

The sections are noticed by the large amount of liquid in the stomach, sometimes mixed with silt, sand, and aquatic plants, which penetrate the stomach when swallowed during drowning. The same fluid is found in the duodenum, where it passes only through the intravital open pylorus as a result of increased reflex peristalsis, which can be considered a sign of drowning.

Overfilling of the stomach with swallowed water, especially sea water and polluted water, causes vomiting. On the gastric mucosa there are striped hemorrhages, as well as ruptures in the area of ​​the lesser curvature, resulting from vomiting in the agonal period or hitting the stomach with water. Occasionally, pinpoint hemorrhages occur under the pancreatic capsule.

Signs of a corpse being in water, accompanying signs of drowning, include: wet clothes covered with silt, sand with the presence in its folds of shells, fish, crayfish, water beetles, algae and fungi characteristic of a given body of water, sticky hair, sharp pallor of the skin, raised vellus hair (“goose bumps”), wrinkling of the breast nipples, areola of the breast and mammary glands, scrotum, glans penis, pink color of the skin at the edges of cadaveric spots, rapid cooling of the corpse, skin maceration phenomena, “bath hand”, “skin” laundress", "glove of death", "groomed hand", post-mortem hair loss, rapid development of decay, fat wax, post-mortem damage.

Sharp pallor of the skin is formed when immersed in cold water - below body temperature, which causes contraction of the blood vessels of the skin and pallor of its integument.

The pink color of the skin at the edges of cadaveric spots occurs due to swelling and loosening of the epidermis under the influence of water. This facilitates the penetration of oxygen through the skin, which oxidizes hemoglobin and turns it into oxyhemoglobin.

The pink color of the skin is also observed on the surface of the skin, free from cadaveric spots, if the body is removed from cold water, which was noted by E. Hoffman and A.S. Ignatovsky.

“Goose bumps” are formed when the skin is exposed to cold water or cold alone, and in some disorders of the nervous system - due to contraction of smooth muscles.

The surface of the skin is covered with multiple tubercles, the formation of which is caused by the contraction of smooth muscle fibers connecting the surface layers of the skin with the hair follicles. As a result, they lift them to the free surface of the skin, forming small tubercles at the places where the hairs emerge.

Irritation of the skin by water leads to a contraction of the muscle fibers of the breast nipples, the areola of the breast, and the scrotum, as a result of which their contraction occurs 1 hour after being in the water.

Their development is significantly influenced by the temperature of the environment, air, depth of the reservoir, concentration of salts in the environment (fresh or salty), mobility of water (standing or flowing), flow speed, thermal conductivity of the environment, clothing, gloves and shoes.

Maceration is one of the signs of a corpse being in water. Maceration, or softening, is formed under the influence of water, as a result of which the epidermis becomes soaked, swells, wrinkles and gradually peels off on the palms and soles. Maceration is clearly visible in places where the skin is thick, rough, and calloused. It starts with the hands and feet. Initially, whitening and fine folding of the skin appear (weak maceration, “bath skin”), then a pearly white color and large folding of the skin (clearly expressed signs of maceration - “washerwoman’s skin”). Gradually, complete separation of the epidermis occurs along with the nails (sharply expressed signs of maceration). The skin is removed along with the nails (the so-called “death glove”). After its removal, smooth skin devoid of epidermis remains (the “sleek hand”).

Subsequently, maceration spreads to the entire body.

Warm running water accelerates maceration. Cold water, gloves and shoes delay it. The degree of development of maceration allows us to roughly judge how long the corpse has been in the water. The literature presents different periods of appearance of initial and final signs of maceration without taking into account water temperature. The most complete terms of development of skin maceration depending on water temperature were studied by Ukrainian scientists E.L. Tunina (1950), S.P. Didkovskaya (1959), supplemented by I.A. Kontsevich (1988) and are presented in table. 27.

Due to loosening of the skin after about 2 weeks. hair loss begins and by the end of the month, especially in warm water, complete baldness occurs. In places where hair has fallen out, their holes are clearly visible.

The presence of vernix lubrication protects the skin of newborns from maceration. Its first signs appear by the end of 3-4 days, and complete separation of the epidermis - by the end of the 2nd months in summer and for 5-6 months. in winter.

A drowned person sinks to the bottom and at first, if there is no strong current, remains in place, but rot develops and the corpse floats to the surface.

Putrefactive changes begin to develop from the intestines, then the corpse floats up if there are no mechanical obstacles. The lifting force of putrefactive gases is so great that a load weighing 30 kg with a total weight of 60-70 kg is not an obstacle to ascent.

D.P. Kosorotov (1914) gives an example when a ship with 30 oxen in the hold sank in the ocean off the coast of India. All efforts to raise it from the water were in vain, but after a few days the ship floated to the surface due to the development of putrefactive gases in the corpses of the oxen.

In warm water, decay processes develop faster than in cold water. In small bodies of water with a water temperature of more than 22 °C, a corpse can float to the surface on the second day. In central Russia, corpses float to the surface on the second or third day, depending on the water temperature. According to the Japanese researcher Furuno, from July to September, in cases of drowning at a depth of 1-2 m, the corpse floats up after 14-24 hours, at a depth of 4-5 m - after 1-2 days, at a depth of 30 m - after 3-4 days . In winter, corpses can remain in the water for up to several months. Rotting in water occurs more slowly than in air, but after removal from water, putrefactive processes proceed extremely rapidly. Within 1-2 hours after removing the corpse, the skin takes on a greenish color, cadaveric emphysema develops, the corpse begins to swell, the skin becomes dirty green, a putrefactive venous network and blisters appear. A foul odor emanates from the corpse. In corpses that are in water for 18 hours in summer and 24-48 hours in winter, along with whitening of the hands and feet, the light blue color of the skin turns into a brick-red color of the head and face to the ears and the upper part of the occipital region. The head, neck and chest acquire a dirty green color interspersed with dark red after 3-5 weeks in summer, after 2-3 in winter months In 5-6 weeks. in summer and winter more than 3 months the body is swollen with gases, the epidermis peels off everywhere, the entire surface takes on a gray or dark green color with a putrefactive venous network. The face becomes unrecognizable, the color of the eyes is indistinguishable. Determining the length of time a corpse spent in water becomes impossible in the summer after 7-10 weeks. and in winter after 4-6 months due to the development of putrefactive changes. If something prevents the ascent, then the rotting that has begun is stopped and the formation of adipose wax gradually occurs.

Occasionally, corpses removed from the water are covered with algae or fungi. In corpses in running water, vellus algae in the form of scattered shaggy areas are found on the 6th day, on the 11th day they are the size of a nut, on the 18th day the corpse is dressed as if in a fur coat of algae, which after 28- After 30 days they fall off, after which on the 8th day a new growth follows, which has the same course.

In addition to these algae, after 10-12 days, mucus-like fungi appear in the form of small red or blue circles with a diameter of 0.2-0.4 cm.

The presence of a corpse in water is judged by the presence of fluid in the tympanic cavity of the middle ear, in the sinuses of the main bone (V.A. Sveshnikov’s symptom), fluid in the respiratory tract, esophagus, stomach, small intestine, pleural (Krushevsky’s symptom) and abdominal (Moro’s symptom) ) cavities, plankton in the lungs when the skin is intact and in other organs when it is damaged.

Moreau found up to 200 ml of blood-colored fluid in the pleural and abdominal cavities, which seeped into the pleural cavities from the lungs, and into the abdominal cavities from the stomach and intestines. How long the corpse has been in the water can be determined by the flow of fluid into the pleural cavities and the disappearance of signs of drowning. The presence of fluid in the pleural and abdominal cavities indicates that the corpse had been in water for 6-9 hours.

The enlargement of the lungs when the corpse is in water gradually disappears by the end of the week. Rasskazov-Lukomsky-Paltauf spots disappear after the corpse remains in water for 2 weeks. Tardieu spots are detected on the surface of the lungs and heart up to a month after drowning (Table 28).

Laboratory diagnostics for drowning

Many laboratory methods have been proposed for the diagnosis of drowning. Among them, the most widespread are microscopic research methods - the histological method of studying diatoms plankton and pseudoplankton.

Plankton- the smallest organisms of plant and animal origin found in tap water, water from various bodies of water, and in the air. They are characteristic of a given reservoir and have specific features. In the diagnosis of drowning, phytoplankton, and especially diatoms, are of greatest importance. Their shell consists of silicon, which can withstand high temperatures, strong acids and alkalis. The shape of the diatom is varied and typical for each body of water.

Plankton, together with water, enters the mouth, from there into the respiratory tract, lungs, from them through the vessels into the left heart, the aorta and through the vessels spread throughout the body, lingering in the parenchymal organs and bone marrow ge long tubular bones (Fig. 282). Plankton persists for a long time in the sinuses of the main bone and can be found in scrapings from its walls. Along with water from the lungs, grains of sand and starch grains suspended in water, the so-called pseudoplankton, can also enter the bloodstream (Fig. 283). Until recently, methods for detecting plankton and pseudoplankton were considered the most convincing methods for diagnosing drowning. Their subsequent examination showed the possibility of post-mortem penetration of plankton elements into the lungs and other organs of the corpse with damage to the skin. Therefore, the detection of plankton and pseudoplankton has evidential value only if the skin is intact.

Currently, the histological method of studying internal organs has become widespread. The most characteristic changes are found in the lungs and liver. In the section of the lungs, foci of atelectasis and emphysema, multiple ruptures of the interalveolar septa with the formation of so-called spurs facing the inside of the alveoli, focal effusions of blood into the interstitial tissue, and swelling are revealed. In the lumen of the alveoli there are light pink masses with an admixture of a certain amount of erythrocytes.

In the liver there are signs of edema, expansion of precapillary spaces with the presence of protein masses in them. The wall of the gallbladder is swollen, collagen fibers are loosened.

A human corpse found or recovered from water may show a variety of injuries. A correct assessment of their morphology and localization will allow a correct assessment of what happened and avoid wasting time searching for non-existent intruders. The main questions that an expert must answer are: by whom, during what, by what and how long ago the damage was caused.

The most common injuries occur during diving. They are formed when the jump technique is performed incorrectly, hitting objects on the path of the fall, objects in the water, hitting the water, hitting the bottom and objects on it and in it. Impacts on objects in the path of falling, located in water, and objects at the bottom cause extremely varied damage, reflecting the characteristics of the contacting surfaces and localized in any of the areas of the body, on any of its surfaces, sides, levels (Fig. 284).

When assessing them, it is necessary to take into account the position of the corpse in the water after death. The human body is somewhat heavier in specific gravity than water. The presence of a small amount of clothing and gases in the gastrointestinal tract allows the corpse to remain at the bottom for a certain time. A significant amount of gases in the gastrointestinal tract and developed during the process of decay quickly lifts the corpse from the bottom, and it begins to move under water and then floats to the surface. Persons in warm clothes sink to the bottom faster. The dressed corpses of men usually float face down, with their heads bowed, the corpses of women float face up, and their legs, weighed down by a dress, can be lowered below the head. This situation is explained by the anatomical structure of male and female bodies.

The impact of a stream of water at the moment of entering it sometimes causes ruptures of the eardrum. The entry of water into the middle ear cavity causes loss of orientation of movements in the water. Those who jump into the water experience ruptured eardrums, injuries in the lumbar region, contusions and dislocations of the lumbar spine due to bending of the body entering the water, sprains of ligaments and muscles, depression spinous processes of the vertebrae, spinal fractures from impact with water. If you fall into the water incorrectly, there may be bruises and ruptures of internal organs, shock, fractures of tubular bones, and dislocation of the shoulder joint.

Occasionally, the injuries found in victims are not fatal in themselves, but can cause a short-term loss of consciousness sufficient to cause drowning.

Hitting the water while entering it flat causes bruises, bruises and damage to internal organs, the severity of which is determined by the angle and height of the fall. A blow to the epigastric region of the abdomen or the external genital area sometimes causes shock, leading to death. An incorrectly performed “soldier” jump with legs spread apart causes bruises of the heels, scrotum, and testicles with the subsequent development of traumatic epididymitis. The “swallow” jump causes damage to the hands of one or both hands, any surface of the head, the chin, and at the handle of the sternum from a blow with the chin. Fractures of the base of the skull and spine are sometimes observed, accompanied by trauma to the brain and spinal cord, causing paralysis of the limbs due to the level of damage to the spinal cord.

Drowning in a shallow place is accompanied by the formation of abrasions on the limbs and torso from impacts on the bottom and objects located on it.

Parts of sea and river vessels cause a variety of damage, including body separation. The rotating propeller blades cause slash-like damage. The presence of several equally directed fan-shaped wounds indicates the action of propeller blades that have the same direction of rotation.

The significant time spent by a corpse under water in a stagnant body of water and developing putrefactive changes do not exclude the possibility of the corpse moving along the bottom and in various layers of water, dragging along the bottom with impact on various objects located in the water and on the surface. In bodies of water with running water, the listed damage can occur even before putrefactive changes develop. In mountain rivers and fast-flowing rivers, corpses sometimes travel a considerable distance. Depending on the topography of the bottom, objects on it and individual stones, rapids, driftwood, clothing and shoes are sometimes completely removed, and the remaining ones suffer from various damage caused by friction and snagging. Damage to a corpse caused by dragging and impact is localized on the skin, nails and even bones of any surface of the body. For water movement, typical transverse tears in trouser legs in the area of ​​the knee joints, abrasion of the toes of shoes in men and heels in women, abrasions on the back of the hands. This localization and morphology of the damage is explained by the fact that the man’s corpse floats face down, and the woman’s – up. In these cases, cadaveric spots in men primarily form and are located on the face.

Damage caused by sharp objects can be caused by dragging along the bottom, but unlike sharp tools and weapons used to take life, these damages are single, superficial, localized in various areas of the body, including those inaccessible to one’s own hand.

Damage to corpses in water is sometimes caused by water rats, snakes, crayfish, fish, snails, stingrays, crabs, amphipods, birds, and leeches. Leeches cause typical damage, forming multiple T-shaped superficial wounds. Fish gnawing on a corpse leave funnel-shaped depressions on the skin. Crayfish and crustaceans can eat all soft tissues, penetrate cavities and eat all internal organs.

Atonal injuries occur in the final stages of drowning during convulsions. They manifest themselves as abrasions, broken nails, bruises on the forearms, abrasions on the anterolateral surfaces of the body, etc.

Attempts to provide assistance are accompanied by extensive abrasions on the lateral surfaces of the chest. Their presence indicates artificial respiration and chest compressions.

Damage from rough removal from the water with hooks, “crampons”, etc. are localized in any area of ​​the body and reflect the characteristics of their active part.

Inspection of the scene of a drowning incident

The investigator's protocol for examining the scene of the incident must reflect the temperature of the water and air, the mobility of the water, the speed of the current, the depth of the reservoir, the position of the corpse in the water - face up or down, and the method of removing the corpse from the water. The corpse is oriented in relation to the flow of the river, its turn or some other fixed landmark.

By examining the corpse, the presence or absence of objects holding the body on the surface of the water (life jacket, etc.) or contributing to its immersion (stones tied to the body, etc.) is noted.

Damage to clothing and shoes is described according to generally accepted schemes. Examining the skin, note its pallor or pinkish color, the presence or absence of goose bumps.

Particularly carefully at the scene of the incident are studied cadaveric phenomena, which, after removing the corpse from the water in the air, develop extremely quickly. The examination focuses on the color of the corpse's spots, which have a pinkish tint, indicating the presence of the corpse in water, their localization on the face and head, indicating the position of the corpse in the water, the degree of development of putrefactive changes, indicating where they are most pronounced, the presence or absence of hair, the degree of their retention by pulling the hair in different areas of the head. If there is no hair, the area and degree of expression of their holes is indicated.

When examining the face, note the presence or absence of pinpoint hemorrhages in the connective membranes of the eyes, dilation of their vessels, accumulations of fine bubble foam in the openings of the nose and mouth, the amount and color (white, gray-red), vomit, damage in protruding areas of the face.

When describing the body of a corpse, they focus on the wrinkling of the areola, nipples, scrotum and penis.

When recording signs of skin maceration, they indicate: localization of areas (palm surface, nail phalanges, plantar and dorsal surfaces of the feet, etc.), severity of maceration - whitening, loosening, swelling of the epidermis, folding (shallow or deep), coloring, degree of retention of the epidermis by pulling , absence of epidermis on the extremities, swelling and separation in other areas of the body from the underlying layers of skin.

When examining the hands, they note the clenching of the fingers into a fist, the presence of sand or silt in it, abrasions with traces of sliding on the back surface of the hands, the presence of sand, silt under the nails of the fingers, etc.

It is not advisable to untie tied hands and feet at the scene of the incident, since it is better to carefully examine the knots and loops during the examination of the corpse in the autopsy room. At the scene of the incident, they describe the material from which the knots and loops are made, and their location on the limbs. The load tied to the corpse is not removed at the scene of the incident, indicating only the place of fixation, and is sent for examination along with the corpse.

Algae and fungi are described by indicating location, color, degree of distribution over surfaces and areas of the body, type, length, thickness, consistency, and strength of connection with the skin.

Before taking a water sample, it is necessary to rinse a liter glass twice with water from the given body of water in which the drowning occurred. Water is taken from the surface layer at a depth of 10-15 cm at the place of drowning or the place where the corpse was found. The container is closed and sealed by the investigator; the label indicates the date, time and place where the sample was taken, the name of the investigator who collected the water, and the case number for which the water was collected.

When corpses are found in puddles or containers (including bathtubs), their size, the depth of the container, what and how much they are filled with, and the temperature of the liquid are noted. If there is no water in the bath, this must be reflected in the protocol.

When describing the pose of a corpse, they indicate which areas of the body are immersed in liquid, which are above it, if the body is completely immersed in water, then at what depth it is and in what layer of water. If the corpse comes into contact with container parts, then the contacting area of ​​the body and parts are described. Diagnosis of drowning is based on a combination of morphological features of laboratory test results and the circumstances of the case, which can be decisive in establishing the type of drowning and death in water. Drowning - an accident - is evidenced by eyewitness testimony about the circumstances of immersion in water, alcohol consumption (confirmed by the results of laboratory tests), and the presence of diseases.

Suicide is supported by the failure to take rescue measures, tying up a load, tying up limbs, and the presence of non-lethal injuries that suicides inflict near water. In these cases, death occurs not from injuries, but from drowning. Criminal deprivation of life is indicated by the presence of injuries that the victim could not have caused to himself.

Information necessary for an expert to conduct an examination in case of drowning

In the establishing part of the resolution, the investigator must reflect: from which body of water the corpse was extracted, the place of its discovery - in the water or on the shore, full or partial immersion in water, whether there was a person in the water, the temperature of the water and air, the speed of the current, the mobility of the water, the depth of the reservoir , method of extraction from the water (with hooks, crampons, etc.), testimony of witnesses about the circumstances of the victim’s immersion in the water, an attempt to stay on the surface of the water, alternating immersion with appearing above the surface of the water, information about the previous fight, drinking alcohol, diving, participation in competitions on water, a shipwreck, provision of first aid by a specialist or an outsider, diseases that the victim had at the time of drowning and had suffered previously.

The type of drowning (true or asphyxial) determines one or another morphological picture revealed by examination of the corpse.

External examination of a corpse in a dissection room differs from that at the scene of the incident in the particular thoroughness of the examination and recording of the identified features of nodes and loops, weighing of the load used to hold the corpse at the bottom, sketching and detailed photographing of the damage.

Internal examination uses a variety of sectional techniques and additional research methods aimed at detecting injuries, changes typical of drowning, and painful changes that contribute to death in water.

Hemorrhages are found in the soft coverings of the head, which may be the result of pulling the victim by the hair. It is necessary to open the cavities of the middle ear, the sinus of the main bone, with a description of their contents, its nature and quantity, the condition of the eardrums, the presence or absence of holes in them, examination of the muscles of the trunk, opening of the spine, examination of the spinal cord, especially in the cervical region. When examining the neck and its organs, they focus on the presence of soft tissue dissections with blood, fine bubble foam in the respiratory tract, its color, quantity, foreign fluid, sand, silt, pebbles (indicating their sizes), note the presence, nature and amount of free fluid in pleural and abdominal cavities. Carefully examining the lungs, record their size, traces of pressure from the ribs, describe their surface, shape and contours of hemorrhages, pay attention to gas bubbles under the pulmonary pleura, the consistency of the lungs, color on the section, the presence and amount of edematous fluid or dryness of the cut surface, reflect the blood supply of the lungs , heart and other organs, blood condition (liquid or with clots). To clarify the dilution of blood with water, a simple test is used, which is made by applying a drop of blood from the left ventricle to filter paper. Thinned blood forms a lighter ring, indicating hemolysis and blood thinning.

When examining the gastrointestinal tract, the presence of foreign bodies and fluid in the stomach and duodenum, its nature and quantity (free fluid, dilution of the contents) are noted. The stomach and duodenum are bandaged before being removed from the corpse, and then, above and below the ligatures, they are cut and placed in a glass vessel to settle the liquid. Dense particles will settle to the bottom, with a layer of liquid above them sometimes covered with foam. The presence of fluid in the duodenum is one of the most reliable signs of drowning, indicating increased peristalsis, but this sign has diagnostic value only on fresh corpses. Particular attention is paid to the lesser curvature of the stomach, where there may be ruptures of the mucous membrane. The diagnosis of drowning is confirmed by laboratory tests for the presence of diatom plankton elements in the internal organs. For the study, an unopened kidney is taken with a ligature placed on the pedicle in the hilum area, about 150 g of the liver, the wall of the left ventricle of the heart, brain, lung, fluid from the cavity of the middle ear or the sinus of the main bone. The femur or humerus is completely removed from putrefactively altered corpses. In addition to testing for diatom plankton, it is also necessary to carry out a histological study to determine changes caused by drowning and diseases that contribute to death in water.