Forensic medical diagnosis of individual poisons. Forensic medical diagnosis of acute fatal alcohol poisoning Forensic medical diagnosis of alcohol poisoning

In cases of poisoning, a forensic medical examination is carried out to establish the cause of death or the connection of a health disorder with the action of toxic substances. The categorical conclusions of the expert largely depend on the data collected by the investigator about the circumstances of the incident and the nature of the alleged poisonous substance, the time elapsed from the moment the poison was taken and the onset of death, the nature of the medical care provided, the correctness of the removal and storage of objects from the corpse sent for forensic chemical research, etc. In some cases, the expert comes to a categorical conclusion about poisoning with a certain poison, in others - he just does not exclude the possibility of poisoning with a certain poison or a certain group of toxic substances that are similar in their effects on the human body (clinical and morphological manifestations).

The suspicion that death came from poisoning may also arise in cases of its unexpected onset, as if in the midst of full health. Diagnosis of death from poisoning often presents great difficulties associated with a number of objective and subjective reasons - incorrect assessment of laboratory data, significant time elapsed between the intake of poison and death, the similarity of clinical manifestations in case of poisoning and certain diseases, etc.

To prove the poisoning that took place, materials collected by the investigation containing information about the circumstances of the incident are used; data of a forensic medical examination of the victim (in case of non-fatal poisoning) and data; data of forensic chemical and other laboratory studies of objects found at the scene, obtained from the attending physicians, seized during the autopsy.

Investigation materials. The materials collected by the investigation about the circumstances of the incident (for example, the simultaneous sudden illness or death of several people after the joint use of an “alcoholic drink”, with the development of the same painful symptoms in the victims) can directly indicate possible poisoning. In the remains of food and drink found at the scene, in dishes, in various packaging materials from medicines, on the corpse (on the hands, at the opening of the mouth and other parts of the body), on clothes and in its pockets, the remains of the poison taken by the victim can be found . The presence of vomit may also indirectly serve as an indication of possible poisoning (the development of vomiting as a protective reaction of the body to intoxication), may contain traces of poison.

Examination of the scene and the corpse should be carried out with the participation of a specialist in the field of forensic medicine. The physical evidence found at the same time, requiring laboratory research, is sent to the Bureau of Forensic Medical Examination.

Medical documents (outpatient cards, etc.) containing a description of the course of poisoning and information about the nature of medical care must be presented to the expert in original.

Forensic examination of a corpse if poisoning is suspected, it has its own characteristics. The dissecting room must be ventilated before the autopsy in order to better capture and determine the nature of the smell felt during the autopsy of the cavities and internal organs of the corpse. Measures are taken to prevent accidental ingestion of poison during its opening. The utensils for placing the removed organs must be cleanly washed.

The clothes, underwear and other things brought along with the corpse are carefully examined in the morgue. When examining clothing items, the remains of poison can be found, to obtain poisonous medicinal substances, etc.

An external examination of the corpse can reveal an unusual color of cadaveric spots (bright pink-red in case of carbon monoxide poisoning, brown or brownish in case of poisoning with poisons that form methemoglobin in the blood, etc.), icteric skin color in case of arsenic hydrogen poisoning and mushroom poisoning; pronounced and quickly onset muscle stiffness (in case of poisoning with strychnine, cicutotoxin aconitine, etc.) burns in the form of streaks or spots on the skin in the area of ​​the mouth, chin, cheeks (in case of poisoning with caustic substances), traces of injections at the injection sites of the poison, a sharp narrowing of the pupils (with poisoning with opium, morphine) or their sharp expansion (with poisoning with atropine, belladonna, asthmatol), irritation and ulceration on the mucous membrane of the lips and gums under the action of caustic poisons, a grayish border on the gums with lead poisoning or.

When opening cavities and organs, a smell specific to some toxic substances can be felt.

In case of poisoning with many poisons, the ways of their excretion suffer - the kidneys, where characteristic changes can be detected. Many ingested substances quickly pass into the urine, are excreted in sweat and can be found on the deceased's linen and in the urine.

The data obtained during the forensic examination of the corpse must necessarily be compared with the data of the investigation and with the data obtained during the laboratory examination of the tissues and organs of the corpse.

Forensic medical examination produced for poisoning that did not lead to death. Such an examination of the victim is carried out both in the hospital and on an outpatient basis. The poisoning that takes place in such cases is proved by investigative materials, medical documents on the provision of assistance and treatment, as well as the data of the examination of the patient by an expert. Having established the fact of poisoning and the nature of its consequences, they determine the severity of these consequences, guided by the all-Union "Rules for forensic determination of the severity of bodily injuries."

Great importance for the preparation of a diagnosis of poisoning with certain poisons is attached to timely laboratory studies of vomit, washings, urine.

On the forensic and other laboratory tests not only the parts of the internal organs seized during the autopsy of the corpse are sent, but also the remains of drinks, food, vomit and other objects found at the scene of the incident that may contain a toxic substance. The choice of the type of laboratory examination of physical evidence is determined by the nature of the alleged poisonous substance. In accordance with this, chemical, physical (often spectral), histological and biological (animal experiments), botanical and other research methods are used.

The results of a forensic chemistry study should be carefully reviewed by a forensic medical examiner.

A positive result of a forensic chemical study, taken in isolation, does not yet prove the fact of poisoning, and a negative one does not exclude it. In the internal organs of a corpse, chemicals can be found, including poisonous ones, which were not a source of poisoning, but entered the human body as a medicine, with food.

The results of a forensic chemical study in case of death from poisoning can be negative for various reasons: due to the rapid release of poison from the body, the transition of the poison to other compounds that are not detected during the forensic chemical study, improper removal and preservation of organs and tissues before their study, the use of the method of investigation appropriate for a given poisoning, etc. The time elapsed from the moment of taking the poison to the onset of death and the opening of the corpse largely determines the preservation of the poison in the corpse, and, consequently, the possibility of its detection during a forensic chemical examination. However, a number of poisons can be found in corpses long after death and burial, for example, salts of heavy metals.

If it is suspected that death has come from poisoning, it is produced; the objects of forensic chemical research can be the boards of the coffin, the surrounding earth, where poisons from the corpse can get.

test questions
1. What is the significance of the investigation materials for the diagnosis of poisoning?
2. What are the features of the examination of a corpse in case of suspected death from poisoning?
3. What data from the external and internal examination of a corpse can be used to prove death from poisoning?
4. What organs and tissues are removed from a corpse in case of suspected death from poisoning and what is the procedure for their removal?
5. How should a forensic examiner evaluate the results of a forensic chemistry study (both positive and negative)?
6. Name the most common laboratory research methods used in the diagnosis of poisoning.

If poisoning is suspected, the forensic expert must first decide whether it was in this case. Next, you need to find out what poison caused the poisoning, how it got into the body, in what dose and in what form, whether this poisoning caused death. Along with these basic questions, the expert may also be asked others arising from the specific circumstances of the incident.
Diagnosis of fatal poisoning is often a complex and responsible task. Before answering the questions posed, the expert must collect and carefully analyze all the materials related to this case: investigative data on the circumstances of death, information about the observed symptoms of poisoning, data from the forensic medical examination of the corpse, the results of forensic chemical and other laboratory studies.
The investigative data of interest to the expert may be contained in the minutes of the interrogation of witnesses who observed the picture of the poisoning, as well as in the protocol of the inspection of the scene.
From the materials of the case, one can obtain information about the profession of the deceased, about the conditions and circumstances under which the poisoning arose and proceeded, about its symptoms, and under what phenomena death occurred. Information about the profession of the poisoned person or his relatives and friends can be used to find out the source of the poison. Essential for the correct assessment of the results of the autopsy and additional studies are information about the nature of first aid, about the antidotes administered, their composition, used medicines. In addition, the expert must have the results of the toxicological analysis of wash water obtained during the provision of medical care.
Under unknown circumstances of death great importance acquire site inspection data. As a result of the examination, poison residues on the hands, around the mouth, on the clothes of the corpse or surrounding objects can be detected. Poison residues are sometimes found in leftover food, drink, empty dishes, vials, opened ampoules, in a syringe, and various kinds of drug packaging. Vomit and secretions (urine, feces) found at the scene of the incident may contain the poison taken, so they must be collected in clean glassware and sent by the investigator to the forensic chemical laboratory.
If the poisoned person was taken to a medical institution, then valuable data for the expert can be obtained from the medical history. Sometimes records in the case history are the only source of information about the circumstances of the poisoning reported to the doctor by the victim himself. For the diagnosis of poisoning, especially with poisons that do not cause noticeable morphological changes, the clinical manifestations recorded in the history of the disease and the dynamics of the development of poisoning, the results of toxicological tests, as well as information about the administered drugs and the detoxification measures taken (hemosorption, peritoneal dialysis, etc.) ).
Of great importance in the diagnosis of poisoning is the forensic medical examination of the corpse. An autopsy may reveal signs characteristic of the action of a particular poison or group of poisons. The study of the corpse must begin with a thorough examination of the clothes, on which the remains of liquid and powdered poisons, vomit, and in the pockets - bottles, boxes, various packages with the remains of poison can be found. Clothing and items found in pockets that are suspicious of containing poison should be sent for forensic chemical research.
External examination can provide valuable indications of the nature of the active poison. First of all, attention is paid to cadaveric spots, the color of which, when poisoned by some poisons, may be unusual (carbon monoxide, hydrocyanic acid and its preparations, methemoglobin-forming poisons). The presence of parchment spots on the lips in the form of streaks, sometimes traces of splashes and drops around the mouth, on the chest and arms may indicate the intake of caustic poisons (acid, alkali, phenol). The poison can be injected under the skin or intramuscularly, so it is necessary to carefully examine the skin with sufficient lighting, on which in such cases pinpoint wounds from injections with a syringe needle are found. Naturally, the possibility of the formation of such traces in the provision of first aid or in the course of treatment should be taken into account. We should not forget about the need for a morphological assessment of the prescription of such traces and their compliance with the timing of the alleged poisoning.
In an internal study, attention is paid to an extraneous smell from the opened cavities and from the internal organs of the corpse (ethanol, acetic acid, dichloroethane, acetone, hydrocyanic acid, FOS, etc.).
The unusual color of the blood and the corresponding shade of the internal organs and tissues makes it possible to suspect poisoning with cyanides or blood poisons (carbon monoxide, nitrates, aniline, hydrazine, etc.). When poisoned with caustic poisons, characteristic inflammatory and necrotic changes are found in the mucous membrane of the tongue, pharynx, esophagus, stomach, and sometimes the small intestine. In addition, some caustic poisons change the color of the mucous membranes due to the characteristic color of the poison itself (nitric acid) or the formation of hemoglobin derivatives - acidic or alkaline hematin (acetic, hydrochloric acid, caustic alkalis).
A careful examination of the contents of the stomach and mucous membrane, especially in the depths of its folds, sometimes makes it possible to detect particles of undissolved poison, pieces of berries, leaves, and tubers. Poisons that cause an increase in capillary permeability (ethylene glycol, phosphorus, arsenic, etc.) lead to the formation of multiple hemorrhages in internal organs and tissues. For the diagnosis of poisoning by many poisons, the nature of changes in the liver and kidneys is essential.
It is advisable to describe the detected changes in the internal organs according to a certain scheme:

1. localization of changes (organ name);
2. shape, size, weight of the organ;
3. content - quantity, character, color, smell;
4. the state of the inner surface of a hollow organ (its mucous membrane): color, relief, density, humidity, gloss on

location, integrity of the mucous and submucosal layers (presence of erosions, ulcers, their localization, shape, depth, condition of the edges, bottom);

1. the state of the organ on the cut (for parenchymal organs): color, blood supply, pattern of tissue separated from the surface of the cut.

Often, in case of poisoning in the internal organs, no morphological changes can be detected, or they are so uncharacteristic that they do not allow diagnosing poisoning based on sectional data only. In such cases, forensic chemical, and, if necessary, other laboratory studies are of primary importance: histological, microscopy
chesky, botanical, pharmacological, bacteriological.
The results obtained are compared with the circumstances of the case, intravital manifestations of poisoning, the nature of the provision of medical care, the data of the forensic medical examination of the corpse, and only after that the final conclusion is made about the presence of poisoning and the poison that caused it.
An important place in the diagnosis of poisoning is occupied by a forensic chemical study. Depending on the specific case, blood, internal organs and their contents, pieces of cadaver tissue (skin with subcutaneous tissue, muscles), washings, body secretions, as well as the remains of various substances found and seized at the scene can be subjected to this type of study.
In case of fatal poisoning, internal organs with their contents and tissues are subject to mandatory forensic chemical research. Depending on the alleged poison that caused the poisoning, certain bodies are sent for forensic chemical research, the list of which is provided for by Order of the USSR Minister of Health N 166 of April 20, 1962, as well as Appendix 2 to Order of the USSR Ministry of Health N 182 of July 9, 1991.
If the introduction of poison through the vagina or uterus is suspected, these organs should be additionally taken into a separate jar; if subcutaneous or intramuscular injection of poison is suspected - areas of the skin, subcutaneous tissue and adjacent muscles from the area of ​​\u200b\u200bthe proposed injection. In principle, it is advisable to send for research the organs (and tissues) through which the poison entered the body; organs in which the poison is usually deposited, and those organs through which the poisonous substance is excreted from the body.
If poisoning with an unknown poison is suspected, as well as in case of combined poisoning, it is necessary to withdraw: in jar N 1 - stomach with contents;
in bank N 2 - one meter of the small and large intestines with the contents of the most altered departments;
in jar N 3 - at least 1/3 of the most full-blooded areas of the liver, gallbladder and its contents;
in jar N 4 - one kidney and all urine; in jar N 5 - 1/3 of the brain; in jar N 6 - at least 200 ml of blood;
in bank N 7 - the spleen and at least 1/4 of the most full-blooded sections of the lung.
The positive or negative results of a forensic chemical examination are not in themselves proof of the presence or absence of poisoning in all cases. The detection of poison in the internal organs and tissues of a corpse can be associated not only with poisoning, but also with the introduction of drugs for therapeutic purposes, as a result of professional contact with poison at work, as well as posthumously, when various toxic substances enter the corpse before, during and after opening.
A negative result of a forensic chemical study does not exclude the possibility of death from poisoning. This may be due to a number of reasons. In protracted cases of poisoning, the toxic substance can be completely eliminated from the body before death occurs, some poisons undergo various transformations during this time, so they are not detected at all, or are determined in the form of decay products. Some poisons can be destroyed post-mortem as a result of putrefaction processes. Strong poisons that cause fatal poisoning in very small doses may not open existing methods chemical analysis due to their insignificant content in biological objects sent for research.
Negative results can sometimes also be associated with violations of the rules for the collection, storage and selection of an object for forensic chemical analysis.
Histological examination of internal organs and tissues in case of poisoning should be considered mandatory. In some cases, it allows you to clarify the nature of the pathological processes caused by the action of the poison at the site of its application (acids, alkalis), in others - to identify characteristic, sometimes specific, changes for a particular poison or group of poisons (destructive poisons, ethylene glycol). In addition, morphological signs of the disease that caused sudden death (microinfarction, acute myocarditis, toxic influenza, etc.) can be detected.
Vomit, the contents of the stomach and intestines, food remnants seized from the scene in order to detect particles of undissolved poisons, small parts of poisonous plants are usually subjected to microscopic examination.
A botanical study of the found plant remains makes it possible to determine their origin. These residues can serve as the only evidence of poisoning, since such poisonings, as a rule, are not accompanied by noticeable changes in the internal organs.
Pharmacological (biological) research complements forensic chemical research in cases where chemical reactions are not sensitive enough to reveal minimal amounts of poison. For this purpose, extracts from the internal organs are administered to animals that react to a low content of the alleged poison.
A bacteriological study of objects taken during the examination of a corpse is performed if food poisoning is suspected.
A forensic medical examination in case of poisoning that ended in recovery is carried out to resolve questions about which poison caused the poisoning, in what way and in what dose it entered the body. The severity of the consequences of poisoning is determined taking into account the "Rules for forensic determination of the severity of bodily injuries." During the examination, investigative materials and records of medical documents are of great importance.

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Moscow

Alcohol poisoning is one of critical factors risk to human health and life expectancy. When considering this category of poisoning, poisoning not with ethyl alcohol, but with the so-called alcohol surrogates, is of particular importance.

According to Tomilin V.V.

et al. (1999) in 1999, out of 70 thousand of all fatal intoxications registered in Russia, 52% were due to poisoning with ethyl alcohol and its surrogates, and the number of deaths in our country from these poisonings remains one of the highest in the world.

In the structure of poisoning, according to the annual reports of the Republican Center for SMEs of the Ministry of Health of the Russian Federation, for 1996-1998. acute alcohol poisoning occupied from 65% to 74% (Klevno V.A. et al., 2006). Against this background, cases of a sudden increase in the number of poisonings, including fatal ones, are periodically recorded, as, for example, in the fall of 2006.

When analyzing cases of non-fatal poisoning, Nuzhny V.P. et al. (2005) found that the total number of hospitalizations for poisoning alcoholic drinks, alcohol surrogates and toxicants used for the purpose of intoxication, in 1987-1988 decreased by an average of 40%, but starting from 1992, the number of such hospitalizations went up sharply and in 1994 exceeded the 1984 figure by 2.7 times.

Moonshine and other home-made drinks in Russia have always competed with legally produced alcoholic drinks.

Among poisonings with multicomponent mixtures, poisonings with various aliphatic alcohols and acetone have an advantage: 1) aliphatic alcohols (ethanol, propyl, butyl, amyl), acetone, ethers in various combinations and ratios; 2) methanol in combination with other aliphatic alcohols, acetone, aromatic hydrocarbons and glycols; 3) glycols (ethylene glycol, propylene glycols, di-, triethylene glycols, glycol ethers), diethyl phthalate, aromatic hydrocarbons in various combinations and ratios.

Impurities are of the greatest importance in cases of using alcoholic beverages made in a handicraft way, falsified, or liquids not intended for oral administration (Berezhnoy R.V., Smusin Y.S., Tomilin V.V., Shirinsky P.P., 1980 ), because the membranotropic effects of alcohol are non-specific and can be mimicked by others chemical compounds, close to ethanol in structure and physicochemical properties.

Many authors (Berezhnoy R.V. et al. 1980; Bonitenko Yu.Yu., 2005) subdivide alcohol surrogates into two categories: 1) preparations prepared on the basis of ethyl alcohol and containing various impurities; 2) drugs that do not contain ethyl alcohol and are other monohydric or polyhydric alcohols, chlorinated hydrocarbons; their toxic danger is much higher (false surrogates).

The most common poisonings are methanol, propyl alcohols (n-propanol, isopropanol), butyl alcohols (n-butanol, butanol-2), amyl alcohol and its isomers, ethylene glycol, ethylene glycol ethers and tetrahydrofurfuryl alcohol. Liquids of this kind are also called false substitutes for alcohol (Luzhnnikov E.A., 1999).

It should be noted that experts from the country's leading toxicological centers in their scientific publications usually do not separate alcohol poisoning, true alcohol surrogates, and even more so poisoning with low-quality alcoholic beverages.

This is not surprising, since the clinical picture of poisoning with alcohol, moonshine, a number of true alcohol surrogates, as well as the tactics of treating patients, are the same. The clinical picture of poisoning by false surrogates of alcohol is largely determined by the active principles of a non-alcoholic nature.

In the clinical picture of acute poisoning with alcohol and its surrogates, it is customary to distinguish the following main syndromes: toxic encephalopathy, respiratory and circulatory disorders, toxic hepato- and nephropathy, and gastrointestinal disorders. The development of certain syndromes and their severity depend on the individual characteristics of the toxic agent, its dose and other causes. Toxic encephalopathy develops in almost all those poisoned by alcohol and its surrogates and includes impaired consciousness, mental, cerebellar and extrapyramidal disorders, asthenovegetative manifestations. As a rule, the clinical picture of the toxicogenic phase of intoxication is dominated by various types of impaired consciousness and mental functions, which can be characterized by both symptoms of CNS excitation (psychomotor agitation with euphoria, delirium, hallucinations, delirium) and its suppression (lethargy, stunning, stupor, and coma in severe cases). One of the serious complications of severe alcohol poisoning and its surrogates is convulsive syndrome, which develops as a result of CNS hypoxia and cerebral edema (Matyshev A.A., 1998; Kildyushov E.M. et al., 2007).

The most common early manifestation of alcohol poisoning and its surrogates is acute gastritis. After taking the poison, nausea, repeated vomiting develop, pains appear in the epigastric region. Unlike gastritis, the phenomena of enteritis (pain in the mesogastrium, bloating, repeated, profuse loose stools, etc.) are not often observed in case of poisoning with alcohol and its surrogates. Perhaps the development of an erosive process, at a later date - acute pancreatitis(or exacerbation of chronic), characterized by repeated vomiting, girdle pain, positive symptoms of peritoneal irritation, etc. (Berezhnoy R.V. et al., 1980).

In acute poisoning with alcohol and its surrogates, serious homeostasis disorders naturally develop, manifested mainly by disturbances in the water-electrolyte balance and acid-base state (Golovinskaya L.I., 1976; Bonitenko Yu.Yu., 2005).

To date, the most studied metabolic changes that develop in ethyl alcohol poisoning.

According to Khamovich O.V. (2004), ethanol poisoning is considered as the main and immediate cause of death due to the toxic effects of ethanol in the resorption stage. In the stage of elimination, the immediate cause of death is acute heart failure due to the toxic effects of acetaldehyde.

The clinic of acute poisoning with medium alcohols (propyl, butyl and amyl) is similar to the manifestations of ethanol intoxication. A small admixture of amyl alcohol and its oxidation products contributes to the development of acute gastritis and pancreatitis. Aspiration of amyl alcohols provokes pulmonary edema. Novikov M.F. (1975) in persons who died from poisoning with propyl alcohol, well-defined cadaveric spots of blue-purple or dark purple color were noted. The internal organs are stagnant and plethoric; point hemorrhages are noted under the epicardium, on the visceral pleura, mucous membranes of the gastrointestinal tract, in some internal organs. Focal hemorrhages in the pancreatic tissue, cerebral edema were revealed. Kidney dystrophy, fatty degeneration of the liver. In case of poisoning with propyl, isopropyl, butyl and amyl alcohols, autopsy often reveals necrosis of the mucous membranes of the gastrointestinal tract, damage to the liver and kidneys (Berezhnoy R.V. et al., 1980; Bonitenko Yu.Yu., 2005).

Features of poisoning with polishes are determined by the components that make up these liquids. The presence of acetone, butyl and amyl alcohols in them leads to more pronounced gastrointestinal and cerebral disorders (Berezhnoy R.V. et al., 1980).

Of great importance in the diagnosis of acute alcohol intoxication are the content of ethanol (in the blood and urine) and its compliance with the clinical picture. It is believed that the concentration of ethanol in the blood, equal to 3.0 g / l and above, is characteristic of acute alcohol intoxication, and 4.0-6.0 g / l is fatal. According to forensic experts, the lowest lethal concentration of alcohol in the blood is 3 g / l. For women, this figure is on average 1.4 times lower than for men. In turn, for persons prone to excessive consumption of alcoholic beverages, the lethal concentration of alcohol in the blood is approximately 30-50% higher (Tomilin V.V. et al., 1999).

IN last years in case of poisoning with alcoholic beverages, due to the frequent detection of other alcohols and their metabolic products in biological media that died along with ethanol, the question of combined poisoning with ethyl alcohol and its surrogates is increasingly being raised. An analysis of such cases allows us to say that, in the presence of blood, not even a large number higher alcohols (Diagnosis of poisoning with alcohol and its surrogates is based on anamnesis data, the clinical picture of intoxication, the results additional examination, including the chemical-toxicological analysis of the remains of the ingested liquid, gastric lavage and other biological material (blood and urine), as well as the results of forensic histological and forensic chemical studies (Bonitenko Yu.Yu., 2005). These poisonings are difficult to diagnose, perhaps in connection with this, the victims do not receive the full range of timely resuscitation and antidote therapy, as evidenced by the high mortality rate in medical institutions.

Chemical-toxicological study of poison residues and biological media of victims of acute exogenous poisoning is an essential component of the diagnostic process. Alcohol poisoning and its surrogates are no exception to this rule (Zatona R.E. et al., 2006). Methods for determining these substances can be divided into two unequal subgroups: express methods and methods of chemical-toxicological analysis proper.

Among the variety of methods for the determination of alcohols, gas chromatography is considered the most simple and specific today.

It can be assumed that the increase in the number of lethal SA poisonings is associated with an increase in the turnover, both free and illegal, of technical liquids, which include various toxic components.

All of the above suggests that alcohol poisoning is not only a purely medical problem, but also a serious social, clinical and demographic problem, which determines the relevance and need for research in this area.

References: 1.

Berezhnoy R.V. Poisoning by technical liquids // Guidelines for forensic medical examination of poisonings. Ch. 10 / R.V. Berezhnoy, Ya.S. Smusin, V.V. Tomilin, P.P. Shirinsky. - M.: Medicine, 1980. - 424 p. 2.

Bonitenko Yu.Yu. Acute poisoning with ethanol and its surrogates / Yu.Yu. Bonitenko. - St. Petersburg, 2005. - 223 p. 3.

Golovinskaya L.I. Improving the methodology for the examination of poisoning with higher alcohols and their combinations with ethanol / L.I. Golovinskaya // Forensic science in the practice of health care and expertise (Materials of the XVI Plenum of the Board of the VNOSM). - Minsk, 1979. - S. 114-117. 4.

Zatona R.E. The use of special knowledge in the conduct of individual investigative actions and operational-search measures in criminal cases related to the illegal circulation of alcohol-containing liquids and alcoholic products / R.E. Zatona, O.R. Rodionova // Forensic expert. - No. 4. - M., 2006. - S. 14-17. five.

Kildyushev E.M. On the problem of diagnosing acute intoxication with ethyl alcohol in expert practice / E.M. Kildyushev, I.V. Buromsky, O.V. Krieger // Forensic Medical Examination. - No. 2. - M., 2007. - S. 14-16. 6.

Klevno V.A. Russian Center for Forensic Medical Examination: pages of history (to the 75th anniversary of its foundation) / V.A. Klevno, I.N. Bogomolova, O.A. Panfilenko, D.V. Bogomolov, V.N. Zvyagin, P.L. Ivanov, A.V. Kapustin, B.M. Lisyansky, E.M. Salomatin, O.V. Samohodskaya, R.S. Sakharov // Edited by prof. V.A. Cool. - M.: RIO FGU "RTsSME Roszdrav", 2006. - 390 p. 7.

Luzhnikov E.A. Alcohol poisoning and its surrogates / E.A. Luzhnikov // Clinical toxicology. - Ch. 11. - M., 1999. - S. 276-300. 8.

Matyshev A.A. Poisoning with ethyl alcohol and its surrogates / A.A. Matyshev // Forensic Medicine. Guide for doctors. - Ch. 21. - Edition 3. - St. Petersburg: Hippocrates Publishing House, 1998. - S. 245-249. nine.

Novikov M.F. To the question of poisoning with propyl alcohol / M.F. Novikov // Materials of the scientific-practical conference of forensic doctors of the Orenburg region on issues of traumatology, toxicology and sudden death. - Orenburg, 1975. - S. 34-38. 10.

Novikov P.I. Expert review distribution dynamics of ethyl alcohol in the body during a forensic examination of a corpse / P.I. Novikov // Forensic Medical Examination. - No. 3. - M., 1963. - S. 13-17. eleven.

Need V.P. Alcohol mortality and toxicity of alcoholic beverages / V.P. Needy, S.A. Savchuk // Partners and competitors. Labrotarium. - No. 5-7. - M., 2005. - S. 44-47. 12.

Tomilin V.V. On fatal poisonings with ethyl alcohol and its surrogates in various subjects Russian Federation/ V.V. Tomilin, E.M. Salomatin, G.N. Nazarov, A.I. Shaev // Forensic Medical Examination. - No. 6. - T. 42. - 1999. - S. 3-7. 13.

Alcohol in everyday life is understood as ethyl alcohol (С2Н5ОН).

Ethyl alcohol in terms of the frequency of poisoning should be put in first place. Every intoxication is an acute poisoning. Usually, alcohol enters the body as a flavoring agent, i. through the mouth. But it can be absorbed through the skin, through wounds (compresses) or through the lungs by inhalation of vapors.
Man got acquainted with ethyl alcohol thousands of years ago, perhaps primitive people accidentally tasted fruit juice and they liked either its taste or its effect. After that, they began to deliberately let fruit juices ferment, getting "fun" drinks. Fruit juice ferments under the influence of microscopic living cells. Bacteria, feeding on the sugar of the juice, turn it into ethyl alcohol.

The action of the standard on the body.

Alcohol acts on the body as a narcotic substance, while the following phases of its action are distinguished:
a) excitement;
b) anesthesia;
c) paralysis.

Like any drug, alcohol acts primarily on the central nervous system, it is on the cerebral cortex that general inhibition occurs hemispheres and release of the subcortex.

In the development of alcohol poisoning, three stages of intoxication are observed - mild, moderate and severe.

1. With a mild degree of intoxication, at first there is an increase in respiration and pulse, expansion of peripheral capillaries (red Str.
250 Forensic medicine in lectures
note) the temperature rises. Such subjects are excited, talkative, unleashed. There is a motor excitation, a feeling of lifting, a feeling of a surge of strength. However, an objective study of the work performed indicates a decrease in muscle strength.

2. In an average degree of intoxication, reflexes fade away, movement coordination is disturbed (ataxia). Speech becomes incoherent, signs of paralysis of the inhibitory centers appear. A drunk becomes frank, sometimes gentle, sometimes rude, often tends to violence, fight, abuse. The pupils constrict, the temperature decreases due to increased heat transfer and reduced heat production. There is vomiting.

3. A severe form of intoxication is characterized by the development of diffuse cortical inhibition. Reflexes drop sharply, breathing becomes rare, hoarse, pupils do not react, the temperature drops significantly, muscle and heart weakness progresses, vomiting continues (aspiration of vomit). There is involuntary urination, defecation.
Due to the prevalence and wide effect of alcohol, many crimes are committed while intoxicated, especially bodily harm and crimes against morality. Intoxication is a mental disorder that clinically resembles some form of true mental illness.
Quite often there is the so-called pathological intoxication, which is characterized by an increased, pathological reaction to alcohol, i.e. from small doses of alcohol, a very strong reaction occurs, in other words, a person does not tolerate alcohol. This condition can often occur in congenital epileptics, in persons after a skull injury. Pathological intoxication is a qualitative change in the reaction to alcohol, i.e. illusory representations, deception of the senses, unmotivated anger and fear are observed without the usual signs of intoxication. This condition can come on suddenly and end in sleep after a short time. In most cases, this is followed by amnesia (loss of memory for the past). The danger lies in the fact that in this state the most serious crimes can be committed.
For a non-drinker, a lethal dose of 96 percent alcohol = 100 - 150.0 or 250 - 300.0 g of vodka (6-8 g of pure alcohol per 1 kg of weight). Children are especially sensitive to alcohol; in a five-year-old child of 10, it is caused by dangerous phenomena. Known poisoning of children caused by alcohol compresses. Alcohol contributes to the onset of death from other causes: death from coronary artery disease, in sclerotics, rupture of cerebral vessels with apoplexy and rapid death, alcohol significantly lowers body temperature and contributes to death from the action of external cold (from cooling), etc.
Often, in cases where patients are taken to the hospital in a state of severe alcohol intoxication and with suspicion of severe traumatic brain injury, such persons should be hospitalized until the circumstances are fully clarified. on this issue the greatest medical errors are observed, sometimes with tragic results.

Forensic medical diagnosis of fatal poisoning with ethyl alcohol and its surrogates.

When opening a corpse, a sharp smell of alcohol is felt from the cavities and organs of the corpse, it can be felt already when opening the cavities of the skull, abdomen and chest. When opening the stomach, the smell of alcohol is practically not felt, especially if it was full of food, then the smell of fermentation becomes sharper in it. There is a sharp plethora and edema of the meninges and brain substance, plethora and pulmonary edema, where large hemorrhages are sometimes found. Parenchymal organs are congestively full-blooded on section. Congestive plethora is noted in the spleen and gastrointestinal tract. Bladder, usually distended and filled with urine. Under the pulmonary pleura, under the epicardium, in the conjunctiva, ecchymoses (small punctate hemorrhages) are found.

However, all these changes are often found in other types of death. Because of this, it is necessary to conduct a chemical study of organs to determine the quantitative content of alcohol in the body. For a forensic chemical study, you need to take urine and blood. Blood should be taken from peripheral vessels (brachial and femoral vein) or from the sinuses of the dura mater, because. in the heart, in the liver, in the lungs, alcohol will be contained more than in the blood of peripheral vessels. This is due to the post-mortem diffusion of alcohol from the stomach to nearby organs.

Toxicological assessment of alcohol poisoning is one of the difficult issues of forensic medical examination. there is no specific lethal dose, which varies widely: from 3 to 5%. Evaluating the results of chemical analysis, the medical examiner must establish the dose of alcohol in the body that was the highest. This is achieved by calculation, since it is established that for every hour that has passed after drinking alcohol, 0.08-0.12% of alcohol is burned in the body or released, and within 24 hours all the alcohol taken disappears from the body. In addition, during the examination of alcohol poisoning, it is necessary to know about the presence of the deceased before death diabetes, anesthesia, taking a large amount of fruits, vegetables (grapes, melons, etc.) alcohol compresses (on wounds), as well as the phenomena of putrefaction of a corpse, in which the alcohol content in the blood may increase. In the presence of alcohol in the blood (3-5‰). Sudden death must be ruled out coronary disease heart, which occurred on the basis of atherosclerotic coronary cardiosclerosis.
Only after all are excluded possible reasons death, if more than 5‰ of alcohol is found in the blood and urine, acute alcohol intoxication can be considered the cause of death. In exceptional cases, in healthy non-drinkers, death from alcohol poisoning can also occur at lower concentrations (3-4‰) in the blood.

Alcohol poisoning.

Along with poisoning with alcohol and alcoholic beverages, there are often poisonings with various poisonous liquids that are used for various technical needs.

These fluids can be divided into 2 groups:
1. Containing ethyl alcohol, but in insufficiently pure form: denatured alcohol, moonshine, cologne.
2. Not containing ethyl alcohol - methyl alcohol, amyl alcohol, dichloroethane, antifreeze (ethylene glycol), tetraethyl lead.
Poisoning by surrogates of the first group is similar to ethyl alcohol poisoning, but they are more severe due to the side effects of substances in these liquids. Poisoning by surrogates of the second group is more dangerous. they themselves are strong poisons.

LECTURE #10

Forensic medical examination of poisonings

According to the World Federation of Poison Control Centers (2000), in modern world a toxicological situation has developed, which is caused by an increase in the number of acute accidental and intentional poisonings with medicinal and industrial products.

WHO (International Chemical Safety Program) indicates that the frequency of poisoning with drugs alone is increasing from year to year in almost all countries, with centrally acting drugs accounting for 60 to 75%. The topical issue is the toxicological aspects of drug addiction, substance abuse and acute overdoses.

Poison is a substance that enters the body from the outside, has the ability to have a chemical and physico-chemical effect and is capable, under certain conditions, even in small doses of causing poisoning. Poison is a relative concept. The same substance, depending on the dose, can lead to fatal poisoning, cause a therapeutic effect or be indifferent, and under certain conditions can be used as a medicine.

Poisons can be systematized by their origin (mineral, organic, etc.), their ability to cause acute or chronic poisoning, their selectivity (poisons with a predominant effect on the cardiovascular, urinary, central or peripheral nervous systems, etc.), their ability to exert predominantly local or general resorptive effect on the body, depending on the state of aggregation of the poison, etc. In forensic medicine, it is customary to consider poisons depending on their ability to have one or another local damaging effect.

Caustic poisons include poisons that cause sharp morphological changes at the point of contact with the body (chemical burns): concentrated acids, alkalis, hydrogen peroxide, etc.

The action of destructive poisons is associated with the formation of dystrophic and necrotic changes in organs and tissues, including the place of contact of the poison with the body. This group includes salts of heavy metals (mercury, copper, zinc), phosphorus, arsenic, organic compounds of mercury, etc.

The third group consists of carbon monoxide and methemoglobin-forming poisons (bertolet salt, aniline, sodium nitrite, etc.).

The fourth group is the most diverse, which includes poisons that have a predominant effect on the central and peripheral nervous systems: excitatory of the central nervous system include the actual excitatory (atropine, phenamine, phenatin) and convulsive (strychnine, ergotamine, etc.), depressing the central nervous system system - narcotic (morphine, codeine, chloroform, ethylene glycol, ethyl, methyl alcohols, etc.) and sleeping pills (barbiturates), to paralyze the central nervous system - cyanide and organophosphorus compounds, to poisons that act mainly on the peripheral nervous system - natural and synthetic muscle relaxants.

1. Conditions for the action of poison on the body

The nature of morphological and functional changes in poisoning depends on the combined influence of a number of conditions. These include: the properties of the poison, the state of the body, the routes of administration, distribution, deposition and ways of removing the poison from the body, environmental conditions, the combined effect of poisons.

The properties of the poison that can affect the nature of the poisoning include its dose, concentration, state of aggregation, solubility and persistence in the external environment. Dose - the amount of poison that enters the body.

Poisons can be introduced into the body in solid, liquid and gaseous states. The most aggressive are those that enter the blood faster, i.e. liquid and gaseous. More dangerous are poisons that can quickly dissolve in body fluids and tissues. Some poisons do not have the ability to persist in the external environment for a long time, such as potassium cyanide.

The development and outcome of poisoning are influenced by the properties of the organism itself, body weight, the amount and nature of the contents of the stomach, age and gender, concomitant pathology, individual sensitivity and general resistance of the organism. In a person with a lower body weight, poisoning is more severe than in a person with a larger body weight. Here the distribution of the dose of the poison taken per kilogram of mass matters. A significant role is played by the use of poison inside its quantity, consistency and chemical composition stomach contents, which can reduce the concentration of poison, oxidize, restore, completely or partially adsorb it. The course of poisoning is aggravated by various diseases that disrupt the detoxification function of the liver, the filtration and excretory function of the kidneys, and thereby contribute to the accumulation of poison in the body.

Children are more susceptible to poisons than adults, which is usually explained by the insufficiently formed general resistance of the child's body to various exogenous influences, as well as the low activity of the biotransformation of the child's liver enzymes.

It is known that during periods of pregnancy and menstruation, the resistance of the female body to poison decreases. The action of a poison on an organism sensitized by this poison can lead to serious consequences and even death at a relatively small, non-lethal dose. Tachyphylaxis (quick defense) is also observed - a decrease in the body's sensitivity to certain substances when they are repeatedly injected at short intervals.

Features of the course of poisoning may be due to genetic causes. It is known that approximately 1 out of 1000 inhabitants has a sharply reduced activity of serum cholinesterase, which hydrolyzes dithylin, used for induction of anesthesia. Some residents of Africa, Southeast Asia and the Mediterranean region have a genetically determined deficiency in the activity of the enzyme glucose-6-phosphate dehydrogenase of erythrocytes, which makes them insensitive to sulfonamides, phenacetin and some antibiotics, the introduction of which leads to hemolysis of erythrocytes.

Repeated administration of small doses of certain poisons into the body is addictive and increases tolerance to this poison. Thus, drug addicts remain alive when doses of drugs are injected into the body that are many times higher than lethal levels. The course and consequences of intoxication are also influenced by the general resistance of the organism. Poisoning is more severe in people weakened by injuries, chronic diseases, detrained and mentally exhausted.

The importance of routes of introduction of poison into the body is determined by how quickly they provide the flow of poison into the blood. Skin applications of the poison are the least dangerous, although some of them (phenol, tetraethyl lead, some fat-soluble substances) are quite aggressive when interacting with the skin surface, depending on the area and time of contact. The most dangerous is aerogenic and parenteral intake of poison, although there are substances that are dangerous mainly when taken orally and are almost harmless when administered subcutaneously (barium carbonate). The aerogenic route of administration usually leads to poisoning under industrial conditions when the maximum permissible concentrations (MPC) in the air of the working area are exceeded.

Other things being equal, the most dangerous is the direct introduction of poison into the blood. The mucous membrane of the gastrointestinal tract has a good absorption capacity, so the introduction of poison through the mouth or rectum leads to its rapid entry into the bloodstream and the development of acute poisoning. The poison can be quickly absorbed into the blood through the mucous membrane of the vagina. The peculiarities of the course of poisoning when poisons are administered through the rectum and vagina are due to the fact that poisons enter the bloodstream bypassing the hepatic barrier, and thus have a more pronounced toxic effect than when the same poisons and in the same doses through the mouth.

The distribution and deposition of poison in the body largely depend on the chemical structure and state of aggregation of the poison, its ability to dissolve in various tissues and environments of the body. Fat-soluble poisons (dichloroethane, carbon tetrachloride, benzene, etc.) accumulate in adipose tissue, liver, and brain. Water-soluble poisons, spreading throughout the body, are mainly concentrated in muscle tissue, brain, liver, kidneys. Some poisons can be deposited in bones and hair (arsenic, lead, phosphorus, etc.).

The excretion of poisons from the body occurs in most cases through the kidneys and lungs. Mostly water-soluble and non-volatile poisons are excreted through the kidneys, and volatile and gaseous substances are excreted through the lungs. Poisons are less actively excreted through the gastrointestinal tract (alkaloids, salts of heavy metals, methyl alcohol, etc.). Alcohols, drugs are excreted with bile, essential oils; through the salivary and mammary glands - salts of heavy metals, morphine, ethyl alcohol, pilocarpine and berthollet salt; through the sweat glands - phenol, halides.

Routes of administration, the nature of distribution, deposition and excretion of poisons often determine the localization, nature and extent of morphological changes in a particular type of poisoning. Knowledge of these features of intoxication is necessary for a targeted search for poison in the body.

Terms environment(high and low temperature, humidity, atmospheric pressure, etc.) are of the greatest importance for occupational poisoning in special production conditions. In general, adverse external conditions weaken the overall resistance of the body and thus increase the clinical course of intoxication. A classic example is the aggravating effect of low ambient temperature on the flow alcohol poisoning. The lack of ventilation is a factor contributing to the occurrence of gas poisoning in the atmosphere of mines, underground wells (methane, hydrogen sulfide, carbon dioxide and etc.).

With the simultaneous intake of several poisons into the body, they can have a combined effect: synergists (alcohol and barbiturates, novocaine and physostigmine, ephedrine and adrenaline, etc.) aggravate the course of poisoning, antagonists (pachycarpine and scopolamine, alcohol and caffeine, potassium cyanide and glucose, cyanides and sodium nitrite, strychnine and chloral hydrate, etc.) mutually weaken the toxic effect of each other. Chemical and physico-chemical antagonism of poisons is widely used in antidote therapy.

The properties of the poison and the set of conditions that accompany its action determine the clinical and morphological consequences of poisoning, which can be expressed in mild, moderate, severe degrees of poisoning, fulminant, acute, subacute and chronic clinical course, local, general manifestations, primary and metatoxic effects, selectivity of action. on subtle biochemical processes in the body, the predominant lesion of certain body systems with a corresponding syndromic course, various ways and intensity of excretion of the poison, a variety of immediate causes of death (pain and toxic shock, infectious complications, acute renal and liver failure, exhaustion, etc.). The complex process of interaction between poison and the organism is covered by the concept of toxicodynamics.

The fate of various poisons in the body is not the same. Some do not undergo significant changes, others are oxidized, reduced, neutralized, adsorbed. In this case, new compounds are formed with both reduced and increased toxicity. Benzene, for example, is first oxidized in the body and then destroyed with the formation of toxic metabolites: hydroxyhydroquinone, phenylmercapturic and muconic acids. Hydrolysis of organophosphorus compounds leads to the loss of their toxicity, oxidation leads to a sharp increase. The processes of biotransformation of poisons mainly take place in the liver, gastrointestinal tract, lungs, kidneys, adipose tissue, etc. The degree of activity of the transformation of poisons in the liver is of the greatest importance. Lingering in the body, the poison can be fixed by the proteins of tissues and blood plasma. In these cases, the resulting "venom-protein" complex becomes partially or completely non-toxic, in others, the protein acts as a carrier of poison to the affected structures. The formation of non-toxic complexes is often accompanied by the consumption of substances that are important for the life of the organism. Deficiency of these substances in the body can lead to severe and sometimes irreversible changes in carbohydrate and other types of metabolism. The transformation of poison in the body is determined by the concept of toxicokinetics.

2. Forensic medical diagnosis of poisoning

The source of information used in the forensic medical diagnosis of poisoning is: materials of the investigation, medical documents of the victim, data from the forensic medical examination of the corpse, the results of forensic chemical analysis and other additional studies.

The external and internal examination of the corpse in the mortuary faces mutually complementary tasks. In an external study, they seek to establish signs indicating:

1) on the way the poison enters the body (chemical burns on the lips, skin, around the mouth, on the mucous membrane of the oral cavity, the skin of the perineum and on the mucous membrane of the vestibule of the vagina, puncture wounds from injections with a syringe, etc.);

2) on the chemical nature of the poison (the color of cadaveric spots, the nature of chemical burns, the size of the pupils, the color of the sclera, etc.);

3) the rate of death (the intensity of cadaveric spots, the presence of cadaveric ecchymosis, subconjunctival hemorrhages, etc.).

The purpose of the internal examination of the corpse is to establish:

1) ways of introducing poison (burns of the mucous membrane of the esophagus, stomach, vagina and other organs, the presence of poison residues in the stomach, etc.);

2) organs and tissues affected to the greatest extent;

3) the nature of contact (chemical burns) and dystrophic changes in internal organs;

4) the presence and nature of the developed complications;

5) signs characteristic of the action of individual poisons (the color of blood and internal organs, the nature of chemical burns of the mucous membranes, the localization and nature of inflammatory changes in the gastrointestinal tract, the specific smell from the opened cavities and from the opened internal organs, etc.);

6) immediate cause and rate of death;

7) collection of materials for additional laboratory research.

The most important among additional methods is a forensic chemical examination of internal organs, tissues and body fluids. Its purpose is to identify the poison, determine its quantitative content and distribution in the body. Of great importance, the results of forensic chemical research are not absolute.

A negative result of a forensic chemical study does not always rule out poisoning. In case of deliberate poisoning, it can be due to the following reasons: intravital transformations of the poison in the body (destruction, oxidation, reduction, neutralization, formation of complexes with proteins, etc.), excretion of the poison from the body (naturally, with vomiting, gastric lavage, etc.) , the use of antidote therapy, improper sampling of biological material for forensic chemical analysis, improper storage of seized biological material, incorrect choice of chemical analysis technique, low sensitivity of the applied chemical research technique, technical errors.

A positive result of a forensic chemical study does not always indicate poisoning. The reasons for a positive result of such an analysis (in the absence of poisoning) may be: endogenous formation of poison in various diseases (for example, the formation of acetone in diabetes), prolonged use of medications, prolonged professional contact with poison, post-mortem formation of some poisons during rotting of a corpse, post-mortem penetration of poison into tissue of a corpse from soil or clothes, intentional posthumous administration of poison, accidental ingress of poison during improper sanitation of the corpse, errors in the organization and technique of forensic chemical research.

Therefore, forensic evidence of poisoning should be the result of an evaluation of all collected data: investigation materials, medical history data, results of sectional, histological and forensic chemical studies.

Simple alcohol intoxication

Single (simple) alcohol intoxication - acute alcohol intoxication. Ethyl alcohol has a general inhibitory effect on the central nervous system. This manifests itself in three main stages:

1) stages of excitation;

2) stages of anesthesia;

3) agonal stage.

The rate of appearance and severity of symptoms of intoxication are determined by the quantity and quality of alcoholic beverages taken, psychophysical conditions, and individual sensitivity to alcohol.

There are light, medium, and severe degrees of intoxication.

Biochemical parameters (blood alcohol content) of the degree of intoxication:

1) light - 0.5–1.5%;

2) medium - 1.5–2.5%;

3) severe - 2.5–5%;

4) fatal - 5-6%.

In the initial period, with a mild degree of intoxication, there is a pleasant feeling of warmth, muscle relaxation and physical comfort. The mood rises: a person is pleased with himself and those around him, self-confident, optimistically overestimates his capabilities, boastful. An intoxicated person speaks a lot and loudly, easily moving from one topic to another. Movements lose their precision. Criticism towards oneself and others is reduced.

When intoxication approaches the middle degree, the benevolent-euphoric mood begins to increasingly give way to irritability, resentment, compliance, and this is reflected in the content of statements and behavior.

The distinctness of the perception of the environment decreases, thought processes, associative activity slow down.

Speech becomes jerky, slurred, blurred, perseverations appear.

Due to a decrease in a conscious, critical attitude towards the behavior of others and their own personality, intoxicated people often perform inappropriate actions. The arisen desires, thoughts can easily be realized in impulsive aggressive acts against others. As a result of the action of alcohol on the body, individual characterological features are sharpened or exposed.

In this stage of intoxication, old psycho-traumatic experiences and resentments easily surface. This leads to scandals, fights, etc.

Reduced pain and temperature sensitivity. Memories relating to the period of intoxication, as in a mild degree, are preserved quite fully.

In severe cases, there is a change in consciousness that varies in depth - from stunning to coma.

Coordination of movements is sharply disturbed, orientation in space and time worsens. Vestibular disorders appear (dizziness, nausea, vomiting, etc.). Decreased cardiac activity arterial pressure, temperature, physical weakness increases, interest in the environment is lost.

The intoxicated one looks drowsy and soon falls into drug-induced sleep, sometimes in the most inappropriate places. In some cases, involuntary urination, defecation, convulsions are noted.

After deep sleep real events during intoxication, they can be stored in memory, memories are fragmentary, and complete forgetting is possible.

In the practice of examination, there are atypical states of simple intoxication with hysterical phenomena, elements of exaggeration, mischief, conscious licentiousness, swagger, etc.

minor quarrels, offensive word, an unsuccessful remark, an unfulfilled desire turn out to be a sufficient reason for the aggressive actions of the drunk, which are immediately realized. The ability to realize the actual nature and social danger of one's actions or to manage them remains, sometimes only weakening.

From the book Forensic Medicine: Lecture Notes the author Levin D G

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