Thanatology

THANATOLOGY (from Greek thanatos-death) represents the "science of death." The main task of T. should be to elucidate all conditions and causes that have led to the death of an organism at the present moment, i.e., to elucidate the etiology and dynamics of dying ("thanatogenesis"). The study of the preagonal state constitutes the content of prethanatology (see below). T. consists of general and special. General T. should give an idea: a) of living matter and of human life; b) of various variants of life and its borderline states; c) of death and its variants; d) of the preterminal period; and e) of the methodology of thanatological research and thanatological thinking. General T. should not be separated from general biology, since in essence T. is only a part of the doctrine of life (biology). "Even now, physiology is not considered scientific which does not consider death as an essential moment of life, which does not understand that the negation of life is essentially inherent in life itself, so that life is always thought of in relation to its inevitable result, contained in it constantly in the germ of death. The dialectical understanding of life is reduced precisely to this... To live means to die"-says F. Engels (Dialectics of Nature, p. 9, 1930 ed.).-The task of special T. includes resolving all questions that life poses to us in connection with diseases of various organs that can play a role in the question of death, and the consideration of which should proceed from the standpoint of the thanatological problem as a whole, i.e., establishing the genesis of death. Until recently, there was no organized approach to the study of the accumulated material on the genesis of death in the literature. Facts alone were certainly insufficient; a synthetic theory was needed that would unite them into a coherent whole. Collecting all these facts from pathological-anatomical literature and related disciplines, uniting them into one coherent whole, noting all ambiguities, and outlining paths for further research was the main task of the doctrine of death (thanatology). The question of the causes of death was resolved everywhere until recently quite formally and in the majority of cases incorrectly. A review of all material from the standpoint of the newest scientific data shows that new approaches are needed to evaluate autopsy findings, in the sense of the necessity of compiling a detailed thanatological conclusion, in the sense of the dynamics of death (thanatography). The old evaluation of findings at autopsy (purely morphological approach and primitive causality) no longer satisfies the modern pathophysiologically thinking physician. The old autopsy technique (the so-called Virchowian organ technique) satisfies modern clinic and forensic medicine less and less. The main requirement of thanatological research of a corpse is the preservation, as far as possible, of the integrity of anatomical relations between normal and pathologically altered organs until the end of the entire investigation. T. must have at its disposal for conclusions more complete material than that used in ordinary autopsies. Thanatological research of a corpse should especially strive for the possibility of determining, based on morphological data, the functional capacity of organs important for preserving life. In the evaluation, the state of an organ is taken in connection with the state of another organ affecting it or dependent on it. All morphological (resp. static) pictures obtained at autopsies represent a film of life of the deceased cut into pieces, and the task of the examiner is to skillfully glue these static pictures into one strip and in his conclusion unfold the history of the organism's relationship with the external environment and its harmful factors. The difficult task of compiling a thanatological conclusion can be successfully performed only in the study of a completely fresh corpse (so-called early autopsies), with the application of modern requirements to the methodology of autopsy and evaluation of all findings, using histological, bacteriological, and serological methods, and in the near future probably also the biological-experimental method of research on the functional sufficiency of "surviving" organs taken from a fresh corpse. The examiner must prepare, as far as possible, complete factual material for his conclusions. He must look at death as a phenomenon in its historical aspect, in motion, but not as a static phenomenon. He must place the organism as a whole and in its environment, not individual organs, at the center of his attention and research. The examiner must abandon primitive causality and the search for a single cause of death, but must always have before him the task of elucidating the cause-complex or complex of conditions that proved incompatible with the continuation of life, and in such a thanatological conclusion of his to distinguish: 1) the basic disease with its complications (as required by state statistics and epidemiology); 2) the presence or absence of data falling under one or another paragraph of the criminal code (as required by practical forensic medicine); 3) a sign (or a series of signs) allowing us to judge the "type" of death (as required by physiology); 4) his judgment on the relationships between the organism and the external environment in their dynamics, which will give him the opportunity to state why a given subject died exactly under given circumstances and at a given time, and not earlier or later (as required by modern clinic, scientific forensic medicine, and thanatology); 5) in the case of sudden death, his judgment on the nature of those factors that were able to play the role of causes accelerating or causing the fatal denouement. T. poses a number of questions that can be resolved only by experiment, e.g., the question of postmortem circulation, the genesis of death in various poisonings, etc. Experimental T. should study the action of poisons taking into account the newest scientific data on the hemodynamic system, on the vegetative and animal nervous systems, on the endocrine system, etc., and not only on healthy, but also on animals with artificially induced diseases and under various pathological conditions. Experimental T. will bring much valuable data to the understanding of the dynamics of death not only for those cases that fall under the criminal code, but also for deaths from various poisonings of endogenous and infectious origin. Prethanatology is a term introduced by A. P. Popov to denote the doctrine of the preterminal period. Prethanatology is only a part of T., and at the present stage its tasks and achievements are outlined only in general terms, and the significance of prethanatology as an organized clinical and experimental study of this branch of T. is certainly enormous, as is clear from what has been said above about T. in general. A. P. Popov calls the preterminal period the time from the development of the basic disease or accompanying disease leading to the death of a given individual, and divides it into two periods closely related to each other but unequal in time: preagonal and agonal. Only in cases of sudden death does the preagonal period coincide with the agonal. The preagonal period corresponds to the clinical picture of a fatal disease, but without signs of a sharp decline in cardiovascular activity. The agonal period begins with a sharp decline in cardiovascular, respiratory, or cerebral activity and represents, in the formulation of A. P. Popov, the final, irrevocable, and unique reaction of the whole organism to severe and irreparable pathological-anatomical, biochemical, and functional changes in its most vital systems. Agony has a great chronological amplitude and lasts from several days to several hours or minutes, and by its clinical picture has three main types: 1) cardiovascular, 2) cerebral, and 3) mixed-cerebro-cardiovascular. A. P. Popov also distinguishes the agonal symptom-complex as a reversible and reversible process, agonal diagnosis, preterminal prognosis, and preterminal therapy.