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Dying and death

The death of an organism is the natural outcome of all life on Earth. "Life is a way of existence of protein bodies, the essential point of which is the constant metabolism with the surrounding nature, and with the cessation of this metabolism, life also ceases, which leads to the decomposition of protein" 1 . The concept of death Engels defines as follows. Death is "... the decomposition of an organic body, leaving nothing behind itself, except for the chemical constituents that formed its substance ..." 2 and further "To live is to die" 3 .

Thus, the concept of "death" is inextricably linked with the concept of "life" and is its logical conclusion. The transition from life to death is associated with a metabolic disorder, which is a consequence of the breakdown of oxidative processes at the subcellular and molecular levels.

Anoxia contributes to the activation of catabolic processes in cells, primarily of the central nervous system. The oxidative type of exchange is replaced by glycolytic, which leads to a sharp decrease in ATP synthesis and is accompanied by inhibition of electron transport, violation of ionic gradients and the formation of free radicals, increased permeability of cell membranes, which leads to destructive changes in the cell in the form of turbid swelling, hydropic degeneration and loss of endogenous pigment. With the ongoing anoxia, these reversible phenomena in the cell pass a kind of critical point and turn into progressive, irreversible degenerative changes. Morphological manifestations of these changes are vacuolation of the nucleus, the appearance of hyperchromic material near the nuclear membrane, fragmentation of the cell nucleus. Irreversible damage to the cellular structure associated with protein denaturation (hydrolysis) is associated with the disappearance of RNA and DNA . Enzymes released from cytoplasmic structures aggravate cell destruction, followed by autolysis.

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In a relatively short time (up to 8 min), the cerebral cortex dies. Survive longer using the glycolytic type of exchange, subcortical centers and the spinal cord. Resistance to the state of hypoxia and anoxia in various organs and tissues varies, and therefore their death occurs at different times after cardiac arrest. For example, the bone marrow retains its vitality up to 4 hours, while the supporting tissues (skin, tendons, muscles, bones) last up to 20-24 hours after the cessation of heart activity. Different ability of experiencing individual organs and tissues and their death at different times from the moment of stopping is the heart and is used in transplantology. Currently, the death of the human body from a general medical point of view is considered from two perspectives. The death of the organism as a whole, that is, a statement of the final cardiac arrest, giving the physician the right to say that the person died, make an appropriate entry in the history of the disease and issue a medical certificate of death. From another point of view, the death of an organism is considered as a gradual, rather than simultaneous cessation of the vital activity of individual tissues and organs.

From a forensic point of view, the death of a person is considered as the death of the whole organism, and this expert is obliged to ascertain at the scene of the incident (and under other conditions, for example, if organs need to be removed for transplantation ).

The science that studies the process of dying, death, its causes and post-mortal manifestations is called thanatology . Forensic medicine, in addition to general tanatology, is engaged in the study and solution of many special issues necessary for the organs of justice and public health. The division of tanatology that is within the competence of forensic physicians is called forensic therapeutics. In addition to general provisions, this section presents specific issues related to violent, sudden and sudden death.

1 Marx K., Engels F. Soch. 2nd ed., T. 20, p. 616.
2 Ibid, p. 610.
3 Ibid. from. 611.