From Big Medical Encyclopedia

THANATOLOGY (Greek thanatos death + logos the doctrine) — the section of theoretical and applied medicine studying a condition of an organism in a final stage of a failure of diseases, dynamics and mechanisms of process of dying, proximate causes of death, clinical, biochemical and morphological manifestations of the gradual termination of life activity of an organism.

Problems of T. include creation and improvement of scientific classification of the reasons and circumstances of approach of death, development of theoretical and methodological bases of the doctrine about terminal states (see), improvement of methodical methods of definition of stages of the terminal period and time of approach of clinical and biological death (see). All-pathological value T. is defined by the fact that it promotes further expansion of ideas of bonds of the bodies and systems providing their activity as a whole, about mechanisms of compensatory and adaptive reactions of an organism, potentialitys of each body, etc. At the same time only on the basis of exact knowledge of the main patterns of a thanatogenesis perhaps effective medical intervention in critical periods of a disease, especially in the conditions of resuscitation (see).

In our country for the first time G. V. Blinders in 1924 formulated philosophy of the tanatologichesky analysis. It entered the concept «tanatologichesky conclusion», careful comparison a wedge, and morfol shall be carried out to Krom. data, all variety of conditions is considered, courses of a disease at this patient and on the basis of it in the strict sequence are stated the stages preceding approach of death. Examples of such conclusion of G. V. Blinders gave on the basis of the analysis of the reasons of death at various types cordial (right-and left ventricular) and vascular insufficiency. Klien, a picture of the terminal period was studied by A. P. Popov (1931), to-ry suggested to subdivide it into two stages: longer predagonal-ny and short — agonal. An important role in development of T. played emergence resuscitation (see), various methods a cut are directed to the termination of further development of the terminal period and recovery of the broken functions.

Distinguish the general and private (special) T. General T. studies the most general patterns of process of dying, private — features of a thanatogenesis at specific diseases and causes of death. Besides, according to S. S. Vail (1974), to private T. it is necessary to refer studying of the reasons and the nature of approach of irreversible changes in separate bodies.

Important component of T. the concept about a thanatogenesis, i.e. the reasons and about mechanisms of approach of death is. It is clinically accurate to define the moment of a disease when these mechanisms begin to operate, it is not possible yet. However it is undoubted that the change of the course of a disease to its tragic final is made gradually and before emergence of the first a wedge, symptoms of this fracture as the last, having already begun, a nek-swarm time is shaded, though up to the end defense reactions of an organism weakening, but not exhausted yet. It is impossible to consider correct the point of view of the nek-ry researchers suggesting to expand a concept of a thanatogenesis nearly on all disease and even all life (hereditary diseases) as in most cases, especially in the conditions of a modern intensive care, the mechanisms which are the cornerstone of approach of death, as a rule, completely are stopped by opposite operating mechanisms of compensation of the broken functions and recovery.

The main signs of approach of death are the cardiac standstill and the termination of breath. There is open a question of whether the same stereotypic mechanism independent of features etiol is the cornerstone of it always. a factor and a pathogeny of this disease, or process of the termination of life significantly differs in each case.

Allocate a cause of death and mechanisms of its approach. It is necessary to understand the major factor which caused death as a cause of death. Mechanisms of approach of death are the chain of consecutive changes of the bodies and fabrics which are developed as the cause and effect relations caused by a cause of death and leading to the termination of life activity.

In nek-ry cases definition of a cause of death does not present special difficulties. It happens, e.g., at massive damages to final fracture of this or that vital (extensive injuries, burns, a total necrosis of a liver, a bilateral cortical necrosis of kidneys, the centers of softenings and hemorrhages, fascinating vital departments of a brain, fibrinferments of the main vessels, etc.). In these cases acts as a cause of death or a basic disease (toxic dystrophy of a liver, an extensive injury, a burn), or its complications: heart or respiratory failure, arrosive bleeding, etc. (proximate cause of death). The failure of a disease is preceded by a number of consecutive changes of bodies and fabrics, napr, stomach ulcer — perforation — peritonitis; gastritis — stomach ulcer — a carcinoma of the stomach — metastasises of cancer in a bone — a pathological fracture of a bone — pneumonia; calculous cholecystitis — a cholangitis — abscess of a liver. From them the last is usually distinguished as a so-called proximate cause of death.

In a crust, time during the definition of a cause of death both as categories and as medical concept are guided by the provisions regulated by WHO. According to these provisions in interests of demographic statistics «the initial previous cause of death», edges is allocated and is registered in statistical reports. This reason is defined as: a) the disease or an injury which caused the sequence of the disease processes which directly led to death, or b) circumstances, at to-rykh there was an accident or the violent damage which caused death. Except an initial cause of death during the filling of the medical certificate on death specify the proximate and intermediate previous cause as stages of development deadly patol. process. Important patol allocate also others. the states promoting death, but which are not connected with a disease or the state which brought to it.

It is frequent to define a cause of death can be difficult, and sometimes and it is impossible. It is explained by the fact that even at extensive, but not total defeat of this or that body there is no confidence that he on himself could not function still this or that time. On the one hand, experience of organ transplantation demonstrates to what so far as with «new» body of people lives and feels well, so really, the main reason of the coming death also consisted in structurally functional insufficiency of this replaced body. However, on the other hand, there are undoubted signs that mechanisms of approach of death come into effect and lead to death how the sick body completely will exhaust the material values. So, many researchers emphasized that the decompensation of hypertrophied heart often comes not owing to its full inability to be reduced, and in view of disturbance of the general noncardiac regulation of activity of a myocardium. G. Bergmann about it wrote: «was considered that the hypertrophy of heart carries in itself rudiments of a decompensation, and still the hypertensive person even with a maximal pressure in 200 mm of mercury. can be left within decades compensated and quite able-bodied, without any cardiac short wind... matter is not that the myocardium had the small „reserve force“... I consider necessary in each case where there comes the decompensation, to systematically ask myself a question: what joined what caused disturbance of balance?». Such sovr. methods of a research, as submicroscopy (see), histochemical methods of a research (see) etc. did not allow to move ahead significantly in understanding of material substrate of a decompensation of heart in general and establishments of criteria of full loss of its working capacity yet in particular. Studying of a problem of reversibility patol. changes of bodies showed that at elimination of a pathogenic factor even far come changes can disappear over time. It testifies to that, as at height of a disease when there could come death, the sick body still kept sufficient «margin of safety». It is quite obvious also that extent of structural changes of bodies and volume of their material resources at the time of death do not happen significantly smaller, than in 2 — 3 days prior to it. Therefore, not only from a decrease of the functioning parenchyma per se, but also from something another that «drop» is formed, edges overflows «bowl». The extensive experience accumulated by resuscitation demonstrates that, apparently, the bodies which exhausted the opportunities and by that caused approach of clinical death, can under the corresponding conditions begin to function again, having returned to life an organism as whole. It means that clinical death comes before that moment when structural changes of sick body become irreversible.

Told receives confirmation in the latest data on the volume of potentialitys of live system and, in particular, cells, received by means of such modern methods of the structurally functional analysis as, e.g., an electronic autoradiography (see). These data do not leave doubts that potentialitys of a cell significantly surpass those, to-rye seemed limit earlier. So, according to D. S. Sarkisov and soavt. (1981), hepatocytes in a condition of sharply expressed fatty and vacuolar dystrophy, i.e. according to traditional criteria of degree of their viability, being «on the brink of disaster», keep still rather high biosynthetic activity and continue to make an essential contribution to the general work of body. According to N. K. Permyakov (see t. 29, additional materials) and soavt. (1982, 1983), so high resistance to action of pathogenic factors is kept by cells of an epithelium of renal tubules and the exocrine device of a pancreas. There are no bases to doubt that cells, these, testimonial of high «reliability», as systems, in the same, and, maybe, and in a bigger measure are applicable also to fabrics, bodies, systems of bodies. This «reliability» of live systems, unlike mechanical, is based not only on big resources of the functioning structures, per se, but also on their continuous self-updating and that is especially important, on highly developed ability to a hyperplasia (see). The live system is the not only continuously renewed system but also which is continuously adapting to the changing conditions of the environment (see. Compensatory processes ).

At an explanation of a material basis of huge, almost inexhaustible ability of an organism it is necessary to compensate the broken functions, except resources of the damaged body, to consider and that circumstance that compensatory reactions can be developed not only in him, but also out of it in fabrics and bodies related to the damaged body anatomo-funktsional-ache systems. So, D.F. Blagovidov, A. N. Pomeltsov, V. N. Shatalov (1972) established in an experiment that after switching off of a pancreas from digestion by bandaging of its channels the quantity and the digesting force of a gastric juice increases, to-ry gains ability to split starch, i.e. there are amiloti-chesk active.

Similar compensatory mechanisms meet in pathology of the person, napr, at a lipomatoza of a pancreas gradual substitution of its exocrine parenchyma fatty tissue. Lipomatoz of a pancreas in some cases significantly is not shown clinically and it can be an accidental find during the opening of the dead from a myocardial infarction, atherosclerosis, etc. T. V. Savina (1976) carried out quantitative assessment of degree of a lipomatoz of a pancreas and, defining on gistotopogra-fichesky cuts of relationship of fatty tissue and a parenchyma of gland, established that the number of the last can decrease up to 13 — 9% of its usual volume without emergence a wedge, signs of defeat of body. In the light of these modern data the question «not clearly not why this patient died and as he could live at such considerable pathological changes of bodies» which became almost traditional does not seem so mysterious any more and inexplicable as it was still quite recently.

The biological system perishes as system earlier, than material resources of its components are completely exhausted and the this system, the, obviously is more difficult, relyefny this principle shall appear. Therefore, into the forefront in a problem of a thanatogenesis the factor of integration, i.e. a factor of the bonds doing system to a whole acts. There are cases when this factor appears as if bared: instant death from superstrong emotions, napr, for fear, can come at full safety of structurally functional potentialities of each of bodies. Studying of a pathogeny of a burn disease demonstrates that disturbance of synoptic contacts in a nervous system leads to serious consequences in the form of disintegration of functions of an organism in spite of the fact that nervous cells in itself and internals keep sufficient degree of working capacity.

So, preservation of the intercommunications of biological system providing its integrity requires, apparently, a bigger stock of material resources in each body of this system, than that its minimum level, to-ry even can support their «independent» life activity. Therefore also disintegration of system occurs, as a rule, before death of its separate parts. It returns to one of the central philosophical problems of biology and medicine — to a problem of the general and local, parts and whole. Broad development of this problem is traditionally carried out in respect of studying of patterns of interaction of bodies and systems in various conditions of life activity of an organism, i.e. usually it is learned through the statement of integrity of an organism. In aspect of a thanatogenesis integrity of an organism, relationship of the general and local, parts and whole become an object of attention as if from an opposite pole, namely, not in respect of their statement, and, on the contrary, denial. Both these, apparently, mutually excluding approach to a solution, actually significantly supplement each other and shall promote its more fruitful development.

Exclusive complexity of a problem of an organism as whole, remaining still in many respects not clear, almost infinite variety inside - and interorgan relationship and wide functional interchangeability of fabrics and bodies cause that circumstance that if usually easily happens to define, than the person was ill and what system of his bodies most suffered, then to accurately list all links of that chain of final events, led edges to death in considerable number of cases if not in their majority, it is not possible yet. On this soil there was an opinion that accurately it is impossible to allocate this or that factor as the main cause of death in general and approach of the last always should be explained only with cumulative action of many conditions, among to-rykh is not present main and minor. M. Fervorp (see Konditsionalizm) was one of the most consecutive supporters of such konditsionalny approach. Need of specification of all set of conditions which could promote approach of death and on the basis of their comparison to approach the solution of this question emphasized G. V. Blinders. It agrees another, causal, to the point of view in mechanisms of approach of death this or that main reason prevailing over all other circumstances and, eventually, defining approach of death always shall take place (see Causality).

Does not raise, however, doubts that any of these extreme points of view equally cannot be a theoretical basis for a fruitful solution of the problem of a thanatogenesis. Of course, on the one hand, in the adverse final of a disease any defining, main reason shall work. It is what surely is present at this disease and without what usually there does not come death of an organism. Such obligatory factors in mechanisms of death are, e.g., disturbance of sokratitelny activity of a myocardium at heart troubles, so-called intoxication at malignant tumors, the progressing decrease of tissue of liver at her toxic dystrophy, the amplifying prelum of tissue of brain the growing tumor, sharp narrowing of a vessel an atherosclerotic plaque and Sp.

On the other hand, in the final of any disease, except the leading reason, also a number of conditions, i.e. such factors often comes into effect, to-rye shall not be present at all cases of this disease at all, but, having appeared, can exert the significant stimulating or braking effect on the main reason, and sometimes and to prevail. So, many conditions can accelerate or, on the contrary, postpone approach of heart failure; bleeding from the broken-up tumor can «outstrip» negative influence on an organism of permanent intoxication; a nek-swarm, maybe, insignificant increase in coagulability of blood in usual conditions in a zone of atherosclerotic narrowing of a vessel leads to thrombosis and development of a heart attack etc. From this it follows that only disclosure of dialectic unity of the reasons and conditions in mechanisms of a thanatogenesis is only a reliable reference point on the way of an explanation of this problem in each case. In the practical (resuscitation) purposes it is always necessary to know the rod, leading reason of an aggravation of symptoms of the patient and not to lose it from a look among a set of other links making the pre-agonal period since in many cases radical elimination of this reason saves the patient. But it is necessary to consider also that treatment cannot be rather effective without account and all those conditions which can exert the essential, especially aggravating impact on the main reason.

Questions of a thanatogenesis in modern conditions in connection with broad use various pharmakol became especially difficult. means, performing extensive surgeries, etc. At the same time death can be caused by action of medical factors — overdose of biologically active and other strongly operating means, their inexpedient appointment or excessively prolonged use. In cases of an unsuccessful result of the surgery which is carried out quite often at rather early stages of a course of a disease in the presence of moderate structural changes of bodies in difficult conditions of a modern anesthesia, use of a big complex pharmakol. means, transfusion of liquid, etc., i.e. in the conditions of massive impact on regulatory systems of an organism, clarification of a thanatogenesis becomes possible only in the comprehensive analysis of results of opening by the prosector jointly with all group-fight of the specialists who had direct or indirect relation to treatment and an operative measure — with the surgeon, the anesthesiologist, the biochemist, etc. Only on the basis of joint researches by specialists of a different profile also other important issues of a thanatogenesis, in particular specific mechanisms of action so-called can be resolved. the intoxication which is very often appearing in quality of one of the reasons of approach of death and at the same time remaining so mysterious in the essence, as well as decades ago. All this demonstrates that the problem of a thanatogenesis is one of the major modern all-biological and all-pathological problems. The decision it can be successful only if its traditional consideration under preferential morphological visual angle is replaced with the comprehensive approach to studying of mechanisms of approach of death which is based not only on the pathoanatomical analysis of these mechanisms, but equally and on biochemical, pathophysiological, pharmacological, microbiological, biophysical, etc.

Comprehensive approach in studying of proximate causes of death, and finally the reasons and mechanisms of a cardiac standstill — the main motor of life — promises the known perspectives not only replenishments of our theoretical knowledge concerning a thanatogenesis, but also in the solution of practical problems of resuscitation — increase in efficiency of cordial resuscitation.

On the example of nek-ry heart diseases (the inborn and acquired defects, a myocardial infarction, myocarditis) it is possible to track the relationship of cause and effect leading to a decompensation and a cardiac standstill. Diagnosis of these diseases, i.e. the main reasons for death, does not represent complexity both for the clinical physician, and for the pathologist — the sum intra-and noncardiac manifestations both the disease, and the symptoms of the acute or progressing heart failure making a kliniko-anatomic profile of a disease, its specifics is available. At light microscopy the sum of inflammatory and distrofpcheski-necrobiotic changes of a myocardium comes to light nek-paradise, to-rye, without being specific separately for each specific disease, in a complex confirm or reject macroscopic ideas of essence patol. process. On the basis of these researches it is possible to document the fact and the reasons of a decompensation of heart, however nothing can be told about direct mechanisms of its stop.

Methods of a submicroscopy, histochemistry, autoradiography, etc. allow to study changes of organoids and membranes of separate cardiomyocytes, however these changes are even more not specific to a specific disease, than the changes found by means of a light microscope. Moreover, diagnosis of the mentioned diseases in general becomes impossible even on the sum and a combination of electronic and microscopic signs. However results of these researches bring closer to knowledge of mechanisms of a cardiac standstill. Their disclosure, apparently, is connected with researches at molecular level, on Krom, obviously, even more nonspecific processes and reactions of a cardiomyocyte will meet.

There are no bases to claim that there is a set of the direct mechanisms of a cardiac standstill caused by a big set of cardiotoxic factors as endo-, and an exogenous origin. Experience prompts that these mechanisms are even more not specific to any one disease, than a feature set of ult-rastrukturny changes of a cardiomyocyte. E. I. Chazov and sotr. consider the leading reasons of heart failure of disturbance in cardiomyocytes of processes of absorption, deposition and emission of calcium, and also disturbance of bio-energetics of cells and genetic security of biosynthesis of sokratitelny proteins. There are bases to believe that action of the majority of cardioplegic factors is implemented by means of the uniform mechanisms which are coming down to disturbance of ion-osmotic balance of cardiomyocytes owing to disturbance of volatile processes of transmembrane transfer of calcium ions, potassium, sodium, etc. (see Membranes biological). Function of electroexcitability, conductivity and contractility of cardiomyocytes is connected with the normal course of these processes. Any deviations in «ionic asymmetry» of cellular membranes lead depending on the structurally functional potential of cells to an asystolia or fibrillation.

Medicolegal thanatology

Medicolegal thanatology — the section of forensic medicine studying causes of death, a thanatogenesis and also changes of bodies and fabrics in the posthumous period. Court. - honey. T. makes a scientific basis for the solution of a number of the special questions arising at law enforcement agencies at investigation of the crimes directed against human life, in particular establishment of a cause of death in this specific case (see Death in the medicolegal relation), prescription of its approach, an intravital or posthumous origin of the damages found on a corpse, prescription of their education (see Damages to the medicolegal relation). Along with it studying of a thanatogenesis at various reasons of violent and nonviolent death taking into account influence of internal and exogenous causes serves further development and improvement to lay down. - the prof. of the help. Knowledge of features of the damages caused in the agonal and posthumous period, which is based on studying of the worrying ability of bodies and fabrics promotes improvement of differential diagnosis of the damages caused in the course of holding resuscitation actions and assessment of timeliness and completeness of the taken measures, possible efficiency of resuscitation in this situation (see. Resuscitation pathology). Close interaction of transplantologists and judicial physicians is defined, except a community of interests in studying of experience and dying of various bodies and fabrics, development of criteria of a limitation period of approach of death, also by the fact that in the majority material for organ transplantation is received from the corpses which are objects court. - medical examinations.

Court. - medical establishment of prescription of approach of death is one of the most complex problems court. - honey. T., still not got the final scientific and practical permission. Now determination of prescription of approach of death is carried out in expert practice generally on the basis of visual and descriptive assessment of postmortem changes (see) and qualitative tests with use pharmakol. means, electric, mechanical and other influences based on experience by bodies and fabrics of the moment of a stop of cordial activity. In particular, as expert criteria use dynamics of livors mortis (appear in 2 — 4 hours after a cardiac standstill, become colourless at manual pressing during 12 — 16 hours of the posthumous period, turn pale — up to the termination of 1 days then colourings do not change), a muscular okocheneniye (appears in 2 — 4 hours after a cardiac standstill, reaches full development by the end of 1 days, starting with the 3rd — it is allowed), the rectal temperature and temperature in axillary hollows (allows to define prescription of approach of death within 1 days of the posthumous period with an accuracy of 6 hours) * Apply consecutive introduction to an anterior chamber of an eye of 1% of solution of atropine and Pilocarpinum (double response — expansion, and then narrowing of a pupil — is observed during 10 hours after a cardiac standstill, single — to 24 hours)? hypodermic administration of solution of adrenaline (during 30 hours after approach of death the strengthened sweating registered by pretreatment of the explored site by solution of iodine, and after its drying by mix of starch and castor oil), mechanical (by strong sharp blow by a firm subject of flexor muscles or razgibatel is observed) or electric (by introduction of needle electrodes to muscles of an eye, mimic muscles, sgibatel toonechnost and giving of electric impulses) influence — at the same time arises respectively the idiom-skulyarnaya a tumor in the form of the muscular roller or reduction of muscles, observed during 6 — 8 hours after a cardiac standstill. In late terms determination of prescription of approach of death is extremely complicated in view of considerable variability of manifestation of late cadaveric changes. Nevertheless it is considered that cadaveric greens in ileal areas appear in 24 — 36 hours after a cardiac standstill, initial symptoms of putrefactive emphysema — by 3 days, the expressed emphysema and coloring develops in green color of all skin of a stomach by 5 days, putrefactive bubbles, rejection of epidermis begins in 1,5 — 2 weeks, the expressed putrefactive softening of fabrics of a corpse — in 3 — 4 months. Essential value for an olredeleniye of a limitation period of approach of death at a research putrefactive nzmenennykh corpses has studying of entomofauna of a corpse (see Entomology). Natural skeletonization of a corpse (without participation of animals) comes not earlier than in 1 year, fragmentation of a skeleton — 5 years. Initial signs of mummification (see) or transformations of a corpse of the adult into an adipocere (see) are defined in 2 — 3 months, however completely these processes come to the end after 1 year and more. On the majority of the listed expert criteria considerable impact is exerted by various internal and exogenous causes that reduces the accuracy of expert establishment of prescription of approach of death on each of them separately, use of a complex of signs allows to define prescription of death in hours during the first 2 — 3 days after a cardiac standstill, days and months in the subsequent.

Scientific search of new expert criteria of prescription of approach of death goes on the way of objectification of assessment of postmortem changes (use of dynamometers at a research of livors mortis, electrothermometry of a liver and bodies of a chest cavity, etc.), creations of the new tests based on the phenomenon of experience of bodies and fabrics, implementations a lab. methods of a research of a complex of bodies, fabrics and environments of a corpse by means of biochemical, biophysical, histochemical, etc. techniques. In the last group the most perspective directions are determination of prescription of approach of death taking into account dynamics of enzymatic activity in various bodies, redistributions macro - and microelements, dynamics of nek-ry biochemical indicators in fluid mediums of an organism (blood, cerebrospinal liquid, a vitreous), changes of electric and magnetic characteristics of fabrics. Development and deployment in court. - to medical practician new a lab. methods creates perspective of further increase in reliability and accuracy of examination of prescription of approach of death.

The Tanatologichesky profile of the battlefield

the Tanatologichesky profile of the battlefield — the characteristic of proximate causes and mechanisms of death which is caused a fighting injury in the field of battle. Questions of tanatologichesky assessment of fight are important and long since concerned military physicians. The first attempts of studying of a tanatologichesky profile of the battlefield were made by N. I. Pirogov and other field surgeons during wars of the second half of 19 century and World War I and were carried out generally by outer inspection of the killed. Systematic studying of causes of death of wounded in the battlefield by means of pathoanatomical openings of corpses was begun under the direction of A. A. Vasilyeva during the Soviet-Finnish conflict in the period of the Great Patriotic War of 1941 — 1945 under the direction of V. JI is also continued. Byalik, N. A. Krayevsky, And „V. Smolyannikov, R. D. Stern, etc. As a result of the researches based on materials apprx. 2000 pathoanatomical openings, the Soviet military pathologists for the first time managed to gain an impression about a tanatologichesky profile of the battlefield. It is found out that the tanatologichesky profile of the battlefield is very dynamic, depends on a set of factors, osnovnymn from to-rykh are: character of defensive works and individual protection equipment, types of the used weapon, its power, geographical and weather conditions, a condition of medical support, etc.

It is established that in the period of the Great Patriotic War in the battlefield the fire fighting injury was the main reason for death, on to-ruyu 99,2% were necessary. Unlike wars of 19 century, missile wounds made 64% and considerably prevailed over bullet — 34.5%. On localization first place was won by wounds and injuries of a skull — 30,9%, the second — a thorax (21,2%), the third — a stomach (11,8%) and the combined injuries of a thorax and a stomach (10%). Further there were damages of extremities (9,8%), necks (3,3%), a backbone (1,6%), a basin (1,1%), the person (0,6%). 8,9% of the killed in the battlefield had wounds to several various areas and only for 0,8% — not fire fighting injury (burns, freezing injuries, etc.).

However at the same localization of a wound proximate causes and the mechanism of death can be various. According to the doctrine about pathology of a fighting injury created in the period of the Great Patriotic War by the Soviet military pathologists, numerous causes of death of wounded are united in three basic groups: death from direct action of an injury, death from complications of wound, the death of wounded from diseases. In the battlefield, as a rule, death from the changes which were a direct consequence of an injury (acute traumatic death) took place, edges on a thanatogenesis death from blood loss, shock, a combination of shock and blood loss, haemo - p pheumothorax, etc. was in turn subdivided to death from destruction of a body and vitals.

Death from destruction of a body and vitals — the most frequent in group of acute traumatic death (52,3%). It came immediately or hours later, days after wound, a cut on the localization are more rare (a brain trunk, heart, an aorta, etc.) or extensiveness it was incompatible with life. On the mechanism of death, i.e. a complex of the developing functional frustration leading to a lethal outcome according to V. L. Byalik's data, in 54,8% so-called brain death took place, the cut is the cornerstone of the mechanism fading of function of c. the N of page owing to its destruction, in 27,7% — so-called cordial death, the mechanism a cut comes down to the termination a krovoobrattse-niya as a result of injury of heart and its main vessels.

Death from blood loss made 32,6%. According to Yu. V. Guljkevi-cha, depending on the mechanism of her development distinguish death from acute bleeding, from an acute anemia and from prolonged or recurrent bleeding. Death from acute bleeding came in early terms (minutes, sometimes seconds) at wounds of rather large vessels owing to bystry reduction of volume of the circulating blood, falling of the ABP, insufficient filling of heart blood and its reflex stop. Death from an acute anemia came during the first 12 hours after wound at damage of averages or a large number of small vessels in connection with development of a heavy hypoxia. Death from prolonged or recurrent bleeding came later, than in 12 hours after wound at multiple damages of small vessels as a result of a circulatory disturbance as a collapse. At the same time the expressed cultivation of blood (decrease in fraction of hemoglobin and erythrocytes of blood) and lack of the general anemia is characteristic.

To death from shock 4% in group of acute traumatic death were necessary. Only cases are carried to it, at to-rykh other causes of death are excluded and there is a discrepancy between weight of an injury and its outcome.

Death from a combination of shock and blood loss made 4,6% in group of acute traumatic death, and death from haemo - and pheumothorax — 2%.

Other causes of death in the battlefield (asphyxia owing to closing of respiratory tracts with foreign bodys, aspiration of blood, traumatic hypostasis of a throat, a fatty and air embolism, cooling of an organism, burns, etc.) during the Great Patriotic War were observed seldom (in general 2,6%).

Thus, during the Great Patriotic War (84,9%) the wounds not compatible to life were the leading causes of death in the battlefield, and blood loss, edges on the value is close to a fatal injury because during fight timely and effective rendering medical aid at it often happened impossible. At the same time the reasons took place, to-rye it is possible to carry to conditionally deadly. Their frequency at damages, various on localization and an objekhma, was different. So, 92,1% wounded in a skull died from certainly deadly damages and only a small part from conditionally deadly (intracraneal hemorrhages and swelling of a brain — 6,1%, outside bleeding — 1,3%). At wounds of a thorax the fatal injury was a cause of death in 51,7%. Close to it on weight bilateral wounds with open haemo - and pheumothorax, damage of a root of a lung made 25%, other 23,3% of wounds were conditionally deadly. Blood loss (74,8%, including in combination with shock — 12,4%), on the second place — shock (11,4%) was the main reason for death of wounded in a stomach. In 11,3% wounded in a stomach died from damages, not compatible to life, in other cases of the reason of their death can be considered as conditionally deadly.

In the conditions of modern war using nuclear missile weapon, incendiary mixes, chemical warfare agents, etc. character and structure of fighting defeats and respectively a tanatologichesky profile of fight will undergo considerable changes. Bigger, than before, specific weight will be occupied the closed mechanical injury, burns, the combined injury. Burns can dominate and often be combined with a mechanical injury, radiation and other injuries. In this regard the general impact of a fighting injury on an organism will increase; more often, approximately at 25 — 35% struck shock can be observed. At a combination of a severe injury to massive ionizing radiation doses development of a syndrome of mutual burdening is possible, at Krom shock reactions become irreversible that will promote the further growth of specific weight of shock in structure of causes of death in the battlefield.

See also Death .

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D. S. Sarkisov, N. K. Permyakov, O. Ya. Kauffman; Yu. Ya. Melnikov (court.), V. A. Nechitaylo (soldier.).