[Development of forensic thanatology through the prism of analysis of postmortem protocols collected at the Department of Forensic Medicine, Jagiellonian University].
Uniwersytet Jagielloński, Collegium Medicum, Wydział Lekarski.Archiwum medycyny sa̧dowej i kryminologii 07/2011; 61(3):213-300.
When assessed based on the analysis of postmortem protocols, the successes of forensic thanatology appear to differ from those that might be assumed using as the foundation a review of publications and textbooks. The greatest achievements date back to as early as the 18th and 19th centuries, when the morphological changes observed in the majority of types of deaths resulting from disease-associated and traumatic causes were described. Within the past 130 years, however, or in other words, in the period when autopsy protocols were written that are today collected in the archives of the Krakow Department of Forensic Medicine, the causes and mechanisms of death became understood even when the said factors were associated with discrete postmortem changes only or no no such changes whatsoever were left. At the end of the 19th century and for a long time afterwards, a difficult problem was posed by sudden deaths, where the postmortem examinations demonstrated solely atherosclerosis and the cause of death was described as "heart palsy". As it turned out, a great portion of such deaths represented individuals with myocardial infarction; in spite of its evident macroscopic presentation, the diagnostic management of the disease was progressing very slowly. Myocardial infarction, known at least since 1912, was associated by forensic medicine with the phenomenon of sudden death only in the forties, and the ability to detect myocardial infarction in practice developed only in the fifties of the last century. The achievement of the present dissertation is the formulation of a theory ascribing such a long delay in macroscopic diagnostics of myocardial infarction to forensic medicine specialists being attached to and fond of employing the "in situ" autopsy technique, which was unfavorable from the viewpoint of heart examination, since the organ was not dissected free and removed from the body in the course of a postmortem examination. When autopsies started to concentrate on hearts dissected free from large vessels, within several years, the number of diagnosed myocardial infarctions increased several times, what gave rise to a theory of a myocardial infarction epidemics formulated in some centers. A proof supporting the theory postulated by the author is a sudden increase in the number of deaths resulting from pulmonary embolism observed in the same several-year period; this diagnosis was also not facilitated by the "in situ" autopsy technique. Another cause of death, which - although undoubtedly common - was for years interpreted as "heart palsy" was alcohol poisoning. Evolution of methods used in chemical examinations for the presence of alcohol, and especially the use of blood tests rather than gastric contents tests allowed in time for determining alcohol poisoning as the cause of death and demonstrated the true extent of the phenomenon. Here, a milestone was the introduction of the Widmark method, what in turn resulted in changes in the toxicology theory, such as for example the use of a new term of "lethal concentration" in addition to the formerly employed notion of a "lethal dose", which is useless in the case of alcohol. Of lesser importance with respect to the number of cases, but of much greater significance in view of its association with homicides were the achievements in diagnostic management of strangulation. Choking and strangulation, as well as hanging--in spite of the fact that their fundamental features were known as early as in the 19th century--were really understood and the ability to diagnose these phenomena was achieved only in the interwar period. Such a long delay resulted from the autopsy technique that did not include examination of the organs situated in the neck, as well as from difficulties in acquiring experience in examining the type of homicide that was very uncommon. On the other hand, for many years, the erroneous theory of the fluidity of blood in a corpse as an indicator of violent strangulation resulted in dubious opinions on strangling by blocking the respiratory orifices of the victim, especially in cases of infanticides. Another erroneous theory, which was obligatory in forensic thanatology, was the theory of thymolymphatic state, which used thymic hypertrophy to explain deaths of young individuals resulting from a small injury or even strong emotion. Statistical tests and development of general medicine allowed for disproving the theory. In the diagnostics management of death from hypothermia, despite the fact that its most important features--Wischnewski spots and the loss of liver glycogen--had been known for a long time, they were regarded useless for several score years. At this time, cases of death from hypothermia were included into the category of "heart palsy". Despite several changes of the authorities, a review of autopsy protocols prepared in the Krakow Department of Forensic Medicine provided the author with a wealth of information of significant historical value. Protocols dating back to the period of Nazi occupation allowed for documenting and analyzing the types of torture employed by the Gestapo, but also for discovering a surprisingly large number of postmortem examinations of bodies of occupation functionaries who were sentenced to death by the Polish Underground State. After World War II, the Department examined numerous victims originating from both sides of skirmishes fought at the time by the then authorities and the armed underground movement, or even individuals murdered in the course of interrogations. The archives of autopsy protocols became a valuable source helpful in estimating the number of victims of the Soviet Army that was stationed in Poland, and later provided the only supply of information needed for evaluation of the number of fatal accidents among the builders of the Krakow district of Nowa Huta. Based on the autopsy protocols it may be concluded that the number of victims of anti-Jewish riots that sparked off in Krakow soon after World War II was over, was most likely lower than that assessed by the historians; on the other hand, the number of victims of similar riots occurring after World War I was higher than the historians believed. A great span of time over which the protocols were written allowed for following some socioeconomic changes. In the period before Poland's regaining independence, a significant social problem was posed by deaths of infants entrusted to foster care to "angel makers" After independence was regained, a similar problem emerged, consisting of deaths of young females due to complications of illegal abortions. In the post-war period, such a social problem was found in deaths due to fatal alcohol poisoning; the annual number of such cases increased almost tenfold within the past 50 years. In addition to obvious cases associated with the war, the Nazi occupation was characterized by a sudden, manifold increase in the number of methanol poisonings and an unexpectedly high increase in the number of victims of fatal traffic road accidents, especially those involving trains and streetcars. Over the past 130 years, there were significant changes in the selection of poisons used for suicidal purposes. In the beginning of the analyzed period, suicides were committed by ingesting caustic substances that damaged parenchymatous organs--these poisons were very brutal in their action, but easy to detect. As new pharmaceuticals--central nervous system depressants--were being introduced to therapeutic management, they gradually replaced caustic and parenchymatous poisons. In contrast to the early phase of the analyzed period, poisoning with such medications cannot be detected on autopsy, yet their introduction promoted the development of forensic toxicology. Nevertheless, for several score years, the heaviest toll was taken by carbon monoxide from the municipal gasworks, which appeared in 1905 and disappeared in 1982, killing as many as in excess of 50 individuals per year. In the collection of more than 60 thousand autopsy protocols, the author managed to find hitherto unknown, interesting cases, e.g. that describing a victim of a fatal accident in a stone quarry, witnessed by Karol Wojtyła during WWII, a victim of an unknown assassination attempt on the life of Bolesław Bierut, as well as protocols of postmortem examinations of bodies of the People's Republic of Poland intelligence agents who died while posted abroad.
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