DROWNING
Death by drowning occurs when the breathing is arrested by watery or
semi-fluid substances, blood, urine, or the muddy semi-fluid matter
found in cesspools and marshes. It is not necessary for the whole body
to be submerged. Death may result if the face alone be immersed, as in
the case of a man in a fit of drunkenness being drowned in the water
contained in the imprint of a horse‘s hoof left in the mud.
In addition to the changes in the internal organs, identical with those
present in persons who have died from suffocation or hanging, water is
found in the lungs or stomach.
Death may be due to--
(_a_) Apoplexy.
(_b_) Asphyxia.
(_c_) A combination of the two.
(_d_) Neuro-paralysis.
Death from pure apoplexy is rare; and it may be affirmed that death
from syncope never occurs in the drowned without leaving some signs of
asphyxia.
It is more difficult to restore the drowned than those dying from mere
stoppage of air from entering the lungs. Few if any persons recover who
have been submerged four minutes, and even in cases where this time has
been exceeded, followed by recovery, this result is probably due to the
person fainting before entering the water.
In death from drowning, the lungs are distended and overlap the heart,
and have a peculiar spongy feeling. They also contain a quantity of
frothy fluid, which cannot be produced in the dead body, as it is
the result of the violent efforts made by the individual to breathe
in the act of dying. This frothy condition of the fluid in the lungs
is an important sign of death by drowning, especially if the fluid
corresponds with that in which the individual is said to have perished.
It is just _possible_, however, that the person may have been first
suffocated, and then thrown into the water, froth in the trachea being
found in those suffocated; but in this case the froth is small in
quantity, and not watery. The froth in the drowned is like that made
with soap and water, and is not viscid, thus differing from bronchitic
exudation. Water in the stomach is an important indication of death
from drowning, especially if the water contained in the stomach can
be shown to possess the same characters as that in which the body was
found. Water in the intestines is still more important. In a great
number of cases this, however, must be next to impossible; when it can
be identified, the value of this sign is enhanced by the fact that
water does not enter the stomach in those submerged after death, unless
putrefaction be far advanced, or the body has lain in very deep water.
Casper concluded that a person had been drowned, by finding a small
quantity of mud in the stomach after putrefaction had set in. Water,
however, may be absent from the stomach if the person fall into the
water in a state of syncope, and it may be present if the person has
taken a draught of water before submersion.
The effect of season on putrefaction in water is shown in the following
table:
Summer. Winter.
5 to 8 hours produce as much change as 3 to 5 days.
24 “ “ “ 4 to 8 “
4 days “ “ 15 “
10 to 12 “ “ “ 28 to 42 “
(Devergie.)
Of the external signs, the presence of sand, gravel, or mud under
the nails may or may not be an important sign, for sand or mud may
collect under the nails during the efforts to drag the body from the
water; but weeds, &c., grasped in the hands show that there has been a
struggle, and point to death from drowning. The _cutis anserina_--goose
skin--present generally on the anterior surface of the body, and not,
however, peculiar to death from drowning, is important as a sign of
recent vitality. The face of those who have been drowned, and then
quickly removed from the water, is pale, and in most cases not swollen;
the eyes may or may not be closed; and not infrequently round the mouth
there is more or less froth, especially when death is due to apnœa. In
summer, however, after two or three days, and longer in winter, the
face assumes a reddish or bluish-red coloration, putrefaction taking
place about the head and upper extremities earlier than in other forms
of death. The _contraction or retraction of the penis_ is a well-marked
sign of death by drowning, and Casper asserts that he has “not observed
anything similar so constantly after any other kind of death.” Ogston
states that he has met with two cases of erection of the penis in the
drowned.
The question as to how long a body may remain in the water before it
floats has given rise to considerable discussion, without, however,
arriving at any very definite conclusion. It may be stated in general
terms that, as floating depends to some extent on the rapidity in which
putrefaction supervenes on submersion, bodies float earlier in summer
than in winter, in salt than fresh water, clothed than naked. In India
bodies have floated in twenty-four hours after immersion. Females and
children float more readily than males. A body from various causes may
float within a few hours of its submersion, especially if the body be
that of a female, fat and clothed. The old idea that the body of a
person thrown into water during life sinks, but that a dead body under
like conditions floats, is a fiction now exploded.
=Suicide or Homicide?=--Homicide by drowning is rare, except in
children. Accidental and suicidal drowning are common enough.
The signs to be sought for in the drowned are--(1) Absence of any
injury. (2) _Cutis anserina_ and retracted penis. (3) Water and mud in
the stomach. (4) Froth in the air-passages. (5) Distended lungs. (6)
General signs of death by asphyxia.
It should be remembered that the fact of the hands being tied together,
or to the feet, does not militate against suicide by drowning.
If wounds and other injuries be found on the body, the question
arises as to whether the injuries were sufficient in themselves to
cause death, and then as to whether they were caused during life.
A person jumping from a height into the water may sustain severe
injuries--dislocation of both arms, fracture of the skull and of
the vertebræ, or even lacerated wounds of more or less severity.
The absence of the signs proper to death by drowning, coupled with
the presence of external injuries, would point to death by violence
prior to immersion. The presence of signs of drowning, and injuries,
sufficient to have caused death in themselves, would indicate that they
had occurred after death.
The following considerations may assist in forming an opinion:
1. Previous history of person found in the water.
(_a_) Any history of suicidal tendency.
(_b_) Any motive that would render suicide probable.
2. Height from which the person fell.
3. Absence or presence of signs of death by drowning.
4. Absence of stakes or other objects in the water that might
have caused injuries to anyone falling against them.
The time required to cause death by drowning is so short that persons
seldom recover after submersion for three or four minutes; but the
cessation of respiration is no guide to the extinction of life, and an
attempt at resuscitation should always be made, for if the respiration
be fairly restored the heart will soon act. Nay more, as pointed out
before, in cases of so-called asphyxia, the heart may continue to act
for several minutes after the entrance of air to the lungs has been
arrested, and in judicial hanging it frequently happens that the pulse
at the wrist can be felt for ten or twelve minutes after suspension.
(See Figs. 16, 17, 18.)
Recapitulation of the Post-mortem Appearances in the Drowned
I. External
1. _In the Skin._--Rose-coloured patches may be present on the face
and neck. The condition of _goose skin_--_cutis anserina_--is hardly
ever absent even in summer. The _cutis anserina_ is not, however,
characteristic of drowning, as it may be present in other forms of
violent death, and also in some persons during life. It is a vital act,
the result of nervous shock, and does not depend upon the temperature
of the water for its production; still, it points to recent vitality.
2. _The Tongue._--The tongue is just as often found behind the jaws as
between them (Casper).
3. _The Hands and Feet._--The hands and feet acquire a greyish-blue
colour when the body has lain in the water from twelve to twenty-four
hours. The skin also becomes corrugated in longitudinal folds. The
greyish-blue condition of the hand is known as the “cholera hand.”
The nails may contain particles of sand and weeds. “No corrugation or
discoloration of the skin of the hands or feet is ever observed on
the body of anyone drowned who has been taken out of the water within
half an hour, within two, six, or even eight hours” (Casper). The same
authority states he has produced these effects by laying the hands
after death in water, or wrapping them in cloths kept constantly wet
for a few days.
4. _The Genitals._--Contraction of the penis and dartos is an almost
constant symptom, and Casper has “not observed anything similar so
constantly after any other kind of death.” It is due, probably, to
the same cause as the _cutis anserina_, which Brettner attributes to
“bundles of unstriped muscular fibres, lying in the upper stratum of
the true skin, surrounding the sebaceous glands, and forcing them
forwards by their contraction, thus making the _cutis anserina_.
Precisely similar unstriped muscles are found in the subcutaneous
cellular tissue of the penis; they run principally parallel to the long
axis of the member, but very often large bundles run across it.” The
action of cold and fright is to induce contraction of these cutaneous
muscles, with a resulting contraction of the penis.
II. Internal
1. _The Brain._--Cerebral hyperæmia is _most_ rare in the drowned, but
cerebral hypostasis is not infrequently mistaken for it.
2. _The Trachea._--The mucous membrane of the trachea and larynx is
always more or less injected, and is of a cinnabar-red, which must
not be mistaken for the dirty, brownish-red colour, the result of
putrefaction. A white froth, but seldom bloody, is also found in
varying quantity in the trachea, and is a most important sign of vital
reaction, but its diagnostic value is destroyed by putrefaction.
Sometimes a portion of the contents of the stomach may be found in the
trachea. When this occurs it is due to the act of coughing, induced by
the admission of water into the lungs. The contents of the stomach are
forced into the mouth, and then drawn into the lungs during the next
attempt at inspiration. This indicates that the person entered the
water during life. In cases where death has taken place from syncope
little or no froth may be found in the trachea.
3. _The Lungs._--The lungs are completely distended, almost entirely
overlapping the heart, and pressing close to the ribs. They are spongy
to the feel, and when cut into, a considerable quantity of bloody froth
escapes. The _froth_ found in the lungs is the result of the powerful
attempts to breathe, and cannot be produced by artificial means. It
adheres not to the sides of the bronchial tubes, as does the exudation
of bronchitis or pneumonia. The distension of the lungs is due partly
to an actual hyperæmia, and partly to inhaled fluid. Water is present
in the pleural cavities.
4. _The Heart and Great Vessels._--As is common to other forms of
asphyxia, the left side of the heart is entirely, or almost entirely,
empty; the right, on the contrary, is engorged. This condition of the
heart is, therefore, not a diagnostic sign of drowning, and is absent
in the drowned when death takes place by neuro-paralysis; in fact, in
some cases of undoubted drowning, both sides have been found empty,
probably, however, the result of putrefaction (Ogston). The same may be
said of the accompanying congestion of the pulmonary artery.
5. _The Blood._--As is common in all forms of death where respiration
has been arrested, the blood is found to be remarkably _fluid_, and of
a cherry-juice colour. M. Faure in his monograph on asphyxia states
that he has found large and firm clots in the right side of the heart
in the drowned who have not remained long under water. The blood is
diluted with water, most marked in the left side of the heart. The
amount of dilution is greater in slow drowning.
6. _The Stomach._--Casper considers that the presence of fluid in the
stomach, corresponding to that in which the body is found, is “an
irrefragable proof of the actual occurrence of death from drowning,”
and that the swallowing of it must have been a vital act of the
individual dying in the water. The absence of water from the stomach
does not negative death from drowning. Water is not always present. It
is possible for it to reach the stomach of a submerged body after death.
Water in the intestines is a more reliable sign of death from drowning,
and indicates submersion during life. It is only after very long
submersion and under great pressure that water finds its way into the
intestines after death.
_N.B._--Putrefaction in the drowned in most cases
commences in the upper part of the body, and extends
downwards. The face, head, and neck are first attacked.
This is the reverse of putrefaction in air.