Scope of investigation:

When a body is recovered from water, four critical

questions require resolution:

Was the victim alive or dead when he entered the

water?

Is the cause of death drowning? (and if not, what

is the cause of death?).

If drowning is determined to be the cause of

death, is the manner of death accident, suicide,
or homicide?

Are wounds present on the body, artifacts or

evidence of primary injury which occurred before
drowning?

To resolve the above questions, the

following information must be correlated:

The circumstances preceding the death,

The circumstances of recovery of the body,
The autopsy findings. The approach should
be to consider the circumstances revealed
by the investigation and to then determine if
the autopsy findings are consistent with
those circumstances.

Drowning
Drowning may be defined as death due to
submersion in a liquid.
The mechanism of death in acute
drowning is irreversible cerebral anoxia.
The original concept of drowning death
was that they were asphyxial in nature
with water occluding the airways.

Experiment in the late 1940s and early

1950s suggested that death was due to
electrolytedisturbances and/or cardiac
arrhytmias produced by large volumes of
water entering the circulation through the
lungs. Present thought, however, is that the
most important physiological consequence
of drowning is hypoxemia.

In drowning, the volume of water inhaled can

range from relatively small to very large. In fresh
water drowning especially, large volumes of water
can pass through the alveolar-capillary interface
and enter the circulation.
Even when large volumes of water are absorbed,
there is no evidence that the increase in blood
volume causes significant electrolyte irregularities
or hemolysis, or that is beyond the capacity of the
heart or kidneys to compensate for the fluid
overload.

Dry Drowning
Some individuals who drown are considered to
be victims of dry drowning. Here the fatal
cerebral hypoxia is due to not to the conclusion
of the airways by water but rather to a laryngeal
spasm.
Dry drowning is said to occur in 10 15% of all
drownings.

Dry Drowning
When a small amount of water enters the larynx
or trachea, there is sudden laryngeal spasm
mediated as a vagal reflex.
Thick mucous, foam, and froth may develop,
producing an actual physical plug at this point.
Thus, the water never enters into the lungs.
Laryngospasm cannot be demonstrated at
autopsy.

When a person sinks beneath the surface of

water, his initial reaction is breath holding. This
continues until a breaking point is reached, at
which time, the individual has to breath. The
braking point is determined by a combination of
high carbon dioxide levels and low oxygen
concentrations. According to Pearn, the breaking
point occurs at PCO2 levels below 55 mm Hg
when there is associated hypoxia, and PAO2
levels below 100 mm Hg when the PCO2 is high.

Upon reaching the breaking point, the individual

involuntarily inhales. At this time, water may
reach the larynx and trachea, producing a
laryngeal spasm with resultant dry drowning. In
most instances, however, there is inhalation of
large volumes of water. Some water is also
swallowed and will be found in the stomach.
During this interval of submersed breathing, the
patient may also vomit and aspirate some gastric
contents.

The involuntarily gasping for air under water will

continue for several minutes, until it is irreversible
and death occurs.
The point at which cerebral anoxia becomes
irreversible is depend on both the age of the
individual and the temperature of the water. With
warm water, this time is somewhere between 3
and 10 min. submersion of children in extremely
cold or icy water has resulted in successful
resuscitation with intact neurological outcome for
as long as 66 min following drowning.

Near Drowning
The term near drowning is occasionally
encountered. This refers to a submersion
victim who arrives at an emergency facility
and survives for 24 h. this definition does
not take into account whether ha has any
neurological impairment.

Immersion artifacts occur in any corpse immersed in water,

irrespective of whether death was from drowning or the person
was dead on entering the water. Therefore, immersion artifacts
do not contribute to proof of death by drowning. However, such
artifacts are typically the most striking findings in a body
recovered from water.

These immersion artifacts include:

Goose-skin, or anserine cutis, which is roughening, or
pimpling of the skin,
Skin maceration, or washer-woman's skin, which is swelling
and wrinkling of the skin,
Adipocerous, which is the transformation of the fatty layer
beneath the skin into a soap-like material - a process
requiring many weeks or months.

Drowned bodies commonly show an assortment of injuries caused by scaping the

bottom, battering against solid object, carnivorous marine animals, and boat. Such
injuries frequently arouse suspicion of foul play

A fine, white, froth or foam in the airways and exuding

from the mouth and nostrils is characteristic of drowning.
It is a vital phenomenon and indicates that the victim
was alive at the time of submersion. However, similar
foam is found in deaths from other causes, e.g. heart
failure, drug overdose, and head injury.

It is disputed whether sand, silt, weed, and other foreign

matter, found in the airways constitutes proof of
immersion during life. The presence of large quantities
of water and debris in the stomach strongly suggests
immersion during life. Conversely, the absence of water
in the stomach suggests either rapid death by drowning,
or death prior to submersion.

Drowning is "suffocation due to immersion of the nostrils and mouth in a liquid". The
mechanism of death is complex and is not simply an asphyxiation due to suffocation

There are no universally accepted diagnostic laboratory tests for drowning. The diatom
test is used in some British laboratories and may provide corroborative evidence of
death by drowning.

The lungs of drowning victim

The lungs are characteristically over-inflated and heavy
with fluid. However, this is not invariable and, when
present, macroscopically, it is not distinguishable from
"fluid on the lungs" (pulmonary edema seen in heart
failure, drug overdose and head injury).

In drowning, aqueous pulmonary emphysema and

edema occur due to water aspiration and the lungs
assumed a characteristic feature of the so called
drowning lung.

Specifically, the lungs become markedly swollen and the

borders become rounded; and the surface ; the surface
appears pale and may exhibit hemorrhagic spots (the so
called paltoufsche flecke) under the pleura, which are
caused by rupture of the alveolar wall.
Aqueous pulmonary edema seen in drowning differs
from ordinary pulmonary edema and is sometimes called
dry edema.

The fluid with minute bits of foam is often expelled from

the cut surface only when pressure is applied to a lung.
Several days after death, the aspirated water in the
lungs shifts to the thoracic cavity through an infiltrative
process.
If a large quantity ( more than 100 ml) of a hemolytic
aqueous substance is found in the thoracic cavity of a
corpse, there is a strong possibility that it had been
drowned.

In case of an intracardiac hemorrhage in a person who

drowned in fresh water, the blood contained in the left
atrium is more diluted and shows a more acute sign of
hemolysis than that of the right atrium.
If drowning occurs in sea water, the blood in the left
atrium is frequently condensed. (the osmotic pressure of
sea water is about 4 times that of the plasma; therefore
the latter moves into the pulmonary alveoli, which
explains the development of acute secondary edema
shortly after drowning.)
These features are preserved even in those corpses that
have been left in water for quite some time. Standard
asphyxial features are also found.