Drowning
 Dr. M Vidanapathirana
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MBBS, DLM, MD, MA, MFFLM (UK)
Senior Lecturer, consultant in forensic Medicine
Definition
 Death due to immersion or submersion in fluid media.
Medico-legal issues
1) Whether it is a case of drowning?
2) Identification?
3) Cause of death?
4) Whether he was alive at the time of immersion?
5) Manner of death?
1) Whether it is a case of drowning?
 A body recovered from water or found near water (eg.
River bank) is considered as a drowned case.
2) Identification?
 Speed of putrefaction in water is slower than in air- because the
temperature of water is less than in air. But after recovery from
water the putrefaction rate of drowned bodies become doubled
than non drowned bodies.
 Putrefaction is higher in the face, due to more development of
post mortem hypostasis in face due to more dependent position of
the head during floating.
 Therefore the facial identification by relatives or friends may
become difficult.
 In such instances forensic pathologist has to use other methods
for identification. Eg. using primary identifiers such as Dental,
Radiology, Finger prints and DNA
3)
Cause of death?
 Body recovered from water or found near water, could
have died of several methods.
1. Natural illnesses occurred before or after entering to
water.
2. Injuries received before or after entering to water.
3. Immersion deaths (dry drowning)
4. Drowning deaths (wet drowning)
1. Natural illnesses Occur before entering to water some times can die of MI or IHD etc and then fall into
water.
 Occur after falling into water due to increased exertion or due to struggle to survive
can precipitate a pre existing natural illness and can die
in water. E.g. With MI or IHD.
2. Injuries A. can occur before entering to water, and then dump in
water eg. Stab, firearm injury, manual or ligature
strangulation, following RTA, blunt force injury etc
(kill by other means and then surreptitiously disposed
by postmortem immersion in water).
Die due to injuries receive while he is in water –
 Head injury due to dashing on rocks,
 cuts by propellers of motor boats,
 injuries by predators such as shark, crocodiles etc.
 Problem in interpretation of injuries in immersed
bodies is due to washing off of the vital reaction
(bleeding) resulting an appearance of postmortem
injury.
Toxic animal injuries
Due to contact with the base of the river.
3. Immersion deaths-(Dry drowning)
 Some times can die by aspiration of water only
up to the level of the larynx. Here the amount
of fluid enter into deep lung tissue is no or
minimal and hence called as dry drowning. The
mechanisms could be,
 laryngeal spasm,
 vagal inhibition.
 Hypothermia.
laryngeal spasm and
vagal inhibition
 These said to cause quick deaths, with no or
minimal fluid entering to lungs.
 “Demaio” do not accept these methods, as he
believes that these are again could be one of
extreme ends of the range of wet drowning cases
where the amount of fluid aspiration is minimal.
4. Drowning deaths
(wet drowning)
 These are due to aspiration of fluid beyond the
larynx up to the distal parts of the lungs.
 They die due to mechanically induced cerebral hypoxia
due to respiratory tract obstruction. But the evidence
of raised venous pressure (Asphyxial features) is no or
minimal due to less mechanical obstruction to the
neck vessels, larynx or trachea, though the terminal
respiratory tree is obstructed.
 The 2 mechanisms of death are,
 Emphysema aquosum.
 Oedema aquosum
a. Emphysema aquosum
 occurs specially in persons who struggle to survive in water such
as young people or good swimmers.
 They aspirate little amount of fluid but due to the struggle, this
fluid is churned with surfactant and oedema fluid resulting a large
amount of froth.
 This ‘classical froth’ is white, tenacious, large, almost filling the
full respiratory tract, bulge out as a plume of froth, reappear
after whipping off and pressing the chest. These bubbles
cannot be pricked even with a pin.
 Lungs are voluminous and can see the rib indentation due to
dilation of the lungs as in emphysema. Sub pleural
hemorrhages can be seen.
 But even these feature are not specific for drowning. The
differential diagnosis are
 heart failure deaths and
 drug overdose deaths.
b. Oedema aquosum if the victim did not struggle to breath, the fluid can
enter into the respiratory tract with out much
obstruction, resulting a massive pulmonary oedema
and a course, blood stained, pink froth.
Diagnosis by exclusion
 Therefore there are no specific features for
drowning hence it is a diagnosis by exclusion.
 So the diagnosis must be done after excluding all
other natural causes of death by histopathology
and toxicology investigations.
 But in our country, if the circumstances are not
suspicious, the cause of death is given as drowning
even without histo or tox.
4) Whether he was alive at the
time of immersion?
 a. Cadaveric spasm
Crystallization of the last act (instantaneous rigor mortis)
due to emotional events at the time of immersion resulting
clenching of weeds or vegetations in their hands.
 b. large amount of froth on nose and mouth and
along the respiratory tract
 c. Large amount of water found in stomach after
excluding the possibility of ante mortem
drinking of large amount.
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In such cases can analyse the water of stomach with the water
from the site of the drowning. Even postmortem immersion
of a dead body, 15m deep in water for more than one hour
may not lead to entry of water into the stomach.
5) Manner of death?
 Accidental/ suicidal/ homicidal
 While walking along a bridge,
a victim can be slipped into water (accidental drowning),
 jumped into water (suicidal drowning), or
 pushed into water (homicidal drowning).
 So the postmortem appearance could be equal. Hence the manner of
death is usually decided by complete postmortem investigation with
circumstantial (non medical) evidence too.
 Postmortem immersion Some times a body can be disposed by dumping in water after killing by
some other method.
 In such instances, a cause of death which cannot be explained by
drowning can be seen. Eg. firearm injury, stab injury, blast injury etc.
 Death in bath tubs
 is a popular method of drowning in western countries. In such cases it
could be natural, accidental, suicidal or homicidal drowning. In cases
of Gorge smith’s ‘brides in the bath’ (serial murder), indicates the value
of meticulous investigation in drowning cases. He used to incapacitate
the brides with alcohol and while she was bathing he used to raise her
with her legs resulting drowning.
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6) Post mortem investigation of drowning
cases 1) Order

court order or ISD order.
 2) History 3) Visit to the scene
almost in all cases,
 4) Identification-
5) Preliminary investigations X-rays specially if suspect strangulation or firearm injuries
or putrefied.
 Trace evidence might have been washed off even a third person
involvement is suspected (suspicious death).
Vaginal sperms may be still found in rape-murder
cases if dumped in water after death.
 Photography specially of injuries
6) Clothing examination
 some times clothes can be removed by the current of
water.
1)
External examination-
 General features-
 identification features can be altered.
 Postmortem hypostasis can be settled at
new sites (differential hypostasis) due to
floatation in face down position eg. More
hypostasis in face and limbs.
 Rigor mortis can be developed later due to
low temperature in water.
 Cooling can be rapid up due to low
temperature in water than in air.
Specific features
Three categories must be discussed.
 Features due to mechanism of death,
 Features due to agent (water) – immersion
features.
 Circumstantial features.
External features due to mechanism of death
 depends on the mechanism of death and the
period of immersion.
 In wet drowning due to emphysema aquosum,
 plume of froth can be seen.
 In dry drowning due to laryngeal spasm evidence of raised venous pressure (‘asphyxial
features) may be seen , such as petechiae, bluish
discolouration, congestion and oedema.
 In dry drowning due to hypothermia the hypostasis is pink.
 If putrefied- all these features are lost.
b. Feature due to agent (water)in all cases, one or more features of immersion are seen. Eg.
 Cutis anserine standing up of hair due to ante mortem contraction of
erector pilae muscles or post mortem development of
rigor mortis in them.
 water logged clothes and body.
 washer woman hands and legs depends on the time of immersion in water. The
epidermis becomes macerated, sodden, whitish
appearance. Eg. In palms or soles in 2-3 hours and in
back of the hands and dorsum of the legs in 7-8 hours
of immersion.
 Animal bites such as crustatians (superficial injuries), sharks
(multiple, parallel, deep cuts), star fish (oval shaped
epidermal loses).
 Differential hypostasis more hypostasis in face and limbs
c. Features due to circumstances in postmortem immersion dumping after killing by another method  stabs,
 firearm injuries,
 blasts,
 manual or ligature strangulation etc.
 but putrefaction may alter these injuries.
Internal features a. features due to mechanism of death In fresh bodies,
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If emphysema aquosum- struggles to breath
 Airways filled with fine white froth,
 distended lungs with rib indentation and
 sub pleural haemorrhages. Lungs cover the heart.
In oedema aquosum massive pulmonary oedema. Lungs cover the heart.
In laryngeal spasm asphyxial signs – all over the internal organs,
In hypothermia pink organs and blood.
If vagal inhibition- no special features.
 If putrefied- loose above features.
Internal features cont…
 b. Features due to agent -
no specific features.
 c. Features due to circumstances Genital injuries if sexually assault before
surreptitiously disposed in water after killing
by another method such as manual
strangulation, stab, etc .
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In summary -the PM findings areIn wet drowning,
 If emphysema aquosum
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White, fine froth,
Emphysematous lungs with rib indentation, lungs cover the heart
Postmortem Immersion features.
More fluid may be found in sphenoid sinus
Hemorrhages in middle ear and mastoid air cells.
 Bluish discoloration of the middle ear area of the
Temporal bone. When removed, can see the bleeding.
Rupture of ear drum – may be present. Examine with
Otoscope before bone removal.
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 In oedema aquosum
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Coarse pink froth,
Pulmonary oedema.
Postmortem Immersion features
More fluid in sphenoid sinus
 In natural deaths
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No froth or lung features.
No or minimal fluid in lungs
Postmortem Immersion features present (cww ad).
Incontrovertible natural COD is found.
 In traumatic death which received in water
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No froth or lung features.
No or minimal fluid in lungs
Postmortem Immersion features present.
A traumatic cause of death is found which could be received while in water.
 In surreptitious disposal after killing by another method
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No froth or lung features.
No or minimal fluid in lungs
Postmortem Immersion features present.
A traumatic cause of death is found which could not be received while in water
eg. Manual or ligature strangulation, firearm injuries, blast etc.
Lab investigationsMainly three types 1. Histology of lungs
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no value.
Alveolar hemorrhages, collapsed or dilated alveoli, pulmonary
oedema. But can occur in both drowning and non drowned bodies.
Mud and aquatic debris may be found in bronchioles and alveolar
ducts.
 2. Chemical analysis
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No value.
comparison of concentrations in right and left ventricles such as
specific gravity, chloride (Getler test), strontium, sodium and
potassium are all now considered to be of no value.
 3. Diatom test-
Diatom test
 diatom is a unicellular algae with silicon axial
skeleton.
 It has thousands of types which could be
specifically identified by a botanist.
 the basis is the diatom found in water are inhaled
with submersion, enter into lungs, then into blood
and then circulate all over the body including bone
marrow.
Importance of diatom test
 The only reliable method of investigation in
putrefied, exhumed or charred bodies.
 Problems the diatoms are so prevalent, it is not only
found in water but in soil, sea food, air, tap
water and almost any where. So the problem
of contamination must be prevented.
So the reliability depends on,
 i. Prevention of contamination by
demonstrating diatoms in femur or teeth pulp
by using sterile methods. Such as sterile
scalpels, saws, saline etc.
 ii. Identification of a specific diatom/s (by
using a botanist) , in significant amounts (eg.
Minimum of 5 diatoms a field) in both the bone
marrow and sample of water from the site of the
drowning, is significant.
Samples obtain for diatom test
 One liter of water
 Femur bone
 Lungs
 Tested at JMO’s
office Colombo (ILMT)
 Government Analyst department
Thank you