DROWNING (2)
CHANGES IN RESPIRATORY TRACT
Fluid in pleural cavities
Fine white froth occasionally blood stained & also some foreign materials like algae,
weeds, mud, sand, depending on the medium of drowning
Regurgitated particles of food
Special pathological changes in wet drowning (cont.)
Heart
Rt. Heart & large veins distended with dark red blood
Stomach & intestines
Stomach may contain water
In dead bodies thrown in water it is not possible for water to get beyond the cardiac
sphincter & into the stomach & intestine
The middle ear & mastoid cells
Water in middle ear
Hemorrhages into the middle ear & mastoid air cells
Biochemical changes in blood
An interchange of water and electrolytes will occur till equilibrium is established.
In fresh water, haemodilution occur, viscosity of blood is decreased, it leads to lyses
of RBS with liberation of potassium.
Changes due to water entering lungs, diffused into pulmonary circulation and passing
to left side of heart.
The chloride content of the left side of heart decreased.
In saltwater drowning ,all above changes are reversed.
There is hemoconcentration, viscosity of blood is increased, RBC‘s are crenulated
and chloride content of heart is increased.
Increased level in magnesium in the CSF in cases of sea water drowning is a useful
criteria
Water cannot enter the Lt side of heart , if dead body thrown in water.
These changes are therefore not seen in bodies recovered from water but died due
to causes other than drowning.
Gettler devised test to estimate chloride content of blood from both sides of heart
The surface of the heart is rendered dry , the heart is punctured with a knife & 20 ml
of blood is withdrawn from each ventricle of heart, using a separate dry pipette.
The chloride content of blood is then analyzed, normal chloride content in each
chamber is 600mg/100ml
a difference of 25mg/100 ml is significant.
Limitations of Gettler test
Progressive loss of chloride content from blood after death, so test must be made
within a short time (12 hours).
In atypical drowning test is of no value, since very little or no water enters the
respiratory passages.
In congenital cardiac defect , the test is valueless.
Test is of no value, if drowning media and blood contains same amount of chloride.
PRESENCE OF DIATOMS IN TISSUES
Microscopic unicellular algae, having a siliceous cell wall, resist acid digestion, heat
and putrefaction.
Only live body with a circulation can transport diatoms.
Before examination , they have to be cleaned.
Sample of material obtained from femoral or sternal bone marrow.
DIATOMS
Acid digestion of marrow by mixing with nitric acid & heat, till clear fluid obtained,
then centrifuged & sediment examined under microscope.
Most delicate & beautiful collection of diatoms are seen in cases of death from
drowning.
As sea water and freshwater diatoms different.
Site of drowning can be determined.
Diatom test is reliable in advanced decomposition.
Diatom test negative in bodies thrown in water and in dry drowning.
M/L ASPECTS
Whether death was due to drowning.
Manner is homicidal, suicidal, or accidental.
Time since death from drowning.
WHETHER DEATH IS DUE TO DROWNING
Persistent , perfuse , fine froth at mouth and nose.
Material grasped in hands.
Fine typical froth in air passages.
Edematous conditions of lungs.
Diatoms in tissues specially brain and bone marrow.
In doubtful cases, viscera should be preserved for chemical analysis.
SUICIDAL , HOMICIDAL ACCIDENTAL
SUICIDE
Fairly common in women.
Women are very careful about private parts.
May take her child with her.
Attach weights to her body.
May take poison, cut her throat/wrists.
Injuries should not indicate an assault or struggle.
Body subjected to injuries water animals
HOMICIDAL ACCIDENTS
Rare except in infants and children, stupefied and overpowered adults.
Injuries may be found on the body .
ACCIDENTAL DROWNING
Very common.
Injuries may be sustained during accidental fall
TIME SINCE DEATH FROM DROWNING
A non waterproof wristwatch
Cooling rate is twice as compared to air
Rigor mortis sets early
Wrinkling of skin
Bleaching of cuticle
Sodden appearance of epidermis
Floating of the body
Body infected with flees and lice (other marine insects)
Putrefactive changes
Skin of the hands and feet loose and peels like gloves and stocking
DIFFICULTIES IN DROWNING
When signs of drowning are absent.
When injuries are found on the body.
When body is in decomposed condition.
ABSENCE OF SIGNS
Death due to shock or laryngeal spasm.
First killed and then thrown in water.
Minimal signs in submersion of unconscious.
INJURIES
Could be suicidal, homicidal or accidental.
May sustained while falling.
May be caused by water animals or passing boats.
Microscopic examination is important.
DECOMPOSED BODIES
Running water retards process
Polluted water accelerates process
Water temperature may effect.
Due to putrefaction signs of drowning are masked.
Fine froth creates confusion (poisoning) Viscera should be sent for chemical analysis.
Diatoms in brain and bone marrow may provide valuable evidence.
CONCLUSION
In event of negative report of chemical analysis and negative diatom test , the cause
of death can not be given.
The postmortem and chemical examination may help to exclude fatal injuries and
poisoning, respectively. It could still be a case of drowning where all signs have
disappeared.
IMMERSION SYNDROME
This also occurs rarely.
It is usually found in temperate or cold zones.
Young swimmers are the victims.
When they dive in very cold water, they may suffer from vagal inhibition & die a
sudden death in water, even though they may be good swimmers.
