IMMERSION DEATH

Drowning: Death due to full or partial submersion in a liquid that results in

asphyxia and death within 24 hours of the incident.
Near Drowning: When the submersion does not immediately result in
death.
Temporary survival for at least 24 hours after the incident.
Secondary Drowning: Death which occurs more than 24 hours.
Progressive pulmonary dysfunction despite successful initial resuscitation.
Historical Background
Original concept of drowning deaths ~ asphyxial in nature, with water
occluding the airways.
Swann (1956) and others:
Concomitant occurrence of fluid and electrolyte disturbances in
blood.
Development of acute cardiac failure.
Asphyxia plays a secondary role.
Current View
Modell & Davis (1969): studies in near drowning biochemical changes
differ from experiments.
Confirmed the important role of hypoxaemia resulting from interference
with the blood-air interface in the alveoli.
Signs of Immersion
Washerwoman appearance: The deceased has been in the water for
more than 12 h.
Goose flesh (Cutis anserina): A spasm of the erector pilae muscles
caused by rigor mortis
Bodies Retrieved from Water
o Many corpses are recovered from water, but NOT all have drowned.
o The determination of the cause and manner of death of a person
whose body is retrieved from water is considered a challenge for
pathologists
Bodies Retrieved from Water
1. Died from natural disease before falling into the water.
2. Died from natural disease while already in water.
3. Died from injury before being thrown into water.
4. Died from injury while in the water.
5. Died from effects of immersion other than drowning.
6. Died of drowning
7. Died from Effects of Immersion
Drowning may occur in deep waters or in as little as 56 cm of fluid.
Suspicious of decreased consciousness:
Head injuries
Epileptic fit
Ingestion of narcotic
Alcoholic intoxication
Sudden entry of cold water into the pharynx and larynx powerful
stimulation of nerve endings in the mucosa.
Reflex cardiac arrest.

Death from Drowning

Pathophysiology of Wet Drowning
Submersion followed by a panicky struggle.
When energy are exhausted, the struggle subsides and actual drowning
begins..
1. Breath holding
2. Laryngospasm
3. Accumulation of carbon dioxide
4. Stimulation of the respiratory center in the brain
5. Relaxation of the airway
6. Take a breath
7. Inhalation of large volumes of water
8. Gasping for air under water.

Swallowing of water : coughing, vomiting.

Escape of air remaining in the lungs and replacement by water.
Lost consciousness within 3 minutes.

Wet Drowning: Fresh Water

Previously believe:
Large volumes of water enter the circulation.
Low salt content of these waters: dilution of blood.
Increase in blood volume rapidly overburden the heart.
Current view:
Entry of fresh water into the lungs destroys surfactant activity and
resulting in the collapse of the alveoli.
Wet Drowning: Salt Water
Strongly salty tends to draw the blood into the lung tissue.
Dilutes or washes the surfactant away and causes destruction of the
alveolar and capillary endothelium.
Pathophysiology of Dry Drowning
Intense laryngospasm which leads to airway closure and hypoxaemia.
Autopsy Signs of Drowning
No pathognomonic finding.
Based on the circumstances of the death, and a variety of nonspecific
findings.
Chemical tests are nonspecific and essentially unreliable.
The rapid onset of putrefaction:
o Obscures the signs for drowning.
o Render the assessment of any injuries extremely difficult.
*To establish the identification of the victim is a difficult task.
Diagnosis of exclusion.
A diagnosis of drowning cannot be made without:
A complete autopsy.
A complete toxicological screen.
Body sinks, assuming a position of head down, buttocks up, and
extremities dangling downward.
Might be evidence of animal activity - fish, turtles, crabs, or shrimp.

 Froth in the Air-Passages

White or haemorrhagic edema fluid is present in the nostrils, mouth,
and airways in wet drowning.
The lungs of the typical wet drowning victim are large and bulky with
prominent rib markings.
Pulmonary oedema: Waterlogged lungs
Antemortem Wounds
Immersion of a body in water for several hours may cause leaching out of
the blood from antemortern wounds.
Bloodless postmortem wounds are, in actual fact, antemortem and the
cause of death.
Manner of Death:
Accidental
Most drownings are
accidental.
Difficulty arose when
known epileptic or
alcoholic recovered
from the shallow end
of a pool or found face
down in a roadside
puddle.

Suicidal
Search for clues
suggesting the
deceased already
had the suicidal
tendency.

Homicidal
Occasionally seen in
infants or young
children who are
virtually defenseless.
The adult victims of
homicidal drowning
may have injuries.

Tests for Drowning

A number of tests have been developed over the years to determine
whether a person has drowned.
The most famous is the Gettler chloride test, in which blood was analyzed
from the right and left sides of the heart.
Identification of Diatoms
Diatoms are microscopic unicellular algae varying in size from 5 to more
than 500 m.
These organisms have a silica skeleton in the shape of two valves.
They are found everywhere in all types of water, on moist soil, and in the
atmosphere.
Diatoms Test
Some authors contend that the identification of diatoms in human organs
is clear proof of drowning;
Others object because of the widespread distribution of these organisms
throughout the environment.
Three possible ways they could have gotten there:
First ~ inhalation of airborne diatoms.
Second ~ ingestion of material containing diatoms.
Third ~ aspiration of water containing diatoms, with subsequent
circulation of these throughout the body.