At autopsy, there are no pathognomonic findings to indicate the diagnosis of drowning. The diagnosis is based on the circumstances of the death, plus a variety of nonspecific anatomical findings. Chemical tests put forth to make the diagnosis are nonspecific and essentially unreliable. A diagnosis of drowning cannot be made without a complete autopsy, especially a complete tox-icological screen, because this is a diagnosis of exclusion. If individuals are found in water and all other causes of death have been excluded, they are presumed to have drowned. It must be remembered, however, that people have fatal heart attacks and fall into water, and that victims of a fatal drug overdose are occasionally "dumped" into a body of water. Attachments of heavy weights to a body to keep it under water is consistent with both homicidal and suicidal drownings, as is disposal of the body of an individual who has died from some other cause than drowning.
When a person drowns, the body sinks, assuming a position of head down, buttocks up, and extremities dangling downward. Unless there are strong currents, the body will not move very far from its initial position. In relatively shallow water, the extremities or face may bump or drag against the bottom of the body of water, often causing postmortem injuries to the face, back of the hands, knees, and toes. The crown of the head and the buttocks can be seen at water level. In deeper water, the body stays below the surface until decomposition begins and gas forms; the body then gradually rises to the surface. In very cold water, the body might stay submerged for months before decomposition creates enough gas to bring it to the surface. Depending on how long a body has been in the water, there might be evidence of animal activity, for example, fish, turtles, crabs, or shrimp. The authors have seen bodies that appear relatively intact but, when opened up, reveal complete absence of the thoracic and abdominal viscera. Examination of the exterior of the body will reveal a defect(s) in the trunk that communicates with the chest or abdominal cavity, through which water denizens have eaten their way inside, where they consume the internal viscera.
The hands and soles typically have a "washerwoman" appearance if the deceased has been in the water for more than 1-2 h (Figure 15.1). Experiments have shown that if you place the hands of a corpse in water whose temperature ranges between 10 and 18°C, initial formation of washerwoman's skin appears at the fingertips in 20-30 min (maximum of 100 min), with the whole finger involved at 50-60 min (maximum of 150 min).9 This appearance of the hands and feet does not indicate that the deceased drowned, as it will develop whether they were alive or dead when they entered the water. The same is true for "goose flesh" (cutis anserina). This is a spasm of the erector pilae muscles caused by rigor mortis and, again, does not indicate whether the person was alive or dead when entering the water.
In the classic wet drowning, white or hemorrhagic edema fluid is present in the nostrils, mouth, and airways. Compression of the chest can cause it to flow out. Pulmonary edema is, however, nonspecific. An individual dying of a drug overdose and disposed of in water can also have pulmonary edema. The lungs of the typical wet drowning victim are large and bulky, completely occupying their respective pleural cavities. On cut section, they usually have a brick-red appearance, with large quantities of edema fluid flowing from the cut surfaces (Figure 15.2). A white or hemorrhagic foam is commonly found in the trachea and bronchi. Water may be found in the lumen of the
stomach. There could be dilatation of the right ventricle. When the brain is examined, it is swollen with flattening of the gyri caused by nonspecific brain swelling.
Hemorrhage may appear in the petrous or mastoid bones. This, again, is nonspecific and, if sought, can be found in individuals dying of heart disease, drug overdose, or other causes of death. Thus, the drug overdose victim dumped in water and the heart attack victim collapsing into water can have the washerwoman appearance of the palms and soles, goose flesh, pulmonary edema, and hemorrhage into the petrous and mastoid bones. The presence of vegetation and stones such as would be found at the bottom of the body of water found clutched in the hands indicates that the cause of death was, in fact, drowning, because they imply that the deceased was alive when entering the water.
When initially recovered from the water, the body might be in full rigor mortis, even though only a short time has passed from the time of the drowning. This is caused by violent struggling at the time of drowning, with a decrease in ATP and rapid development of rigor mortis. Bodies cool much more rapidly in water than air. Thus, decomposition of bodies in water takes longer.
Immersion of a body in water for several hours may cause leaching out of the blood from antemortern wounds. Thus, an individual might be found with a number of what appear to be bloodless postmortem wounds that are, in actual fact, antemortem and the cause of death. This can cause problems when a body is pulled out of the water exhibiting propellor cuts. There may be no bleeding around these injuries, initially leading to the conclusion that these were postmortem injuries when, in fact, they were antemortem, the blood having been leached out by the action of the water. The authors have seen leaching out of blood as early as 3-4 h following immersion.
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