Drowning

DROWNING, closure of the respiratory openings by a liquid medium. Such a medium is most often water; D. in sewage is usually encountered as child murder. D. is also possible in other liquids. Immersion of the whole body in liquid is not necessary for D.; immersion of only the head or the respiratory openings is sufficient. This can happen to children, intoxicated persons, epileptics, and others. The mechanism of death in D. can be different. In some cases, the drowning person is quickly submerged in water, making no attempt to save themselves, swallowing no liquid, and dying very quickly. The rapidity of death is explained by shock caused by the action of cold liquid on the skin or on the mucous membrane of the larynx, vocal cords. This type of D. is called drowning-inhibition. Another type of D., drowning in the proper sense of the word—drowning-asphyxia—in which the respiratory passages are closed by a liquid medium. The mechanism of death from D. has been studied experimentally and is subdivided by authors into several periods. Ziemke distinguishes 4 periods: 1st—deep inspiration followed by breath holding; 2nd—dyspnea, initially inspiratory, then expiratory, and convulsions; 3rd—unconscious state, expiratory dyspnea, convulsions; 4th, final period—terminal breathing. Hoffman distinguishes 3 periods, Brüar—5 phases, Margulies—2 periods: the period of defense and the period of helplessness. The whole process of D. ends in death within 3–5 minutes. The changes observed in drowning victims can be subdivided into external and internal. During external examination of the corpses of drowning persons, in a number of cases one can note the presence of foam in the form of white clumps at the openings of the nose and mouth. The formation of foam occurs during the convulsive period of D., when the liquid filling the respiratory passages, due to convulsive contractions of the bronchi, is whipped up with air into foam. The surface of the body appears cold due to intensified evaporation of moisture. Livor mortis has a pink-red color, since maceration of the epithelium allows air oxygen to penetrate through the skin and oxidize reduced hemoglobin. Next, goose flesh (see) and maceration (see) are observed. The surface of the body may be covered with silt, sand, algae, or the liquid in which D. occurred (sewage, oil, etc.). One should only not forget that most of these signs testify not to D., but to the presence of the corpse in water. Internal changes consist of changes characterizing asphyxial death, on the one hand, and changes caused by the penetration of liquid into the organism. Hoffman attaches decisive diagnostic importance to changes in the lungs. The lungs are sharply inflated, with rounded edges having a relatively pale color. The lobular structure is clearly visible (volumen pulmonare auctum, Hyperaerie, emphysema aquosum). The surface of the lungs is uneven, inflated and pale areas in the form of stripes alternate with sunken darker areas (impressions from the pressure of the ribs). Under the pleura, sometimes the presence of large pale hemorrhages from the penetration of fluid under the pleura and its mixing with blood is noted. Foreign particles found in the aspirated liquid—small pebbles, sand, silt, small plant (diatoms, algae, bacteria) and animal organisms (plankton)—can be detected in the respiratory passages either by the naked eye or by microscopic examination. In D. in sewage—remains of vegetable and animal food. For microscopic examination, one can take either sections from the lungs or smears from the peripheral parts of the lungs. Besides the respiratory passages, fluid can be detected in the stomach, duodenum, jejunum, and sometimes even in the ileum, which, according to Hoffman, is almost conclusive for D. in that liquid which was found in the intestine, since posthumously fluid can penetrate so far only if it is introduced into the stomach under great pressure. Among changes in other organs, anemic, contracted spleen is noted. Absorption of liquid into the lungs through capillaries and lymphatic vessels leads to thinning and hemolysis of blood in the left heart, wherefore the blood takes a bright red color and becomes more liquid. Hemorrhages may be observed in the muscles of the neck and chest. The diagnosis of D. often presents significant difficulties, not only for corpses that have been in water for a long time, but also for fresh corpses, since the noted signs—foam in the respiratory passages, presence of foreign particles and liquid in the lungs and stomach—can be detected on a corpse that has fallen into the water. Various methods have been proposed for the diagnosis of D. These include: 1) cryoscopy of blood from the heart, giving an increase in the freezing point for blood of the left heart compared to the right; 2) study of the electrical conductivity of blood, revealing poorer electrical conductivity of blood of the left heart as it is less concentrated; 3) study of plankton, mineral and other foreign particles in the lungs. But all these methods, as shown by corresponding studies, are not sufficiently reliable and cannot be applied in everyday practical work. Those extracted from the water alive usually die very soon, not coming to consciousness; others die on the first day from pulmonary edema. In those who survived for a longer time, inflammatory processes on the part of the respiratory organs (bronchitis, pneumonia, pleuritis) are observed, which can be explained both by the ingress of contaminated liquid and by the cooling of the lungs. Next, convulsions, retrograde amnesia, anuria, and hemoglobinuria are observed. One should distinguish D. from death in water, which can occur suddenly from other causes (hemorrhage into the brain, pulmonary embolism, etc.), so that the person is already dead when they go under the water.