Postmortem Findings in Drowning

Signs of Immersion (Not Specific to Drowning)

1. Maceration / "Washerwoman's Hands"

• Starts within minutes in warm water (e.g., bathtub); visible after 4-5 hours in cold water
• Skin at fingertips, palms, and soles becomes wrinkled, pale, and sodden
• After days to weeks, the thick keratin of hands and feet detaches in a "glove and stocking" pattern
• Nails and hair become loosened simultaneously

2. Cutis Anserina (Goose Flesh)

• Granular, puckered skin appearance due to contraction of erector pilae muscles
• More common in cold water; also occurs in post-mortem cold exposure generally
• Retraction of scrotum and penis is also seen

3. Postmortem Hypostasis

• Difficult to recognize due to swelling and loss of skin translucency
• Pattern is variable as the body may roll with water movements
• In decomposed bodies, lividity appears in the head, neck, and chest

4. Algae Growth

• Algae attach to exposed skin within 3-4 days in summer; scraping may remove superficial skin and mimic abrasions

5. Adipocere Formation

• Common in victims of prolonged submersion

Duration of Immersion (Approximate Guide)

External Signs of Drowning (at Autopsy)

1. Clothing and skin: Wet, cold, clammy, pale due to vasoconstriction
2. Postmortem staining: Pink due to oxygenation; may be dusky and cyanotic
3. Head, neck, face: Congested, cyanotic; petechial hemorrhages in conjunctiva
4. Pupils: May be dilated; tongue swollen and protruded
5. Froth at mouth and nostrils: Fine, white, leathery, tenacious; may be blood-stained. Created by churning of inhaled water + mucus + air. Projects as a small balloon or mushroom-like mass. Does NOT easily collapse when touched with a knife. Absent in dry drowning.
6. Cutis anserina (see above)
7. Cadaveric spasm: Hands may grasp weeds, sand, mud, or gravel - a vital reaction indicating the person was alive when they entered the water. Damaged nails and abraded fingertips from struggling may accompany this.
8. Rigor mortis: Appears early when violent struggle occurred before death
9. Washerwoman's hands (see maceration above)

Internal Signs of Drowning

Lungs - the Key Organ

• Lungs are voluminous and waterlogged, completely covering the pericardial sac and bulging out of the chest on removing the sternum
• Rib impressions are visible on the lung surface due to overdistension
• Passive collapse - which normally occurs after death - does NOT happen because edema fluid blocks the bronchi
• Lungs do not collapse when removed and placed on a table
• On cut section, large amounts of frothy fluid ooze from the surface on squeezing

• Subpleural hemorrhages caused by rupture of alveolar walls under forced respiratory effort
• Located mainly on the anterior and interlobar surfaces, predominantly in the lower lobes
• Shining, pale bluish-red or grey patches, ranging from minute to 3-5 cm in diameter
• Pathognomonic when found together with frothy airway fluid, though not on their own

• Stage 1: Alveolar wall thickness reduced to capillary width; capillaries appear round/oval like a chain; partial fiber ruptures
• Stage 2: Alveoli more distended; capillaries lie separately; fiber rupture more marked
• Stage 3: Maximal alveolar wall distension; capillaries appear thread-like

Other Internal Organs

• Stomach and intestines: May contain water, sand, mud, or weeds - indicating antemortem swallowing while struggling
• Pleural cavities: In decomposed bodies, water is found in increasing quantity due to diffusion from collapsed lungs
• Temporal bones / middle ear: Hemorrhages may be found in some drowning victims
• Blood: More fluid; body tends to bleed more readily from wounds

Laboratory / Investigative Tests

1. Diatom Test (Diagnostic Test for Drowning)

1. All species recovered from the organs must be present in water from the site of submersion
2. Species must not be found in control (non-drowned) subjects

• Seasonal variation (diatom-poor water)
• Dry drowning
• Delayed body recovery / decomposition
• Post-mortem immersion

• Ingested shellfish or raw vegetables grown in diatom-rich soil
• Inhalation of industrial diatom-containing dust (cement, paint, insulators)
• Dusting powders
• Intestinal penetration into blood

2. Gettler Test (Chloride Test)

• Normal: Chloride ~600 mg/100 mL, equal in left and right heart chambers

• A 25% difference in chloride between sides is considered significant
• The test is of doubtful value in routine practice and is largely historical

3. Plasma Specific Gravity

• In drowning: specific gravity of plasma from the left side is less than the right side (due to hemodilution)
• In non-drowning cases: the reverse

4. Magnesium

• In saltwater drowning: magnesium content on the left side is >1.25 mg/1000 mL more than the right side

5. Serum Strontium

• Raised serum strontium in deaths due to drowning (Abdallah et al., 1985)
• Left-right strontium difference is always >75 µg/L in seawater drowning
• Helps differentiate antemortem drowning from postmortem immersion

Reliable Signs of Drowning - Summary

1. Fine white froth at mouth and nose
2. Weeds, sand, or mud firmly grasped in the hands (cadaveric spasm)
3. Weeds, sand, mud, or fine froth in lungs and air passages
4. Voluminous, waterlogged lungs (Emphysema aquosum)
5. Water in stomach and intestines
6. Diatoms found in viscera/bone marrow matching the site of submersion

When Signs Are Absent

• Dry drowning / vagal inhibition (sudden cardiac arrest from cold water shock - laryngeal spasm, no water inhalation; postmortem shows asphyxia signs only)
• Helplessness from alcohol, drugs, or injury preventing struggle
• Delayed body recovery (putrefaction destroys most signs)
• Advanced decomposition - only residual evidence is water in pleural cavities and froth in bronchi; in advanced putrefaction all signs are absent