Drowning - Signs & Postmortem Appearances

Definition

Types of Drowning

Postmortem Appearances

External Signs

1. Clothing - wet; skin is wet, cold, moist and pale (vascular surface contraction)
2. Foreign material - mud, silt, sand, seaweed, algae, small aquatic life in mouth, nostrils, ears
3. Postmortem lividity - light pink in color (resembles CO poisoning) due to unreduced hemoglobin in superficial vessels from cold; may also be dusky/cyanotic; found on face, upper chest, hands, forearms, feet and calves (body floats face down, buttocks up)
4. Face - may or may not be cyanotic; conjunctivae sometimes congested with few petechial hemorrhages under lower eyelids
5. Froth at mouth and nose - fine, white, persistent, mushroom-shaped froth due to mixture of air, water and mucus beaten by respiratory movements
   • Appears within 2 minutes of drowning
   • Persists for several days unless washed away
   • May be blood-stained in sea water drowning
   
6. Cutis anserina (Goose skin) - caused by contraction of arrector pili muscles from cold water stimulation; not exclusively a sign of drowning
   
7. Washerwoman's hands/feet - skin soddening, wrinkling, thickening, bleaching due to water absorption:
   • Fingertips: 2-4 hours
   • Palms and dorsum: ~24 hours
   • Full washerwoman appearance: ~20 hours
   • Feet take about twice as long when shoes are worn
   

   
8. Cadaveric spasm / Death grip - hands may tightly grasp weeds, grass, sand, mud; highly significant sign as it indicates the person was alive when entering the water

Internal Signs

• Voluminous, over-distended (emphysema aquosum), covering the heart and overlapping at the front
• Waterlogged, heavy, pits on pressure, do not retain shape when removed
• Froth in air passages; copious fluid pours from cut sections
• No crepitus on sectioning

• Presence of water in stomach and intestines (swallowed during drowning)

• Small and anaemic due to vasoconstriction - Sabinsky's sign
• Drowning index = Weight of both lungs / Weight of spleen ≥ 14.1

• May be present in subepicardial region (posteriorly)
• Temporal bone/petrous bone hemorrhages also seen

Diatom Test (Most Reliable Confirmatory Test)

• Finding diatoms in bone marrow/internal organs = strong evidence of antemortem drowning
• Demonstrated by digestion with nitric acid + sulphuric acid (the tissue dissolves but diatoms survive)
• Negative results are more reliable than positive (deceased may have consumed water containing diatoms)

Reliable Signs of Drowning at Autopsy (Summary)

1. Fine, white froth at the mouth and nose
2. Weeds, sand, mud firmly grasped in the hands (cadaveric spasm)
3. Weeds, sand, mud, fine froth in the lungs and air-passages
4. Voluminous, waterlogged lungs (emphysema aquosum)
5. Presence of water in the stomach and intestines
6. Finding of diatoms in the tissues

Gettler Test (Blood Chloride Test)

• Normal blood chloride: ~600 mg/100 mL (equal in right and left heart)
• Fresh water drowning: Left heart chloride up to 50% lower than right (hemodilution)
• Sea water drowning: Left heart chloride shows 30-40% increase (hemoconcentration)
• A 25% difference in chloride is significant; but the test is of doubtful value

The Essentials of Forensic Medicine and Toxicology, 36th Ed. (Narayan Reddy/Gautam Biswas), pp. 359-367

Drowning - লক্ষণ (Signs) 🌊

Easy to Remember Version

Definition (1 line)

Fluid aspiration into air-passages causing asphyxia = Drowning

Types - "WDSI" মনে রাখো

Postmortem Signs - "FWCWSD" মনে রাখো

Washerwoman Timing (easy to remember)

2-4 hrs   → Fingertips
24 hrs    → Full hand (palm + back)
20 hrs    → Bleached, wrinkled appearance

Lungs - Fresh vs Salt Water (2 min table)

Reliable Signs at Autopsy - "F-W-W-L-W-D"

1. Froth at mouth/nose
2. Weeds grasped in hands
3. Weeds/froth in lungs
4. Lungs waterlogged
5. Water in stomach
6. Diatoms in tissues

Key Numbers to Remember

Diatom Test - 1 Line

Silica skeleton → resists acid → found in bone marrow/kidney = antemortem drowning confirmed ✓