POSTMORTEM CHANGES IN

DROWNING BODY
DR AISHWARYA GAVALI
MBBS , FCCM, PGD FM&T, DMM
PIAS , MSC FORENSIC SCIENCE (SEM 2)
DROWNING

• Drowning is a form of violent asphyxial death, caused by aspiration of fluid

into air passages, caused by complete or partial submersion in water or other
fluids. Thus death occurs either due to entry of the fluid in the respiratory
passages or due to effects of severe water and electrolyte imbalance.
CIRCUMSTANCES OF BODY IN WATER

•Died from natural disease before falling into the water

•Died from natural disease while already in the water
•Died from injury before being thrown into the water
•Died from injury while in the water
•Died from effects of immersion other than drowning
•Died from drowning
SWALLOWING OF WATER CAN CAUSE…

•Coughing,
•vomiting progressive
•loss of consciousness
•Escape of air remaining
•In the lungs and replaced by water
•Profound unconsciousness and convulsions
•Gasping
•Respiratory standstill
•Failure of heart
•Irreversible changes in the brain
•Death
SIGNS OF IMMERSION

•Maceration of the skin in warm water

•• Washer-woman's skin
•Keratin of hands and feet peels off in "glove and stocking'
•fashion
•Nails and hair loosened
•Cutis anserina - or "goose-flesh'- cold water.
•Float with buttocks uppermost, head and limbs down
 
•Wrinkled fingers, palms and feet, half a day
to 3 days
•Decomposition,
•Often first in the dependent head and neck,
abdomen and thighs:
•4-10 days
•Bloating of face and abdomen with marbling
of veins and
•peeling of epidermis on hands and feet, and
slippage of scalp:
•2-4 weeks
•Gross skin shedding, muscle loss with
skeletal exposure, partial
•liquefaction: 1-2 months,
DEATH FROM NATURAL CAUSES BEFORE ENTERING THE
WATER

•Myocardial infarct
•Occasionally, accidental o r suicidal injuries may be
•inflicted
•Trauma in the water is common
•Sudden entry of cold water into the pharynx and larynx, and
•perhaps nasal passages can produce powerful stimulation of
•nerve endings in the mucosa.
•A bolus of water entering the trachea can also cause reflex
•cardiac arrest.
 DROWNING AND CLASSIFICATION

•Drowning is a form of asphyxial death due to aspiration

•of fluid into the air passages by submersion of the body
•in water or fluid medium.
•Complete submersion not necessary, submersion of
•nose and mouth is enough.

•Classification
•Typical
•Atypical
TYPICAL DROWNING
•Obstruction of air passages and lungs by inhalation of fluid and is known as "Wet drowning"
•Typical signs are found at autopsy.
 

Atypical drowning
•Conditions in which there is very little or no inhalation of water or fluid in the air passages
•Dry drowning.
•Immersion syndrome(vagal inhibition)
•Submersion of the unconscious.
•Secondary drowning syndrome/near-drowning
TYPICAL DROWNING -FRESH WATER DROWNING

•Water cross the alveolar membrane into the circulation

•Produces marked hypervolemia.
•Red cells swell or burst-hemolysis-liberation of potassium.
•Circulation will suffer 50% dilution within 2-3 min
•The heart is submitted to the insult of anoxia, hypervolemia potassium excess and sodium deficit.
•Ventricular fibrillation due to anoxia and potassium excess within 4-5 min.
TYPICAL DROWNING –SALT WATER DROWNING

•Marked hyper tonicity of the inhaled water cause loss of fluid from circulation into the lungs-
fulminating pulmonary edema and progressive hypovolemia

•Circulatory shock and cardiac arrest.

 ATYPICAL DROWNING
•Dry drowning
•intense laryngeal spasm due to entry of water into nasopharynx and larynx.
•Very little water enters into lungs.
•Best case for resuscitation

•Immersion syndrome
•Due to sudden impact with very cold water and causes death from cardiac arrest
•Victims are young people with excess of alcohol 
•It also result from falling or diving with feet or duck diving by the inexperienced swimmers
•Loss of consciousness instantaneous and death occurs in few minutes.
•Autopsy disclose non of the usual signs of drowning.
SUBMERSION OF THE UNCONSCIOUS

•Commonly seen if the victim is suffering from disease like epilepsy, heart diseases and is drunk or head
injury during fall.

•Ballooning of the lungs may be absent.

•Formation of the foam my be negligible

•Complete picture of death by drowning is not found.

SECONDARY DROWNING/NEAR-DROWNING
•Its mainly due to infection from inhalation of
contaminated water.

•Lung complications, oxygen lack, tired heart

muscle and cerebral edema.

•A victim look alert and breathing, may

respond to initial resuscitation.

•Late stage-respiratory distress, hypotension

and cardiac arrhythmia may cause death.
 MEDICO LEGAL ASPECTS

•Whether the death was due to drowning or other cause?

•Length of time the body was in water.

•Whether it was accidental/suicidal/homicide?

•"Brides of the bath case"

Post-mortem findings
• Fine froth at the nose
• External findings
• consists of a proteinaceous exudates and surfactant mixed
with the water of the drowning medium. It is usually white,
but may be pink or red-tinged, because of slight admixture
with blood from intrapulmonary bleeding.
• Rarely the presence of weeds, mud etc
CUTIS ANSERINA (GOOSE SKIN)

•Due to spasm of the erector pili muscles (hair erector muscles) and due to exposure to cold water at
the time of death
•Rarely seen in India
•Skin appears granular and puckered, with hair standing on the end
•Extremities are mainly affected. 
•The skin of the finger, palms and later the soles of the feet may be wrinkled, bleached and sodden
•Due to osmotic action of water, on thickened epidermis.
•This immersion changes known as Hands and Feet of a Washer-Woman.
 INTERNAL FINDINGS
•Lungs & respiratory tract:-
•Airways filled with froth, sand, weeds etc found in the water.
•Lungs are voluminous, edematous, doughy to feel with rib
markings
•Paltauf’ hemorrhages seen
•C/s:- Oozing out of blood stained frothy fluid and ballooning
of the lungs is known as "Emphysema Aquosum"
•Wt up to 2 kgs.
•Watery fluid transudates into pleural cavities during
putrefaction.
•Hydrostatic lung:- 2meters depth-20min.
•Hemorrhages in the middle ear & mastoid air cells.
•The stomach may contain watery fluid or even foreign
material from the water, such as silt, weed or sand,
 DIATOMS
•Microscopic unicellular algae present in water.
•Salicaceous cell wall which resists acid digestion,
heat and putrefaction.
• Size 10-80 microns.
•Only a live body with a circulation can transport
diatoms from lungs to the brain or bone marrow.

•Isolation- acid digestion of tissue commonly

bone marrow, lung, blood and kidney-
centrifugation and washing. Residue is examined
under phase contrast microscopy. 
CAUSE OF DEATH
•Asphyxia
•Ventricular fibrillation
•Laryngeal spasm.
•Vagal inhibition
•Exhaustion.
•Injuries.
•Fatal period 4-8min
DIAGNOSIS OF DROWNING

•Froth
•Weeds & gravel/soil in hand
•Voluminous lungs
•Diatoms in tissues.
THANK YOU…