The document details the mechanisms and classifications of drowning, highlighting causes of death and the physiological effects of asphyxia and immersion. It distinguishes between typical drowning (wet and dry) and atypical drowning scenarios, as well as discusses the postmortem findings relevant to forensic medicine. Additionally, it outlines diagnostic indicators such as the presence of froth, diatoms, and respiratory findings that assist in determining drowning as the cause of death.

1. By
Dr Mohd Kaleem Khan
Assistant Professor
Department of Forensic
Medicine
JNMCH AMU Aligarh

2.  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.

3. Breath Holding
◦ Lasts for a variable length of
◦ Carbon dioxide accumulation
◦ Stimulation of the respiratory centre in brain
◦ Inevitable inhalation of large volumes of water.

4.  • Swallowing Of Water
 Coughing, vomiting progressive loss of consciousness
 Escape of air remaining
 In the lungs and replaced by water

5.  Profound unconsciousness and convulsions
 Gasping
 Respiratory standstill
 Failure of heart
 Irreversible changes in the brain
 Death

6. ◦ 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

8.  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.

9.  Myocardial infarct
 Occasionally, accidental or 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.

10.  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.

11. 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.

12. 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.

13. Typical drowning
 Fresh water drowning.
 Salt water drowning.
Fresh water drowning
◦ Water cross the alveolar membrane into the circulation.
◦ Produces marked hypervolaemia.
◦ Red cells swell or burst-hemolysis-liberation of
potassium.
◦ Circulation will suffer 50% dilution within 2-3 min.

14. ◦ The heart is submitted to the insult of anoxia, hypervolaemia,
potassium excess and sodium deficit.
◦ Ventricular fibrillation due to anoxia and potassium excess within
4-5 min.
Salt water drowning
◦ Marked hyper tonicity of the inhaled water cause loss of fluid from
circulation into the lungs-fulminating pulmonary edema and
progressive hypovolaemia.
◦ Circulatory shock and cardiac arrest.

15. 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.

16. ◦ 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.

17. ◦ 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.

18. ◦ A victim look alert and breathing, may respond to initial
resuscitation.
◦ Late stage-respiratory distress, hypotension and cardiac
arrhythmia may cause death.

19. Vicious cycle of drowning
 Deep inspiration
 Need for air
Water enters
resp.passage
 Air driven out of lungs
Cough reflex

20. 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”

21. Postmortem findings
External findings
 Fine froth at the nose
 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.

23. Cutis Anserina (goose Skin)
◦ Due to spasm of the erector pilae 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.

24. ◦ 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.

25. 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.

27. ◦ 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,

29. Diatoms
 Microscopic unicellular algae present in water.
 Silicaceous 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.

33. Cause of death
◦ Asphyxia
◦ Ventricular fibrillation
◦ Laryngeal spasm.
◦ Vagal inhibition.
◦ Exhaustion.
◦ Injuries.
◦ Fatal period 4-8min.

34. Diagnosis of drowning
 Froth
 Weeds & gravel/soil in hand.
 Voluminous lungs.
 Diatoms in tissues.

35. thanks