Immersion Death

dr nouh hamdan
Bodies retrieved from water may have:
• 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.
Signs of immersion
• Maceration of the skin begins within minutes in warm water, such as
death in a bathtub, but in cold water is visible after a variable time.
The first signs tend to be on areas with an appreciable keratin layer
(such as the fingertips, palms, backs of the hands and later the
soles) where the surface becomes wrinkled, pale and sodden – the
so-called ‘washerwoman’s skin’, for obvious reasons.

After some days in warmer water and up to several weeks in cold,

the thick keratin of hands and feet becomes detached and
eventually peels off in “glove and stocking” fashion.

Problems of obtaining fingerprints in such circumstances are dealt

with later.
• Cutis anserina – or ‘goose-flesh’ – is a common
finding in immersed bodies, but is related to cold
rather than warm water. The erector pilae
muscles attached to each hair follicle can
contract in any type of death.
The distribution of post-mortem hypostasis is
of no value in immersed bodies. It is usual
for most corpses to float or hang in the water
with buttocks uppermost, and the head and
limbs hanging down, but water movements
often roll the body constantly unless in a
placid lake or wide river.
Mud, coal-slurry, oil, silt or sand may be present on or in
the body, as well as other artefacts such as seaweed,
water weed, algae and small aquatic animal life of many
types. Mud may be adherent to the whole body surface
and clothing, or may be retained in the hair, mouth,
nostrils, ears and other more protected sites. In
appropriate circumstances, such deposits should be
retained for scientific examination, if they might help
establish where the body has travelled from in marine or
riverine waters

Where a body is decomposed and partly skeletalized,

molluscs may colonize the bones
ESTIMATION OF DURATION OF
IMMERSION
The over-riding variable factor is water temperature
which has the most effect upon decomposition.
When a body falls into water in average temperate
climates, the following is an approximate guide to
timing, in conjunction with the other usual signs,
such as rigor:
• If no wrinkling of the finger-pads is present, less
than a few hours
• Wrinkled fingers, palms and feet, progressively
from half a day to 3 days
• Early 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.
NATURAL DEATH WHILST IN THE
WATER
It may well be impossible to determine whether a person recovered
from the water, with a potentially fatal natural disease, suffered this
before or after immersion.

Cardiovascular disease is the most common reason for death in the

water. A pre-existing condition may be exacerbated either by the
physical exertion of swimming or struggling, or by the effects of cold.
The common belief that swimming after a heavy meal is dangerous
probably has some basis in fact, because of circulatory changes
such as the ‘splanchnic shunt’. When an acute cardiac episode
occurs, such as sudden myocardial insufficiency or an arrhythmia,
death may follow either from the cardiac lesion itself, or from
drowning because of sudden physical incapacity.
INJURIES SUSTAINED BEFORE ENTERING THE
WATER
In marine, air or road transport accidents, the victims
may be injured or killed before entering the water.
Persons falling from docks, bridges or ships may strike
masonry or solid obstructions before hitting the water.
Suicides may suffer in the same way or in exceptional
circumstances, may stab themselves or cut their throats
in a position where they fall into water immediately
afterwards.

When the nature of the injuries is such that they could

not have occurred in water, the issue is clear. Burns,
missile wounds, the effect of explosions (other than
compression injury) and patterned injuries may be
incompatible with infliction in water, and must therefore
be related to the effects of a previous assault or some
accident on board ship or aircraft.
 INJURIESSUSTAINED IN THEWATER
• Trauma in the water is common, as both an ante-mortem
and a postmortem phenomenon.
• The issue usually becomes one of attempting to
distinguish injuries sustained during life from those after
death.
• Water complicates the problem by washing away surface
bleeding from open injuries. A laceration inflicted during
life will, however, usually show some bleeding into the
tissues under the margins of the wound, at least until
postmortem decomposition blurs the appearances.
▶ Freshwater vs seawater
▶ Causes of death in drowning
▶ The autopsy signs of drowning
▶ Chemical changes in the blood
▶ Histologic changes
▶ Diatoms and the diagnosis of drowning
▶ Estimate time of drowning
Types of drowning:

Drowning is of four types:

Wet drowning: in this , water is inhaled into lungs and the
victim has severe chest pain. If resuscitated, he has no
pleasant recollections.
Dry drowning: in this type water does not enter the lungs
but deaths result from immediate sustained laryngeal
spasm due to inrush of water into the nasopharynx or
larynx. Thick mucus foam and frothy may develop,
producing a plug. This is seen in 10 to 20% cases of
immersion. Resuscitated victims have panoramic views
past of life and pleasant dreams without distress.
Secondary drowning: (post immersion syndrome or
near drowning): in this type death occurs from
within half hour to several days after resuscitation.
Electrolyte disturbances and metabolic acidosis
occur. Death occurs from cerebral anoxia with
irreversible brain damage. Microscopically , the
lungs show hemorrhage desquamative and
exudative reaction. Later change are of inhalation
pnemonitis with hyaline membranes in alveolar
ducts and foreign body reaction to inhaled
particle, progressing to bronchopneumonia or
abscess formation. The loss of normal surfactant by
the inhaled water can result in large areas of
atelectasis. Death may occur from cerebral anoxia
with irreversible brain damage. Myocardial anoxia
may cause delayed heart failure.
Immersion syndrome(hydrocution or submersion inhibition):
death results from cardiac arrest due to vagal inhibition as
result of :
1) Cold
water stimulating the nerve ending of the surface of the
body.
2) Water striking the epigastria.
3) Cold
water entering ear burns , nasal passages, and larynx
which cause stimulation of nerve ending of the mucosa.
Fresh water drowning

▶ A massive absorption of water through the alveolar membranes.

▶ Relative anaemia and myocardial hypoxia.

▶ Hemolysis of red cells release potassium- ventriculer fibrillation.

▶ Death in freshwater typically took some 4–5 minutes

Seawater drowning

▶ Withdrawal of water from the plasma into the lungs.

▶ Less deleterious to heart function and helped to explain the longer

survival time in seawater immersion.

▶ Seawater drowning take 8–12 minutes.

Causes of death in drowning

1) Asphyxia. Inhalation of fluid causes obstruction to the air-passages.

Circulatory and respiratory failure occur simultaneously, due to
anoxia of both the myocardium and the respiratory center.
2) Ventricular fibrillation. In fresh water drowning, arrhythmias of the
heart beat, ventricular tachycardia and fibrillation cause death
within three to five minutes.
3) Laryngeal spasm may result from inrush of water into the naso-
pharynx or larynx.
4) Vagal inhibition is due to icy cold water, high emotion or
excitement and unexpected immersion.

5) Exhaustion.

6) Injuries: Fracture of skull and fracture-dislocation of cervical

vertebrae may occur due to the head striking forcibly against some
solid object. Concussion may occur due to striking the head
against some hard substance or the water itself while falling from a
height.
The Autopsy Sings of Drowning
Froth in the air passage
 The froth is oedema fluid from the lungs.

 Exudes through the mouth and nostrils.

 pink or red-tinged, because of intrapulmonary bleeding.

 Not all froth around the mouth is from drowning.

Overinflation of the lungs

Overinflation of the lungs (emphysema aquosum)

 The older name for this condition is ‘emphysema aquosum’

 The oedema fluid in the bronchi blocks the passive collapse that
normally occurs at death.

 This may be sufficient to mark the lateral surfaces of the lungs with
the impression of the ribs, leaving visible and palpable grooves after
removal of the organs from the thorax.
Fig. Cut section of lung showing
Pulmonary edema
Sub-pleural
▶ Reflecting intra-alveolar heamorrhages

heamorrhages
(paultauf spots):
Stomach full of water
Haemorrhage into the middle ears and into
the temporal bone
Aqueous liquid inside sinuses
Cadaveric Spasms
Involving the hand (firmly grasping weeds or sands) indicating the
victims was alive when immersed
Chemical changes

▶ Because of the marked haemodilution that occurs in freshwater

drowning and the electrolyte shifts in saltwater drowning, it is
reasonable to expect that chemical analyses of the plasma should
provide reliable evidence of drowning.
▶ Unfortunately, these theoretical hopes have not been realized in
practice, mainly because of the biochemical chaos that occurs
soon after death from any cause, in which the ability of live cell
membranes to partition fluid and electrolytes is rapidly lost.
▶ Normally chloride con. In rt. And lt. chambers are equal.

▶ Changes more than 25mg/100ml : suspect drowning.

Histologic changes

▶ The reduction of spleen weight and spleen–liver ratios postulated as

a diagnostic marker in drowning when compared with other modes
of ‘asphyxia’.
▶ The skin changes in maceration are also well recorded, and some
have been claimed to have use in dating the period of immersion.
Diatoms

▶ Diatoms are Unicellular algae with outer siliceous wall.

▶ Resist heat and acid.

▶ The basic premise is that when a live person is drowned in water

containing diatoms (microscopic algae with a silicaceous
exoskeleton), many diatoms will penetrate the alveolar walls and be
carried to distant target organs such as brain, kidney, liver and bone
marrow. After autopsy, samples of these organs can be digested
with strong acid to dissolve the soft tissue, thus leaving the highly
resistant diatom skeletons to be identified under the microscope.
▶ When a dead body is deposited in water or when death in the
water is not due to drowning, then, although diatoms may reach
the lungs by passive percolation, the absence of a beating heart
prevents circulation of diatoms to distant organs.
Time passed since drowning

 Estimated through :
 Rate of body cooling
 Floating of body (occurs after 5-8 days in summer)
 Volume of pleural fluid accumulated