The diagnosis of drowning. A review

Abstract

The author first considers what is known at present of the physiopathology of drowning. Subsequently full attention is given to obvious differences between experimental drowning and drowning as it normally occurs. Putrefaction and post-mortem mutilation are both frequent and set limits to the investigation possibilities of drowned bodies. The picture is altered in relation to the degree of pollution of the water responsible. Moreover resuscitation efforts, i.e. artificial ventilation and drug administration, can influence some post-mortem laboratory measurements. Hydrocution and death from hypothermia in water are then commented upon. These cases call rather for a diagnosis per exclusionem, since no visible specific cadaveric signs are induced, except for the occasional diatom penetration into the lungs. The investigation possibilities under these different circumstances are summed up. The possible findings in the upper air passages and stomach are considered in regard to their diagnostic significance. Most of the methods applicable to examination of lung tissue are mentioned. They are judged according to their own merits. Blood analysis in relation to the aqueous inflow or biochemical reactions are summarized. The diagnostic value of the presence of diatoms in the organs, and particularly in the bone marrow, is sketched and illustrated by two particular cases. In conclusion the author emphasizes the reliability of the diatom examination when used critically in experienced hands.