Macromorphological findings in cases of death in water: a critical view on “drowning signs”

Abstract

Death in water is a challenging issue in forensic pathology since from natural death to homicide all circumstances of death in water are conceivable. Therefore, the correct interpretation of all abnormal autopsy findings is important. In order to determine a death by drowning, numerous internal and external signs of drowning are already described. However, these are supposed to be influenced by various factors reducing their significance and evidence. Moreover, the autopsy of water corpses often reveals further pathological findings that should not be underestimated for determining the cause of death. The aim of this study was to set frequencies of the observed drowning signs in context to the forensic literature and to identify possible influencing factors. In this study, we observed that pathological organ changes of the cardiovascular system were significantly more common in corpses after shortened (atypical) drowning processes than in classical drowned victims. Furthermore only a complete formation of external foam, immediately after the corpse’s recovery, was exclusively found in drowning victims. All other drowning signs were either also observed in non-drowning deaths in water or no information could be provided with reasonable assurance. In addition, many of the examined drowning signs were negatively affected by prolonged postmortem intervals, putrefaction, or resuscitation attempts. It can be concluded from our analysis that morbidity is an important factor in deaths in water. Morbidity can support a death by drowning in case of incidents in water. For the examined drowning signs, no high diagnostic certainty could be observed. Nevertheless, these findings can increase their diagnostic value—if forensic physicians take influencing factors into consideration.

Autopsy Findings on Decomposing Drowned Body: Identification of Specific Diagnostic Features of External, Internal, and Laboratory Examinations

“…These fluid-filled bubbles are called edema aquosum resulting from the redistribution of osmotic fluid into the alveolar space with hypertonic hyperhydration occurring during saltwater submersion. After weighing, lung weight did not increase from the average lung weight of about 250-300 g [10].…”

“…This is accomplished by opening the head and looking at the middle ear and spongy stratum of the mastoid bone. Bleeding points can be found on the mucous membranes of the mastoid bone and middle ear, which is a strong indication of drowning [10].…”

Epidemiological analysis of intramuscular hemorrhage of respiratory and accessory respiratory muscles in fatal drowning cases

“…In addition, even if the cause of death is drowning, the cause of drowning can range from external, such as trauma or the effects of drugs, to internal causes [ 1 , 2 ]. Therefore, in the case of corpse in water, the diagnosis of the cause of death should be made comprehensively and carefully on the basis of autopsy and supplemental examination findings [ 1 – 4 ].…”

“…The most important external sign of vital drowning is froth, which results from the mixture of air, water of the drowning medium, proteinaceous exudate, and pulmonary surfactant [ 5 , 6 ]. The froth is observed typically as a fungiform structure (mushroom shape) around the mouth and nostrils, but is only seen in fresh corpses (within about 1 day of death) [ 4 ]. Moreover, it is not specific to drowning, as froth is also present in other causes of death, such as cardiogenic pulmonary edema, poisoning, and strangulation [ 3 , 4 ].…”

“…The froth is observed typically as a fungiform structure (mushroom shape) around the mouth and nostrils, but is only seen in fresh corpses (within about 1 day of death) [ 4 ]. Moreover, it is not specific to drowning, as froth is also present in other causes of death, such as cardiogenic pulmonary edema, poisoning, and strangulation [ 3 , 4 ]. The most important internal sign of drowning is hyperinflation of the lungs (called emphysema aquosum) [ 1 – 6 ].…”