Findings and interpretations in deaths after submersion in water
It is important to distinguish changes directly attributable to death following submersion (discussed here) from those which purely reflect immersion (discussed later).The changes described here, which are well documented in standard textbooks and review articles are those encountered in fresh bodies that is, those removed from the water before decomposition becomes established; once a lengthy delay has occurred, positive diagnosis may be difficult.
DROWNING
Externally, although a range of changes maybe identified, there may be nothing specific to drowning. Sometimes, however ,firm tenacious foam is present at the mouth or nostrils. Typically, it is white or blood tinged, and reappears after wiping away.It is thought to represent an admixture of air, fluid, mucus and surfactant, and therefore an ante mortem phenomenon.
Internally, the foam, even if not apparent externally, is often found in major airways or secondary bronchi and bronchioles.The airways may also contain water and such extrinsic materials as silt, weeds, or sand. Similar substances (particularly water) may be swallowed and thus identified within the stomach. Pulmonary changes vary according to the drowning fluid, although they are often not as distinct as suggested by differences in causative mechanisms and as implied in some textbooks.
Fresh water
Typically, the lungs are almost twice their normal weight, and present an appearance sometimes still designated "emphysema aquosum" they are bulky and overdistended (such that they may well overlap the pericardial sac and meet in the midline), with a very characteristic doughy texture which causes them to pit on digital pressure and sometimes to show prominent rib markings. Classic petechial haemorrhages are uncommon, but larger subpleural and intrapulmonary haemorrhages may be identified. Section releases frothy, often blood tinged fluid. Elsewhere, haemodilution causes the blood to appear rather"watery"; haemolysis may produce intimal staining of major vessels.
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