Drowning
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Direct answer
Drowning is a form of asphyxia from aspiration of water into the air passages, or, in about ten to fifteen per cent of cases, from laryngospasm without aspiration — dry drowning. Death results from hypoxia, with fresh water causing haemolysis and ventricular fibrillation and sea water drawing fluid into the alveoli. Diagnosis rests on external signs — fine white froth at the mouth and nose, washerwoman skin, cutis anserina — and internal findings of emphysema aquosum, Paltauf haemorrhages and debris in the airways, with the diatom test as supportive evidence.
What you must remember
- Stages: breath-holding with struggle, involuntary gasping and aspiration of water, convulsions, and terminal apnoea within minutes; sudden submersion in cold water can kill instantly through vagal inhibition, especially with alcohol.
- External signs: abundant fine white or blood-tinged froth at mouth and nose, often mushroom-like — the single most useful sign; cadaveric spasm gripping weeds or grass proves the person entered water alive; washerwoman skin of hands and feet, and cutis anserina.
- Internal signs: ballooned, oedematous lungs with rib imprints — emphysema aquosum; froth in the air passages; water, mud and plankton in the trachea and stomach; and Paltauf haemorrhages, the pale subpleural patches and haemorrhages of alveolar rupture.
- Fresh versus sea water: fresh water is absorbed and haemolyses blood, causing haemodilution and fibrillation; sea water draws plasma into alveoli, causing haemoconcentration and a longer survival.
- Diatom test: diatoms aspirated during drowning reach the bloodstream and lodge in bone marrow and organs; matching them with the water's species supports drowning, though specificity is debated and contamination must be excluded.
- Bodies in water: a drowned body sinks first, floats bloated face down later; postmortem propeller and animal injuries lack vital reaction and must not be misread as assault.
- Immersion versus drowning: washerwoman change and cutis anserina show only time in water; a corpse thrown in shows no froth, no emphysema aquosum and no diatoms in organs.
Common confusion
Being found in water is equated with drowning. The examiner wants antemortem drowning distinguished from postmortem immersion — froth, emphysema aquosum, Paltauf haemorrhages and diatoms indicate drowning; skin maceration only indicates immersion. Remember too that most drowning is accidental, and homicide by other means with disposal in water must be excluded.
Exam-focused takeaway
Examiners ask the sequence of drowning, the characteristic external and internal signs, fresh versus sea water differences, and the basis and limits of the diatom test. MCQs name cadaveric spasm, cutis anserina and Paltauf haemorrhages. In viva, discuss a bloated river body with propeller cuts, and near drowning with its hypoxic complications.
Frequently asked questions
What is the most characteristic external sign of drowning?
Fine, abundant, white or blood-tinged froth at the mouth and nostrils, persisting and increasing on chest compression.
What is emphysema aquosum?
The waterlogged, over-distended, oedematous lung of drowning, with rib imprints on the pleura and frothy fluid exuding from the cut surface.
What is the diatom test?
A supportive test matching diatoms found in bone marrow and organs with the species in the suspected water, showing that the person aspirated that water alive.
What is dry drowning?
Death from intense laryngospasm after a small amount of water touches the larynx, without significant aspiration — roughly a tenth or more of drownings.
How are injuries on a recovered body interpreted?
Antemortem injuries show vital reaction and suggest assault before submersion; propeller, rock and animal injuries without vital reaction occurred after death.
Why does a drowned body float face down?
The head is relatively heavy and gases collect later in the trunk and limbs, so the prone posture with hanging limbs is typical.