CADAVERIC SIGNS IN CASES OF DROWNING.
The signs alleged to be common to death by drowning and characteristic of it are difficult to deal with, for the reason that there are no sure signs of drowning and the lesions furnished by necropsy are of feeble importance. There is consequently a divergence of opinion on this subject.
External Signs.
Among the external diagnostic signs consistent with the supposition of death by drowning, the presence of froth at the mouth and nostrils is of first importance. Cadaveric rigidity, pallor, goose-skin, rosy or violet discolorations on various parts of the body, retraction of the penis and scrotum, fish-like expression of the eye, peculiar position of the tongue, maceration of the palmar and plantar epidermis, and convulsive contraction of the limbs, particularly of the hands, which may be clinched after the manner that marks death by asphyxia, are all signs which when united form strong presumption in favor of submersion.
These typical and classic signs may, however, be varied by many circumstances. Hence the dissidence of authors. Dr. F. W. Draper states that after inspecting 149 drowned bodies, he has never observed that important sign of death, the presence of substances grasped in the hands.[941] Sand or mud in the hollow of the nails and excoriations of the fingers are also regarded as probable, not certain, signs, since each of these might have occurred either before or after death. The peculiar clinched condition of the hand is not pathognomonic, though strongly suggestive of drowning, as it may appear in asphyxiation from other causes. I have lately noticed this among the external appearances of the bodies taken from the Pompeiian excavations. The further index of drowning known as washer-woman’s or cholera hand, with non-adherent tendency of the epidermis, is an effect that may be produced upon the living after a prolonged bath, notably in the aged and habitually unclean. Nor is the position of the tongue a special and distinctive characteristic of drowning. Only a few months ago I observed its presence in some of the victims of mechanical suffocation in the Ford’s Theatre disaster in Washington.
The shrunken state of the genital organs is apparently of little positive value as a thanatological sign, since the negative and opposite state of erection has been often observed, and Dr. Ogston states that he met semi-erection in twenty-two cases.
The value of “goose-flesh” as a link in the chain of evidence is also weakened when we consider that it frequently occurs after other violent modes of death. Anserine skin is often met with during life, and cases of drowning are recorded where this appearance has been absent.
The aspect of the face and the general position of a drowned cadaver may likewise vary according to the mode of death. Immobility of the body in the attitude of agony, the horrible grimaces of asphyxia, the pale, calm features of syncope, and putrefactive changes are further circumstances of medico-legal detail that may complicate the problem and render an autopsy necessary in order to invalidate or confirm the uncertain conclusions furnished by the external signs.
Internal Lesions.
Autopsies on the drowned are remarkable owing to their negative signs. But as an extension of diagnostic means, the autopsy may show the vertical (though not invariable) position of the epiglottis; the presence of water and foreign matter in the bronchi; swelling and emphysema of the lungs; hydræmic engorgement of the liver; fulness of the right heart and emptiness of the left; fluidity of the blood; water in the stomach and middle ear; and a characteristic frothy mucus or lather more or less bloody, which most observers and writers consider the only constant post-mortem appearance of drowning.
Examination of the respiratory apparatus is of extreme importance in a question of this kind, for it is contended that the presence of foreign bodies is a proof of submersion.[942]
This opinion is in part erroneous, since it has been observed that when a body is submerged after death water will penetrate the larynx, trachea, and remote bronchi, as well as the stomach and middle ear. Moreover, Dr. Ogston states that in 48.7 per cent of cases of drowning no water was found in the lungs.
The emphysematous condition of the lungs, which are said to force their way out of the chest on removing the sternum, is difficult to distinguish from the result of putrefaction. Dr. Gilberti shows that in the drowned the lungs disintegrate rapidly, while the heart, in which putrefaction begins chronologically, is relatively in a good state of preservation.[943]
Since many cases have been observed in which both sides of the heart may be partly filled or both be empty and flaccid, or the left side distended more than the right, we are obliged to regard the exceptions concerning this post-mortem sign of drowning as co-extensive with the rule.
Excessive fluidity of the blood depends upon the rapidity with which the drowning took place. Slight hydræmia occurs in rapid submersion, but when the drowning has taken place slowly a large amount of water passes into the blood. In certain poisonings by opium this fluidity also exists; but it is claimed that analysis and the spectroscope may clear up the diagnosis.
Hydræmic engorgement of the liver is regarded as a characteristic fact by Lacassagne, who claims to be able to diagnosticate drowning from a single examination of this organ.[944]
It is now generally admitted that the presence in the stomach of a certain quantity of liquid in which the body was found immersed may be considered as a sign almost certain of asphyxia by submersion.
Dr. Fagerlund concludes from his experiments that liquids do not penetrate after death either the stomach or anus unless strong pressure be made. But when asphyxia occurs in water the liquid is found in the stomach and the intestines, where it is helped on by peristaltic movements. The pylorus is an obstacle to the passage of this water, the movement of which is easier when the stomach is empty and the submersion prolonged.[945]
The quantity and quality of the water may constitute important evidence; but to be of full value the water or other fluid found in the stomach ought to be the same as that in which the immersion has taken place.
The liquid, which may have been taken just before drowning, should not be noticed unless it exceeds half a pint; but anything peculiar in the fluids, either of the lungs or stomach, should be subjected to microscopic or other examination.
Presence of water in the middle ear is regarded as a thanatological sign of great value. Dr. Bourgier claims as the result of his examination that 23 cases out of 27 had water in the middle ear. Several German observers pretend to have found amniotic liquid in cases of fœtal asphyxia. The fluid may be aspired by a small pipette.
Many of the foregoing signs and lesions disappear or undergo variable alterations after sojourn in water, putrefaction, etc. They may, as they have done in the past, give rise to many controversies, so that presumptions only can be established. Hence the necessity for careful and detailed necropsy in such cases, with a view not only to minimize conjecture and uncertainty, but to prevent opposing counsel from entering the plea of negligence and incompleteness.