Text-book of forensic medicine and toxicology

by R. J. M. Buchanan

1. In the Skin.—Rose-coloured patches may be present on the face and neck. The condition of goose skin—cutis anserina—is hardly ever absent even in summer. The cutis anserina is not, however, characteristic of drowning, as it may be present in other forms of violent death, and also in some persons during life. It is a vital act, the result of nervous shock, and does not depend upon the temperature of the water for its production; still, it points to recent vitality.

2. The Tongue.—The tongue is just as often found behind the jaws as between them (Casper).

3. The Hands and Feet.—The hands and feet acquire a greyish-blue colour when the body has lain in the water from twelve to twenty-four hours. The skin also becomes corrugated in longitudinal folds. The greyish-blue condition of the hand is known as the “cholera hand.” The nails may contain particles of sand and weeds. “No corrugation or discoloration of the skin of the hands or feet is ever observed on the body of anyone drowned who has been taken out of the water within half an hour, within two, six, or even eight hours” (Casper). The same authority states he has produced these effects by laying the hands after death in water, or wrapping them in cloths kept constantly wet for a few days.

4. The Genitals.—Contraction of the penis and dartos is an almost constant symptom, and Casper has “not observed anything similar so constantly after any other kind of death.” It is due, probably, to the same cause as the cutis anserina, which Brettner attributes to “bundles of unstriped muscular fibres, lying in the upper stratum of the true skin, surrounding the sebaceous glands, and forcing them forwards by their contraction, thus making the cutis anserina. Precisely similar unstriped muscles are found in the subcutaneous cellular tissue of the penis; they run principally parallel to the long axis of the member, but very often large bundles run across it.” The action of cold and fright is to induce contraction of these cutaneous muscles, with a resulting contraction of the penis.

II. Internal

1. The Brain.—Cerebral hyperæmia is most rare in the drowned, but cerebral hypostasis is not infrequently mistaken for it.

2. The Trachea.—The mucous membrane of the trachea and larynx is always more or less injected, and is of a cinnabar-red, which must not be mistaken for the dirty, brownish-red colour, the result of putrefaction. A white froth, but seldom bloody, is also found in varying quantity in the trachea, and is a most important sign of vital reaction, but its diagnostic value is destroyed by putrefaction. Sometimes a portion of the contents of the stomach may be found in the trachea. When this occurs it is due to the act of coughing, induced by the admission of water into the lungs. The contents of the stomach are forced into the mouth, and then drawn into the lungs during the next attempt at inspiration. This indicates that the person entered the water during life. In cases where death has taken place from syncope little or no froth may be found in the trachea.

3. The Lungs.—The lungs are completely distended, almost entirely overlapping the heart, and pressing close to the ribs. They are spongy to the feel, and when cut into, a considerable quantity of bloody froth escapes. The froth found in the lungs is the result of the powerful attempts to breathe, and cannot be produced by artificial means. It adheres not to the sides of the bronchial tubes, as does the exudation of bronchitis or pneumonia. The distension of the lungs is due partly to an actual hyperæmia, and partly to inhaled fluid. Water is present in the pleural cavities.

4. The Heart and Great Vessels.—As is common to other forms of asphyxia, the left side of the heart is entirely, or almost entirely, empty; the right, on the contrary, is engorged. This condition of the heart is, therefore, not a diagnostic sign of drowning, and is absent in the drowned when death takes place by neuro-paralysis; in fact, in some cases of undoubted drowning, both sides have been found empty, probably, however, the result of putrefaction (Ogston). The same may be said of the accompanying congestion of the pulmonary artery.

5. The Blood.—As is common in all forms of death where respiration has been arrested, the blood is found to be remarkably fluid, and of a cherry-juice colour. M. Faure in his monograph on asphyxia states that he has found large and firm clots in the right side of the heart in the drowned who have not remained long under water. The blood is diluted with water, most marked in the left side of the heart. The amount of dilution is greater in slow drowning.