a U?UST 1902.1 ASPHYXIA CAUSED BY DROWNING 297 Table I. Shows the occurrence of fluid and mud in the 55 fresh bodies. ?ritfinal Jlrttclcs. Fluid. Mud. Air-passage ... .... 20 2 ? ? and stomach ... ig 6 ? ? stomach and intestine ... 7 1 ? ? and intestine X ??? Stomach ... ??? THE POST-MORTEM APPEARANCES IN Intestine ... ... 1 Stomach and intestine ... ... i CASES OF ASPHYXIA CAUSED BY DROWNING. Total 46 9 = 55 By J. B. GIBBONS, From the above table it will be seen that fluid was in the alone in 20 LIEUT.-COL., I.M.S., present air-passage cases, in the air-passage and stomach in sixteen, Lute Police-Surgeon, Calcutta, Civil Surgeon, Ilowrah. in the air-passage, stomach and intestine in seven, in the air-passage and intestine in one. As used in this table the term includes frothy and non- frothy fluid. Frothy fluid is only to be expected In the period from June 1893 to November when the has been quickly recovered from months which I body 1900, excluding three during the water in which drowning took place and cases on leave, 15/ of was privilege asphyxia examined without delay. In some of my cases were examined me in the due to drowning by it was present in a most typical form; there was For the of this Calcutta Morgue. purpose a bunch of fine lathery froth about the nostrils, all cases of death inhibition paper I exclude by and the respiratory tract down to the bronchi due to submersion and all cases of or syncope was filled with it. received after into death from injuries falling The quantity of fluid in the air-passage varies the water. greatly ; this is explained by varying dura- Of these 157 cases of asphyxia due to drown- tion of the third stage of drowning. The longer were in a efforts the ing in 55 the bodies fresh condition the inspiratory continue, greater the were into the when examined ; 21 slightly decomposed, quantity of fluid aspirated air-passage were also the the that is, signs of beginning putrefaction and lungs, and greater transudation swelling of the body, cloudiness and of serum from the blood-vessels. It is in these present' of softening of the conjunctivae, the blood begin- cases of prolonged third stage drowning that of disco- we full of ning to putrefy, the surface the body get the typical lungs, fluid, soddened 81 was loured ; in the remaining putrefaction and ballooning. far advanced, the bodies enormously swollen, On the other hand, every medical jurist can cuticle peeling off or gone, the eyes protruding call to mind cases of: drowning in which the and putrid, gases bubbling from nostrils and lungs presented an ordinary appearance and the orbits, the brain liquefied, the internal organs air-passage contained only a small quantity of bodies ot putrid. In some of the the abdomen had fluids. These are instances death occurring burst, the stomach was pultaceous, the lungs in the second stage or of a very short third also completely decomposed. stage. It be mentioned that the In the remarks, attention will be may presence of following and are much fluid in the lungs fluid in the directed only to those appearances which frothy to is not confined to cases of of value, especially the occurrence air-passage drowning ; diagnostic in death from other causes of fluid and mud in the air-passage, stomach by asphyxia they are the most familiar in and intestine. also present; instance India is when death occurs " in the opium poisoning, the term following a By air-passage" and there has been long third stage, so to be understood the tract slowly, tables, is respiratory that much fluid has been poured out of the rima ; when a has been below'the glottis corpse vessels into the lungs and bronchi where it is in water for some time, fluid and mud are churned up with air. In some cases of found in the nose and mouth, but, hanging, generally froth and fluid are abundant. From the table are no value. of diagnostic it will be seen that in none of the cases was the cases in As fluid in stomach, fluid found in the stomach alone; the presence regards was which a small quantity present, are not of fluid in the alimentary canal is the result of only the included in the tables unless water presented swallowing in the first and second stages of the oi unless the air- some distinctive character, drowning process. Fluid transudes rapidly also contained fluid. passage or the intestine through the mucous membrane of the stomach ; in the intestine was this accounts for the with which The presence of fluid frequency only a fluid is judged in the same way. small quantity of found in the organ. 298 THE INDIAN MEDICAL GAZETTE. [August 1902. Only in nine of the 55 cases referred to in Table Of the 81 decomposed bodies in 47 signs were I was mud found within the body; in most of found upon which a diagnosi^of death by drown- the cases the drowning took place in clean water, ing could be made with certainty. It will be several were children, who were accidentally observed that no fluid was found in the air- drowned in the cisterns of bathing places. The passage, and in the alimentary canal in three mud was mixed with fluid. cases only, that is, in sufficient quantity to be of In these 55 bodies the appearances of death diagnostic value. Although fluids in the air- by asphyxia were well marked and, as shown in passage and alimentary canal disappear when the table, in all, special signs of drowning were putrefaction is advanced, solid matter, mud, found; hence the diagnosis of the cause of death sand, or other foreign substance remains, and, as was possible without reference to the history of the above table shows, enables the medical jurist the cases. to give a positive opinion of the cause of I have not referred to the presence of cutis death. anserina and retraction of the penis ; these signs In 34 of the decomposed bodies neither fluid are of value, but in my experience they are nor mud was present; in '?these cases the deter- not usually present and, moreover, the}7, are not mination of the cause of death was attended peculiar to drowning. Neither have I mentioned with much difficulty, especially in those in which the soddened condition of the cuticle of hands, the history furnished by the police was scanty, feet, knees and elbows produced after death by or merely recorded the fact that the body had inhibition of water, for this sign only shows been found floating; in water. I extract from in water that the body has been for not less my notes the following which may be taken than one hour. as the type of a large number of cases of drown- sent Table II. ing to the Police Surgeon of Calcutta. The Police report states that the body of an Shows the occurrence of fluid and mud in the European, name unknown, was discovered 21 slightly decomposed bodies. in a tank on the maidan, on the Fluid. Mud. floating of the 5th November 1896. The Air-passage ... 4 morning post- mortem examination was held in the ,, and stomach ..5 2 early 1 afternoon of same The was ? stomach and intestine the day. body ... 1 ? and intestine enormously distended from putrefaction ; the Stomach ... clothing, stretched and in places burst, Intestine ... tightly consisted of a khaki coat and Stomach and intestine 2 trousers, shirt, vest, underdrawers, inside of which were pieces 7 8=15 of brick and stones, shoes and socks. Attached ... Neither fluid nor mud 6 to the belt of a truss there was a pillow case of brick and stones. Total ... 21 containing pieces The features the hair Froth was not found in any of these cases; enormously swollen, the and the fluid in the air-passage was generally of a loosened, eyes putrid protruding, gas from the nose and reddish colour from transuded blood. It will be bubbling orbits, mouth, tongue with The cuticle observed that in six, that is, in almost one-third projecting covered mud. loosened, most of it was detached in of the cases, neither fluid nor mud was found. removing the that of the and toes came oft In these cases the that death was due clothes; fingers opinion in a mass. to drowning was based on the signs of asphyxia, glove-like The were the absence of all other causes for this condi- internal organs putrid, the lungs tion and the history. In many of the cases pultaceous, the brain liquefied. In the pleural were sacs there an the external appearances of assistance in was accumulation of reddish determining the cause of death. watery fluid. The heart cavities were empty, the endocardium of the side was stained a III. right Table dark red colour. Shows the occurrence of fluid and mud in The viscera were sent for chemical analysis: 81 decomposed bodies. no poison was detected. Fluid. Mud. At the I Air-passage ... 19 Coroner's Court gave the opinion that and stomach 8 deceased died due to ? of suffocation drowning, stomach and intestine ... 5 ? and in to the further question that the and intestine 2 reply ? case was one of suicide. There can be no doubt ??? Stomach ... 1 8 case ??? the was one of the Intestine ... 1 1 suicide, circumstances, Stomach and intestine ... 1 1 the absence of signs of violence on the body and of poison as proved by the chemical exa- 44 = 47 miner, more the manner in which the Neither fluid nor mud ..