Diagnosis of death from drowning is often difficult; only a set of signs and the use of laboratory research methods allows one to correctly determine the cause of death.

Rice. 12. Foam around the mouth and nose openings during drowning.

During an external examination of a corpse, the following signs are important, allowing one to suspect: the skin, as a result of a spasm of the skin capillaries, is paler than usual; cadaveric spots are purple with a gray tint and pinkish coloring along their periphery. So-called goose bumps are often observed, which is a consequence of contraction of the muscles that lift the hair. Around the openings of the mouth and nose, as a rule, pinkish-white, persistent, fine-bubble foam is detected (Fig. 12). The foam around the breathing holes persists for up to two days after the corpse is removed from the water, then it dries and a mesh film of a dirty gray color is visible on the skin.

During internal examination, a number of characteristic signs attract attention. When opening the chest, a sharply pronounced appearance is observed; the latter completely fill the chest cavity, covering the heart. Imprints of the ribs are almost always visible on the posterolateral surfaces of the lungs. The lungs have a doughy consistency to the touch due to significant swelling of the lung tissue. The increase in lung volume while the corpse is in water gradually disappears by the end of the week. Lukomsky-Rasskazov spots are observed under the visceral pleura. These spots are hemorrhages of a reddish-pink color, much larger in size compared to Tardieu spots, located only under the visceral pleura: Their color and size depend on the amount of water entering the systemic circulation through the torn and gaping capillaries of the interalveolar septa. Diluted and hemolyzed blood becomes lighter, its viscosity decreases, and therefore hemorrhages become blurry. Lukomsky-Rasskazov spots disappear after the corpse remains in water for more than two weeks. Thus, the absence of Lukomsky-Rasskazov spots when the corpse remained in water for a long time does not indicate that they did not exist at all.

The visceral pleura is cloudy. When examining the respiratory tract, a grayish-pink, finely bubbled foam is found in them, in the composition of which, upon microscopic examination, foreign inclusions (sand, small algae, etc.) can often be detected. The mucous membrane and bronchi are edematous and cloudy. Bloody, foamy fluid flows copiously from the surface of the lung incisions. The stomach usually contains a large amount of fluid. The liver capsule is also somewhat cloudy. The gall bladder bed and its wall are markedly swollen. In the serous cavities one can see a significant amount of , which, according to a number of authors, is formed 6-9 hours after the corpse has been in the water and essentially refers to the signs indicating that the corpse has been in the water. The detection of fluid in the tympanic cavities of the middle ear is of the same importance. As a result of laryngospasm, the pressure in the nasopharynx decreases, and therefore water enters the sinuses of the main bone through the pyriform slits. The volume of water in the sinuses can reach 5 ml (Sveshnikov's sign). In case of drowning, hemorrhages are found in the tympanic cavity, mastoid cells and mastoid caves, which look like free accumulations of blood or abundant soaking of the mucous membranes. The occurrence of this phenomenon is associated with an increase in pressure in the nasopharynx, circulatory vascular disorders, which, in combination with severe hypoxia, lead to an increase in the permeability of the vascular walls with the formation of these hemorrhages.

Laboratory tests, especially the plankton detection method, are important for the diagnosis of drowning. Plankton are the smallest organisms of plant and animal origin that live in lakes, rivers, seas, etc. Each body of water is characterized by certain types of plankton, which have specific differences. For the diagnosis of drowning, plankton of plant origin is of greatest importance - phytoplankton, especially diatoms. Diatoms have a shell consisting of inorganic compounds - silicon. This shell can withstand high temperatures, strong acids, etc. Diatom phytoplankton has different shapes and is found in the form of sticks, stars, boats, etc. Diatoms up to 200 microns in size, together with water, through broken capillaries of the alveoli, penetrate into the systemic circulation and are carried through the bloodstream throughout the body, lingering in the parenchymal organs and bone brain. Detection of this type of plankton in internal organs and bone marrow is an objective method of proving death from drowning.

Sign of Sveshnikov V.A. - the presence of fluid (drowning medium) in the sinus of the sphenoid bone. Having removed the pituitary gland, rinse the back of the sella turcica from a syringe with distilled water, use a small chisel to cut a small window into the sinus of the main bone, through which the liquid located there is extracted using a syringe needle (washed, like the chisel, with distilled water).

In case of drowning, its amount reaches 0.6-5 ml, which does not happen in other types of death. A drop of this liquid is applied to the slide either directly or after enrichment.

Under a microscope, you can find plankton, plant spores, microorganisms and even protozoa in it, which are found in 65-80% of deaths from drowning and are an indicator of the lifetime of drowning.

The trait was described in 1958(?).

Sources

Sveshnikov V.A. About a new sign in the diagnosis of drowning // Forensic medical examination and criminology in the service of investigation (collection of works). - Stavropol, 1965. - 4. - P. 348-350.

Drowning is a special type of mechanical asphyxia, which occurs when the body is completely or partially immersed in a liquid medium (usually water) and proceeds differently depending on the conditions of the incident and the characteristics of the victim’s body.

The medium of drowning is most often water, and the scene of the incident is natural bodies of water (rivers, lakes, seas), into which the human body is completely immersed. Drowning occurs in small shallow bodies of water (ditches, streams, puddles), when liquid covers only the head or even only the face of the deceased, who is often in a state of severe alcohol intoxication. Drowning can occur in limited containers (baths, barrels, tanks) filled with water or other liquid (gasoline, oil, milk, beer, etc.).

Types of drowning

Drowning is divided into aspiration (true, wet), asphyxial (spastic, dry) and syncope (reflex).

True (aspiration drowning) is characterized by the obligatory penetration of water into the lungs with its subsequent entry into the blood, occurring in 65-70% of cases.

With spastic (asphyxial) type drowning due to water irritation of the respiratory tract receptors, a reflex spasm of the larynx occurs and water does not enter the lungs; this type of drowning most often occurs when it gets into contaminated water containing impurities of chemicals, sand and other suspended particles; occurs in 10-20% of cases.

Reflex (syncope) drowning characterized by a primary arrest of cardiac activity and breathing almost immediately after a person enters the water. It occurs in people who are emotionally excitable and can be the result of reflex effects: cold shock, an allergic reaction to substances contained in water, reflexes from the eyes, mucous membrane of the nose, middle ear, facial skin, etc. It is more correct to consider it one of the types of death in water, rather than drowning, occurs in 10-15% of cases.

Signs of drowning

In case of true drowning, external examination of the corpse is characterized by the following: signs:

• white, persistent fine-bubble foam at the openings of the nose and mouth, formed as a result of mixing air with water and mucus of the respiratory tract, the foam lasts 2-3 days, when it dries, a thin fine-meshed film remains on the skin;
• increase in chest volume.

During internal examination of the corpse the following signs :

• acute swelling of the lungs (in 90% of cases) - the lungs completely fill the chest cavity, covering the heart, imprints of the ribs are almost always visible on the posterolateral surfaces of the lungs;
• grayish-pink, finely bubbled foam in the lumen of the respiratory tract (larynx, trachea, bronchi);
• under the pleura (outer membrane) of the lungs there are red-pink hemorrhages with unclear contours (Rasskazov-Lukomsky-Paltauf spots);
• fluid (drowning medium) in the sinus of the main bone of the skull (Sveshnikov’s sign);
• liquid (drowning environment) in the stomach and in the initial part of the small intestine;

With the spastic type of drowning, common signs characteristic of mechanical asphyxia are found during external and internal examination of the corpse, the presence of fluid (drowning medium) in the sinus of the main bone.

There are no specific signs for reflex (syncope) drowning; there are general asphyxial signs.

Death in the water

Drowning is usually an accident during swimming, water sports, or accidental entry into water.

There are many factors that contribute to drowning in water: overheating, hypothermia, loss of consciousness (fainting), convulsive contraction of the calf muscles in water, alcohol intoxication, etc.

Drowning is rarely a suicide. Sometimes there are combined suicides, when a person, before falling into the water, takes poison or inflicts gunshot wounds, cut wounds or other injuries on himself.

Murder by drowning is relatively rare by pushing people into the water from a bridge, boat, throwing newborns into cesspools, etc. or forced immersion in water.

Murder-drowning in a bathtub is possible when the legs of a person in the bathtub are suddenly raised.

Death in water can also occur from other causes. In people suffering from diseases of the cardiovascular system, death can occur from acute cardiovascular failure.

When jumping into water in a relatively shallow place, the diver hits his head on the ground, as a result of which fractures of the cervical spine may occur with damage to the spinal cord; death may occur from this injury and there will be no signs of drowning. If the injury is not fatal, the unconscious person may drown in the water.

Damage to corpses recovered from water

When damage is detected on the body, it is necessary to resolve the issue of the nature of their origin and lifetime. Damage is sometimes caused to a corpse by parts of water transport (propellers), when removing a corpse from the water (hooks, poles), when moving in a fast current and hitting various objects (stones, trees, etc.), as well as by animals living in the water (water rats, crustaceans, marine animals, etc.).

Corpses may end up in the water when a corpse is deliberately thrown into the water to hide traces of a crime.

Signs of a corpse being in water, regardless of the cause of death:

• wet clothes;
• the presence of sand or silt on clothing and body, especially at the roots of the hair;
• maceration of the skin in the form of swelling and wrinkling, gradual detachment of the epidermis (cuticle) on the palmar surfaces of the hands and soles. After 1-3 days, the skin of the entire palm wrinkles (“washerwoman’s hands”), and after 5-6 days - the skin of the feet (“gloves of death”); by the end of 3 weeks, the loosened and wrinkled epidermis can be removed in the form of a glove (“glove of death” );
• hair loss, due to loosening of the skin, hair loss begins after two weeks, and complete baldness may occur at the end of the month;
• signs of rotting;
• presence of signs of fat wax.

. Laboratory research methods for drowning

Research on diatom plankton. Plankton are the smallest animal and plant organisms that live in the water of natural reservoirs. Of all plankton, diatoms are of greatest forensic importance - a type of phytoplankton (plant plankton), since they have a shell of inorganic silicon compounds. Together with water, plankton enters the bloodstream and spreads throughout the body, lingering in parenchymal organs (liver, kidneys, etc.) and bone marrow.

The discovery of diatom shells in the kidney, liver, bone marrow, and long tubular bones is a reliable sign of drowning in water, their composition matching the plankton of the reservoir from which the corpse was extracted. For a comparative study of the characteristics of the plankton found in the corpse, it is necessary to simultaneously examine the water from which the corpse was extracted.

Histological examination. Histological examination of the internal organs of corpses removed from water is mandatory. In the lungs, microscopic examination reveals a predominance of emphysema (bloating) over small foci of atelectasis (collapse), which are located mainly in the central areas of the lungs.

Oil sample. The test is based on the ability of oil and petroleum products to produce bright fluorescence in ultraviolet rays: from greenish-blue, blue to yellow-brown. Fluorescence is detected in the contents and on the mucous membrane of the stomach and duodenum. A reliable sign of drowning is a positive oil sample in cases of drowning in navigable rivers.

Other physical and technical research methods. Determination of blood electrolyte concentrations, measurement of electrical conductivity, viscosity, blood density. Determining the freezing point of blood in the left half, the blood is diluted with water, so the freezing point of the blood will be different, which is determined by cryoscopy.

Forensic chemical research. Taking blood and urine for quantitative determination of ethyl alcohol using gas chromatography.

All of these methods help to establish with greater objectivity the fact of death from drowning.

Issues resolved by forensic medical examination during drowning

1. Was death due to drowning or another cause?

2. In what liquid (medium) did the drowning occur?

3. Are there any reasons that could have contributed to the drowning?

4. How long was the corpse in the water?

5. If there are injuries on the corpse, what is their nature, location, mechanism, did they occur intravitum or after death?

6. What diseases were discovered during the examination of the corpse? Did they cause death in the water?

7. Did the deceased drink alcohol shortly before death?

1

An analysis of the literature on modern and historical principles of drowning diagnostics was carried out. The article reflects the evolution of approaches to solving this problem, starting from the most banal and absurd views dating back to the Middle Ages, ending with modern methods widely used in global forensic practice. The most complete classification of drowning is presented with a detailed description of the pathogenesis of each of its types. A separate part of the article is devoted to aspects that are often ignored by many authors. We are talking about establishing the fact of post-mortem immersion of a body in water, death in water, and separating it as such into an independent group of the reflex type of drowning. The key place of research is the differential diagnosis of types of drowning. Despite the lack of specific data and markers, it was possible to identify groups of signs that are most characteristic of each of them. The final part of the publication demonstrates modern microscopy methods. The main nuances of histological examination and diatomaceous earth test are revealed in detail.

death in the water

drowning diagnosis

drowning

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Drowning is a type of violent death that occurs when a person is immersed in water (less commonly, another liquid), caused by an acute disruption of the functions of the vital systems of the body under the influence of the aquatic environment. When studying corpses taken from water, a number of fundamental questions arise: intravital entry of a person into a body of water, thanatogenesis of death, elucidation of other reasons contributing to the development of drowning.

The purpose of the study was the coverage of modern techniques and methods for diagnosing death from drowning, used both in domestic and foreign forensic practice, as well as consideration of the evolution of approaches to solving this problem.

Materials and research methods

The research methods were the study of modern approaches to the diagnosis of drowning, as well as comparative historical analysis, followed by generalization and systematization of the data obtained. The research materials were domestic and foreign journalistic research publications, reflecting the range of approaches to the study of this issue. The use of these methods, as well as the analysis of the material used, made it possible to ensure the objectivity of the conclusions and results obtained.

Research results and discussion

The problems of diagnosing drowning have been known since ancient times. The first mentions are already found in Hsi Yuan Chi Lu (1247). The chapter “Drowning” includes both common beliefs, devoid of any scientific basis (the position of the victim’s hands, eyes and hair as a way to determine the nature of death; determination of the posture during swimming, characteristic of men and women), and a description of the signs used still in modern expert activity (presence of foamy liquid in the nasal and oral cavity of the victim, detection of the drowning environment in the stomach as evidence of the victim’s lifetime exposure to water). In Europe, the first works on forensic medicine appeared during the Renaissance. The most representative were the textbooks of Paré, Fidelis, de Castro, Platter, Zachia, Bon, and Valentini. Ambrois Pare le Houvre (1575) (France) identified signs that prove the survival of drowning: the presence of water in the stomach and abdominal cavity, the presence of foam released from the external nasal passages and oral cavity, abrasions on the forehead and fingers resulting from involuntary movements with injuries to the rock bottom before death. Fortunatus Fidelis, Italy, points out in De Relationibus Medicorum (1602) that the diagnosis of drowning is usually not difficult: in drowning, the victim has a distended abdomen; mucous discharge from the external nasal openings and foamy discharge from the mouth are observed. The cause of bloating is not the large amount of absorbed water, but the release of steam generated when the liquid is heated during the process of decay. Rodrigo de Castro (Portugal) identifies bloating, mucous discharge from the nostrils and foaming at the mouth as signs of drowning, which are absent in cases of post-mortem immersion in water. At the same time, he refutes abrasions on the fingertips as a sign of drowning, which also occurs when a body is posthumously immersed in water. The author argues that the rise of a body to the surface may be the result of its being in water. Paulus Zakia's work highlights the difficulties in differentiating between drowning and post-mortem immersion. He, along with Paré, Fidelis and de Castro, unanimously recognize the following signs: a swollen abdomen filled with water, mucous discharge from the nasal passages and foamy discharge from the mouth. Secretion from the nasal passages is a consequence of the filling of the ventricles of the brain with water after breathing stops. Foam released from the mouth appears as a result of increased expulsion of air from the lungs and respiratory tract; therefore, the cause of death is cessation of breathing, and not the absorption of water. The third sign identified by Paulus is abrasions on the fingers and face that occur when trying to swim out, grabbing the bottom soil. Johannes Bohn (Germany) in 1711 criticized the signs of drowning mentioned by Paré, Fidelis, de Castro, Platter and Zacchia, emphasizing that these signs were not typical in some cases of drowning. Such a sign as the presence of fluid in the stomach and respiratory tract is often poorly expressed, since the volume of water is detected insignificant.

According to the classification of Yu.S. Isaev and V.A. Sveshnikov distinguishes four main types of drowning in water: aspiration, spastic (asphyxial), reflex (syncope), mixed type.

1. The aspiration type of drowning is characterized by the entry of water into the respiratory tract and lungs with the further development of mechanical asphyxia from the closure of the respiratory tract. When drowning in fresh water, liquid penetrates into small alveoli with their further rupture due to hydrostatic pressure, penetration of water into the general bloodstream, causing hemodilution, hemolysis of red blood cells and, as a result, an imbalance of water-electrolyte balance, leading to fibrillation of the left heart. The duration of the drowning period is 3-5 minutes. When drowning in salt water (sea), water from the bloodstream enters the lumen of the alveoli due to osmotic pressure, thereby causing the process of acute pulmonary edema. Cardiac arrest, as a rule, as a result of asystole develops gradually, over 7-8 minutes with increasing myocardial hypoxia. Cardiac activity stops after breathing for 10-20 seconds.

2. Spastic (asphyxial) type of drowning is characterized by the occurrence of persistent laryngospasm in response to irritation of the receptors of the laryngeal mucosa by the drowning environment, which also triggers the mechanism of mechanical asphyxia from the closure of the airways. Foreign authors claim that the experimentally proven spasm lasts about 2 minutes, then it is replaced by other pathological mechanisms, such as vago-vagal cardiac arrest, which reflexively occurs when fluid comes into contact with the upper respiratory tract. The duration of the drowning period is 5.5-12.5 minutes. The cessation of cardiac activity occurs against the background of arterial hypotension 20-40 seconds after the cessation of breathing. The frequency of occurrence, according to various authors, is from 35% to 61%.

3. The reflex (syncope) type of drowning is characterized by a sudden stop in respiratory and cardiac activity. An important role is played by the emotional background (feelings of fear, panic), as well as the presence of concomitant diseases. Taking this into account, it would be more correct to talk not about drowning, but about death in water. The reflex type of drowning is observed on average in 10% of cases and develops more often in children and women.

4. The mixed type of drowning occurs on average in 35% of observations and is characterized by polymorphism of detected signs, which is associated with a combination of different types of dying. More often, this type of drowning can begin with laryngospasm, which subsequently resolves in later phases of drowning, which entails the penetration of water into the respiratory tract and lungs with the development of phenomena characteristic of the aspiration type of drowning.

The diagnosis of drowning consists of a combination of nonspecific signs, individually each of which is not a reliable confirmation of the diagnosis. There are numerous cases of death in water due to acute pathological conditions of the cardiovascular and respiratory systems, injuries, as well as cases of post-mortem immersion of bodies in water in order to conceal a criminal act. In this regard, the diagnosis of “drowning” is a diagnosis of exclusion and is established when other causes of death are refuted. The presence of additional weight tied to the corpse is not always evidence of forced immersion in water; methods of suicide and post-mortem concealment of the corpse are also possible.

Circumstances of death that make it possible to suspect death from drowning are: removal of a corpse from the water of large bodies of water, discovery on the shore of these bodies of water and in artificial containers with water or near them. The depth of the reservoir does not play a decisive role; just submerging the head or just covering the breathing holes with liquid is enough. In this case, the helpless state of the victim (alcohol and drug intoxication, unconsciousness, disability, etc.) is of decisive importance. Physically healthy people are also at risk of drowning, even professional swimmers. The risk increases with the development of asphyxial and reflex types of drowning, in particular with a sudden and unexpected immersion in water, when, as a rule, the victim becomes helpless and loses the ability to use swimming skills.

External inspection begins with an inspection of clothing, which in most cases is wet with traces of silt and aquatic vegetation (algae). The skin is usually pale, cold to the touch, wrinkled on the palmar and plantar surfaces (“washerwoman’s hands”). When a corpse remains in water for a long time, subcutaneous emphysema and areas of detachment of the epidermis along with appendages (“socks and gloves of death”) appear; “goose bumps” are a sign of death in the cold. The set of these signs in one or another combination is common to all types of drowning, as well as post-mortem immersion of the body in water and for the most part carries information only about the presence of the corpse in water. The most valuable sign is persistent fine bubble foam protruding from the mouth and nasal passages. However, it can also be observed with cardiogenic pulmonary edema, epilepsy, intoxication and electric shock. An important aspect is the detection of general asphyxial signs, such as subconjunctival hemorrhage and hemorrhage under the sclera of the eyes, puffiness and cyanosis of the face, involuntary urination, defecation, ejaculation and squeezing out the mucus plug in women. The nature of cadaveric spots can vary: from intense diffuse (with asphyxial type of drowning) to light pink (with aspiration, due to dilution of blood with water).

The presence of general asphyxial signs detected during internal examination may also be characteristic of all types of drowning. These signs include: dark liquid blood, congestion of the right half of the heart, plethora of internal organs, anemia of the spleen, subpleural and subepicardial hemorrhages (Tardier spots). The presence of liquid in the stomach, a drowning environment, with a characteristic admixture of silt and algae (Fegerlund’s sign) with the asphyxial type there is a lot of liquid, with the “true” type there is little. The possibility of post-mortem penetration of fluid into the gastrointestinal tract is rejected by most authors. Paltauf-Reiter-Wachholtz sign - hemorrhages in the sternocleidomastoid muscle, muscles of the neck, chest and back - as a result of severe tension in the muscles of a drowning person while trying to escape. Bystrov's sample S.S. (“oil sample” as a result of contamination of almost all water bodies with petroleum products) - a test to determine intravital exposure to water. Ullrich's sign - extensive hemorrhage in the cavity of the middle ear, the bony auditory canal - is characteristic of a sharp immersion to a great depth. Moro's sign - the accumulation of a small amount of fluid in the abdominal cavity - only confirms the presence of the corpse in water and develops after 6-8 hours.

Despite the difficulty of diagnosing death in corpses removed from water, a number of signs can be identified that help resolve this issue. Conventionally, two groups of deaths can be distinguished. The first group is causes of death not related to direct exposure to water, and the second is direct drowning.

The first group includes all cases of post-mortem immersion of a body in water, which is characterized only by the presence of signs of the corpse being in water. Identification of obvious signs of death, contrary to drowning, somewhat facilitates the diagnosis, but the question remains about the victim’s lifetime exposure to the aquatic environment and its (aquatic environment) influence on the development of the immediate cause of death.

It is logical to divide the diagnosis of drowning according to its types. The aspiration type of drowning (drowning in fresh water) is characterized by persistent fine-bubble foam with a pinkish tint in the trachea and bronchi, possibly with an admixture of bottom soil and aquatic vegetation. The lungs are enlarged and heavier than normal, due to which they almost completely fill the pleural cavity. The lung tissue is hyperhydrated due to the penetration of fluid from the drowning environment (“balloon appearance”). On the posterolateral surfaces, large vague hemorrhages of a pale red color in the form of stripes or spots (Rasskazov-Lukomsky-Paltauf spots) are found. Swelling of the bed and wall of the gallbladder and hepatoduodenal fold (sign of F.I. Shkaravsky, A.V. Rusakov). There are a number of tests comparing blood samples in the right and left halves of the heart for various indicators (such as electrolyte composition, specific gravity, freezing point difference, etc.), but the essence comes down to establishing the fact of blood dilution in the arterial bed, which is also not typical only for drowning. When drowning in salt water, processes of hemoconcentration of arterial blood occur with an increase in its viscosity coefficient and hypovolemia. In the lungs there is a picture of focal atelectasis, severe edema and large-focal hemorrhages with a significant decrease in the airiness of the lung tissue. The foam found in the respiratory tract and lungs has a fine-mesh appearance and a bright white color as a result of inspiratory dyspnea, as a result of which water begins to actively enter the respiratory tract, irritating the mucous membrane of the trachea and large bronchi, causing coughing movements. The mucus released during this process mixes with water and air, forming a foamy mass of grayish-white color that fills the lumen of the respiratory tract. The diatomaceous earth test and the study of the state of the electrolyte balance of the blood do not reveal noticeable changes. Thus, the diagnostic substantiation of expert conclusions about the cause of death is carried out mainly based on the changes that occur in the lungs.

Laryngospasm in the asphyxial type of drowning leads to the occurrence of a number of processes that are characteristic of this type of drowning. Firstly, this is a decrease in pressure in the nasopharynx, which leads to a difference in pressure with the environment and the flow of fluid into the sinus of the main bone (Sveshnikov’s sign); traces of fluid can also be found in the frontal sinus and in the cavity of the middle ear. Another consequence is the ingestion of a large amount of liquid and, as a result, its detection on the section (Fegerlund's sign). Secondly, this is the occurrence of expiratory shortness of breath, which leads to hyperaeration of the lungs, the development of acute emphysema and an increase in their volume, rupture of the interalveolar walls with the occurrence of small focal hemorrhages, and the development of air embolism. The lungs have a “marble appearance”, increased airiness, filling almost the entire pleural cavity; imprints of the ribs are noted on the lateral surfaces. In the trachea and bronchi there is no fine bubble foam or there is a small amount of it. During puncture of the left heart, air bubbles are detected. Thirdly, this is venous stagnation of blood in a small circle, as a result - venous hypertension, which results in the reflux of red blood cells into the thoracic lymphatic duct.

During autopsy of corpses with a reflex type of drowning, there are no signs of drowning and changes in the blood; only concomitant diseases of the cardiovascular and respiratory systems can be detected.

The mixed type of drowning occurs on average in 35% of cases and is characterized by polymorphism of identified signs characteristic of different types of drowning.

Histological examination of lung tissue reveals emphysematous foci and areas of edema. In the area of ​​swelling, the alveoli are expanded, their walls are thinned with areas of rupture of the septa. Collapsed vessels. In areas of edema, the picture is the opposite: the capillaries are full-blooded and dilated, the alveoli are of normal size and filled with a pinkish mass containing desquamated epithelium and red blood cells. It is also possible to detect foci of atelectasis of the lung tissue, as well as areas of interstitial and intra-alveolar hemorrhage. Exogenous particles in the form of impurities of bottom soil, aquatic vegetation and plankton are rarely detected by microscopy. Changes in brain tissue are characterized by vascular changes, namely the expansion of capillaries and veins. The blood is liquid; in limited areas in the lumen of the vessels, adhesive accumulations of erythrocytes are found, as well as small focal hemorrhages in the perivascular spaces. Nissl-stained preparations show nerve cells with swollen processes. The cytoplasm is stained pale blue. The nucleus is enlarged and pale in color. The vessels of the pia mater are full of blood. Vascular changes in the heart are characterized by spasm of interstitial vessels and anemia of epicardial capillaries. The intervening tissue is swollen and loosened, and in the thickness of the epicardium there are foci of hemorrhage, varying in nature. In the kidneys, the capillaries of the medulla are sharply dilated and overflowing with blood. The tubular epithelium is swollen and slightly stained. Shumlyansky capsules are edematous, in the lumen of individual glomerular capsules there is a homogeneous mass with an admixture of red blood cells. The intralobular capillaries of the liver and central veins are dilated and full of blood. The perivascular spaces contain a pale pink mass for some extent. The intervening tissue is loosened and weakly colored. Liver cells are also faintly stained. The stroma of the gallbladder is loosened and swollen. Spleen - collagen fibers of the capsule and stroma are loosened. The pulp vessels are sharply anemic, red blood cells are detected only along certain sections of the sinuses and arteries. The follicles are hyperplastic, the pulp is anemic.

The diatom test is based on the identification of diatom plankton present in any aquatic environment. When the drowning environment enters the lungs during inhalation, plankton overcomes the pulmonary barrier and is carried into organs and tissues by the blood stream. When water enters the lungs posthumously, diatoms are not able to penetrate into the general bloodstream and, accordingly, do not spread throughout the body. In terms of their structure, diatom plankton are eukaryotic unicellular or colonial algae that are present not only in water, but also in soil and air. The cell wall of diatoms contains a large amount of silica, due to which they are not destroyed for a long time, remaining in the tissues of the body, which facilitates their identification even in putrefactively altered corpses. For analysis, from a practical point of view, it is recommended to remove an unopened kidney with a capsule and a ligature applied at the gate, as well as a fragment of brain matter weighing at least 100 g. When conducting an examination of a putrefactive or skeletalized corpse, it is recommended to take a fragment of a long tubular bone. As a control, a sample of the drowning environment is taken. In cases where there is no need to identify a body of water, a fragment of lung tissue is removed for control, since the lung tissue contains the liquid of the drowning environment. To avoid false positive results, it is prohibited to use running water until the material is taken. Tools used during work, as well as containers for storing and transporting biomaterial, must be treated with a chromium mixture and rinsed with distilled water, or disposable sterile ones must be used. It is recommended to consider the detection of at least 20-30 diatoms in each of the studied preparations as a diagnostic sign. In cases where fewer quantities are detected, samples are compared with controls. A false positive result is possible if the correct technique for removing, storing and examining biomaterial is not followed. Some authors argue about the possibility of post-mortem penetration of plankton into the body, especially in the presence of damage to the skin; when the deceased consumed, shortly before death, foods or water that could contain diatomaceous plankton. Plankton can enter the body throughout life and, due to difficult evacuation from the body, remain in the tissues for a long time. A false negative result may be due to a low concentration of diatoms in the drowning environment, a small volume of inhaled fluid (asphyxial and reflex types of drowning), as well as their destruction during sample preparation.

Conclusions

The article describes the modern capabilities of forensic medicine in diagnosing death from drowning, and also reflects the different points of view of the authors and the evolution of approaches to this issue. Despite the constant interest of global science in the topic of drowning and extensive research on this issue, there are still many blank spots. It is still not possible to accurately judge the duration of death and the exact period of time the corpse was in the water, to most accurately carry out a differential diagnosis of concomitant somatic diseases and “dry” types of drowning, to determine the reliability of the results of tests and analyzes, etc. A modern look into the future, associated with solving the issue of diagnosing death from drowning, it is aimed at studying the molecular changes that occur in the body of victims under the influence of the drowning environment. Researchers are trying to identify more specific changes characteristic of drowning and possible methods for detecting them.

Reviewers:

Zheleznov L.M., Doctor of Medical Sciences, Professor, Head of the Department of Human Anatomy, Orenburg State Medical Academy, Ministry of Health, Orenburg;

Polyakova V.S., MD, Prof., Head of the Department of Pathological Anatomy, Orenburg State Medical Academy, Ministry of Health, Orenburg.

Bibliographic link

Firsov A.S., Kalinina E.Yu. DIAGNOSTICS OF DROWNING: EVOLUTION OF APPROACHES AND MODERN METHODS // Modern problems of science and education. – 2015. – No. 3.;
URL: http://site/ru/article/view?id=19598 (access date: 02/01/2020).

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Kasper's sign I. L. A constant sign of drowning in water. This is liquid, cherry-colored blood in the vessels and in the cavity of the left ventricle of the heart. Blood acquires this color as a result of water leaching hemoglobin from red blood cells. Due to the dilution of blood with water, the number of red blood cells in a certain volume (1 mm) decreases significantly, as a result of which the amount of hemoglobin in the blood of the left ventricle of the heart also decreases.

Krushevsky's sign S.V. Persistent fine-bubble white foam in the respiratory tract when their mucous membrane is congested. Observed in cases of death from drowning in water. The sign indicates that drowning occurred during the lifetime. Proposed in 1870.
Moro's sign. Increased accumulation of fluid (100 or more ml) in the abdominal cavity during death from drowning in water due to post-mortem transudation of water from the stomach cavity into the peritoneal cavity. Described in 1899.

Paltauf's sign A. Hemorrhages in the sternocleidomastoid muscle and pectoralis major muscles, located on both sides, parallel to the longitudinal fibers of the muscles. These hemorrhages occur as a result of severe tension in the muscles of a drowning person while trying to escape. A similar type of hemorrhage was described by Reiter and Wachholz.

Rasskazov-Lukomsky-Paltauf spots. One of the most reliable signs of drowning. The spots are blurry with indistinct contours, of uncertain shape, somewhat elevated, pale red in color, due to dilution of blood with water, hemorrhage under the pulmonary pleura up to 1-2 cm in size (sometimes more). When a corpse remains in water for more than one to two weeks, the spots may disappear. These hemorrhages were first described independently of each other by I. Rasskazov in 1860 and by the Ukrainian scientist Yu. Lukomsky in 1860, and then by A. Paltauf in 1880.

Sign of Rusakov A.V. - Shkaravsky F.I. Swelling of the bed and wall of the gallbladder during death from drowning.

Sign of Sveshnikov V.A. The presence of fluid - a drowning environment in the sinus of the sphenoid bone. It occurs in 65-80% of deaths from drowning and is an indicator of the lifetime of drowning. Described in 1958.

Sign of Sveshnikov V.A. and Isaeva Yu.S. Lymphohemia is the reflux of red blood cells into the thoracic lymphatic duct. Laryngospasm leads to venous congestion in the vena cava system and venous hypertension, resulting in retrograde reflux of blood into the thoracic lymphatic duct. It is observed in asphyxial (spastic) type of drowning. Quantitative assessment of lymphohemia is carried out using a counting camera during microscopy of the thoracic lymphatic duct. The trait was described in 1986.

Sign of Sveshnikov V.A and Isaev Yu.S. Air embolism of the left ventricle. With the development of pulmonary hyperaeria, thinning and rupture of the interalveolar septa are observed, followed by the penetration of air into the pulmonary veins and the left half of the heart. Observed in asphyxial type of drowning. The trait was described in 1986.

Sign of Ulrich K. Extensive hemorrhage in the middle ear cavity, in the bony auditory canal and in the cortical bone marrow of the temporal bone pyramid. Observed in cases of death from drowning in water. Described by Ulrich in 1932 in the monograph “Ear and Death from Drowning.”

Fegerlund's sign. The presence of liquid in the stomach and upper part of the small intestine - a reservoir environment mixed with silt, sand, and algae. With the asphyxial type of drowning there is a lot of fluid, with the aspiration type of drowning there is little fluid.

Moro's sign. Increased accumulation of fluid (100 ml or more) in the abdominal cavity during death from drowning in water due to post-mortem transudation of water from the stomach cavity into the peritoneal cavity. Described in 1899.