DEATH BY SUBMERSION OR DROWNING.

GENERAL CONSIDERATIONS.

The frequence and importance of drowning having arrested attention from the days of Noah’s Ark and those of Hippocrates down to the present time, it is quite possible to array in chronological order the fictitious, transitory, and positive periods that mark the sequence of ideas touching the subject.

Mooted questions relative to drowning have been debated since the fourteenth century; and modern statistics show the great development of this class of emergency, than which none is of more startling character. In France between four and five thousand cases of this kind of accident are officially recognized each year, which is about one-third of all the accidental deaths, and the number appears to increase yearly. Nearly the same figures apply to the inland waters of England and Wales, not including the coast. The Board of Trade Return shows that out of 86,695 seamen who died in English ships abroad, 53,673 were drowned, and a late report of the Fisherman’s Federation places the number drowned in the inland waters and upon the immediate coasts of the United Kingdom and its adjacent islands as 6,268 annually. The many hundreds drowned in the late Victoria disaster and in the great storm that swept the British Isles are matters of current knowledge. In our own country accounts of drowning are of daily occurrence, and help to the drowning forms the greater part of the work done by that noble governmental branch, the Life Saving Service. Not only does the sea claim its numerous victims, but the great floods and cyclones have destroyed thousands, while on the lakes and rivers drowning accidents are lamentably frequent. If the statistics of such accidents were as available as those of the late war, for instance, the exhibit would doubtless be surprising. Where the aggregation of killed in action is shown to be 67,058, there were drowned 106 officers and 4,838 men. The small regular army lost 5 officers and 89 men from this cause; the negro troops, 6 officers and 289 men; and the volunteers furnished a large contingent, the State of Ohio alone having lost 14 officers and 770 men from drowning.[935]

Aside from the point of view of public hygiene and that of pathology, further evidence is not wanting to show the medico-legal value of the phenomena of drowning, and the frequency and importance of the judicial questions that may arise in this class of accidents.

DEFINITION AND PHENOMENA OF DROWNING.

Late studies as to the cause and mechanism of asphyxia by submersion or drowning warrant our speaking of submersion as immersion complete enough to menace or to extinguish life.

When an animated body or a part only of the body is immersed a sufficient time in water or any liquid medium whatever in such a way as to exclude fresh air from the respiratory orifices, suffocation follows, and death by submersion or drowning takes place.

The phenomena occurring in such instances are mostly those common to imperfect aeration or non-aeration of the blood, and for this reason the majority of medical writers describe asphyxia or apnœa, that is, death beginning at the lungs, as the determining cause of death by drowning. It must not be thought that asphyxia is always the mode of death in those submerged, although it is commonly present in a certain number of cases. Other causes may often modify the circumstances of the death or directly produce it, as congestion of the brain and syncope, or the cause of death may be a mixed one. Occasionally one reads accounts of persons resuscitated from drowning who, on recovering from the primary effects of the asphyxia, die suddenly without apparent cause after a lapse of a few minutes or several days. Such cases are explained as the secondary results of the arrested interstitial nutrition that took place during the period while breathing was temporarily arrested. Another secondary cause is physical injury to the lungs from water penetration, which may result in a fatal pneumonia. A case related in England last summer is that of a drowning boy who, on being resuscitated after submersion in contaminated water, suddenly died of cholera.

MODE OF DEATH IN DROWNING.

Since various lesions may be found, accordingly as the death from drowning has taken place from one or more of the foregoing modes, it is necessary to have a clear notion of asphyxia and to study in detail the mechanism of arrest of the thoracic movements and of the hindrance to hæmatosis.

Broadly speaking, there will be asphyxia when any obstacle hinders air from entering the pulmonary vesicles, or when the fluid that penetrates them is of any other nature than the medium in which the animal is destined to live. Consequently the name asphyxia is applied generically to all accidental conditions in which life is threatened by any intervention whatever of the respiration. (See Mechanical Suffocation, Vol. I., p. 705 et seq., and Asphyxiating Gases, Vol. IV.)

Submersion in any liquid medium causes asphyxia. This condition may be caused on being surrounded by a medium devoid of oxygen and improper to support sufficient hæmatosis, as hydrogen, nitrogen, and the protoxide of nitrogen, gases not toxic properly speaking, but considered irrespirable. Diminished respiration from deficiency of oxygen is the true cause of asphyxia. No animal can maintain the respiratory process in an atmosphere devoid of oxygen or in one that does not contain at least ten per cent of this gas, and such quadrupeds as whales, hippopotami, and seals or the pygopodous birds would drown in the same manner as a dog if kept submerged long enough. The suppression of the gaseous exchange by submersion is also fatal to such aquatic insects as hydrophiles, dytiscidæ, and the like, which drown in the same manner as the hymenoptera, coleoptera, diptera, or other terrestrial insects. Ants drown in less than a minute when the body is wet, and the disappearance of apparent vitality is accompanied by convulsive movements indicating functional trouble of the nervous apparatus. Sir John Lubbock found that after eight hours of immersion they could be restored to life, and several ants after two days and five days were restored to momentary life with feeble motions, followed by death in two hours. Even a terrestrial plant when submerged drowns like a terrestrial animal, the mechanism of asphyxia by submersion being the same in plants and aerian animals, and due to closure of the principal way of gaseous exchange.

Notwithstanding the interruption of the gaseous exchange necessary to support life, there is long persistence of vitality after submersion of some creatures in which an intra-molecular respiration or gaseous dialysis with aerated water takes place, as in ants who have not been wetted before submersion.

The resistance of new-born animals to this mode of asphyxiation is especially noted in the greater time required to drown a pup than an adult dog. One minute and a half usually suffices to drown a dog, while a new-born pup often requires as much as fifty minutes. This great difference is owing to the less active change of tissue and the smaller consumption of oxygen in the young animal. The more active the vital combustion and the greater the demand upon the general store of oxygen in the blood, the quicker the young animal perishes when the respiration is obstructed.

It is observed in a general way that all kinds of death caused by the privation of respirable air have between themselves the greatest resemblance. Whatever be the obstacle that intercepts the connection of the lungs with the atmosphere, the apparent differences are only secondary and the essential symptoms are identical, because all act in suppressing the functions of the blood and hæmatosis. In fact, the phenomena of asphyxia are constant and related to disturbances in the respiration, innervation, and circulation, which vary according as the asphyxia is the result of submersion or of the absence of oxygen in the surrounding medium, according as asphyxia is immediate or slow. The fatal result of asphyxia is owing to the introductory arrest of the pulmonary circulation, the capillaries of the lungs being incapable of conveying venous blood. The stagnation of the blood in the lungs is followed by paresis of the respiratory centre and stoppage of the heart.

STAGES AND SYMPTOMS OF DEATH BY DROWNING.

The authorities are that an individual who dies asphyxiated by submersion passes through three stages. At first he experiences a violent shock, followed by an inspiration of surprise, which results from the contact of water with the lungs causing a reflex cough. Then for some seconds there is a voluntary suspension of respiration, giving rise to other forcible involuntary expirations. In this dyspnœic second period the face and brain become congested, owing to slowing of the encephalic circulation. Loss of consciousness soon follows, when the drowning person enters the third stage, which is that of asphyxia. In this period the individual gasps deeply, the pupils are dilated, the sphincters paralyzed, and the limbs are agitated by clonic convulsions. This is followed by complete insensibility and speedy death.

When a fatal termination in drowning results from that form of neuro-paralysis known as syncope, in which death begins at the heart, we infer from experiments that the sudden loss of consciousness arises from the violent impressions that the sensitive nerves convey to the bulb. Such a result is more likely to occur in persons with weak heart and languid circulation, who are more susceptible to fright and shock or to the sudden collapse from intense cold. It is also shown that stammerers, who have a defective innervation of the phrenic and of the pneumogastric, succumb more rapidly than others.

The importance of syncope as a cause of death in drowning is much restricted when we consider the fact that the circulation is the last of the functions extinguished in an animal that for purposes of experiment has been subjected to submersion. This has been shown in a sensuous way by experiment, aided by the resources of the graphic method, which registers the respiratory modifications as shown by the pneumograph and also the condition of the femoral artery in connection with a kymographion. The heart continues to beat as much as three minutes after the animal has succumbed, and recent autopsy gives almost constant proof of asphyxia. In fact, it is held that syncope takes but small part in this form of death, the general agreement of opinion being that nothing short of a syncope that would be fatal either in or out of the liquid medium can account for the entire absence of some of the signs of death from asphyxia.

Among the symptoms often present in drowning persons, many relate to nervous phenomena and the mental state, which may vary with individual presence of mind and moral force. Persons who have escaped this kind of death have observed auditory and visual hallucinations, as flashes of light, the ringing of distant bells, and the like. Just before the outset of the asphyxiation a rather curious functioning of the brain known as hypermnesia[936] takes place, in which the revivescence of ideas, of objects, or of facts relates to anterior impressions long past that seem to have been forgotten. According to the narratives of many drowning persons who have escaped the last consequences of asphyxia, this condition was attended by general exaltation of the memory of such a nature that their whole previous conscious existence seemed, in an incredibly short period and with great clearness and precision, to pass before them in panoramic review. In Admiral Beaufort’s letter to Dr. Wollaston, the memory impressions are said to have occurred in retrograde succession. A medical man resuscitated from drowning reports that just before losing consciousness this particular cerebral activity, in his case, took on a most realizing sense of the situation and of the consequences to his family. This cerebral superexcitement is not, however, a constant thing, nor do all subjects experience the ineffable agony of drowning. Persons have been taken from the water apparently dead who, on regaining consciousness, declared that they experienced neither oppression nor suffering and had no recollection of what had passed. A very intelligent woman of my acquaintance, having such an experience a few years since at Newport, quotes herself as and really believes that she is an instance of a person once dead and afterward restored to life.

This peculiar vividness of mind has been observed in other kinds of death than drowning, notably in chronic insanity. A priest with extended experience at the Government Hospital for the Insane tells me that he has often noticed the vaticinatio morientium in the form of so-called lucid interval of the insane when called on to administer the last rites of the Church. The condition is explainable from the stoppage of the pulmonary artery and the stimulus caused by circulation of non-oxygenated blood in the brain.

The condition known as asynesia, or amnesia, sometimes follows the return to consciousness in persons asphyxiated and apparently dead from drowning. Dr. F. A. Burrell reports the case of a boy of eighteen, submerged for six minutes and resuscitated after four and three-quarter hours, in whom the memory of everything that had occurred from half an hour previous to the accident up to return of consciousness had been entirely obliterated. When last heard from the lapse of memory still remained.[937]

The statement that death from submersion results from true asphyxia or from asphyxia in a more or less modified form rests on the authority of a large number of facts. Indeed, recent investigators make the proportion so much greater than formerly as to warrant the statement that asphyxia is the generic cause of death by drowning. Dr. S. Coull Mackenzie[938] reports 305 cases of drowning, in which 297, or 93.37 per cent, died from asphyxiation; 1, or .32 per cent, from syncope; 1, or .32 per cent, from apoplexy and asphyxia; and in 6, or 1.96 per cent, the mode of death could not be determined because of advanced putrefaction.

As the post-mortem signs of drowning are known to vary according to a number of circumstances, it is difficult to deal with the subject unless certain fundamental points be kept in mind. These relate more particularly to the external signs and to the different lesions that follow the mode of death, although they are not constant. Surgeon-Major E. G. Russell[939] illustrates how widely the post-mortem appearances may vary in cases of drowning, even when the outward circumstances of the period of death are identical and the bodies have been subjected to precisely similar conditions as regards duration of immersion, subsequent exposure to air, and times of necropsy. He relates that five persons were drowned while proceeding to a ship in the Hooghley River. Three died the same death; and at the same time the bodies were recovered together after the same period of immersion, and were examined together; thus from beginning to end they had been under exactly similar conditions, yet there were very marked differences in the state of preservation of the bodies and in the post-mortem appearances. After five hours’ exposure in air at 88° F., one body, in which the tissues were extremely fatty, showed beginning decomposition; in the other two there were no signs. Decomposition in the scalp, face, and neck indicative of drowning had begun under water, although in ordinary cases it first invades the abdomen, genitals, breasts, etc. Rigor mortis present in one case was absent in the other. The penis was semi-erect in one case, flaccid in the other, retracted and shrunken in the third. Emission of semen and expulsion of fæces were also noted. Tongue not swollen or protruded in any case, and cutis anserina absent in all three, which may have been owing to the high temperature. Water was inspired into the lungs in two cases. The larynx, trachea, and bronchi had regular congestion and scarlet ecchymoses in one case characteristic of asphyxia, and there was muddy water in the stomach.

The first question likely to arise when a drowned body has been found is the one of identity. All the circumstances in which the body was observed before its removal to the place where it lies for examination should therefore be minutely detailed, and all lethal injuries and the like should be noted with care, since the smallest accessories often lead to identification. The locality in which a drowned body is found may be a fact of considerable importance that may help to complete the chain of evidence in which the matter of crime or of accident turns upon the question of identity. It must be remembered that bodies often drift many miles away from the spot where the drowning occurred, owing to tides or currents. Such a circumstance I noted a few years ago at Brownsville, Texas, where it was a common sight to see bloated cadavers going down the Rio Grande. Time and putrefactive changes are also elements that enter into the matter of recognizing the drowned cadaver. To resolve this question with desirable precision, the reader is referred to more detailed instruction in the chapter on Identity.

TREATMENT OF THE APPARENTLY DROWNED.

Help to the drowned does not properly come within the province of judiciary medicine, being rather a humane question that belongs to public hygiene. Systematic writers, however, treat the subject at considerable length, and the statistics of institutions for helping the drowned give such marvellous results that it would manifestly not be out of place to cite briefly some of the means employed for restoring life to persons taken from the water asphyxiated and apparently dead.

The prime object in resuscitating the drowned is the introduction of air into the pulmonary vesicles, which is best accomplished by artificial respiration, and the employment of such means as excite the nervous system with a view to reanimate sensibility and develop the reflex movements that contribute to the re-establishment of the respiratory function.

The exigencies of drowning also call for special means to restore the animal heat and the circulation, as well as the precaution of removing mucus and fluids from the obstructed air-passages.

As the knowledge of securing patency of the air-passages by artificial respiration is generally diffused among medical students and is taught in some schools, it would be superfluous to repeat in detail the procedures of Hall, Sylvester, and others.

Laborde’s method of resuscitating those apparently dead has lately gained some notoriety. It consists in stimulating the respiratory reflex by regular rhythmical traction of the tongue, which should be vigorously pulled forward fifteen or eighteen times a minute, to correspond in frequency to the normal respiration.

Another method, alleged to have marvellous effects over the respiration, is that of anal dilatation. Its advocates claim that irritation of the anus is a much more effective measure in resuscitating the drowning or narcotized.[940]

Respiration may be further promoted by alternate dashes of hot and cold water on the face and chest, by smelling-salts, tickling the throat and nares with a feather, and by electrization of the diaphragm and inspiratory muscles. Protracted galvanism may, however, prove dangerous.

When signs of life appear, a warm tonic stimulating drink should be given. A hypodermic injection of caffeine is also recommended.

Whatever means are employed should be used on the spot in the open air and without a moment’s delay.

Restorative efforts may be kept up for two or three hours, although in the majority of cases life is extinct in the human subject after two minutes’ submersion or even less, and the chance of restoration after five minutes’ complete submersion is doubtful. To be sure, trained tank performers remain under water longer than two minutes, and exceptional instances occur of recovery after twenty minutes’ submersion in individuals in a state of syncope or with catalepsy.

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.

WAS THE DROWNING ACCIDENTAL, SUICIDAL, OR CRIMINAL?

Assuming the probabilities to be in favor of death by submersion, the question next turns upon the character of the event.

In the absence of lesions it is almost impossible to say whether the individual fell in, jumped in, or was pushed in the submerging fluid. The person’s antecedents should be inquired into—whether subject to epilepsy, vertigo, intemperance, or mental aberration. Alcoholism is an important factor in accidental drowning, and a person intoxicated may be drowned in very shallow water. A few years ago a young man over six feet tall, while bathing in a tributary of the Potomac River, near Washington, was drowned in only three feet of water. On considering all these circumstances, it may not be possible, even after careful inspection of the body and minute exploration of all the organs, to declare the drowning the consequence of an accident. The existence of traces of violence or of injury which may have occasioned death or disability, of such a nature as to render the person unable to defend himself, would seem to merit particular attention. But their presence leads to further consideration—were the marks of injury caused by the water itself, by some object in the water, or were they self-inflicted? Dislocations, fractures, and other injuries have been caused by jumping or falling into the water from a great height. I know an instance of a professional who, on jumping from a height of ninety feet, split his upper lip on striking the water with his mouth open. The autopsy in the case of Odlum, the Brooklyn Bridge jumper, is said to have shown rupture of the liver. On the other hand, many persons jump from great heights into water with perfect impunity. For many weeks at the London Aquarium a performer has nightly jumped into a tank from an elevation of 127 feet, and several persons have successfully jumped from bridges much higher.

Objects in the water that may account for cadaveric lesions are numerous. I have known a soldier, a good swimmer, to break his neck on diving from a river bank.[946] Other traumatic lesions may occur in a rapid current, from the breaking up of ice, from the screw or paddle-wheel of a passing steamer, or from aquatic animals.

A matter much discussed in connection with this subject—that of shark-bites—may enter into the question of survivorship where it is alleged that several persons during shipwreck or other disasters at sea have been devoured by sharks. Though an occasional accident, such bites are more a figment of the mind than a reality, as the concurrent testimony of disinterested observers will show. After years of investigation among nautical people and much experience as a swimmer in widely different parts of the world, I have no personal knowledge of such injuries, and have met but two persons that had any actual personal knowledge of shark-bites.

Documentary evidence as to shark-bites is also very scanty. During the last fifty years soldiers by the tens of thousands have swum at Fort Monroe, Virginia, yet there is no record of one having been bitten by a shark; nor have I been able to ascertain that any accident of the kind has occurred at Malta or at Gibraltar. There does not appear to be a record of any one ever having been bitten off the British Isles. I have been unable to ascertain that a single bite of the kind is reported among the medical records of our War or Navy Department or those of the Marine Hospital. In the West Indies but few facts are reported indicating danger from sharks, and these are not well authenticated. The same may be said as to newspaper accounts, which deserve about as much credence as the reports concerning sea-serpents. A few years ago a public journal gave an account of a boy who was bitten while swimming near New York and afterward died in a hospital.

But medical literature has a few reports of shark-bites. After ten years’ diligent search I have found seven references, the earliest in the London Medical Gazette, 1823, and the latest in the London Lancet, 1886. The bites occurred in Australia, South Africa, and India. The Hooghley and Ganges Rivers are the worst place in the world for sharks and alligators. A particular kind of shark, the Carcharras Gangeticus, which is very fierce and bold, sometimes dashes among the crowds at the bathing ghâts, and has been known to bite a boy in two feet of water. All persons bitten at these places generally die from the bite, for the reason that the shark, living on carrion, portions of which stick between the teeth, carries infection to those whom it may afterward bite. The former habit of throwing the dead in the river is supposed to account for the boldness of these particular sharks in attacking the human species.

Self-inflicted wounds rather suggest suicide, as numerous instances attest, where one or two kinds of death were intended to make assurance doubly sure. I once saw an Eskimo stab himself and then jump overboard from a ship off the Siberian coast. But as a rule suicidal drowning is unaccompanied by traumatic lesions, unless it be those produced by falls. Hence the absence of lesions leads to the presumption that the individual while living fell into the water or other fluid accidentally or voluntarily.

Exception may be made in the case of infanticide and homicidal submersion as the result of surprise, where a person taken unawares is suddenly and unexpectedly pushed or thrown into the water. A case in point is that of a man suddenly robbed and seized by three persons, who threw him into the river. Another is that of a man who, wishing to get rid of his wife, gave her arsenic. The effects of the poison being slow he induced her to take a walk along the river, and when her back was turned he pushed her rapidly off the bank into the stream, where she drowned. Death by submersion is rarely the result of murderous intent, and in the case of adults it is suddenly resorted to in order to paralyze resistance and facilitate the success of crime.

Submersion is oftener intended to hide a crime. A body may be taken from the water after murder or rape. Whether the cadaver is recent or one that has lain in the water a long time, the expert is confronted with a question of the differences that he may expect to find in a body drowned and one thrown into the water after death. This difficulty can only be resolved by considering all the signs and lesions furnished by the autopsy. No single sign or post-mortem appearance is characteristic of drowning, and none enables us surely to diagnosticate death by submersion either in putrid or fresh cadavers. Nor do we have any significant infallible signs that may serve as a parallel between the immerged post mortem and the submerged. The exterior signs being nearly the same in the two, the diagnosis must necessarily depend upon assembled circumstances, and these are liable to vary.

CIRCUMSTANCES THAT MAY AFFECT THE TIME OF SUBMERSION.

Putrid decomposition is the chief obstacle to diagnosis in a body that has been drowned. This presents great differences. The death happening in winter or summer, in a temperate or intertropical country, and sojourn of the cadaver in salt or fresh water, are each and all important details to be considered in studying the submergence of a body.[947]

It is only by studying the events in this order, along with the immediate signs of death, that the duration of the submergence may be conjectured. With anatomical appearances as the only guide it is impossible to fix the time of immersion. Many elements combined may affect even the gaseous putrefaction that takes place in submerged bodies. Summer heat and shallow or stagnant water hasten the development of putrid gas and subcutaneous emphysema which bring the cadaver to the surface, and that, too, sometimes in spite of precautions taken to insure the submersion. A case in point is the body of the Italian admiral, Caraccioli, mentioned in Southey’s “Life of Nelson.” Bodies weighted with lead or other heavy substance for the purpose of hiding crime have also been known to float in consequence of the putrefactive phenomena.

At Evansville, Ind., unsuccessful efforts were made to raise a sunken steamer with thirty head of cattle between decks. A few days after the attempt was abandoned the steamer was suddenly seen to float. The carcasses of the putrefying animals, swollen by gas, had sufficed to bring the wreck to the surface.

A great development of gas is very noticeable in what is known as a “blasted” whale, the stomach of which assumes balloon-like proportions. A few summers ago, at Provincetown, Mass., it was my rare fortune to be within a few feet of an enormously distended putrid whale, which suddenly exploded.

In cold countries drowned bodies are longer in coming to the surface. In Russia, for instance, in spring after the rivers and lakes have thawed, the bodies of numerous victims of alcoholism and accidental drowning of the previous winter are taken from the water. Last summer, at Quebec, I was present when the body of a man drowned the winter before came to the surface of the St. Lawrence River. On a visit to the northern lakes many persons connected with the navigation of Lake Superior told me that bodies drowned in its waters seldom or never came to the surface.

Specific gravity of the water itself may be an additional cause for the body coming to the surface. Dr. Tidy says that every structure of the human body floats in the water of the Dead Sea. The same cannot be said about the buoyancy of the water of Great Salt Lake, the accounts of which have been greatly exaggerated. It does not “support a bather as if he were sitting in an arm-chair and float him like a fresh egg.” Experience shows that there is no difficulty either in swimming or in sinking in its waters, the solid constituents of which are estimated to be about six and a half times more than that of sea-water. Analysis of Dead Sea water places the solid constituents at 24.580, while that of Salt Lake is 22.282. Another strong natural brine in the United States is said to be that of Syracuse Saline, New York, which contains 17.35 per cent of sodium chloride.

It is evident from what has been stated that no positive assertion can be made as to how soon a drowned body will rise to the surface, and at best any conclusion as to the date of submersion is so unsatisfactory that it may be said to be an unscrupulous use of guessing privileges. Errors in legal medicine are sadder in their consequences than those of medical diagnosis. The medical legist would therefore do well to preserve the frame of mind that often doubts and rarely affirms, and he should be circumspect enough to avoid dogmatic assertions about matters of uncertainty.

DEATH FROM STARVATION.

IN ITS MEDICO-LEGAL ASPECT.

BY

ENOCH V. STODDARD, A.M., M.D.,

Emeritus Professor of Materia Medica and Hygiene in the University of Buffalo; Member of the Medical Society of the State of New York and of the Central New York Medical Association; Fellow of the New York Academy of Medicine and of the American Academy of Medicine; Late Surgeon 65th Regt. N. Y. Vols.; Late Health Commissioner, Rochester, N. Y.; etc., etc.