Anatomy of a Drowning
For those who think that drowning is a pleasant way to go, think again. Drowning is a violent assault on the body during which the frightened victim fiercely, albeit briefly, battles to survive. Death follows exhaustion within only two or three minutes.
Technically, it is true that a person can drown in as little as a cup of water. A cup, a puddle, a ditch, a bathtub—anytime liquid enters the air passages and lungs, even if someone doesn’t die immediately, it can still turn fatal because there are a host of medical complications which arise that are always life-threatening, such as pneumonia and renal failure. These type of delayed fatalities are known as “secondary drownings” and, although their symptoms may develop over the course of several days, or even longer for some patients, they’re usually triggered within only a few hours of the initial incident.
But most victims drown fully submerged in water when the nose and mouth inadvertently become covered. Sometimes, when there is an instantaneous glottal spasm blocking off oxygen, or a preexisting medical condition, death can be automatic without any signs of a struggle. In the majority of drownings, however, this is not the case. Struggling is one of the key stages leading to unconsciousness and death. In fact, so intense can this final fight for life be that, in more than ten percent of drowning fatalities, an autopsy will actually reveal bruised and ruptured muscles, particularly in the shoulders, chest and neck. Evidence of injuries of this nature suggest to a medical examiner the strong likelihood that a victim was alive in the water at the time of their demise and not placed there already dead.
The stages of a full-immersion drowning event are fairly quick and, because the victim’s airways are being blocked, either by water and/or the epiglottis, it’s often completely soundless. There will be panicked thrashing as the victim desperately attempts to get air and to grab onto nearby objects for security, and then, when they can no longer hold their breath, they’ll begin to inhale water in large quantities, gulping it into their stomach as well. This action also rapidly circulates water throughout their other systems and bloodstream with differing biochemical reactions depending on whether they’re in saltwater or in fresh. This last stage of drowning ends with coughing, vomiting, convulsions, loss of consciousness, death, and rigormortis.
Very shortly after the victim dies their body will start to sink. If retrieved soon thereafter, their arms and hands may display cadaveric spasm, a posture in death borne out of extreme mental anguish and which reveals the person’s final thoughts and movements as they frantically fought to stay alive.
If a victim is not promptly retrieved at death, then, without exception and no matter how deep or how swift the water may be, their corpse will continue to drift downward until it reaches the bottom. This is where it will remain in a somewhat fetal position until gases from putrefaction cause it to rise to the surface once more. A semi-fetal posture is the norm for all drown victims, so if divers do locate such a body before it ascends, but it isn’t in this pose and/or the head is seen to be tilted to one side, they will include these observations in their police recovery report, as it reveals the victim died on land and was put in the water post-rigormortis.
Typically, once the body does emerge on its own, it will surface in the general vicinity of where the victim originally went under. From this location the water may then carry the corpse along for quite a distance, depending on the strength of the currents or if it becomes ensnared and is thereby prevented.
Refloat largely varies on the water’s depth and temperature, taking only a matter of hours to occur if extremely warm and up to two weeks or longer if at 40 degrees Fahrenheit or less. The timetable, therefore, is not fixed but is loosely as follows: at 40 degrees Fahrenheit it takes approximately fourteen to twenty days for a drown victim’s corpse to resurface; at 50 degrees ten to fourteen days; at 60 degrees seven to ten days; at 70 degrees three to seven days; and at 80+ degrees one to two days or sooner. In very cold and very deep bodies of water, like certain oceans or the Great Lakes of North America, it’s not unusual at all for a drown victim to never resurface, lying on the bottom in a state of suspended decomposition until their body eventually disintegrates or is otherwise destroyed.
But in temperate oceans, rivers, lakes, ponds, pools, reservoirs, quarries, or the like, a corpse will inevitably rise again sooner or later, occasionally exploding to the surface if it was deliberately anchored. And when it does reappear, if the person did genuinely die from drowning, then they will always be discovered floating face down in the water, with the head drooping forward and lower than the rest of the body. Lividity, the pooling of blood and fluids, will then have permanently settled into the under regions of the corpse by then, weighting it from beneath and essentially acting as a ballast so that, even when disturbed, say by a collision with a boat, it will return to this original position.
If one can stomach a physical inspection of the body and knows what to look for, at this point it becomes relatively easy to determine the length of time a victim’s actually been submerged. However, because a previously sunken body could have been slowly dragged along the water’s bed by currents and thereby further damaged against rocks and similar objects, or even partially eaten by marine animals, it may be difficult for the layperson to ascertain if any visible injuries happened in life or were obtained postmortem.
Damaged or not, though, if a body has been in the water for at least one to 48 hours, wrinkling of the skin will be present already, particularly on the palms of the hands and fingertips and on the soles and toes of the feet. Noticeable blanching and bloating of the epidermis may also be underway too, with pronounced blotches and discolorations ranging in hue from pink to dark red distributed unevenly across the body.
In excess of the above time period, the victim’s epidermis may look a greenish bronze and will have begun pimpling and even pre-peeling as fat deposits just beneath it slowly transform into a soapy material and loosen the skin. This is especially true of the flesh on the hands and feet which will slip off on their own―or when tugged on―just like gloves, a process of decay aptly named “degloving”. If signs of degloving are already evident on such a corpse, special care must be taken in recovering the body from the water, as additional harm can easily be inflicted when physically grappling with it or maneuvering it about with hooks and mechanical devices.
Once it has been successfully recovered, a waterlogged body will rapidly deteriorate when fully exposed to air, therefore an autopsy must be performed immediately in order to help determine the exact cause of death and the manner. This may seem superfluous, but the fact is death by drowning is not wholly assumed by medical experts and law enforcement, especially where there have been no witnesses to unequivocally substantiate it.
In forensic terms, there is nothing whatsoever deemed “classic” about any drowning, no one particular physical characteristic manifesting in a corpse that would aid in expediting such a ruling. Because of this, the methodology for reaching a determination that it was a water death and accidental is one that is chiefly focused on excluding foul play. This places a great deal of importance on the initial investigative role of police personnel who could inform or misinform a medical examiner with their onsite reports and early conclusions.
Even the autopsy is insufficient on its own for definitively pinpointing the victim’s cause of death as an accidental drowning, but the line of inquiry a medical examiner follows during this phase of the inquest is to review the circumstances of how the deceased person reportedly first entered the water and to try to judge if the body they’re viewing matches up to that version of events. If so, and the death indeed appears benign, the medical examiner will then proceed to determine whether the drowning was a result of the individual’s own failure to stay afloat or the byproduct of some underlying ailment. For this reason, there are educated assumptions which may safely be arrived at when the victim in question is young and healthy, whereas it’s not impossible in older people that they may have died in the water as a result of a heart attack or emphysema, or some other serious medical problem.
That makes prompt identification of the body vital to a postmortem medical exam, but, of course, a corpse will always be more deeply probed in those cases where the victim’s identity is still not known or the fatality somehow looks and sounds suspicious.
Lying on the examiner’s slab and before taking a scalpel to flesh, there are visual clues that can provide a few preliminary answers about the death. For instance, drowning produces a thin foam in and around the victim’s mouth which usually lingers there for several days before washing away. The presence or absence of this transient substance, on the other hand, is not conclusive because drug overdoses, electrocutions and strangulations also have the same foaming effect, and because up to 20% of drownings are actually “dry drownings” where the victim took no water into their airways but died instantly, or else suffocated very quickly from a sudden throat-closing reflex.
To see if this telltale foam did once exist, though, placing a hand firmly on the victim’s chest and gently compressing it should bring the substance back up once more, perhaps even with pebbles and sand in it. Alternately, when a corpse has begun to decay a darkish, foul-smelling fluid might fill the mouth instead, but this is standard to all types of deaths where putrefaction has set in and is therefore of little diagnostic value. It is the existence of a pair of oversaturated lungs, ideally with debris in them, that will most strongly point to death by drowning. But, again, this by itself is not proof positive either, since a dead body can slowly draw water into its air passages even if only placed in the water after having died elsewhere.
Also, the victim’s hands can, and often do, reveal important evidence to a medical examiner. A drowning person grasps at everything within arm’s reach to prevent themselves from going under, so they may still be clutching a variety of foreign objects in them. These can be anything they managed to grab hold of before losing consciousness, such as nearby plants, twigs and other artifacts. In fact, this phenomenon is so common, that in some cases it can be considered suspicious if the hands are empty. For example, if the victim’s body was entangled in a densely weeded aquatic environment it is reasonable to expect to find them clutching fistfuls of such weeds. Similarly, victims holding things that aren’t natural to the settings they drowned in will also be indicative of foul play. And, finally, in very rocky locations, a victim’s hands might even be slightly mangled with a missing fingernail or two from scraping against stone to stay afloat.
In death as in life, a person’s eyes can tell a story, too. If the victim still has eyeballs in their sockets and these are wide open and glistening, as is usual for bodies found face down in the water, then there is a high probability that they drowned, although this alone won’t yet prove whether it was on purpose or by accident. If, instead, a horizontal demarcation “line” is perceptible on each of the eyes (showing distinct cloudy and un-cloudy zones created by postmortem exposure to the air) then they expired, or were killed, someplace on dry land.
Opening the corpse comes next. If the victim truly died in the water then, regardless if it was a dry or wet drowning event, there will always be a considerable volume of watery fluid in the stomach with yet more debris in this mixture, because a person cannot help but to drink water in the final act of drowning. A thorough analysis of the stomach contents is required then and these fluids must be found consistent with a sample of the water the victim allegedly succumbed in. If they are not, this will be determined to be just as suspicious as not finding any such fluid present.
The rapid ingestion and aspiration of large quantities of freshwater and its swift circulation throughout the body will, as well as diluting the victim’s blood by as much as 50%, dilute whatever fluids they might have consumed antemortem (prior to the agonal event). Thus, a postmortem toxicology test to determine if any of those might have been intoxicants, and alcohol thereby a culprit in the death, will obviously be thwarted—a blood/alcohol reading from a drowning victim can be drastically lower than what it would have been if measured when the person presumed to be drunk was still alive.
Additionally, taking an accurate BAC from a drown victim is further rendered futile in cases where decomposition has already begun, since alcohol is naturally manufactured in the body through the process of decaying. Consequently, a BAC level in these type of deaths, which on the average requires another month for a lab to process, is not very informative to an experienced and astute medical examiner, especially one who isn’t totally convinced that drinking was what caused the individual’s drowning.
Signs of trauma to the body, if any, can be equally as perplexing at a glance. While bloody wounds the victim may have received when still living will leach from prolonged soaking and no longer be as noticeable to the naked eye, postmortem injuries a corpse derived from impacts as it traveled along may be much more prominent and deceptively appear as intentional. That’s because those latter injuries tend to occur on the more vulnerable parts of the deceased, like the face where a lot of excess blood has collected, and a puncture or tear to these sensitive areas can cause them to ooze profusely.
So too, the whole head of a rotting corpse might totally blacken from all the blood that’s shifted to it and congealed, and to the unfamiliar observer this shocking appearance can be mistaken for evidence of having been burnt.
Because all of the foregoing demonstrate that a drowning is never medically clear cut and, often enough, can be simulated to disguise a murder, and because a drowned person may even falsely resemble a murder victim on some occasions, it does demand 100% certainty to officially rule it as the cause of death and an accident. This means any lingering doubts a medical examiner still has should and must be disposed of in a more comprehensive autopsy.
There are any number of additional tests which, when performed, can begin to reduce overarching concerns, but a Diatom Test has proved the most decisive in an inquest where the truth of a drowning death still remains shrouded in some mystery.
A diatom, that bountiful microscopic organism found in every single environment on Earth, creates a hard, crusty exterior casing which is virtually indestructible even to decay. Identifying the specific diatoms native to the waters the victim allegedly drowned in and then finding the presence of those diatom breeds in the tissue samples of the victim’s organs and in their blood makes it all the more certain that this is the place where the person ultimately died. It also proves the individual did in fact drown and was not placed in that locale after death, since, even if a pre-dead body did take water into the stomach and lungs, there is no way for the dead to circulate water (and that water’s microorganisms) throughout all the rest of their systems. Only a living person—or rather a person who is dying—could achieve this, as they’re drowning.
After that comparative analysis and matchup is made, if drowning is judged to be the actual cause of death, but the manner itself still cannot confidently be listed as accidental, the death certificate issued will reflect this finding, citing the manner as unknown or undetermined, and the case will then be turned over to the police once again, pending further investigation.