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THROWING CORROSIVE LIQUIDS.

softened, and the bone itself diseased (carious). The injury had led to death indirectly by producing disease of the brain. (Lond. Med. Gaz., vol. xvii. p. 897) In a case tried at Aberdeen, the evidence proved that a woman had poured oil of vitriol down the throat of her husband while he was lying asleep with his mouth open. She was convicted of the murder. In another case, a woman killed her husband by pouring a solution of corrosive sublimate down his throat while he was sleeping. These, however, were treated as cases of poisoning, as death did not depend on the local or external mischief produced by the corrosive agent employed.

ASPHYXIA-DROWNING.

375

ASPHYXIA.

DROWNING.

CHAPTER XXXVIII.

CAUSE OF DEATH.-SECONDARY CAUSES.-POST-MORTEM APPEARANCES.-MEDICAL PROOFS OF DEATH FROM DROWNING,-SPECIFIC GRAVITY OF THE BODY.-COINCIDENTAL CAUSES OF DEATH.-MARKS OF VIOLENCE.-ACCIDENTAL FRACTURES.-HOMICIDAL AND SUICIDAL

DROWNING.

UNDER the term Asphyxia are included those forms of violent death in which the act of respiration is primarily arrested (p. 64). This comprises dath from drowning, hanging, strangulation, and suffocation, and in this section the fatal effects of lightning, cold, and starvation will be considered. Apnea is a term sometimes improperly applied for asphyxia.

The subject of asphyxia and the appearances presented by the body in this mode of death have been fully considered at p. 64.

Drowning. Cause of Death. Asphyxia.-In drowning, asphyxia is produced by a physical impediment to the introduction of air into the Jungs. The medium in which the person is immersed acts mechanically, and even more effectually than a rope or ligature round the neck; for, although air escapes from the lungs, and water penetrates into the minute air-tubes, yet no air can enter to supply the place of that which has already "xpended its oxygen on the blood. Hence this fluid must circulate, in the st few minutes after submersion, in a state unfitted for the support of life (unaërated); but the person lives, and is susceptible of recovery within a short interval. After the entire suspension of respiration the action of the heart gradually slackens and finally stops. It is at this period of the arrest of circulation that asphyxia passes into death. Asphyxia is determined by the period at which respiration is completely arrested; but the point of time at which death from drowning occurs is fixed by the moment at which the action of the heart ceases. This varies considerably, according to age, *, state of health, and other circumstances.

When a person falls into water, and retains his consciousness, violent stempts are made to breathe; at each time that he rises to the surface a portion of air is received into the lungs, but, owing to the mouth being on a level with the liquid, water also enters and passes into the throat. A quantity of water thus usually enters the mouth, which the drowning person is irresistibly compelled to swallow. In his efforts to breathe while his head is below water a portion of this liquid is drawn into the air-tubes and cells of the lungs. The struggle for life may continue for a longer or shorter period, according to the age, sex, and strength of the person; but the result is that the blood in the lungs is imperfectly aërated,

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DEATH FROM DROWNING.

the person becomes exhausted, and insensibility follows. The mouth then sinks altogether below the level of the water-air can no longer enter into the lungs; a portion of that which they contain is expelled, and rises in bubbles to the surface; an indescribable feeling of delirium, with a ringing sensation in the cars, supervenes; the person loses all consciousness, and sinks asphyxiated. In the state of asphyxia, while the dark-colored blood is circulated, convulsive movements of the body take place, and the contents of the stomach are sometimes ejected by vomiting. There does not appear to be any sensation of pain, and, as in other cases of asphyxia, if the person recovers, there is a total unconsciousness of suffering during the period when the access of air was cut off from the lungs. The sensations of the drowned are stated to be by no means so acute as has conmonly been supposed. A child thrown into the water by a nurse stated that she was conscious of sinking through the water till she felt her feet touch the bottom, and that she then fell asleep till she found herself rescued. (Case of Reg. v. Redstone, C. C. C., Feb. 1885; Brit. Med. Jour. 1885, i. p. 341.) One of the editor's colleagues at Guy's Hospital, who was drowned to the stage of insensibility, describes his sensations as having been by no means so fearful as might have been expected.

Ths successive phenomena of drowning have been divided into three stages by Bergeron and Montano. (Ann. d'Hyg., 1877, t. 48, p. 332.) These authorities also state that the presence of a froth in the pharynx. larynx, and bronchial tubes is an invariable concomitant of death from drowning; that there is always a certain amount of congestion of the lungs, and sometimes this is accompanied by sub-pleural ecchymosis; and that the extent of the congestion and of the ecchymosis is always proportional to the efforts made at self-preservation.

Some persons who fall into water are observed to sink at once, without making any attempt to extricate themselves. This may arise either from sudden syncope or from the stunning produced by the fall. Should the person be intoxicated, or otherwise incapacitated, as by striking his head in falling, he may not again rise. These different conditions under which death may take place will sufficiently account for the difference in the appearances met with in the bodies of those who have died in water. A fatal result may be accelerated by the impression suddenly produced upon the skin, from the difference of temperature between the body and the water. To those who are not accustomed to water, a sudden immersion produces a great and rapid cooling of the surface and forces the blood into the internal organs. There is difficulty of breathing, or severe spasmodic respiration, with giddiness and other symptoms, which may render a person powerless to extricate himself. The effect of cold on the skin is seen in the contracted state of the cutis in the bodies of those who have been drowned during the winter. It is calculated that in 25 per cent, of all who are drowned the cause of death is pure asphyxia, and that in the remainder syncope and cerebral congestion, amounting to apoplexy, may have a share in causing death.

In regard to the time required for death to take place by drowning, it may be observed that, when the mouth is so covered by water that air cannot enter, asphyxia comes on in the course of one or two minutes at the furthest, and the time at which this occurs does not appear to vary materially. Complete insensibility has supervened after one minute's submersion, and it is probable that in most cases a few seconds would suffice for the commencement of asphyxia. In this state a person can make no efforts to save himself, and death commonly ensues in from two to five minutes. The power of restoring life depends, not merely on the time

EFFECTS OF SUBMERSION.

377

the body may have been submerged, but on the condition of the lungs the time of its removal from the water. Experiments performed by a mmittee of the Medico-Chirurgical Society have clearly proved that, as arm of asphyxia, drowning is not only more speedily fatal to life than rinary suffocation, but, from the physical changes produced in the lungs water the chances of recovery are lessened. The committee found that edference in the results was not owing to exhaustion from struggling, m the violent efforts made to breathe, nor from the effects of cold in nersing the whole of the body, but to the introduction of water by -piration into the minute air-tubes and cells of the lungs. This conclua was derived from the following experiments: Two dogs of the same se were submerged at the same moment, but one had his windpipe izged so that no air or water could enter, while the other had not. After two minutes they were taken out together: the one with the windplazzed recovered at once, the other died. In three experiments gs with their windpipes plugged were kept below water for four tex: the animals recovered perfectly when removed from the water. M-L-Chir. Trans., 1862, p. 449) An inspection of the bodies at once *aled the difference. In animals simply deprived of air by plugging * windpipe, the lungs were merely congested; but in those which were bmerged in their ordinary condition, the lungs, besides being more congested and showing ecchymosed points on the surface and in the substance, ained in their bronchial tubes a bloody mucous froth formed of water, d and mucus, which completely filled the small air-tubes. The violent respiratory efforts made by the animal before death had caused the protution of this froth, which formed a mechanical impediment to the entrance of air by the movements of the chest, as in respiration. This

us froth or foam issued from the lungs on section, and appeared to penetrate their entire substance, which was saturated with water tinged with blood. The lungs were sodden with water, heavy, soft, doughy, ained an impression produced by the finger, and were incapable of ollapsing. In the lungs of animals which recovered after a short submersion, little or none of this mucous froth was found in the air-cells. In Le fatal cases, the quantity was great in proportion to the time of submersion. There is no doubt that this froth is produced by the violent eforts to breathe which are made within a minute after submersion.

It may be inferred from these results that the power of recovery in man beings has a direct relation to the quantity of mucous froth in The air tubes, and to the penetration of the substance of the lungs with Sater. The larger the amount of froth produced and the greater the penetration, the less the hope of recovery; for when the lungs have undergone Lese changes they are physically unfitted either to receive or expel air by respiration, and are incapable of collapsing. These circumstances will ant for the fact that persons have been resuscitated in drowning under Various and even opposite modes of treatment, and even under no treatneat at all. It is right that every reasonable effort should be made to restore life, but if the lungs are sodden with water their functions cannot be restored by any mode of treatment. The committee found that a complete submersion of four minutes effectually killed dogs, although, after renoval from water, the heart continued to beat from four to five minutes. The continuance of the heart's action furnishes, therefore, no criterion of the power of recovery. A human being, as a rule, dies if submerged for a period of from four to five minutes. In a few exceptional cases, persons have been resuscitated after this period; but it is most probable that in them the lungs had sustained no physical damage. When the submersion has

378

DROWNING-EXTERNAL APPEARANCES.

been short, the respiratory struggle below water slight, and the person has been treated immediately on removal, recovery is probable; but under opposite conditions it is, with rare exceptions, hopeless.

Death from Secondary Causes.-Drowning niay operate indirectly as the cause of death. Thus it has been repeatedly remarked that persons who have been rescued from water in a living state, and who have apparently recovered from the effects of submersion, have died, in spite of treatment, after the lapse of some minutes or hours; others have lingered for one or two days, and then have sunk, apparently from exhaustion. In those who perish soon after removal from water, death may arise either from exhaustion or from the obstruction of respiration by the penetration of water into the air-cells of the lungs. The case of Colonel Mackenzie,

in 1873, furnishes an instance of rapid death from secondary causes. The colonel and a companion while crossing a river were carried away by the current. After much struggling they both reached, the bank in an exhausted state. The companion left the colonel apparently well, to procure assistance. On his return, soon afterwards, the colonel was found dead. Death was attributed to apoplexy, but it was more probably due to exhaustion from over-exertion. A child, æt. 2 years, was found floating on water. It was insensible, with gasping breathing, fluttering heart, no pulse at the wrists, tongue protruded, and cold water draining from the mouth and nose. Artificial respiration restored breathing, but not sensibility. Convulsions followed, lasting for two hours. These passed off. The breathing was natural and the body warm; temperature, 101.2° F. In this state the child continued seven hours, when difficulty of breathing suddenly came on, and the child died eighteen or twenty hours after removal from the water. Marcet states that spasm of the glottis has been among the severe secondary symptoms in persons who have been removed from water apparently drowned. A severe spasm of this kind manifested itself in one case while placing the patient in a warm bath. (Med. Times and Gaz., 1857, i. p. 148.) When death takes place at a remote period, it may be caused by disease; and a question may then arise whether the disease was produced by the immersion in water or not. Such cases, occasionally present themselves before our courts of assize.

Post-mortem Appearances.-The external and internal appearances produced by drowning vary according to the length of time during which the body has remained in water, and the period that has elapsed after its removal and before it is examined. Thus, in reference to the bodies of two persons drowned by a common accident, if one is removed and examined immediately, and the other is not removed from the water until after the lapse of several days and is then inspected, the appearances will be different. So, if the two bodies are removed at the same time, and one is immediately examined, while the other is not inspected until a month after removal, the procfs of drowning which may be discoverable in the former will probably have disappeared in the latter. A protracted exposure of the drowned body either to water or air, especially if the temperature is high, may render an inspection useless for the purpose of evidence.

External Appearances. Supposing that the body has remained in the water only a few hours after death, and the inspection has taken place immediately on its removal, the skin will be found cold and pallid-sometimes contracted, under the form of "cutis anserina. " This contracted state of the skin, when found, furnishes strong evidence of the body having gone into the water living. The skin is often covered to a greater or less extent by livid discolorations; the face is pale and calm, with a placid ex