XIX Death by Drowning
Death by drowning occurs when breathing is arrested by watery or semi-fluid substances—blood, urine, etc. The fluid acts mechanically by entering the air-cells of the lung and preventing the due oxidation of the blood. The post-mortem appearances include those usually present in death by asphyxia, together with the following, peculiar to death by drowning: Excoriations of the fingers, with sand or mud under the nails; fragments of plants grasped in the hand; water in the stomach (this is a vital act, and shows that the person fell into the water alive); fine froth at the mouth and nostrils; cutis anserina; retraction of penis and scrotum. On post-mortem examination, the lungs are found to be increased in size (‘ballooned’); on section, froth, water mud, sand, in air-tubes. The presence of this fine (often blood-stained) froth is the most characteristic sign of drowning. Froth like that of soap-suds in the trachea is an indication of a vital act, and must not be mistaken for the tenacious mucus of bronchitis. The presence of vomited matters in the trachea and bronchi is a valuable sign of drowning. The blood collects in the venous system, and is dark and fluid. Tardieu’s spots are not so frequently met with in cases of drowning as in other forms of asphyxia. The other signs of death by asphyxia are present. Wounds may be present on the body, due to falling on stakes, injuries from passing vessels, etc.
The methods of performing artificial respiration in the case of the apparently drowned are the following (the best and most easily performed is Schäfer’s prone pressure method):
1. Schäfer’s.—Place the patient on his face, with a folded coat under the lower part of the chest. Unfasten the collar and neckband. Go to work at once. Kneel over him athwart or on one side facing his head. Place your hands flat over the lower part of his back, and make pressure on his ribs on both sides, and throw the weight of your body on to them so as to squeeze out the air from his chest. Get back into position at once, but leave your hands as they were. Do this every five seconds, and get someone to time you with a watch. Keep this going for half an hour, and when you are tired get someone to relieve you.
Other people may apply hot flannels to the limbs and hot water to the feet. Hypodermic injections of 1/50 grain of atropine, suprarenal or pituitary extracts, may be found useful.
2. Silvester’s..—In this method the capacity of the chest is increased by raising the arms above the head, holding them by the elbows, and thus dragging upon and elevating the ribs, the chest being emptied by lowering the arms against the sides of the chest and exerting lateral pressure on the thorax. The patient is in the supine position—but first the water must have been drained from the mouth and nose by keeping the body in the prone position. The tongue must be kept forward by transfixing with a pin.
3. Marshall Hall’s.—This consists in placing the patient in the prone position, with a folded coat under the chest, and rolling the body alternately into the lateral and prone positions.
4. Howard’s.—This consists in emptying the thorax by forcibly compressing the lower part of the chest; on relaxing the pressure the chest again fills with air. Here the patient is placed in the supine position.
The objections to the supine position are that the tongue falls back, and not only blocks the entrance of air, but prevents the escape of water, mucus, and froth from the air-passages.
5. Laborde’s Method.—This consists in holding the tongue by means of a handkerchief, and rhythmically drawing it out fully at the rate of fifteen times per minute. This excites the respiratory centre, and this method may be employed along with any of the other methods.