Articles from Aids To Forensic Medicine And Toxicology
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Definition Of A Poison
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
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
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.
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