The idea that drowning could be ‘cured’ enjoyed little currency in medical literature before the 1760s. However, in late eighteenth-century Europe, with the advent of the Humane Movement, drowning for the first time enjoyed widespread attention as a reversible and preventable accidental death. Before the emergence of medico–philanthropic societies that embodied this movement, rescue and recovery of the drowned was practised, but in a haphazard and limited way characterized by ignorance and fatalism. As champions of the Enlightenment's optimism in science, reason, and progress, the founders of these societies sought more effective and reliable methods. Beginning in Amsterdam in 1767, and spreading in the next 30 years throughout Europe and on to America and the Indian Subcontinent, these organizations publicized methods of recovery from all states of accidental and sudden apparent death, including drowning, strangulation, narcotics, and lightning.
It was drowning that most intrigued those who wanted to explore the latent powers of recovery in a near-dead body. This was for three main reasons. First, it began to be believed that drowning led to a brief suspension of the vital powers, rather than an immediate extinction. In this the drowned body appeared to epitomize a state of ‘apparent death’, a notion that had gained a high profile in Europe following the publication of J.- J. Bruhier's L'incertritude des signes de la mort (Paris, 1742). In this book Bruhier argued that the body could display the signs of death yet spontaneously recover. This argument shed doubt upon the possibility of knowing the moment of death with any precision, and hence made the idea of a ‘suspension’ of life intelligible. Second, because drowning happened to healthy bodies, and did not necessarily involve internal destruction of the organs, or extensive lesions, its reversibility seemed more likely. Third, on the busy European rivers, where drowning was both conspicuous and plentiful, resuscitation could be tested in practice.
The desire to perfect a therapy for drowning led medical men back to the body. The patronage of the Royal Humane Society of London (RHS), founded in 1774, ensured the publication of experimental works, such as Edmund Goodwyn's The Connexion of Life with Respiration (1788), that investigated the effects of drowning on animal bodies. These explorations sought reliable knowledge of the signs of life and death, as well as the mechanical and chemical processes of vitality. Because drowning in humans was impossible to reconstruct experimentally, these researches entailed extensive dissection of freshly drowned puppies and kittens. Here drowning figured as an experimental method and analytical device, which generated new data on respiration and circulation, and provided greater conceptual and empirical clarity about the relationship between states of life and death. This work represented the cutting edge of physiology, but was later eclipsed by the subsequent influence of French morbid anatomist Xavier Bichat, whose definition, in 1800, of life as ‘the totality of functions which resist death’ replaced the Aristotelian notion of death as the absence of life used by Goodwyn.
The new knowledge had to be translated into action if deaths by drowning were actually to be averted. The act of translation was a frictional process for, in exhorting people to change their behaviour towards drowning bodies, the RHS required alterations in popular accounts of the body itself, and these cut across beliefs about how the world was and ought to be. First, to discourage witnesses of drowning from believing that the moment of death had already passed and that further activity was useless, the RHS had to overcome existing assumptions about the signs of death and replace them with the counterintuitive idea of apparent death. Second, the RHS had to override popular reluctance to interfere with the corpse, either for fear of obstructing the law, or for fear that the corpse might bring about bad luck. (Local fishermen in Germany, for example, would not rescue drowning persons for fear of eliciting the wrath of the river spirits.) Third, the RHS had to challenge those ideas about Providence which sat uneasily with the concept of an ‘accidental’ death, and which saw resuscitation as an impious and hubristic activity that, Prometheus-like, mimicked the animating power of God. Clergymen supporting the RHS attacked such charges of impiety, and reinterpreted scriptural accounts of body–soul activity at death to make way for the idea of apparent death. In other words, in order to fashion a cultural ambience favourable to the rescue and revival of a drowning/drowned body, which we take for granted, men and women of the eighteenth century had to unlearn their assumptions about these cosmic, practical, and ethical fundamentals that were mediated by the drowned body.
Interest in resuscitation no longer grips the imagination as it did between 1770 and 1830, when it unleashed a more general interest in reanimation that brought about anaesthesia, blood transfusion, and Mary Shelley's Frankenstein (1818). Consequently, drowning no longer constitutes such a generative locus for new knowledge of, and practices surrounding, the body.
See also near-drowning.
Drowning (Signs Of)
Drowning (Signs Of)
A forensic examiner must consider that a body recovered from water may or may not have been dead when the water was entered. If the person died in the water, there are several possible causes of death, including drowning. It is actually difficult to prove drowning as a cause of death with 100% accuracy. The forensic pathologist cannot rely on autopsy or laboratory findings alone. Instead, the pathologist may focus on elimination of other causes for the death and on the circumstances surrounding the event.
Immersion of a body in water causes certain characteristic changes that are not necessarily signs of drowning. The skin on the palms and soles becomes white and wrinkled. A similar effect is seen on the tips of the fingers in someone who has their hands in water for extended periods of time. After a few days in water, this macerated skin will begin to separate, and after about a week, it will peel off from the body.
There may also be some evidence of decomposition when a body is pulled from water, although this occurs more slowly than it would on land. After about two weeks in water, the rest of the skin and the hair are sloughed, and the face, abdomen, and genitals become bloated with the gases of decomposition. This results in most bodies eventually floating to the surface, unless they have been weighted down to avoid discovery. Predators, such as fish and reptiles, will tend to prey on a corpse in water and this will accelerate decomposition. The body may also knock against objects in the water such as boats, piers, and rocks, and this may cause postmortem injury.
Drowning occurs when water enters the airways and blocks off the supply of oxygen to the body. When this happens, the person will struggle to breathe and will cough, which unfortunately sets off a reflex action that only draws more water into the lungs. The person will generally lose consciousness within a minute or two and then the heart will stop. The brain is the most vulnerable part of the body to oxygen deprivation and it can usually survive for less than four minutes before irreversible damage occurs, along with cardiac arrest. In some cases, however, hypothermia , or the chilling of the body that occurs in cold water, has protected the brain by slowing metabolic demands for oxygen, and allowed the person to survive.
The mechanism of drowning differs depending on whether the person was found in fresh water or salt water. Fresh water enters the circulation through the lungs rapidly and dramatically increases the blood volume, creating great strain on the heart. The massive dilution of the blood also causes substantial disruption to its normal chemistry and starts to break down red blood cells. Sea water has an opposite effect. It draws fluid from the blood plasma into the lungs. This does not have the effect of increasing the workload on the heart, so people tend to survive for longer before drowning in salt water.
Postmortem, there may be few obvious signs of drowning on external examination. There may be a copious (visible amount of) froth, perhaps bloodstained, that has come from the lungs and surrounds the nose and mouth. This is a mixture of water and protein from the blood plasma, which froths up as the person struggles to breathe. However, the froth is not always present in cases of drowning and should not be relied on as an indicator.
Internal examination may reveal froth in the windpipe and lungs. Although the lungs are usually swollen, spongy, and full of water on drowning, this can also be seen with other causes of death, such as drug overdose or cardiac arrest upon hitting the water. The struggle to breathe causes great pressure to the sinuses, which often bleed and sometimes leave evidence of hemorrhage.
Laboratory tests may reveal the presence of diatoms in the body. Diatoms are microscopic algae found in both seawater and fresh water. Their silica-based skeletons do not readily decay and they can sometimes be detected even in heavily decomposed bodies. If the person is still alive when entering the water, diatoms will enter the lungs if the person inhales water and drowns. The diatoms are then carried to distant parts of the body such as the brain, kidneys, and bone marrow by circulation. If the person is dead when entering the water, then there is no circulation and diatoms cannot enter the body. Diatoms do not occur naturally in the body. If laboratory tests show diatoms in the corpse that are of the same species found in the water where the body was recovered, then it may be good evidence of drowning as the cause of death. However, the diatom test is now considered very unreliable and would never be used, on its own, as evidence of drowning. The forensic pathologist has to rely on many other sources of evidence to determine cause of death when a body is found in water.
see also Death, cause of; Death, mechanism of.
Drowning is defined by the American Academy of Pediatrics as death resulting from suffocation within twenty-four hours of submersion in water. Near-drowning applies to all other victims, whether or not they survive. For every child that drowns, four children are hospitalized for near-drowning, according to the National Center for Injury Prevention and Control. Children less than one year of age frequently drown in bathtubs and buckets; children aged one to four years most often drown in swimming pools; and children and adolescents aged five to nineteen years most frequently drown in natural bodies of water. Alcohol use in adolescents and adults is estimated to be associated with 25 to 50 percent of drownings. Males comprise the overwhelming majority of drowning victims.
Although people can hold their breath under-water for a limited amount of time, rising carbon dioxide levels in the blood initiate the need to take a breath. Most drowning victims quickly lose consciousness due to lack of oxygen and then inhale water. Death is typically a result of brain damage due to lack of oxygen and/or acute lung injury from aspirated fluids. Both sea and fresh water affect a substance called surfactant that coats the tiny air sacs, or alveoli, in the lungs. Lack of surfactant activity causes elevated surface tension in the lungs. This increases the effort required to inflate the alveoli and thus decreases the amount of air that can fill the lungs and the extent of oxygenation of the blood.
Treatment of a drowning victim is to restore breathing and circulation as soon as possible, because irreversible brain damage or death may occur in four to six minutes after breathing stops. Artificial respiration (mouth-to-mouth resuscitation) and cardiopulmonary resuscitation (CPR) are techniques used for this purpose.
See also: Causes of Death
American Academy of Pediatrics. "Drowning in Infants, Children, and Adolescents (RE9319)." Pediatrics 92 (1993):292–294.
ALLISON K. WILSON