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BROWNING                                                           175

Internal Appearances.-J!he~ brain is hyperaemie, and the vessels of its
membranes are injected.

Xtxe lungs are distended like balloons, overlap the heart and protrude
out of the thorax on laying it open by the removal of the sternum. They
are often indented by the ribs, are heavy, oedematous and spongy to the
feel, and pit on pressure with the finger. They are of a pale grey colour
with reddish stains, and on section exude a large quantity of a frothy, blood-
stained fluid. Minute, punctiform sub-pleural and pericardial ecchymoses
noted in other forms of asphyxia are seldom f ound in cases of drowning.

The larynx, trachea and bronchial tubes usually contain a fine, white
froth, and may contain some foreign matter, such as sand, mud or fragments
of aquatic plants. Their mucous membrane is usually red and congested.
J^gJii appears within two minutes of submersion, and its quantity varies
according to the length of submersion and the violent respiratory efforts.
Particles of food may be found regurgitated in the air-passages owing to the
vomiting set up by the imbibition of water especially if the stomach was
full at the time of drowning.

During putrefaction the watery fluid from the lungs may transude into
the pleural cavities.

The heart presents the appearance usually found in death from
asphyxia ; the left side is usually empty, the right side is full, and the large
veins are gorged with blood which is dark in colour and unusually fluid
owing to admixture of water.

Alexander C. Gettler15 suggests the determination of the chloride,
content in the blood of the right and left chambers of the heart as a specific *
test for drowning. This test is based on the fact that the water enters into
the lungs during drowning, and dilutes the chloride content of the blood in
the heart by osmosis. Normally the chloride content of the right and
left chambers of the heart is almost the same, the greatest difference being
5 mg. in 100 cc. of blood. In cases of drowning the difference is always
much more than 5 mg., ranging from 19 to 294 mg. This difference depends
on the amount of water going into the lungs, and also on the time interval
between the entrance of water into the lungs and death. The longer this
time interval, the more water passes to the left chamber of the heart. In
cases where drowning occurs in salt water, the left chamber of the heart
shows a higher chloride content and in cases where drowning occurs in fresh
water the left chamber shows a 'lower chloride content. It must be remem-
bered that persons who die of shock immediately after submersion in water
may not show this difference in the chloride content. It must also be borne
in mind that water cannot get into the left side of the heart, if the body is
thrown into water after death.

Ifee jaresence in the stomach of a certain quantitiy of water is regarded
as an important sign of death, particularly if the water possesses the same
characteristics as that in which tihe body was found immersed, and contains
sand, mud, algse, weeds, fine shells, etc. ItJ[s almost impossible for water
to get into the stomach, if a body is submerged after death. In rare cases,
it is possible that the water found in the stomach may have been drunk by
the deceased immediately before submersion occurred, On the other hand,
water may not be present in the stomach, if the person TEST from syncope
or shock, or became unconscious immediately after falling into water, so
that he could not struggle and swallow water in the act of drowning. There
will also be no water in the stomach, if the body has undergone putrefaeMo^
for water, even if it is present in the stomach, is forced out by the pres
of the gases of decomposition. In Northern India, it is not usual to

15.   Jour. Amsr. Med. Assoc^ Nov. 1% 1921, p. 1,650.