‘Dry’ Drowning

This misnomer continues to be reported, despite the absence of experimental and clinical support for drowning without aspiration. The proponents originally quoted the observations of Charles Cot7, a Belgian doctor who reported in the French literature in 1931. He observed the ‘dry’ lungs of dogs fished from the Seine. Because there was no reason to believe that the dogs had drowned, as opposed to being disposed of in the water after death, this support was dubious.

The colourful terminology ensured the popularity of ‘dry drowning’, and many clinicians observed that persons who drowned may not have had obvious water in the lungs at autopsy. This was attributed to laryngospasm caused by asphyxia, continuing until death. Virtually every review of drowning over the rest of that century acknowledged this concept, without question, although the incidence was often increased to 20 to 40 per cent. It did conflict with the findings of earlier animal experiments.

Clinicians who dealt with sea water drownings, such as in scuba divers, never witnessed this paradox – indeed, they marveled at the degree of foam in the lungs and airways, whereas clinicians who dealt with fresh water drownings were much more enthusiastic about the ‘dry drowning’ pathological observation. Now the incidence of presumed ‘dry’ drownings has sunk to less than 2 per cent, even among the earlier proponents of this concept. It is a pathological entity, not a clinical one.

As it has been stated, fresh water is absorbed very rapidly from the lungs after death, and therefore autopsy findings cannot be used to imply (let alone prove) the absence of a previous aspirant. This is especially so when these investigations are performed sometime after the event or after cardiopulmonary resuscitation. ‘Dry drowning’ is probably an artefact of fluid absorption from the lungs, or it may indicate death from other causes. The deleterious effects of the aspiration can proceed even after the absorption of the fluid.

In the absence of more information, it would be prudent to presume that all victims of near drowning or drowning have aspirated and base one’s first aid and management on this presumption. This is supported by the knowledge that laryngospasm does not usually continue until death, and thus even if it does occur during the drowning process, it will not prevent aspiration as hypoxic death is approached.