9.3 Water

Case: TC-10

Sex: Male

Age: Middle aged adult

Cause of Death: Unascertained

Circumstances: Suicide: The individual was located floating face down in a water course 6 months after having been reported missing.

Description/Information from CT: With the exception of the skull and distal right hand, which were partially skeletonized, the rest of the body had residual soft tissue with large areas of adipocere (a crumbly, soaplike postmortem product—Ubelaker and Zarenko, 2011) (Fig. 9.43). Figure 9.43. TC-10, anterior view of the head and chest (top left) and detail of the head (top right) and chest and right hand (bottom) showing the partial skeletonization of the skull and right hand with extensive adipocere formation on the rest of the body.

Postmortem CT showed evidence of an obvious lesion approximately 1 cm × 2 cm in size in the region of the greater tubercle on the left humerus (Fig. 9.44). The head and lesser tubercle of the humerus were normal as was the glenoid fossa. Figure 9.44. TC-10, sagittal (left) and coronal (right) reconstructions of the left shoulder showing a lesion in the region of the greater tubercle on the left humerus (red arrow).

Further physical investigation located three small pieces of bone in the rotator cuff muscle (Fig. 9.45). These bone pieces could be articulated and appeared to be the remains of what was the greater tubercle, which more thank likely had been affected by an avulsion fracture at some time in the past. Figure 9.45. TC-10, anterior view of the excised left shoulder (left) and detail of the left proximal humerus (right) showing the depression in the region of the greater tubercle and three associated bone pieces.

Comment: Compared with preservation in soils, the preservation of human remains in aquatic environments has been relatively poorly studied (e.g., Hagland and Sorg, 2002; Stuart and Ueland, 2017). However, the initial destruction of soft tissue on the head and extremities resulting in exposure of the underlying bone, as seen in this case, has been documented (Hagland and Sorg, 2002, p. 210). It is important to note in this case that the presence of clothing may have altered the pattern of soft tissue loss. Even with significant decomposition and the presence of adipocere, it is still possible to identify pathology and trauma, which may be of use in the identification process.

Case: TC-11

Sex: Female

Age: Young adult

Cause of Death: Unascertained

Circumstances: The individual was recovered from the sea 18 days after she was reported missing. Sea temperatures at the time were reported to be 22°C, and the area had strong currents around a rocky seabed.

Description/Information from CT: The body was in an advanced state of decomposition. There was extensive loss of skin over most of the body, with residual deep soft tissues present around the spine and upper back. The skull was loosely attached to the cervical spine. There were a number of skeletal elements missing, including the mandible, some ribs, left and right forearms and bones of the hand, and left and right lower legs and feet. In addition, the internal organs of the chest, abdomen, and pelvis were absent. The hyoid bone and thyroid and cricoid cartilage were identified among the remains and showed no evidence of injury. Although only a few teeth remained in situ, the right 2nd premolar and 1st molar showed pink discoloration (Fig. 9.46). Figure 9.46. TC-11, right lateral view of the cranium showing pink discoloration of the right 2nd premolar and 1st molar (red arrowheads).

There was considerable erosion damage to a number of bony prominences on the skull (see Fig. 9.46) and the distal articular surfaces of left and right humeri and femora (Fig. 9.47). Figure 9.47. TC-11, anterior view of the distal right femur (left) and detail of the distal femur (middle); posterior view of the right distal humerus (right) showing considerable erosion damage to the articular surfaces.

Some of the ribs showed evidence of fractures (Fig. 9.48). Figure 9.48. TC-11, superior view of a right rib showing an oblique fracture in the posterolateral region.

Postmortem CT provided a complete three-dimensional record of the body including detail of the eroded skeletal elements (Fig. 9.49). Figure 9.49. TC-11, VR images of the anterior (left) and posterior (right) views of the skeletal elements recovered from the sea showing the preservation, including the erosion of some of the elements.

The scan documented the extent of the remains and the presence of some of the bony damage. No additional features were seen in the CT scans that were not seen in the subsequent macroscopic examination of the body remains.

Comment: Expressing an unequivocal medical cause of death in cases such as this is problematic if not impossible because of the absence of critical structures such as the brain, skin, and major organs. Although there was no evidence of blunt-force head injury to the vault of the skull, blunt-force head injury causing death by brain injury and hemorrhage within the skull can occur in the absence of skull fractures.

Penetrating injuries of the chest can damage the heart, lungs, and great vessels, but when many of these tissues are absent, injury to these structures cannot be excluded. Although some rib fractures in this case were seen, there was no evidence of any fresh, incised injury to the bones of the sternum or ribs.

When the soft tissue and neck structures of the neck are absent, damage to the arteries and veins of the neck cannot be excluded or confirmed.

When the distal arms and legs are absent, injury to these structures, which contain large blood vessels which if injured can lead to extensive hemorrhage, cannot be excluded or confirmed.

Immersion in the sea can retard decomposition in certain situations and usually prevents the infestation of the body by maggots. However, an individual in seawater can suffer considerable scavenging by marine creatures including crustacean and fish (Higgs and Pokines, 2013; Merritt and Wallace, 2010). This can result in exposed areas of skin being completely destroyed together with much of the underlying soft tissue. Over time, a body can become completely skeletonized, and in warmer months, this process can be quite rapid.

The pattern of decomposition and tissue loss in this case is in keeping with individuals who have been immersed in water after death rather than those seen in an individual who had started to decompose on land and then been subsequently placed in water.

Pink discoloration in teeth can occur in life and after death. The discoloration is a result of seepage of hemoglobin or its derivatives into the dentinal tubules and is most often associated with water immersion (Borrman et al., 1994; Rai and Kaur 2013).

The erosion observed on the articular surfaces of the long bones is consistent with postmortem damage caused by wave and tidal action on rocky and stony surfaces.

The fractures observed on the ribs occurred perimortem. However, in cases such as this where preservation is relatively poor, determining whether the fracture occurred during life or after death (i.e., at which stage of the perimortem interval the fracture occurred) is difficult and may be impossible. The complexities of interpreting the timing of skeletal trauma in poorly preserved remains have been well documented (e.g., Blau, 2017).

In this case the poor preservation of the soft tissue around the ribs meant it was difficult to determine the presence of any hemorrhage in the intercostal musculature such as might be expected. Having said this, fractures of the ribs in the living are relatively uncommon in young people as a result of minor trauma. This is because at the medial ends, ribs are held in place by soft flexible cartilage, which tends to give and provide elasticity to the rib cage preventing rib fractures from minor trauma.

Case : TC-12

Sex: Male

Age: Adolescent

Cause of Death: Unascertained in circumstances of immersion.

Circumstances: Accident: The individual was washed off rocks into the sea. He was not recovered until 3 weeks after being reported missing.

Description/Information from CT: The human remains located included the skull (cranium and mandible), entire axial spine including the sacrum, the right humerus, both scapulae, both clavicles, and semi-intact upper right and left ribs. The manubrium and sternum remains were in situ (Fig. 9.50). Figure 9.50. TC-12, anterior view of the incomplete human remains (top left) and detail of the head (top right) and posterior view (bottom).

The mid and lower ribs were largely absent. Residual posterior fragments of ribs showed oblique-oriented fractures.

The teeth were in good condition and showed distinct pink discoloration (see Fig. 9.50). An amorphous mass of bleached decomposed skin was present over both right and left sides of the skull and, to a lesser degree, over the mandible. The skin of the neck remained intact as did the upper anterior and upper back areas of the torso. No internal organs remained for examination. Examination of the cranium showed no immediate evidence of trauma.

Postmortem CT provided a complete three-dimensional record of the preservation of the body (Fig. 9.51). Figure 9.51. TC-12, VR images of the anterior and posterior (top) and left and right views of the skull and vertebrae (bottom) showing the preservation (incomplete) of the human remains recovered from the sea.

Comment: This individual could have died from drowning, natural disease, or trauma. The poor preservation of the remains restricts the ability of the examination to provide a definitive answer. As commented above (see Case TC-11), pink teeth are often associated with water immersion but also occur in a number of scenarios.