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Madrid, Spain. Corpse of a 48-year-old woman, found in the bathroom in her home address, in a bathtub full of water. There was no news of her in the preceding four days. Among her medical records depression and chronic alcoholism are included. She had a very erratic monitoring of her prescribed medical treatment, without quitting/abandoning the alcohol abuse. She had not expressed autolytic intentions.

Fig.1 The corpse floating in the bathtub.

On a small table, next to the bathtub, there were remains of tobacco, a jug of drink and various anxiolytic and antidepressant drugs/medication. In other rooms in the house alcoholic beverages galore were found. The examination of the scene did not reveal any sign consistent with violence. There were no sources of artificial heat in the bathroom, noticing the water at room temperature. The bathtub faucet was closed/turned off, only a thin puddle of water was visible on the floor. Four days before the find, the neighbors downstairs had complained about a leak of water appeared in their ceiling, leaving her a warning under the door.

Fig.2 Small bubbles near the mouth and the nose.

The corpse was partially submerged, floating in right lateral decubitus with half of the head in the water. It was in an emphysematosus putrefactive phase, with a marked venous vascular pattern in the skin and “washer- woman” hands. The water, where a bottle of shampoo and a sponge were floating, showed a reddish and sanious appearance, distinguishing small bubbles around the mouth and nostrils. The water had left perimeter marks on the inner surface of the bathtub, indicating at least three levels reached at different times, as a result of the evolution of putrefaction.

In the autopsy examination, no violent lesions/ injuries were found, neither froth in the air ways nor water in the lungs. In the pleural cavities there was a liquid of putrefaction. The stomach appeared without content. On the part of the face and the hemithorax that were kept out of the water, remains of sanious material remained deposited. The toxicological analysis was limited to the routine determination of drugs of abuse and certain drugs on a liver sample, resulting in: Ethyl alcohol: 1.09 g/ L, Paroxetine: 11.27 mg / Kg, Zolpidem: 2.59 mg / Kg. Therefore, based on the autopsy findings and the examination of the scene, a death of unintended origin was considered, due to a probable arrhythmic pattern.

Fig.3 The different marks left by the water levels in the bathtub.

In this case here discussed no clear signs of asphyxia by submersion have been found, although they could be altered due to putrefaction or even missing a reaction of laryngospasm, dry drowning. The slight foaming observed in the water near the mouth is a possible drowning sign, but cannot be considered a specific one. So, possibly, she did not get to breathe underwater.

In the liver sample moderate amounts of alcohol, zolpidem and paroxetine were determined, the latter associated with alterations in heart rhythm. The quantification obtained, however, is only indicative, given the liver nature of the sample and its state of putrefaction. The analysis did not investigate the possible intake of disulfiram, found at home and susceptible, in association with alcohol consumption, to cause cardiovascular alterations. On the other hand, the potentiation of the effects between alcohol and different drugs is known. Therefore, in the absence of signs of violence or any trace suggesting suicide, such as a farewell letter, the discovery of another means of suicide or the body being dressed, it was considered to be related to an unintentional death while she was in the bathtub due to a disturbance of the heart rate, in relation to the drugs and alcohol revealed in the toxicological study.

Fig.4 The corpse out of the water, showing clear delimitation of the different stages of putrefaction.

Regarding the cadaverous phenomena, the body was in putrefaction, with different evolution between the submerged corporal regions and those that had remained out of the water, delimiting the corporal surface in a clear and symmetrical way. In this case the imbibition of the skin by water is considered fundamental in the evolution of putrefaction. The marks on the inner surface of the bathtub allowed to differentiate at least three levels reached by water, between the initial moment after death and its gradual flotation because of the gases formed by putrefaction. The deposits in a part of the left hemithorax and in the left side of the face, out of the water, showed that they were initially submerged before the flotation of the body.

In deaths occuring in a bathtub, it is often difficult to know the fundamental cause of death, leading to a difficulty in establishing the manner of death as natural or violent. So, the investigation of the clinicall record and a careful examination of the scene are mandatory, in addition to the autopsy and toxicology study, in order to achieve a good medico-legal asessment.

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