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Schreyer Flotation Test – Forensic Lung Examination

The Schreyer flotation test is a forensic-medical method used to examine the lungs of newborns in order to determine whether a child was born alive.

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Things worth knowing about "Schreyer Flotation Test"

The Schreyer flotation test is a forensic-medical method used to examine the lungs of newborns in order to determine whether a child was born alive.

What is the Schreyer Flotation Test?

The Schreyer flotation test is a forensic pathology examination method used in legal medicine to assess whether a newborn infant was alive after birth and had breathed. It represents a refinement of the classical hydrostatic lung test (also known as the lung flotation test) used in forensic medicine. The test is named after the physician Schreyer, who described this enhanced approach to evaluating the presence of air in neonatal lung tissue.

Background and Forensic Significance

In forensic medicine, determining whether a newborn was born alive (live birth) is of critical legal importance, particularly in suspected cases of neonaticide (the killing of a newborn). If a child is born alive and breathes, air enters the lungs, rendering them aerated. A stillborn child that never breathed will have air-free, so-called atelectatic lungs.

The classical hydrostatic lung test, extended by the Schreyer method, evaluates whether lung tissue floats or sinks in water:

Floating: Indicates the presence of air and therefore suggests that breathing occurred.
Sinking: Suggests atelectatic (air-free) tissue, indicating no respiratory activity.

Methodology of the Schreyer Flotation Test

In the Schreyer flotation test, the lung tissue of the newborn is examined systematically. The procedure typically involves the following steps:

The entire lung is first placed in a water bath and its floating behavior is observed.
Individual lung lobes and then the smallest pieces of lung tissue (lobules) are tested separately.
The Schreyer method places particular emphasis on the examination of small tissue samples to reliably detect even partial aeration of the lungs.
Additionally, the so-called crepitation sound when cutting into lung tissue is evaluated -- this crackling sound is characteristic of air-containing lungs.

Diagnostic Limitations and Critical Evaluation

Although the Schreyer flotation test is an established method in forensic medicine, it has significant limitations that must always be taken into account in modern forensic pathology:

Putrefaction: Decomposition gases can cause atelectatic tissue to float, producing false-positive results.
Resuscitation attempts: Artificial ventilation or cardiopulmonary resuscitation can introduce air into the lungs, distorting the findings.
Aspiration: Aspirated material may complicate the assessment.
Incomplete aeration: Premature or ill newborns may have partially non-aerated lung areas despite having been born alive.

For these reasons, the Schreyer flotation test is never used as the sole piece of evidence in modern forensic medicine. It is always evaluated in combination with histological, biochemical, and imaging methods.

Role in Modern Forensic Medicine

Today, the flotation test is supplemented by modern techniques, including:

Histological examination of lung tissue (microscopic assessment of alveolar expansion)
Radiological methods (e.g., post-mortem CT scanning to assess lung aeration)
Biochemical markers to evaluate signs of respiratory activity and vital reactions

Nevertheless, the Schreyer flotation test remains a historically significant and practically relevant tool in forensic neonatology, and is described as a supplementary method in forensic medical reports.

References

Madea, B. (Ed.): Handbuch gerichtliche Medizin, Springer, Berlin/Heidelberg, 2nd edition, 2014.
Dettmeyer, R., Verhoff, M. A., Schutz, H.: Forensic Medicine - Fundamentals and Perspectives, Springer, 2014.
Brinkmann, B., Madea, B.: Handbuch gerichtliche Medizin, Band 1, Springer, Berlin, 2004.

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